White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INJ PERC TX OF EXT PSEUDOANERYSM BCE

Facility

$1,987.00

Service Code	HCPCS 36002
Hospital Charge Code	2117968
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,351.16

INJ RT VENTR/ATRIAL ANGIO

Facility

$2,150.00

Service Code	HCPCS 93566
Hospital Charge Code	2350069
Hospital Revenue Code	481
Rate for Payer: Cash Price	$1,462.00

INJ RT VENTR/ATRIAL ANGIO

Facility

$2,150.00

Service Code	HCPCS 93566
Hospital Charge Code	2350069
Hospital Revenue Code	481
Min. Negotiated Rate	$30.93
Max. Negotiated Rate	$1,548.00
Rate for Payer: Amerigroup CHIP/Medicaid	$193.50
Rate for Payer: BCBS of TX Blue Advantage	$645.00
Rate for Payer: BCBS of TX Blue Essentials	$774.00
Rate for Payer: BCBS of TX PPO	$860.00
Rate for Payer: Cash Price	$1,462.00
Rate for Payer: Cash Price	$1,462.00
Rate for Payer: Cigna Medicaid	$1,548.00
Rate for Payer: Molina CHIP/Medicaid	$1,548.00
Rate for Payer: Multiplan Auto	$1,397.50
Rate for Payer: Multiplan Commercial	$1,397.50
Rate for Payer: Multiplan Workers Comp	$1,397.50
Rate for Payer: Parkland Medicaid	$1,548.00
Rate for Payer: Scott and White EPO/PPO	$30.93
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,548.00
Rate for Payer: Superior Health Plan EPO	$292.40

Inkjet Printable DVD+R Discs, 4.7GB, 16x, Spindle, White

Facility

$1.36

Hospital Charge Code	993238
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.92

Inkjet Printable DVD+R Discs, 4.7GB, 16x, Spindle, White

Facility

$1.36

Hospital Charge Code	993238
Hospital Revenue Code	270
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.98
Rate for Payer: Amerigroup CHIP/Medicaid	$0.12
Rate for Payer: BCBS of TX Blue Advantage	$0.41
Rate for Payer: BCBS of TX Blue Essentials	$0.49
Rate for Payer: BCBS of TX PPO	$0.54
Rate for Payer: Cash Price	$0.92
Rate for Payer: Cigna Medicaid	$0.98
Rate for Payer: Molina CHIP/Medicaid	$0.98
Rate for Payer: Multiplan Auto	$0.88
Rate for Payer: Multiplan Commercial	$0.88
Rate for Payer: Multiplan Workers Comp	$0.88
Rate for Payer: Parkland Medicaid	$0.98
Rate for Payer: Scott and White EPO/PPO	$0.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.98
Rate for Payer: Superior Health Plan EPO	$0.18

INNOVA 6 X 150 X 130

Facility

$21,506.02

Service Code	HCPCS C1876
Hospital Charge Code	991298
Hospital Revenue Code	278
Min. Negotiated Rate	$1,935.54
Max. Negotiated Rate	$15,484.33
Rate for Payer: Amerigroup CHIP/Medicaid	$1,935.54
Rate for Payer: BCBS of TX Blue Advantage	$6,451.81
Rate for Payer: BCBS of TX Blue Essentials	$7,742.17
Rate for Payer: BCBS of TX PPO	$8,602.41
Rate for Payer: Cash Price	$14,624.09
Rate for Payer: Cigna Medicaid	$15,484.33
Rate for Payer: Molina CHIP/Medicaid	$15,484.33
Rate for Payer: Multiplan Auto	$10,753.01
Rate for Payer: Multiplan Commercial	$10,753.01
Rate for Payer: Multiplan Workers Comp	$10,753.01
Rate for Payer: Parkland Medicaid	$15,484.33
Rate for Payer: Scott and White EPO/PPO	$10,753.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$15,484.33
Rate for Payer: Superior Health Plan EPO	$2,924.82

INNOVA 6 X 150 X 130

Facility

$21,506.02

Service Code	HCPCS C1876
Hospital Charge Code	991298
Hospital Revenue Code	278
Min. Negotiated Rate	$5,376.51
Max. Negotiated Rate	$10,753.01
Rate for Payer: Cash Price	$14,624.09
Rate for Payer: Cigna Commercial	$5,376.51
Rate for Payer: Multiplan Auto	$10,753.01
Rate for Payer: Multiplan Commercial	$10,753.01
Rate for Payer: Multiplan Workers Comp	$10,753.01
Rate for Payer: Scott and White EPO/PPO	$10,753.01

INNOVA 6 X 150 X 130

Facility

$15,638.55

Service Code	HCPCS C1876
Hospital Charge Code	991279
Hospital Revenue Code	278
Min. Negotiated Rate	$3,909.64
Max. Negotiated Rate	$7,819.27
Rate for Payer: Cash Price	$10,634.21
Rate for Payer: Cigna Commercial	$3,909.64
Rate for Payer: Multiplan Auto	$7,819.27
Rate for Payer: Multiplan Commercial	$7,819.27
Rate for Payer: Multiplan Workers Comp	$7,819.27
Rate for Payer: Scott and White EPO/PPO	$7,819.27

INNOVA 6 X 150 X 130

Facility

$15,638.55

Service Code	HCPCS C1876
Hospital Charge Code	991279
Hospital Revenue Code	278
Min. Negotiated Rate	$1,407.47
Max. Negotiated Rate	$11,259.76
Rate for Payer: Amerigroup CHIP/Medicaid	$1,407.47
Rate for Payer: BCBS of TX Blue Advantage	$4,691.56
Rate for Payer: BCBS of TX Blue Essentials	$5,629.88
Rate for Payer: BCBS of TX PPO	$6,255.42
Rate for Payer: Cash Price	$10,634.21
Rate for Payer: Cigna Medicaid	$11,259.76
Rate for Payer: Molina CHIP/Medicaid	$11,259.76
Rate for Payer: Multiplan Auto	$7,819.27
Rate for Payer: Multiplan Commercial	$7,819.27
Rate for Payer: Multiplan Workers Comp	$7,819.27
Rate for Payer: Parkland Medicaid	$11,259.76
Rate for Payer: Scott and White EPO/PPO	$7,819.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,259.76
Rate for Payer: Superior Health Plan EPO	$2,126.84

innovance d-dimer

Facility

$2,860.15

Hospital Charge Code	993842
Hospital Revenue Code	270
Rate for Payer: Cash Price	$1,944.90

innovance d-dimer

Facility

$2,860.15

Hospital Charge Code	993842
Hospital Revenue Code	270
Min. Negotiated Rate	$257.41
Max. Negotiated Rate	$2,059.31
Rate for Payer: Amerigroup CHIP/Medicaid	$257.41
Rate for Payer: BCBS of TX Blue Advantage	$858.04
Rate for Payer: BCBS of TX Blue Essentials	$1,029.65
Rate for Payer: BCBS of TX PPO	$1,144.06
Rate for Payer: Cash Price	$1,944.90
Rate for Payer: Cigna Medicaid	$2,059.31
Rate for Payer: Molina CHIP/Medicaid	$2,059.31
Rate for Payer: Multiplan Auto	$1,859.10
Rate for Payer: Multiplan Commercial	$1,859.10
Rate for Payer: Multiplan Workers Comp	$1,859.10
Rate for Payer: Parkland Medicaid	$2,059.31
Rate for Payer: Scott and White EPO/PPO	$1,430.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,059.31
Rate for Payer: Superior Health Plan EPO	$388.98

innovance d-dimer controls

Facility

$29.42

Hospital Charge Code	993563
Hospital Revenue Code	270
Rate for Payer: Cash Price	$20.01

innovance d-dimer controls

Facility

$29.42

Hospital Charge Code	993563
Hospital Revenue Code	270
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$21.18
Rate for Payer: Amerigroup CHIP/Medicaid	$2.65
Rate for Payer: BCBS of TX Blue Advantage	$8.83
Rate for Payer: BCBS of TX Blue Essentials	$10.59
Rate for Payer: BCBS of TX PPO	$11.77
Rate for Payer: Cash Price	$20.01
Rate for Payer: Cigna Medicaid	$21.18
Rate for Payer: Molina CHIP/Medicaid	$21.18
Rate for Payer: Multiplan Auto	$19.12
Rate for Payer: Multiplan Commercial	$19.12
Rate for Payer: Multiplan Workers Comp	$19.12
Rate for Payer: Parkland Medicaid	$21.18
Rate for Payer: Scott and White EPO/PPO	$14.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$21.18
Rate for Payer: Superior Health Plan EPO	$4.00

INPATIENT DIALYSIS

Facility

$2,663.24

Service Code	HCPCS 90935
Hospital Charge Code	991059
Hospital Revenue Code	801
Min. Negotiated Rate	$86.31
Max. Negotiated Rate	$1,917.53
Rate for Payer: Amerigroup CHIP/Medicaid	$239.69
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$689.44
Rate for Payer: Amerigroup Medicare	$689.44
Rate for Payer: BCBS of TX Blue Advantage	$798.97
Rate for Payer: BCBS of TX Blue Essentials	$958.77
Rate for Payer: BCBS of TX Medicare	$689.44
Rate for Payer: BCBS of TX PPO	$1,065.30
Rate for Payer: Cash Price	$1,811.00
Rate for Payer: Cash Price	$1,811.00
Rate for Payer: Cash Price	$1,811.00
Rate for Payer: Cigna Commercial	$1,457.36
Rate for Payer: Cigna Medicaid	$1,917.53
Rate for Payer: Cigna Medicare	$689.44
Rate for Payer: Employer Direct Commercial	$689.44
Rate for Payer: Humana Medicare/TRICARE	$689.44
Rate for Payer: Molina CHIP/Medicaid	$1,917.53
Rate for Payer: Molina Dual Medicare/Medicaid	$689.44
Rate for Payer: Molina Medicare	$689.44
Rate for Payer: Multiplan Auto	$1,731.11
Rate for Payer: Multiplan Commercial	$1,731.11
Rate for Payer: Multiplan Workers Comp	$1,731.11
Rate for Payer: Parkland Medicaid	$1,917.53
Rate for Payer: Scott and White EPO/PPO	$86.31
Rate for Payer: Scott and White Medicare	$689.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,917.53
Rate for Payer: Superior Health Plan EPO	$689.44
Rate for Payer: Superior Health Plan Medicare	$689.44
Rate for Payer: Universal American Dual Medicare/Medicaid	$689.44
Rate for Payer: Universal American Medicare	$689.44
Rate for Payer: Wellcare Medicare	$689.44
Rate for Payer: Wellmed Medicare	$689.44

INPATIENT DIALYSIS

Facility

$2,495.91

Service Code	HCPCS 90945
Hospital Charge Code	8856543
Hospital Revenue Code	801
Rate for Payer: Cash Price	$1,697.22

INPATIENT DIALYSIS

Facility

$2,495.91

Service Code	HCPCS 90945
Hospital Charge Code	8856543
Hospital Revenue Code	801
Min. Negotiated Rate	$104.41
Max. Negotiated Rate	$1,797.06
Rate for Payer: Amerigroup CHIP/Medicaid	$224.63
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$419.16
Rate for Payer: Amerigroup Medicare	$419.16
Rate for Payer: BCBS of TX Blue Advantage	$748.77
Rate for Payer: BCBS of TX Blue Essentials	$898.53
Rate for Payer: BCBS of TX Medicare	$419.16
Rate for Payer: BCBS of TX PPO	$998.36
Rate for Payer: Cash Price	$1,697.22
Rate for Payer: Cash Price	$1,697.22
Rate for Payer: Cash Price	$1,697.22
Rate for Payer: Cigna Commercial	$886.05
Rate for Payer: Cigna Medicaid	$1,797.06
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	$1,797.06
Rate for Payer: Molina Dual Medicare/Medicaid	$419.16
Rate for Payer: Molina Medicare	$419.16
Rate for Payer: Multiplan Auto	$1,622.34
Rate for Payer: Multiplan Commercial	$1,622.34
Rate for Payer: Multiplan Workers Comp	$1,622.34
Rate for Payer: Parkland Medicaid	$1,797.06
Rate for Payer: Scott and White EPO/PPO	$104.41
Rate for Payer: Scott and White Medicare	$419.16
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,797.06
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

INPATIENT DIALYSIS

Facility

$2,663.24

Service Code	HCPCS 90935
Hospital Charge Code	991059
Hospital Revenue Code	801
Rate for Payer: Cash Price	$1,811.00

INPATIENT DIALYSIS

Facility

$1,688.00

Service Code	HCPCS 90945
Hospital Charge Code	991025
Hospital Revenue Code	801
Rate for Payer: Cash Price	$1,147.84

INPATIENT DIALYSIS

Facility

$1,688.00

Service Code	HCPCS 90945
Hospital Charge Code	991025
Hospital Revenue Code	801
Min. Negotiated Rate	$104.41
Max. Negotiated Rate	$1,215.36
Rate for Payer: Amerigroup CHIP/Medicaid	$151.92
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$419.16
Rate for Payer: Amerigroup Medicare	$419.16
Rate for Payer: BCBS of TX Blue Advantage	$506.40
Rate for Payer: BCBS of TX Blue Essentials	$607.68
Rate for Payer: BCBS of TX Medicare	$419.16
Rate for Payer: BCBS of TX PPO	$675.20
Rate for Payer: Cash Price	$1,147.84
Rate for Payer: Cash Price	$1,147.84
Rate for Payer: Cash Price	$1,147.84
Rate for Payer: Cigna Commercial	$886.05
Rate for Payer: Cigna Medicaid	$1,215.36
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	$1,215.36
Rate for Payer: Molina Dual Medicare/Medicaid	$419.16
Rate for Payer: Molina Medicare	$419.16
Rate for Payer: Multiplan Auto	$1,097.20
Rate for Payer: Multiplan Commercial	$1,097.20
Rate for Payer: Multiplan Workers Comp	$1,097.20
Rate for Payer: Parkland Medicaid	$1,215.36
Rate for Payer: Scott and White EPO/PPO	$104.41
Rate for Payer: Scott and White Medicare	$419.16
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,215.36
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

INPATIENT-ONLY SERVICE, VERIFY!! Open Fusion, Sacroiliac Joint

Facility

$95,208.78

Service Code	HCPCS 27280
Hospital Charge Code	9900387
Hospital Revenue Code	360
Rate for Payer: Cash Price	$64,741.97

INPATIENT-ONLY SERVICE, VERIFY!! Open Fusion, Sacroiliac Joint

Facility

$95,208.78

Service Code	HCPCS 27280
Hospital Charge Code	9900387
Hospital Revenue Code	360
Min. Negotiated Rate	$2,360.46
Max. Negotiated Rate	$68,550.32
Rate for Payer: Amerigroup CHIP/Medicaid	$8,568.79
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$17,613.72
Rate for Payer: Amerigroup Medicare	$17,613.72
Rate for Payer: BCBS of TX Blue Advantage	$2,360.46
Rate for Payer: BCBS of TX Blue Essentials	$2,826.90
Rate for Payer: BCBS of TX Medicare	$17,613.72
Rate for Payer: BCBS of TX PPO	$3,561.89
Rate for Payer: Cash Price	$64,741.97
Rate for Payer: Cash Price	$64,741.97
Rate for Payer: Cash Price	$64,741.97
Rate for Payer: Cigna Commercial	$37,232.21
Rate for Payer: Cigna Medicaid	$68,550.32
Rate for Payer: Cigna Medicare	$17,613.72
Rate for Payer: Employer Direct Commercial	$17,613.72
Rate for Payer: Humana Medicare/TRICARE	$17,613.72
Rate for Payer: Molina CHIP/Medicaid	$68,550.32
Rate for Payer: Molina Dual Medicare/Medicaid	$17,613.72
Rate for Payer: Molina Medicare	$17,613.72
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	$68,550.32
Rate for Payer: Scott and White EPO/PPO	$47,604.39
Rate for Payer: Scott and White Medicare	$17,613.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$68,550.32
Rate for Payer: Superior Health Plan EPO	$17,613.72
Rate for Payer: Superior Health Plan Medicare	$17,613.72
Rate for Payer: Universal American Dual Medicare/Medicaid	$17,613.72
Rate for Payer: Universal American Medicare	$17,613.72
Rate for Payer: Wellcare Medicare	$17,613.72
Rate for Payer: Wellmed Medicare	$17,613.72

INPATIENT-ONLY SERVICE, VERIFY!! Open Fusion, Sacroiliac Joint

Facility

$37,232.21

Service Code	CPT 27280
Hospital Charge Code	36027280
Hospital Revenue Code	360
Min. Negotiated Rate	$1,667.11
Max. Negotiated Rate	$37,232.21
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$17,613.72
Rate for Payer: Amerigroup Medicare	$17,613.72
Rate for Payer: BCBS of TX Blue Advantage	$2,360.46
Rate for Payer: BCBS of TX Blue Essentials	$2,826.90
Rate for Payer: BCBS of TX Medicare	$17,613.72
Rate for Payer: BCBS of TX PPO	$3,561.89
Rate for Payer: Cigna Commercial	$37,232.21
Rate for Payer: Cigna Medicare	$17,613.72
Rate for Payer: Employer Direct Commercial	$17,613.72
Rate for Payer: Humana Medicare/TRICARE	$17,613.72
Rate for Payer: Molina Dual Medicare/Medicaid	$17,613.72
Rate for Payer: Molina Medicare	$17,613.72
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	$1,667.11
Rate for Payer: Scott and White Medicare	$17,613.72
Rate for Payer: Superior Health Plan EPO	$17,613.72
Rate for Payer: Superior Health Plan Medicare	$17,613.72
Rate for Payer: Universal American Dual Medicare/Medicaid	$17,613.72
Rate for Payer: Universal American Medicare	$17,613.72
Rate for Payer: Wellcare Medicare	$17,613.72
Rate for Payer: Wellmed Medicare	$17,613.72

INS CATH REN ART 1ST UNI

Facility

$8,679.00

Service Code	HCPCS 36251
Hospital Charge Code	4616251
Hospital Revenue Code	361
Rate for Payer: Cash Price	$5,901.72

INS CATH REN ART 1ST UNI

Facility

$8,679.00

Service Code	HCPCS 36251
Hospital Charge Code	4616251
Hospital Revenue Code	361
Min. Negotiated Rate	$781.11
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$781.11
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	$4,628.04
Rate for Payer: BCBS of TX Blue Essentials	$5,542.56
Rate for Payer: BCBS of TX Medicare	$3,171.87
Rate for Payer: BCBS of TX PPO	$6,983.63
Rate for Payer: Cash Price	$5,901.72
Rate for Payer: Cash Price	$5,901.72
Rate for Payer: Cash Price	$5,901.72
Rate for Payer: Cigna Commercial	$6,704.76
Rate for Payer: Cigna Medicaid	$6,248.88
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	$6,248.88
Rate for Payer: Molina Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Molina Medicare	$3,171.87
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	$6,248.88
Rate for Payer: Scott and White EPO/PPO	$5,392.94
Rate for Payer: Scott and White Medicare	$3,171.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,248.88
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

INSER/REPLAC DIFIBRILATOR SUB CUT

Facility

$38,514.00

Service Code	HCPCS 33270
Hospital Charge Code	2351000
Hospital Revenue Code	481
Min. Negotiated Rate	$670.60
Max. Negotiated Rate	$81,352.25
Rate for Payer: Amerigroup CHIP/Medicaid	$3,466.26
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$31,531.90
Rate for Payer: Amerigroup Medicare	$31,531.90
Rate for Payer: BCBS of TX Blue Advantage	$53,912.01
Rate for Payer: BCBS of TX Blue Essentials	$64,565.28
Rate for Payer: BCBS of TX Medicare	$31,531.90
Rate for Payer: BCBS of TX PPO	$81,352.25
Rate for Payer: Cash Price	$26,189.52
Rate for Payer: Cash Price	$26,189.52
Rate for Payer: Cash Price	$26,189.52
Rate for Payer: Cigna Commercial	$66,652.72
Rate for Payer: Cigna Medicaid	$27,730.08
Rate for Payer: Cigna Medicare	$31,531.90
Rate for Payer: Employer Direct Commercial	$31,531.90
Rate for Payer: Humana Medicare/TRICARE	$31,531.90
Rate for Payer: Molina CHIP/Medicaid	$27,730.08
Rate for Payer: Molina Dual Medicare/Medicaid	$31,531.90
Rate for Payer: Molina Medicare	$31,531.90
Rate for Payer: Multiplan Auto	$25,034.10
Rate for Payer: Multiplan Commercial	$25,034.10
Rate for Payer: Multiplan Workers Comp	$25,034.10
Rate for Payer: Parkland Medicaid	$27,730.08
Rate for Payer: Scott and White EPO/PPO	$670.60
Rate for Payer: Scott and White Medicare	$31,531.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$27,730.08
Rate for Payer: Superior Health Plan EPO	$31,531.90
Rate for Payer: Superior Health Plan Medicare	$31,531.90
Rate for Payer: Universal American Dual Medicare/Medicaid	$31,531.90
Rate for Payer: Universal American Medicare	$31,531.90
Rate for Payer: Wellcare Medicare	$31,531.90
Rate for Payer: Wellmed Medicare	$31,531.90

Know your out-of-pocket cost for care.

All Charges