White Rock Medical Center

All Charges

Charge

Type

Setting

Price

PT Selective Wound Debride Addtl 20cm Assist Units BCE

Facility

$351.00

Service Code	CPT 97598 CQ,GP
Hospital Charge Code	5707592
Hospital Revenue Code	420
Rate for Payer: Cash Price	$308.88

PT Selective Wound Debridement <20cm Assist Units

Facility

$399.00

Service Code	CPT 97597 CQ,GP
Hospital Charge Code	5707591
Hospital Revenue Code	420
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$274.64
Rate for Payer: Aetna Commercial	$219.45
Rate for Payer: Aetna Medicare	$274.64
Rate for Payer: Amerigroup CHIP/Medicaid	$35.91
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$183.09
Rate for Payer: Amerigroup Medicare	$183.09
Rate for Payer: BCBS of TX Blue Advantage	$42.65
Rate for Payer: BCBS of TX Blue Essentials	$50.98
Rate for Payer: BCBS of TX Medicare	$183.09
Rate for Payer: BCBS of TX PPO	$56.86
Rate for Payer: Cash Price	$351.12
Rate for Payer: Cash Price	$351.12
Rate for Payer: Cash Price	$351.12
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicare	$183.09
Rate for Payer: Employer Direct Commercial	$183.09
Rate for Payer: Humana Medicare/TRICARE	$183.09
Rate for Payer: Molina Dual Medicare/Medicaid	$183.09
Rate for Payer: Molina Medicare	$183.09
Rate for Payer: Multiplan Auto	$259.35
Rate for Payer: Multiplan Commercial	$259.35
Rate for Payer: Multiplan Workers Comp	$259.35
Rate for Payer: Scott and White EPO/PPO	$3.27
Rate for Payer: Scott and White Medicare	$183.09
Rate for Payer: Superior Health Plan EPO	$183.09
Rate for Payer: Superior Health Plan Medicare	$183.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$183.09
Rate for Payer: Universal American Medicare	$183.09
Rate for Payer: Wellcare Medicare	$183.09
Rate for Payer: Wellmed Medicare	$183.09

PT Selective Wound Debridement <20cm Assist Units BCE

Facility

$399.00

Service Code	CPT 97597 CQ,GP
Hospital Charge Code	5707591
Hospital Revenue Code	420
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$274.64
Rate for Payer: Aetna Commercial	$219.45
Rate for Payer: Aetna Medicare	$274.64
Rate for Payer: Amerigroup CHIP/Medicaid	$35.91
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$183.09
Rate for Payer: Amerigroup Medicare	$183.09
Rate for Payer: BCBS of TX Blue Advantage	$42.65
Rate for Payer: BCBS of TX Blue Essentials	$50.98
Rate for Payer: BCBS of TX Medicare	$183.09
Rate for Payer: BCBS of TX PPO	$56.86
Rate for Payer: Cash Price	$351.12
Rate for Payer: Cash Price	$351.12
Rate for Payer: Cash Price	$351.12
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicare	$183.09
Rate for Payer: Employer Direct Commercial	$183.09
Rate for Payer: Humana Medicare/TRICARE	$183.09
Rate for Payer: Molina Dual Medicare/Medicaid	$183.09
Rate for Payer: Molina Medicare	$183.09
Rate for Payer: Multiplan Auto	$259.35
Rate for Payer: Multiplan Commercial	$259.35
Rate for Payer: Multiplan Workers Comp	$259.35
Rate for Payer: Scott and White EPO/PPO	$3.27
Rate for Payer: Scott and White Medicare	$183.09
Rate for Payer: Superior Health Plan EPO	$183.09
Rate for Payer: Superior Health Plan Medicare	$183.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$183.09
Rate for Payer: Universal American Medicare	$183.09
Rate for Payer: Wellcare Medicare	$183.09
Rate for Payer: Wellmed Medicare	$183.09

PT Selective Wound Debridement <20cm Assist Units BCE

Facility

$399.00

Service Code	CPT 97597 CQ,GP
Hospital Charge Code	5707591
Hospital Revenue Code	420
Rate for Payer: Cash Price	$351.12

PT Selective Wound Debridement <20cm Units

Facility

$399.00

Service Code	CPT 97597 GP
Hospital Charge Code	5707591
Hospital Revenue Code	420
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$274.64
Rate for Payer: Aetna Commercial	$219.45
Rate for Payer: Aetna Medicare	$274.64
Rate for Payer: Amerigroup CHIP/Medicaid	$35.91
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$183.09
Rate for Payer: Amerigroup Medicare	$183.09
Rate for Payer: BCBS of TX Blue Advantage	$42.65
Rate for Payer: BCBS of TX Blue Essentials	$50.98
Rate for Payer: BCBS of TX Medicare	$183.09
Rate for Payer: BCBS of TX PPO	$56.86
Rate for Payer: Cash Price	$351.12
Rate for Payer: Cash Price	$351.12
Rate for Payer: Cash Price	$351.12
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicare	$183.09
Rate for Payer: Employer Direct Commercial	$183.09
Rate for Payer: Humana Medicare/TRICARE	$183.09
Rate for Payer: Molina Dual Medicare/Medicaid	$183.09
Rate for Payer: Molina Medicare	$183.09
Rate for Payer: Multiplan Auto	$259.35
Rate for Payer: Multiplan Commercial	$259.35
Rate for Payer: Multiplan Workers Comp	$259.35
Rate for Payer: Scott and White EPO/PPO	$3.27
Rate for Payer: Scott and White Medicare	$183.09
Rate for Payer: Superior Health Plan EPO	$183.09
Rate for Payer: Superior Health Plan Medicare	$183.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$183.09
Rate for Payer: Universal American Medicare	$183.09
Rate for Payer: Wellcare Medicare	$183.09
Rate for Payer: Wellmed Medicare	$183.09

PT Selective Wound Debridement <20cm Units BCE

Facility

$399.00

Service Code	CPT 97597 GP
Hospital Charge Code	5707591
Hospital Revenue Code	420
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$274.64
Rate for Payer: Aetna Commercial	$219.45
Rate for Payer: Aetna Medicare	$274.64
Rate for Payer: Amerigroup CHIP/Medicaid	$35.91
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$183.09
Rate for Payer: Amerigroup Medicare	$183.09
Rate for Payer: BCBS of TX Blue Advantage	$42.65
Rate for Payer: BCBS of TX Blue Essentials	$50.98
Rate for Payer: BCBS of TX Medicare	$183.09
Rate for Payer: BCBS of TX PPO	$56.86
Rate for Payer: Cash Price	$351.12
Rate for Payer: Cash Price	$351.12
Rate for Payer: Cash Price	$351.12
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicare	$183.09
Rate for Payer: Employer Direct Commercial	$183.09
Rate for Payer: Humana Medicare/TRICARE	$183.09
Rate for Payer: Molina Dual Medicare/Medicaid	$183.09
Rate for Payer: Molina Medicare	$183.09
Rate for Payer: Multiplan Auto	$259.35
Rate for Payer: Multiplan Commercial	$259.35
Rate for Payer: Multiplan Workers Comp	$259.35
Rate for Payer: Scott and White EPO/PPO	$3.27
Rate for Payer: Scott and White Medicare	$183.09
Rate for Payer: Superior Health Plan EPO	$183.09
Rate for Payer: Superior Health Plan Medicare	$183.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$183.09
Rate for Payer: Universal American Medicare	$183.09
Rate for Payer: Wellcare Medicare	$183.09
Rate for Payer: Wellmed Medicare	$183.09

PT Selective Wound Debridement Addtl 20cm Units

Facility

$351.00

Service Code	CPT 97598 GP
Hospital Charge Code	5707592
Hospital Revenue Code	420
Min. Negotiated Rate	$20.06
Max. Negotiated Rate	$228.15
Rate for Payer: Aetna Commercial	$193.05
Rate for Payer: Amerigroup CHIP/Medicaid	$31.59
Rate for Payer: BCBS of TX Blue Advantage	$20.06
Rate for Payer: BCBS of TX Blue Essentials	$23.98
Rate for Payer: BCBS of TX PPO	$26.75
Rate for Payer: Cash Price	$308.88
Rate for Payer: Cash Price	$308.88
Rate for Payer: Cash Price	$308.88
Rate for Payer: Cash Price	$308.88
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Multiplan Auto	$228.15
Rate for Payer: Multiplan Commercial	$228.15
Rate for Payer: Multiplan Workers Comp	$228.15
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Superior Health Plan EPO	$47.74

PT Selective Wound Debridement Addtl 20cm Units BCE

Facility

$351.00

Service Code	CPT 97598 GP
Hospital Charge Code	5707592
Hospital Revenue Code	420
Min. Negotiated Rate	$20.06
Max. Negotiated Rate	$228.15
Rate for Payer: Aetna Commercial	$193.05
Rate for Payer: Amerigroup CHIP/Medicaid	$31.59
Rate for Payer: BCBS of TX Blue Advantage	$20.06
Rate for Payer: BCBS of TX Blue Essentials	$23.98
Rate for Payer: BCBS of TX PPO	$26.75
Rate for Payer: Cash Price	$308.88
Rate for Payer: Cash Price	$308.88
Rate for Payer: Cash Price	$308.88
Rate for Payer: Cash Price	$308.88
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Multiplan Auto	$228.15
Rate for Payer: Multiplan Commercial	$228.15
Rate for Payer: Multiplan Workers Comp	$228.15
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Superior Health Plan EPO	$47.74

PT Self Care, Home Management Assistant Units

Facility

$125.00

Service Code	CPT 97535 CQ,GP
Hospital Charge Code	4252056
Hospital Revenue Code	420
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$221.00
Rate for Payer: Aetna Commercial	$221.00
Rate for Payer: Amerigroup CHIP/Medicaid	$11.25
Rate for Payer: BCBS of TX Blue Advantage	$60.83
Rate for Payer: BCBS of TX Blue Essentials	$72.72
Rate for Payer: BCBS of TX PPO	$81.11
Rate for Payer: Cash Price	$110.00
Rate for Payer: Cash Price	$110.00
Rate for Payer: Cash Price	$110.00
Rate for Payer: Cash Price	$110.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Multiplan Auto	$81.25
Rate for Payer: Multiplan Commercial	$81.25
Rate for Payer: Multiplan Workers Comp	$81.25
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Superior Health Plan EPO	$17.00

PT Self Care, Home Management Assistant Units BCE

Facility

$125.00

Service Code	CPT 97535 CQ,GP
Hospital Charge Code	4252056
Hospital Revenue Code	420
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$221.00
Rate for Payer: Aetna Commercial	$221.00
Rate for Payer: Amerigroup CHIP/Medicaid	$11.25
Rate for Payer: BCBS of TX Blue Advantage	$60.83
Rate for Payer: BCBS of TX Blue Essentials	$72.72
Rate for Payer: BCBS of TX PPO	$81.11
Rate for Payer: Cash Price	$110.00
Rate for Payer: Cash Price	$110.00
Rate for Payer: Cash Price	$110.00
Rate for Payer: Cash Price	$110.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Multiplan Auto	$81.25
Rate for Payer: Multiplan Commercial	$81.25
Rate for Payer: Multiplan Workers Comp	$81.25
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Superior Health Plan EPO	$17.00

PT Self Care, Home Management Assistant Units BCE

Facility

$125.00

Service Code	CPT 97535 CQ,GP
Hospital Charge Code	4252056
Hospital Revenue Code	420
Rate for Payer: Cash Price	$110.00

PT Self Care, Home Management Units

Facility

$125.00

Service Code	CPT 97535 GP
Hospital Charge Code	4252050
Hospital Revenue Code	420
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$221.00
Rate for Payer: Aetna Commercial	$221.00
Rate for Payer: Amerigroup CHIP/Medicaid	$11.25
Rate for Payer: BCBS of TX Blue Advantage	$60.83
Rate for Payer: BCBS of TX Blue Essentials	$72.72
Rate for Payer: BCBS of TX PPO	$81.11
Rate for Payer: Cash Price	$110.00
Rate for Payer: Cash Price	$110.00
Rate for Payer: Cash Price	$110.00
Rate for Payer: Cash Price	$110.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Multiplan Auto	$81.25
Rate for Payer: Multiplan Commercial	$81.25
Rate for Payer: Multiplan Workers Comp	$81.25
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Superior Health Plan EPO	$17.00

PT Self Care, Home Management Units BCE

Facility

$125.00

Service Code	CPT 97535 GP
Hospital Charge Code	4252050
Hospital Revenue Code	420
Rate for Payer: Cash Price	$110.00

PT Self Care, Home Management Units BCE

Facility

$125.00

Service Code	CPT 97535 GP
Hospital Charge Code	4252050
Hospital Revenue Code	420
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$221.00
Rate for Payer: Aetna Commercial	$221.00
Rate for Payer: Amerigroup CHIP/Medicaid	$11.25
Rate for Payer: BCBS of TX Blue Advantage	$60.83
Rate for Payer: BCBS of TX Blue Essentials	$72.72
Rate for Payer: BCBS of TX PPO	$81.11
Rate for Payer: Cash Price	$110.00
Rate for Payer: Cash Price	$110.00
Rate for Payer: Cash Price	$110.00
Rate for Payer: Cash Price	$110.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Multiplan Auto	$81.25
Rate for Payer: Multiplan Commercial	$81.25
Rate for Payer: Multiplan Workers Comp	$81.25
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Superior Health Plan EPO	$17.00

PTT, Activated SO

Facility

$220.00

Service Code	CPT 85730
Hospital Charge Code	1600535
Hospital Revenue Code	305
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$143.00
Rate for Payer: Aetna Commercial	$6.32
Rate for Payer: Aetna Medicare	$9.02
Rate for Payer: Amerigroup CHIP/Medicaid	$2.34
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6.01
Rate for Payer: Amerigroup Medicare	$6.01
Rate for Payer: BCBS of TX Blue Advantage	$9.92
Rate for Payer: BCBS of TX Blue Essentials	$11.90
Rate for Payer: BCBS of TX Medicare	$6.01
Rate for Payer: BCBS of TX PPO	$13.28
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cigna Medicaid	$6.01
Rate for Payer: Cigna Medicare	$6.01
Rate for Payer: Employer Direct Commercial	$6.01
Rate for Payer: Humana Medicare/TRICARE	$6.01
Rate for Payer: Molina CHIP/Medicaid	$6.01
Rate for Payer: Molina Dual Medicare/Medicaid	$6.01
Rate for Payer: Molina Medicare	$6.01
Rate for Payer: Multiplan Auto	$143.00
Rate for Payer: Multiplan Commercial	$143.00
Rate for Payer: Multiplan Workers Comp	$143.00
Rate for Payer: Parkland Medicaid	$6.01
Rate for Payer: Scott and White EPO/PPO	$7.51
Rate for Payer: Scott and White Medicare	$6.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.01
Rate for Payer: Superior Health Plan EPO	$6.01
Rate for Payer: Superior Health Plan Medicare	$6.01
Rate for Payer: Universal American Dual Medicare/Medicaid	$6.01
Rate for Payer: Universal American Medicare	$6.01
Rate for Payer: Wellcare Medicare	$6.01
Rate for Payer: Wellmed Medicare	$6.01

PT Therapeutic Activity Assistant Units

Facility

$188.00

Service Code	CPT 97530 CQ,GP
Hospital Charge Code	4252057
Hospital Revenue Code	420
Min. Negotiated Rate	$16.92
Max. Negotiated Rate	$221.00
Rate for Payer: Aetna Commercial	$221.00
Rate for Payer: Amerigroup CHIP/Medicaid	$16.92
Rate for Payer: BCBS of TX Blue Advantage	$70.85
Rate for Payer: BCBS of TX Blue Essentials	$84.70
Rate for Payer: BCBS of TX PPO	$94.47
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Multiplan Auto	$122.20
Rate for Payer: Multiplan Commercial	$122.20
Rate for Payer: Multiplan Workers Comp	$122.20
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Superior Health Plan EPO	$25.57

PT Therapeutic Activity Assistant Units BCE

Facility

$188.00

Service Code	CPT 97530 CQ,GP
Hospital Charge Code	4252057
Hospital Revenue Code	420
Min. Negotiated Rate	$16.92
Max. Negotiated Rate	$221.00
Rate for Payer: Aetna Commercial	$221.00
Rate for Payer: Amerigroup CHIP/Medicaid	$16.92
Rate for Payer: BCBS of TX Blue Advantage	$70.85
Rate for Payer: BCBS of TX Blue Essentials	$84.70
Rate for Payer: BCBS of TX PPO	$94.47
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Multiplan Auto	$122.20
Rate for Payer: Multiplan Commercial	$122.20
Rate for Payer: Multiplan Workers Comp	$122.20
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Superior Health Plan EPO	$25.57

PT Therapeutic Activity Assistant Units BCE

Facility

$188.00

Service Code	CPT 97530 CQ,GP
Hospital Charge Code	4252057
Hospital Revenue Code	420
Rate for Payer: Cash Price	$165.44

PT Therapeutic Activity Units

Facility

$188.00

Service Code	CPT 97530 GP
Hospital Charge Code	4252030
Hospital Revenue Code	420
Min. Negotiated Rate	$16.92
Max. Negotiated Rate	$221.00
Rate for Payer: Aetna Commercial	$221.00
Rate for Payer: Amerigroup CHIP/Medicaid	$16.92
Rate for Payer: BCBS of TX Blue Advantage	$70.85
Rate for Payer: BCBS of TX Blue Essentials	$84.70
Rate for Payer: BCBS of TX PPO	$94.47
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Multiplan Auto	$122.20
Rate for Payer: Multiplan Commercial	$122.20
Rate for Payer: Multiplan Workers Comp	$122.20
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Superior Health Plan EPO	$25.57

PT Therapeutic Activity Units BCE

Facility

$188.00

Service Code	CPT 97530 GP
Hospital Charge Code	4252030
Hospital Revenue Code	420
Min. Negotiated Rate	$16.92
Max. Negotiated Rate	$221.00
Rate for Payer: Aetna Commercial	$221.00
Rate for Payer: Amerigroup CHIP/Medicaid	$16.92
Rate for Payer: BCBS of TX Blue Advantage	$70.85
Rate for Payer: BCBS of TX Blue Essentials	$84.70
Rate for Payer: BCBS of TX PPO	$94.47
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cash Price	$165.44
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Multiplan Auto	$122.20
Rate for Payer: Multiplan Commercial	$122.20
Rate for Payer: Multiplan Workers Comp	$122.20
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Superior Health Plan EPO	$25.57

PT Therapeutic Activity Units BCE

Facility

$188.00

Service Code	CPT 97530 GP
Hospital Charge Code	4252030
Hospital Revenue Code	420
Rate for Payer: Cash Price	$165.44

PT Therapeutic Exercise Assistant Units

Facility

$152.00

Service Code	CPT 97110 CQ,GP
Hospital Charge Code	4252058
Hospital Revenue Code	420
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$221.00
Rate for Payer: Aetna Commercial	$221.00
Rate for Payer: Amerigroup CHIP/Medicaid	$13.68
Rate for Payer: BCBS of TX Blue Advantage	$54.55
Rate for Payer: BCBS of TX Blue Essentials	$65.21
Rate for Payer: BCBS of TX PPO	$72.73
Rate for Payer: Cash Price	$133.76
Rate for Payer: Cash Price	$133.76
Rate for Payer: Cash Price	$133.76
Rate for Payer: Cash Price	$133.76
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Multiplan Auto	$98.80
Rate for Payer: Multiplan Commercial	$98.80
Rate for Payer: Multiplan Workers Comp	$98.80
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Superior Health Plan EPO	$20.67

PT Therapeutic Exercise Assistant Units BCE

Facility

$152.00

Service Code	CPT 97110 CQ,GP
Hospital Charge Code	4252058
Hospital Revenue Code	420
Rate for Payer: Cash Price	$133.76

PT Therapeutic Exercise Assistant Units BCE

Facility

$152.00

Service Code	CPT 97110 CQ,GP
Hospital Charge Code	4252058
Hospital Revenue Code	420
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$221.00
Rate for Payer: Aetna Commercial	$221.00
Rate for Payer: Amerigroup CHIP/Medicaid	$13.68
Rate for Payer: BCBS of TX Blue Advantage	$54.55
Rate for Payer: BCBS of TX Blue Essentials	$65.21
Rate for Payer: BCBS of TX PPO	$72.73
Rate for Payer: Cash Price	$133.76
Rate for Payer: Cash Price	$133.76
Rate for Payer: Cash Price	$133.76
Rate for Payer: Cash Price	$133.76
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Multiplan Auto	$98.80
Rate for Payer: Multiplan Commercial	$98.80
Rate for Payer: Multiplan Workers Comp	$98.80
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Superior Health Plan EPO	$20.67

PT Therapeutic Exercise Units

Facility

$152.00

Service Code	CPT 97110 GP
Hospital Charge Code	4252025
Hospital Revenue Code	420
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$221.00
Rate for Payer: Aetna Commercial	$221.00
Rate for Payer: Amerigroup CHIP/Medicaid	$13.68
Rate for Payer: BCBS of TX Blue Advantage	$54.55
Rate for Payer: BCBS of TX Blue Essentials	$65.21
Rate for Payer: BCBS of TX PPO	$72.73
Rate for Payer: Cash Price	$133.76
Rate for Payer: Cash Price	$133.76
Rate for Payer: Cash Price	$133.76
Rate for Payer: Cash Price	$133.76
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Multiplan Auto	$98.80
Rate for Payer: Multiplan Commercial	$98.80
Rate for Payer: Multiplan Workers Comp	$98.80
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Superior Health Plan EPO	$20.67

Know your out-of-pocket cost for care.

All Charges