White Rock Medical Center

All Charges

Charge

Type

Setting

Price

HIP BLADE

Facility

$1,638.94

Hospital Charge Code	992665
Hospital Revenue Code	272
Min. Negotiated Rate	$147.50
Max. Negotiated Rate	$1,180.04
Rate for Payer: Amerigroup CHIP/Medicaid	$147.50
Rate for Payer: BCBS of TX Blue Advantage	$491.68
Rate for Payer: BCBS of TX Blue Essentials	$590.02
Rate for Payer: BCBS of TX PPO	$655.58
Rate for Payer: Cash Price	$1,114.48
Rate for Payer: Cigna Medicaid	$1,180.04
Rate for Payer: Molina CHIP/Medicaid	$1,180.04
Rate for Payer: Multiplan Auto	$1,065.31
Rate for Payer: Multiplan Commercial	$1,065.31
Rate for Payer: Multiplan Workers Comp	$1,065.31
Rate for Payer: Parkland Medicaid	$1,180.04
Rate for Payer: Scott and White EPO/PPO	$819.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,180.04
Rate for Payer: Superior Health Plan EPO	$222.90

HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC

Facility

$40,135.60

Service Code	MSDRG 481
Min. Negotiated Rate	$17,735.78
Max. Negotiated Rate	$40,135.60
Rate for Payer: BCBS of TX Blue Advantage	$17,735.78
Rate for Payer: BCBS of TX Blue Essentials	$21,280.87
Rate for Payer: BCBS of TX PPO	$23,646.33

HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC

Facility

$56,354.00

Service Code	MSDRG 480
Min. Negotiated Rate	$25,952.50
Max. Negotiated Rate	$56,354.00
Rate for Payer: BCBS of TX Blue Advantage	$26,061.44
Rate for Payer: BCBS of TX Blue Essentials	$31,270.70
Rate for Payer: BCBS of TX PPO	$34,746.57

HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC

Facility

$31,275.90

Service Code	MSDRG 482
Min. Negotiated Rate	$14,314.70
Max. Negotiated Rate	$31,275.90
Rate for Payer: BCBS of TX Blue Advantage	$14,314.70
Rate for Payer: BCBS of TX Blue Essentials	$17,175.98
Rate for Payer: BCBS of TX PPO	$19,085.16

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC

Facility

$57,364.80

Service Code	MSDRG 521
Min. Negotiated Rate	$25,795.86
Max. Negotiated Rate	$57,364.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$25,795.86
Rate for Payer: Amerigroup Medicare	$25,795.86
Rate for Payer: BCBS of TX Medicare	$25,795.86
Rate for Payer: Cigna Commercial	$36,968.18
Rate for Payer: Cigna Medicare	$25,795.86
Rate for Payer: Employer Direct Commercial	$25,795.86
Rate for Payer: Humana Medicare/TRICARE	$25,795.86
Rate for Payer: Molina Dual Medicare/Medicaid	$25,795.86
Rate for Payer: Molina Medicare	$25,795.86
Rate for Payer: Multiplan Auto	$57,364.80
Rate for Payer: Multiplan Commercial	$57,364.80
Rate for Payer: Multiplan Workers Comp	$57,364.80
Rate for Payer: Scott and White EPO/PPO	$26,418.00
Rate for Payer: Scott and White Medicare	$25,795.86
Rate for Payer: Superior Health Plan EPO	$25,795.86
Rate for Payer: Superior Health Plan Medicare	$25,795.86
Rate for Payer: Universal American Dual Medicare/Medicaid	$25,795.86
Rate for Payer: Universal American Medicare	$25,795.86
Rate for Payer: Wellcare Medicare	$25,795.86
Rate for Payer: Wellmed Medicare	$25,795.86

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC

Facility

$41,285.10

Service Code	MSDRG 522
Min. Negotiated Rate	$19,012.88
Max. Negotiated Rate	$41,285.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$20,280.76
Rate for Payer: Amerigroup Medicare	$20,280.76
Rate for Payer: BCBS of TX Medicare	$20,280.76
Rate for Payer: Cigna Commercial	$27,275.98
Rate for Payer: Cigna Medicare	$20,280.76
Rate for Payer: Employer Direct Commercial	$20,280.76
Rate for Payer: Humana Medicare/TRICARE	$20,280.76
Rate for Payer: Molina Dual Medicare/Medicaid	$20,280.76
Rate for Payer: Molina Medicare	$20,280.76
Rate for Payer: Multiplan Auto	$41,285.10
Rate for Payer: Multiplan Commercial	$41,285.10
Rate for Payer: Multiplan Workers Comp	$41,285.10
Rate for Payer: Scott and White EPO/PPO	$19,012.88
Rate for Payer: Scott and White Medicare	$20,280.76
Rate for Payer: Superior Health Plan EPO	$20,280.76
Rate for Payer: Superior Health Plan Medicare	$20,280.76
Rate for Payer: Universal American Dual Medicare/Medicaid	$20,280.76
Rate for Payer: Universal American Medicare	$20,280.76
Rate for Payer: Wellcare Medicare	$20,280.76
Rate for Payer: Wellmed Medicare	$20,280.76

HIS BUNDLE RECORDING

Facility

$6,825.00

Service Code	HCPCS 93600
Hospital Charge Code	4613600
Hospital Revenue Code	480
Min. Negotiated Rate	$614.25
Max. Negotiated Rate	$16,562.21
Rate for Payer: Amerigroup CHIP/Medicaid	$614.25
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	$4,641.00
Rate for Payer: Cash Price	$4,641.00
Rate for Payer: Cash Price	$4,641.00
Rate for Payer: Cigna Commercial	$16,562.21
Rate for Payer: Cigna Medicaid	$4,914.00
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	$4,914.00
Rate for Payer: Molina Dual Medicare/Medicaid	$7,835.21
Rate for Payer: Molina Medicare	$7,835.21
Rate for Payer: Multiplan Auto	$4,436.25
Rate for Payer: Multiplan Commercial	$4,436.25
Rate for Payer: Multiplan Workers Comp	$4,436.25
Rate for Payer: Parkland Medicaid	$4,914.00
Rate for Payer: Scott and White EPO/PPO	$3,412.50
Rate for Payer: Scott and White Medicare	$7,835.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,914.00
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

HIS BUNDLE RECORDING

Facility

$6,825.00

Service Code	HCPCS 93600
Hospital Charge Code	4613600
Hospital Revenue Code	480
Rate for Payer: Cash Price	$4,641.00

HIV 1/2 Abs

Facility

$234.00

Service Code	HCPCS 86703
Hospital Charge Code	1602879
Hospital Revenue Code	302
Min. Negotiated Rate	$5.35
Max. Negotiated Rate	$168.48
Rate for Payer: Amerigroup CHIP/Medicaid	$5.35
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13.71
Rate for Payer: Amerigroup Medicare	$13.71
Rate for Payer: BCBS of TX Blue Advantage	$70.20
Rate for Payer: BCBS of TX Blue Essentials	$84.24
Rate for Payer: BCBS of TX Medicare	$13.71
Rate for Payer: BCBS of TX PPO	$93.60
Rate for Payer: Cash Price	$159.12
Rate for Payer: Cash Price	$159.12
Rate for Payer: Cigna Medicaid	$168.48
Rate for Payer: Cigna Medicare	$13.71
Rate for Payer: Employer Direct Commercial	$13.71
Rate for Payer: Humana Medicare/TRICARE	$13.71
Rate for Payer: Molina CHIP/Medicaid	$168.48
Rate for Payer: Molina Dual Medicare/Medicaid	$13.71
Rate for Payer: Molina Medicare	$13.71
Rate for Payer: Multiplan Auto	$152.10
Rate for Payer: Multiplan Commercial	$152.10
Rate for Payer: Multiplan Workers Comp	$152.10
Rate for Payer: Parkland Medicaid	$168.48
Rate for Payer: Scott and White EPO/PPO	$17.14
Rate for Payer: Scott and White Medicare	$13.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$168.48
Rate for Payer: Superior Health Plan EPO	$13.71
Rate for Payer: Superior Health Plan Medicare	$13.71
Rate for Payer: Universal American Dual Medicare/Medicaid	$13.71
Rate for Payer: Universal American Medicare	$13.71
Rate for Payer: Wellcare Medicare	$13.71
Rate for Payer: Wellmed Medicare	$13.71

HIV 1/2 Abs

Facility

$234.00

Service Code	HCPCS 86703
Hospital Charge Code	1602879
Hospital Revenue Code	302
Rate for Payer: Cash Price	$159.12

HIV-1/HIV-2 Qualitative RNA SO

Facility

$414.00

Service Code	HCPCS 87535
Hospital Charge Code	8738617
Hospital Revenue Code	306
Rate for Payer: Cash Price	$281.52

HIV-1/HIV-2 Qualitative RNA SO

Facility

$414.00

Service Code	HCPCS 87535
Hospital Charge Code	8738617
Hospital Revenue Code	306
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$298.08
Rate for Payer: Amerigroup CHIP/Medicaid	$13.69
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$35.09
Rate for Payer: Amerigroup Medicare	$35.09
Rate for Payer: BCBS of TX Blue Advantage	$124.20
Rate for Payer: BCBS of TX Blue Essentials	$149.04
Rate for Payer: BCBS of TX Medicare	$35.09
Rate for Payer: BCBS of TX PPO	$165.60
Rate for Payer: Cash Price	$281.52
Rate for Payer: Cash Price	$281.52
Rate for Payer: Cigna Medicaid	$298.08
Rate for Payer: Cigna Medicare	$35.09
Rate for Payer: Employer Direct Commercial	$35.09
Rate for Payer: Humana Medicare/TRICARE	$35.09
Rate for Payer: Molina CHIP/Medicaid	$298.08
Rate for Payer: Molina Dual Medicare/Medicaid	$35.09
Rate for Payer: Molina Medicare	$35.09
Rate for Payer: Multiplan Auto	$269.10
Rate for Payer: Multiplan Commercial	$269.10
Rate for Payer: Multiplan Workers Comp	$269.10
Rate for Payer: Parkland Medicaid	$298.08
Rate for Payer: Scott and White EPO/PPO	$43.86
Rate for Payer: Scott and White Medicare	$35.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$298.08
Rate for Payer: Superior Health Plan EPO	$35.09
Rate for Payer: Superior Health Plan Medicare	$35.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$35.09
Rate for Payer: Universal American Medicare	$35.09
Rate for Payer: Wellcare Medicare	$35.09
Rate for Payer: Wellmed Medicare	$35.09

HIV-1/O/2, 4th Generation SO

Facility

$190.00

Service Code	HCPCS 87389
Hospital Charge Code	1640071
Hospital Revenue Code	302
Min. Negotiated Rate	$9.39
Max. Negotiated Rate	$136.80
Rate for Payer: Amerigroup CHIP/Medicaid	$9.39
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$24.08
Rate for Payer: Amerigroup Medicare	$24.08
Rate for Payer: BCBS of TX Blue Advantage	$57.00
Rate for Payer: BCBS of TX Blue Essentials	$68.40
Rate for Payer: BCBS of TX Medicare	$24.08
Rate for Payer: BCBS of TX PPO	$76.00
Rate for Payer: Cash Price	$129.20
Rate for Payer: Cash Price	$129.20
Rate for Payer: Cigna Medicaid	$136.80
Rate for Payer: Cigna Medicare	$24.08
Rate for Payer: Employer Direct Commercial	$24.08
Rate for Payer: Humana Medicare/TRICARE	$24.08
Rate for Payer: Molina CHIP/Medicaid	$136.80
Rate for Payer: Molina Dual Medicare/Medicaid	$24.08
Rate for Payer: Molina Medicare	$24.08
Rate for Payer: Multiplan Auto	$123.50
Rate for Payer: Multiplan Commercial	$123.50
Rate for Payer: Multiplan Workers Comp	$123.50
Rate for Payer: Parkland Medicaid	$136.80
Rate for Payer: Scott and White EPO/PPO	$30.10
Rate for Payer: Scott and White Medicare	$24.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$136.80
Rate for Payer: Superior Health Plan EPO	$24.08
Rate for Payer: Superior Health Plan Medicare	$24.08
Rate for Payer: Universal American Dual Medicare/Medicaid	$24.08
Rate for Payer: Universal American Medicare	$24.08
Rate for Payer: Wellcare Medicare	$24.08
Rate for Payer: Wellmed Medicare	$24.08

HIV-1/O/2, 4th Generation SO

Facility

$190.00

Service Code	HCPCS 87389
Hospital Charge Code	1640071
Hospital Revenue Code	302
Rate for Payer: Cash Price	$129.20

HIV W EXTENSIVE O.R. PROCEDURE W MCC

Facility

$137,704.40

Service Code	MSDRG 969
Min. Negotiated Rate	$48,148.82
Max. Negotiated Rate	$137,704.40
Rate for Payer: BCBS of TX Blue Advantage	$48,148.82
Rate for Payer: BCBS of TX Blue Essentials	$57,772.99
Rate for Payer: BCBS of TX PPO	$64,194.69

HIV W EXTENSIVE O.R. PROCEDURE W/O MCC

Facility

$58,679.60

Service Code	MSDRG 970
Min. Negotiated Rate	$23,974.22
Max. Negotiated Rate	$58,679.60
Rate for Payer: BCBS of TX Blue Advantage	$23,974.22
Rate for Payer: BCBS of TX Blue Essentials	$28,766.28
Rate for Payer: BCBS of TX PPO	$31,963.77

HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC

Facility

$137,704.40

Service Code	MSDRG 969
Min. Negotiated Rate	$48,148.82
Max. Negotiated Rate	$137,704.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$49,623.25
Rate for Payer: Amerigroup Medicare	$49,623.25
Rate for Payer: BCBS of TX Medicare	$49,623.25
Rate for Payer: Cigna Commercial	$78,842.34
Rate for Payer: Cigna Medicare	$49,623.25
Rate for Payer: Employer Direct Commercial	$49,623.25
Rate for Payer: Humana Medicare/TRICARE	$49,623.25
Rate for Payer: Molina Dual Medicare/Medicaid	$49,623.25
Rate for Payer: Molina Medicare	$49,623.25
Rate for Payer: Multiplan Auto	$137,704.40
Rate for Payer: Multiplan Commercial	$137,704.40
Rate for Payer: Multiplan Workers Comp	$137,704.40
Rate for Payer: Scott and White EPO/PPO	$63,416.50
Rate for Payer: Scott and White Medicare	$49,623.25
Rate for Payer: Superior Health Plan EPO	$49,623.25
Rate for Payer: Superior Health Plan Medicare	$49,623.25
Rate for Payer: Universal American Dual Medicare/Medicaid	$49,623.25
Rate for Payer: Universal American Medicare	$49,623.25
Rate for Payer: Wellcare Medicare	$49,623.25
Rate for Payer: Wellmed Medicare	$49,623.25

HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC

Facility

$58,679.60

Service Code	MSDRG 970
Min. Negotiated Rate	$23,974.22
Max. Negotiated Rate	$58,679.60
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$24,089.66
Rate for Payer: Amerigroup Medicare	$24,089.66
Rate for Payer: BCBS of TX Medicare	$24,089.66
Rate for Payer: Cigna Commercial	$33,969.71
Rate for Payer: Cigna Medicare	$24,089.66
Rate for Payer: Employer Direct Commercial	$24,089.66
Rate for Payer: Humana Medicare/TRICARE	$24,089.66
Rate for Payer: Molina Dual Medicare/Medicaid	$24,089.66
Rate for Payer: Molina Medicare	$24,089.66
Rate for Payer: Multiplan Auto	$58,679.60
Rate for Payer: Multiplan Commercial	$58,679.60
Rate for Payer: Multiplan Workers Comp	$58,679.60
Rate for Payer: Scott and White EPO/PPO	$27,023.50
Rate for Payer: Scott and White Medicare	$24,089.66
Rate for Payer: Superior Health Plan EPO	$24,089.66
Rate for Payer: Superior Health Plan Medicare	$24,089.66
Rate for Payer: Universal American Dual Medicare/Medicaid	$24,089.66
Rate for Payer: Universal American Medicare	$24,089.66
Rate for Payer: Wellcare Medicare	$24,089.66
Rate for Payer: Wellmed Medicare	$24,089.66

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$9,287.15

Service Code	APR-DRG 8924
Min. Negotiated Rate	$8,756.25
Max. Negotiated Rate	$9,287.15
Rate for Payer: Amerigroup CHIP/Medicaid	$8,756.25
Rate for Payer: Cigna Medicaid	$8,756.25
Rate for Payer: Molina CHIP/Medicaid	$8,756.25
Rate for Payer: Parkland Medicaid	$8,756.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,287.15

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$6,130.83

Service Code	APR-DRG 8923
Min. Negotiated Rate	$5,780.36
Max. Negotiated Rate	$6,130.83
Rate for Payer: Amerigroup CHIP/Medicaid	$5,780.36
Rate for Payer: Cigna Medicaid	$5,780.36
Rate for Payer: Molina CHIP/Medicaid	$5,780.36
Rate for Payer: Parkland Medicaid	$5,780.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,130.83

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$3,941.63

Service Code	APR-DRG 8922
Min. Negotiated Rate	$3,716.30
Max. Negotiated Rate	$3,941.63
Rate for Payer: Amerigroup CHIP/Medicaid	$3,716.30
Rate for Payer: Cigna Medicaid	$3,716.30
Rate for Payer: Molina CHIP/Medicaid	$3,716.30
Rate for Payer: Parkland Medicaid	$3,716.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,941.63

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$3,155.94

Service Code	APR-DRG 8921
Min. Negotiated Rate	$2,975.53
Max. Negotiated Rate	$3,155.94
Rate for Payer: Amerigroup CHIP/Medicaid	$2,975.53
Rate for Payer: Cigna Medicaid	$2,975.53
Rate for Payer: Molina CHIP/Medicaid	$2,975.53
Rate for Payer: Parkland Medicaid	$2,975.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,155.94

HIV WITH MAJOR RELATED CONDITION WITH CC

Facility

$26,138.30

Service Code	MSDRG 975
Min. Negotiated Rate	$11,093.14
Max. Negotiated Rate	$26,138.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14,251.16
Rate for Payer: Amerigroup Medicare	$14,251.16
Rate for Payer: BCBS of TX Medicare	$14,251.16
Rate for Payer: Cigna Commercial	$16,679.60
Rate for Payer: Cigna Medicare	$14,251.16
Rate for Payer: Employer Direct Commercial	$14,251.16
Rate for Payer: Humana Medicare/TRICARE	$14,251.16
Rate for Payer: Molina Dual Medicare/Medicaid	$14,251.16
Rate for Payer: Molina Medicare	$14,251.16
Rate for Payer: Multiplan Auto	$26,138.30
Rate for Payer: Multiplan Commercial	$26,138.30
Rate for Payer: Multiplan Workers Comp	$26,138.30
Rate for Payer: Scott and White EPO/PPO	$12,037.38
Rate for Payer: Scott and White Medicare	$14,251.16
Rate for Payer: Superior Health Plan EPO	$14,251.16
Rate for Payer: Superior Health Plan Medicare	$14,251.16
Rate for Payer: Universal American Dual Medicare/Medicaid	$14,251.16
Rate for Payer: Universal American Medicare	$14,251.16
Rate for Payer: Wellcare Medicare	$14,251.16
Rate for Payer: Wellmed Medicare	$14,251.16

HIV WITH MAJOR RELATED CONDITION WITH MCC

Facility

$54,587.00

Service Code	MSDRG 974
Min. Negotiated Rate	$23,417.80
Max. Negotiated Rate	$54,587.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$25,911.64
Rate for Payer: Amerigroup Medicare	$25,911.64
Rate for Payer: BCBS of TX Medicare	$25,911.64
Rate for Payer: Cigna Commercial	$37,171.68
Rate for Payer: Cigna Medicare	$25,911.64
Rate for Payer: Employer Direct Commercial	$25,911.64
Rate for Payer: Humana Medicare/TRICARE	$25,911.64
Rate for Payer: Molina Dual Medicare/Medicaid	$25,911.64
Rate for Payer: Molina Medicare	$25,911.64
Rate for Payer: Multiplan Auto	$54,587.00
Rate for Payer: Multiplan Commercial	$54,587.00
Rate for Payer: Multiplan Workers Comp	$54,587.00
Rate for Payer: Scott and White EPO/PPO	$25,138.75
Rate for Payer: Scott and White Medicare	$25,911.64
Rate for Payer: Superior Health Plan EPO	$25,911.64
Rate for Payer: Superior Health Plan Medicare	$25,911.64
Rate for Payer: Universal American Dual Medicare/Medicaid	$25,911.64
Rate for Payer: Universal American Medicare	$25,911.64
Rate for Payer: Wellcare Medicare	$25,911.64
Rate for Payer: Wellmed Medicare	$25,911.64

HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC

Facility

$17,533.20

Service Code	MSDRG 976
Min. Negotiated Rate	$8,071.96
Max. Negotiated Rate	$17,533.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,375.99
Rate for Payer: Amerigroup Medicare	$11,375.99
Rate for Payer: BCBS of TX Medicare	$11,375.99
Rate for Payer: Cigna Commercial	$11,521.16
Rate for Payer: Cigna Medicare	$11,375.99
Rate for Payer: Employer Direct Commercial	$11,375.99
Rate for Payer: Humana Medicare/TRICARE	$11,375.99
Rate for Payer: Molina Dual Medicare/Medicaid	$11,375.99
Rate for Payer: Molina Medicare	$11,375.99
Rate for Payer: Multiplan Auto	$17,533.20
Rate for Payer: Multiplan Commercial	$17,533.20
Rate for Payer: Multiplan Workers Comp	$17,533.20
Rate for Payer: Scott and White EPO/PPO	$8,074.50
Rate for Payer: Scott and White Medicare	$11,375.99
Rate for Payer: Superior Health Plan EPO	$11,375.99
Rate for Payer: Superior Health Plan Medicare	$11,375.99
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,375.99
Rate for Payer: Universal American Medicare	$11,375.99
Rate for Payer: Wellcare Medicare	$11,375.99
Rate for Payer: Wellmed Medicare	$11,375.99

Know your out-of-pocket cost for care.

All Charges