White Rock Medical Center

All Charges

Charge

Type

Setting

Price

XR Small Bowel w/ Multiple Series BCE

Facility

$685.00

Service Code	CPT 74250 FY
Hospital Charge Code	3101136
Hospital Revenue Code	320
Rate for Payer: Cash Price	$602.80

XR Speech Evaluation w/ Cine Video

Facility

$719.00

Service Code	CPT 70371 FY
Hospital Charge Code	3160413
Hospital Revenue Code	320
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$515.02
Rate for Payer: Aetna Commercial	$74.55
Rate for Payer: Aetna Medicare	$336.15
Rate for Payer: Amerigroup CHIP/Medicaid	$108.59
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	$632.72
Rate for Payer: Cash Price	$632.72
Rate for Payer: Cash Price	$632.72
Rate for Payer: Cigna Commercial	$507.64
Rate for Payer: Cigna Medicaid	$108.59
Rate for Payer: Molina CHIP/Medicaid	$108.59
Rate for Payer: Multiplan Auto	$467.35
Rate for Payer: Multiplan Commercial	$467.35
Rate for Payer: Multiplan Workers Comp	$467.35
Rate for Payer: Parkland Medicaid	$108.59
Rate for Payer: Scott and White EPO/PPO	$359.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$108.59
Rate for Payer: Superior Health Plan EPO	$97.78

XR Speech Evaluation w/ Cine Video BCE

Facility

$719.00

Service Code	CPT 70371 FY
Hospital Charge Code	3160413
Hospital Revenue Code	320
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$515.02
Rate for Payer: Aetna Commercial	$74.55
Rate for Payer: Aetna Medicare	$336.15
Rate for Payer: Amerigroup CHIP/Medicaid	$108.59
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	$632.72
Rate for Payer: Cash Price	$632.72
Rate for Payer: Cash Price	$632.72
Rate for Payer: Cigna Commercial	$507.64
Rate for Payer: Cigna Medicaid	$108.59
Rate for Payer: Molina CHIP/Medicaid	$108.59
Rate for Payer: Multiplan Auto	$467.35
Rate for Payer: Multiplan Commercial	$467.35
Rate for Payer: Multiplan Workers Comp	$467.35
Rate for Payer: Parkland Medicaid	$108.59
Rate for Payer: Scott and White EPO/PPO	$359.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$108.59
Rate for Payer: Superior Health Plan EPO	$97.78

XR Speech Evaluation w/ Cine Video BCE

Facility

$719.00

Service Code	CPT 70371 FY
Hospital Charge Code	3160413
Hospital Revenue Code	320
Rate for Payer: Cash Price	$632.72

XR Spinal Puncture Therapeutic

Facility

$1,519.00

Service Code	CPT 62272 FY
Hospital Charge Code	2161020
Hospital Revenue Code	361
Min. Negotiated Rate	$206.58
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$948.67
Rate for Payer: Amerigroup CHIP/Medicaid	$262.86
Rate for Payer: BCBS of TX Blue Advantage	$1,043.83
Rate for Payer: BCBS of TX Blue Essentials	$1,250.10
Rate for Payer: BCBS of TX PPO	$1,575.13
Rate for Payer: Cash Price	$1,336.72
Rate for Payer: Cash Price	$1,336.72
Rate for Payer: Cash Price	$1,336.72
Rate for Payer: Cigna Commercial	$1,432.68
Rate for Payer: Cigna Medicaid	$262.86
Rate for Payer: Molina CHIP/Medicaid	$262.86
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	$262.86
Rate for Payer: Scott and White EPO/PPO	$759.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$262.86
Rate for Payer: Superior Health Plan EPO	$206.58

XR Spinal Puncture Therapeutic BCE

Facility

$1,519.00

Service Code	CPT 62272 FY
Hospital Charge Code	2161020
Hospital Revenue Code	361
Min. Negotiated Rate	$206.58
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$948.67
Rate for Payer: Amerigroup CHIP/Medicaid	$262.86
Rate for Payer: BCBS of TX Blue Advantage	$1,043.83
Rate for Payer: BCBS of TX Blue Essentials	$1,250.10
Rate for Payer: BCBS of TX PPO	$1,575.13
Rate for Payer: Cash Price	$1,336.72
Rate for Payer: Cash Price	$1,336.72
Rate for Payer: Cash Price	$1,336.72
Rate for Payer: Cigna Commercial	$1,432.68
Rate for Payer: Cigna Medicaid	$262.86
Rate for Payer: Molina CHIP/Medicaid	$262.86
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	$262.86
Rate for Payer: Scott and White EPO/PPO	$759.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$262.86
Rate for Payer: Superior Health Plan EPO	$206.58

XR Spinal Puncture Therapeutic BCE

Facility

$1,519.00

Service Code	CPT 62272 FY
Hospital Charge Code	2161020
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,336.72

XR Spine Cervical 1 View

Facility

$364.00

Service Code	CPT 72020 FY
Hospital Charge Code	3100377
Hospital Revenue Code	320
Min. Negotiated Rate	$19.07
Max. Negotiated Rate	$236.60
Rate for Payer: Aetna Commercial	$19.07
Rate for Payer: Aetna Medicare	$124.65
Rate for Payer: Amerigroup CHIP/Medicaid	$24.73
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	$320.32
Rate for Payer: Cash Price	$320.32
Rate for Payer: Cash Price	$320.32
Rate for Payer: Cigna Commercial	$188.25
Rate for Payer: Cigna Medicaid	$24.73
Rate for Payer: Molina CHIP/Medicaid	$24.73
Rate for Payer: Multiplan Auto	$236.60
Rate for Payer: Multiplan Commercial	$236.60
Rate for Payer: Multiplan Workers Comp	$236.60
Rate for Payer: Parkland Medicaid	$24.73
Rate for Payer: Scott and White EPO/PPO	$182.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$24.73
Rate for Payer: Superior Health Plan EPO	$49.50

XR Spine Cervical 1 View BCE

Facility

$364.00

Service Code	CPT 72020 FY
Hospital Charge Code	3100377
Hospital Revenue Code	320
Min. Negotiated Rate	$19.07
Max. Negotiated Rate	$236.60
Rate for Payer: Aetna Commercial	$19.07
Rate for Payer: Aetna Medicare	$124.65
Rate for Payer: Amerigroup CHIP/Medicaid	$24.73
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	$320.32
Rate for Payer: Cash Price	$320.32
Rate for Payer: Cash Price	$320.32
Rate for Payer: Cigna Commercial	$188.25
Rate for Payer: Cigna Medicaid	$24.73
Rate for Payer: Molina CHIP/Medicaid	$24.73
Rate for Payer: Multiplan Auto	$236.60
Rate for Payer: Multiplan Commercial	$236.60
Rate for Payer: Multiplan Workers Comp	$236.60
Rate for Payer: Parkland Medicaid	$24.73
Rate for Payer: Scott and White EPO/PPO	$182.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$24.73
Rate for Payer: Superior Health Plan EPO	$49.50

XR Spine Cervical 2 or 3 Views

Facility

$570.00

Service Code	CPT 72040 FY
Hospital Charge Code	3100401
Hospital Revenue Code	320
Min. Negotiated Rate	$32.95
Max. Negotiated Rate	$370.50
Rate for Payer: Aetna Commercial	$32.95
Rate for Payer: Aetna Medicare	$124.65
Rate for Payer: Amerigroup CHIP/Medicaid	$39.76
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	$501.60
Rate for Payer: Cash Price	$501.60
Rate for Payer: Cash Price	$501.60
Rate for Payer: Cigna Commercial	$188.25
Rate for Payer: Cigna Medicaid	$39.76
Rate for Payer: Molina CHIP/Medicaid	$39.76
Rate for Payer: Multiplan Auto	$370.50
Rate for Payer: Multiplan Commercial	$370.50
Rate for Payer: Multiplan Workers Comp	$370.50
Rate for Payer: Parkland Medicaid	$39.76
Rate for Payer: Scott and White EPO/PPO	$285.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$39.76
Rate for Payer: Superior Health Plan EPO	$77.52

XR Spine Cervical 2 or 3 Views BCE

Facility

$570.00

Service Code	CPT 72040 FY
Hospital Charge Code	3100401
Hospital Revenue Code	320
Rate for Payer: Cash Price	$501.60

XR Spine Cervical 2 or 3 Views BCE

Facility

$570.00

Service Code	CPT 72040 FY
Hospital Charge Code	3100401
Hospital Revenue Code	320
Min. Negotiated Rate	$32.95
Max. Negotiated Rate	$370.50
Rate for Payer: Aetna Commercial	$32.95
Rate for Payer: Aetna Medicare	$124.65
Rate for Payer: Amerigroup CHIP/Medicaid	$39.76
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	$501.60
Rate for Payer: Cash Price	$501.60
Rate for Payer: Cash Price	$501.60
Rate for Payer: Cigna Commercial	$188.25
Rate for Payer: Cigna Medicaid	$39.76
Rate for Payer: Molina CHIP/Medicaid	$39.76
Rate for Payer: Multiplan Auto	$370.50
Rate for Payer: Multiplan Commercial	$370.50
Rate for Payer: Multiplan Workers Comp	$370.50
Rate for Payer: Parkland Medicaid	$39.76
Rate for Payer: Scott and White EPO/PPO	$285.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$39.76
Rate for Payer: Superior Health Plan EPO	$77.52

XR Spine Cervical 4 or 5 Views

Facility

$685.00

Service Code	CPT 72050 FY
Hospital Charge Code	3100419
Hospital Revenue Code	320
Min. Negotiated Rate	$46.04
Max. Negotiated Rate	$445.25
Rate for Payer: Aetna Commercial	$46.04
Rate for Payer: Aetna Medicare	$150.82
Rate for Payer: Amerigroup CHIP/Medicaid	$53.46
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	$602.80
Rate for Payer: Cash Price	$602.80
Rate for Payer: Cash Price	$602.80
Rate for Payer: Cigna Commercial	$227.77
Rate for Payer: Cigna Medicaid	$53.46
Rate for Payer: Molina CHIP/Medicaid	$53.46
Rate for Payer: Multiplan Auto	$445.25
Rate for Payer: Multiplan Commercial	$445.25
Rate for Payer: Multiplan Workers Comp	$445.25
Rate for Payer: Parkland Medicaid	$53.46
Rate for Payer: Scott and White EPO/PPO	$342.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$53.46
Rate for Payer: Superior Health Plan EPO	$93.16

XR Spine Cervical 4 or 5 Views BCE

Facility

$685.00

Service Code	CPT 72050 FY
Hospital Charge Code	3100419
Hospital Revenue Code	320
Rate for Payer: Cash Price	$602.80

XR Spine Cervical 4 or 5 Views BCE

Facility

$685.00

Service Code	CPT 72050 FY
Hospital Charge Code	3100419
Hospital Revenue Code	320
Min. Negotiated Rate	$46.04
Max. Negotiated Rate	$445.25
Rate for Payer: Aetna Commercial	$46.04
Rate for Payer: Aetna Medicare	$150.82
Rate for Payer: Amerigroup CHIP/Medicaid	$53.46
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	$602.80
Rate for Payer: Cash Price	$602.80
Rate for Payer: Cash Price	$602.80
Rate for Payer: Cigna Commercial	$227.77
Rate for Payer: Cigna Medicaid	$53.46
Rate for Payer: Molina CHIP/Medicaid	$53.46
Rate for Payer: Multiplan Auto	$445.25
Rate for Payer: Multiplan Commercial	$445.25
Rate for Payer: Multiplan Workers Comp	$445.25
Rate for Payer: Parkland Medicaid	$53.46
Rate for Payer: Scott and White EPO/PPO	$342.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$53.46
Rate for Payer: Superior Health Plan EPO	$93.16

XR Spine Cervical 6+ Views

Facility

$774.00

Service Code	CPT 72052 FY
Hospital Charge Code	3100427
Hospital Revenue Code	320
Min. Negotiated Rate	$54.91
Max. Negotiated Rate	$503.10
Rate for Payer: Aetna Commercial	$54.91
Rate for Payer: Aetna Medicare	$150.82
Rate for Payer: Amerigroup CHIP/Medicaid	$62.49
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	$681.12
Rate for Payer: Cash Price	$681.12
Rate for Payer: Cash Price	$681.12
Rate for Payer: Cigna Commercial	$227.77
Rate for Payer: Cigna Medicaid	$62.49
Rate for Payer: Molina CHIP/Medicaid	$62.49
Rate for Payer: Multiplan Auto	$503.10
Rate for Payer: Multiplan Commercial	$503.10
Rate for Payer: Multiplan Workers Comp	$503.10
Rate for Payer: Parkland Medicaid	$62.49
Rate for Payer: Scott and White EPO/PPO	$387.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$62.49
Rate for Payer: Superior Health Plan EPO	$105.26

XR Spine Cervical 6+ Views BCE

Facility

$774.00

Service Code	CPT 72052 FY
Hospital Charge Code	3100427
Hospital Revenue Code	320
Rate for Payer: Cash Price	$681.12

XR Spine Cervical 6+ Views BCE

Facility

$774.00

Service Code	CPT 72052 FY
Hospital Charge Code	3100427
Hospital Revenue Code	320
Min. Negotiated Rate	$54.91
Max. Negotiated Rate	$503.10
Rate for Payer: Aetna Commercial	$54.91
Rate for Payer: Aetna Medicare	$150.82
Rate for Payer: Amerigroup CHIP/Medicaid	$62.49
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	$681.12
Rate for Payer: Cash Price	$681.12
Rate for Payer: Cash Price	$681.12
Rate for Payer: Cigna Commercial	$227.77
Rate for Payer: Cigna Medicaid	$62.49
Rate for Payer: Molina CHIP/Medicaid	$62.49
Rate for Payer: Multiplan Auto	$503.10
Rate for Payer: Multiplan Commercial	$503.10
Rate for Payer: Multiplan Workers Comp	$503.10
Rate for Payer: Parkland Medicaid	$62.49
Rate for Payer: Scott and White EPO/PPO	$387.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$62.49
Rate for Payer: Superior Health Plan EPO	$105.26

XR Spine Lumbar 1 View

Facility

$364.00

Service Code	CPT 72020 FY
Hospital Charge Code	3100385
Hospital Revenue Code	320
Min. Negotiated Rate	$19.07
Max. Negotiated Rate	$236.60
Rate for Payer: Aetna Commercial	$19.07
Rate for Payer: Aetna Medicare	$124.65
Rate for Payer: Amerigroup CHIP/Medicaid	$24.73
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	$320.32
Rate for Payer: Cash Price	$320.32
Rate for Payer: Cash Price	$320.32
Rate for Payer: Cigna Commercial	$188.25
Rate for Payer: Cigna Medicaid	$24.73
Rate for Payer: Molina CHIP/Medicaid	$24.73
Rate for Payer: Multiplan Auto	$236.60
Rate for Payer: Multiplan Commercial	$236.60
Rate for Payer: Multiplan Workers Comp	$236.60
Rate for Payer: Parkland Medicaid	$24.73
Rate for Payer: Scott and White EPO/PPO	$182.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$24.73
Rate for Payer: Superior Health Plan EPO	$49.50

XR Spine Lumbar 1 View BCE

Facility

$364.00

Service Code	CPT 72020 FY
Hospital Charge Code	3100385
Hospital Revenue Code	320
Rate for Payer: Cash Price	$320.32

XR Spine Lumbar 1 View BCE

Facility

$364.00

Service Code	CPT 72020 FY
Hospital Charge Code	3100385
Hospital Revenue Code	320
Min. Negotiated Rate	$19.07
Max. Negotiated Rate	$236.60
Rate for Payer: Aetna Commercial	$19.07
Rate for Payer: Aetna Medicare	$124.65
Rate for Payer: Amerigroup CHIP/Medicaid	$24.73
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	$320.32
Rate for Payer: Cash Price	$320.32
Rate for Payer: Cash Price	$320.32
Rate for Payer: Cigna Commercial	$188.25
Rate for Payer: Cigna Medicaid	$24.73
Rate for Payer: Molina CHIP/Medicaid	$24.73
Rate for Payer: Multiplan Auto	$236.60
Rate for Payer: Multiplan Commercial	$236.60
Rate for Payer: Multiplan Workers Comp	$236.60
Rate for Payer: Parkland Medicaid	$24.73
Rate for Payer: Scott and White EPO/PPO	$182.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$24.73
Rate for Payer: Superior Health Plan EPO	$49.50

XR Spine Lumbosacral 2 or 3 Views

Facility

$890.00

Service Code	CPT 72100 FY
Hospital Charge Code	3100476
Hospital Revenue Code	320
Min. Negotiated Rate	$33.34
Max. Negotiated Rate	$578.50
Rate for Payer: Aetna Commercial	$33.34
Rate for Payer: Aetna Medicare	$150.82
Rate for Payer: Amerigroup CHIP/Medicaid	$40.10
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	$783.20
Rate for Payer: Cash Price	$783.20
Rate for Payer: Cash Price	$783.20
Rate for Payer: Cigna Commercial	$227.77
Rate for Payer: Cigna Medicaid	$40.10
Rate for Payer: Molina CHIP/Medicaid	$40.10
Rate for Payer: Multiplan Auto	$578.50
Rate for Payer: Multiplan Commercial	$578.50
Rate for Payer: Multiplan Workers Comp	$578.50
Rate for Payer: Parkland Medicaid	$40.10
Rate for Payer: Scott and White EPO/PPO	$445.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$40.10
Rate for Payer: Superior Health Plan EPO	$121.04

XR Spine Lumbosacral 2 or 3 Views BCE

Facility

$890.00

Service Code	CPT 72100 FY
Hospital Charge Code	3100476
Hospital Revenue Code	320
Min. Negotiated Rate	$33.34
Max. Negotiated Rate	$578.50
Rate for Payer: Aetna Commercial	$33.34
Rate for Payer: Aetna Medicare	$150.82
Rate for Payer: Amerigroup CHIP/Medicaid	$40.10
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	$783.20
Rate for Payer: Cash Price	$783.20
Rate for Payer: Cash Price	$783.20
Rate for Payer: Cigna Commercial	$227.77
Rate for Payer: Cigna Medicaid	$40.10
Rate for Payer: Molina CHIP/Medicaid	$40.10
Rate for Payer: Multiplan Auto	$578.50
Rate for Payer: Multiplan Commercial	$578.50
Rate for Payer: Multiplan Workers Comp	$578.50
Rate for Payer: Parkland Medicaid	$40.10
Rate for Payer: Scott and White EPO/PPO	$445.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$40.10
Rate for Payer: Superior Health Plan EPO	$121.04

XR Spine Lumbosacral 2 or 3 Views BCE

Facility

$890.00

Service Code	CPT 72100 FY
Hospital Charge Code	3100476
Hospital Revenue Code	320
Rate for Payer: Cash Price	$783.20

XR Spine Lumbosacral 4+ Views

Facility

$1,077.00

Service Code	CPT 72110 FY
Hospital Charge Code	3100484
Hospital Revenue Code	320
Min. Negotiated Rate	$44.50
Max. Negotiated Rate	$700.05
Rate for Payer: Aetna Commercial	$44.50
Rate for Payer: Aetna Medicare	$150.82
Rate for Payer: Amerigroup CHIP/Medicaid	$51.45
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	$947.76
Rate for Payer: Cash Price	$947.76
Rate for Payer: Cash Price	$947.76
Rate for Payer: Cigna Commercial	$227.77
Rate for Payer: Cigna Medicaid	$51.45
Rate for Payer: Molina CHIP/Medicaid	$51.45
Rate for Payer: Multiplan Auto	$700.05
Rate for Payer: Multiplan Commercial	$700.05
Rate for Payer: Multiplan Workers Comp	$700.05
Rate for Payer: Parkland Medicaid	$51.45
Rate for Payer: Scott and White EPO/PPO	$538.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$51.45
Rate for Payer: Superior Health Plan EPO	$146.47

Know your out-of-pocket cost for care.

All Charges