White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Second Dose Pfizer Peds 0072A

Facility

$60.00

Service Code	CPT 0072A
Hospital Charge Code	8734595
Hospital Revenue Code	771
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna Commercial	$33.00
Rate for Payer: Amerigroup CHIP/Medicaid	$5.40
Rate for Payer: BCBS of TX Blue Advantage	$18.00
Rate for Payer: BCBS of TX Blue Essentials	$21.60
Rate for Payer: BCBS of TX PPO	$24.00
Rate for Payer: Cash Price	$52.80
Rate for Payer: Multiplan Auto	$39.00
Rate for Payer: Multiplan Commercial	$39.00
Rate for Payer: Multiplan Workers Comp	$39.00
Rate for Payer: Scott and White EPO/PPO	$30.00
Rate for Payer: Superior Health Plan EPO	$8.16

Second Dose Pfizer Peds 0072A

Facility

$60.00

Service Code	CPT 0072A
Hospital Charge Code	8734595
Hospital Revenue Code	771
Rate for Payer: Cash Price	$52.80

Sedimentation Rate

Facility

$191.00

Service Code	CPT 85652
Hospital Charge Code	1630019
Hospital Revenue Code	305
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$124.15
Rate for Payer: Aetna Commercial	$2.84
Rate for Payer: Aetna Medicare	$4.05
Rate for Payer: Amerigroup CHIP/Medicaid	$1.05
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2.70
Rate for Payer: Amerigroup Medicare	$2.70
Rate for Payer: BCBS of TX Blue Advantage	$4.46
Rate for Payer: BCBS of TX Blue Essentials	$5.35
Rate for Payer: BCBS of TX Medicare	$2.70
Rate for Payer: BCBS of TX PPO	$5.97
Rate for Payer: Cash Price	$168.08
Rate for Payer: Cash Price	$168.08
Rate for Payer: Cigna Medicaid	$2.70
Rate for Payer: Cigna Medicare	$2.70
Rate for Payer: Employer Direct Commercial	$2.70
Rate for Payer: Humana Medicare/TRICARE	$2.70
Rate for Payer: Molina CHIP/Medicaid	$2.70
Rate for Payer: Molina Dual Medicare/Medicaid	$2.70
Rate for Payer: Molina Medicare	$2.70
Rate for Payer: Multiplan Auto	$124.15
Rate for Payer: Multiplan Commercial	$124.15
Rate for Payer: Multiplan Workers Comp	$124.15
Rate for Payer: Parkland Medicaid	$2.70
Rate for Payer: Scott and White EPO/PPO	$3.38
Rate for Payer: Scott and White Medicare	$2.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.70
Rate for Payer: Superior Health Plan EPO	$2.70
Rate for Payer: Superior Health Plan Medicare	$2.70
Rate for Payer: Universal American Dual Medicare/Medicaid	$2.70
Rate for Payer: Universal American Medicare	$2.70
Rate for Payer: Wellcare Medicare	$2.70
Rate for Payer: Wellmed Medicare	$2.70

Sedimentation Rate

Facility

$191.00

Service Code	CPT 85652
Hospital Charge Code	1630019
Hospital Revenue Code	305
Rate for Payer: Cash Price	$168.08

SEE CLEAR LAPARSCOPIC SMOKE EVAC

Facility

$133.93

Hospital Charge Code	117227
Hospital Revenue Code	270
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$87.05
Rate for Payer: Aetna Commercial	$73.66
Rate for Payer: Amerigroup CHIP/Medicaid	$12.05
Rate for Payer: BCBS of TX Blue Advantage	$40.18
Rate for Payer: BCBS of TX Blue Essentials	$48.21
Rate for Payer: BCBS of TX PPO	$53.57
Rate for Payer: Cash Price	$117.86
Rate for Payer: Multiplan Auto	$87.05
Rate for Payer: Multiplan Commercial	$87.05
Rate for Payer: Multiplan Workers Comp	$87.05
Rate for Payer: Scott and White EPO/PPO	$66.96
Rate for Payer: Superior Health Plan EPO	$18.21

SEE CLEAR LAPARSCOPIC SMOKE EVAC

Facility

$133.93

Hospital Charge Code	117227
Hospital Revenue Code	270
Rate for Payer: Cash Price	$117.86

SEIZURES WITH MCC

Facility

$37,667.50

Service Code	MSDRG 100
Min. Negotiated Rate	$13,704.10
Max. Negotiated Rate	$37,667.50
Rate for Payer: Aetna Commercial	$22,303.12
Rate for Payer: Aetna Medicare	$25,503.03
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$17,002.02
Rate for Payer: Amerigroup Medicare	$17,002.02
Rate for Payer: BCBS of TX Blue Advantage	$13,704.10
Rate for Payer: BCBS of TX Blue Essentials	$18,702.16
Rate for Payer: BCBS of TX Medicare	$17,002.02
Rate for Payer: BCBS of TX PPO	$20,780.98
Rate for Payer: Cigna Commercial	$25,534.60
Rate for Payer: Cigna Medicare	$17,002.02
Rate for Payer: Employer Direct Commercial	$17,002.02
Rate for Payer: Humana Medicare/TRICARE	$17,002.02
Rate for Payer: Molina Dual Medicare/Medicaid	$17,002.02
Rate for Payer: Molina Medicare	$17,002.02
Rate for Payer: Multiplan Auto	$37,667.50
Rate for Payer: Multiplan Commercial	$37,667.50
Rate for Payer: Multiplan Workers Comp	$37,667.50
Rate for Payer: Scott and White EPO/PPO	$17,346.88
Rate for Payer: Scott and White Medicare	$17,002.02
Rate for Payer: Superior Health Plan EPO	$17,002.02
Rate for Payer: Superior Health Plan Medicare	$17,002.02
Rate for Payer: Universal American Dual Medicare/Medicaid	$17,002.02
Rate for Payer: Universal American Medicare	$17,002.02
Rate for Payer: Wellcare Medicare	$17,002.02
Rate for Payer: Wellmed Medicare	$17,002.02

SEIZURES WITHOUT MCC

Facility

$17,282.40

Service Code	MSDRG 101
Min. Negotiated Rate	$6,871.40
Max. Negotiated Rate	$17,282.40
Rate for Payer: Aetna Commercial	$10,233.00
Rate for Payer: Aetna Medicare	$14,018.60
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$9,345.73
Rate for Payer: Amerigroup Medicare	$9,345.73
Rate for Payer: BCBS of TX Blue Advantage	$6,871.40
Rate for Payer: BCBS of TX Blue Essentials	$8,970.31
Rate for Payer: BCBS of TX Medicare	$9,345.73
Rate for Payer: BCBS of TX PPO	$9,967.39
Rate for Payer: Cigna Commercial	$11,715.65
Rate for Payer: Cigna Medicare	$9,345.73
Rate for Payer: Employer Direct Commercial	$9,345.73
Rate for Payer: Humana Medicare/TRICARE	$9,345.73
Rate for Payer: Molina Dual Medicare/Medicaid	$9,345.73
Rate for Payer: Molina Medicare	$9,345.73
Rate for Payer: Multiplan Auto	$17,282.40
Rate for Payer: Multiplan Commercial	$17,282.40
Rate for Payer: Multiplan Workers Comp	$17,282.40
Rate for Payer: Scott and White EPO/PPO	$7,959.00
Rate for Payer: Scott and White Medicare	$9,345.73
Rate for Payer: Superior Health Plan EPO	$9,345.73
Rate for Payer: Superior Health Plan Medicare	$9,345.73
Rate for Payer: Universal American Dual Medicare/Medicaid	$9,345.73
Rate for Payer: Universal American Medicare	$9,345.73
Rate for Payer: Wellcare Medicare	$9,345.73
Rate for Payer: Wellmed Medicare	$9,345.73

SELECT CATH PLCMNT, 1ST ORD, ART AB

Facility

$3,394.00

Service Code	CPT 36245
Hospital Charge Code	2301802
Hospital Revenue Code	361
Rate for Payer: Cash Price	$2,986.72

SELECT CATH PLCMNT, 1ST ORD, ART AB

Facility

$3,394.00

Service Code	CPT 36245
Hospital Charge Code	2301802
Hospital Revenue Code	361
Min. Negotiated Rate	$305.46
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$1,866.70
Rate for Payer: Amerigroup CHIP/Medicaid	$305.46
Rate for Payer: Cash Price	$2,986.72
Rate for Payer: Cash Price	$2,986.72
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	$1,697.00
Rate for Payer: Superior Health Plan EPO	$461.58

SELECT CATH PLCMNT, 2ND ORD, ART AB

Facility

$3,747.00

Service Code	CPT 36246
Hospital Charge Code	2301810
Hospital Revenue Code	361
Min. Negotiated Rate	$337.23
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$2,060.85
Rate for Payer: Amerigroup CHIP/Medicaid	$337.23
Rate for Payer: Cash Price	$3,297.36
Rate for Payer: Cash Price	$3,297.36
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	$1,873.50
Rate for Payer: Superior Health Plan EPO	$509.59

SELECT CATH PLCMNT, 2ND ORD, ART AB

Facility

$3,747.00

Service Code	CPT 36246
Hospital Charge Code	2301810
Hospital Revenue Code	361
Rate for Payer: Cash Price	$3,297.36

SELECT CATH PLCMNT, 2ND ORD, ART TH

Facility

$3,236.00

Service Code	CPT 36216
Hospital Charge Code	2301794
Hospital Revenue Code	361
Rate for Payer: Cash Price	$2,847.68

SELECT CATH PLCMNT, 2ND ORD, ART TH

Facility

$3,236.00

Service Code	CPT 36216
Hospital Charge Code	2301794
Hospital Revenue Code	361
Min. Negotiated Rate	$291.24
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$1,779.80
Rate for Payer: Amerigroup CHIP/Medicaid	$291.24
Rate for Payer: Cash Price	$2,847.68
Rate for Payer: Cash Price	$2,847.68
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	$1,618.00
Rate for Payer: Superior Health Plan EPO	$440.10

Sel Sharp Deb <=20 Sq cm

Facility

$399.00

Service Code	CPT 97597
Hospital Charge Code	7150659
Hospital Revenue Code	761
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$414.75
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	$38.00
Rate for Payer: BCBS of TX Blue Essentials	$45.00
Rate for Payer: BCBS of TX Medicare	$183.09
Rate for Payer: BCBS of TX PPO	$50.00
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	$414.75
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

Sel Sharp Deb Each Addl 20 cm

Facility

$351.00

Service Code	CPT 97598
Hospital Charge Code	7150667
Hospital Revenue Code	761
Min. Negotiated Rate	$31.59
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	$38.00
Rate for Payer: BCBS of TX Blue Essentials	$45.00
Rate for Payer: BCBS of TX PPO	$50.00
Rate for Payer: Cash Price	$308.88
Rate for Payer: Cash Price	$308.88
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	$175.50
Rate for Payer: Superior Health Plan EPO	$47.74

senna 8.6 mg Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	78419863
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$4.97
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.30
Rate for Payer: BCBS of TX Blue Essentials	$2.75
Rate for Payer: BCBS of TX PPO	$3.06
Rate for Payer: Cash Price	$5.20
Rate for Payer: Multiplan Auto	$4.97
Rate for Payer: Multiplan Commercial	$4.97
Rate for Payer: Multiplan Workers Comp	$4.97
Rate for Payer: Scott and White EPO/PPO	$3.82
Rate for Payer: Superior Health Plan EPO	$1.04

senna 8.6 mg Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	78419863
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

SENSOR DISP BIS -- DHF

Facility

$117.50

Hospital Charge Code	80340177
Hospital Revenue Code	271
Min. Negotiated Rate	$10.58
Max. Negotiated Rate	$76.38
Rate for Payer: Aetna Commercial	$64.62
Rate for Payer: Amerigroup CHIP/Medicaid	$10.58
Rate for Payer: BCBS of TX Blue Advantage	$35.25
Rate for Payer: BCBS of TX Blue Essentials	$42.30
Rate for Payer: BCBS of TX PPO	$47.00
Rate for Payer: Cash Price	$103.40
Rate for Payer: Multiplan Auto	$76.38
Rate for Payer: Multiplan Commercial	$76.38
Rate for Payer: Multiplan Workers Comp	$76.38
Rate for Payer: Scott and White EPO/PPO	$58.75
Rate for Payer: Superior Health Plan EPO	$15.98

SENSOR DISP BIS -- DHF

Facility

$117.50

Hospital Charge Code	80340177
Hospital Revenue Code	271
Rate for Payer: Cash Price	$103.40

SEPTIC ARTHRITIS WITH CC

Facility

$22,917.80

Service Code	MSDRG 549
Min. Negotiated Rate	$9,919.24
Max. Negotiated Rate	$22,917.80
Rate for Payer: Aetna Commercial	$13,569.75
Rate for Payer: Aetna Medicare	$17,193.45
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,462.30
Rate for Payer: Amerigroup Medicare	$11,462.30
Rate for Payer: BCBS of TX Blue Advantage	$9,919.24
Rate for Payer: BCBS of TX Blue Essentials	$12,838.90
Rate for Payer: BCBS of TX Medicare	$11,462.30
Rate for Payer: BCBS of TX PPO	$14,266.00
Rate for Payer: Cigna Commercial	$15,535.86
Rate for Payer: Cigna Medicare	$11,462.30
Rate for Payer: Employer Direct Commercial	$11,462.30
Rate for Payer: Humana Medicare/TRICARE	$11,462.30
Rate for Payer: Molina Dual Medicare/Medicaid	$11,462.30
Rate for Payer: Molina Medicare	$11,462.30
Rate for Payer: Multiplan Auto	$22,917.80
Rate for Payer: Multiplan Commercial	$22,917.80
Rate for Payer: Multiplan Workers Comp	$22,917.80
Rate for Payer: Scott and White EPO/PPO	$10,554.25
Rate for Payer: Scott and White Medicare	$11,462.30
Rate for Payer: Superior Health Plan EPO	$11,462.30
Rate for Payer: Superior Health Plan Medicare	$11,462.30
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,462.30
Rate for Payer: Universal American Medicare	$11,462.30
Rate for Payer: Wellcare Medicare	$11,462.30
Rate for Payer: Wellmed Medicare	$11,462.30

SEPTIC ARTHRITIS WITH MCC

Facility

$37,046.20

Service Code	MSDRG 548
Min. Negotiated Rate	$15,907.42
Max. Negotiated Rate	$37,046.20
Rate for Payer: Aetna Commercial	$21,935.25
Rate for Payer: Aetna Medicare	$25,153.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16,768.67
Rate for Payer: Amerigroup Medicare	$16,768.67
Rate for Payer: BCBS of TX Blue Advantage	$15,907.42
Rate for Payer: BCBS of TX Blue Essentials	$21,331.44
Rate for Payer: BCBS of TX Medicare	$16,768.67
Rate for Payer: BCBS of TX PPO	$23,702.52
Rate for Payer: Cigna Commercial	$25,113.42
Rate for Payer: Cigna Medicare	$16,768.67
Rate for Payer: Employer Direct Commercial	$16,768.67
Rate for Payer: Humana Medicare/TRICARE	$16,768.67
Rate for Payer: Molina Dual Medicare/Medicaid	$16,768.67
Rate for Payer: Molina Medicare	$16,768.67
Rate for Payer: Multiplan Auto	$37,046.20
Rate for Payer: Multiplan Commercial	$37,046.20
Rate for Payer: Multiplan Workers Comp	$37,046.20
Rate for Payer: Scott and White EPO/PPO	$17,060.75
Rate for Payer: Scott and White Medicare	$16,768.67
Rate for Payer: Superior Health Plan EPO	$16,768.67
Rate for Payer: Superior Health Plan Medicare	$16,768.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$16,768.67
Rate for Payer: Universal American Medicare	$16,768.67
Rate for Payer: Wellcare Medicare	$16,768.67
Rate for Payer: Wellmed Medicare	$16,768.67

SEPTIC ARTHRITIS WITHOUT CC/MCC

Facility

$17,495.20

Service Code	MSDRG 550
Min. Negotiated Rate	$7,514.68
Max. Negotiated Rate	$17,495.20
Rate for Payer: Aetna Commercial	$10,359.00
Rate for Payer: Aetna Medicare	$14,381.48
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$9,587.65
Rate for Payer: Amerigroup Medicare	$9,587.65
Rate for Payer: BCBS of TX Blue Advantage	$7,514.68
Rate for Payer: BCBS of TX Blue Essentials	$9,532.69
Rate for Payer: BCBS of TX Medicare	$9,587.65
Rate for Payer: BCBS of TX PPO	$10,592.29
Rate for Payer: Cigna Commercial	$11,859.90
Rate for Payer: Cigna Medicare	$9,587.65
Rate for Payer: Employer Direct Commercial	$9,587.65
Rate for Payer: Humana Medicare/TRICARE	$9,587.65
Rate for Payer: Molina Dual Medicare/Medicaid	$9,587.65
Rate for Payer: Molina Medicare	$9,587.65
Rate for Payer: Multiplan Auto	$17,495.20
Rate for Payer: Multiplan Commercial	$17,495.20
Rate for Payer: Multiplan Workers Comp	$17,495.20
Rate for Payer: Scott and White EPO/PPO	$8,057.00
Rate for Payer: Scott and White Medicare	$9,587.65
Rate for Payer: Superior Health Plan EPO	$9,587.65
Rate for Payer: Superior Health Plan Medicare	$9,587.65
Rate for Payer: Universal American Dual Medicare/Medicaid	$9,587.65
Rate for Payer: Universal American Medicare	$9,587.65
Rate for Payer: Wellcare Medicare	$9,587.65
Rate for Payer: Wellmed Medicare	$9,587.65

SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS

Facility

$132,333.10

Service Code	MSDRG 870
Min. Negotiated Rate	$50,705.60
Max. Negotiated Rate	$132,333.10
Rate for Payer: Aetna Commercial	$78,355.12
Rate for Payer: Aetna Medicare	$78,835.08
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$52,556.72
Rate for Payer: Amerigroup Medicare	$52,556.72
Rate for Payer: BCBS of TX Blue Advantage	$50,705.60
Rate for Payer: BCBS of TX Blue Essentials	$64,961.20
Rate for Payer: BCBS of TX Medicare	$52,556.72
Rate for Payer: BCBS of TX PPO	$72,181.91
Rate for Payer: Cigna Commercial	$89,707.91
Rate for Payer: Cigna Medicare	$52,556.72
Rate for Payer: Employer Direct Commercial	$52,556.72
Rate for Payer: Humana Medicare/TRICARE	$52,556.72
Rate for Payer: Molina Dual Medicare/Medicaid	$52,556.72
Rate for Payer: Molina Medicare	$52,556.72
Rate for Payer: Multiplan Auto	$132,333.10
Rate for Payer: Multiplan Commercial	$132,333.10
Rate for Payer: Multiplan Workers Comp	$132,333.10
Rate for Payer: Scott and White EPO/PPO	$60,942.88
Rate for Payer: Scott and White Medicare	$52,556.72
Rate for Payer: Superior Health Plan EPO	$52,556.72
Rate for Payer: Superior Health Plan Medicare	$52,556.72
Rate for Payer: Universal American Dual Medicare/Medicaid	$52,556.72
Rate for Payer: Universal American Medicare	$52,556.72
Rate for Payer: Wellcare Medicare	$52,556.72
Rate for Payer: Wellmed Medicare	$52,556.72

SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC

Facility

$37,669.40

Service Code	MSDRG 871
Min. Negotiated Rate	$15,187.60
Max. Negotiated Rate	$37,669.40
Rate for Payer: Aetna Commercial	$22,304.25
Rate for Payer: Aetna Medicare	$25,504.12
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$17,002.75
Rate for Payer: Amerigroup Medicare	$17,002.75
Rate for Payer: BCBS of TX Blue Advantage	$15,187.60
Rate for Payer: BCBS of TX Blue Essentials	$19,156.19
Rate for Payer: BCBS of TX Medicare	$17,002.75
Rate for Payer: BCBS of TX PPO	$21,285.48
Rate for Payer: Cigna Commercial	$25,535.89
Rate for Payer: Cigna Medicare	$17,002.75
Rate for Payer: Employer Direct Commercial	$17,002.75
Rate for Payer: Humana Medicare/TRICARE	$17,002.75
Rate for Payer: Molina Dual Medicare/Medicaid	$17,002.75
Rate for Payer: Molina Medicare	$17,002.75
Rate for Payer: Multiplan Auto	$37,669.40
Rate for Payer: Multiplan Commercial	$37,669.40
Rate for Payer: Multiplan Workers Comp	$37,669.40
Rate for Payer: Scott and White EPO/PPO	$17,347.75
Rate for Payer: Scott and White Medicare	$17,002.75
Rate for Payer: Superior Health Plan EPO	$17,002.75
Rate for Payer: Superior Health Plan Medicare	$17,002.75
Rate for Payer: Universal American Dual Medicare/Medicaid	$17,002.75
Rate for Payer: Universal American Medicare	$17,002.75
Rate for Payer: Wellcare Medicare	$17,002.75
Rate for Payer: Wellmed Medicare	$17,002.75

Know your out-of-pocket cost for care.

All Charges