White Rock Medical Center

All Charges

Charge

Type

Setting

Price

ibuprofen 800 mg / 200 mL

Facility

$128.17

Service Code	HCPCS J1741
Hospital Charge Code	79495460
Hospital Revenue Code	636
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$92.28
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3.20
Rate for Payer: Amerigroup Medicare	$3.20
Rate for Payer: BCBS of TX Blue Advantage	$2.91
Rate for Payer: BCBS of TX Blue Essentials	$3.50
Rate for Payer: BCBS of TX Medicare	$3.20
Rate for Payer: BCBS of TX PPO	$3.88
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cigna Medicaid	$92.28
Rate for Payer: Cigna Medicare	$3.20
Rate for Payer: Employer Direct Commercial	$3.20
Rate for Payer: Humana Medicare/TRICARE	$3.20
Rate for Payer: Molina CHIP/Medicaid	$92.28
Rate for Payer: Molina Dual Medicare/Medicaid	$3.20
Rate for Payer: Molina Medicare	$3.20
Rate for Payer: Multiplan Auto	$83.31
Rate for Payer: Multiplan Commercial	$83.31
Rate for Payer: Multiplan Workers Comp	$83.31
Rate for Payer: Parkland Medicaid	$92.28
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Scott and White Medicare	$3.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$92.28
Rate for Payer: Superior Health Plan EPO	$3.20
Rate for Payer: Superior Health Plan Medicare	$3.20
Rate for Payer: Universal American Dual Medicare/Medicaid	$3.20
Rate for Payer: Universal American Medicare	$3.20
Rate for Payer: Wellcare Medicare	$3.20
Rate for Payer: Wellmed Medicare	$3.20

ibuprofen 800 mg / 200 mL

Facility

$128.17

Service Code	HCPCS J1741
Hospital Charge Code	79495460
Hospital Revenue Code	636
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$64.08
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cigna Commercial	$32.04
Rate for Payer: Scott and White EPO/PPO	$64.08

IGF-1 SO

Facility

$200.22

Service Code	HCPCS 84305
Hospital Charge Code	1707140
Hospital Revenue Code	301
Rate for Payer: Cash Price	$136.15

IGF-1 SO

Facility

$200.22

Service Code	HCPCS 84305
Hospital Charge Code	1707140
Hospital Revenue Code	301
Min. Negotiated Rate	$8.29
Max. Negotiated Rate	$144.16
Rate for Payer: Amerigroup CHIP/Medicaid	$8.29
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$21.26
Rate for Payer: Amerigroup Medicare	$21.26
Rate for Payer: BCBS of TX Blue Advantage	$60.07
Rate for Payer: BCBS of TX Blue Essentials	$72.08
Rate for Payer: BCBS of TX Medicare	$21.26
Rate for Payer: BCBS of TX PPO	$80.09
Rate for Payer: Cash Price	$136.15
Rate for Payer: Cash Price	$136.15
Rate for Payer: Cigna Medicaid	$144.16
Rate for Payer: Cigna Medicare	$21.26
Rate for Payer: Employer Direct Commercial	$21.26
Rate for Payer: Humana Medicare/TRICARE	$21.26
Rate for Payer: Molina CHIP/Medicaid	$144.16
Rate for Payer: Molina Dual Medicare/Medicaid	$21.26
Rate for Payer: Molina Medicare	$21.26
Rate for Payer: Multiplan Auto	$130.14
Rate for Payer: Multiplan Commercial	$130.14
Rate for Payer: Multiplan Workers Comp	$130.14
Rate for Payer: Parkland Medicaid	$144.16
Rate for Payer: Scott and White EPO/PPO	$26.57
Rate for Payer: Scott and White Medicare	$21.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$144.16
Rate for Payer: Superior Health Plan EPO	$21.26
Rate for Payer: Superior Health Plan Medicare	$21.26
Rate for Payer: Universal American Dual Medicare/Medicaid	$21.26
Rate for Payer: Universal American Medicare	$21.26
Rate for Payer: Wellcare Medicare	$21.26
Rate for Payer: Wellmed Medicare	$21.26

illuminator surg 60mm

Facility

$4,199.50

Hospital Charge Code	8672529
Hospital Revenue Code	272
Min. Negotiated Rate	$377.95
Max. Negotiated Rate	$3,023.64
Rate for Payer: Amerigroup CHIP/Medicaid	$377.95
Rate for Payer: BCBS of TX Blue Advantage	$1,259.85
Rate for Payer: BCBS of TX Blue Essentials	$1,511.82
Rate for Payer: BCBS of TX PPO	$1,679.80
Rate for Payer: Cash Price	$2,855.66
Rate for Payer: Cigna Medicaid	$3,023.64
Rate for Payer: Molina CHIP/Medicaid	$3,023.64
Rate for Payer: Multiplan Auto	$2,729.68
Rate for Payer: Multiplan Commercial	$2,729.68
Rate for Payer: Multiplan Workers Comp	$2,729.68
Rate for Payer: Parkland Medicaid	$3,023.64
Rate for Payer: Scott and White EPO/PPO	$2,099.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,023.64
Rate for Payer: Superior Health Plan EPO	$571.13

illuminator surg 60mm

Facility

$4,199.50

Hospital Charge Code	8672529
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,855.66

Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction

Facility

$19,555.95

Service Code	HCPCS 19340
Hospital Charge Code	9900160
Hospital Revenue Code	360
Rate for Payer: Cash Price	$13,298.05

Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction

Facility

$17,355.80

Service Code	CPT 19340
Hospital Charge Code	36019340
Hospital Revenue Code	360
Min. Negotiated Rate	$1,845.21
Max. Negotiated Rate	$17,355.80
Rate for Payer: Amerigroup CHIP/Medicaid	$1,845.21
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8,210.63
Rate for Payer: Amerigroup Medicare	$8,210.63
Rate for Payer: BCBS of TX Blue Advantage	$8,746.27
Rate for Payer: BCBS of TX Blue Essentials	$10,474.58
Rate for Payer: BCBS of TX Medicare	$8,210.63
Rate for Payer: BCBS of TX PPO	$13,197.97
Rate for Payer: Cigna Commercial	$17,355.80
Rate for Payer: Cigna Medicare	$8,210.63
Rate for Payer: Employer Direct Commercial	$8,210.63
Rate for Payer: Humana Medicare/TRICARE	$8,210.63
Rate for Payer: Molina Dual Medicare/Medicaid	$8,210.63
Rate for Payer: Molina Medicare	$8,210.63
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	$15,189.67
Rate for Payer: Scott and White Medicare	$8,210.63
Rate for Payer: Superior Health Plan EPO	$8,210.63
Rate for Payer: Superior Health Plan Medicare	$8,210.63
Rate for Payer: Universal American Dual Medicare/Medicaid	$8,210.63
Rate for Payer: Universal American Medicare	$8,210.63
Rate for Payer: Wellcare Medicare	$8,210.63
Rate for Payer: Wellmed Medicare	$8,210.63

Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction

Facility

$19,555.95

Service Code	HCPCS 19340
Hospital Charge Code	9900160
Hospital Revenue Code	360
Min. Negotiated Rate	$1,845.21
Max. Negotiated Rate	$17,355.80
Rate for Payer: Amerigroup CHIP/Medicaid	$1,845.21
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8,210.63
Rate for Payer: Amerigroup Medicare	$8,210.63
Rate for Payer: BCBS of TX Blue Advantage	$8,746.27
Rate for Payer: BCBS of TX Blue Essentials	$10,474.58
Rate for Payer: BCBS of TX Medicare	$8,210.63
Rate for Payer: BCBS of TX PPO	$13,197.97
Rate for Payer: Cash Price	$13,298.05
Rate for Payer: Cash Price	$13,298.05
Rate for Payer: Cash Price	$13,298.05
Rate for Payer: Cigna Commercial	$17,355.80
Rate for Payer: Cigna Medicaid	$14,080.28
Rate for Payer: Cigna Medicare	$8,210.63
Rate for Payer: Employer Direct Commercial	$8,210.63
Rate for Payer: Humana Medicare/TRICARE	$8,210.63
Rate for Payer: Molina CHIP/Medicaid	$14,080.28
Rate for Payer: Molina Dual Medicare/Medicaid	$8,210.63
Rate for Payer: Molina Medicare	$8,210.63
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	$14,080.28
Rate for Payer: Scott and White EPO/PPO	$15,189.67
Rate for Payer: Scott and White Medicare	$8,210.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14,080.28
Rate for Payer: Superior Health Plan EPO	$8,210.63
Rate for Payer: Superior Health Plan Medicare	$8,210.63
Rate for Payer: Universal American Dual Medicare/Medicaid	$8,210.63
Rate for Payer: Universal American Medicare	$8,210.63
Rate for Payer: Wellcare Medicare	$8,210.63
Rate for Payer: Wellmed Medicare	$8,210.63

IMMOBILIZER SHOULDER KAHUNA MINI

Facility

$352.76

Hospital Charge Code	144898
Hospital Revenue Code	270
Min. Negotiated Rate	$31.75
Max. Negotiated Rate	$253.99
Rate for Payer: Amerigroup CHIP/Medicaid	$31.75
Rate for Payer: BCBS of TX Blue Advantage	$105.83
Rate for Payer: BCBS of TX Blue Essentials	$126.99
Rate for Payer: BCBS of TX PPO	$141.10
Rate for Payer: Cash Price	$239.88
Rate for Payer: Cigna Medicaid	$253.99
Rate for Payer: Molina CHIP/Medicaid	$253.99
Rate for Payer: Multiplan Auto	$229.29
Rate for Payer: Multiplan Commercial	$229.29
Rate for Payer: Multiplan Workers Comp	$229.29
Rate for Payer: Parkland Medicaid	$253.99
Rate for Payer: Scott and White EPO/PPO	$176.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$253.99
Rate for Payer: Superior Health Plan EPO	$47.98

IMMOBILIZER SHOULDER KAHUNA MINI

Facility

$352.76

Hospital Charge Code	144898
Hospital Revenue Code	270
Rate for Payer: Cash Price	$239.88

.Immunofixation Elect 001686 SO

Facility

$417.00

Service Code	HCPCS 86334
Hospital Charge Code	1602044
Hospital Revenue Code	302
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$300.24
Rate for Payer: Amerigroup CHIP/Medicaid	$8.71
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$22.34
Rate for Payer: Amerigroup Medicare	$22.34
Rate for Payer: BCBS of TX Blue Advantage	$125.10
Rate for Payer: BCBS of TX Blue Essentials	$150.12
Rate for Payer: BCBS of TX Medicare	$22.34
Rate for Payer: BCBS of TX PPO	$166.80
Rate for Payer: Cash Price	$283.56
Rate for Payer: Cash Price	$283.56
Rate for Payer: Cigna Medicaid	$300.24
Rate for Payer: Cigna Medicare	$22.34
Rate for Payer: Employer Direct Commercial	$22.34
Rate for Payer: Humana Medicare/TRICARE	$22.34
Rate for Payer: Molina CHIP/Medicaid	$300.24
Rate for Payer: Molina Dual Medicare/Medicaid	$22.34
Rate for Payer: Molina Medicare	$22.34
Rate for Payer: Multiplan Auto	$271.05
Rate for Payer: Multiplan Commercial	$271.05
Rate for Payer: Multiplan Workers Comp	$271.05
Rate for Payer: Parkland Medicaid	$300.24
Rate for Payer: Scott and White EPO/PPO	$27.93
Rate for Payer: Scott and White Medicare	$22.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$300.24
Rate for Payer: Superior Health Plan EPO	$22.34
Rate for Payer: Superior Health Plan Medicare	$22.34
Rate for Payer: Universal American Dual Medicare/Medicaid	$22.34
Rate for Payer: Universal American Medicare	$22.34
Rate for Payer: Wellcare Medicare	$22.34
Rate for Payer: Wellmed Medicare	$22.34

.Immunofixation Elect 001686 SO

Facility

$417.00

Service Code	HCPCS 86334
Hospital Charge Code	1602044
Hospital Revenue Code	302
Rate for Payer: Cash Price	$283.56

Immunoglobulin G,Syn Rate,CSF SO

Facility

$180.00

Service Code	HCPCS 82040 QW
Hospital Charge Code	1601491
Hospital Revenue Code	301
Rate for Payer: Cash Price	$122.40

Immunoglobulin G,Syn Rate,CSF SO

Facility

$180.00

Service Code	HCPCS 82040 QW
Hospital Charge Code	1601491
Hospital Revenue Code	301
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$129.60
Rate for Payer: Amerigroup CHIP/Medicaid	$1.93
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$4.95
Rate for Payer: Amerigroup Medicare	$4.95
Rate for Payer: BCBS of TX Blue Advantage	$54.00
Rate for Payer: BCBS of TX Blue Essentials	$64.80
Rate for Payer: BCBS of TX Medicare	$4.95
Rate for Payer: BCBS of TX PPO	$72.00
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cigna Medicaid	$129.60
Rate for Payer: Cigna Medicare	$4.95
Rate for Payer: Employer Direct Commercial	$4.95
Rate for Payer: Humana Medicare/TRICARE	$4.95
Rate for Payer: Molina CHIP/Medicaid	$129.60
Rate for Payer: Molina Dual Medicare/Medicaid	$4.95
Rate for Payer: Molina Medicare	$4.95
Rate for Payer: Multiplan Auto	$117.00
Rate for Payer: Multiplan Commercial	$117.00
Rate for Payer: Multiplan Workers Comp	$117.00
Rate for Payer: Parkland Medicaid	$129.60
Rate for Payer: Scott and White EPO/PPO	$6.19
Rate for Payer: Scott and White Medicare	$4.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$129.60
Rate for Payer: Superior Health Plan EPO	$4.95
Rate for Payer: Superior Health Plan Medicare	$4.95
Rate for Payer: Universal American Dual Medicare/Medicaid	$4.95
Rate for Payer: Universal American Medicare	$4.95
Rate for Payer: Wellcare Medicare	$4.95
Rate for Payer: Wellmed Medicare	$4.95

Immunoglobulins A/E/G/M, Serum SO

Facility

$246.00

Service Code	HCPCS 82785
Hospital Charge Code	1701408
Hospital Revenue Code	301
Min. Negotiated Rate	$6.42
Max. Negotiated Rate	$177.12
Rate for Payer: Amerigroup CHIP/Medicaid	$6.42
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16.46
Rate for Payer: Amerigroup Medicare	$16.46
Rate for Payer: BCBS of TX Blue Advantage	$73.80
Rate for Payer: BCBS of TX Blue Essentials	$88.56
Rate for Payer: BCBS of TX Medicare	$16.46
Rate for Payer: BCBS of TX PPO	$98.40
Rate for Payer: Cash Price	$167.28
Rate for Payer: Cash Price	$167.28
Rate for Payer: Cigna Medicaid	$177.12
Rate for Payer: Cigna Medicare	$16.46
Rate for Payer: Employer Direct Commercial	$16.46
Rate for Payer: Humana Medicare/TRICARE	$16.46
Rate for Payer: Molina CHIP/Medicaid	$177.12
Rate for Payer: Molina Dual Medicare/Medicaid	$16.46
Rate for Payer: Molina Medicare	$16.46
Rate for Payer: Multiplan Auto	$159.90
Rate for Payer: Multiplan Commercial	$159.90
Rate for Payer: Multiplan Workers Comp	$159.90
Rate for Payer: Parkland Medicaid	$177.12
Rate for Payer: Scott and White EPO/PPO	$20.57
Rate for Payer: Scott and White Medicare	$16.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$177.12
Rate for Payer: Superior Health Plan EPO	$16.46
Rate for Payer: Superior Health Plan Medicare	$16.46
Rate for Payer: Universal American Dual Medicare/Medicaid	$16.46
Rate for Payer: Universal American Medicare	$16.46
Rate for Payer: Wellcare Medicare	$16.46
Rate for Payer: Wellmed Medicare	$16.46

Immunoglobulins A/E/G/M, Serum SO

Facility

$246.00

Service Code	HCPCS 82785
Hospital Charge Code	1701408
Hospital Revenue Code	301
Rate for Payer: Cash Price	$167.28

IMOBL SHLDR -- DHF

Facility

$130.67

Hospital Charge Code	81143505
Hospital Revenue Code	270
Rate for Payer: Cash Price	$88.86

IMOBL SHLDR -- DHF

Facility

$130.67

Hospital Charge Code	81143505
Hospital Revenue Code	270
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$94.08
Rate for Payer: Amerigroup CHIP/Medicaid	$11.76
Rate for Payer: BCBS of TX Blue Advantage	$39.20
Rate for Payer: BCBS of TX Blue Essentials	$47.04
Rate for Payer: BCBS of TX PPO	$52.27
Rate for Payer: Cash Price	$88.86
Rate for Payer: Cigna Medicaid	$94.08
Rate for Payer: Molina CHIP/Medicaid	$94.08
Rate for Payer: Multiplan Auto	$84.94
Rate for Payer: Multiplan Commercial	$84.94
Rate for Payer: Multiplan Workers Comp	$84.94
Rate for Payer: Parkland Medicaid	$94.08
Rate for Payer: Scott and White EPO/PPO	$65.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$94.08
Rate for Payer: Superior Health Plan EPO	$17.77

IMP BN SUBST FOAM 5CC -- DHF

Facility

$10,538.00

Service Code	HCPCS C1734
Hospital Charge Code	40112013
Hospital Revenue Code	278
Min. Negotiated Rate	$948.42
Max. Negotiated Rate	$7,587.36
Rate for Payer: Amerigroup CHIP/Medicaid	$948.42
Rate for Payer: BCBS of TX Blue Advantage	$3,161.40
Rate for Payer: BCBS of TX Blue Essentials	$3,793.68
Rate for Payer: BCBS of TX PPO	$4,215.20
Rate for Payer: Cash Price	$7,165.84
Rate for Payer: Cigna Medicaid	$7,587.36
Rate for Payer: Molina CHIP/Medicaid	$7,587.36
Rate for Payer: Multiplan Auto	$5,269.00
Rate for Payer: Multiplan Commercial	$5,269.00
Rate for Payer: Multiplan Workers Comp	$5,269.00
Rate for Payer: Parkland Medicaid	$7,587.36
Rate for Payer: Scott and White EPO/PPO	$5,269.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,587.36
Rate for Payer: Superior Health Plan EPO	$1,433.17

IMP BN SUBST FOAM 5CC -- DHF

Facility

$10,538.00

Service Code	HCPCS C1734
Hospital Charge Code	40112013
Hospital Revenue Code	278
Min. Negotiated Rate	$2,634.50
Max. Negotiated Rate	$5,269.00
Rate for Payer: Cash Price	$7,165.84
Rate for Payer: Cigna Commercial	$2,634.50
Rate for Payer: Multiplan Auto	$5,269.00
Rate for Payer: Multiplan Commercial	$5,269.00
Rate for Payer: Multiplan Workers Comp	$5,269.00
Rate for Payer: Scott and White EPO/PPO	$5,269.00

imp bone vitoss 5ml

Facility

$13,044.00

Service Code	HCPCS C1734
Hospital Charge Code	8666519
Hospital Revenue Code	278
Min. Negotiated Rate	$3,261.00
Max. Negotiated Rate	$6,522.00
Rate for Payer: Cash Price	$8,869.92
Rate for Payer: Cigna Commercial	$3,261.00
Rate for Payer: Multiplan Auto	$6,522.00
Rate for Payer: Multiplan Commercial	$6,522.00
Rate for Payer: Multiplan Workers Comp	$6,522.00
Rate for Payer: Scott and White EPO/PPO	$6,522.00

imp bone vitoss 5ml

Facility

$13,044.00

Service Code	HCPCS C1734
Hospital Charge Code	8666519
Hospital Revenue Code	278
Min. Negotiated Rate	$1,173.96
Max. Negotiated Rate	$9,391.68
Rate for Payer: Amerigroup CHIP/Medicaid	$1,173.96
Rate for Payer: BCBS of TX Blue Advantage	$3,913.20
Rate for Payer: BCBS of TX Blue Essentials	$4,695.84
Rate for Payer: BCBS of TX PPO	$5,217.60
Rate for Payer: Cash Price	$8,869.92
Rate for Payer: Cigna Medicaid	$9,391.68
Rate for Payer: Molina CHIP/Medicaid	$9,391.68
Rate for Payer: Multiplan Auto	$6,522.00
Rate for Payer: Multiplan Commercial	$6,522.00
Rate for Payer: Multiplan Workers Comp	$6,522.00
Rate for Payer: Parkland Medicaid	$9,391.68
Rate for Payer: Scott and White EPO/PPO	$6,522.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,391.68
Rate for Payer: Superior Health Plan EPO	$1,773.98

IMPL ANCHOR SUTURE WITH ORTHOCORD

Facility

$5,215.00

Service Code	HCPCS C1713
Hospital Charge Code	8446469
Hospital Revenue Code	278
Min. Negotiated Rate	$1,303.75
Max. Negotiated Rate	$2,607.50
Rate for Payer: Cash Price	$3,546.20
Rate for Payer: Cigna Commercial	$1,303.75
Rate for Payer: Multiplan Auto	$2,607.50
Rate for Payer: Multiplan Commercial	$2,607.50
Rate for Payer: Multiplan Workers Comp	$2,607.50
Rate for Payer: Scott and White EPO/PPO	$2,607.50

IMPL ANCHOR SUTURE WITH ORTHOCORD

Facility

$5,215.00

Service Code	HCPCS C1713
Hospital Charge Code	8446469
Hospital Revenue Code	278
Min. Negotiated Rate	$469.35
Max. Negotiated Rate	$3,754.80
Rate for Payer: Amerigroup CHIP/Medicaid	$469.35
Rate for Payer: BCBS of TX Blue Advantage	$1,564.50
Rate for Payer: BCBS of TX Blue Essentials	$1,877.40
Rate for Payer: BCBS of TX PPO	$2,086.00
Rate for Payer: Cash Price	$3,546.20
Rate for Payer: Cigna Medicaid	$3,754.80
Rate for Payer: Molina CHIP/Medicaid	$3,754.80
Rate for Payer: Multiplan Auto	$2,607.50
Rate for Payer: Multiplan Commercial	$2,607.50
Rate for Payer: Multiplan Workers Comp	$2,607.50
Rate for Payer: Parkland Medicaid	$3,754.80
Rate for Payer: Scott and White EPO/PPO	$2,607.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,754.80
Rate for Payer: Superior Health Plan EPO	$709.24

Know your out-of-pocket cost for care.

All Charges