White Rock Medical Center

All Charges

Charge

Type

Setting

Price

HCG Qualitative Urine

Facility

$367.00

Service Code	HCPCS 81025
Hospital Charge Code	1605187
Hospital Revenue Code	307
Rate for Payer: Cash Price	$249.56

HCG Qualitative Urine

Facility

$367.00

Service Code	HCPCS 81025
Hospital Charge Code	1605187
Hospital Revenue Code	307
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$264.24
Rate for Payer: Amerigroup CHIP/Medicaid	$3.36
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8.61
Rate for Payer: Amerigroup Medicare	$8.61
Rate for Payer: BCBS of TX Blue Advantage	$110.10
Rate for Payer: BCBS of TX Blue Essentials	$132.12
Rate for Payer: BCBS of TX Medicare	$8.61
Rate for Payer: BCBS of TX PPO	$146.80
Rate for Payer: Cash Price	$249.56
Rate for Payer: Cash Price	$249.56
Rate for Payer: Cigna Medicaid	$264.24
Rate for Payer: Cigna Medicare	$8.61
Rate for Payer: Employer Direct Commercial	$8.61
Rate for Payer: Humana Medicare/TRICARE	$8.61
Rate for Payer: Molina CHIP/Medicaid	$264.24
Rate for Payer: Molina Dual Medicare/Medicaid	$8.61
Rate for Payer: Molina Medicare	$8.61
Rate for Payer: Multiplan Auto	$238.55
Rate for Payer: Multiplan Commercial	$238.55
Rate for Payer: Multiplan Workers Comp	$238.55
Rate for Payer: Parkland Medicaid	$264.24
Rate for Payer: Scott and White EPO/PPO	$10.76
Rate for Payer: Scott and White Medicare	$8.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$264.24
Rate for Payer: Superior Health Plan EPO	$8.61
Rate for Payer: Superior Health Plan Medicare	$8.61
Rate for Payer: Universal American Dual Medicare/Medicaid	$8.61
Rate for Payer: Universal American Medicare	$8.61
Rate for Payer: Wellcare Medicare	$8.61
Rate for Payer: Wellmed Medicare	$8.61

(HCG) Quantitative

Facility

$431.00

Service Code	HCPCS 84702
Hospital Charge Code	8222373
Hospital Revenue Code	301
Min. Negotiated Rate	$5.87
Max. Negotiated Rate	$310.32
Rate for Payer: Amerigroup CHIP/Medicaid	$5.87
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15.05
Rate for Payer: Amerigroup Medicare	$15.05
Rate for Payer: BCBS of TX Blue Advantage	$129.30
Rate for Payer: BCBS of TX Blue Essentials	$155.16
Rate for Payer: BCBS of TX Medicare	$15.05
Rate for Payer: BCBS of TX PPO	$172.40
Rate for Payer: Cash Price	$293.08
Rate for Payer: Cash Price	$293.08
Rate for Payer: Cigna Medicaid	$310.32
Rate for Payer: Cigna Medicare	$15.05
Rate for Payer: Employer Direct Commercial	$15.05
Rate for Payer: Humana Medicare/TRICARE	$15.05
Rate for Payer: Molina CHIP/Medicaid	$310.32
Rate for Payer: Molina Dual Medicare/Medicaid	$15.05
Rate for Payer: Molina Medicare	$15.05
Rate for Payer: Multiplan Auto	$280.15
Rate for Payer: Multiplan Commercial	$280.15
Rate for Payer: Multiplan Workers Comp	$280.15
Rate for Payer: Parkland Medicaid	$310.32
Rate for Payer: Scott and White EPO/PPO	$18.81
Rate for Payer: Scott and White Medicare	$15.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$310.32
Rate for Payer: Superior Health Plan EPO	$15.05
Rate for Payer: Superior Health Plan Medicare	$15.05
Rate for Payer: Universal American Dual Medicare/Medicaid	$15.05
Rate for Payer: Universal American Medicare	$15.05
Rate for Payer: Wellcare Medicare	$15.05
Rate for Payer: Wellmed Medicare	$15.05

(HCG) Quantitative

Facility

$431.00

Service Code	HCPCS 84702
Hospital Charge Code	8222373
Hospital Revenue Code	301
Rate for Payer: Cash Price	$293.08

.HCG Urine (POCT)

Facility

$431.00

Service Code	HCPCS 81025
Hospital Charge Code	1602598
Hospital Revenue Code	301
Rate for Payer: Cash Price	$293.08

.HCG Urine (POCT)

Facility

$431.00

Service Code	HCPCS 81025
Hospital Charge Code	1602598
Hospital Revenue Code	301
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$310.32
Rate for Payer: Amerigroup CHIP/Medicaid	$3.36
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8.61
Rate for Payer: Amerigroup Medicare	$8.61
Rate for Payer: BCBS of TX Blue Advantage	$129.30
Rate for Payer: BCBS of TX Blue Essentials	$155.16
Rate for Payer: BCBS of TX Medicare	$8.61
Rate for Payer: BCBS of TX PPO	$172.40
Rate for Payer: Cash Price	$293.08
Rate for Payer: Cash Price	$293.08
Rate for Payer: Cigna Medicaid	$310.32
Rate for Payer: Cigna Medicare	$8.61
Rate for Payer: Employer Direct Commercial	$8.61
Rate for Payer: Humana Medicare/TRICARE	$8.61
Rate for Payer: Molina CHIP/Medicaid	$310.32
Rate for Payer: Molina Dual Medicare/Medicaid	$8.61
Rate for Payer: Molina Medicare	$8.61
Rate for Payer: Multiplan Auto	$280.15
Rate for Payer: Multiplan Commercial	$280.15
Rate for Payer: Multiplan Workers Comp	$280.15
Rate for Payer: Parkland Medicaid	$310.32
Rate for Payer: Scott and White EPO/PPO	$10.76
Rate for Payer: Scott and White Medicare	$8.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$310.32
Rate for Payer: Superior Health Plan EPO	$8.61
Rate for Payer: Superior Health Plan Medicare	$8.61
Rate for Payer: Universal American Dual Medicare/Medicaid	$8.61
Rate for Payer: Universal American Medicare	$8.61
Rate for Payer: Wellcare Medicare	$8.61
Rate for Payer: Wellmed Medicare	$8.61

.HCV Ab Verification 144075 SO

Facility

$356.00

Service Code	HCPCS 86804
Hospital Charge Code	1703560
Hospital Revenue Code	302
Rate for Payer: Cash Price	$242.08

.HCV Ab Verification 144075 SO

Facility

$356.00

Service Code	HCPCS 86804
Hospital Charge Code	1703560
Hospital Revenue Code	302
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$256.32
Rate for Payer: Amerigroup CHIP/Medicaid	$6.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15.49
Rate for Payer: Amerigroup Medicare	$15.49
Rate for Payer: BCBS of TX Blue Advantage	$106.80
Rate for Payer: BCBS of TX Blue Essentials	$128.16
Rate for Payer: BCBS of TX Medicare	$15.49
Rate for Payer: BCBS of TX PPO	$142.40
Rate for Payer: Cash Price	$242.08
Rate for Payer: Cash Price	$242.08
Rate for Payer: Cigna Medicaid	$256.32
Rate for Payer: Cigna Medicare	$15.49
Rate for Payer: Employer Direct Commercial	$15.49
Rate for Payer: Humana Medicare/TRICARE	$15.49
Rate for Payer: Molina CHIP/Medicaid	$256.32
Rate for Payer: Molina Dual Medicare/Medicaid	$15.49
Rate for Payer: Molina Medicare	$15.49
Rate for Payer: Multiplan Auto	$231.40
Rate for Payer: Multiplan Commercial	$231.40
Rate for Payer: Multiplan Workers Comp	$231.40
Rate for Payer: Parkland Medicaid	$256.32
Rate for Payer: Scott and White EPO/PPO	$19.36
Rate for Payer: Scott and White Medicare	$15.49
Rate for Payer: Superior Health Plan CHIP/Medicaid	$256.32
Rate for Payer: Superior Health Plan EPO	$15.49
Rate for Payer: Superior Health Plan Medicare	$15.49
Rate for Payer: Universal American Dual Medicare/Medicaid	$15.49
Rate for Payer: Universal American Medicare	$15.49
Rate for Payer: Wellcare Medicare	$15.49
Rate for Payer: Wellmed Medicare	$15.49

HCV Antibody RFX to Qual NAA SO

Facility

$376.00

Service Code	HCPCS 86803
Hospital Charge Code	1602895
Hospital Revenue Code	302
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$270.72
Rate for Payer: Amerigroup CHIP/Medicaid	$5.57
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14.27
Rate for Payer: Amerigroup Medicare	$14.27
Rate for Payer: BCBS of TX Blue Advantage	$112.80
Rate for Payer: BCBS of TX Blue Essentials	$135.36
Rate for Payer: BCBS of TX Medicare	$14.27
Rate for Payer: BCBS of TX PPO	$150.40
Rate for Payer: Cash Price	$255.68
Rate for Payer: Cash Price	$255.68
Rate for Payer: Cigna Medicaid	$270.72
Rate for Payer: Cigna Medicare	$14.27
Rate for Payer: Employer Direct Commercial	$14.27
Rate for Payer: Humana Medicare/TRICARE	$14.27
Rate for Payer: Molina CHIP/Medicaid	$270.72
Rate for Payer: Molina Dual Medicare/Medicaid	$14.27
Rate for Payer: Molina Medicare	$14.27
Rate for Payer: Multiplan Auto	$244.40
Rate for Payer: Multiplan Commercial	$244.40
Rate for Payer: Multiplan Workers Comp	$244.40
Rate for Payer: Parkland Medicaid	$270.72
Rate for Payer: Scott and White EPO/PPO	$17.84
Rate for Payer: Scott and White Medicare	$14.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$270.72
Rate for Payer: Superior Health Plan EPO	$14.27
Rate for Payer: Superior Health Plan Medicare	$14.27
Rate for Payer: Universal American Dual Medicare/Medicaid	$14.27
Rate for Payer: Universal American Medicare	$14.27
Rate for Payer: Wellcare Medicare	$14.27
Rate for Payer: Wellmed Medicare	$14.27

HCV Antibody RFX to Qual NAA SO

Facility

$376.00

Service Code	HCPCS 86803
Hospital Charge Code	1602895
Hospital Revenue Code	302
Rate for Payer: Cash Price	$255.68

HCV Genotyping Non Reflex SO

Facility

$769.40

Service Code	HCPCS 87902
Hospital Charge Code	1709526
Hospital Revenue Code	306
Rate for Payer: Cash Price	$523.19

HCV Genotyping Non Reflex SO

Facility

$769.40

Service Code	HCPCS 87902
Hospital Charge Code	1709526
Hospital Revenue Code	306
Min. Negotiated Rate	$100.41
Max. Negotiated Rate	$553.97
Rate for Payer: Amerigroup CHIP/Medicaid	$100.41
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$257.45
Rate for Payer: Amerigroup Medicare	$257.45
Rate for Payer: BCBS of TX Blue Advantage	$230.82
Rate for Payer: BCBS of TX Blue Essentials	$276.98
Rate for Payer: BCBS of TX Medicare	$257.45
Rate for Payer: BCBS of TX PPO	$307.76
Rate for Payer: Cash Price	$523.19
Rate for Payer: Cash Price	$523.19
Rate for Payer: Cigna Medicaid	$553.97
Rate for Payer: Cigna Medicare	$257.45
Rate for Payer: Employer Direct Commercial	$257.45
Rate for Payer: Humana Medicare/TRICARE	$257.45
Rate for Payer: Molina CHIP/Medicaid	$553.97
Rate for Payer: Molina Dual Medicare/Medicaid	$257.45
Rate for Payer: Molina Medicare	$257.45
Rate for Payer: Multiplan Auto	$500.11
Rate for Payer: Multiplan Commercial	$500.11
Rate for Payer: Multiplan Workers Comp	$500.11
Rate for Payer: Parkland Medicaid	$553.97
Rate for Payer: Scott and White EPO/PPO	$321.81
Rate for Payer: Scott and White Medicare	$257.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$553.97
Rate for Payer: Superior Health Plan EPO	$257.45
Rate for Payer: Superior Health Plan Medicare	$257.45
Rate for Payer: Universal American Dual Medicare/Medicaid	$257.45
Rate for Payer: Universal American Medicare	$257.45
Rate for Payer: Wellcare Medicare	$257.45
Rate for Payer: Wellmed Medicare	$257.45

.HCV RT-PCR, Quant (Non-Graph) 55036 SO

Facility

$571.43

Service Code	HCPCS 87522
Hospital Charge Code	1703677
Hospital Revenue Code	306
Rate for Payer: Cash Price	$388.57

.HCV RT-PCR, Quant (Non-Graph) 55036 SO

Facility

$571.43

Service Code	HCPCS 87522
Hospital Charge Code	1703677
Hospital Revenue Code	306
Min. Negotiated Rate	$16.71
Max. Negotiated Rate	$411.43
Rate for Payer: Amerigroup CHIP/Medicaid	$16.71
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$42.84
Rate for Payer: Amerigroup Medicare	$42.84
Rate for Payer: BCBS of TX Blue Advantage	$171.43
Rate for Payer: BCBS of TX Blue Essentials	$205.71
Rate for Payer: BCBS of TX Medicare	$42.84
Rate for Payer: BCBS of TX PPO	$228.57
Rate for Payer: Cash Price	$388.57
Rate for Payer: Cash Price	$388.57
Rate for Payer: Cigna Medicaid	$411.43
Rate for Payer: Cigna Medicare	$42.84
Rate for Payer: Employer Direct Commercial	$42.84
Rate for Payer: Humana Medicare/TRICARE	$42.84
Rate for Payer: Molina CHIP/Medicaid	$411.43
Rate for Payer: Molina Dual Medicare/Medicaid	$42.84
Rate for Payer: Molina Medicare	$42.84
Rate for Payer: Multiplan Auto	$371.43
Rate for Payer: Multiplan Commercial	$371.43
Rate for Payer: Multiplan Workers Comp	$371.43
Rate for Payer: Parkland Medicaid	$411.43
Rate for Payer: Scott and White EPO/PPO	$53.55
Rate for Payer: Scott and White Medicare	$42.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$411.43
Rate for Payer: Superior Health Plan EPO	$42.84
Rate for Payer: Superior Health Plan Medicare	$42.84
Rate for Payer: Universal American Dual Medicare/Medicaid	$42.84
Rate for Payer: Universal American Medicare	$42.84
Rate for Payer: Wellcare Medicare	$42.84
Rate for Payer: Wellmed Medicare	$42.84

HEADACHES WITH MCC

Facility

$21,848.10

Service Code	MSDRG 102
Min. Negotiated Rate	$9,257.90
Max. Negotiated Rate	$21,848.10
Rate for Payer: Cigna Commercial	$14,437.19
Rate for Payer: Cigna Medicare	$12,975.19
Rate for Payer: Employer Direct Commercial	$12,975.19
Rate for Payer: Humana Medicare/TRICARE	$12,975.19
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,975.19
Rate for Payer: Amerigroup Medicare	$12,975.19
Rate for Payer: BCBS of TX Medicare	$12,975.19
Rate for Payer: Molina Dual Medicare/Medicaid	$12,975.19
Rate for Payer: Molina Medicare	$12,975.19
Rate for Payer: Multiplan Auto	$21,848.10
Rate for Payer: Multiplan Commercial	$21,848.10
Rate for Payer: Multiplan Workers Comp	$21,848.10
Rate for Payer: Scott and White EPO/PPO	$10,061.62
Rate for Payer: Scott and White Medicare	$12,975.19
Rate for Payer: Superior Health Plan EPO	$12,975.19
Rate for Payer: Superior Health Plan Medicare	$12,975.19
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,975.19
Rate for Payer: Universal American Medicare	$12,975.19
Rate for Payer: Wellcare Medicare	$12,975.19
Rate for Payer: Wellmed Medicare	$12,975.19

HEADACHES WITHOUT MCC

Facility

$15,817.50

Service Code	MSDRG 103
Min. Negotiated Rate	$6,720.04
Max. Negotiated Rate	$15,817.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,889.34
Rate for Payer: Amerigroup Medicare	$10,889.34
Rate for Payer: BCBS of TX Medicare	$10,889.34
Rate for Payer: Cigna Commercial	$10,771.54
Rate for Payer: Cigna Medicare	$10,889.34
Rate for Payer: Employer Direct Commercial	$10,889.34
Rate for Payer: Humana Medicare/TRICARE	$10,889.34
Rate for Payer: Molina Dual Medicare/Medicaid	$10,889.34
Rate for Payer: Molina Medicare	$10,889.34
Rate for Payer: Multiplan Auto	$15,817.50
Rate for Payer: Multiplan Commercial	$15,817.50
Rate for Payer: Multiplan Workers Comp	$15,817.50
Rate for Payer: Scott and White EPO/PPO	$7,284.38
Rate for Payer: Scott and White Medicare	$10,889.34
Rate for Payer: Superior Health Plan EPO	$10,889.34
Rate for Payer: Superior Health Plan Medicare	$10,889.34
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,889.34
Rate for Payer: Universal American Medicare	$10,889.34
Rate for Payer: Wellcare Medicare	$10,889.34
Rate for Payer: Wellmed Medicare	$10,889.34

HEADACHES W MCC

Facility

$21,848.10

Service Code	MSDRG 102
Min. Negotiated Rate	$9,257.90
Max. Negotiated Rate	$21,848.10
Rate for Payer: BCBS of TX Blue Advantage	$9,257.90
Rate for Payer: BCBS of TX Blue Essentials	$11,108.40
Rate for Payer: BCBS of TX PPO	$12,343.15

HEADACHES W/O MCC

Facility

$15,817.50

Service Code	MSDRG 103
Min. Negotiated Rate	$6,720.04
Max. Negotiated Rate	$15,817.50
Rate for Payer: BCBS of TX Blue Advantage	$6,720.04
Rate for Payer: BCBS of TX Blue Essentials	$8,063.27
Rate for Payer: BCBS of TX PPO	$8,959.53

HEAD CERAMIC V40 DELTA BIOLOX 36MM 2.6

Facility

$6,024.10

Service Code	HCPCS C1776
Hospital Charge Code	992155
Hospital Revenue Code	278
Min. Negotiated Rate	$542.17
Max. Negotiated Rate	$4,337.35
Rate for Payer: Amerigroup CHIP/Medicaid	$542.17
Rate for Payer: BCBS of TX Blue Advantage	$1,807.23
Rate for Payer: BCBS of TX Blue Essentials	$2,168.68
Rate for Payer: BCBS of TX PPO	$2,409.64
Rate for Payer: Cash Price	$4,096.39
Rate for Payer: Cigna Medicaid	$4,337.35
Rate for Payer: Molina CHIP/Medicaid	$4,337.35
Rate for Payer: Multiplan Auto	$3,012.05
Rate for Payer: Multiplan Commercial	$3,012.05
Rate for Payer: Multiplan Workers Comp	$3,012.05
Rate for Payer: Parkland Medicaid	$4,337.35
Rate for Payer: Scott and White EPO/PPO	$3,012.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,337.35
Rate for Payer: Superior Health Plan EPO	$819.28

HEAD CERAMIC V40 DELTA BIOLOX 36MM 2.6

Facility

$6,024.10

Service Code	HCPCS C1776
Hospital Charge Code	992155
Hospital Revenue Code	278
Min. Negotiated Rate	$1,506.03
Max. Negotiated Rate	$3,012.05
Rate for Payer: Cash Price	$4,096.39
Rate for Payer: Cigna Commercial	$1,506.03
Rate for Payer: Multiplan Auto	$3,012.05
Rate for Payer: Multiplan Commercial	$3,012.05
Rate for Payer: Multiplan Workers Comp	$3,012.05
Rate for Payer: Scott and White EPO/PPO	$3,012.05

HEADED REAMER 6MM, CANNULATED

Facility

$1,629.86

Hospital Charge Code	992602
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,108.30

HEADED REAMER 6MM, CANNULATED

Facility

$1,629.86

Hospital Charge Code	992602
Hospital Revenue Code	272
Min. Negotiated Rate	$146.69
Max. Negotiated Rate	$1,173.50
Rate for Payer: Amerigroup CHIP/Medicaid	$146.69
Rate for Payer: BCBS of TX Blue Advantage	$488.96
Rate for Payer: BCBS of TX Blue Essentials	$586.75
Rate for Payer: BCBS of TX PPO	$651.94
Rate for Payer: Cash Price	$1,108.30
Rate for Payer: Cigna Medicaid	$1,173.50
Rate for Payer: Molina CHIP/Medicaid	$1,173.50
Rate for Payer: Multiplan Auto	$1,059.41
Rate for Payer: Multiplan Commercial	$1,059.41
Rate for Payer: Multiplan Workers Comp	$1,059.41
Rate for Payer: Parkland Medicaid	$1,173.50
Rate for Payer: Scott and White EPO/PPO	$814.93
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,173.50
Rate for Payer: Superior Health Plan EPO	$221.66

HEADED SCREW 2.0MM X 12MM DART-FIRE COMPRESSION SCREW

Facility

$1,159.64

Service Code	HCPCS C1713
Hospital Charge Code	993130
Hospital Revenue Code	278
Min. Negotiated Rate	$289.91
Max. Negotiated Rate	$579.82
Rate for Payer: Cash Price	$788.56
Rate for Payer: Cigna Commercial	$289.91
Rate for Payer: Multiplan Auto	$579.82
Rate for Payer: Multiplan Commercial	$579.82
Rate for Payer: Multiplan Workers Comp	$579.82
Rate for Payer: Scott and White EPO/PPO	$579.82

HEADED SCREW 2.0MM X 12MM DART-FIRE COMPRESSION SCREW

Facility

$1,159.64

Service Code	HCPCS C1713
Hospital Charge Code	993130
Hospital Revenue Code	278
Min. Negotiated Rate	$104.37
Max. Negotiated Rate	$834.94
Rate for Payer: Amerigroup CHIP/Medicaid	$104.37
Rate for Payer: BCBS of TX Blue Advantage	$347.89
Rate for Payer: BCBS of TX Blue Essentials	$417.47
Rate for Payer: BCBS of TX PPO	$463.86
Rate for Payer: Cash Price	$788.56
Rate for Payer: Cigna Medicaid	$834.94
Rate for Payer: Molina CHIP/Medicaid	$834.94
Rate for Payer: Multiplan Auto	$579.82
Rate for Payer: Multiplan Commercial	$579.82
Rate for Payer: Multiplan Workers Comp	$579.82
Rate for Payer: Parkland Medicaid	$834.94
Rate for Payer: Scott and White EPO/PPO	$579.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$834.94
Rate for Payer: Superior Health Plan EPO	$157.71

HEADED SCREW 3.0MM X 22MM DART-FIRE COMPRESSION SCREW

Facility

$1,199.40

Service Code	HCPCS C1713
Hospital Charge Code	992407
Hospital Revenue Code	278
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$863.57
Rate for Payer: Amerigroup CHIP/Medicaid	$107.95
Rate for Payer: BCBS of TX Blue Advantage	$359.82
Rate for Payer: BCBS of TX Blue Essentials	$431.78
Rate for Payer: BCBS of TX PPO	$479.76
Rate for Payer: Cash Price	$815.59
Rate for Payer: Cigna Medicaid	$863.57
Rate for Payer: Molina CHIP/Medicaid	$863.57
Rate for Payer: Multiplan Auto	$599.70
Rate for Payer: Multiplan Commercial	$599.70
Rate for Payer: Multiplan Workers Comp	$599.70
Rate for Payer: Parkland Medicaid	$863.57
Rate for Payer: Scott and White EPO/PPO	$599.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$863.57
Rate for Payer: Superior Health Plan EPO	$163.12

Know your out-of-pocket cost for care.

All Charges