White Rock Medical Center

All Charges

Charge

Type

Setting

Price

STOCKINETTE, IMPERVIOUS X-LARGE 12'''' X 48'''' -- DHF

Facility

$354.16

Hospital Charge Code	80241557
Hospital Revenue Code	270
Min. Negotiated Rate	$31.87
Max. Negotiated Rate	$230.20
Rate for Payer: Aetna Commercial	$194.79
Rate for Payer: Amerigroup CHIP/Medicaid	$31.87
Rate for Payer: BCBS of TX Blue Advantage	$106.25
Rate for Payer: BCBS of TX Blue Essentials	$127.50
Rate for Payer: BCBS of TX PPO	$141.66
Rate for Payer: Cash Price	$311.66
Rate for Payer: Multiplan Auto	$230.20
Rate for Payer: Multiplan Commercial	$230.20
Rate for Payer: Multiplan Workers Comp	$230.20
Rate for Payer: Scott and White EPO/PPO	$177.08
Rate for Payer: Superior Health Plan EPO	$48.17

STOCKINETTE, TUBULAR 100% COTTN 2-PLY 6''''X48'''' STERL -- DHF

Facility

$354.16

Hospital Charge Code	80241557
Hospital Revenue Code	270
Rate for Payer: Cash Price	$311.66

STOCKINETTE, TUBULAR 100% COTTN 2-PLY 6''''X48'''' STERL -- DHF

Facility

$354.16

Hospital Charge Code	80241557
Hospital Revenue Code	270
Min. Negotiated Rate	$31.87
Max. Negotiated Rate	$230.20
Rate for Payer: Aetna Commercial	$194.79
Rate for Payer: Amerigroup CHIP/Medicaid	$31.87
Rate for Payer: BCBS of TX Blue Advantage	$106.25
Rate for Payer: BCBS of TX Blue Essentials	$127.50
Rate for Payer: BCBS of TX PPO	$141.66
Rate for Payer: Cash Price	$311.66
Rate for Payer: Multiplan Auto	$230.20
Rate for Payer: Multiplan Commercial	$230.20
Rate for Payer: Multiplan Workers Comp	$230.20
Rate for Payer: Scott and White EPO/PPO	$177.08
Rate for Payer: Superior Health Plan EPO	$48.17

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC

Facility

$47,450.60

Service Code	MSDRG 327
Min. Negotiated Rate	$20,676.37
Max. Negotiated Rate	$47,450.60
Rate for Payer: Aetna Commercial	$28,095.75
Rate for Payer: Aetna Medicare	$31,014.56
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$20,676.37
Rate for Payer: Amerigroup Medicare	$20,676.37
Rate for Payer: BCBS of TX Blue Advantage	$22,273.14
Rate for Payer: BCBS of TX Blue Essentials	$25,635.49
Rate for Payer: BCBS of TX Medicare	$20,676.37
Rate for Payer: BCBS of TX PPO	$28,484.98
Rate for Payer: Cigna Commercial	$32,166.51
Rate for Payer: Cigna Medicare	$20,676.37
Rate for Payer: Employer Direct Commercial	$20,676.37
Rate for Payer: Humana Medicare/TRICARE	$20,676.37
Rate for Payer: Molina Dual Medicare/Medicaid	$20,676.37
Rate for Payer: Molina Medicare	$20,676.37
Rate for Payer: Multiplan Auto	$47,450.60
Rate for Payer: Multiplan Commercial	$47,450.60
Rate for Payer: Multiplan Workers Comp	$47,450.60
Rate for Payer: Scott and White EPO/PPO	$21,852.25
Rate for Payer: Scott and White Medicare	$20,676.37
Rate for Payer: Superior Health Plan EPO	$20,676.37
Rate for Payer: Superior Health Plan Medicare	$20,676.37
Rate for Payer: Universal American Dual Medicare/Medicaid	$20,676.37
Rate for Payer: Universal American Medicare	$20,676.37
Rate for Payer: Wellcare Medicare	$20,676.37
Rate for Payer: Wellmed Medicare	$20,676.37

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC

Facility

$96,501.00

Service Code	MSDRG 326
Min. Negotiated Rate	$39,098.84
Max. Negotiated Rate	$96,501.00
Rate for Payer: Aetna Commercial	$57,138.75
Rate for Payer: Aetna Medicare	$58,648.26
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$39,098.84
Rate for Payer: Amerigroup Medicare	$39,098.84
Rate for Payer: BCBS of TX Blue Advantage	$46,156.20
Rate for Payer: BCBS of TX Blue Essentials	$54,235.63
Rate for Payer: BCBS of TX Medicare	$39,098.84
Rate for Payer: BCBS of TX PPO	$60,264.15
Rate for Payer: Cigna Commercial	$65,417.52
Rate for Payer: Cigna Medicare	$39,098.84
Rate for Payer: Employer Direct Commercial	$39,098.84
Rate for Payer: Humana Medicare/TRICARE	$39,098.84
Rate for Payer: Molina Dual Medicare/Medicaid	$39,098.84
Rate for Payer: Molina Medicare	$39,098.84
Rate for Payer: Multiplan Auto	$96,501.00
Rate for Payer: Multiplan Commercial	$96,501.00
Rate for Payer: Multiplan Workers Comp	$96,501.00
Rate for Payer: Scott and White EPO/PPO	$44,441.25
Rate for Payer: Scott and White Medicare	$39,098.84
Rate for Payer: Superior Health Plan EPO	$39,098.84
Rate for Payer: Superior Health Plan Medicare	$39,098.84
Rate for Payer: Universal American Dual Medicare/Medicaid	$39,098.84
Rate for Payer: Universal American Medicare	$39,098.84
Rate for Payer: Wellcare Medicare	$39,098.84
Rate for Payer: Wellmed Medicare	$39,098.84

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC

Facility

$30,348.70

Service Code	MSDRG 328
Min. Negotiated Rate	$13,207.02
Max. Negotiated Rate	$30,348.70
Rate for Payer: Aetna Commercial	$17,969.62
Rate for Payer: Aetna Medicare	$21,379.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14,253.20
Rate for Payer: Amerigroup Medicare	$14,253.20
Rate for Payer: BCBS of TX Blue Advantage	$13,207.02
Rate for Payer: BCBS of TX Blue Essentials	$15,912.93
Rate for Payer: BCBS of TX Medicare	$14,253.20
Rate for Payer: BCBS of TX PPO	$17,681.72
Rate for Payer: Cigna Commercial	$20,573.22
Rate for Payer: Cigna Medicare	$14,253.20
Rate for Payer: Employer Direct Commercial	$14,253.20
Rate for Payer: Humana Medicare/TRICARE	$14,253.20
Rate for Payer: Molina Dual Medicare/Medicaid	$14,253.20
Rate for Payer: Molina Medicare	$14,253.20
Rate for Payer: Multiplan Auto	$30,348.70
Rate for Payer: Multiplan Commercial	$30,348.70
Rate for Payer: Multiplan Workers Comp	$30,348.70
Rate for Payer: Scott and White EPO/PPO	$13,976.38
Rate for Payer: Scott and White Medicare	$14,253.20
Rate for Payer: Superior Health Plan EPO	$14,253.20
Rate for Payer: Superior Health Plan Medicare	$14,253.20
Rate for Payer: Universal American Dual Medicare/Medicaid	$14,253.20
Rate for Payer: Universal American Medicare	$14,253.20
Rate for Payer: Wellcare Medicare	$14,253.20
Rate for Payer: Wellmed Medicare	$14,253.20

Stool Culture

Facility

$375.00

Service Code	CPT 87045
Hospital Charge Code	4107055
Hospital Revenue Code	306
Rate for Payer: Cash Price	$330.00

Stool Culture

Facility

$375.00

Service Code	CPT 87045
Hospital Charge Code	4107055
Hospital Revenue Code	306
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$243.75
Rate for Payer: Aetna Commercial	$9.90
Rate for Payer: Aetna Medicare	$14.16
Rate for Payer: Amerigroup CHIP/Medicaid	$3.68
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$9.44
Rate for Payer: Amerigroup Medicare	$9.44
Rate for Payer: BCBS of TX Blue Advantage	$15.58
Rate for Payer: BCBS of TX Blue Essentials	$18.69
Rate for Payer: BCBS of TX Medicare	$9.44
Rate for Payer: BCBS of TX PPO	$20.86
Rate for Payer: Cash Price	$330.00
Rate for Payer: Cash Price	$330.00
Rate for Payer: Cigna Medicaid	$9.44
Rate for Payer: Cigna Medicare	$9.44
Rate for Payer: Employer Direct Commercial	$9.44
Rate for Payer: Humana Medicare/TRICARE	$9.44
Rate for Payer: Molina CHIP/Medicaid	$9.44
Rate for Payer: Molina Dual Medicare/Medicaid	$9.44
Rate for Payer: Molina Medicare	$9.44
Rate for Payer: Multiplan Auto	$243.75
Rate for Payer: Multiplan Commercial	$243.75
Rate for Payer: Multiplan Workers Comp	$243.75
Rate for Payer: Parkland Medicaid	$9.44
Rate for Payer: Scott and White EPO/PPO	$11.80
Rate for Payer: Scott and White Medicare	$9.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.44
Rate for Payer: Superior Health Plan EPO	$9.44
Rate for Payer: Superior Health Plan Medicare	$9.44
Rate for Payer: Universal American Dual Medicare/Medicaid	$9.44
Rate for Payer: Universal American Medicare	$9.44
Rate for Payer: Wellcare Medicare	$9.44
Rate for Payer: Wellmed Medicare	$9.44

STOPCOCK, 3-WAY STD BORE W/ROTATING MALE LUER LOCK -- DHF

Facility

$65.75

Hospital Charge Code	54200860
Hospital Revenue Code	270
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$42.74
Rate for Payer: Aetna Commercial	$36.16
Rate for Payer: Amerigroup CHIP/Medicaid	$5.92
Rate for Payer: BCBS of TX Blue Advantage	$19.72
Rate for Payer: BCBS of TX Blue Essentials	$23.67
Rate for Payer: BCBS of TX PPO	$26.30
Rate for Payer: Cash Price	$57.86
Rate for Payer: Multiplan Auto	$42.74
Rate for Payer: Multiplan Commercial	$42.74
Rate for Payer: Multiplan Workers Comp	$42.74
Rate for Payer: Scott and White EPO/PPO	$32.88
Rate for Payer: Superior Health Plan EPO	$8.94

STOPCOCK, 3-WAY STD BORE W/ROTATING MALE LUER LOCK -- DHF

Facility

$65.75

Hospital Charge Code	54200860
Hospital Revenue Code	270
Rate for Payer: Cash Price	$57.86

STOPCOCK 3W DBL -- DHF

Facility

$101.80

Hospital Charge Code	54201264
Hospital Revenue Code	270
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$66.17
Rate for Payer: Aetna Commercial	$55.99
Rate for Payer: Amerigroup CHIP/Medicaid	$9.16
Rate for Payer: BCBS of TX Blue Advantage	$30.54
Rate for Payer: BCBS of TX Blue Essentials	$36.65
Rate for Payer: BCBS of TX PPO	$40.72
Rate for Payer: Cash Price	$89.58
Rate for Payer: Multiplan Auto	$66.17
Rate for Payer: Multiplan Commercial	$66.17
Rate for Payer: Multiplan Workers Comp	$66.17
Rate for Payer: Scott and White EPO/PPO	$50.90
Rate for Payer: Superior Health Plan EPO	$13.84

STOPCOCK 3W DBL -- DHF

Facility

$101.80

Hospital Charge Code	54201264
Hospital Revenue Code	270
Rate for Payer: Cash Price	$89.58

STOPCOCK W MLL -- DHF

Facility

$108.14

Hospital Charge Code	54202502
Hospital Revenue Code	272
Rate for Payer: Cash Price	$95.16

STOPCOCK W MLL -- DHF

Facility

$108.14

Hospital Charge Code	54202502
Hospital Revenue Code	272
Min. Negotiated Rate	$9.73
Max. Negotiated Rate	$70.29
Rate for Payer: Aetna Commercial	$59.48
Rate for Payer: Amerigroup CHIP/Medicaid	$9.73
Rate for Payer: BCBS of TX Blue Advantage	$32.44
Rate for Payer: BCBS of TX Blue Essentials	$38.93
Rate for Payer: BCBS of TX PPO	$43.26
Rate for Payer: Cash Price	$95.16
Rate for Payer: Multiplan Auto	$70.29
Rate for Payer: Multiplan Commercial	$70.29
Rate for Payer: Multiplan Workers Comp	$70.29
Rate for Payer: Scott and White EPO/PPO	$54.07
Rate for Payer: Superior Health Plan EPO	$14.71

STPLR SKN SUBCUTICULA -- DHF

Facility

$242.55

Hospital Charge Code	81940017
Hospital Revenue Code	272
Min. Negotiated Rate	$21.83
Max. Negotiated Rate	$157.66
Rate for Payer: Aetna Commercial	$133.40
Rate for Payer: Amerigroup CHIP/Medicaid	$21.83
Rate for Payer: BCBS of TX Blue Advantage	$72.76
Rate for Payer: BCBS of TX Blue Essentials	$87.32
Rate for Payer: BCBS of TX PPO	$97.02
Rate for Payer: Cash Price	$213.44
Rate for Payer: Multiplan Auto	$157.66
Rate for Payer: Multiplan Commercial	$157.66
Rate for Payer: Multiplan Workers Comp	$157.66
Rate for Payer: Scott and White EPO/PPO	$121.28
Rate for Payer: Superior Health Plan EPO	$32.99

STPLR SKN SUBCUTICULA -- DHF

Facility

$242.55

Hospital Charge Code	81940017
Hospital Revenue Code	272
Rate for Payer: Cash Price	$213.44

ST PRIMARY CNTFLW -- DHF

Facility

$118.74

Hospital Charge Code	54200209
Hospital Revenue Code	270
Rate for Payer: Cash Price	$104.49

ST PRIMARY CNTFLW -- DHF

Facility

$118.74

Hospital Charge Code	54200209
Hospital Revenue Code	270
Min. Negotiated Rate	$10.69
Max. Negotiated Rate	$77.18
Rate for Payer: Aetna Commercial	$65.31
Rate for Payer: Amerigroup CHIP/Medicaid	$10.69
Rate for Payer: BCBS of TX Blue Advantage	$35.62
Rate for Payer: BCBS of TX Blue Essentials	$42.75
Rate for Payer: BCBS of TX PPO	$47.50
Rate for Payer: Cash Price	$104.49
Rate for Payer: Multiplan Auto	$77.18
Rate for Payer: Multiplan Commercial	$77.18
Rate for Payer: Multiplan Workers Comp	$77.18
Rate for Payer: Scott and White EPO/PPO	$59.37
Rate for Payer: Superior Health Plan EPO	$16.15

STRAPPING UNA BOOT LT

Facility

$353.00

Service Code	CPT 29580 LT
Hospital Charge Code	7150832
Hospital Revenue Code	761
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$326.44
Rate for Payer: Aetna Commercial	$194.15
Rate for Payer: Aetna Medicare	$216.15
Rate for Payer: Amerigroup CHIP/Medicaid	$31.77
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$144.10
Rate for Payer: Amerigroup Medicare	$144.10
Rate for Payer: BCBS of TX Blue Advantage	$70.51
Rate for Payer: BCBS of TX Blue Essentials	$84.44
Rate for Payer: BCBS of TX Medicare	$144.10
Rate for Payer: BCBS of TX PPO	$106.39
Rate for Payer: Cash Price	$310.64
Rate for Payer: Cash Price	$310.64
Rate for Payer: Cash Price	$310.64
Rate for Payer: Cigna Commercial	$326.44
Rate for Payer: Cigna Medicaid	$35.16
Rate for Payer: Cigna Medicare	$144.10
Rate for Payer: Employer Direct Commercial	$144.10
Rate for Payer: Humana Medicare/TRICARE	$144.10
Rate for Payer: Molina CHIP/Medicaid	$35.16
Rate for Payer: Molina Dual Medicare/Medicaid	$144.10
Rate for Payer: Molina Medicare	$144.10
Rate for Payer: Multiplan Auto	$229.45
Rate for Payer: Multiplan Commercial	$229.45
Rate for Payer: Multiplan Workers Comp	$229.45
Rate for Payer: Parkland Medicaid	$35.16
Rate for Payer: Scott and White EPO/PPO	$2.58
Rate for Payer: Scott and White Medicare	$144.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$35.16
Rate for Payer: Superior Health Plan EPO	$144.10
Rate for Payer: Superior Health Plan Medicare	$144.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$144.10
Rate for Payer: Universal American Medicare	$144.10
Rate for Payer: Wellcare Medicare	$144.10
Rate for Payer: Wellmed Medicare	$144.10

STRAPPING UNA BOOT RT

Facility

$353.00

Service Code	CPT 29580 RT
Hospital Charge Code	7150831
Hospital Revenue Code	761
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$326.44
Rate for Payer: Aetna Commercial	$194.15
Rate for Payer: Aetna Medicare	$216.15
Rate for Payer: Amerigroup CHIP/Medicaid	$31.77
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$144.10
Rate for Payer: Amerigroup Medicare	$144.10
Rate for Payer: BCBS of TX Blue Advantage	$70.51
Rate for Payer: BCBS of TX Blue Essentials	$84.44
Rate for Payer: BCBS of TX Medicare	$144.10
Rate for Payer: BCBS of TX PPO	$106.39
Rate for Payer: Cash Price	$310.64
Rate for Payer: Cash Price	$310.64
Rate for Payer: Cash Price	$310.64
Rate for Payer: Cigna Commercial	$326.44
Rate for Payer: Cigna Medicaid	$35.16
Rate for Payer: Cigna Medicare	$144.10
Rate for Payer: Employer Direct Commercial	$144.10
Rate for Payer: Humana Medicare/TRICARE	$144.10
Rate for Payer: Molina CHIP/Medicaid	$35.16
Rate for Payer: Molina Dual Medicare/Medicaid	$144.10
Rate for Payer: Molina Medicare	$144.10
Rate for Payer: Multiplan Auto	$229.45
Rate for Payer: Multiplan Commercial	$229.45
Rate for Payer: Multiplan Workers Comp	$229.45
Rate for Payer: Parkland Medicaid	$35.16
Rate for Payer: Scott and White EPO/PPO	$2.58
Rate for Payer: Scott and White Medicare	$144.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$35.16
Rate for Payer: Superior Health Plan EPO	$144.10
Rate for Payer: Superior Health Plan Medicare	$144.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$144.10
Rate for Payer: Universal American Medicare	$144.10
Rate for Payer: Wellcare Medicare	$144.10
Rate for Payer: Wellmed Medicare	$144.10

Strep A PCR

Facility

$176.00

Service Code	CPT 87561
Hospital Charge Code	8554470
Hospital Revenue Code	306
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$114.40
Rate for Payer: Aetna Commercial	$36.84
Rate for Payer: Aetna Medicare	$52.64
Rate for Payer: Amerigroup CHIP/Medicaid	$13.69
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$35.09
Rate for Payer: Amerigroup Medicare	$35.09
Rate for Payer: BCBS of TX Blue Advantage	$57.90
Rate for Payer: BCBS of TX Blue Essentials	$69.48
Rate for Payer: BCBS of TX Medicare	$35.09
Rate for Payer: BCBS of TX PPO	$77.55
Rate for Payer: Cash Price	$154.88
Rate for Payer: Cash Price	$154.88
Rate for Payer: Cigna Medicaid	$35.09
Rate for Payer: Cigna Medicare	$35.09
Rate for Payer: Employer Direct Commercial	$35.09
Rate for Payer: Humana Medicare/TRICARE	$35.09
Rate for Payer: Molina CHIP/Medicaid	$35.09
Rate for Payer: Molina Dual Medicare/Medicaid	$35.09
Rate for Payer: Molina Medicare	$35.09
Rate for Payer: Multiplan Auto	$114.40
Rate for Payer: Multiplan Commercial	$114.40
Rate for Payer: Multiplan Workers Comp	$114.40
Rate for Payer: Parkland Medicaid	$35.09
Rate for Payer: Scott and White EPO/PPO	$43.86
Rate for Payer: Scott and White Medicare	$35.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$35.09
Rate for Payer: Superior Health Plan EPO	$35.09
Rate for Payer: Superior Health Plan Medicare	$35.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$35.09
Rate for Payer: Universal American Medicare	$35.09
Rate for Payer: Wellcare Medicare	$35.09
Rate for Payer: Wellmed Medicare	$35.09

Strep A PCR

Facility

$176.00

Service Code	CPT 87561
Hospital Charge Code	8554470
Hospital Revenue Code	306
Rate for Payer: Cash Price	$154.88

Streptococcus Group B Antigen PCR

Facility

$222.00

Service Code	CPT 87653
Hospital Charge Code	4108765
Hospital Revenue Code	300
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$144.30
Rate for Payer: Aetna Commercial	$36.84
Rate for Payer: Aetna Medicare	$52.64
Rate for Payer: Amerigroup CHIP/Medicaid	$13.69
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$35.09
Rate for Payer: Amerigroup Medicare	$35.09
Rate for Payer: BCBS of TX Blue Advantage	$57.90
Rate for Payer: BCBS of TX Blue Essentials	$69.48
Rate for Payer: BCBS of TX Medicare	$35.09
Rate for Payer: BCBS of TX PPO	$77.55
Rate for Payer: Cash Price	$195.36
Rate for Payer: Cash Price	$195.36
Rate for Payer: Cigna Medicaid	$35.09
Rate for Payer: Cigna Medicare	$35.09
Rate for Payer: Employer Direct Commercial	$35.09
Rate for Payer: Humana Medicare/TRICARE	$35.09
Rate for Payer: Molina CHIP/Medicaid	$35.09
Rate for Payer: Molina Dual Medicare/Medicaid	$35.09
Rate for Payer: Molina Medicare	$35.09
Rate for Payer: Multiplan Auto	$144.30
Rate for Payer: Multiplan Commercial	$144.30
Rate for Payer: Multiplan Workers Comp	$144.30
Rate for Payer: Parkland Medicaid	$35.09
Rate for Payer: Scott and White EPO/PPO	$43.86
Rate for Payer: Scott and White Medicare	$35.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$35.09
Rate for Payer: Superior Health Plan EPO	$35.09
Rate for Payer: Superior Health Plan Medicare	$35.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$35.09
Rate for Payer: Universal American Medicare	$35.09
Rate for Payer: Wellcare Medicare	$35.09
Rate for Payer: Wellmed Medicare	$35.09

Streptococcus Group B Antigen PCR

Facility

$222.00

Service Code	CPT 87653
Hospital Charge Code	4108765
Hospital Revenue Code	300
Rate for Payer: Cash Price	$195.36

Streptococcus pneumoniae Ag SO

Facility

$138.00

Service Code	CPT 87899
Hospital Charge Code	1605872
Hospital Revenue Code	306
Min. Negotiated Rate	$6.27
Max. Negotiated Rate	$89.70
Rate for Payer: Aetna Commercial	$16.87
Rate for Payer: Aetna Medicare	$24.10
Rate for Payer: Amerigroup CHIP/Medicaid	$6.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16.07
Rate for Payer: Amerigroup Medicare	$16.07
Rate for Payer: BCBS of TX Blue Advantage	$26.52
Rate for Payer: BCBS of TX Blue Essentials	$31.82
Rate for Payer: BCBS of TX Medicare	$16.07
Rate for Payer: BCBS of TX PPO	$35.51
Rate for Payer: Cash Price	$121.44
Rate for Payer: Cash Price	$121.44
Rate for Payer: Cigna Medicaid	$16.07
Rate for Payer: Cigna Medicare	$16.07
Rate for Payer: Employer Direct Commercial	$16.07
Rate for Payer: Humana Medicare/TRICARE	$16.07
Rate for Payer: Molina CHIP/Medicaid	$16.07
Rate for Payer: Molina Dual Medicare/Medicaid	$16.07
Rate for Payer: Molina Medicare	$16.07
Rate for Payer: Multiplan Auto	$89.70
Rate for Payer: Multiplan Commercial	$89.70
Rate for Payer: Multiplan Workers Comp	$89.70
Rate for Payer: Parkland Medicaid	$16.07
Rate for Payer: Scott and White EPO/PPO	$20.09
Rate for Payer: Scott and White Medicare	$16.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16.07
Rate for Payer: Superior Health Plan EPO	$16.07
Rate for Payer: Superior Health Plan Medicare	$16.07
Rate for Payer: Universal American Dual Medicare/Medicaid	$16.07
Rate for Payer: Universal American Medicare	$16.07
Rate for Payer: Wellcare Medicare	$16.07
Rate for Payer: Wellmed Medicare	$16.07

Know your out-of-pocket cost for care.

All Charges