White Rock Medical Center

All Charges

Charge

Type

Setting

Price

NERVOUS SYSTEM NEOPLASMS W MCC

Facility

$26,353.00

Service Code	MSDRG 054
Min. Negotiated Rate	$11,322.76
Max. Negotiated Rate	$26,353.00
Rate for Payer: BCBS of TX Blue Advantage	$11,322.76
Rate for Payer: BCBS of TX Blue Essentials	$13,586.00
Rate for Payer: BCBS of TX PPO	$15,096.14

NERVOUS SYSTEM NEOPLASMS W/O MCC

Facility

$19,157.70

Service Code	MSDRG 055
Min. Negotiated Rate	$8,822.62
Max. Negotiated Rate	$19,157.70
Rate for Payer: BCBS of TX Blue Advantage	$9,005.92
Rate for Payer: BCBS of TX Blue Essentials	$10,806.06
Rate for Payer: BCBS of TX PPO	$12,007.20

NET RETRIEVAL FOREIGN BODY 230CM

Facility

$385.90

Hospital Charge Code	136730
Hospital Revenue Code	272
Rate for Payer: Cash Price	$262.41

NET RETRIEVAL FOREIGN BODY 230CM

Facility

$385.90

Hospital Charge Code	136730
Hospital Revenue Code	272
Min. Negotiated Rate	$34.73
Max. Negotiated Rate	$277.85
Rate for Payer: Amerigroup CHIP/Medicaid	$34.73
Rate for Payer: BCBS of TX Blue Advantage	$115.77
Rate for Payer: BCBS of TX Blue Essentials	$138.92
Rate for Payer: BCBS of TX PPO	$154.36
Rate for Payer: Cash Price	$262.41
Rate for Payer: Cigna Medicaid	$277.85
Rate for Payer: Molina CHIP/Medicaid	$277.85
Rate for Payer: Multiplan Auto	$250.84
Rate for Payer: Multiplan Commercial	$250.84
Rate for Payer: Multiplan Workers Comp	$250.84
Rate for Payer: Parkland Medicaid	$277.85
Rate for Payer: Scott and White EPO/PPO	$192.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$277.85
Rate for Payer: Superior Health Plan EPO	$52.48

NEUMOTHORAX CATH KIT

Facility

$572.04

Hospital Charge Code	104581
Hospital Revenue Code	272
Min. Negotiated Rate	$51.48
Max. Negotiated Rate	$411.87
Rate for Payer: Amerigroup CHIP/Medicaid	$51.48
Rate for Payer: BCBS of TX Blue Advantage	$171.61
Rate for Payer: BCBS of TX Blue Essentials	$205.93
Rate for Payer: BCBS of TX PPO	$228.82
Rate for Payer: Cash Price	$388.99
Rate for Payer: Cigna Medicaid	$411.87
Rate for Payer: Molina CHIP/Medicaid	$411.87
Rate for Payer: Multiplan Auto	$371.83
Rate for Payer: Multiplan Commercial	$371.83
Rate for Payer: Multiplan Workers Comp	$371.83
Rate for Payer: Parkland Medicaid	$411.87
Rate for Payer: Scott and White EPO/PPO	$286.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$411.87
Rate for Payer: Superior Health Plan EPO	$77.80

NEUMOTHORAX CATH KIT

Facility

$572.04

Hospital Charge Code	104581
Hospital Revenue Code	272
Rate for Payer: Cash Price	$388.99

NEUROLOGICAL EYE DISORDERS

Facility

$15,082.20

Service Code	MSDRG 123
Min. Negotiated Rate	$6,474.94
Max. Negotiated Rate	$15,082.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,613.03
Rate for Payer: Amerigroup Medicare	$10,613.03
Rate for Payer: BCBS of TX Blue Advantage	$6,474.94
Rate for Payer: BCBS of TX Blue Essentials	$7,769.18
Rate for Payer: BCBS of TX Medicare	$10,613.03
Rate for Payer: BCBS of TX PPO	$8,632.75
Rate for Payer: Cigna Commercial	$10,285.97
Rate for Payer: Cigna Medicare	$10,613.03
Rate for Payer: Employer Direct Commercial	$10,613.03
Rate for Payer: Humana Medicare/TRICARE	$10,613.03
Rate for Payer: Molina Dual Medicare/Medicaid	$10,613.03
Rate for Payer: Molina Medicare	$10,613.03
Rate for Payer: Multiplan Auto	$15,082.20
Rate for Payer: Multiplan Commercial	$15,082.20
Rate for Payer: Multiplan Workers Comp	$15,082.20
Rate for Payer: Scott and White EPO/PPO	$6,945.75
Rate for Payer: Scott and White Medicare	$10,613.03
Rate for Payer: Superior Health Plan EPO	$10,613.03
Rate for Payer: Superior Health Plan Medicare	$10,613.03
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,613.03
Rate for Payer: Universal American Medicare	$10,613.03
Rate for Payer: Wellcare Medicare	$10,613.03
Rate for Payer: Wellmed Medicare	$10,613.03

Neuroplasty digital, 1 or both, same digit

Facility

$8,771.95

Service Code	HCPCS 64702
Hospital Charge Code	9900837
Hospital Revenue Code	360
Min. Negotiated Rate	$659.94
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$659.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Amerigroup Medicare	$1,961.62
Rate for Payer: BCBS of TX Blue Advantage	$2,871.31
Rate for Payer: BCBS of TX Blue Essentials	$3,438.70
Rate for Payer: BCBS of TX Medicare	$1,961.62
Rate for Payer: BCBS of TX PPO	$4,332.76
Rate for Payer: Cash Price	$5,964.93
Rate for Payer: Cash Price	$5,964.93
Rate for Payer: Cash Price	$5,964.93
Rate for Payer: Cigna Commercial	$4,146.52
Rate for Payer: Cigna Medicaid	$6,315.80
Rate for Payer: Cigna Medicare	$1,961.62
Rate for Payer: Employer Direct Commercial	$1,961.62
Rate for Payer: Humana Medicare/TRICARE	$1,961.62
Rate for Payer: Molina CHIP/Medicaid	$6,315.80
Rate for Payer: Molina Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Molina Medicare	$1,961.62
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	$6,315.80
Rate for Payer: Scott and White EPO/PPO	$3,266.71
Rate for Payer: Scott and White Medicare	$1,961.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,315.80
Rate for Payer: Superior Health Plan EPO	$1,961.62
Rate for Payer: Superior Health Plan Medicare	$1,961.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Universal American Medicare	$1,961.62
Rate for Payer: Wellcare Medicare	$1,961.62
Rate for Payer: Wellmed Medicare	$1,961.62

Neuroplasty digital, 1 or both, same digit

Facility

$10,000.00

Service Code	CPT 64702
Hospital Charge Code	36064702
Hospital Revenue Code	360
Min. Negotiated Rate	$659.94
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$659.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Amerigroup Medicare	$1,961.62
Rate for Payer: BCBS of TX Blue Advantage	$2,871.31
Rate for Payer: BCBS of TX Blue Essentials	$3,438.70
Rate for Payer: BCBS of TX Medicare	$1,961.62
Rate for Payer: BCBS of TX PPO	$4,332.76
Rate for Payer: Cigna Commercial	$4,146.52
Rate for Payer: Cigna Medicare	$1,961.62
Rate for Payer: Employer Direct Commercial	$1,961.62
Rate for Payer: Humana Medicare/TRICARE	$1,961.62
Rate for Payer: Molina Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Molina Medicare	$1,961.62
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	$3,266.71
Rate for Payer: Scott and White Medicare	$1,961.62
Rate for Payer: Superior Health Plan EPO	$1,961.62
Rate for Payer: Superior Health Plan Medicare	$1,961.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Universal American Medicare	$1,961.62
Rate for Payer: Wellcare Medicare	$1,961.62
Rate for Payer: Wellmed Medicare	$1,961.62

Neuroplasty digital, 1 or both, same digit

Facility

$8,771.95

Service Code	HCPCS 64702
Hospital Charge Code	9900837
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,964.93

Neuroplasty, major peripheral nerve, arm or leg, open other than specified

Facility

$14,035.12

Service Code	HCPCS 64708
Hospital Charge Code	9900839
Hospital Revenue Code	360
Rate for Payer: Cash Price	$9,543.88

Neuroplasty, major peripheral nerve, arm or leg, open other than specified

Facility

$10,000.00

Service Code	CPT 64708
Hospital Charge Code	36064708
Hospital Revenue Code	360
Min. Negotiated Rate	$659.94
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$659.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Amerigroup Medicare	$1,961.62
Rate for Payer: BCBS of TX Blue Advantage	$2,871.31
Rate for Payer: BCBS of TX Blue Essentials	$3,438.70
Rate for Payer: BCBS of TX Medicare	$1,961.62
Rate for Payer: BCBS of TX PPO	$4,332.76
Rate for Payer: Cigna Commercial	$4,146.52
Rate for Payer: Cigna Medicare	$1,961.62
Rate for Payer: Employer Direct Commercial	$1,961.62
Rate for Payer: Humana Medicare/TRICARE	$1,961.62
Rate for Payer: Molina Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Molina Medicare	$1,961.62
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	$3,266.71
Rate for Payer: Scott and White Medicare	$1,961.62
Rate for Payer: Superior Health Plan EPO	$1,961.62
Rate for Payer: Superior Health Plan Medicare	$1,961.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Universal American Medicare	$1,961.62
Rate for Payer: Wellcare Medicare	$1,961.62
Rate for Payer: Wellmed Medicare	$1,961.62

Neuroplasty, major peripheral nerve, arm or leg, open other than specified

Facility

$14,035.12

Service Code	HCPCS 64708
Hospital Charge Code	9900839
Hospital Revenue Code	360
Min. Negotiated Rate	$659.94
Max. Negotiated Rate	$10,105.29
Rate for Payer: Amerigroup CHIP/Medicaid	$659.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Amerigroup Medicare	$1,961.62
Rate for Payer: BCBS of TX Blue Advantage	$2,871.31
Rate for Payer: BCBS of TX Blue Essentials	$3,438.70
Rate for Payer: BCBS of TX Medicare	$1,961.62
Rate for Payer: BCBS of TX PPO	$4,332.76
Rate for Payer: Cash Price	$9,543.88
Rate for Payer: Cash Price	$9,543.88
Rate for Payer: Cash Price	$9,543.88
Rate for Payer: Cigna Commercial	$4,146.52
Rate for Payer: Cigna Medicaid	$10,105.29
Rate for Payer: Cigna Medicare	$1,961.62
Rate for Payer: Employer Direct Commercial	$1,961.62
Rate for Payer: Humana Medicare/TRICARE	$1,961.62
Rate for Payer: Molina CHIP/Medicaid	$10,105.29
Rate for Payer: Molina Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Molina Medicare	$1,961.62
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	$10,105.29
Rate for Payer: Scott and White EPO/PPO	$3,266.71
Rate for Payer: Scott and White Medicare	$1,961.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,105.29
Rate for Payer: Superior Health Plan EPO	$1,961.62
Rate for Payer: Superior Health Plan Medicare	$1,961.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Universal American Medicare	$1,961.62
Rate for Payer: Wellcare Medicare	$1,961.62
Rate for Payer: Wellmed Medicare	$1,961.62

Neuroplasty; nerve of hand or foot

Facility

$10,526.34

Service Code	HCPCS 64704
Hospital Charge Code	9900838
Hospital Revenue Code	360
Min. Negotiated Rate	$659.94
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$659.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Amerigroup Medicare	$1,961.62
Rate for Payer: BCBS of TX Blue Advantage	$2,871.31
Rate for Payer: BCBS of TX Blue Essentials	$3,438.70
Rate for Payer: BCBS of TX Medicare	$1,961.62
Rate for Payer: BCBS of TX PPO	$4,332.76
Rate for Payer: Cash Price	$7,157.91
Rate for Payer: Cash Price	$7,157.91
Rate for Payer: Cash Price	$7,157.91
Rate for Payer: Cigna Commercial	$4,146.52
Rate for Payer: Cigna Medicaid	$7,578.96
Rate for Payer: Cigna Medicare	$1,961.62
Rate for Payer: Employer Direct Commercial	$1,961.62
Rate for Payer: Humana Medicare/TRICARE	$1,961.62
Rate for Payer: Molina CHIP/Medicaid	$7,578.96
Rate for Payer: Molina Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Molina Medicare	$1,961.62
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	$7,578.96
Rate for Payer: Scott and White EPO/PPO	$3,266.71
Rate for Payer: Scott and White Medicare	$1,961.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,578.96
Rate for Payer: Superior Health Plan EPO	$1,961.62
Rate for Payer: Superior Health Plan Medicare	$1,961.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Universal American Medicare	$1,961.62
Rate for Payer: Wellcare Medicare	$1,961.62
Rate for Payer: Wellmed Medicare	$1,961.62

Neuroplasty; nerve of hand or foot

Facility

$10,000.00

Service Code	CPT 64704
Hospital Charge Code	36064704
Hospital Revenue Code	360
Min. Negotiated Rate	$659.94
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$659.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Amerigroup Medicare	$1,961.62
Rate for Payer: BCBS of TX Blue Advantage	$2,871.31
Rate for Payer: BCBS of TX Blue Essentials	$3,438.70
Rate for Payer: BCBS of TX Medicare	$1,961.62
Rate for Payer: BCBS of TX PPO	$4,332.76
Rate for Payer: Cigna Commercial	$4,146.52
Rate for Payer: Cigna Medicare	$1,961.62
Rate for Payer: Employer Direct Commercial	$1,961.62
Rate for Payer: Humana Medicare/TRICARE	$1,961.62
Rate for Payer: Molina Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Molina Medicare	$1,961.62
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	$3,266.71
Rate for Payer: Scott and White Medicare	$1,961.62
Rate for Payer: Superior Health Plan EPO	$1,961.62
Rate for Payer: Superior Health Plan Medicare	$1,961.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Universal American Medicare	$1,961.62
Rate for Payer: Wellcare Medicare	$1,961.62
Rate for Payer: Wellmed Medicare	$1,961.62

Neuroplasty; nerve of hand or foot

Facility

$10,526.34

Service Code	HCPCS 64704
Hospital Charge Code	9900838
Hospital Revenue Code	360
Rate for Payer: Cash Price	$7,157.91

NEUROSES EXCEPT DEPRESSIVE

Facility

$16,596.50

Service Code	MSDRG 882
Min. Negotiated Rate	$6,665.00
Max. Negotiated Rate	$16,596.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,629.99
Rate for Payer: Amerigroup Medicare	$12,629.99
Rate for Payer: BCBS of TX Blue Advantage	$6,665.00
Rate for Payer: BCBS of TX Blue Essentials	$7,997.23
Rate for Payer: BCBS of TX Medicare	$12,629.99
Rate for Payer: BCBS of TX PPO	$8,886.15
Rate for Payer: Cigna Commercial	$13,830.54
Rate for Payer: Cigna Medicare	$12,629.99
Rate for Payer: Employer Direct Commercial	$12,629.99
Rate for Payer: Molina Dual Medicare/Medicaid	$12,629.99
Rate for Payer: Molina Medicare	$12,629.99
Rate for Payer: Multiplan Auto	$16,596.50
Rate for Payer: Multiplan Commercial	$16,596.50
Rate for Payer: Multiplan Workers Comp	$16,596.50
Rate for Payer: Scott and White EPO/PPO	$7,643.12
Rate for Payer: Scott and White Medicare	$12,629.99
Rate for Payer: Superior Health Plan EPO	$12,629.99
Rate for Payer: Superior Health Plan Medicare	$12,629.99
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,629.99
Rate for Payer: Universal American Medicare	$12,629.99
Rate for Payer: Wellcare Medicare	$12,629.99
Rate for Payer: Wellmed Medicare	$12,629.99

NEUROSTIMULATOR INTELLIS ADAPTIVESTIM

Facility

$127,160.00

Service Code	HCPCS C1767
Hospital Charge Code	119131
Hospital Revenue Code	278
Min. Negotiated Rate	$31,790.00
Max. Negotiated Rate	$63,580.00
Rate for Payer: Cash Price	$86,468.80
Rate for Payer: Cigna Commercial	$31,790.00
Rate for Payer: Multiplan Auto	$63,580.00
Rate for Payer: Multiplan Commercial	$63,580.00
Rate for Payer: Multiplan Workers Comp	$63,580.00
Rate for Payer: Scott and White EPO/PPO	$63,580.00

NEUROSTIMULATOR INTELLIS ADAPTIVESTIM

Facility

$127,160.00

Service Code	HCPCS C1767
Hospital Charge Code	119131
Hospital Revenue Code	278
Min. Negotiated Rate	$11,444.40
Max. Negotiated Rate	$91,555.20
Rate for Payer: Amerigroup CHIP/Medicaid	$11,444.40
Rate for Payer: BCBS of TX Blue Advantage	$38,148.00
Rate for Payer: BCBS of TX Blue Essentials	$45,777.60
Rate for Payer: BCBS of TX PPO	$50,864.00
Rate for Payer: Cash Price	$86,468.80
Rate for Payer: Cigna Medicaid	$91,555.20
Rate for Payer: Molina CHIP/Medicaid	$91,555.20
Rate for Payer: Multiplan Auto	$63,580.00
Rate for Payer: Multiplan Commercial	$63,580.00
Rate for Payer: Multiplan Workers Comp	$63,580.00
Rate for Payer: Parkland Medicaid	$91,555.20
Rate for Payer: Scott and White EPO/PPO	$63,580.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$91,555.20
Rate for Payer: Superior Health Plan EPO	$17,293.76

Newborn Screen 2 SO

Facility

$138.00

Service Code	HCPCS 99001
Hospital Charge Code	4201300
Hospital Revenue Code	300
Min. Negotiated Rate	$12.42
Max. Negotiated Rate	$99.36
Rate for Payer: Amerigroup CHIP/Medicaid	$12.42
Rate for Payer: BCBS of TX Blue Advantage	$41.40
Rate for Payer: BCBS of TX Blue Essentials	$49.68
Rate for Payer: BCBS of TX PPO	$55.20
Rate for Payer: Cash Price	$93.84
Rate for Payer: Cigna Medicaid	$99.36
Rate for Payer: Molina CHIP/Medicaid	$99.36
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	$99.36
Rate for Payer: Scott and White EPO/PPO	$69.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$99.36
Rate for Payer: Superior Health Plan EPO	$18.77

Newborn Screen 2 SO

Facility

$138.00

Service Code	HCPCS 99001
Hospital Charge Code	4201300
Hospital Revenue Code	300
Rate for Payer: Cash Price	$93.84

NEXTEP CONTOUR 2 WALKER, SMALL

Facility

$152.50

Hospital Charge Code	993914
Hospital Revenue Code	274
Min. Negotiated Rate	$13.72
Max. Negotiated Rate	$109.80
Rate for Payer: Amerigroup CHIP/Medicaid	$13.72
Rate for Payer: BCBS of TX Blue Advantage	$45.75
Rate for Payer: BCBS of TX Blue Essentials	$54.90
Rate for Payer: BCBS of TX PPO	$61.00
Rate for Payer: Cash Price	$103.70
Rate for Payer: Cigna Medicaid	$109.80
Rate for Payer: Molina CHIP/Medicaid	$109.80
Rate for Payer: Multiplan Auto	$76.25
Rate for Payer: Multiplan Commercial	$76.25
Rate for Payer: Multiplan Workers Comp	$76.25
Rate for Payer: Parkland Medicaid	$109.80
Rate for Payer: Scott and White EPO/PPO	$76.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$109.80
Rate for Payer: Superior Health Plan EPO	$20.74

NEXTEP CONTOUR 2 WALKER, SMALL

Facility

$152.50

Hospital Charge Code	993914
Hospital Revenue Code	274
Min. Negotiated Rate	$38.12
Max. Negotiated Rate	$76.25
Rate for Payer: Cash Price	$103.70
Rate for Payer: Cigna Commercial	$38.12
Rate for Payer: Multiplan Auto	$76.25
Rate for Payer: Multiplan Commercial	$76.25
Rate for Payer: Multiplan Workers Comp	$76.25
Rate for Payer: Scott and White EPO/PPO	$76.25

NH TEST KIT VTK2 20 CARDS

Facility

$492.59

Hospital Charge Code	992626
Hospital Revenue Code	270
Rate for Payer: Cash Price	$334.96

NH TEST KIT VTK2 20 CARDS

Facility

$492.59

Hospital Charge Code	992626
Hospital Revenue Code	270
Min. Negotiated Rate	$44.33
Max. Negotiated Rate	$354.66
Rate for Payer: Amerigroup CHIP/Medicaid	$44.33
Rate for Payer: BCBS of TX Blue Advantage	$147.78
Rate for Payer: BCBS of TX Blue Essentials	$177.33
Rate for Payer: BCBS of TX PPO	$197.04
Rate for Payer: Cash Price	$334.96
Rate for Payer: Cigna Medicaid	$354.66
Rate for Payer: Molina CHIP/Medicaid	$354.66
Rate for Payer: Multiplan Auto	$320.18
Rate for Payer: Multiplan Commercial	$320.18
Rate for Payer: Multiplan Workers Comp	$320.18
Rate for Payer: Parkland Medicaid	$354.66
Rate for Payer: Scott and White EPO/PPO	$246.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$354.66
Rate for Payer: Superior Health Plan EPO	$66.99

Know your out-of-pocket cost for care.

All Charges