White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Triage Patient Type - Established Patient BCE

Facility

$211.00

Service Code	CPT 99213
Hospital Charge Code	3101201
Hospital Revenue Code	510
Min. Negotiated Rate	$18.99
Max. Negotiated Rate	$137.15
Rate for Payer: Aetna Commercial	$116.05
Rate for Payer: Amerigroup CHIP/Medicaid	$18.99
Rate for Payer: BCBS of TX Blue Advantage	$90.31
Rate for Payer: BCBS of TX Blue Essentials	$107.95
Rate for Payer: BCBS of TX PPO	$120.41
Rate for Payer: Cash Price	$185.68
Rate for Payer: Cash Price	$185.68
Rate for Payer: Cigna Medicaid	$31.23
Rate for Payer: Molina CHIP/Medicaid	$31.23
Rate for Payer: Multiplan Auto	$137.15
Rate for Payer: Multiplan Commercial	$137.15
Rate for Payer: Multiplan Workers Comp	$137.15
Rate for Payer: Parkland Medicaid	$31.23
Rate for Payer: Scott and White EPO/PPO	$80.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$31.23

Triage Patient Type - Established Patient BCE

Facility

$211.00

Service Code	CPT 99213
Hospital Charge Code	3101201
Hospital Revenue Code	510
Rate for Payer: Cash Price	$185.68

Triage Patient Type:New Patient

Facility

$411.00

Service Code	CPT 99203
Hospital Charge Code	3101200
Hospital Revenue Code	510
Min. Negotiated Rate	$36.99
Max. Negotiated Rate	$267.15
Rate for Payer: Aetna Commercial	$226.05
Rate for Payer: Amerigroup CHIP/Medicaid	$36.99
Rate for Payer: BCBS of TX Blue Advantage	$134.82
Rate for Payer: BCBS of TX Blue Essentials	$161.16
Rate for Payer: BCBS of TX PPO	$179.75
Rate for Payer: Cash Price	$361.68
Rate for Payer: Cash Price	$361.68
Rate for Payer: Cigna Medicaid	$51.08
Rate for Payer: Molina CHIP/Medicaid	$51.08
Rate for Payer: Multiplan Auto	$267.15
Rate for Payer: Multiplan Commercial	$267.15
Rate for Payer: Multiplan Workers Comp	$267.15
Rate for Payer: Parkland Medicaid	$51.08
Rate for Payer: Scott and White EPO/PPO	$99.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$51.08

Triage Patient Type - New Patient BCE

Facility

$411.00

Service Code	CPT 99203
Hospital Charge Code	3101200
Hospital Revenue Code	510
Min. Negotiated Rate	$36.99
Max. Negotiated Rate	$267.15
Rate for Payer: Aetna Commercial	$226.05
Rate for Payer: Amerigroup CHIP/Medicaid	$36.99
Rate for Payer: BCBS of TX Blue Advantage	$134.82
Rate for Payer: BCBS of TX Blue Essentials	$161.16
Rate for Payer: BCBS of TX PPO	$179.75
Rate for Payer: Cash Price	$361.68
Rate for Payer: Cash Price	$361.68
Rate for Payer: Cigna Medicaid	$51.08
Rate for Payer: Molina CHIP/Medicaid	$51.08
Rate for Payer: Multiplan Auto	$267.15
Rate for Payer: Multiplan Commercial	$267.15
Rate for Payer: Multiplan Workers Comp	$267.15
Rate for Payer: Parkland Medicaid	$51.08
Rate for Payer: Scott and White EPO/PPO	$99.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$51.08

Triage Patient Type - New Patient BCE

Facility

$411.00

Service Code	CPT 99203
Hospital Charge Code	3101200
Hospital Revenue Code	510
Rate for Payer: Cash Price	$361.68

triamcinolone 0.1% Cream 15 g

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77857166
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$5.20
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: Multiplan Auto	$5.20
Rate for Payer: Multiplan Commercial	$5.20
Rate for Payer: Multiplan Workers Comp	$5.20
Rate for Payer: Scott and White EPO/PPO	$4.00
Rate for Payer: Superior Health Plan EPO	$1.09

triamcinolone 0.1% Cream 15 g

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77857166
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.44

triamcinolone 10 mg/mL Inj Susp 5 mL

Facility

$128.17

Service Code	HCPCS J3301
Hospital Charge Code	77858154
Hospital Revenue Code	636
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$64.08
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cigna Commercial	$32.04
Rate for Payer: Scott and White EPO/PPO	$64.08

triamcinolone 10 mg/mL Inj Susp 5 mL

Facility

$128.17

Service Code	HCPCS J3301
Hospital Charge Code	77858154
Hospital Revenue Code	636
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$83.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$1.84
Rate for Payer: BCBS of TX Blue Essentials	$2.21
Rate for Payer: BCBS of TX PPO	$2.45
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cash Price	$87.16
Rate for Payer: Multiplan Auto	$83.31
Rate for Payer: Multiplan Commercial	$83.31
Rate for Payer: Multiplan Workers Comp	$83.31
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan EPO	$17.43

triamcinolone acetonide 40 mg/mL Kit

Facility

$128.17

Service Code	HCPCS J3301
Hospital Charge Code	78333838
Hospital Revenue Code	636
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$83.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$1.84
Rate for Payer: BCBS of TX Blue Essentials	$2.21
Rate for Payer: BCBS of TX PPO	$2.45
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cash Price	$87.16
Rate for Payer: Multiplan Auto	$83.31
Rate for Payer: Multiplan Commercial	$83.31
Rate for Payer: Multiplan Workers Comp	$83.31
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan EPO	$17.43

triamcinolone acetonide 40 mg/mL Kit

Facility

$128.17

Service Code	HCPCS J3301
Hospital Charge Code	78333838
Hospital Revenue Code	636
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$64.08
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cigna Commercial	$32.04
Rate for Payer: Scott and White EPO/PPO	$64.08

Trichamonas PCR

Facility

$223.00

Service Code	CPT 87661
Hospital Charge Code	7257661
Hospital Revenue Code	306
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$144.95
Rate for Payer: Aetna Commercial	$36.84
Rate for Payer: Aetna Medicare	$52.63
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	$196.24
Rate for Payer: Cash Price	$196.24
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	$144.95
Rate for Payer: Multiplan Commercial	$144.95
Rate for Payer: Multiplan Workers Comp	$144.95
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

Trichamonas PCR

Facility

$223.00

Service Code	CPT 87661
Hospital Charge Code	7257661
Hospital Revenue Code	306
Rate for Payer: Cash Price	$196.24

TRICHOMONAS VEGININALIS AMP PROBE

Facility

$223.00

Service Code	CPT 87661
Hospital Charge Code	1840004
Hospital Revenue Code	306
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$144.95
Rate for Payer: Aetna Commercial	$36.84
Rate for Payer: Aetna Medicare	$52.63
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	$196.24
Rate for Payer: Cash Price	$196.24
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	$144.95
Rate for Payer: Multiplan Commercial	$144.95
Rate for Payer: Multiplan Workers Comp	$144.95
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

Trich vag by NAA SO

Facility

$223.00

Service Code	CPT 87661
Hospital Charge Code	1840004
Hospital Revenue Code	306
Rate for Payer: Cash Price	$196.24

Trich vag by NAA SO

Facility

$223.00

Service Code	CPT 87661
Hospital Charge Code	1840004
Hospital Revenue Code	306
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$144.95
Rate for Payer: Aetna Commercial	$36.84
Rate for Payer: Aetna Medicare	$52.63
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	$196.24
Rate for Payer: Cash Price	$196.24
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	$144.95
Rate for Payer: Multiplan Commercial	$144.95
Rate for Payer: Multiplan Workers Comp	$144.95
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

Triglyceride Body Fluid

Facility

$309.00

Service Code	CPT 84478
Hospital Charge Code	4104475
Hospital Revenue Code	301
Rate for Payer: Cash Price	$271.92

Triglyceride Body Fluid

Facility

$309.00

Service Code	CPT 84478
Hospital Charge Code	4104475
Hospital Revenue Code	301
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$200.85
Rate for Payer: Aetna Commercial	$6.02
Rate for Payer: Aetna Medicare	$8.61
Rate for Payer: Amerigroup CHIP/Medicaid	$2.24
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.74
Rate for Payer: Amerigroup Medicare	$5.74
Rate for Payer: BCBS of TX Blue Advantage	$9.47
Rate for Payer: BCBS of TX Blue Essentials	$11.37
Rate for Payer: BCBS of TX Medicare	$5.74
Rate for Payer: BCBS of TX PPO	$12.69
Rate for Payer: Cash Price	$271.92
Rate for Payer: Cash Price	$271.92
Rate for Payer: Cigna Medicaid	$5.74
Rate for Payer: Cigna Medicare	$5.74
Rate for Payer: Employer Direct Commercial	$5.74
Rate for Payer: Humana Medicare/TRICARE	$5.74
Rate for Payer: Molina CHIP/Medicaid	$5.74
Rate for Payer: Molina Dual Medicare/Medicaid	$5.74
Rate for Payer: Molina Medicare	$5.74
Rate for Payer: Multiplan Auto	$200.85
Rate for Payer: Multiplan Commercial	$200.85
Rate for Payer: Multiplan Workers Comp	$200.85
Rate for Payer: Parkland Medicaid	$5.74
Rate for Payer: Scott and White EPO/PPO	$7.17
Rate for Payer: Scott and White Medicare	$5.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.74
Rate for Payer: Superior Health Plan EPO	$5.74
Rate for Payer: Superior Health Plan Medicare	$5.74
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.74
Rate for Payer: Universal American Medicare	$5.74
Rate for Payer: Wellcare Medicare	$5.74
Rate for Payer: Wellmed Medicare	$5.74

Triglycerides

Facility

$309.00

Service Code	CPT 84478
Hospital Charge Code	1601731
Hospital Revenue Code	301
Rate for Payer: Cash Price	$271.92

Triglycerides

Facility

$309.00

Service Code	CPT 84478
Hospital Charge Code	1601731
Hospital Revenue Code	301
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$200.85
Rate for Payer: Aetna Commercial	$6.02
Rate for Payer: Aetna Medicare	$8.61
Rate for Payer: Amerigroup CHIP/Medicaid	$2.24
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.74
Rate for Payer: Amerigroup Medicare	$5.74
Rate for Payer: BCBS of TX Blue Advantage	$9.47
Rate for Payer: BCBS of TX Blue Essentials	$11.37
Rate for Payer: BCBS of TX Medicare	$5.74
Rate for Payer: BCBS of TX PPO	$12.69
Rate for Payer: Cash Price	$271.92
Rate for Payer: Cash Price	$271.92
Rate for Payer: Cigna Medicaid	$5.74
Rate for Payer: Cigna Medicare	$5.74
Rate for Payer: Employer Direct Commercial	$5.74
Rate for Payer: Humana Medicare/TRICARE	$5.74
Rate for Payer: Molina CHIP/Medicaid	$5.74
Rate for Payer: Molina Dual Medicare/Medicaid	$5.74
Rate for Payer: Molina Medicare	$5.74
Rate for Payer: Multiplan Auto	$200.85
Rate for Payer: Multiplan Commercial	$200.85
Rate for Payer: Multiplan Workers Comp	$200.85
Rate for Payer: Parkland Medicaid	$5.74
Rate for Payer: Scott and White EPO/PPO	$7.17
Rate for Payer: Scott and White Medicare	$5.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.74
Rate for Payer: Superior Health Plan EPO	$5.74
Rate for Payer: Superior Health Plan Medicare	$5.74
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.74
Rate for Payer: Universal American Medicare	$5.74
Rate for Payer: Wellcare Medicare	$5.74
Rate for Payer: Wellmed Medicare	$5.74

Triiodothyronine (T3), Free SO

Facility

$453.00

Service Code	CPT 84481
Hospital Charge Code	1703008
Hospital Revenue Code	301
Rate for Payer: Cash Price	$398.64

Triiodothyronine (T3), Free SO

Facility

$453.00

Service Code	CPT 84481
Hospital Charge Code	1703008
Hospital Revenue Code	301
Min. Negotiated Rate	$6.61
Max. Negotiated Rate	$294.45
Rate for Payer: Aetna Commercial	$17.78
Rate for Payer: Aetna Medicare	$25.41
Rate for Payer: Amerigroup CHIP/Medicaid	$6.61
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16.94
Rate for Payer: Amerigroup Medicare	$16.94
Rate for Payer: BCBS of TX Blue Advantage	$27.95
Rate for Payer: BCBS of TX Blue Essentials	$33.54
Rate for Payer: BCBS of TX Medicare	$16.94
Rate for Payer: BCBS of TX PPO	$37.44
Rate for Payer: Cash Price	$398.64
Rate for Payer: Cash Price	$398.64
Rate for Payer: Cigna Medicaid	$16.94
Rate for Payer: Cigna Medicare	$16.94
Rate for Payer: Employer Direct Commercial	$16.94
Rate for Payer: Humana Medicare/TRICARE	$16.94
Rate for Payer: Molina CHIP/Medicaid	$16.94
Rate for Payer: Molina Dual Medicare/Medicaid	$16.94
Rate for Payer: Molina Medicare	$16.94
Rate for Payer: Multiplan Auto	$294.45
Rate for Payer: Multiplan Commercial	$294.45
Rate for Payer: Multiplan Workers Comp	$294.45
Rate for Payer: Parkland Medicaid	$16.94
Rate for Payer: Scott and White EPO/PPO	$21.18
Rate for Payer: Scott and White Medicare	$16.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16.94
Rate for Payer: Superior Health Plan EPO	$16.94
Rate for Payer: Superior Health Plan Medicare	$16.94
Rate for Payer: Universal American Dual Medicare/Medicaid	$16.94
Rate for Payer: Universal American Medicare	$16.94
Rate for Payer: Wellcare Medicare	$16.94
Rate for Payer: Wellmed Medicare	$16.94

Triiodothyronine (T3) SO

Facility

$400.00

Service Code	CPT 84480
Hospital Charge Code	1602309
Hospital Revenue Code	301
Rate for Payer: Cash Price	$352.00

Triiodothyronine (T3) SO

Facility

$400.00

Service Code	CPT 84480
Hospital Charge Code	1602309
Hospital Revenue Code	301
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$260.00
Rate for Payer: Aetna Commercial	$14.89
Rate for Payer: Aetna Medicare	$21.27
Rate for Payer: Amerigroup CHIP/Medicaid	$5.53
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14.18
Rate for Payer: Amerigroup Medicare	$14.18
Rate for Payer: BCBS of TX Blue Advantage	$23.40
Rate for Payer: BCBS of TX Blue Essentials	$28.08
Rate for Payer: BCBS of TX Medicare	$14.18
Rate for Payer: BCBS of TX PPO	$31.34
Rate for Payer: Cash Price	$352.00
Rate for Payer: Cash Price	$352.00
Rate for Payer: Cigna Medicaid	$14.18
Rate for Payer: Cigna Medicare	$14.18
Rate for Payer: Employer Direct Commercial	$14.18
Rate for Payer: Humana Medicare/TRICARE	$14.18
Rate for Payer: Molina CHIP/Medicaid	$14.18
Rate for Payer: Molina Dual Medicare/Medicaid	$14.18
Rate for Payer: Molina Medicare	$14.18
Rate for Payer: Multiplan Auto	$260.00
Rate for Payer: Multiplan Commercial	$260.00
Rate for Payer: Multiplan Workers Comp	$260.00
Rate for Payer: Parkland Medicaid	$14.18
Rate for Payer: Scott and White EPO/PPO	$17.73
Rate for Payer: Scott and White Medicare	$14.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14.18
Rate for Payer: Superior Health Plan EPO	$14.18
Rate for Payer: Superior Health Plan Medicare	$14.18
Rate for Payer: Universal American Dual Medicare/Medicaid	$14.18
Rate for Payer: Universal American Medicare	$14.18
Rate for Payer: Wellcare Medicare	$14.18
Rate for Payer: Wellmed Medicare	$14.18

Trim Nails Any Number

Facility

$191.00

Service Code	CPT 11719
Hospital Charge Code	7150238
Hospital Revenue Code	761
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$138.63
Rate for Payer: Aetna Commercial	$105.05
Rate for Payer: Aetna Medicare	$83.91
Rate for Payer: Amerigroup CHIP/Medicaid	$17.19
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$55.94
Rate for Payer: Amerigroup Medicare	$55.94
Rate for Payer: BCBS of TX Blue Advantage	$91.87
Rate for Payer: BCBS of TX Blue Essentials	$110.02
Rate for Payer: BCBS of TX Medicare	$55.94
Rate for Payer: BCBS of TX PPO	$138.63
Rate for Payer: Cash Price	$168.08
Rate for Payer: Cash Price	$168.08
Rate for Payer: Cash Price	$168.08
Rate for Payer: Cigna Commercial	$126.71
Rate for Payer: Cigna Medicare	$55.94
Rate for Payer: Employer Direct Commercial	$55.94
Rate for Payer: Humana Medicare/TRICARE	$55.94
Rate for Payer: Molina Dual Medicare/Medicaid	$55.94
Rate for Payer: Molina Medicare	$55.94
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: Scott and White EPO/PPO	$9.04
Rate for Payer: Scott and White Medicare	$55.94
Rate for Payer: Superior Health Plan EPO	$55.94
Rate for Payer: Superior Health Plan Medicare	$55.94
Rate for Payer: Universal American Dual Medicare/Medicaid	$55.94
Rate for Payer: Universal American Medicare	$55.94
Rate for Payer: Wellcare Medicare	$55.94
Rate for Payer: Wellmed Medicare	$55.94

Know your out-of-pocket cost for care.

All Charges