White Rock Medical Center

All Charges

Charge

Type

Setting

Price

ORTHO OFC/OUTPT E&M NEW MOD COMPLEXITY BCE

Facility

$488.00

Service Code	HCPCS 99204
Hospital Charge Code	9220244
Hospital Revenue Code	510
Min. Negotiated Rate	$43.92
Max. Negotiated Rate	$351.36
Rate for Payer: Amerigroup CHIP/Medicaid	$43.92
Rate for Payer: BCBS of TX Blue Advantage	$146.40
Rate for Payer: BCBS of TX Blue Essentials	$175.68
Rate for Payer: BCBS of TX PPO	$195.20
Rate for Payer: Cash Price	$331.84
Rate for Payer: Cigna Medicaid	$351.36
Rate for Payer: Molina CHIP/Medicaid	$351.36
Rate for Payer: Multiplan Auto	$317.20
Rate for Payer: Multiplan Commercial	$317.20
Rate for Payer: Multiplan Workers Comp	$317.20
Rate for Payer: Parkland Medicaid	$351.36
Rate for Payer: Scott and White EPO/PPO	$244.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$351.36

ORTHO OFC/OUTPT E&M NEW MOD COMPLEXITY BCE

Facility

$488.00

Service Code	HCPCS 99204
Hospital Charge Code	9220244
Hospital Revenue Code	510
Rate for Payer: Cash Price	$331.84

Orthopedic Cast Application Foot/Ankle BCE

Facility

$579.92

Service Code	HCPCS 29405
Hospital Charge Code	9220238
Hospital Revenue Code	361
Min. Negotiated Rate	$39.03
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$39.03
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$280.97
Rate for Payer: Amerigroup Medicare	$280.97
Rate for Payer: BCBS of TX Blue Advantage	$80.76
Rate for Payer: BCBS of TX Blue Essentials	$96.72
Rate for Payer: BCBS of TX Medicare	$280.97
Rate for Payer: BCBS of TX PPO	$121.87
Rate for Payer: Cash Price	$394.35
Rate for Payer: Cash Price	$394.35
Rate for Payer: Cash Price	$394.35
Rate for Payer: Cigna Commercial	$593.92
Rate for Payer: Cigna Medicaid	$417.54
Rate for Payer: Cigna Medicare	$280.97
Rate for Payer: Employer Direct Commercial	$280.97
Rate for Payer: Humana Medicare/TRICARE	$280.97
Rate for Payer: Molina CHIP/Medicaid	$417.54
Rate for Payer: Molina Dual Medicare/Medicaid	$280.97
Rate for Payer: Molina Medicare	$280.97
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	$417.54
Rate for Payer: Scott and White EPO/PPO	$519.79
Rate for Payer: Scott and White Medicare	$280.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$417.54
Rate for Payer: Superior Health Plan EPO	$280.97
Rate for Payer: Superior Health Plan Medicare	$280.97
Rate for Payer: Universal American Dual Medicare/Medicaid	$280.97
Rate for Payer: Universal American Medicare	$280.97
Rate for Payer: Wellcare Medicare	$280.97
Rate for Payer: Wellmed Medicare	$280.97

Orthopedic Cast Application Foot/Ankle BCE

Facility

$579.92

Service Code	HCPCS 29405
Hospital Charge Code	9220238
Hospital Revenue Code	361
Rate for Payer: Cash Price	$394.35

oseltamivir 30 mg Cap

Facility

$23.94

Service Code	HCPCS j3490
Hospital Charge Code	77738222
Hospital Revenue Code	250
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$17.24
Rate for Payer: Amerigroup CHIP/Medicaid	$2.15
Rate for Payer: BCBS of TX Blue Advantage	$7.18
Rate for Payer: BCBS of TX Blue Essentials	$8.62
Rate for Payer: BCBS of TX PPO	$9.58
Rate for Payer: Cash Price	$16.28
Rate for Payer: Cigna Medicaid	$17.24
Rate for Payer: Molina CHIP/Medicaid	$17.24
Rate for Payer: Multiplan Auto	$15.56
Rate for Payer: Multiplan Commercial	$15.56
Rate for Payer: Multiplan Workers Comp	$15.56
Rate for Payer: Parkland Medicaid	$17.24
Rate for Payer: Scott and White EPO/PPO	$11.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.24
Rate for Payer: Superior Health Plan EPO	$3.26

oseltamivir 30 mg Cap

Facility

$23.94

Service Code	HCPCS j3490
Hospital Charge Code	77738222
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.28

oseltamivir 6 mg/mL Oral suspension 5 mL REPACK

Facility

$7.65

Service Code	HCPCS J8499
Hospital Charge Code	79165964
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

oseltamivir 6 mg/mL Oral suspension 5 mL REPACK

Facility

$7.65

Service Code	HCPCS J8499
Hospital Charge Code	79165964
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$5.51
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.29
Rate for Payer: BCBS of TX Blue Essentials	$2.75
Rate for Payer: BCBS of TX PPO	$3.06
Rate for Payer: Cash Price	$5.20
Rate for Payer: Cigna Medicaid	$5.51
Rate for Payer: Molina CHIP/Medicaid	$5.51
Rate for Payer: Multiplan Auto	$4.97
Rate for Payer: Multiplan Commercial	$4.97
Rate for Payer: Multiplan Workers Comp	$4.97
Rate for Payer: Parkland Medicaid	$5.51
Rate for Payer: Scott and White EPO/PPO	$3.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.51
Rate for Payer: Superior Health Plan EPO	$1.04

oseltamivir 75 mg Cap

Facility

$54.55

Service Code	HCPCS J8499
Hospital Charge Code	77738369
Hospital Revenue Code	250
Rate for Payer: Cash Price	$37.09

oseltamivir 75 mg Cap

Facility

$54.55

Service Code	HCPCS J8499
Hospital Charge Code	77738369
Hospital Revenue Code	250
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$39.28
Rate for Payer: Amerigroup CHIP/Medicaid	$4.91
Rate for Payer: BCBS of TX Blue Advantage	$16.36
Rate for Payer: BCBS of TX Blue Essentials	$19.64
Rate for Payer: BCBS of TX PPO	$21.82
Rate for Payer: Cash Price	$37.09
Rate for Payer: Cigna Medicaid	$39.28
Rate for Payer: Molina CHIP/Medicaid	$39.28
Rate for Payer: Multiplan Auto	$35.46
Rate for Payer: Multiplan Commercial	$35.46
Rate for Payer: Multiplan Workers Comp	$35.46
Rate for Payer: Parkland Medicaid	$39.28
Rate for Payer: Scott and White EPO/PPO	$27.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$39.28
Rate for Payer: Superior Health Plan EPO	$7.42

Osmolality, Fecal SO

Facility

$123.00

Service Code	HCPCS 84999
Hospital Charge Code	1700301
Hospital Revenue Code	301
Min. Negotiated Rate	$11.07
Max. Negotiated Rate	$88.56
Rate for Payer: Amerigroup CHIP/Medicaid	$11.07
Rate for Payer: BCBS of TX Blue Advantage	$36.90
Rate for Payer: BCBS of TX Blue Essentials	$44.28
Rate for Payer: BCBS of TX PPO	$49.20
Rate for Payer: Cash Price	$83.64
Rate for Payer: Cigna Medicaid	$88.56
Rate for Payer: Molina CHIP/Medicaid	$88.56
Rate for Payer: Multiplan Auto	$79.95
Rate for Payer: Multiplan Commercial	$79.95
Rate for Payer: Multiplan Workers Comp	$79.95
Rate for Payer: Parkland Medicaid	$88.56
Rate for Payer: Scott and White EPO/PPO	$61.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$88.56
Rate for Payer: Superior Health Plan EPO	$16.73

Osmolality, Fecal SO

Facility

$123.00

Service Code	HCPCS 84999
Hospital Charge Code	1700301
Hospital Revenue Code	301
Rate for Payer: Cash Price	$83.64

Osmolality SO

Facility

$72.00

Service Code	HCPCS 83930
Hospital Charge Code	1602168
Hospital Revenue Code	301
Rate for Payer: Cash Price	$48.96

Osmolality SO

Facility

$72.00

Service Code	HCPCS 83930
Hospital Charge Code	1602168
Hospital Revenue Code	301
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$51.84
Rate for Payer: Amerigroup CHIP/Medicaid	$2.58
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6.61
Rate for Payer: Amerigroup Medicare	$6.61
Rate for Payer: BCBS of TX Blue Advantage	$21.60
Rate for Payer: BCBS of TX Blue Essentials	$25.92
Rate for Payer: BCBS of TX Medicare	$6.61
Rate for Payer: BCBS of TX PPO	$28.80
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cash Price	$48.96
Rate for Payer: Cigna Medicaid	$51.84
Rate for Payer: Cigna Medicare	$6.61
Rate for Payer: Employer Direct Commercial	$6.61
Rate for Payer: Humana Medicare/TRICARE	$6.61
Rate for Payer: Molina CHIP/Medicaid	$51.84
Rate for Payer: Molina Dual Medicare/Medicaid	$6.61
Rate for Payer: Molina Medicare	$6.61
Rate for Payer: Multiplan Auto	$46.80
Rate for Payer: Multiplan Commercial	$46.80
Rate for Payer: Multiplan Workers Comp	$46.80
Rate for Payer: Parkland Medicaid	$51.84
Rate for Payer: Scott and White EPO/PPO	$8.26
Rate for Payer: Scott and White Medicare	$6.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$51.84
Rate for Payer: Superior Health Plan EPO	$6.61
Rate for Payer: Superior Health Plan Medicare	$6.61
Rate for Payer: Universal American Dual Medicare/Medicaid	$6.61
Rate for Payer: Universal American Medicare	$6.61
Rate for Payer: Wellcare Medicare	$6.61
Rate for Payer: Wellmed Medicare	$6.61

Ostectomy, calcaneus

Facility

$10,000.00

Service Code	CPT 28118
Hospital Charge Code	36028118
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
Rate for Payer: BCBS of TX Blue Advantage	$4,571.54
Rate for Payer: BCBS of TX Blue Essentials	$5,474.90
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
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	$6,080.78
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Ostectomy, calcaneus

Facility

$7,783.60

Service Code	HCPCS 28118
Hospital Charge Code	9900479
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,292.85

Ostectomy, calcaneus

Facility

$7,783.60

Service Code	HCPCS 28118
Hospital Charge Code	9900479
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
Rate for Payer: BCBS of TX Blue Advantage	$4,571.54
Rate for Payer: BCBS of TX Blue Essentials	$5,474.90
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cash Price	$5,292.85
Rate for Payer: Cash Price	$5,292.85
Rate for Payer: Cash Price	$5,292.85
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicaid	$5,604.19
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina CHIP/Medicaid	$5,604.19
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
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	$5,604.19
Rate for Payer: Scott and White EPO/PPO	$6,080.78
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,604.19
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Ostectomy, calcaneus for spur, with or without plantar fascial release

Facility

$8,491.20

Service Code	HCPCS 28119
Hospital Charge Code	9900480
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
Rate for Payer: BCBS of TX Blue Advantage	$4,571.54
Rate for Payer: BCBS of TX Blue Essentials	$5,474.90
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cash Price	$5,774.02
Rate for Payer: Cash Price	$5,774.02
Rate for Payer: Cash Price	$5,774.02
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicaid	$6,113.66
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina CHIP/Medicaid	$6,113.66
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
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	$6,113.66
Rate for Payer: Scott and White EPO/PPO	$6,080.78
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,113.66
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Ostectomy, calcaneus for spur, with or without plantar fascial release

Facility

$10,000.00

Service Code	CPT 28119
Hospital Charge Code	36028119
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
Rate for Payer: BCBS of TX Blue Advantage	$4,571.54
Rate for Payer: BCBS of TX Blue Essentials	$5,474.90
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
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	$6,080.78
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Ostectomy, calcaneus for spur, with or without plantar fascial release

Facility

$8,491.20

Service Code	HCPCS 28119
Hospital Charge Code	9900480
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,774.02

Ostectomy, complete excision; fifth metatarsal head

Facility

$10,000.00

Service Code	CPT 28113
Hospital Charge Code	36028113
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
Rate for Payer: BCBS of TX Blue Advantage	$4,571.54
Rate for Payer: BCBS of TX Blue Essentials	$5,474.90
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
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	$6,080.78
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Ostectomy, complete excision; fifth metatarsal head

Facility

$7,783.60

Service Code	HCPCS 28113
Hospital Charge Code	9900476
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
Rate for Payer: BCBS of TX Blue Advantage	$4,571.54
Rate for Payer: BCBS of TX Blue Essentials	$5,474.90
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cash Price	$5,292.85
Rate for Payer: Cash Price	$5,292.85
Rate for Payer: Cash Price	$5,292.85
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicaid	$5,604.19
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina CHIP/Medicaid	$5,604.19
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
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	$5,604.19
Rate for Payer: Scott and White EPO/PPO	$6,080.78
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,604.19
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Ostectomy, complete excision; fifth metatarsal head

Facility

$7,783.60

Service Code	HCPCS 28113
Hospital Charge Code	9900476
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,292.85

Ostectomy, complete excision first metatarsal head

Facility

$16,228.62

Service Code	HCPCS 28111
Hospital Charge Code	9900474
Hospital Revenue Code	360
Rate for Payer: Cash Price	$11,035.46

Ostectomy, complete excision first metatarsal head

Facility

$10,000.00

Service Code	CPT 28111
Hospital Charge Code	36028111
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
Rate for Payer: BCBS of TX Blue Advantage	$4,571.54
Rate for Payer: BCBS of TX Blue Essentials	$5,474.90
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
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	$6,080.78
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Know your out-of-pocket cost for care.

All Charges