White Rock Medical Center

All Charges

Charge

Type

Setting

Price

vancomycin 1.25 g in 250 mL

Facility

$128.17

Service Code	HCPCS J3370
Hospital Charge Code	77869690
Hospital Revenue Code	636
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$83.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$2.06
Rate for Payer: BCBS of TX Blue Essentials	$2.47
Rate for Payer: BCBS of TX PPO	$2.74
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

vancomycin 1.25 g in 250 mL

Facility

$128.17

Service Code	HCPCS J3370
Hospital Charge Code	77869690
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

vancomycin 1 g IV Inj

Facility

$128.17

Service Code	HCPCS J3370
Hospital Charge Code	77869305
Hospital Revenue Code	636
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$83.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$2.06
Rate for Payer: BCBS of TX Blue Essentials	$2.47
Rate for Payer: BCBS of TX PPO	$2.74
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

vancomycin 1 g IV Inj

Facility

$128.17

Service Code	HCPCS J3370
Hospital Charge Code	77869305
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

vancomycin 500 mg IV Inj

Facility

$128.17

Service Code	HCPCS J3370
Hospital Charge Code	77870620
Hospital Revenue Code	636
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$83.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$2.06
Rate for Payer: BCBS of TX Blue Essentials	$2.47
Rate for Payer: BCBS of TX PPO	$2.74
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

vancomycin 500 mg IV Inj

Facility

$128.17

Service Code	HCPCS J3370
Hospital Charge Code	77870620
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

vancomycin 50 mg/mL Oral Liquid 300 mL

Facility

$483.93

Service Code	HCPCS J3490
Hospital Charge Code	77870571
Hospital Revenue Code	250
Rate for Payer: Cash Price	$329.07

vancomycin 50 mg/mL Oral Liquid 300 mL

Facility

$483.93

Service Code	HCPCS J3490
Hospital Charge Code	77870571
Hospital Revenue Code	250
Min. Negotiated Rate	$43.55
Max. Negotiated Rate	$314.55
Rate for Payer: Amerigroup CHIP/Medicaid	$43.55
Rate for Payer: BCBS of TX Blue Advantage	$145.18
Rate for Payer: BCBS of TX Blue Essentials	$174.21
Rate for Payer: BCBS of TX PPO	$193.57
Rate for Payer: Cash Price	$329.07
Rate for Payer: Multiplan Auto	$314.55
Rate for Payer: Multiplan Commercial	$314.55
Rate for Payer: Multiplan Workers Comp	$314.55
Rate for Payer: Scott and White EPO/PPO	$241.96
Rate for Payer: Superior Health Plan EPO	$65.81

Vancomycin Level

Facility

$404.00

Service Code	CPT 80202
Hospital Charge Code	1601525
Hospital Revenue Code	300
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$262.60
Rate for Payer: Aetna Commercial	$14.21
Rate for Payer: Aetna Medicare	$20.31
Rate for Payer: Amerigroup CHIP/Medicaid	$5.28
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13.54
Rate for Payer: Amerigroup Medicare	$13.54
Rate for Payer: BCBS of TX Blue Advantage	$22.34
Rate for Payer: BCBS of TX Blue Essentials	$26.81
Rate for Payer: BCBS of TX Medicare	$13.54
Rate for Payer: BCBS of TX PPO	$29.92
Rate for Payer: Cash Price	$355.52
Rate for Payer: Cash Price	$355.52
Rate for Payer: Cigna Medicaid	$13.54
Rate for Payer: Cigna Medicare	$13.54
Rate for Payer: Employer Direct Commercial	$13.54
Rate for Payer: Humana Medicare/TRICARE	$13.54
Rate for Payer: Molina CHIP/Medicaid	$13.54
Rate for Payer: Molina Dual Medicare/Medicaid	$13.54
Rate for Payer: Molina Medicare	$13.54
Rate for Payer: Multiplan Auto	$262.60
Rate for Payer: Multiplan Commercial	$262.60
Rate for Payer: Multiplan Workers Comp	$262.60
Rate for Payer: Parkland Medicaid	$13.54
Rate for Payer: Scott and White EPO/PPO	$16.92
Rate for Payer: Scott and White Medicare	$13.54
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.54
Rate for Payer: Superior Health Plan EPO	$13.54
Rate for Payer: Superior Health Plan Medicare	$13.54
Rate for Payer: Universal American Dual Medicare/Medicaid	$13.54
Rate for Payer: Universal American Medicare	$13.54
Rate for Payer: Wellcare Medicare	$13.54
Rate for Payer: Wellmed Medicare	$13.54

Vancomycin Level Peak

Facility

$404.00

Service Code	CPT 80202
Hospital Charge Code	1601525
Hospital Revenue Code	300
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$262.60
Rate for Payer: Aetna Commercial	$14.21
Rate for Payer: Aetna Medicare	$20.31
Rate for Payer: Amerigroup CHIP/Medicaid	$5.28
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13.54
Rate for Payer: Amerigroup Medicare	$13.54
Rate for Payer: BCBS of TX Blue Advantage	$22.34
Rate for Payer: BCBS of TX Blue Essentials	$26.81
Rate for Payer: BCBS of TX Medicare	$13.54
Rate for Payer: BCBS of TX PPO	$29.92
Rate for Payer: Cash Price	$355.52
Rate for Payer: Cash Price	$355.52
Rate for Payer: Cigna Medicaid	$13.54
Rate for Payer: Cigna Medicare	$13.54
Rate for Payer: Employer Direct Commercial	$13.54
Rate for Payer: Humana Medicare/TRICARE	$13.54
Rate for Payer: Molina CHIP/Medicaid	$13.54
Rate for Payer: Molina Dual Medicare/Medicaid	$13.54
Rate for Payer: Molina Medicare	$13.54
Rate for Payer: Multiplan Auto	$262.60
Rate for Payer: Multiplan Commercial	$262.60
Rate for Payer: Multiplan Workers Comp	$262.60
Rate for Payer: Parkland Medicaid	$13.54
Rate for Payer: Scott and White EPO/PPO	$16.92
Rate for Payer: Scott and White Medicare	$13.54
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.54
Rate for Payer: Superior Health Plan EPO	$13.54
Rate for Payer: Superior Health Plan Medicare	$13.54
Rate for Payer: Universal American Dual Medicare/Medicaid	$13.54
Rate for Payer: Universal American Medicare	$13.54
Rate for Payer: Wellcare Medicare	$13.54
Rate for Payer: Wellmed Medicare	$13.54

Vancomycin Level Trough

Facility

$404.00

Service Code	CPT 80202
Hospital Charge Code	1601525
Hospital Revenue Code	300
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$262.60
Rate for Payer: Aetna Commercial	$14.21
Rate for Payer: Aetna Medicare	$20.31
Rate for Payer: Amerigroup CHIP/Medicaid	$5.28
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13.54
Rate for Payer: Amerigroup Medicare	$13.54
Rate for Payer: BCBS of TX Blue Advantage	$22.34
Rate for Payer: BCBS of TX Blue Essentials	$26.81
Rate for Payer: BCBS of TX Medicare	$13.54
Rate for Payer: BCBS of TX PPO	$29.92
Rate for Payer: Cash Price	$355.52
Rate for Payer: Cash Price	$355.52
Rate for Payer: Cigna Medicaid	$13.54
Rate for Payer: Cigna Medicare	$13.54
Rate for Payer: Employer Direct Commercial	$13.54
Rate for Payer: Humana Medicare/TRICARE	$13.54
Rate for Payer: Molina CHIP/Medicaid	$13.54
Rate for Payer: Molina Dual Medicare/Medicaid	$13.54
Rate for Payer: Molina Medicare	$13.54
Rate for Payer: Multiplan Auto	$262.60
Rate for Payer: Multiplan Commercial	$262.60
Rate for Payer: Multiplan Workers Comp	$262.60
Rate for Payer: Parkland Medicaid	$13.54
Rate for Payer: Scott and White EPO/PPO	$16.92
Rate for Payer: Scott and White Medicare	$13.54
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.54
Rate for Payer: Superior Health Plan EPO	$13.54
Rate for Payer: Superior Health Plan Medicare	$13.54
Rate for Payer: Universal American Dual Medicare/Medicaid	$13.54
Rate for Payer: Universal American Medicare	$13.54
Rate for Payer: Wellcare Medicare	$13.54
Rate for Payer: Wellmed Medicare	$13.54

Vancomycin Level Trough

Facility

$404.00

Service Code	CPT 80202
Hospital Charge Code	1601525
Hospital Revenue Code	300
Rate for Payer: Cash Price	$355.52

Vancomycin Resistant Enterococcus Culture

Facility

$229.00

Service Code	CPT 87081
Hospital Charge Code	4107053
Hospital Revenue Code	306
Rate for Payer: Cash Price	$201.52

Vancomycin Resistant Enterococcus Culture

Facility

$229.00

Service Code	CPT 87081
Hospital Charge Code	4107053
Hospital Revenue Code	306
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$148.85
Rate for Payer: Aetna Commercial	$6.96
Rate for Payer: Aetna Medicare	$9.94
Rate for Payer: Amerigroup CHIP/Medicaid	$2.59
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6.63
Rate for Payer: Amerigroup Medicare	$6.63
Rate for Payer: BCBS of TX Blue Advantage	$10.94
Rate for Payer: BCBS of TX Blue Essentials	$13.13
Rate for Payer: BCBS of TX Medicare	$6.63
Rate for Payer: BCBS of TX PPO	$14.65
Rate for Payer: Cash Price	$201.52
Rate for Payer: Cash Price	$201.52
Rate for Payer: Cigna Medicaid	$6.63
Rate for Payer: Cigna Medicare	$6.63
Rate for Payer: Employer Direct Commercial	$6.63
Rate for Payer: Humana Medicare/TRICARE	$6.63
Rate for Payer: Molina CHIP/Medicaid	$6.63
Rate for Payer: Molina Dual Medicare/Medicaid	$6.63
Rate for Payer: Molina Medicare	$6.63
Rate for Payer: Multiplan Auto	$148.85
Rate for Payer: Multiplan Commercial	$148.85
Rate for Payer: Multiplan Workers Comp	$148.85
Rate for Payer: Parkland Medicaid	$6.63
Rate for Payer: Scott and White EPO/PPO	$8.29
Rate for Payer: Scott and White Medicare	$6.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.63
Rate for Payer: Superior Health Plan EPO	$6.63
Rate for Payer: Superior Health Plan Medicare	$6.63
Rate for Payer: Universal American Dual Medicare/Medicaid	$6.63
Rate for Payer: Universal American Medicare	$6.63
Rate for Payer: Wellcare Medicare	$6.63
Rate for Payer: Wellmed Medicare	$6.63

Vanillylmandelic Acid, 24-Hr U SO

Facility

$78.00

Service Code	CPT 84585
Hospital Charge Code	1702182
Hospital Revenue Code	301
Rate for Payer: Cash Price	$68.64

Vanillylmandelic Acid, 24-Hr U SO

Facility

$78.00

Service Code	CPT 84585
Hospital Charge Code	1702182
Hospital Revenue Code	301
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$50.70
Rate for Payer: Aetna Commercial	$16.28
Rate for Payer: Aetna Medicare	$23.25
Rate for Payer: Amerigroup CHIP/Medicaid	$6.05
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15.50
Rate for Payer: Amerigroup Medicare	$15.50
Rate for Payer: BCBS of TX Blue Advantage	$25.58
Rate for Payer: BCBS of TX Blue Essentials	$30.69
Rate for Payer: BCBS of TX Medicare	$15.50
Rate for Payer: BCBS of TX PPO	$34.26
Rate for Payer: Cash Price	$68.64
Rate for Payer: Cash Price	$68.64
Rate for Payer: Cigna Medicaid	$15.50
Rate for Payer: Cigna Medicare	$15.50
Rate for Payer: Employer Direct Commercial	$15.50
Rate for Payer: Humana Medicare/TRICARE	$15.50
Rate for Payer: Molina CHIP/Medicaid	$15.50
Rate for Payer: Molina Dual Medicare/Medicaid	$15.50
Rate for Payer: Molina Medicare	$15.50
Rate for Payer: Multiplan Auto	$50.70
Rate for Payer: Multiplan Commercial	$50.70
Rate for Payer: Multiplan Workers Comp	$50.70
Rate for Payer: Parkland Medicaid	$15.50
Rate for Payer: Scott and White EPO/PPO	$19.38
Rate for Payer: Scott and White Medicare	$15.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$15.50
Rate for Payer: Superior Health Plan EPO	$15.50
Rate for Payer: Superior Health Plan Medicare	$15.50
Rate for Payer: Universal American Dual Medicare/Medicaid	$15.50
Rate for Payer: Universal American Medicare	$15.50
Rate for Payer: Wellcare Medicare	$15.50
Rate for Payer: Wellmed Medicare	$15.50

Varicella Zoster Abs, IgG/IgM SO

Facility

$197.00

Service Code	CPT 86787
Hospital Charge Code	1700897
Hospital Revenue Code	302
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$128.05
Rate for Payer: Aetna Commercial	$13.53
Rate for Payer: Aetna Medicare	$19.32
Rate for Payer: Amerigroup CHIP/Medicaid	$5.02
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12.88
Rate for Payer: Amerigroup Medicare	$12.88
Rate for Payer: BCBS of TX Blue Advantage	$21.25
Rate for Payer: BCBS of TX Blue Essentials	$25.50
Rate for Payer: BCBS of TX Medicare	$12.88
Rate for Payer: BCBS of TX PPO	$28.46
Rate for Payer: Cash Price	$173.36
Rate for Payer: Cash Price	$173.36
Rate for Payer: Cigna Medicaid	$12.88
Rate for Payer: Cigna Medicare	$12.88
Rate for Payer: Employer Direct Commercial	$12.88
Rate for Payer: Humana Medicare/TRICARE	$12.88
Rate for Payer: Molina CHIP/Medicaid	$12.88
Rate for Payer: Molina Dual Medicare/Medicaid	$12.88
Rate for Payer: Molina Medicare	$12.88
Rate for Payer: Multiplan Auto	$128.05
Rate for Payer: Multiplan Commercial	$128.05
Rate for Payer: Multiplan Workers Comp	$128.05
Rate for Payer: Parkland Medicaid	$12.88
Rate for Payer: Scott and White EPO/PPO	$16.10
Rate for Payer: Scott and White Medicare	$12.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.88
Rate for Payer: Superior Health Plan EPO	$12.88
Rate for Payer: Superior Health Plan Medicare	$12.88
Rate for Payer: Universal American Dual Medicare/Medicaid	$12.88
Rate for Payer: Universal American Medicare	$12.88
Rate for Payer: Wellcare Medicare	$12.88
Rate for Payer: Wellmed Medicare	$12.88

Varicella Zoster Antibody IgG

Facility

$197.00

Service Code	CPT 86787
Hospital Charge Code	1700897
Hospital Revenue Code	302
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$128.05
Rate for Payer: Aetna Commercial	$13.53
Rate for Payer: Aetna Medicare	$19.32
Rate for Payer: Amerigroup CHIP/Medicaid	$5.02
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12.88
Rate for Payer: Amerigroup Medicare	$12.88
Rate for Payer: BCBS of TX Blue Advantage	$21.25
Rate for Payer: BCBS of TX Blue Essentials	$25.50
Rate for Payer: BCBS of TX Medicare	$12.88
Rate for Payer: BCBS of TX PPO	$28.46
Rate for Payer: Cash Price	$173.36
Rate for Payer: Cash Price	$173.36
Rate for Payer: Cigna Medicaid	$12.88
Rate for Payer: Cigna Medicare	$12.88
Rate for Payer: Employer Direct Commercial	$12.88
Rate for Payer: Humana Medicare/TRICARE	$12.88
Rate for Payer: Molina CHIP/Medicaid	$12.88
Rate for Payer: Molina Dual Medicare/Medicaid	$12.88
Rate for Payer: Molina Medicare	$12.88
Rate for Payer: Multiplan Auto	$128.05
Rate for Payer: Multiplan Commercial	$128.05
Rate for Payer: Multiplan Workers Comp	$128.05
Rate for Payer: Parkland Medicaid	$12.88
Rate for Payer: Scott and White EPO/PPO	$16.10
Rate for Payer: Scott and White Medicare	$12.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.88
Rate for Payer: Superior Health Plan EPO	$12.88
Rate for Payer: Superior Health Plan Medicare	$12.88
Rate for Payer: Universal American Dual Medicare/Medicaid	$12.88
Rate for Payer: Universal American Medicare	$12.88
Rate for Payer: Wellcare Medicare	$12.88
Rate for Payer: Wellmed Medicare	$12.88

Varicella-Zoster V Ab, IgG SO

Facility

$197.00

Service Code	CPT 86787
Hospital Charge Code	1700897
Hospital Revenue Code	302
Rate for Payer: Cash Price	$173.36

Varicella-Zoster V Ab, IgG SO

Facility

$197.00

Service Code	CPT 86787
Hospital Charge Code	1700897
Hospital Revenue Code	302
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$128.05
Rate for Payer: Aetna Commercial	$13.53
Rate for Payer: Aetna Medicare	$19.32
Rate for Payer: Amerigroup CHIP/Medicaid	$5.02
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12.88
Rate for Payer: Amerigroup Medicare	$12.88
Rate for Payer: BCBS of TX Blue Advantage	$21.25
Rate for Payer: BCBS of TX Blue Essentials	$25.50
Rate for Payer: BCBS of TX Medicare	$12.88
Rate for Payer: BCBS of TX PPO	$28.46
Rate for Payer: Cash Price	$173.36
Rate for Payer: Cash Price	$173.36
Rate for Payer: Cigna Medicaid	$12.88
Rate for Payer: Cigna Medicare	$12.88
Rate for Payer: Employer Direct Commercial	$12.88
Rate for Payer: Humana Medicare/TRICARE	$12.88
Rate for Payer: Molina CHIP/Medicaid	$12.88
Rate for Payer: Molina Dual Medicare/Medicaid	$12.88
Rate for Payer: Molina Medicare	$12.88
Rate for Payer: Multiplan Auto	$128.05
Rate for Payer: Multiplan Commercial	$128.05
Rate for Payer: Multiplan Workers Comp	$128.05
Rate for Payer: Parkland Medicaid	$12.88
Rate for Payer: Scott and White EPO/PPO	$16.10
Rate for Payer: Scott and White Medicare	$12.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.88
Rate for Payer: Superior Health Plan EPO	$12.88
Rate for Payer: Superior Health Plan Medicare	$12.88
Rate for Payer: Universal American Dual Medicare/Medicaid	$12.88
Rate for Payer: Universal American Medicare	$12.88
Rate for Payer: Wellcare Medicare	$12.88
Rate for Payer: Wellmed Medicare	$12.88

VASC EMB/OCC ARTERY

Facility

$24,099.00

Service Code	CPT 37242
Hospital Charge Code	4617242
Hospital Revenue Code	361
Min. Negotiated Rate	$353.72
Max. Negotiated Rate	$36,327.72
Rate for Payer: Aetna Commercial	$8,755.00
Rate for Payer: Aetna Medicare	$24,055.02
Rate for Payer: Amerigroup CHIP/Medicaid	$5,195.63
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16,036.68
Rate for Payer: Amerigroup Medicare	$16,036.68
Rate for Payer: BCBS of TX Blue Advantage	$16,547.16
Rate for Payer: BCBS of TX Blue Essentials	$19,816.96
Rate for Payer: BCBS of TX Medicare	$16,036.68
Rate for Payer: BCBS of TX PPO	$24,969.37
Rate for Payer: Cash Price	$21,207.12
Rate for Payer: Cash Price	$21,207.12
Rate for Payer: Cigna Commercial	$36,327.72
Rate for Payer: Cigna Medicaid	$5,195.63
Rate for Payer: Cigna Medicare	$16,036.68
Rate for Payer: Employer Direct Commercial	$16,036.68
Rate for Payer: Humana Medicare/TRICARE	$16,036.68
Rate for Payer: Molina CHIP/Medicaid	$5,195.63
Rate for Payer: Molina Dual Medicare/Medicaid	$16,036.68
Rate for Payer: Molina Medicare	$16,036.68
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: Parkland Medicaid	$5,195.63
Rate for Payer: Scott and White EPO/PPO	$353.72
Rate for Payer: Scott and White Medicare	$16,036.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,195.63
Rate for Payer: Superior Health Plan EPO	$16,036.68
Rate for Payer: Superior Health Plan Medicare	$16,036.68
Rate for Payer: Universal American Dual Medicare/Medicaid	$16,036.68
Rate for Payer: Universal American Medicare	$16,036.68
Rate for Payer: Wellcare Medicare	$16,036.68
Rate for Payer: Wellmed Medicare	$16,036.68

VASC EMB/OCC ARTERY

Facility

$24,099.00

Service Code	CPT 37242
Hospital Charge Code	4617242
Hospital Revenue Code	361
Rate for Payer: Cash Price	$21,207.12

VASC RMVL TUNNELED CV CATH BCE

Facility

$1,849.00

Service Code	CPT 36589
Hospital Charge Code	8750540
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,627.12

VASC RMVL TUNNELED CV CATH BCE

Facility

$1,849.00

Service Code	CPT 36589
Hospital Charge Code	8750540
Hospital Revenue Code	361
Min. Negotiated Rate	$12.67
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$861.78
Rate for Payer: Amerigroup CHIP/Medicaid	$223.75
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$574.52
Rate for Payer: Amerigroup Medicare	$574.52
Rate for Payer: BCBS of TX Blue Advantage	$1,052.95
Rate for Payer: BCBS of TX Blue Essentials	$1,261.02
Rate for Payer: BCBS of TX Medicare	$574.52
Rate for Payer: BCBS of TX PPO	$1,588.89
Rate for Payer: Cash Price	$1,627.12
Rate for Payer: Cash Price	$1,627.12
Rate for Payer: Cigna Commercial	$1,301.46
Rate for Payer: Cigna Medicaid	$223.75
Rate for Payer: Cigna Medicare	$574.52
Rate for Payer: Employer Direct Commercial	$574.52
Rate for Payer: Humana Medicare/TRICARE	$574.52
Rate for Payer: Molina CHIP/Medicaid	$223.75
Rate for Payer: Molina Dual Medicare/Medicaid	$574.52
Rate for Payer: Molina Medicare	$574.52
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	$223.75
Rate for Payer: Scott and White EPO/PPO	$12.67
Rate for Payer: Scott and White Medicare	$574.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$223.75
Rate for Payer: Superior Health Plan EPO	$574.52
Rate for Payer: Superior Health Plan Medicare	$574.52
Rate for Payer: Universal American Dual Medicare/Medicaid	$574.52
Rate for Payer: Universal American Medicare	$574.52
Rate for Payer: Wellcare Medicare	$574.52
Rate for Payer: Wellmed Medicare	$574.52

VASCU-GUARD PERIPHERAL VAS PATCH 0.8X8MM

Facility

$1,100.42

Service Code	HCPCS C1768
Hospital Charge Code	131744
Hospital Revenue Code	278
Min. Negotiated Rate	$99.04
Max. Negotiated Rate	$550.21
Rate for Payer: Aetna Commercial	$330.13
Rate for Payer: Amerigroup CHIP/Medicaid	$99.04
Rate for Payer: BCBS of TX Blue Advantage	$330.13
Rate for Payer: BCBS of TX Blue Essentials	$396.15
Rate for Payer: BCBS of TX PPO	$440.17
Rate for Payer: Cash Price	$968.37
Rate for Payer: Multiplan Auto	$550.21
Rate for Payer: Multiplan Commercial	$550.21
Rate for Payer: Multiplan Workers Comp	$550.21
Rate for Payer: Scott and White EPO/PPO	$550.21
Rate for Payer: Superior Health Plan EPO	$149.66

Know your out-of-pocket cost for care.

All Charges