White Rock Medical Center

All Charges

Charge

Type

Setting

Price

NAIL TROCH /GAMMA NAIL 3

Facility

$10,667.00

Service Code	HCPCS C1776
Hospital Charge Code	8692522
Hospital Revenue Code	278
Min. Negotiated Rate	$960.03
Max. Negotiated Rate	$7,680.24
Rate for Payer: Amerigroup CHIP/Medicaid	$960.03
Rate for Payer: BCBS of TX Blue Advantage	$3,200.10
Rate for Payer: BCBS of TX Blue Essentials	$3,840.12
Rate for Payer: BCBS of TX PPO	$4,266.80
Rate for Payer: Cash Price	$7,253.56
Rate for Payer: Cigna Medicaid	$7,680.24
Rate for Payer: Molina CHIP/Medicaid	$7,680.24
Rate for Payer: Multiplan Auto	$5,333.50
Rate for Payer: Multiplan Commercial	$5,333.50
Rate for Payer: Multiplan Workers Comp	$5,333.50
Rate for Payer: Parkland Medicaid	$7,680.24
Rate for Payer: Scott and White EPO/PPO	$5,333.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,680.24
Rate for Payer: Superior Health Plan EPO	$1,450.71

NAIL TROCH /GAMMA NAIL 3

Facility

$10,667.00

Service Code	HCPCS C1776
Hospital Charge Code	8692522
Hospital Revenue Code	278
Min. Negotiated Rate	$2,666.75
Max. Negotiated Rate	$5,333.50
Rate for Payer: Cash Price	$7,253.56
Rate for Payer: Cigna Commercial	$2,666.75
Rate for Payer: Multiplan Auto	$5,333.50
Rate for Payer: Multiplan Commercial	$5,333.50
Rate for Payer: Multiplan Workers Comp	$5,333.50
Rate for Payer: Scott and White EPO/PPO	$5,333.50

Nail w Compression Screw DIA 8 X 110MM

Facility

$24,307.23

Service Code	HCPCS C1713
Hospital Charge Code	992196
Hospital Revenue Code	278
Min. Negotiated Rate	$2,187.65
Max. Negotiated Rate	$17,501.21
Rate for Payer: Amerigroup CHIP/Medicaid	$2,187.65
Rate for Payer: BCBS of TX Blue Advantage	$7,292.17
Rate for Payer: BCBS of TX Blue Essentials	$8,750.60
Rate for Payer: BCBS of TX PPO	$9,722.89
Rate for Payer: Cash Price	$16,528.92
Rate for Payer: Cigna Medicaid	$17,501.21
Rate for Payer: Molina CHIP/Medicaid	$17,501.21
Rate for Payer: Multiplan Auto	$12,153.61
Rate for Payer: Multiplan Commercial	$12,153.61
Rate for Payer: Multiplan Workers Comp	$12,153.61
Rate for Payer: Parkland Medicaid	$17,501.21
Rate for Payer: Scott and White EPO/PPO	$12,153.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17,501.21
Rate for Payer: Superior Health Plan EPO	$3,305.78

Nail w Compression Screw DIA 8 X 110MM

Facility

$24,307.23

Service Code	HCPCS C1713
Hospital Charge Code	992196
Hospital Revenue Code	278
Min. Negotiated Rate	$6,076.81
Max. Negotiated Rate	$12,153.61
Rate for Payer: Cash Price	$16,528.92
Rate for Payer: Cigna Commercial	$6,076.81
Rate for Payer: Multiplan Auto	$12,153.61
Rate for Payer: Multiplan Commercial	$12,153.61
Rate for Payer: Multiplan Workers Comp	$12,153.61
Rate for Payer: Scott and White EPO/PPO	$12,153.61

NAIL W COMPRESSION SCREW DIA 8 X 110 MM

Facility

$24,307.23

Service Code	HCPCS C1713
Hospital Charge Code	992302
Hospital Revenue Code	278
Min. Negotiated Rate	$6,076.81
Max. Negotiated Rate	$12,153.61
Rate for Payer: Cash Price	$16,528.92
Rate for Payer: Cigna Commercial	$6,076.81
Rate for Payer: Multiplan Auto	$12,153.61
Rate for Payer: Multiplan Commercial	$12,153.61
Rate for Payer: Multiplan Workers Comp	$12,153.61
Rate for Payer: Scott and White EPO/PPO	$12,153.61

NAIL W COMPRESSION SCREW DIA 8 X 110 MM

Facility

$24,307.23

Service Code	HCPCS C1713
Hospital Charge Code	992302
Hospital Revenue Code	278
Min. Negotiated Rate	$2,187.65
Max. Negotiated Rate	$17,501.21
Rate for Payer: Amerigroup CHIP/Medicaid	$2,187.65
Rate for Payer: BCBS of TX Blue Advantage	$7,292.17
Rate for Payer: BCBS of TX Blue Essentials	$8,750.60
Rate for Payer: BCBS of TX PPO	$9,722.89
Rate for Payer: Cash Price	$16,528.92
Rate for Payer: Cigna Medicaid	$17,501.21
Rate for Payer: Molina CHIP/Medicaid	$17,501.21
Rate for Payer: Multiplan Auto	$12,153.61
Rate for Payer: Multiplan Commercial	$12,153.61
Rate for Payer: Multiplan Workers Comp	$12,153.61
Rate for Payer: Parkland Medicaid	$17,501.21
Rate for Payer: Scott and White EPO/PPO	$12,153.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17,501.21
Rate for Payer: Superior Health Plan EPO	$3,305.78

naloxone 0.4 mg/mL Inj Soln 1 mL

Facility

$128.00

Service Code	HCPCS J2313
Hospital Charge Code	77720016
Hospital Revenue Code	636
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$92.16
Rate for Payer: Amerigroup CHIP/Medicaid	$11.52
Rate for Payer: BCBS of TX Blue Advantage	$38.40
Rate for Payer: BCBS of TX Blue Essentials	$46.08
Rate for Payer: BCBS of TX PPO	$51.20
Rate for Payer: Cash Price	$87.04
Rate for Payer: Cigna Medicaid	$92.16
Rate for Payer: Molina CHIP/Medicaid	$92.16
Rate for Payer: Multiplan Auto	$83.20
Rate for Payer: Multiplan Commercial	$83.20
Rate for Payer: Multiplan Workers Comp	$83.20
Rate for Payer: Parkland Medicaid	$92.16
Rate for Payer: Scott and White EPO/PPO	$64.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$92.16
Rate for Payer: Superior Health Plan EPO	$17.41

naloxone 0.4 mg/mL Inj Soln 1 mL

Facility

$128.00

Service Code	HCPCS J2313
Hospital Charge Code	77720016
Hospital Revenue Code	636
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$64.00
Rate for Payer: Cash Price	$87.04
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: Scott and White EPO/PPO	$64.00

naloxone 1 mg/mL Inj Soln 2 mL

Facility

$128.00

Service Code	HCPCS J2312
Hospital Charge Code	77720128
Hospital Revenue Code	636
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$64.00
Rate for Payer: Cash Price	$87.04
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: Scott and White EPO/PPO	$64.00

naloxone 1 mg/mL Inj Soln 2 mL

Facility

$128.00

Service Code	HCPCS J2312
Hospital Charge Code	77720128
Hospital Revenue Code	636
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$92.16
Rate for Payer: Amerigroup CHIP/Medicaid	$11.52
Rate for Payer: BCBS of TX Blue Advantage	$38.40
Rate for Payer: BCBS of TX Blue Essentials	$46.08
Rate for Payer: BCBS of TX PPO	$51.20
Rate for Payer: Cash Price	$87.04
Rate for Payer: Cigna Medicaid	$92.16
Rate for Payer: Molina CHIP/Medicaid	$92.16
Rate for Payer: Multiplan Auto	$83.20
Rate for Payer: Multiplan Commercial	$83.20
Rate for Payer: Multiplan Workers Comp	$83.20
Rate for Payer: Parkland Medicaid	$92.16
Rate for Payer: Scott and White EPO/PPO	$64.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$92.16
Rate for Payer: Superior Health Plan EPO	$17.41

naphazoline-pheniramine 0.025%-0.3% Ophth Soln 15 mL

Facility

$25.77

Service Code	HCPCS J3490
Hospital Charge Code	77720695
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.52

naphazoline-pheniramine 0.025%-0.3% Ophth Soln 15 mL

Facility

$25.77

Service Code	HCPCS J3490
Hospital Charge Code	77720695
Hospital Revenue Code	250
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$18.55
Rate for Payer: Amerigroup CHIP/Medicaid	$2.32
Rate for Payer: BCBS of TX Blue Advantage	$7.73
Rate for Payer: BCBS of TX Blue Essentials	$9.28
Rate for Payer: BCBS of TX PPO	$10.31
Rate for Payer: Cash Price	$17.52
Rate for Payer: Cigna Medicaid	$18.55
Rate for Payer: Molina CHIP/Medicaid	$18.55
Rate for Payer: Multiplan Auto	$16.75
Rate for Payer: Multiplan Commercial	$16.75
Rate for Payer: Multiplan Workers Comp	$16.75
Rate for Payer: Parkland Medicaid	$18.55
Rate for Payer: Scott and White EPO/PPO	$12.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18.55
Rate for Payer: Superior Health Plan EPO	$3.50

naproxen 250 mg tablet

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77720899
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.44

naproxen 250 mg tablet

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77720899
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$5.76
Rate for Payer: Amerigroup CHIP/Medicaid	$0.72
Rate for Payer: BCBS of TX Blue Advantage	$2.40
Rate for Payer: BCBS of TX Blue Essentials	$2.88
Rate for Payer: BCBS of TX PPO	$3.20
Rate for Payer: Cash Price	$5.44
Rate for Payer: Cigna Medicaid	$5.76
Rate for Payer: Molina CHIP/Medicaid	$5.76
Rate for Payer: Multiplan Auto	$5.20
Rate for Payer: Multiplan Commercial	$5.20
Rate for Payer: Multiplan Workers Comp	$5.20
Rate for Payer: Parkland Medicaid	$5.76
Rate for Payer: Scott and White EPO/PPO	$4.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.76
Rate for Payer: Superior Health Plan EPO	$1.09

NASAL, RHINO, ROCKET, SINGLE, XL, 10X1.5 CM X 2 CM

Facility

$122.65

Hospital Charge Code	993307
Hospital Revenue Code	270
Min. Negotiated Rate	$11.04
Max. Negotiated Rate	$88.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.04
Rate for Payer: BCBS of TX Blue Advantage	$36.80
Rate for Payer: BCBS of TX Blue Essentials	$44.15
Rate for Payer: BCBS of TX PPO	$49.06
Rate for Payer: Cash Price	$83.40
Rate for Payer: Cigna Medicaid	$88.31
Rate for Payer: Molina CHIP/Medicaid	$88.31
Rate for Payer: Multiplan Auto	$79.72
Rate for Payer: Multiplan Commercial	$79.72
Rate for Payer: Multiplan Workers Comp	$79.72
Rate for Payer: Parkland Medicaid	$88.31
Rate for Payer: Scott and White EPO/PPO	$61.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$88.31
Rate for Payer: Superior Health Plan EPO	$16.68

NASAL, RHINO, ROCKET, SINGLE, XL, 10X1.5 CM X 2 CM

Facility

$122.65

Hospital Charge Code	993307
Hospital Revenue Code	270
Rate for Payer: Cash Price	$83.40

Nasal/sinus endoscopy, surgical with concha bullosa resection

Facility

$10,000.00

Service Code	CPT 31240
Hospital Charge Code	36031240
Hospital Revenue Code	360
Min. Negotiated Rate	$525.71
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$525.71
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,788.01
Rate for Payer: Amerigroup Medicare	$1,788.01
Rate for Payer: BCBS of TX Blue Advantage	$2,389.12
Rate for Payer: BCBS of TX Blue Essentials	$2,861.22
Rate for Payer: BCBS of TX Medicare	$1,788.01
Rate for Payer: BCBS of TX PPO	$3,605.14
Rate for Payer: Cigna Commercial	$3,779.52
Rate for Payer: Cigna Medicare	$1,788.01
Rate for Payer: Employer Direct Commercial	$1,788.01
Rate for Payer: Humana Medicare/TRICARE	$1,788.01
Rate for Payer: Molina Dual Medicare/Medicaid	$1,788.01
Rate for Payer: Molina Medicare	$1,788.01
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	$2,871.63
Rate for Payer: Scott and White Medicare	$1,788.01
Rate for Payer: Superior Health Plan EPO	$1,788.01
Rate for Payer: Superior Health Plan Medicare	$1,788.01
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,788.01
Rate for Payer: Universal American Medicare	$1,788.01
Rate for Payer: Wellcare Medicare	$1,788.01
Rate for Payer: Wellmed Medicare	$1,788.01

Nasal/sinus endoscopy, surgical with concha bullosa resection

Facility

$8,978.34

Service Code	HCPCS 31240
Hospital Charge Code	9900602
Hospital Revenue Code	360
Rate for Payer: Cash Price	$6,105.27

Nasal/sinus endoscopy, surgical with concha bullosa resection

Facility

$8,978.34

Service Code	HCPCS 31240
Hospital Charge Code	9900602
Hospital Revenue Code	360
Min. Negotiated Rate	$525.71
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$525.71
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,788.01
Rate for Payer: Amerigroup Medicare	$1,788.01
Rate for Payer: BCBS of TX Blue Advantage	$2,389.12
Rate for Payer: BCBS of TX Blue Essentials	$2,861.22
Rate for Payer: BCBS of TX Medicare	$1,788.01
Rate for Payer: BCBS of TX PPO	$3,605.14
Rate for Payer: Cash Price	$6,105.27
Rate for Payer: Cash Price	$6,105.27
Rate for Payer: Cash Price	$6,105.27
Rate for Payer: Cigna Commercial	$3,779.52
Rate for Payer: Cigna Medicaid	$6,464.40
Rate for Payer: Cigna Medicare	$1,788.01
Rate for Payer: Employer Direct Commercial	$1,788.01
Rate for Payer: Humana Medicare/TRICARE	$1,788.01
Rate for Payer: Molina CHIP/Medicaid	$6,464.40
Rate for Payer: Molina Dual Medicare/Medicaid	$1,788.01
Rate for Payer: Molina Medicare	$1,788.01
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	$6,464.40
Rate for Payer: Scott and White EPO/PPO	$2,871.63
Rate for Payer: Scott and White Medicare	$1,788.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,464.40
Rate for Payer: Superior Health Plan EPO	$1,788.01
Rate for Payer: Superior Health Plan Medicare	$1,788.01
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,788.01
Rate for Payer: Universal American Medicare	$1,788.01
Rate for Payer: Wellcare Medicare	$1,788.01
Rate for Payer: Wellmed Medicare	$1,788.01

Nasal/sinus endoscopy, surgical with control of nasal hemorrhage

Facility

$6,733.76

Service Code	HCPCS 31238
Hospital Charge Code	9900601
Hospital Revenue Code	360
Min. Negotiated Rate	$525.71
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$525.71
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,788.01
Rate for Payer: Amerigroup Medicare	$1,788.01
Rate for Payer: BCBS of TX Blue Advantage	$2,389.12
Rate for Payer: BCBS of TX Blue Essentials	$2,861.22
Rate for Payer: BCBS of TX Medicare	$1,788.01
Rate for Payer: BCBS of TX PPO	$3,605.14
Rate for Payer: Cash Price	$4,578.96
Rate for Payer: Cash Price	$4,578.96
Rate for Payer: Cash Price	$4,578.96
Rate for Payer: Cigna Commercial	$3,779.52
Rate for Payer: Cigna Medicaid	$4,848.31
Rate for Payer: Cigna Medicare	$1,788.01
Rate for Payer: Employer Direct Commercial	$1,788.01
Rate for Payer: Humana Medicare/TRICARE	$1,788.01
Rate for Payer: Molina CHIP/Medicaid	$4,848.31
Rate for Payer: Molina Dual Medicare/Medicaid	$1,788.01
Rate for Payer: Molina Medicare	$1,788.01
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	$4,848.31
Rate for Payer: Scott and White EPO/PPO	$2,871.63
Rate for Payer: Scott and White Medicare	$1,788.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,848.31
Rate for Payer: Superior Health Plan EPO	$1,788.01
Rate for Payer: Superior Health Plan Medicare	$1,788.01
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,788.01
Rate for Payer: Universal American Medicare	$1,788.01
Rate for Payer: Wellcare Medicare	$1,788.01
Rate for Payer: Wellmed Medicare	$1,788.01

Nasal/sinus endoscopy, surgical with control of nasal hemorrhage

Facility

$10,000.00

Service Code	CPT 31238
Hospital Charge Code	36031238
Hospital Revenue Code	360
Min. Negotiated Rate	$525.71
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$525.71
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,788.01
Rate for Payer: Amerigroup Medicare	$1,788.01
Rate for Payer: BCBS of TX Blue Advantage	$2,389.12
Rate for Payer: BCBS of TX Blue Essentials	$2,861.22
Rate for Payer: BCBS of TX Medicare	$1,788.01
Rate for Payer: BCBS of TX PPO	$3,605.14
Rate for Payer: Cigna Commercial	$3,779.52
Rate for Payer: Cigna Medicare	$1,788.01
Rate for Payer: Employer Direct Commercial	$1,788.01
Rate for Payer: Humana Medicare/TRICARE	$1,788.01
Rate for Payer: Molina Dual Medicare/Medicaid	$1,788.01
Rate for Payer: Molina Medicare	$1,788.01
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	$2,871.63
Rate for Payer: Scott and White Medicare	$1,788.01
Rate for Payer: Superior Health Plan EPO	$1,788.01
Rate for Payer: Superior Health Plan Medicare	$1,788.01
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,788.01
Rate for Payer: Universal American Medicare	$1,788.01
Rate for Payer: Wellcare Medicare	$1,788.01
Rate for Payer: Wellmed Medicare	$1,788.01

Nasal/sinus endoscopy, surgical with control of nasal hemorrhage

Facility

$6,733.76

Service Code	HCPCS 31238
Hospital Charge Code	9900601
Hospital Revenue Code	360
Rate for Payer: Cash Price	$4,578.96

Nasal/sinus endoscopy, surgical with ethmoidectomy partial (anterior)

Facility

$14,986.17

Service Code	CPT 31254
Hospital Charge Code	36031254
Hospital Revenue Code	360
Min. Negotiated Rate	$1,630.12
Max. Negotiated Rate	$14,986.17
Rate for Payer: Amerigroup CHIP/Medicaid	$1,630.12
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,089.62
Rate for Payer: Amerigroup Medicare	$7,089.62
Rate for Payer: BCBS of TX Blue Advantage	$9,085.40
Rate for Payer: BCBS of TX Blue Essentials	$10,880.72
Rate for Payer: BCBS of TX Medicare	$7,089.62
Rate for Payer: BCBS of TX PPO	$13,709.71
Rate for Payer: Cigna Commercial	$14,986.17
Rate for Payer: Cigna Medicare	$7,089.62
Rate for Payer: Employer Direct Commercial	$7,089.62
Rate for Payer: Humana Medicare/TRICARE	$7,089.62
Rate for Payer: Molina Dual Medicare/Medicaid	$7,089.62
Rate for Payer: Molina Medicare	$7,089.62
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	$11,579.95
Rate for Payer: Scott and White Medicare	$7,089.62
Rate for Payer: Superior Health Plan EPO	$7,089.62
Rate for Payer: Superior Health Plan Medicare	$7,089.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,089.62
Rate for Payer: Universal American Medicare	$7,089.62
Rate for Payer: Wellcare Medicare	$7,089.62
Rate for Payer: Wellmed Medicare	$7,089.62

Nasal/sinus endoscopy, surgical with ethmoidectomy partial (anterior)

Facility

$14,453.00

Service Code	HCPCS 31254
Hospital Charge Code	9900604
Hospital Revenue Code	360
Rate for Payer: Cash Price	$9,828.04

Nasal/sinus endoscopy, surgical with ethmoidectomy partial (anterior)

Facility

$14,453.00

Service Code	HCPCS 31254
Hospital Charge Code	9900604
Hospital Revenue Code	360
Min. Negotiated Rate	$1,630.12
Max. Negotiated Rate	$14,986.17
Rate for Payer: Amerigroup CHIP/Medicaid	$1,630.12
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,089.62
Rate for Payer: Amerigroup Medicare	$7,089.62
Rate for Payer: BCBS of TX Blue Advantage	$9,085.40
Rate for Payer: BCBS of TX Blue Essentials	$10,880.72
Rate for Payer: BCBS of TX Medicare	$7,089.62
Rate for Payer: BCBS of TX PPO	$13,709.71
Rate for Payer: Cash Price	$9,828.04
Rate for Payer: Cash Price	$9,828.04
Rate for Payer: Cash Price	$9,828.04
Rate for Payer: Cigna Commercial	$14,986.17
Rate for Payer: Cigna Medicaid	$10,406.16
Rate for Payer: Cigna Medicare	$7,089.62
Rate for Payer: Employer Direct Commercial	$7,089.62
Rate for Payer: Humana Medicare/TRICARE	$7,089.62
Rate for Payer: Molina CHIP/Medicaid	$10,406.16
Rate for Payer: Molina Dual Medicare/Medicaid	$7,089.62
Rate for Payer: Molina Medicare	$7,089.62
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	$10,406.16
Rate for Payer: Scott and White EPO/PPO	$11,579.95
Rate for Payer: Scott and White Medicare	$7,089.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,406.16
Rate for Payer: Superior Health Plan EPO	$7,089.62
Rate for Payer: Superior Health Plan Medicare	$7,089.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,089.62
Rate for Payer: Universal American Medicare	$7,089.62
Rate for Payer: Wellcare Medicare	$7,089.62
Rate for Payer: Wellmed Medicare	$7,089.62

Know your out-of-pocket cost for care.

All Charges