White Rock Medical Center

All Charges

Charge

Type

Setting

Price

XR Hysterosalpingography

Facility

$821.00

Service Code	CPT 74740 FY
Hospital Charge Code	3101268
Hospital Revenue Code	320
Min. Negotiated Rate	$14.43
Max. Negotiated Rate	$533.65
Rate for Payer: Aetna Commercial	$92.28
Rate for Payer: Aetna Medicare	$336.15
Rate for Payer: Amerigroup CHIP/Medicaid	$66.83
Rate for Payer: BCBS of TX Blue Advantage	$384.52
Rate for Payer: BCBS of TX Blue Essentials	$461.42
Rate for Payer: BCBS of TX PPO	$515.02
Rate for Payer: Cash Price	$722.48
Rate for Payer: Cash Price	$722.48
Rate for Payer: Cash Price	$722.48
Rate for Payer: Cigna Commercial	$507.64
Rate for Payer: Cigna Medicaid	$14.43
Rate for Payer: Molina CHIP/Medicaid	$14.43
Rate for Payer: Multiplan Auto	$533.65
Rate for Payer: Multiplan Commercial	$533.65
Rate for Payer: Multiplan Workers Comp	$533.65
Rate for Payer: Parkland Medicaid	$14.43
Rate for Payer: Scott and White EPO/PPO	$410.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14.43
Rate for Payer: Superior Health Plan EPO	$111.66

XR Hysterosalpingography BCE

Facility

$821.00

Service Code	CPT 74740 FY
Hospital Charge Code	3101268
Hospital Revenue Code	320
Rate for Payer: Cash Price	$722.48

XR Hysterosalpingography BCE

Facility

$821.00

Service Code	CPT 74740 FY
Hospital Charge Code	3101268
Hospital Revenue Code	320
Min. Negotiated Rate	$14.43
Max. Negotiated Rate	$533.65
Rate for Payer: Aetna Commercial	$92.28
Rate for Payer: Aetna Medicare	$336.15
Rate for Payer: Amerigroup CHIP/Medicaid	$66.83
Rate for Payer: BCBS of TX Blue Advantage	$384.52
Rate for Payer: BCBS of TX Blue Essentials	$461.42
Rate for Payer: BCBS of TX PPO	$515.02
Rate for Payer: Cash Price	$722.48
Rate for Payer: Cash Price	$722.48
Rate for Payer: Cash Price	$722.48
Rate for Payer: Cigna Commercial	$507.64
Rate for Payer: Cigna Medicaid	$14.43
Rate for Payer: Molina CHIP/Medicaid	$14.43
Rate for Payer: Multiplan Auto	$533.65
Rate for Payer: Multiplan Commercial	$533.65
Rate for Payer: Multiplan Workers Comp	$533.65
Rate for Payer: Parkland Medicaid	$14.43
Rate for Payer: Scott and White EPO/PPO	$410.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14.43
Rate for Payer: Superior Health Plan EPO	$111.66

XR Injection Contrast for Tube Eval

Facility

$857.00

Service Code	CPT 49465 FY
Hospital Charge Code	3181070
Hospital Revenue Code	320
Min. Negotiated Rate	$77.13
Max. Negotiated Rate	$587.26
Rate for Payer: Aetna Commercial	$471.35
Rate for Payer: Aetna Medicare	$336.15
Rate for Payer: Amerigroup CHIP/Medicaid	$77.13
Rate for Payer: BCBS of TX Blue Advantage	$389.18
Rate for Payer: BCBS of TX Blue Essentials	$466.08
Rate for Payer: BCBS of TX PPO	$587.26
Rate for Payer: Cash Price	$754.16
Rate for Payer: Cash Price	$754.16
Rate for Payer: Cash Price	$754.16
Rate for Payer: Cigna Commercial	$507.64
Rate for Payer: Multiplan Auto	$557.05
Rate for Payer: Multiplan Commercial	$557.05
Rate for Payer: Multiplan Workers Comp	$557.05
Rate for Payer: Scott and White EPO/PPO	$428.50
Rate for Payer: Superior Health Plan EPO	$116.55

XR Injection Contrast for Tube Eval BCE

Facility

$857.00

Service Code	CPT 49465 FY
Hospital Charge Code	3181070
Hospital Revenue Code	320
Min. Negotiated Rate	$77.13
Max. Negotiated Rate	$587.26
Rate for Payer: Aetna Commercial	$471.35
Rate for Payer: Aetna Medicare	$336.15
Rate for Payer: Amerigroup CHIP/Medicaid	$77.13
Rate for Payer: BCBS of TX Blue Advantage	$389.18
Rate for Payer: BCBS of TX Blue Essentials	$466.08
Rate for Payer: BCBS of TX PPO	$587.26
Rate for Payer: Cash Price	$754.16
Rate for Payer: Cash Price	$754.16
Rate for Payer: Cash Price	$754.16
Rate for Payer: Cigna Commercial	$507.64
Rate for Payer: Multiplan Auto	$557.05
Rate for Payer: Multiplan Commercial	$557.05
Rate for Payer: Multiplan Workers Comp	$557.05
Rate for Payer: Scott and White EPO/PPO	$428.50
Rate for Payer: Superior Health Plan EPO	$116.55

XR Injection Contrast for Tube Eval BCE

Facility

$857.00

Service Code	CPT 49465 FY
Hospital Charge Code	3181070
Hospital Revenue Code	320
Rate for Payer: Cash Price	$754.16

XR Insertion of G-Tube

Facility

$638.00

Service Code	CPT 74340 FY
Hospital Charge Code	4904340
Hospital Revenue Code	320
Min. Negotiated Rate	$45.79
Max. Negotiated Rate	$414.70
Rate for Payer: Aetna Commercial	$86.83
Rate for Payer: Amerigroup CHIP/Medicaid	$57.42
Rate for Payer: BCBS of TX Blue Advantage	$45.79
Rate for Payer: BCBS of TX Blue Essentials	$54.95
Rate for Payer: BCBS of TX PPO	$61.33
Rate for Payer: Cash Price	$561.44
Rate for Payer: Cash Price	$561.44
Rate for Payer: Multiplan Auto	$414.70
Rate for Payer: Multiplan Commercial	$414.70
Rate for Payer: Multiplan Workers Comp	$414.70
Rate for Payer: Scott and White EPO/PPO	$319.00
Rate for Payer: Superior Health Plan EPO	$86.77

XR Insertion of G-Tube BCE

Facility

$638.00

Service Code	CPT 74340 FY
Hospital Charge Code	4904340
Hospital Revenue Code	320
Rate for Payer: Cash Price	$561.44

XR Insertion of G-Tube BCE

Facility

$638.00

Service Code	CPT 74340 FY
Hospital Charge Code	4904340
Hospital Revenue Code	320
Min. Negotiated Rate	$45.79
Max. Negotiated Rate	$414.70
Rate for Payer: Aetna Commercial	$86.83
Rate for Payer: Amerigroup CHIP/Medicaid	$57.42
Rate for Payer: BCBS of TX Blue Advantage	$45.79
Rate for Payer: BCBS of TX Blue Essentials	$54.95
Rate for Payer: BCBS of TX PPO	$61.33
Rate for Payer: Cash Price	$561.44
Rate for Payer: Cash Price	$561.44
Rate for Payer: Multiplan Auto	$414.70
Rate for Payer: Multiplan Commercial	$414.70
Rate for Payer: Multiplan Workers Comp	$414.70
Rate for Payer: Scott and White EPO/PPO	$319.00
Rate for Payer: Superior Health Plan EPO	$86.77

XR Insert NG tube w/ Fluoro Guide

Facility

$601.00

Service Code	CPT 43752 FY
Hospital Charge Code	4613752
Hospital Revenue Code	361
Min. Negotiated Rate	$81.74
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$330.55
Rate for Payer: Aetna Medicare	$546.59
Rate for Payer: Amerigroup CHIP/Medicaid	$112.34
Rate for Payer: BCBS of TX Blue Advantage	$607.20
Rate for Payer: BCBS of TX Blue Essentials	$727.18
Rate for Payer: BCBS of TX PPO	$916.25
Rate for Payer: Cash Price	$528.88
Rate for Payer: Cash Price	$528.88
Rate for Payer: Cash Price	$528.88
Rate for Payer: Cigna Commercial	$825.46
Rate for Payer: Cigna Medicaid	$112.34
Rate for Payer: Molina CHIP/Medicaid	$112.34
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	$112.34
Rate for Payer: Scott and White EPO/PPO	$300.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$112.34
Rate for Payer: Superior Health Plan EPO	$81.74

XR Insert NG Tube w/ Fluoro Guide BCE

Facility

$601.00

Service Code	CPT 43752 FY
Hospital Charge Code	4613752
Hospital Revenue Code	361
Rate for Payer: Cash Price	$528.88

XR Insert NG Tube w/ Fluoro Guide BCE

Facility

$601.00

Service Code	CPT 43752 FY
Hospital Charge Code	4613752
Hospital Revenue Code	361
Min. Negotiated Rate	$81.74
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$330.55
Rate for Payer: Aetna Medicare	$546.59
Rate for Payer: Amerigroup CHIP/Medicaid	$112.34
Rate for Payer: BCBS of TX Blue Advantage	$607.20
Rate for Payer: BCBS of TX Blue Essentials	$727.18
Rate for Payer: BCBS of TX PPO	$916.25
Rate for Payer: Cash Price	$528.88
Rate for Payer: Cash Price	$528.88
Rate for Payer: Cash Price	$528.88
Rate for Payer: Cigna Commercial	$825.46
Rate for Payer: Cigna Medicaid	$112.34
Rate for Payer: Molina CHIP/Medicaid	$112.34
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	$112.34
Rate for Payer: Scott and White EPO/PPO	$300.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$112.34
Rate for Payer: Superior Health Plan EPO	$81.74

XR IVP

Facility

$1,041.00

Service Code	CPT 74400 FY
Hospital Charge Code	4904400
Hospital Revenue Code	320
Min. Negotiated Rate	$132.72
Max. Negotiated Rate	$676.65
Rate for Payer: Aetna Commercial	$132.72
Rate for Payer: Aetna Medicare	$252.04
Rate for Payer: Amerigroup CHIP/Medicaid	$137.00
Rate for Payer: BCBS of TX Blue Advantage	$158.17
Rate for Payer: BCBS of TX Blue Essentials	$189.80
Rate for Payer: BCBS of TX PPO	$211.85
Rate for Payer: Cash Price	$916.08
Rate for Payer: Cash Price	$916.08
Rate for Payer: Cash Price	$916.08
Rate for Payer: Cigna Commercial	$380.65
Rate for Payer: Cigna Medicaid	$137.00
Rate for Payer: Molina CHIP/Medicaid	$137.00
Rate for Payer: Multiplan Auto	$676.65
Rate for Payer: Multiplan Commercial	$676.65
Rate for Payer: Multiplan Workers Comp	$676.65
Rate for Payer: Parkland Medicaid	$137.00
Rate for Payer: Scott and White EPO/PPO	$520.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$137.00
Rate for Payer: Superior Health Plan EPO	$141.58

XR IVP BCE

Facility

$1,041.00

Service Code	CPT 74400 FY
Hospital Charge Code	4904400
Hospital Revenue Code	320
Rate for Payer: Cash Price	$916.08

XR IVP BCE

Facility

$1,041.00

Service Code	CPT 74400 FY
Hospital Charge Code	4904400
Hospital Revenue Code	320
Min. Negotiated Rate	$132.72
Max. Negotiated Rate	$676.65
Rate for Payer: Aetna Commercial	$132.72
Rate for Payer: Aetna Medicare	$252.04
Rate for Payer: Amerigroup CHIP/Medicaid	$137.00
Rate for Payer: BCBS of TX Blue Advantage	$158.17
Rate for Payer: BCBS of TX Blue Essentials	$189.80
Rate for Payer: BCBS of TX PPO	$211.85
Rate for Payer: Cash Price	$916.08
Rate for Payer: Cash Price	$916.08
Rate for Payer: Cash Price	$916.08
Rate for Payer: Cigna Commercial	$380.65
Rate for Payer: Cigna Medicaid	$137.00
Rate for Payer: Molina CHIP/Medicaid	$137.00
Rate for Payer: Multiplan Auto	$676.65
Rate for Payer: Multiplan Commercial	$676.65
Rate for Payer: Multiplan Workers Comp	$676.65
Rate for Payer: Parkland Medicaid	$137.00
Rate for Payer: Scott and White EPO/PPO	$520.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$137.00
Rate for Payer: Superior Health Plan EPO	$141.58

XR Joint/Bursa Major Arthr/Asp/Inj Left

Facility

$1,676.00

Service Code	CPT 20610 LT,FY
Hospital Charge Code	3170080
Hospital Revenue Code	361
Min. Negotiated Rate	$27.96
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$921.80
Rate for Payer: Aetna Medicare	$406.31
Rate for Payer: Amerigroup CHIP/Medicaid	$27.96
Rate for Payer: BCBS of TX Blue Advantage	$51.84
Rate for Payer: BCBS of TX Blue Essentials	$62.08
Rate for Payer: BCBS of TX PPO	$78.22
Rate for Payer: Cash Price	$1,474.88
Rate for Payer: Cash Price	$1,474.88
Rate for Payer: Cash Price	$1,474.88
Rate for Payer: Cigna Commercial	$613.61
Rate for Payer: Cigna Medicaid	$27.96
Rate for Payer: Molina CHIP/Medicaid	$27.96
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	$27.96
Rate for Payer: Scott and White EPO/PPO	$838.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$27.96
Rate for Payer: Superior Health Plan EPO	$227.94

XR Joint/Bursa Major Arthr/Asp/Inj Left BCE

Facility

$1,676.00

Service Code	CPT 20610 LT,FY
Hospital Charge Code	3170080
Hospital Revenue Code	361
Min. Negotiated Rate	$27.96
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$921.80
Rate for Payer: Aetna Medicare	$406.31
Rate for Payer: Amerigroup CHIP/Medicaid	$27.96
Rate for Payer: BCBS of TX Blue Advantage	$51.84
Rate for Payer: BCBS of TX Blue Essentials	$62.08
Rate for Payer: BCBS of TX PPO	$78.22
Rate for Payer: Cash Price	$1,474.88
Rate for Payer: Cash Price	$1,474.88
Rate for Payer: Cash Price	$1,474.88
Rate for Payer: Cigna Commercial	$613.61
Rate for Payer: Cigna Medicaid	$27.96
Rate for Payer: Molina CHIP/Medicaid	$27.96
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	$27.96
Rate for Payer: Scott and White EPO/PPO	$838.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$27.96
Rate for Payer: Superior Health Plan EPO	$227.94

XR Joint/Bursa Major Arthr/Asp/Inj Right

Facility

$1,676.00

Service Code	CPT 20610 RT,FY
Hospital Charge Code	3170080
Hospital Revenue Code	361
Min. Negotiated Rate	$27.96
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$921.80
Rate for Payer: Aetna Medicare	$406.31
Rate for Payer: Amerigroup CHIP/Medicaid	$27.96
Rate for Payer: BCBS of TX Blue Advantage	$51.84
Rate for Payer: BCBS of TX Blue Essentials	$62.08
Rate for Payer: BCBS of TX PPO	$78.22
Rate for Payer: Cash Price	$1,474.88
Rate for Payer: Cash Price	$1,474.88
Rate for Payer: Cash Price	$1,474.88
Rate for Payer: Cigna Commercial	$613.61
Rate for Payer: Cigna Medicaid	$27.96
Rate for Payer: Molina CHIP/Medicaid	$27.96
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	$27.96
Rate for Payer: Scott and White EPO/PPO	$838.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$27.96
Rate for Payer: Superior Health Plan EPO	$227.94

XR Joint/Bursa Major Arthr/Asp/Inj Right BCE

Facility

$1,676.00

Service Code	CPT 20610 RT,FY
Hospital Charge Code	3170080
Hospital Revenue Code	361
Min. Negotiated Rate	$27.96
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$921.80
Rate for Payer: Aetna Medicare	$406.31
Rate for Payer: Amerigroup CHIP/Medicaid	$27.96
Rate for Payer: BCBS of TX Blue Advantage	$51.84
Rate for Payer: BCBS of TX Blue Essentials	$62.08
Rate for Payer: BCBS of TX PPO	$78.22
Rate for Payer: Cash Price	$1,474.88
Rate for Payer: Cash Price	$1,474.88
Rate for Payer: Cash Price	$1,474.88
Rate for Payer: Cigna Commercial	$613.61
Rate for Payer: Cigna Medicaid	$27.96
Rate for Payer: Molina CHIP/Medicaid	$27.96
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	$27.96
Rate for Payer: Scott and White EPO/PPO	$838.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$27.96
Rate for Payer: Superior Health Plan EPO	$227.94

XR Joint/Bursa Major Arthr/Asp/Inj Right BCE

Facility

$1,676.00

Service Code	CPT 20610 RT,FY
Hospital Charge Code	3170080
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,474.88

XR Joint/Bursa Small Arthr/Asp/Inj Left

Facility

$622.00

Service Code	CPT 20600 LT,FY
Hospital Charge Code	4900600
Hospital Revenue Code	361
Min. Negotiated Rate	$22.70
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$342.10
Rate for Payer: Aetna Medicare	$406.31
Rate for Payer: Amerigroup CHIP/Medicaid	$22.70
Rate for Payer: BCBS of TX Blue Advantage	$41.58
Rate for Payer: BCBS of TX Blue Essentials	$49.80
Rate for Payer: BCBS of TX PPO	$62.75
Rate for Payer: Cash Price	$547.36
Rate for Payer: Cash Price	$547.36
Rate for Payer: Cash Price	$547.36
Rate for Payer: Cigna Commercial	$613.61
Rate for Payer: Cigna Medicaid	$22.70
Rate for Payer: Molina CHIP/Medicaid	$22.70
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	$22.70
Rate for Payer: Scott and White EPO/PPO	$311.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$22.70
Rate for Payer: Superior Health Plan EPO	$84.59

XR Joint/Bursa Small Arthr/Asp/Inj Left BCE

Facility

$622.00

Service Code	CPT 20600 LT,FY
Hospital Charge Code	4900600
Hospital Revenue Code	361
Min. Negotiated Rate	$22.70
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$342.10
Rate for Payer: Aetna Medicare	$406.31
Rate for Payer: Amerigroup CHIP/Medicaid	$22.70
Rate for Payer: BCBS of TX Blue Advantage	$41.58
Rate for Payer: BCBS of TX Blue Essentials	$49.80
Rate for Payer: BCBS of TX PPO	$62.75
Rate for Payer: Cash Price	$547.36
Rate for Payer: Cash Price	$547.36
Rate for Payer: Cash Price	$547.36
Rate for Payer: Cigna Commercial	$613.61
Rate for Payer: Cigna Medicaid	$22.70
Rate for Payer: Molina CHIP/Medicaid	$22.70
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	$22.70
Rate for Payer: Scott and White EPO/PPO	$311.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$22.70
Rate for Payer: Superior Health Plan EPO	$84.59

XR Joint/Bursa Small Arthr/Asp/Inj Right

Facility

$622.00

Service Code	CPT 20600 RT,FY
Hospital Charge Code	4900600
Hospital Revenue Code	361
Min. Negotiated Rate	$22.70
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$342.10
Rate for Payer: Aetna Medicare	$406.31
Rate for Payer: Amerigroup CHIP/Medicaid	$22.70
Rate for Payer: BCBS of TX Blue Advantage	$41.58
Rate for Payer: BCBS of TX Blue Essentials	$49.80
Rate for Payer: BCBS of TX PPO	$62.75
Rate for Payer: Cash Price	$547.36
Rate for Payer: Cash Price	$547.36
Rate for Payer: Cash Price	$547.36
Rate for Payer: Cigna Commercial	$613.61
Rate for Payer: Cigna Medicaid	$22.70
Rate for Payer: Molina CHIP/Medicaid	$22.70
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	$22.70
Rate for Payer: Scott and White EPO/PPO	$311.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$22.70
Rate for Payer: Superior Health Plan EPO	$84.59

XR Joint/Bursa Small Arthr/Asp/Inj Right BCE

Facility

$622.00

Service Code	CPT 20600 RT,FY
Hospital Charge Code	4900600
Hospital Revenue Code	361
Rate for Payer: Cash Price	$547.36

XR Joint/Bursa Small Arthr/Asp/Inj Right BCE

Facility

$622.00

Service Code	CPT 20600 RT,FY
Hospital Charge Code	4900600
Hospital Revenue Code	361
Min. Negotiated Rate	$22.70
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$342.10
Rate for Payer: Aetna Medicare	$406.31
Rate for Payer: Amerigroup CHIP/Medicaid	$22.70
Rate for Payer: BCBS of TX Blue Advantage	$41.58
Rate for Payer: BCBS of TX Blue Essentials	$49.80
Rate for Payer: BCBS of TX PPO	$62.75
Rate for Payer: Cash Price	$547.36
Rate for Payer: Cash Price	$547.36
Rate for Payer: Cash Price	$547.36
Rate for Payer: Cigna Commercial	$613.61
Rate for Payer: Cigna Medicaid	$22.70
Rate for Payer: Molina CHIP/Medicaid	$22.70
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	$22.70
Rate for Payer: Scott and White EPO/PPO	$311.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$22.70
Rate for Payer: Superior Health Plan EPO	$84.59

Know your out-of-pocket cost for care.

All Charges