White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INSER/REPLAC DIFIBRILATOR SUB CUT

Facility

$38,514.00

Service Code	HCPCS 33270
Hospital Charge Code	2351000
Hospital Revenue Code	481
Rate for Payer: Cash Price	$26,189.52

INSERT CLICKLINE SCISSOR STRL OUTER SHEATH 36CM

Facility

$177.24

Hospital Charge Code	144481
Hospital Revenue Code	272
Min. Negotiated Rate	$15.95
Max. Negotiated Rate	$127.61
Rate for Payer: Amerigroup CHIP/Medicaid	$15.95
Rate for Payer: BCBS of TX Blue Advantage	$53.17
Rate for Payer: BCBS of TX Blue Essentials	$63.81
Rate for Payer: BCBS of TX PPO	$70.90
Rate for Payer: Cash Price	$120.52
Rate for Payer: Cigna Medicaid	$127.61
Rate for Payer: Molina CHIP/Medicaid	$127.61
Rate for Payer: Multiplan Auto	$115.21
Rate for Payer: Multiplan Commercial	$115.21
Rate for Payer: Multiplan Workers Comp	$115.21
Rate for Payer: Parkland Medicaid	$127.61
Rate for Payer: Scott and White EPO/PPO	$88.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$127.61
Rate for Payer: Superior Health Plan EPO	$24.10

INSERT CLICKLINE SCISSOR STRL OUTER SHEATH 36CM

Facility

$177.24

Hospital Charge Code	144481
Hospital Revenue Code	272
Rate for Payer: Cash Price	$120.52

inserter tip psn pk

Facility

$381.36

Hospital Charge Code	144814
Hospital Revenue Code	272
Rate for Payer: Cash Price	$259.32

inserter tip psn pk

Facility

$381.36

Hospital Charge Code	144814
Hospital Revenue Code	272
Min. Negotiated Rate	$34.32
Max. Negotiated Rate	$274.58
Rate for Payer: Amerigroup CHIP/Medicaid	$34.32
Rate for Payer: BCBS of TX Blue Advantage	$114.41
Rate for Payer: BCBS of TX Blue Essentials	$137.29
Rate for Payer: BCBS of TX PPO	$152.54
Rate for Payer: Cash Price	$259.32
Rate for Payer: Cigna Medicaid	$274.58
Rate for Payer: Molina CHIP/Medicaid	$274.58
Rate for Payer: Multiplan Auto	$247.88
Rate for Payer: Multiplan Commercial	$247.88
Rate for Payer: Multiplan Workers Comp	$247.88
Rate for Payer: Parkland Medicaid	$274.58
Rate for Payer: Scott and White EPO/PPO	$190.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$274.58
Rate for Payer: Superior Health Plan EPO	$51.86

INSERTION CATH SVC/IVC

Facility

$4,428.00

Service Code	HCPCS 36010
Hospital Charge Code	2330004
Hospital Revenue Code	361
Rate for Payer: Cash Price	$3,011.04

INSERTION CATH SVC/IVC

Facility

$4,428.00

Service Code	HCPCS 36010
Hospital Charge Code	2330004
Hospital Revenue Code	361
Min. Negotiated Rate	$398.52
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$398.52
Rate for Payer: BCBS of TX Blue Advantage	$1,328.40
Rate for Payer: BCBS of TX Blue Essentials	$1,594.08
Rate for Payer: BCBS of TX PPO	$1,771.20
Rate for Payer: Cash Price	$3,011.04
Rate for Payer: Cash Price	$3,011.04
Rate for Payer: Cigna Medicaid	$3,188.16
Rate for Payer: Molina CHIP/Medicaid	$3,188.16
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	$3,188.16
Rate for Payer: Scott and White EPO/PPO	$2,214.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,188.16
Rate for Payer: Superior Health Plan EPO	$602.21

Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable)

Facility

$345.48

Service Code	HCPCS 11981
Hospital Charge Code	9900106
Hospital Revenue Code	360
Rate for Payer: Cash Price	$234.93

Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable)

Facility

$345.48

Service Code	HCPCS 11981
Hospital Charge Code	9900106
Hospital Revenue Code	360
Min. Negotiated Rate	$46.38
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$46.38
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$133.65
Rate for Payer: Amerigroup Medicare	$133.65
Rate for Payer: BCBS of TX Blue Advantage	$182.08
Rate for Payer: BCBS of TX Blue Essentials	$218.06
Rate for Payer: BCBS of TX Medicare	$133.65
Rate for Payer: BCBS of TX PPO	$274.76
Rate for Payer: Cash Price	$234.93
Rate for Payer: Cash Price	$234.93
Rate for Payer: Cash Price	$234.93
Rate for Payer: Cigna Commercial	$282.53
Rate for Payer: Cigna Medicaid	$248.75
Rate for Payer: Cigna Medicare	$133.65
Rate for Payer: Employer Direct Commercial	$133.65
Rate for Payer: Humana Medicare/TRICARE	$133.65
Rate for Payer: Molina CHIP/Medicaid	$248.75
Rate for Payer: Molina Dual Medicare/Medicaid	$133.65
Rate for Payer: Molina Medicare	$133.65
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	$248.75
Rate for Payer: Scott and White EPO/PPO	$216.12
Rate for Payer: Scott and White Medicare	$133.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$248.75
Rate for Payer: Superior Health Plan EPO	$133.65
Rate for Payer: Superior Health Plan Medicare	$133.65
Rate for Payer: Universal American Dual Medicare/Medicaid	$133.65
Rate for Payer: Universal American Medicare	$133.65
Rate for Payer: Wellcare Medicare	$133.65
Rate for Payer: Wellmed Medicare	$133.65

Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable)

Facility

$10,000.00

Service Code	CPT 11981
Hospital Charge Code	36011981
Hospital Revenue Code	360
Min. Negotiated Rate	$46.38
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$46.38
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$133.65
Rate for Payer: Amerigroup Medicare	$133.65
Rate for Payer: BCBS of TX Blue Advantage	$182.08
Rate for Payer: BCBS of TX Blue Essentials	$218.06
Rate for Payer: BCBS of TX Medicare	$133.65
Rate for Payer: BCBS of TX PPO	$274.76
Rate for Payer: Cigna Commercial	$282.53
Rate for Payer: Cigna Medicare	$133.65
Rate for Payer: Employer Direct Commercial	$133.65
Rate for Payer: Humana Medicare/TRICARE	$133.65
Rate for Payer: Molina Dual Medicare/Medicaid	$133.65
Rate for Payer: Molina Medicare	$133.65
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	$216.12
Rate for Payer: Scott and White Medicare	$133.65
Rate for Payer: Superior Health Plan EPO	$133.65
Rate for Payer: Superior Health Plan Medicare	$133.65
Rate for Payer: Universal American Dual Medicare/Medicaid	$133.65
Rate for Payer: Universal American Medicare	$133.65
Rate for Payer: Wellcare Medicare	$133.65
Rate for Payer: Wellmed Medicare	$133.65

Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable)

Facility

$486.84

Service Code	HCPCS 11981
Hospital Charge Code	990975
Hospital Revenue Code	360
Rate for Payer: Cash Price	$331.05

Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable)

Facility

$486.84

Service Code	HCPCS 11981
Hospital Charge Code	990975
Hospital Revenue Code	360
Min. Negotiated Rate	$46.38
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$46.38
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$133.65
Rate for Payer: Amerigroup Medicare	$133.65
Rate for Payer: BCBS of TX Blue Advantage	$182.08
Rate for Payer: BCBS of TX Blue Essentials	$218.06
Rate for Payer: BCBS of TX Medicare	$133.65
Rate for Payer: BCBS of TX PPO	$274.76
Rate for Payer: Cash Price	$331.05
Rate for Payer: Cash Price	$331.05
Rate for Payer: Cash Price	$331.05
Rate for Payer: Cigna Commercial	$282.53
Rate for Payer: Cigna Medicaid	$350.52
Rate for Payer: Cigna Medicare	$133.65
Rate for Payer: Employer Direct Commercial	$133.65
Rate for Payer: Humana Medicare/TRICARE	$133.65
Rate for Payer: Molina CHIP/Medicaid	$350.52
Rate for Payer: Molina Dual Medicare/Medicaid	$133.65
Rate for Payer: Molina Medicare	$133.65
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	$350.52
Rate for Payer: Scott and White EPO/PPO	$216.12
Rate for Payer: Scott and White Medicare	$133.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$350.52
Rate for Payer: Superior Health Plan EPO	$133.65
Rate for Payer: Superior Health Plan Medicare	$133.65
Rate for Payer: Universal American Dual Medicare/Medicaid	$133.65
Rate for Payer: Universal American Medicare	$133.65
Rate for Payer: Wellcare Medicare	$133.65
Rate for Payer: Wellmed Medicare	$133.65

INSERTION IVC FILTER W/GUIDANCE

Facility

$12,866.00

Service Code	HCPCS 37191
Hospital Charge Code	2320569
Hospital Revenue Code	361
Rate for Payer: Cash Price	$8,748.88

INSERTION IVC FILTER W/GUIDANCE

Facility

$12,866.00

Service Code	HCPCS 37191
Hospital Charge Code	2320569
Hospital Revenue Code	361
Min. Negotiated Rate	$1,157.94
Max. Negotiated Rate	$11,815.91
Rate for Payer: Amerigroup CHIP/Medicaid	$1,157.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Amerigroup Medicare	$5,589.84
Rate for Payer: BCBS of TX Blue Advantage	$7,675.64
Rate for Payer: BCBS of TX Blue Essentials	$9,192.38
Rate for Payer: BCBS of TX Medicare	$5,589.84
Rate for Payer: BCBS of TX PPO	$11,582.40
Rate for Payer: Cash Price	$8,748.88
Rate for Payer: Cash Price	$8,748.88
Rate for Payer: Cash Price	$8,748.88
Rate for Payer: Cigna Commercial	$11,815.91
Rate for Payer: Cigna Medicaid	$9,263.52
Rate for Payer: Cigna Medicare	$5,589.84
Rate for Payer: Employer Direct Commercial	$5,589.84
Rate for Payer: Humana Medicare/TRICARE	$5,589.84
Rate for Payer: Molina CHIP/Medicaid	$9,263.52
Rate for Payer: Molina Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Molina Medicare	$5,589.84
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	$9,263.52
Rate for Payer: Scott and White EPO/PPO	$9,297.64
Rate for Payer: Scott and White Medicare	$5,589.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,263.52
Rate for Payer: Superior Health Plan EPO	$5,589.84
Rate for Payer: Superior Health Plan Medicare	$5,589.84
Rate for Payer: Universal American Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Universal American Medicare	$5,589.84
Rate for Payer: Wellcare Medicare	$5,589.84
Rate for Payer: Wellmed Medicare	$5,589.84

Insertion of catheter (PICC), without subcutaneous port or pump

Facility

$2,825.00

Service Code	HCPCS 36573
Hospital Charge Code	994141
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,921.00

Insertion of catheter (PICC), without subcutaneous port or pump

Facility

$2,825.00

Service Code	HCPCS 36573
Hospital Charge Code	4616573
Hospital Revenue Code	450
Min. Negotiated Rate	$99.94
Max. Negotiated Rate	$4,110.45
Rate for Payer: Amerigroup CHIP/Medicaid	$254.25
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,581.33
Rate for Payer: Amerigroup Medicare	$1,581.33
Rate for Payer: BCBS of TX Blue Advantage	$2,723.99
Rate for Payer: BCBS of TX Blue Essentials	$3,262.26
Rate for Payer: BCBS of TX Medicare	$1,581.33
Rate for Payer: BCBS of TX PPO	$4,110.45
Rate for Payer: Cash Price	$1,921.00
Rate for Payer: Cash Price	$1,921.00
Rate for Payer: Cash Price	$1,921.00
Rate for Payer: Cigna Commercial	$3,342.63
Rate for Payer: Cigna Medicaid	$2,034.00
Rate for Payer: Cigna Medicare	$1,581.33
Rate for Payer: Employer Direct Commercial	$1,581.33
Rate for Payer: Humana Medicare/TRICARE	$1,581.33
Rate for Payer: Molina CHIP/Medicaid	$2,034.00
Rate for Payer: Molina Dual Medicare/Medicaid	$1,581.33
Rate for Payer: Molina Medicare	$1,581.33
Rate for Payer: Multiplan Auto	$1,836.25
Rate for Payer: Multiplan Commercial	$1,836.25
Rate for Payer: Multiplan Workers Comp	$1,836.25
Rate for Payer: Parkland Medicaid	$2,034.00
Rate for Payer: Scott and White EPO/PPO	$99.94
Rate for Payer: Scott and White Medicare	$1,581.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,034.00
Rate for Payer: Superior Health Plan EPO	$1,581.33
Rate for Payer: Superior Health Plan Medicare	$1,581.33
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,581.33
Rate for Payer: Universal American Medicare	$1,581.33
Rate for Payer: Wellcare Medicare	$1,581.33
Rate for Payer: Wellmed Medicare	$1,581.33

Insertion of catheter (PICC), without subcutaneous port or pump

Facility

$2,825.00

Service Code	HCPCS 36573
Hospital Charge Code	4616573
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,921.00

Insertion of catheter (PICC), without subcutaneous port or pump

Facility

$2,825.00

Service Code	HCPCS 36573
Hospital Charge Code	994141
Hospital Revenue Code	450
Min. Negotiated Rate	$99.94
Max. Negotiated Rate	$4,110.45
Rate for Payer: Amerigroup CHIP/Medicaid	$254.25
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,581.33
Rate for Payer: Amerigroup Medicare	$1,581.33
Rate for Payer: BCBS of TX Blue Advantage	$2,723.99
Rate for Payer: BCBS of TX Blue Essentials	$3,262.26
Rate for Payer: BCBS of TX Medicare	$1,581.33
Rate for Payer: BCBS of TX PPO	$4,110.45
Rate for Payer: Cash Price	$1,921.00
Rate for Payer: Cash Price	$1,921.00
Rate for Payer: Cash Price	$1,921.00
Rate for Payer: Cigna Commercial	$3,342.63
Rate for Payer: Cigna Medicaid	$2,034.00
Rate for Payer: Cigna Medicare	$1,581.33
Rate for Payer: Employer Direct Commercial	$1,581.33
Rate for Payer: Humana Medicare/TRICARE	$1,581.33
Rate for Payer: Molina CHIP/Medicaid	$2,034.00
Rate for Payer: Molina Dual Medicare/Medicaid	$1,581.33
Rate for Payer: Molina Medicare	$1,581.33
Rate for Payer: Multiplan Auto	$1,836.25
Rate for Payer: Multiplan Commercial	$1,836.25
Rate for Payer: Multiplan Workers Comp	$1,836.25
Rate for Payer: Parkland Medicaid	$2,034.00
Rate for Payer: Scott and White EPO/PPO	$99.94
Rate for Payer: Scott and White Medicare	$1,581.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,034.00
Rate for Payer: Superior Health Plan EPO	$1,581.33
Rate for Payer: Superior Health Plan Medicare	$1,581.33
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,581.33
Rate for Payer: Universal American Medicare	$1,581.33
Rate for Payer: Wellcare Medicare	$1,581.33
Rate for Payer: Wellmed Medicare	$1,581.33

INSERTION OF FOLEY CATH LAB

Facility

$564.00

Service Code	HCPCS 51702
Hospital Charge Code	4613670
Hospital Revenue Code	360
Rate for Payer: Cash Price	$383.52

INSERTION OF FOLEY CATH LAB

Facility

$564.00

Service Code	HCPCS 51702
Hospital Charge Code	4613670
Hospital Revenue Code	360
Min. Negotiated Rate	$50.76
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$50.76
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$133.65
Rate for Payer: Amerigroup Medicare	$133.65
Rate for Payer: BCBS of TX Blue Advantage	$182.08
Rate for Payer: BCBS of TX Blue Essentials	$218.06
Rate for Payer: BCBS of TX Medicare	$133.65
Rate for Payer: BCBS of TX PPO	$274.76
Rate for Payer: Cash Price	$383.52
Rate for Payer: Cash Price	$383.52
Rate for Payer: Cash Price	$383.52
Rate for Payer: Cigna Commercial	$282.53
Rate for Payer: Cigna Medicaid	$406.08
Rate for Payer: Cigna Medicare	$133.65
Rate for Payer: Employer Direct Commercial	$133.65
Rate for Payer: Humana Medicare/TRICARE	$133.65
Rate for Payer: Molina CHIP/Medicaid	$406.08
Rate for Payer: Molina Dual Medicare/Medicaid	$133.65
Rate for Payer: Molina Medicare	$133.65
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	$406.08
Rate for Payer: Scott and White EPO/PPO	$216.12
Rate for Payer: Scott and White Medicare	$133.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$406.08
Rate for Payer: Superior Health Plan EPO	$133.65
Rate for Payer: Superior Health Plan Medicare	$133.65
Rate for Payer: Universal American Dual Medicare/Medicaid	$133.65
Rate for Payer: Universal American Medicare	$133.65
Rate for Payer: Wellcare Medicare	$133.65
Rate for Payer: Wellmed Medicare	$133.65

Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, inc

Facility

$99,080.16

Service Code	HCPCS 22867
Hospital Charge Code	9900210
Hospital Revenue Code	360
Rate for Payer: Cash Price	$67,374.51

Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, inc

Facility

$24,770.04

Service Code	HCPCS 22868
Hospital Charge Code	9900211
Hospital Revenue Code	360
Rate for Payer: Cash Price	$16,843.63

Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, inc

Facility

$99,080.16

Service Code	HCPCS 22867
Hospital Charge Code	9900210
Hospital Revenue Code	360
Min. Negotiated Rate	$8,917.21
Max. Negotiated Rate	$71,337.72
Rate for Payer: Amerigroup CHIP/Medicaid	$8,917.21
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	$26,629.95
Rate for Payer: BCBS of TX Blue Essentials	$31,892.16
Rate for Payer: BCBS of TX Medicare	$17,613.72
Rate for Payer: BCBS of TX PPO	$40,184.12
Rate for Payer: Cash Price	$67,374.51
Rate for Payer: Cash Price	$67,374.51
Rate for Payer: Cash Price	$67,374.51
Rate for Payer: Cigna Commercial	$37,232.21
Rate for Payer: Cigna Medicaid	$71,337.72
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	$71,337.72
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: Parkland Medicaid	$71,337.72
Rate for Payer: Scott and White EPO/PPO	$31,530.55
Rate for Payer: Scott and White Medicare	$17,613.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$71,337.72
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

Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, inc

Facility

$10,000.00

Service Code	CPT 22868
Hospital Charge Code	36022868
Hospital Revenue Code	360
Min. Negotiated Rate	$292.61
Max. Negotiated Rate	$10,000.00
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	$292.61

Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, inc

Facility

$24,770.04

Service Code	HCPCS 22868
Hospital Charge Code	9900211
Hospital Revenue Code	360
Min. Negotiated Rate	$2,229.30
Max. Negotiated Rate	$17,834.43
Rate for Payer: Amerigroup CHIP/Medicaid	$2,229.30
Rate for Payer: BCBS of TX Blue Advantage	$7,431.01
Rate for Payer: BCBS of TX Blue Essentials	$8,917.21
Rate for Payer: BCBS of TX PPO	$9,908.02
Rate for Payer: Cash Price	$16,843.63
Rate for Payer: Cash Price	$16,843.63
Rate for Payer: Cigna Medicaid	$17,834.43
Rate for Payer: Molina CHIP/Medicaid	$17,834.43
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	$17,834.43
Rate for Payer: Scott and White EPO/PPO	$12,385.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17,834.43
Rate for Payer: Superior Health Plan EPO	$3,368.73

Know your out-of-pocket cost for care.

All Charges