White Rock Medical Center

All Charges

Charge

Type

Setting

Price

OPWC Skin Sub Grft Fce/Nck/FH/G Ch ad 20sqcm BCE

Facility

$10,292.16

Service Code	HCPCS 15276
Hospital Charge Code	8910575
Hospital Revenue Code	361
Rate for Payer: Cash Price	$6,998.67

OPWC Skin Sub Grft Trk/Arm/Leg Ch 1st 100sqcm BCE

Facility

$6,927.00

Service Code	HCPCS 15273
Hospital Charge Code	8910573
Hospital Revenue Code	361
Min. Negotiated Rate	$1,565.86
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,565.86
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Amerigroup Medicare	$2,072.68
Rate for Payer: BCBS of TX Blue Advantage	$4,972.07
Rate for Payer: BCBS of TX Blue Essentials	$5,954.58
Rate for Payer: BCBS of TX Medicare	$2,072.68
Rate for Payer: BCBS of TX PPO	$7,502.77
Rate for Payer: Cash Price	$4,710.36
Rate for Payer: Cash Price	$4,710.36
Rate for Payer: Cash Price	$4,710.36
Rate for Payer: Cigna Commercial	$4,381.27
Rate for Payer: Cigna Medicaid	$4,987.44
Rate for Payer: Cigna Medicare	$2,072.68
Rate for Payer: Employer Direct Commercial	$2,072.68
Rate for Payer: Humana Medicare/TRICARE	$2,072.68
Rate for Payer: Molina CHIP/Medicaid	$4,987.44
Rate for Payer: Molina Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Molina Medicare	$2,072.68
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	$4,987.44
Rate for Payer: Scott and White EPO/PPO	$6,069.94
Rate for Payer: Scott and White Medicare	$2,072.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,987.44
Rate for Payer: Superior Health Plan EPO	$2,072.68
Rate for Payer: Superior Health Plan Medicare	$2,072.68
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Universal American Medicare	$2,072.68
Rate for Payer: Wellcare Medicare	$2,072.68
Rate for Payer: Wellmed Medicare	$2,072.68

OPWC Skin Sub Grft Trk/Arm/Leg Ch 1st 100sqcm BCE

Facility

$6,927.00

Service Code	HCPCS 15273
Hospital Charge Code	8910573
Hospital Revenue Code	361
Rate for Payer: Cash Price	$4,710.36

OPWC Skin Sub Grft Trk/Arm/Leg Ch 1st 25 sqcm BCE

Facility

$10,292.16

Service Code	HCPCS 15271
Hospital Charge Code	8912556
Hospital Revenue Code	361
Min. Negotiated Rate	$742.44
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$784.87
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$742.44
Rate for Payer: Amerigroup Medicare	$742.44
Rate for Payer: BCBS of TX Blue Advantage	$2,709.98
Rate for Payer: BCBS of TX Blue Essentials	$3,245.48
Rate for Payer: BCBS of TX Medicare	$742.44
Rate for Payer: BCBS of TX PPO	$4,089.30
Rate for Payer: Cash Price	$6,998.67
Rate for Payer: Cash Price	$6,998.67
Rate for Payer: Cash Price	$6,998.67
Rate for Payer: Cigna Commercial	$1,569.38
Rate for Payer: Cigna Medicaid	$7,410.36
Rate for Payer: Cigna Medicare	$742.44
Rate for Payer: Employer Direct Commercial	$742.44
Rate for Payer: Humana Medicare/TRICARE	$742.44
Rate for Payer: Molina CHIP/Medicaid	$7,410.36
Rate for Payer: Molina Dual Medicare/Medicaid	$742.44
Rate for Payer: Molina Medicare	$742.44
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	$7,410.36
Rate for Payer: Scott and White EPO/PPO	$3,085.41
Rate for Payer: Scott and White Medicare	$742.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,410.36
Rate for Payer: Superior Health Plan EPO	$742.44
Rate for Payer: Superior Health Plan Medicare	$742.44
Rate for Payer: Universal American Dual Medicare/Medicaid	$742.44
Rate for Payer: Universal American Medicare	$742.44
Rate for Payer: Wellcare Medicare	$742.44
Rate for Payer: Wellmed Medicare	$742.44

OPWC Skin Sub Grft Trk/Arm/Leg Ch 1st 25 sqcm BCE

Facility

$10,292.16

Service Code	HCPCS 15271
Hospital Charge Code	8912556
Hospital Revenue Code	361
Rate for Payer: Cash Price	$6,998.67

OPWC Skin Sub Grft Trk/Arm/Leg Ch ad 25 sqcm BCE

Facility

$977.00

Service Code	HCPCS 15272
Hospital Charge Code	8910572
Hospital Revenue Code	361
Min. Negotiated Rate	$87.93
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$87.93
Rate for Payer: BCBS of TX Blue Advantage	$293.10
Rate for Payer: BCBS of TX Blue Essentials	$351.72
Rate for Payer: BCBS of TX PPO	$390.80
Rate for Payer: Cash Price	$664.36
Rate for Payer: Cash Price	$664.36
Rate for Payer: Cigna Medicaid	$703.44
Rate for Payer: Molina CHIP/Medicaid	$703.44
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	$703.44
Rate for Payer: Scott and White EPO/PPO	$488.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$703.44
Rate for Payer: Superior Health Plan EPO	$132.87

OPWC Skin Sub Grft Trk/Arm/Leg Ch ad 25 sqcm BCE

Facility

$977.00

Service Code	HCPCS 15272
Hospital Charge Code	8910572
Hospital Revenue Code	361
Rate for Payer: Cash Price	$664.36

OPWC Skin Sub Grft Trnk/Arm/Leg Ch ad 100sqcm BCE

Facility

$3,438.00

Service Code	HCPCS 15274
Hospital Charge Code	8910574
Hospital Revenue Code	361
Rate for Payer: Cash Price	$2,337.84

OPWC Skin Sub Grft Trnk/Arm/Leg Ch ad 100sqcm BCE

Facility

$3,438.00

Service Code	HCPCS 15274
Hospital Charge Code	8910574
Hospital Revenue Code	361
Min. Negotiated Rate	$309.42
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$309.42
Rate for Payer: BCBS of TX Blue Advantage	$1,031.40
Rate for Payer: BCBS of TX Blue Essentials	$1,237.68
Rate for Payer: BCBS of TX PPO	$1,375.20
Rate for Payer: Cash Price	$2,337.84
Rate for Payer: Cash Price	$2,337.84
Rate for Payer: Cigna Medicaid	$2,475.36
Rate for Payer: Molina CHIP/Medicaid	$2,475.36
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	$2,475.36
Rate for Payer: Scott and White EPO/PPO	$1,719.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,475.36
Rate for Payer: Superior Health Plan EPO	$467.57

OPWC Strapping Una Boot Lt BCE

Facility

$993.50

Service Code	HCPCS 29580
Hospital Charge Code	8910576
Hospital Revenue Code	361
Min. Negotiated Rate	$33.12
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$33.12
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$163.24
Rate for Payer: Amerigroup Medicare	$163.24
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	$163.24
Rate for Payer: BCBS of TX PPO	$106.39
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cigna Commercial	$345.06
Rate for Payer: Cigna Medicaid	$715.32
Rate for Payer: Cigna Medicare	$163.24
Rate for Payer: Employer Direct Commercial	$163.24
Rate for Payer: Humana Medicare/TRICARE	$163.24
Rate for Payer: Molina CHIP/Medicaid	$715.32
Rate for Payer: Molina Dual Medicare/Medicaid	$163.24
Rate for Payer: Molina Medicare	$163.24
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	$715.32
Rate for Payer: Scott and White EPO/PPO	$266.58
Rate for Payer: Scott and White Medicare	$163.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$715.32
Rate for Payer: Superior Health Plan EPO	$163.24
Rate for Payer: Superior Health Plan Medicare	$163.24
Rate for Payer: Universal American Dual Medicare/Medicaid	$163.24
Rate for Payer: Universal American Medicare	$163.24
Rate for Payer: Wellcare Medicare	$163.24
Rate for Payer: Wellmed Medicare	$163.24

OPWC Strapping Una Boot Lt BCE

Facility

$993.50

Service Code	HCPCS 29580
Hospital Charge Code	8910576
Hospital Revenue Code	361
Rate for Payer: Cash Price	$675.58

OPWC Strapping Una Boot Rt BCE

Facility

$993.50

Service Code	HCPCS 29580
Hospital Charge Code	7150831
Hospital Revenue Code	361
Rate for Payer: Cash Price	$675.58

OPWC Strapping Una Boot Rt BCE

Facility

$993.50

Service Code	HCPCS 29580
Hospital Charge Code	7150831
Hospital Revenue Code	361
Min. Negotiated Rate	$33.12
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$33.12
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$163.24
Rate for Payer: Amerigroup Medicare	$163.24
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	$163.24
Rate for Payer: BCBS of TX PPO	$106.39
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cigna Commercial	$345.06
Rate for Payer: Cigna Medicaid	$715.32
Rate for Payer: Cigna Medicare	$163.24
Rate for Payer: Employer Direct Commercial	$163.24
Rate for Payer: Humana Medicare/TRICARE	$163.24
Rate for Payer: Molina CHIP/Medicaid	$715.32
Rate for Payer: Molina Dual Medicare/Medicaid	$163.24
Rate for Payer: Molina Medicare	$163.24
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	$715.32
Rate for Payer: Scott and White EPO/PPO	$266.58
Rate for Payer: Scott and White Medicare	$163.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$715.32
Rate for Payer: Superior Health Plan EPO	$163.24
Rate for Payer: Superior Health Plan Medicare	$163.24
Rate for Payer: Universal American Dual Medicare/Medicaid	$163.24
Rate for Payer: Universal American Medicare	$163.24
Rate for Payer: Wellcare Medicare	$163.24
Rate for Payer: Wellmed Medicare	$163.24

OPWC Strapping Una Boot Rt BCE

Facility

$993.50

Service Code	HCPCS 29580
Hospital Charge Code	8912558
Hospital Revenue Code	361
Min. Negotiated Rate	$33.12
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$33.12
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$163.24
Rate for Payer: Amerigroup Medicare	$163.24
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	$163.24
Rate for Payer: BCBS of TX PPO	$106.39
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cigna Commercial	$345.06
Rate for Payer: Cigna Medicaid	$715.32
Rate for Payer: Cigna Medicare	$163.24
Rate for Payer: Employer Direct Commercial	$163.24
Rate for Payer: Humana Medicare/TRICARE	$163.24
Rate for Payer: Molina CHIP/Medicaid	$715.32
Rate for Payer: Molina Dual Medicare/Medicaid	$163.24
Rate for Payer: Molina Medicare	$163.24
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	$715.32
Rate for Payer: Scott and White EPO/PPO	$266.58
Rate for Payer: Scott and White Medicare	$163.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$715.32
Rate for Payer: Superior Health Plan EPO	$163.24
Rate for Payer: Superior Health Plan Medicare	$163.24
Rate for Payer: Universal American Dual Medicare/Medicaid	$163.24
Rate for Payer: Universal American Medicare	$163.24
Rate for Payer: Wellcare Medicare	$163.24
Rate for Payer: Wellmed Medicare	$163.24

OPWC Strapping Una Boot Rt BCE

Facility

$993.50

Service Code	HCPCS 29580
Hospital Charge Code	8912558
Hospital Revenue Code	361
Rate for Payer: Cash Price	$675.58

OPWC Tangntl Bx Skin Ea Sep/Addl BCE

Facility

$399.00

Service Code	HCPCS 11103
Hospital Charge Code	8914561
Hospital Revenue Code	361
Min. Negotiated Rate	$35.91
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$35.91
Rate for Payer: BCBS of TX Blue Advantage	$119.70
Rate for Payer: BCBS of TX Blue Essentials	$143.64
Rate for Payer: BCBS of TX PPO	$159.60
Rate for Payer: Cash Price	$271.32
Rate for Payer: Cash Price	$271.32
Rate for Payer: Cigna Medicaid	$287.28
Rate for Payer: Molina CHIP/Medicaid	$287.28
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	$287.28
Rate for Payer: Scott and White EPO/PPO	$199.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$287.28
Rate for Payer: Superior Health Plan EPO	$54.26

OPWC Tangntl Bx Skin Ea Sep/Addl BCE

Facility

$399.00

Service Code	HCPCS 11103
Hospital Charge Code	8914561
Hospital Revenue Code	361
Rate for Payer: Cash Price	$271.32

OPWC Tangntl Bx Skin Single Les BCE

Facility

$715.00

Service Code	HCPCS 11102
Hospital Charge Code	8912559
Hospital Revenue Code	361
Rate for Payer: Cash Price	$486.20

OPWC Tangntl Bx Skin Single Les BCE

Facility

$715.00

Service Code	HCPCS 11102
Hospital Charge Code	8912559
Hospital Revenue Code	361
Min. Negotiated Rate	$64.23
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$64.23
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$408.37
Rate for Payer: Amerigroup Medicare	$408.37
Rate for Payer: BCBS of TX Blue Advantage	$126.57
Rate for Payer: BCBS of TX Blue Essentials	$151.58
Rate for Payer: BCBS of TX Medicare	$408.37
Rate for Payer: BCBS of TX PPO	$190.99
Rate for Payer: Cash Price	$486.20
Rate for Payer: Cash Price	$486.20
Rate for Payer: Cash Price	$486.20
Rate for Payer: Cigna Commercial	$863.21
Rate for Payer: Cigna Medicaid	$514.80
Rate for Payer: Cigna Medicare	$408.37
Rate for Payer: Employer Direct Commercial	$408.37
Rate for Payer: Humana Medicare/TRICARE	$408.37
Rate for Payer: Molina CHIP/Medicaid	$514.80
Rate for Payer: Molina Dual Medicare/Medicaid	$408.37
Rate for Payer: Molina Medicare	$408.37
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	$514.80
Rate for Payer: Scott and White EPO/PPO	$338.72
Rate for Payer: Scott and White Medicare	$408.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$514.80
Rate for Payer: Superior Health Plan EPO	$408.37
Rate for Payer: Superior Health Plan Medicare	$408.37
Rate for Payer: Universal American Dual Medicare/Medicaid	$408.37
Rate for Payer: Universal American Medicare	$408.37
Rate for Payer: Wellcare Medicare	$408.37
Rate for Payer: Wellmed Medicare	$408.37

OPWC Tobacco Counsel >10Min Symtomatic BCE

Facility

$97.00

Service Code	HCPCS 99407
Hospital Charge Code	7150782
Hospital Revenue Code	761
Rate for Payer: Cash Price	$65.96

OPWC Tobacco Counsel >10Min Symtomatic BCE

Facility

$97.00

Service Code	HCPCS 99407
Hospital Charge Code	8910577
Hospital Revenue Code	761
Rate for Payer: Cash Price	$65.96

OPWC Tobacco Counsel >10Min Symtomatic BCE

Facility

$97.00

Service Code	HCPCS 99407
Hospital Charge Code	8910577
Hospital Revenue Code	761
Min. Negotiated Rate	$8.73
Max. Negotiated Rate	$79.55
Rate for Payer: Amerigroup CHIP/Medicaid	$8.73
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$37.64
Rate for Payer: Amerigroup Medicare	$37.64
Rate for Payer: BCBS of TX Blue Advantage	$38.00
Rate for Payer: BCBS of TX Blue Essentials	$45.00
Rate for Payer: BCBS of TX Medicare	$37.64
Rate for Payer: BCBS of TX PPO	$50.00
Rate for Payer: Cash Price	$65.96
Rate for Payer: Cash Price	$65.96
Rate for Payer: Cash Price	$65.96
Rate for Payer: Cigna Commercial	$79.55
Rate for Payer: Cigna Medicaid	$69.84
Rate for Payer: Cigna Medicare	$37.64
Rate for Payer: Employer Direct Commercial	$37.64
Rate for Payer: Humana Medicare/TRICARE	$37.64
Rate for Payer: Molina CHIP/Medicaid	$69.84
Rate for Payer: Molina Dual Medicare/Medicaid	$37.64
Rate for Payer: Molina Medicare	$37.64
Rate for Payer: Multiplan Auto	$63.05
Rate for Payer: Multiplan Commercial	$63.05
Rate for Payer: Multiplan Workers Comp	$63.05
Rate for Payer: Parkland Medicaid	$69.84
Rate for Payer: Scott and White EPO/PPO	$30.38
Rate for Payer: Scott and White Medicare	$37.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$69.84
Rate for Payer: Superior Health Plan EPO	$37.64
Rate for Payer: Superior Health Plan Medicare	$37.64
Rate for Payer: Universal American Dual Medicare/Medicaid	$37.64
Rate for Payer: Universal American Medicare	$37.64
Rate for Payer: Wellcare Medicare	$37.64
Rate for Payer: Wellmed Medicare	$37.64

OPWC Tobacco Counsel >10Min Symtomatic BCE

Facility

$97.00

Service Code	HCPCS 99407
Hospital Charge Code	7150782
Hospital Revenue Code	761
Min. Negotiated Rate	$8.73
Max. Negotiated Rate	$79.55
Rate for Payer: Amerigroup CHIP/Medicaid	$8.73
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$37.64
Rate for Payer: Amerigroup Medicare	$37.64
Rate for Payer: BCBS of TX Blue Advantage	$38.00
Rate for Payer: BCBS of TX Blue Essentials	$45.00
Rate for Payer: BCBS of TX Medicare	$37.64
Rate for Payer: BCBS of TX PPO	$50.00
Rate for Payer: Cash Price	$65.96
Rate for Payer: Cash Price	$65.96
Rate for Payer: Cash Price	$65.96
Rate for Payer: Cigna Commercial	$79.55
Rate for Payer: Cigna Medicaid	$69.84
Rate for Payer: Cigna Medicare	$37.64
Rate for Payer: Employer Direct Commercial	$37.64
Rate for Payer: Humana Medicare/TRICARE	$37.64
Rate for Payer: Molina CHIP/Medicaid	$69.84
Rate for Payer: Molina Dual Medicare/Medicaid	$37.64
Rate for Payer: Molina Medicare	$37.64
Rate for Payer: Multiplan Auto	$63.05
Rate for Payer: Multiplan Commercial	$63.05
Rate for Payer: Multiplan Workers Comp	$63.05
Rate for Payer: Parkland Medicaid	$69.84
Rate for Payer: Scott and White EPO/PPO	$30.38
Rate for Payer: Scott and White Medicare	$37.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$69.84
Rate for Payer: Superior Health Plan EPO	$37.64
Rate for Payer: Superior Health Plan Medicare	$37.64
Rate for Payer: Universal American Dual Medicare/Medicaid	$37.64
Rate for Payer: Universal American Medicare	$37.64
Rate for Payer: Wellcare Medicare	$37.64
Rate for Payer: Wellmed Medicare	$37.64

OPWC Trim Nails Any Number BCE

Facility

$993.50

Service Code	HCPCS 11719
Hospital Charge Code	8910578
Hospital Revenue Code	361
Rate for Payer: Cash Price	$675.58

OPWC Trim Nails Any Number BCE

Facility

$993.50

Service Code	HCPCS 11719
Hospital Charge Code	8910578
Hospital Revenue Code	361
Min. Negotiated Rate	$59.26
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$89.42
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$59.26
Rate for Payer: Amerigroup Medicare	$59.26
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	$59.26
Rate for Payer: BCBS of TX PPO	$138.63
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cash Price	$675.58
Rate for Payer: Cigna Commercial	$125.27
Rate for Payer: Cigna Medicaid	$715.32
Rate for Payer: Cigna Medicare	$59.26
Rate for Payer: Employer Direct Commercial	$59.26
Rate for Payer: Humana Medicare/TRICARE	$59.26
Rate for Payer: Molina CHIP/Medicaid	$715.32
Rate for Payer: Molina Dual Medicare/Medicaid	$59.26
Rate for Payer: Molina Medicare	$59.26
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	$715.32
Rate for Payer: Scott and White EPO/PPO	$103.49
Rate for Payer: Scott and White Medicare	$59.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$715.32
Rate for Payer: Superior Health Plan EPO	$59.26
Rate for Payer: Superior Health Plan Medicare	$59.26
Rate for Payer: Universal American Dual Medicare/Medicaid	$59.26
Rate for Payer: Universal American Medicare	$59.26
Rate for Payer: Wellcare Medicare	$59.26
Rate for Payer: Wellmed Medicare	$59.26

Know your out-of-pocket cost for care.

All Charges