White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W CC

Facility

$100,582.20

Service Code	MSDRG 021
Min. Negotiated Rate	$43,558.49
Max. Negotiated Rate	$100,582.20
Rate for Payer: BCBS of TX Blue Advantage	$67,988.16
Rate for Payer: BCBS of TX Blue Essentials	$81,577.89
Rate for Payer: BCBS of TX PPO	$90,645.61

INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W MCC

Facility

$149,507.20

Service Code	MSDRG 020
Min. Negotiated Rate	$62,430.71
Max. Negotiated Rate	$149,507.20
Rate for Payer: BCBS of TX Blue Advantage	$89,657.58
Rate for Payer: BCBS of TX Blue Essentials	$107,578.67
Rate for Payer: BCBS of TX PPO	$119,536.49

INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W/O CC/MCC

Facility

$59,135.89

Service Code	MSDRG 022
Min. Negotiated Rate	$26,907.12
Max. Negotiated Rate	$59,135.89
Rate for Payer: BCBS of TX Blue Advantage	$44,354.50
Rate for Payer: BCBS of TX Blue Essentials	$53,220.24
Rate for Payer: BCBS of TX PPO	$59,135.89

INTRAOCULAR PROCEDURES W CC/MCC

Facility

$34,353.90

Service Code	MSDRG 116
Min. Negotiated Rate	$14,688.80
Max. Negotiated Rate	$34,353.90
Rate for Payer: BCBS of TX Blue Advantage	$14,688.80
Rate for Payer: BCBS of TX Blue Essentials	$17,624.85
Rate for Payer: BCBS of TX PPO	$19,583.93

INTRAOCULAR PROCEDURES WITH CC/MCC

Facility

$34,353.90

Service Code	MSDRG 116
Min. Negotiated Rate	$14,688.80
Max. Negotiated Rate	$34,353.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$18,011.70
Rate for Payer: Amerigroup Medicare	$18,011.70
Rate for Payer: BCBS of TX Medicare	$18,011.70
Rate for Payer: Cigna Commercial	$23,288.33
Rate for Payer: Cigna Medicare	$18,011.70
Rate for Payer: Employer Direct Commercial	$18,011.70
Rate for Payer: Humana Medicare/TRICARE	$18,011.70
Rate for Payer: Molina Dual Medicare/Medicaid	$18,011.70
Rate for Payer: Molina Medicare	$18,011.70
Rate for Payer: Multiplan Auto	$34,353.90
Rate for Payer: Multiplan Commercial	$34,353.90
Rate for Payer: Multiplan Workers Comp	$34,353.90
Rate for Payer: Scott and White EPO/PPO	$15,820.88
Rate for Payer: Scott and White Medicare	$18,011.70
Rate for Payer: Superior Health Plan EPO	$18,011.70
Rate for Payer: Superior Health Plan Medicare	$18,011.70
Rate for Payer: Universal American Dual Medicare/Medicaid	$18,011.70
Rate for Payer: Universal American Medicare	$18,011.70
Rate for Payer: Wellcare Medicare	$18,011.70
Rate for Payer: Wellmed Medicare	$18,011.70

INTRAOCULAR PROCEDURES WITHOUT CC/MCC

Facility

$20,613.10

Service Code	MSDRG 117
Min. Negotiated Rate	$8,621.50
Max. Negotiated Rate	$20,613.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,711.35
Rate for Payer: Amerigroup Medicare	$12,711.35
Rate for Payer: BCBS of TX Medicare	$12,711.35
Rate for Payer: Cigna Commercial	$13,973.51
Rate for Payer: Cigna Medicare	$12,711.35
Rate for Payer: Employer Direct Commercial	$12,711.35
Rate for Payer: Humana Medicare/TRICARE	$12,711.35
Rate for Payer: Molina Dual Medicare/Medicaid	$12,711.35
Rate for Payer: Molina Medicare	$12,711.35
Rate for Payer: Multiplan Auto	$20,613.10
Rate for Payer: Multiplan Commercial	$20,613.10
Rate for Payer: Multiplan Workers Comp	$20,613.10
Rate for Payer: Scott and White EPO/PPO	$9,492.88
Rate for Payer: Scott and White Medicare	$12,711.35
Rate for Payer: Superior Health Plan EPO	$12,711.35
Rate for Payer: Superior Health Plan Medicare	$12,711.35
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,711.35
Rate for Payer: Universal American Medicare	$12,711.35
Rate for Payer: Wellcare Medicare	$12,711.35
Rate for Payer: Wellmed Medicare	$12,711.35

INTRAOCULAR PROCEDURES W/O CC/MCC

Facility

$20,613.10

Service Code	MSDRG 117
Min. Negotiated Rate	$8,621.50
Max. Negotiated Rate	$20,613.10
Rate for Payer: BCBS of TX Blue Advantage	$8,621.50
Rate for Payer: BCBS of TX Blue Essentials	$10,344.80
Rate for Payer: BCBS of TX PPO	$11,494.67

Intraoperative epicardial cardiac ultrasound

Facility

$3,825.00

Service Code	HCPCS 76987
Hospital Charge Code	994175
Hospital Revenue Code	480
Rate for Payer: Cash Price	$2,601.00

Intraoperative epicardial cardiac ultrasound

Facility

$3,825.00

Service Code	HCPCS 76987
Hospital Charge Code	994175
Hospital Revenue Code	480
Min. Negotiated Rate	$157.11
Max. Negotiated Rate	$2,754.00
Rate for Payer: Amerigroup CHIP/Medicaid	$344.25
Rate for Payer: BCBS of TX Blue Advantage	$157.11
Rate for Payer: BCBS of TX Blue Essentials	$188.54
Rate for Payer: BCBS of TX PPO	$210.44
Rate for Payer: Cash Price	$2,601.00
Rate for Payer: Cash Price	$2,601.00
Rate for Payer: Cigna Medicaid	$2,754.00
Rate for Payer: Molina CHIP/Medicaid	$2,754.00
Rate for Payer: Multiplan Auto	$2,486.25
Rate for Payer: Multiplan Commercial	$2,486.25
Rate for Payer: Multiplan Workers Comp	$2,486.25
Rate for Payer: Parkland Medicaid	$2,754.00
Rate for Payer: Scott and White EPO/PPO	$1,912.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,754.00
Rate for Payer: Superior Health Plan EPO	$520.20

INTRAVASCULAR STENT 1ST ARTERY

Facility

$24,854.00

Service Code	HCPCS 37236
Hospital Charge Code	2350071
Hospital Revenue Code	481
Rate for Payer: Cash Price	$16,900.72

INTRAVASCULAR STENT 1ST ARTERY

Facility

$24,854.00

Service Code	HCPCS 37236
Hospital Charge Code	2350071
Hospital Revenue Code	481
Min. Negotiated Rate	$2,236.86
Max. Negotiated Rate	$24,969.37
Rate for Payer: Amerigroup CHIP/Medicaid	$2,236.86
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,596.79
Rate for Payer: Amerigroup Medicare	$11,596.79
Rate for Payer: BCBS of TX Blue Advantage	$16,547.16
Rate for Payer: BCBS of TX Blue Essentials	$19,816.96
Rate for Payer: BCBS of TX Medicare	$11,596.79
Rate for Payer: BCBS of TX PPO	$24,969.37
Rate for Payer: Cash Price	$16,900.72
Rate for Payer: Cash Price	$16,900.72
Rate for Payer: Cash Price	$16,900.72
Rate for Payer: Cigna Commercial	$24,513.51
Rate for Payer: Cigna Medicaid	$17,894.88
Rate for Payer: Cigna Medicare	$11,596.79
Rate for Payer: Employer Direct Commercial	$11,596.79
Rate for Payer: Humana Medicare/TRICARE	$11,596.79
Rate for Payer: Molina CHIP/Medicaid	$17,894.88
Rate for Payer: Molina Dual Medicare/Medicaid	$11,596.79
Rate for Payer: Molina Medicare	$11,596.79
Rate for Payer: Multiplan Auto	$16,155.10
Rate for Payer: Multiplan Commercial	$16,155.10
Rate for Payer: Multiplan Workers Comp	$16,155.10
Rate for Payer: Parkland Medicaid	$17,894.88
Rate for Payer: Scott and White EPO/PPO	$12,427.00
Rate for Payer: Scott and White Medicare	$11,596.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17,894.88
Rate for Payer: Superior Health Plan EPO	$11,596.79
Rate for Payer: Superior Health Plan Medicare	$11,596.79
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,596.79
Rate for Payer: Universal American Medicare	$11,596.79
Rate for Payer: Wellcare Medicare	$11,596.79
Rate for Payer: Wellmed Medicare	$11,596.79

Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

Facility

$122.61

Service Code	HCPCS 96361
Hospital Charge Code	8932542
Hospital Revenue Code	260
Rate for Payer: Cash Price	$83.37

Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

Facility

$122.61

Service Code	HCPCS 96361
Hospital Charge Code	7003593
Hospital Revenue Code	260
Min. Negotiated Rate	$11.03
Max. Negotiated Rate	$99.43
Rate for Payer: Amerigroup CHIP/Medicaid	$11.03
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$47.04
Rate for Payer: Amerigroup Medicare	$47.04
Rate for Payer: BCBS of TX Blue Advantage	$36.78
Rate for Payer: BCBS of TX Blue Essentials	$44.14
Rate for Payer: BCBS of TX Medicare	$47.04
Rate for Payer: BCBS of TX PPO	$49.04
Rate for Payer: Cash Price	$83.37
Rate for Payer: Cash Price	$83.37
Rate for Payer: Cash Price	$83.37
Rate for Payer: Cigna Commercial	$99.43
Rate for Payer: Cigna Medicaid	$88.28
Rate for Payer: Cigna Medicare	$47.04
Rate for Payer: Employer Direct Commercial	$47.04
Rate for Payer: Humana Medicare/TRICARE	$47.04
Rate for Payer: Molina CHIP/Medicaid	$88.28
Rate for Payer: Molina Dual Medicare/Medicaid	$47.04
Rate for Payer: Molina Medicare	$47.04
Rate for Payer: Multiplan Auto	$79.70
Rate for Payer: Multiplan Commercial	$79.70
Rate for Payer: Multiplan Workers Comp	$79.70
Rate for Payer: Parkland Medicaid	$88.28
Rate for Payer: Scott and White EPO/PPO	$61.30
Rate for Payer: Scott and White Medicare	$47.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$88.28
Rate for Payer: Superior Health Plan EPO	$47.04
Rate for Payer: Superior Health Plan Medicare	$47.04
Rate for Payer: Universal American Dual Medicare/Medicaid	$47.04
Rate for Payer: Universal American Medicare	$47.04
Rate for Payer: Wellcare Medicare	$47.04
Rate for Payer: Wellmed Medicare	$47.04

Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

Facility

$10,000.00

Service Code	CPT 96361
Hospital Charge Code	36096361
Hospital Revenue Code	360
Min. Negotiated Rate	$47.04
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$47.04
Rate for Payer: Amerigroup Medicare	$47.04
Rate for Payer: BCBS of TX Medicare	$47.04
Rate for Payer: Cigna Commercial	$99.43
Rate for Payer: Cigna Medicare	$47.04
Rate for Payer: Employer Direct Commercial	$47.04
Rate for Payer: Humana Medicare/TRICARE	$47.04
Rate for Payer: Molina Dual Medicare/Medicaid	$47.04
Rate for Payer: Molina Medicare	$47.04
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 Medicare	$47.04
Rate for Payer: Superior Health Plan EPO	$47.04
Rate for Payer: Superior Health Plan Medicare	$47.04
Rate for Payer: Universal American Dual Medicare/Medicaid	$47.04
Rate for Payer: Universal American Medicare	$47.04
Rate for Payer: Wellcare Medicare	$47.04
Rate for Payer: Wellmed Medicare	$47.04

Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

Facility

$122.61

Service Code	HCPCS 96361
Hospital Charge Code	8932542
Hospital Revenue Code	260
Min. Negotiated Rate	$11.03
Max. Negotiated Rate	$99.43
Rate for Payer: Amerigroup CHIP/Medicaid	$11.03
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$47.04
Rate for Payer: Amerigroup Medicare	$47.04
Rate for Payer: BCBS of TX Blue Advantage	$36.78
Rate for Payer: BCBS of TX Blue Essentials	$44.14
Rate for Payer: BCBS of TX Medicare	$47.04
Rate for Payer: BCBS of TX PPO	$49.04
Rate for Payer: Cash Price	$83.37
Rate for Payer: Cash Price	$83.37
Rate for Payer: Cash Price	$83.37
Rate for Payer: Cigna Commercial	$99.43
Rate for Payer: Cigna Medicaid	$88.28
Rate for Payer: Cigna Medicare	$47.04
Rate for Payer: Employer Direct Commercial	$47.04
Rate for Payer: Humana Medicare/TRICARE	$47.04
Rate for Payer: Molina CHIP/Medicaid	$88.28
Rate for Payer: Molina Dual Medicare/Medicaid	$47.04
Rate for Payer: Molina Medicare	$47.04
Rate for Payer: Multiplan Auto	$79.70
Rate for Payer: Multiplan Commercial	$79.70
Rate for Payer: Multiplan Workers Comp	$79.70
Rate for Payer: Parkland Medicaid	$88.28
Rate for Payer: Scott and White EPO/PPO	$61.30
Rate for Payer: Scott and White Medicare	$47.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$88.28
Rate for Payer: Superior Health Plan EPO	$47.04
Rate for Payer: Superior Health Plan Medicare	$47.04
Rate for Payer: Universal American Dual Medicare/Medicaid	$47.04
Rate for Payer: Universal American Medicare	$47.04
Rate for Payer: Wellcare Medicare	$47.04
Rate for Payer: Wellmed Medicare	$47.04

Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

Facility

$122.61

Service Code	HCPCS 96361
Hospital Charge Code	7003593
Hospital Revenue Code	260
Rate for Payer: Cash Price	$83.37

Intravenous infusion, hydration; initial, 31 minutes to 1 hour

Facility

$626.79

Service Code	HCPCS 96360
Hospital Charge Code	9900910
Hospital Revenue Code	260
Rate for Payer: Cash Price	$426.22

Intravenous infusion, hydration; initial, 31 minutes to 1 hour

Facility

$626.79

Service Code	HCPCS 96360
Hospital Charge Code	9900910
Hospital Revenue Code	260
Min. Negotiated Rate	$56.41
Max. Negotiated Rate	$451.67
Rate for Payer: Amerigroup CHIP/Medicaid	$56.41
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$213.67
Rate for Payer: Amerigroup Medicare	$213.67
Rate for Payer: BCBS of TX Blue Advantage	$188.04
Rate for Payer: BCBS of TX Blue Essentials	$225.64
Rate for Payer: BCBS of TX Medicare	$213.67
Rate for Payer: BCBS of TX PPO	$250.72
Rate for Payer: Cash Price	$426.22
Rate for Payer: Cash Price	$426.22
Rate for Payer: Cash Price	$426.22
Rate for Payer: Cigna Commercial	$451.67
Rate for Payer: Cigna Medicaid	$451.29
Rate for Payer: Cigna Medicare	$213.67
Rate for Payer: Employer Direct Commercial	$213.67
Rate for Payer: Humana Medicare/TRICARE	$213.67
Rate for Payer: Molina CHIP/Medicaid	$451.29
Rate for Payer: Molina Dual Medicare/Medicaid	$213.67
Rate for Payer: Molina Medicare	$213.67
Rate for Payer: Multiplan Auto	$407.41
Rate for Payer: Multiplan Commercial	$407.41
Rate for Payer: Multiplan Workers Comp	$407.41
Rate for Payer: Parkland Medicaid	$451.29
Rate for Payer: Scott and White EPO/PPO	$313.39
Rate for Payer: Scott and White Medicare	$213.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$451.29
Rate for Payer: Superior Health Plan EPO	$213.67
Rate for Payer: Superior Health Plan Medicare	$213.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$213.67
Rate for Payer: Universal American Medicare	$213.67
Rate for Payer: Wellcare Medicare	$213.67
Rate for Payer: Wellmed Medicare	$213.67

Intravenous infusion, hydration; initial, 31 minutes to 1 hour

Facility

$626.79

Service Code	HCPCS 96360
Hospital Charge Code	8996978
Hospital Revenue Code	260
Rate for Payer: Cash Price	$426.22

Intravenous infusion, hydration; initial, 31 minutes to 1 hour

Facility

$10,000.00

Service Code	CPT 96360
Hospital Charge Code	36096360
Hospital Revenue Code	360
Min. Negotiated Rate	$213.67
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$213.67
Rate for Payer: Amerigroup Medicare	$213.67
Rate for Payer: BCBS of TX Medicare	$213.67
Rate for Payer: Cigna Commercial	$451.67
Rate for Payer: Cigna Medicare	$213.67
Rate for Payer: Employer Direct Commercial	$213.67
Rate for Payer: Humana Medicare/TRICARE	$213.67
Rate for Payer: Molina Dual Medicare/Medicaid	$213.67
Rate for Payer: Molina Medicare	$213.67
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 Medicare	$213.67
Rate for Payer: Superior Health Plan EPO	$213.67
Rate for Payer: Superior Health Plan Medicare	$213.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$213.67
Rate for Payer: Universal American Medicare	$213.67
Rate for Payer: Wellcare Medicare	$213.67
Rate for Payer: Wellmed Medicare	$213.67

Intravenous infusion, hydration; initial, 31 minutes to 1 hour

Facility

$626.79

Service Code	HCPCS 96360
Hospital Charge Code	8996978
Hospital Revenue Code	260
Min. Negotiated Rate	$56.41
Max. Negotiated Rate	$451.67
Rate for Payer: Amerigroup CHIP/Medicaid	$56.41
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$213.67
Rate for Payer: Amerigroup Medicare	$213.67
Rate for Payer: BCBS of TX Blue Advantage	$188.04
Rate for Payer: BCBS of TX Blue Essentials	$225.64
Rate for Payer: BCBS of TX Medicare	$213.67
Rate for Payer: BCBS of TX PPO	$250.72
Rate for Payer: Cash Price	$426.22
Rate for Payer: Cash Price	$426.22
Rate for Payer: Cash Price	$426.22
Rate for Payer: Cigna Commercial	$451.67
Rate for Payer: Cigna Medicaid	$451.29
Rate for Payer: Cigna Medicare	$213.67
Rate for Payer: Employer Direct Commercial	$213.67
Rate for Payer: Humana Medicare/TRICARE	$213.67
Rate for Payer: Molina CHIP/Medicaid	$451.29
Rate for Payer: Molina Dual Medicare/Medicaid	$213.67
Rate for Payer: Molina Medicare	$213.67
Rate for Payer: Multiplan Auto	$407.41
Rate for Payer: Multiplan Commercial	$407.41
Rate for Payer: Multiplan Workers Comp	$407.41
Rate for Payer: Parkland Medicaid	$451.29
Rate for Payer: Scott and White EPO/PPO	$313.39
Rate for Payer: Scott and White Medicare	$213.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$451.29
Rate for Payer: Superior Health Plan EPO	$213.67
Rate for Payer: Superior Health Plan Medicare	$213.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$213.67
Rate for Payer: Universal American Medicare	$213.67
Rate for Payer: Wellcare Medicare	$213.67
Rate for Payer: Wellmed Medicare	$213.67

Intravenous injection of agent (eg, fluorescein) to test vascular flow in flap or graft

Facility

$1,518.52

Service Code	HCPCS 15860
Hospital Charge Code	991150
Hospital Revenue Code	360
Min. Negotiated Rate	$136.67
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$136.67
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$448.76
Rate for Payer: Amerigroup Medicare	$448.76
Rate for Payer: BCBS of TX Blue Advantage	$607.20
Rate for Payer: BCBS of TX Blue Essentials	$727.18
Rate for Payer: BCBS of TX Medicare	$448.76
Rate for Payer: BCBS of TX PPO	$916.25
Rate for Payer: Cash Price	$1,032.59
Rate for Payer: Cash Price	$1,032.59
Rate for Payer: Cash Price	$1,032.59
Rate for Payer: Cigna Commercial	$948.59
Rate for Payer: Cigna Medicaid	$1,093.33
Rate for Payer: Cigna Medicare	$448.76
Rate for Payer: Employer Direct Commercial	$448.76
Rate for Payer: Humana Medicare/TRICARE	$448.76
Rate for Payer: Molina CHIP/Medicaid	$1,093.33
Rate for Payer: Molina Dual Medicare/Medicaid	$448.76
Rate for Payer: Molina Medicare	$448.76
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	$1,093.33
Rate for Payer: Scott and White EPO/PPO	$830.21
Rate for Payer: Scott and White Medicare	$448.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,093.33
Rate for Payer: Superior Health Plan EPO	$448.76
Rate for Payer: Superior Health Plan Medicare	$448.76
Rate for Payer: Universal American Dual Medicare/Medicaid	$448.76
Rate for Payer: Universal American Medicare	$448.76
Rate for Payer: Wellcare Medicare	$448.76
Rate for Payer: Wellmed Medicare	$448.76

Intravenous injection of agent (eg, fluorescein) to test vascular flow in flap or graft

Facility

$1,518.52

Service Code	HCPCS 15860
Hospital Charge Code	991150
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,032.59

INTRCRD EP 3DMAP

Facility

$8,562.00

Service Code	HCPCS 93613
Hospital Charge Code	4613613
Hospital Revenue Code	480
Rate for Payer: Cash Price	$5,822.16

INTRCRD EP 3DMAP

Facility

$8,562.00

Service Code	HCPCS 93613
Hospital Charge Code	4613613
Hospital Revenue Code	480
Min. Negotiated Rate	$770.58
Max. Negotiated Rate	$6,164.64
Rate for Payer: Amerigroup CHIP/Medicaid	$770.58
Rate for Payer: BCBS of TX Blue Advantage	$2,568.60
Rate for Payer: BCBS of TX Blue Essentials	$3,082.32
Rate for Payer: BCBS of TX PPO	$3,424.80
Rate for Payer: Cash Price	$5,822.16
Rate for Payer: Cigna Medicaid	$6,164.64
Rate for Payer: Molina CHIP/Medicaid	$6,164.64
Rate for Payer: Multiplan Auto	$5,565.30
Rate for Payer: Multiplan Commercial	$5,565.30
Rate for Payer: Multiplan Workers Comp	$5,565.30
Rate for Payer: Parkland Medicaid	$6,164.64
Rate for Payer: Scott and White EPO/PPO	$4,281.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,164.64
Rate for Payer: Superior Health Plan EPO	$1,164.43

Know your out-of-pocket cost for care.

All Charges