White Rock Medical Center

All Charges

Charge

Type

Setting

Price

99281 - Level 1

Facility

$375.00

Service Code	HCPCS 99281
Hospital Charge Code	8930545
Hospital Revenue Code	450
Rate for Payer: Cash Price	$255.00

99281 - Level 1

Facility

$375.00

Service Code	HCPCS 99281
Hospital Charge Code	8930545
Hospital Revenue Code	450
Min. Negotiated Rate	$13.90
Max. Negotiated Rate	$550.00
Rate for Payer: Amerigroup CHIP/Medicaid	$280.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$84.71
Rate for Payer: Amerigroup Medicare	$84.71
Rate for Payer: BCBS of TX Blue Advantage	$413.00
Rate for Payer: BCBS of TX Blue Essentials	$495.00
Rate for Payer: BCBS of TX Medicare	$84.71
Rate for Payer: BCBS of TX PPO	$550.00
Rate for Payer: Cash Price	$255.00
Rate for Payer: Cash Price	$255.00
Rate for Payer: Cash Price	$255.00
Rate for Payer: Cigna Commercial	$314.76
Rate for Payer: Cigna Medicaid	$270.00
Rate for Payer: Cigna Medicare	$84.71
Rate for Payer: Employer Direct Commercial	$84.71
Rate for Payer: Humana Medicare/TRICARE	$84.71
Rate for Payer: Molina CHIP/Medicaid	$270.00
Rate for Payer: Molina Dual Medicare/Medicaid	$84.71
Rate for Payer: Molina Medicare	$84.71
Rate for Payer: Multiplan Auto	$243.75
Rate for Payer: Multiplan Commercial	$243.75
Rate for Payer: Multiplan Workers Comp	$243.75
Rate for Payer: Parkland Medicaid	$270.00
Rate for Payer: Scott and White EPO/PPO	$13.90
Rate for Payer: Scott and White Medicare	$84.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$270.00
Rate for Payer: Superior Health Plan EPO	$84.71
Rate for Payer: Superior Health Plan Medicare	$84.71
Rate for Payer: Universal American Dual Medicare/Medicaid	$84.71
Rate for Payer: Universal American Medicare	$84.71
Rate for Payer: Wellcare Medicare	$84.71
Rate for Payer: Wellmed Medicare	$84.71

99282 - Level 2

Facility

$762.00

Service Code	HCPCS 99282
Hospital Charge Code	8932545
Hospital Revenue Code	450
Rate for Payer: Cash Price	$518.16

99282 - Level 2

Facility

$762.00

Service Code	HCPCS 99282
Hospital Charge Code	8932545
Hospital Revenue Code	450
Min. Negotiated Rate	$50.73
Max. Negotiated Rate	$900.00
Rate for Payer: Amerigroup CHIP/Medicaid	$280.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$154.24
Rate for Payer: Amerigroup Medicare	$154.24
Rate for Payer: BCBS of TX Blue Advantage	$375.00
Rate for Payer: BCBS of TX Blue Essentials	$810.00
Rate for Payer: BCBS of TX Medicare	$154.24
Rate for Payer: BCBS of TX PPO	$900.00
Rate for Payer: Cash Price	$518.16
Rate for Payer: Cash Price	$518.16
Rate for Payer: Cash Price	$518.16
Rate for Payer: Cigna Commercial	$573.14
Rate for Payer: Cigna Medicaid	$548.64
Rate for Payer: Cigna Medicare	$154.24
Rate for Payer: Employer Direct Commercial	$154.24
Rate for Payer: Humana Medicare/TRICARE	$154.24
Rate for Payer: Molina CHIP/Medicaid	$548.64
Rate for Payer: Molina Dual Medicare/Medicaid	$154.24
Rate for Payer: Molina Medicare	$154.24
Rate for Payer: Multiplan Auto	$495.30
Rate for Payer: Multiplan Commercial	$495.30
Rate for Payer: Multiplan Workers Comp	$495.30
Rate for Payer: Parkland Medicaid	$548.64
Rate for Payer: Scott and White EPO/PPO	$50.73
Rate for Payer: Scott and White Medicare	$154.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$548.64
Rate for Payer: Superior Health Plan EPO	$154.24
Rate for Payer: Superior Health Plan Medicare	$154.24
Rate for Payer: Universal American Dual Medicare/Medicaid	$154.24
Rate for Payer: Universal American Medicare	$154.24
Rate for Payer: Wellcare Medicare	$154.24
Rate for Payer: Wellmed Medicare	$154.24

99284 - Level 4

Facility

$2,117.00

Service Code	HCPCS 99284
Hospital Charge Code	5201801
Hospital Revenue Code	450
Min. Negotiated Rate	$146.88
Max. Negotiated Rate	$2,500.00
Rate for Payer: Amerigroup CHIP/Medicaid	$280.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$419.16
Rate for Payer: Amerigroup Medicare	$419.16
Rate for Payer: BCBS of TX Blue Advantage	$1,875.00
Rate for Payer: BCBS of TX Blue Essentials	$2,250.00
Rate for Payer: BCBS of TX Medicare	$419.16
Rate for Payer: BCBS of TX PPO	$2,500.00
Rate for Payer: Cash Price	$1,439.56
Rate for Payer: Cash Price	$1,439.56
Rate for Payer: Cash Price	$1,439.56
Rate for Payer: Cigna Commercial	$1,557.58
Rate for Payer: Cigna Medicaid	$1,524.24
Rate for Payer: Cigna Medicare	$419.16
Rate for Payer: Employer Direct Commercial	$419.16
Rate for Payer: Humana Medicare/TRICARE	$419.16
Rate for Payer: Molina CHIP/Medicaid	$1,524.24
Rate for Payer: Molina Dual Medicare/Medicaid	$419.16
Rate for Payer: Molina Medicare	$419.16
Rate for Payer: Multiplan Auto	$1,376.05
Rate for Payer: Multiplan Commercial	$1,376.05
Rate for Payer: Multiplan Workers Comp	$1,376.05
Rate for Payer: Parkland Medicaid	$1,524.24
Rate for Payer: Scott and White EPO/PPO	$146.88
Rate for Payer: Scott and White Medicare	$419.16
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,524.24
Rate for Payer: Superior Health Plan EPO	$419.16
Rate for Payer: Superior Health Plan Medicare	$419.16
Rate for Payer: Universal American Dual Medicare/Medicaid	$419.16
Rate for Payer: Universal American Medicare	$419.16
Rate for Payer: Wellcare Medicare	$419.16
Rate for Payer: Wellmed Medicare	$419.16

99284 - Level 4

Facility

$2,117.00

Service Code	HCPCS 99284
Hospital Charge Code	5201801
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,439.56

99285 - Level 5

Facility

$3,040.00

Service Code	HCPCS 99285
Hospital Charge Code	5201819
Hospital Revenue Code	450
Rate for Payer: Cash Price	$2,067.20

99285 - Level 5

Facility

$3,040.00

Service Code	HCPCS 99285
Hospital Charge Code	5201819
Hospital Revenue Code	450
Min. Negotiated Rate	$212.75
Max. Negotiated Rate	$3,520.00
Rate for Payer: Amerigroup CHIP/Medicaid	$280.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$598.24
Rate for Payer: Amerigroup Medicare	$598.24
Rate for Payer: BCBS of TX Blue Advantage	$2,640.00
Rate for Payer: BCBS of TX Blue Essentials	$3,168.00
Rate for Payer: BCBS of TX Medicare	$598.24
Rate for Payer: BCBS of TX PPO	$3,520.00
Rate for Payer: Cash Price	$2,067.20
Rate for Payer: Cash Price	$2,067.20
Rate for Payer: Cash Price	$2,067.20
Rate for Payer: Cigna Commercial	$2,968.44
Rate for Payer: Cigna Medicaid	$2,188.80
Rate for Payer: Cigna Medicare	$598.24
Rate for Payer: Employer Direct Commercial	$598.24
Rate for Payer: Humana Medicare/TRICARE	$598.24
Rate for Payer: Molina CHIP/Medicaid	$2,188.80
Rate for Payer: Molina Dual Medicare/Medicaid	$598.24
Rate for Payer: Molina Medicare	$598.24
Rate for Payer: Multiplan Auto	$1,976.00
Rate for Payer: Multiplan Commercial	$1,976.00
Rate for Payer: Multiplan Workers Comp	$1,976.00
Rate for Payer: Parkland Medicaid	$2,188.80
Rate for Payer: Scott and White EPO/PPO	$212.75
Rate for Payer: Scott and White Medicare	$598.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,188.80
Rate for Payer: Superior Health Plan EPO	$598.24
Rate for Payer: Superior Health Plan Medicare	$598.24
Rate for Payer: Universal American Dual Medicare/Medicaid	$598.24
Rate for Payer: Universal American Medicare	$598.24
Rate for Payer: Wellcare Medicare	$598.24
Rate for Payer: Wellmed Medicare	$598.24

9mm x 4cm x 80cm Saber Balloon

Facility

$567.50

Service Code	HCPCS C1726
Hospital Charge Code	992564
Hospital Revenue Code	272
Min. Negotiated Rate	$51.08
Max. Negotiated Rate	$408.60
Rate for Payer: Amerigroup CHIP/Medicaid	$51.08
Rate for Payer: BCBS of TX Blue Advantage	$170.25
Rate for Payer: BCBS of TX Blue Essentials	$204.30
Rate for Payer: BCBS of TX PPO	$227.00
Rate for Payer: Cash Price	$385.90
Rate for Payer: Cigna Medicaid	$408.60
Rate for Payer: Molina CHIP/Medicaid	$408.60
Rate for Payer: Multiplan Auto	$368.88
Rate for Payer: Multiplan Commercial	$368.88
Rate for Payer: Multiplan Workers Comp	$368.88
Rate for Payer: Parkland Medicaid	$408.60
Rate for Payer: Scott and White EPO/PPO	$283.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$408.60
Rate for Payer: Superior Health Plan EPO	$77.18

9mm x 4cm x 80cm Saber Balloon

Facility

$567.50

Service Code	HCPCS C1726
Hospital Charge Code	992564
Hospital Revenue Code	272
Rate for Payer: Cash Price	$385.90

AAMI 6 Pin to 3 Lead Fixed (Din) ECG Cable

Facility

$364.34

Hospital Charge Code	993565
Hospital Revenue Code	270
Rate for Payer: Cash Price	$247.75

AAMI 6 Pin to 3 Lead Fixed (Din) ECG Cable

Facility

$364.34

Hospital Charge Code	993565
Hospital Revenue Code	270
Min. Negotiated Rate	$32.79
Max. Negotiated Rate	$262.32
Rate for Payer: Amerigroup CHIP/Medicaid	$32.79
Rate for Payer: BCBS of TX Blue Advantage	$109.30
Rate for Payer: BCBS of TX Blue Essentials	$131.16
Rate for Payer: BCBS of TX PPO	$145.74
Rate for Payer: Cash Price	$247.75
Rate for Payer: Cigna Medicaid	$262.32
Rate for Payer: Molina CHIP/Medicaid	$262.32
Rate for Payer: Multiplan Auto	$236.82
Rate for Payer: Multiplan Commercial	$236.82
Rate for Payer: Multiplan Workers Comp	$236.82
Rate for Payer: Parkland Medicaid	$262.32
Rate for Payer: Scott and White EPO/PPO	$182.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$262.32
Rate for Payer: Superior Health Plan EPO	$49.55

ABD AORTA W/BI LWR EXT

Facility

$4,977.00

Service Code	HCPCS 75630
Hospital Charge Code	4615631
Hospital Revenue Code	323
Rate for Payer: Cash Price	$3,384.36

ABD AORTA W/BI LWR EXT

Facility

$4,977.00

Service Code	HCPCS 75630
Hospital Charge Code	4615631
Hospital Revenue Code	323
Min. Negotiated Rate	$157.04
Max. Negotiated Rate	$6,704.76
Rate for Payer: Amerigroup CHIP/Medicaid	$157.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Amerigroup Medicare	$3,171.87
Rate for Payer: BCBS of TX Blue Advantage	$4,572.61
Rate for Payer: BCBS of TX Blue Essentials	$5,487.13
Rate for Payer: BCBS of TX Medicare	$3,171.87
Rate for Payer: BCBS of TX PPO	$6,124.53
Rate for Payer: Cash Price	$3,384.36
Rate for Payer: Cash Price	$3,384.36
Rate for Payer: Cash Price	$3,384.36
Rate for Payer: Cigna Commercial	$6,704.76
Rate for Payer: Cigna Medicaid	$3,583.44
Rate for Payer: Cigna Medicare	$3,171.87
Rate for Payer: Employer Direct Commercial	$3,171.87
Rate for Payer: Humana Medicare/TRICARE	$3,171.87
Rate for Payer: Molina CHIP/Medicaid	$3,583.44
Rate for Payer: Molina Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Molina Medicare	$3,171.87
Rate for Payer: Multiplan Auto	$3,235.05
Rate for Payer: Multiplan Commercial	$3,235.05
Rate for Payer: Multiplan Workers Comp	$3,235.05
Rate for Payer: Parkland Medicaid	$3,583.44
Rate for Payer: Scott and White EPO/PPO	$192.82
Rate for Payer: Scott and White Medicare	$3,171.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,583.44
Rate for Payer: Superior Health Plan EPO	$3,171.87
Rate for Payer: Superior Health Plan Medicare	$3,171.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Universal American Medicare	$3,171.87
Rate for Payer: Wellcare Medicare	$3,171.87
Rate for Payer: Wellmed Medicare	$3,171.87

ABDOMINAL PAIN

Facility

$4,192.83

Service Code	APR-DRG 2513
Min. Negotiated Rate	$3,953.15
Max. Negotiated Rate	$4,192.83
Rate for Payer: Amerigroup CHIP/Medicaid	$3,953.15
Rate for Payer: Cigna Medicaid	$3,953.15
Rate for Payer: Molina CHIP/Medicaid	$3,953.15
Rate for Payer: Parkland Medicaid	$3,953.15
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,192.83

ABDOMINAL PAIN

Facility

$3,084.27

Service Code	APR-DRG 2512
Min. Negotiated Rate	$2,907.96
Max. Negotiated Rate	$3,084.27
Rate for Payer: Amerigroup CHIP/Medicaid	$2,907.96
Rate for Payer: Cigna Medicaid	$2,907.96
Rate for Payer: Molina CHIP/Medicaid	$2,907.96
Rate for Payer: Parkland Medicaid	$2,907.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,084.27

ABDOMINAL PAIN

Facility

$8,760.59

Service Code	APR-DRG 2514
Min. Negotiated Rate	$8,259.79
Max. Negotiated Rate	$8,760.59
Rate for Payer: Amerigroup CHIP/Medicaid	$8,259.79
Rate for Payer: Cigna Medicaid	$8,259.79
Rate for Payer: Molina CHIP/Medicaid	$8,259.79
Rate for Payer: Parkland Medicaid	$8,259.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,760.59

ABDOMINAL PAIN

Facility

$2,143.19

Service Code	APR-DRG 2511
Min. Negotiated Rate	$2,020.67
Max. Negotiated Rate	$2,143.19
Rate for Payer: Amerigroup CHIP/Medicaid	$2,020.67
Rate for Payer: Cigna Medicaid	$2,020.67
Rate for Payer: Molina CHIP/Medicaid	$2,020.67
Rate for Payer: Parkland Medicaid	$2,020.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,143.19

ABD PARACENTESIS W/IMAGE

Facility

$1,947.00

Service Code	HCPCS 49083
Hospital Charge Code	4619083
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,323.96

ABD PARACENTESIS W/IMAGE

Facility

$1,947.00

Service Code	HCPCS 49083
Hospital Charge Code	4619083
Hospital Revenue Code	361
Min. Negotiated Rate	$334.95
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$334.95
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$911.12
Rate for Payer: Amerigroup Medicare	$911.12
Rate for Payer: BCBS of TX Blue Advantage	$1,312.49
Rate for Payer: BCBS of TX Blue Essentials	$1,571.84
Rate for Payer: BCBS of TX Medicare	$911.12
Rate for Payer: BCBS of TX PPO	$1,980.52
Rate for Payer: Cash Price	$1,323.96
Rate for Payer: Cash Price	$1,323.96
Rate for Payer: Cash Price	$1,323.96
Rate for Payer: Cigna Commercial	$1,925.93
Rate for Payer: Cigna Medicaid	$1,401.84
Rate for Payer: Cigna Medicare	$911.12
Rate for Payer: Employer Direct Commercial	$911.12
Rate for Payer: Humana Medicare/TRICARE	$911.12
Rate for Payer: Molina CHIP/Medicaid	$1,401.84
Rate for Payer: Molina Dual Medicare/Medicaid	$911.12
Rate for Payer: Molina Medicare	$911.12
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$1,401.84
Rate for Payer: Scott and White EPO/PPO	$1,533.69
Rate for Payer: Scott and White Medicare	$911.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,401.84
Rate for Payer: Superior Health Plan EPO	$911.12
Rate for Payer: Superior Health Plan Medicare	$911.12
Rate for Payer: Universal American Dual Medicare/Medicaid	$911.12
Rate for Payer: Universal American Medicare	$911.12
Rate for Payer: Wellcare Medicare	$911.12
Rate for Payer: Wellmed Medicare	$911.12

ABLATION-AV NODE

Facility

$7,540.00

Service Code	HCPCS 93650
Hospital Charge Code	4610650
Hospital Revenue Code	480
Min. Negotiated Rate	$678.60
Max. Negotiated Rate	$16,562.21
Rate for Payer: Amerigroup CHIP/Medicaid	$678.60
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,835.21
Rate for Payer: Amerigroup Medicare	$7,835.21
Rate for Payer: BCBS of TX Blue Advantage	$9,829.14
Rate for Payer: BCBS of TX Blue Essentials	$11,771.42
Rate for Payer: BCBS of TX Medicare	$7,835.21
Rate for Payer: BCBS of TX PPO	$14,831.99
Rate for Payer: Cash Price	$5,127.20
Rate for Payer: Cash Price	$5,127.20
Rate for Payer: Cash Price	$5,127.20
Rate for Payer: Cigna Commercial	$16,562.21
Rate for Payer: Cigna Medicaid	$5,428.80
Rate for Payer: Cigna Medicare	$7,835.21
Rate for Payer: Employer Direct Commercial	$7,835.21
Rate for Payer: Humana Medicare/TRICARE	$7,835.21
Rate for Payer: Molina CHIP/Medicaid	$5,428.80
Rate for Payer: Molina Dual Medicare/Medicaid	$7,835.21
Rate for Payer: Molina Medicare	$7,835.21
Rate for Payer: Multiplan Auto	$4,901.00
Rate for Payer: Multiplan Commercial	$4,901.00
Rate for Payer: Multiplan Workers Comp	$4,901.00
Rate for Payer: Parkland Medicaid	$5,428.80
Rate for Payer: Scott and White EPO/PPO	$690.01
Rate for Payer: Scott and White Medicare	$7,835.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,428.80
Rate for Payer: Superior Health Plan EPO	$7,835.21
Rate for Payer: Superior Health Plan Medicare	$7,835.21
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,835.21
Rate for Payer: Universal American Medicare	$7,835.21
Rate for Payer: Wellcare Medicare	$7,835.21
Rate for Payer: Wellmed Medicare	$7,835.21

ABLATION-AV NODE

Facility

$7,540.00

Service Code	HCPCS 93650
Hospital Charge Code	4610650
Hospital Revenue Code	480
Rate for Payer: Cash Price	$5,127.20

Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocauter

Facility

$8,029.00

Service Code	HCPCS 30802
Hospital Charge Code	9900599
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,459.72

Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocauter

Facility

$8,029.00

Service Code	HCPCS 30802
Hospital Charge Code	9900599
Hospital Revenue Code	360
Min. Negotiated Rate	$420.64
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$420.64
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,558.65
Rate for Payer: Amerigroup Medicare	$1,558.65
Rate for Payer: BCBS of TX Blue Advantage	$2,253.40
Rate for Payer: BCBS of TX Blue Essentials	$2,698.68
Rate for Payer: BCBS of TX Medicare	$1,558.65
Rate for Payer: BCBS of TX PPO	$3,400.34
Rate for Payer: Cash Price	$5,459.72
Rate for Payer: Cash Price	$5,459.72
Rate for Payer: Cash Price	$5,459.72
Rate for Payer: Cigna Commercial	$3,294.71
Rate for Payer: Cigna Medicaid	$5,780.88
Rate for Payer: Cigna Medicare	$1,558.65
Rate for Payer: Employer Direct Commercial	$1,558.65
Rate for Payer: Humana Medicare/TRICARE	$1,558.65
Rate for Payer: Molina CHIP/Medicaid	$5,780.88
Rate for Payer: Molina Dual Medicare/Medicaid	$1,558.65
Rate for Payer: Molina Medicare	$1,558.65
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$5,780.88
Rate for Payer: Scott and White EPO/PPO	$2,580.23
Rate for Payer: Scott and White Medicare	$1,558.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,780.88
Rate for Payer: Superior Health Plan EPO	$1,558.65
Rate for Payer: Superior Health Plan Medicare	$1,558.65
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,558.65
Rate for Payer: Universal American Medicare	$1,558.65
Rate for Payer: Wellcare Medicare	$1,558.65
Rate for Payer: Wellmed Medicare	$1,558.65

Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocauter

Facility

$10,000.00

Service Code	CPT 30802
Hospital Charge Code	36030802
Hospital Revenue Code	360
Min. Negotiated Rate	$420.64
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$420.64
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,558.65
Rate for Payer: Amerigroup Medicare	$1,558.65
Rate for Payer: BCBS of TX Blue Advantage	$2,253.40
Rate for Payer: BCBS of TX Blue Essentials	$2,698.68
Rate for Payer: BCBS of TX Medicare	$1,558.65
Rate for Payer: BCBS of TX PPO	$3,400.34
Rate for Payer: Cigna Commercial	$3,294.71
Rate for Payer: Cigna Medicare	$1,558.65
Rate for Payer: Employer Direct Commercial	$1,558.65
Rate for Payer: Humana Medicare/TRICARE	$1,558.65
Rate for Payer: Molina Dual Medicare/Medicaid	$1,558.65
Rate for Payer: Molina Medicare	$1,558.65
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Scott and White EPO/PPO	$2,580.23
Rate for Payer: Scott and White Medicare	$1,558.65
Rate for Payer: Superior Health Plan EPO	$1,558.65
Rate for Payer: Superior Health Plan Medicare	$1,558.65
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,558.65
Rate for Payer: Universal American Medicare	$1,558.65
Rate for Payer: Wellcare Medicare	$1,558.65
Rate for Payer: Wellmed Medicare	$1,558.65

Know your out-of-pocket cost for care.

All Charges