White Rock Medical Center

All Charges

Charge

Type

Setting

Price

XR Osseous Survey Infant BCE

Facility

$499.00

Service Code	CPT 77076 FY
Hospital Charge Code	3120086
Hospital Revenue Code	320
Rate for Payer: Cash Price	$439.12

XR Osseous Survey Infant BCE

Facility

$499.00

Service Code	CPT 77076 FY
Hospital Charge Code	3120086
Hospital Revenue Code	320
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$324.35
Rate for Payer: Aetna Commercial	$84.96
Rate for Payer: Aetna Medicare	$150.82
Rate for Payer: Amerigroup CHIP/Medicaid	$106.88
Rate for Payer: BCBS of TX Blue Advantage	$184.93
Rate for Payer: BCBS of TX Blue Essentials	$221.92
Rate for Payer: BCBS of TX PPO	$247.70
Rate for Payer: Cash Price	$439.12
Rate for Payer: Cash Price	$439.12
Rate for Payer: Cash Price	$439.12
Rate for Payer: Cigna Commercial	$227.77
Rate for Payer: Cigna Medicaid	$106.88
Rate for Payer: Molina CHIP/Medicaid	$106.88
Rate for Payer: Multiplan Auto	$324.35
Rate for Payer: Multiplan Commercial	$324.35
Rate for Payer: Multiplan Workers Comp	$324.35
Rate for Payer: Parkland Medicaid	$106.88
Rate for Payer: Scott and White EPO/PPO	$249.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$106.88
Rate for Payer: Superior Health Plan EPO	$67.86

XR Osseous Survey Limited

Facility

$452.00

Service Code	CPT 77074 FY
Hospital Charge Code	4906060
Hospital Revenue Code	320
Min. Negotiated Rate	$51.06
Max. Negotiated Rate	$293.80
Rate for Payer: Aetna Commercial	$51.06
Rate for Payer: Aetna Medicare	$150.82
Rate for Payer: Amerigroup CHIP/Medicaid	$65.15
Rate for Payer: BCBS of TX Blue Advantage	$184.93
Rate for Payer: BCBS of TX Blue Essentials	$221.92
Rate for Payer: BCBS of TX PPO	$247.70
Rate for Payer: Cash Price	$397.76
Rate for Payer: Cash Price	$397.76
Rate for Payer: Cash Price	$397.76
Rate for Payer: Cigna Commercial	$227.77
Rate for Payer: Cigna Medicaid	$65.15
Rate for Payer: Molina CHIP/Medicaid	$65.15
Rate for Payer: Multiplan Auto	$293.80
Rate for Payer: Multiplan Commercial	$293.80
Rate for Payer: Multiplan Workers Comp	$293.80
Rate for Payer: Parkland Medicaid	$65.15
Rate for Payer: Scott and White EPO/PPO	$226.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$65.15
Rate for Payer: Superior Health Plan EPO	$61.47

XR Osseous Survey Limited BCE

Facility

$452.00

Service Code	CPT 77074 FY
Hospital Charge Code	4906060
Hospital Revenue Code	320
Min. Negotiated Rate	$51.06
Max. Negotiated Rate	$293.80
Rate for Payer: Aetna Commercial	$51.06
Rate for Payer: Aetna Medicare	$150.82
Rate for Payer: Amerigroup CHIP/Medicaid	$65.15
Rate for Payer: BCBS of TX Blue Advantage	$184.93
Rate for Payer: BCBS of TX Blue Essentials	$221.92
Rate for Payer: BCBS of TX PPO	$247.70
Rate for Payer: Cash Price	$397.76
Rate for Payer: Cash Price	$397.76
Rate for Payer: Cash Price	$397.76
Rate for Payer: Cigna Commercial	$227.77
Rate for Payer: Cigna Medicaid	$65.15
Rate for Payer: Molina CHIP/Medicaid	$65.15
Rate for Payer: Multiplan Auto	$293.80
Rate for Payer: Multiplan Commercial	$293.80
Rate for Payer: Multiplan Workers Comp	$293.80
Rate for Payer: Parkland Medicaid	$65.15
Rate for Payer: Scott and White EPO/PPO	$226.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$65.15
Rate for Payer: Superior Health Plan EPO	$61.47

XR Osseous Survey Limited BCE

Facility

$452.00

Service Code	CPT 77074 FY
Hospital Charge Code	4906060
Hospital Revenue Code	320
Rate for Payer: Cash Price	$397.76

XR Pelvis 1 or 2 Views

Facility

$546.00

Service Code	CPT 72170 FY
Hospital Charge Code	3100518
Hospital Revenue Code	320
Min. Negotiated Rate	$22.16
Max. Negotiated Rate	$354.90
Rate for Payer: Aetna Commercial	$22.16
Rate for Payer: Aetna Medicare	$150.82
Rate for Payer: Amerigroup CHIP/Medicaid	$28.06
Rate for Payer: BCBS of TX Blue Advantage	$184.93
Rate for Payer: BCBS of TX Blue Essentials	$221.92
Rate for Payer: BCBS of TX PPO	$247.70
Rate for Payer: Cash Price	$480.48
Rate for Payer: Cash Price	$480.48
Rate for Payer: Cash Price	$480.48
Rate for Payer: Cigna Commercial	$227.77
Rate for Payer: Cigna Medicaid	$28.06
Rate for Payer: Molina CHIP/Medicaid	$28.06
Rate for Payer: Multiplan Auto	$354.90
Rate for Payer: Multiplan Commercial	$354.90
Rate for Payer: Multiplan Workers Comp	$354.90
Rate for Payer: Parkland Medicaid	$28.06
Rate for Payer: Scott and White EPO/PPO	$273.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$28.06
Rate for Payer: Superior Health Plan EPO	$74.26

XR Pelvis 1 or 2 Views BCE

Facility

$546.00

Service Code	CPT 72170 FY
Hospital Charge Code	3100518
Hospital Revenue Code	320
Min. Negotiated Rate	$22.16
Max. Negotiated Rate	$354.90
Rate for Payer: Aetna Commercial	$22.16
Rate for Payer: Aetna Medicare	$150.82
Rate for Payer: Amerigroup CHIP/Medicaid	$28.06
Rate for Payer: BCBS of TX Blue Advantage	$184.93
Rate for Payer: BCBS of TX Blue Essentials	$221.92
Rate for Payer: BCBS of TX PPO	$247.70
Rate for Payer: Cash Price	$480.48
Rate for Payer: Cash Price	$480.48
Rate for Payer: Cash Price	$480.48
Rate for Payer: Cigna Commercial	$227.77
Rate for Payer: Cigna Medicaid	$28.06
Rate for Payer: Molina CHIP/Medicaid	$28.06
Rate for Payer: Multiplan Auto	$354.90
Rate for Payer: Multiplan Commercial	$354.90
Rate for Payer: Multiplan Workers Comp	$354.90
Rate for Payer: Parkland Medicaid	$28.06
Rate for Payer: Scott and White EPO/PPO	$273.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$28.06
Rate for Payer: Superior Health Plan EPO	$74.26

XR Pelvis 1 or 2 Views BCE

Facility

$546.00

Service Code	CPT 72170 FY
Hospital Charge Code	3100518
Hospital Revenue Code	320
Rate for Payer: Cash Price	$480.48

XR Pelvis Complete 3+ Views

Facility

$603.00

Service Code	CPT 72190 FY
Hospital Charge Code	3160132
Hospital Revenue Code	320
Min. Negotiated Rate	$34.49
Max. Negotiated Rate	$391.95
Rate for Payer: Aetna Commercial	$34.49
Rate for Payer: Aetna Medicare	$150.82
Rate for Payer: Amerigroup CHIP/Medicaid	$42.44
Rate for Payer: BCBS of TX Blue Advantage	$184.93
Rate for Payer: BCBS of TX Blue Essentials	$221.92
Rate for Payer: BCBS of TX PPO	$247.70
Rate for Payer: Cash Price	$530.64
Rate for Payer: Cash Price	$530.64
Rate for Payer: Cash Price	$530.64
Rate for Payer: Cigna Commercial	$227.77
Rate for Payer: Cigna Medicaid	$42.44
Rate for Payer: Molina CHIP/Medicaid	$42.44
Rate for Payer: Multiplan Auto	$391.95
Rate for Payer: Multiplan Commercial	$391.95
Rate for Payer: Multiplan Workers Comp	$391.95
Rate for Payer: Parkland Medicaid	$42.44
Rate for Payer: Scott and White EPO/PPO	$301.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$42.44
Rate for Payer: Superior Health Plan EPO	$82.01

XR Pelvis Complete 3+ Views BCE

Facility

$603.00

Service Code	CPT 72190 FY
Hospital Charge Code	3160132
Hospital Revenue Code	320
Rate for Payer: Cash Price	$530.64

XR Pelvis Complete 3+ Views BCE

Facility

$603.00

Service Code	CPT 72190 FY
Hospital Charge Code	3160132
Hospital Revenue Code	320
Min. Negotiated Rate	$34.49
Max. Negotiated Rate	$391.95
Rate for Payer: Aetna Commercial	$34.49
Rate for Payer: Aetna Medicare	$150.82
Rate for Payer: Amerigroup CHIP/Medicaid	$42.44
Rate for Payer: BCBS of TX Blue Advantage	$184.93
Rate for Payer: BCBS of TX Blue Essentials	$221.92
Rate for Payer: BCBS of TX PPO	$247.70
Rate for Payer: Cash Price	$530.64
Rate for Payer: Cash Price	$530.64
Rate for Payer: Cash Price	$530.64
Rate for Payer: Cigna Commercial	$227.77
Rate for Payer: Cigna Medicaid	$42.44
Rate for Payer: Molina CHIP/Medicaid	$42.44
Rate for Payer: Multiplan Auto	$391.95
Rate for Payer: Multiplan Commercial	$391.95
Rate for Payer: Multiplan Workers Comp	$391.95
Rate for Payer: Parkland Medicaid	$42.44
Rate for Payer: Scott and White EPO/PPO	$301.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$42.44
Rate for Payer: Superior Health Plan EPO	$82.01

XR Replace Duodenostomy Tube

Facility

$1,591.00

Service Code	CPT 49451 FY
Hospital Charge Code	4906589
Hospital Revenue Code	360
Min. Negotiated Rate	$216.38
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$1,243.53
Rate for Payer: Amerigroup CHIP/Medicaid	$334.95
Rate for Payer: BCBS of TX Blue Advantage	$1,312.49
Rate for Payer: BCBS of TX Blue Essentials	$1,571.84
Rate for Payer: BCBS of TX PPO	$1,980.52
Rate for Payer: Cash Price	$1,400.08
Rate for Payer: Cash Price	$1,400.08
Rate for Payer: Cash Price	$1,400.08
Rate for Payer: Cigna Commercial	$1,877.98
Rate for Payer: Cigna Medicaid	$334.95
Rate for Payer: Molina CHIP/Medicaid	$334.95
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	$334.95
Rate for Payer: Scott and White EPO/PPO	$795.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$334.95
Rate for Payer: Superior Health Plan EPO	$216.38

XR Replace Duodenostomy Tube BCE

Facility

$1,591.00

Service Code	CPT 49451 FY
Hospital Charge Code	4906589
Hospital Revenue Code	360
Min. Negotiated Rate	$216.38
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$1,243.53
Rate for Payer: Amerigroup CHIP/Medicaid	$334.95
Rate for Payer: BCBS of TX Blue Advantage	$1,312.49
Rate for Payer: BCBS of TX Blue Essentials	$1,571.84
Rate for Payer: BCBS of TX PPO	$1,980.52
Rate for Payer: Cash Price	$1,400.08
Rate for Payer: Cash Price	$1,400.08
Rate for Payer: Cash Price	$1,400.08
Rate for Payer: Cigna Commercial	$1,877.98
Rate for Payer: Cigna Medicaid	$334.95
Rate for Payer: Molina CHIP/Medicaid	$334.95
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	$334.95
Rate for Payer: Scott and White EPO/PPO	$795.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$334.95
Rate for Payer: Superior Health Plan EPO	$216.38

XR Replace Duodenostomy Tube BCE

Facility

$1,591.00

Service Code	CPT 49451 FY
Hospital Charge Code	4906589
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,400.08

XR Ribs 2 Views Left

Facility

$727.00

Service Code	CPT 71100 LT,FY
Hospital Charge Code	3100351
Hospital Revenue Code	320
Min. Negotiated Rate	$29.87
Max. Negotiated Rate	$472.55
Rate for Payer: Aetna Commercial	$29.87
Rate for Payer: Aetna Medicare	$124.65
Rate for Payer: Amerigroup CHIP/Medicaid	$37.09
Rate for Payer: BCBS of TX Blue Advantage	$131.69
Rate for Payer: BCBS of TX Blue Essentials	$158.02
Rate for Payer: BCBS of TX PPO	$176.38
Rate for Payer: Cash Price	$639.76
Rate for Payer: Cash Price	$639.76
Rate for Payer: Cash Price	$639.76
Rate for Payer: Cigna Commercial	$188.25
Rate for Payer: Cigna Medicaid	$37.09
Rate for Payer: Molina CHIP/Medicaid	$37.09
Rate for Payer: Multiplan Auto	$472.55
Rate for Payer: Multiplan Commercial	$472.55
Rate for Payer: Multiplan Workers Comp	$472.55
Rate for Payer: Parkland Medicaid	$37.09
Rate for Payer: Scott and White EPO/PPO	$363.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$37.09
Rate for Payer: Superior Health Plan EPO	$98.87

XR Ribs 2 Views Left BCE

Facility

$727.00

Service Code	CPT 71100 LT,FY
Hospital Charge Code	3100351
Hospital Revenue Code	320
Rate for Payer: Cash Price	$639.76

XR Ribs 2 Views Left BCE

Facility

$727.00

Service Code	CPT 71100 LT,FY
Hospital Charge Code	3100351
Hospital Revenue Code	320
Min. Negotiated Rate	$29.87
Max. Negotiated Rate	$472.55
Rate for Payer: Aetna Commercial	$29.87
Rate for Payer: Aetna Medicare	$124.65
Rate for Payer: Amerigroup CHIP/Medicaid	$37.09
Rate for Payer: BCBS of TX Blue Advantage	$131.69
Rate for Payer: BCBS of TX Blue Essentials	$158.02
Rate for Payer: BCBS of TX PPO	$176.38
Rate for Payer: Cash Price	$639.76
Rate for Payer: Cash Price	$639.76
Rate for Payer: Cash Price	$639.76
Rate for Payer: Cigna Commercial	$188.25
Rate for Payer: Cigna Medicaid	$37.09
Rate for Payer: Molina CHIP/Medicaid	$37.09
Rate for Payer: Multiplan Auto	$472.55
Rate for Payer: Multiplan Commercial	$472.55
Rate for Payer: Multiplan Workers Comp	$472.55
Rate for Payer: Parkland Medicaid	$37.09
Rate for Payer: Scott and White EPO/PPO	$363.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$37.09
Rate for Payer: Superior Health Plan EPO	$98.87

XR Ribs 2 Views Right

Facility

$727.00

Service Code	CPT 71100 RT,FY
Hospital Charge Code	3100369
Hospital Revenue Code	320
Min. Negotiated Rate	$29.87
Max. Negotiated Rate	$472.55
Rate for Payer: Aetna Commercial	$29.87
Rate for Payer: Aetna Medicare	$124.65
Rate for Payer: Amerigroup CHIP/Medicaid	$37.09
Rate for Payer: BCBS of TX Blue Advantage	$131.69
Rate for Payer: BCBS of TX Blue Essentials	$158.02
Rate for Payer: BCBS of TX PPO	$176.38
Rate for Payer: Cash Price	$639.76
Rate for Payer: Cash Price	$639.76
Rate for Payer: Cash Price	$639.76
Rate for Payer: Cigna Commercial	$188.25
Rate for Payer: Cigna Medicaid	$37.09
Rate for Payer: Molina CHIP/Medicaid	$37.09
Rate for Payer: Multiplan Auto	$472.55
Rate for Payer: Multiplan Commercial	$472.55
Rate for Payer: Multiplan Workers Comp	$472.55
Rate for Payer: Parkland Medicaid	$37.09
Rate for Payer: Scott and White EPO/PPO	$363.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$37.09
Rate for Payer: Superior Health Plan EPO	$98.87

XR Ribs 2 Views Right BCE

Facility

$727.00

Service Code	CPT 71100 RT,FY
Hospital Charge Code	3100369
Hospital Revenue Code	320
Rate for Payer: Cash Price	$639.76

XR Ribs 2 Views Right BCE

Facility

$727.00

Service Code	CPT 71100 RT,FY
Hospital Charge Code	3100369
Hospital Revenue Code	320
Min. Negotiated Rate	$29.87
Max. Negotiated Rate	$472.55
Rate for Payer: Aetna Commercial	$29.87
Rate for Payer: Aetna Medicare	$124.65
Rate for Payer: Amerigroup CHIP/Medicaid	$37.09
Rate for Payer: BCBS of TX Blue Advantage	$131.69
Rate for Payer: BCBS of TX Blue Essentials	$158.02
Rate for Payer: BCBS of TX PPO	$176.38
Rate for Payer: Cash Price	$639.76
Rate for Payer: Cash Price	$639.76
Rate for Payer: Cash Price	$639.76
Rate for Payer: Cigna Commercial	$188.25
Rate for Payer: Cigna Medicaid	$37.09
Rate for Payer: Molina CHIP/Medicaid	$37.09
Rate for Payer: Multiplan Auto	$472.55
Rate for Payer: Multiplan Commercial	$472.55
Rate for Payer: Multiplan Workers Comp	$472.55
Rate for Payer: Parkland Medicaid	$37.09
Rate for Payer: Scott and White EPO/PPO	$363.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$37.09
Rate for Payer: Superior Health Plan EPO	$98.87

XR Ribs 3 Views Bilateral

Facility

$900.00

Service Code	CPT 71110 FY
Hospital Charge Code	3170015
Hospital Revenue Code	320
Min. Negotiated Rate	$34.49
Max. Negotiated Rate	$585.00
Rate for Payer: Aetna Commercial	$34.49
Rate for Payer: Aetna Medicare	$150.82
Rate for Payer: Amerigroup CHIP/Medicaid	$44.10
Rate for Payer: BCBS of TX Blue Advantage	$184.93
Rate for Payer: BCBS of TX Blue Essentials	$221.92
Rate for Payer: BCBS of TX PPO	$247.70
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cigna Commercial	$227.77
Rate for Payer: Cigna Medicaid	$44.10
Rate for Payer: Molina CHIP/Medicaid	$44.10
Rate for Payer: Multiplan Auto	$585.00
Rate for Payer: Multiplan Commercial	$585.00
Rate for Payer: Multiplan Workers Comp	$585.00
Rate for Payer: Parkland Medicaid	$44.10
Rate for Payer: Scott and White EPO/PPO	$450.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$44.10
Rate for Payer: Superior Health Plan EPO	$122.40

XR Ribs 3 Views Bilateral BCE

Facility

$900.00

Service Code	CPT 71110 FY
Hospital Charge Code	3170015
Hospital Revenue Code	320
Min. Negotiated Rate	$34.49
Max. Negotiated Rate	$585.00
Rate for Payer: Aetna Commercial	$34.49
Rate for Payer: Aetna Medicare	$150.82
Rate for Payer: Amerigroup CHIP/Medicaid	$44.10
Rate for Payer: BCBS of TX Blue Advantage	$184.93
Rate for Payer: BCBS of TX Blue Essentials	$221.92
Rate for Payer: BCBS of TX PPO	$247.70
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cigna Commercial	$227.77
Rate for Payer: Cigna Medicaid	$44.10
Rate for Payer: Molina CHIP/Medicaid	$44.10
Rate for Payer: Multiplan Auto	$585.00
Rate for Payer: Multiplan Commercial	$585.00
Rate for Payer: Multiplan Workers Comp	$585.00
Rate for Payer: Parkland Medicaid	$44.10
Rate for Payer: Scott and White EPO/PPO	$450.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$44.10
Rate for Payer: Superior Health Plan EPO	$122.40

XR Ribs 3 Views Bilateral BCE

Facility

$900.00

Service Code	CPT 71110 FY
Hospital Charge Code	3170015
Hospital Revenue Code	320
Rate for Payer: Cash Price	$792.00

XR Sacroiliac Joints 3+ Views

Facility

$241.00

Service Code	CPT 72202 FY
Hospital Charge Code	3100534
Hospital Revenue Code	320
Min. Negotiated Rate	$32.57
Max. Negotiated Rate	$247.70
Rate for Payer: Aetna Commercial	$32.57
Rate for Payer: Aetna Medicare	$150.82
Rate for Payer: Amerigroup CHIP/Medicaid	$39.43
Rate for Payer: BCBS of TX Blue Advantage	$184.93
Rate for Payer: BCBS of TX Blue Essentials	$221.92
Rate for Payer: BCBS of TX PPO	$247.70
Rate for Payer: Cash Price	$212.08
Rate for Payer: Cash Price	$212.08
Rate for Payer: Cash Price	$212.08
Rate for Payer: Cigna Commercial	$227.77
Rate for Payer: Cigna Medicaid	$39.43
Rate for Payer: Molina CHIP/Medicaid	$39.43
Rate for Payer: Multiplan Auto	$156.65
Rate for Payer: Multiplan Commercial	$156.65
Rate for Payer: Multiplan Workers Comp	$156.65
Rate for Payer: Parkland Medicaid	$39.43
Rate for Payer: Scott and White EPO/PPO	$120.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$39.43
Rate for Payer: Superior Health Plan EPO	$32.78

XR Sacroiliac Joints 3+ Views BCE

Facility

$241.00

Service Code	CPT 72202 FY
Hospital Charge Code	3100534
Hospital Revenue Code	320
Min. Negotiated Rate	$32.57
Max. Negotiated Rate	$247.70
Rate for Payer: Aetna Commercial	$32.57
Rate for Payer: Aetna Medicare	$150.82
Rate for Payer: Amerigroup CHIP/Medicaid	$39.43
Rate for Payer: BCBS of TX Blue Advantage	$184.93
Rate for Payer: BCBS of TX Blue Essentials	$221.92
Rate for Payer: BCBS of TX PPO	$247.70
Rate for Payer: Cash Price	$212.08
Rate for Payer: Cash Price	$212.08
Rate for Payer: Cash Price	$212.08
Rate for Payer: Cigna Commercial	$227.77
Rate for Payer: Cigna Medicaid	$39.43
Rate for Payer: Molina CHIP/Medicaid	$39.43
Rate for Payer: Multiplan Auto	$156.65
Rate for Payer: Multiplan Commercial	$156.65
Rate for Payer: Multiplan Workers Comp	$156.65
Rate for Payer: Parkland Medicaid	$39.43
Rate for Payer: Scott and White EPO/PPO	$120.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$39.43
Rate for Payer: Superior Health Plan EPO	$32.78

Know your out-of-pocket cost for care.

All Charges