White Rock Medical Center

All Charges

Charge

Type

Setting

Price

XR Spine Thoracolumbar 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 Thoracolumbar 2+ Views

Facility

$336.00

Service Code	CPT 72080 FY
Hospital Charge Code	3160124
Hospital Revenue Code	320
Min. Negotiated Rate	$28.33
Max. Negotiated Rate	$218.40
Rate for Payer: Aetna Commercial	$28.33
Rate for Payer: Aetna Medicare	$124.65
Rate for Payer: Amerigroup CHIP/Medicaid	$34.75
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	$295.68
Rate for Payer: Cash Price	$295.68
Rate for Payer: Cash Price	$295.68
Rate for Payer: Cigna Commercial	$188.25
Rate for Payer: Cigna Medicaid	$34.75
Rate for Payer: Molina CHIP/Medicaid	$34.75
Rate for Payer: Multiplan Auto	$218.40
Rate for Payer: Multiplan Commercial	$218.40
Rate for Payer: Multiplan Workers Comp	$218.40
Rate for Payer: Parkland Medicaid	$34.75
Rate for Payer: Scott and White EPO/PPO	$168.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$34.75
Rate for Payer: Superior Health Plan EPO	$45.70

XR Spine Thoracolumbar 2+ Views BCE

Facility

$336.00

Service Code	CPT 72080 FY
Hospital Charge Code	3160124
Hospital Revenue Code	320
Rate for Payer: Cash Price	$295.68

XR Spine Thoracolumbar 2+ Views BCE

Facility

$336.00

Service Code	CPT 72080 FY
Hospital Charge Code	3160124
Hospital Revenue Code	320
Min. Negotiated Rate	$28.33
Max. Negotiated Rate	$218.40
Rate for Payer: Aetna Commercial	$28.33
Rate for Payer: Aetna Medicare	$124.65
Rate for Payer: Amerigroup CHIP/Medicaid	$34.75
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	$295.68
Rate for Payer: Cash Price	$295.68
Rate for Payer: Cash Price	$295.68
Rate for Payer: Cigna Commercial	$188.25
Rate for Payer: Cigna Medicaid	$34.75
Rate for Payer: Molina CHIP/Medicaid	$34.75
Rate for Payer: Multiplan Auto	$218.40
Rate for Payer: Multiplan Commercial	$218.40
Rate for Payer: Multiplan Workers Comp	$218.40
Rate for Payer: Parkland Medicaid	$34.75
Rate for Payer: Scott and White EPO/PPO	$168.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$34.75
Rate for Payer: Superior Health Plan EPO	$45.70

XR Sternum 2+ Views

Facility

$283.00

Service Code	CPT 71120 FY
Hospital Charge Code	3100328
Hospital Revenue Code	320
Min. Negotiated Rate	$27.95
Max. Negotiated Rate	$188.25
Rate for Payer: Aetna Commercial	$27.95
Rate for Payer: Aetna Medicare	$124.65
Rate for Payer: Amerigroup CHIP/Medicaid	$33.75
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	$249.04
Rate for Payer: Cash Price	$249.04
Rate for Payer: Cash Price	$249.04
Rate for Payer: Cigna Commercial	$188.25
Rate for Payer: Cigna Medicaid	$33.75
Rate for Payer: Molina CHIP/Medicaid	$33.75
Rate for Payer: Multiplan Auto	$183.95
Rate for Payer: Multiplan Commercial	$183.95
Rate for Payer: Multiplan Workers Comp	$183.95
Rate for Payer: Parkland Medicaid	$33.75
Rate for Payer: Scott and White EPO/PPO	$141.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$33.75
Rate for Payer: Superior Health Plan EPO	$38.49

XR Sternum 2+ Views BCE

Facility

$283.00

Service Code	CPT 71120 FY
Hospital Charge Code	3100328
Hospital Revenue Code	320
Min. Negotiated Rate	$27.95
Max. Negotiated Rate	$188.25
Rate for Payer: Aetna Commercial	$27.95
Rate for Payer: Aetna Medicare	$124.65
Rate for Payer: Amerigroup CHIP/Medicaid	$33.75
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	$249.04
Rate for Payer: Cash Price	$249.04
Rate for Payer: Cash Price	$249.04
Rate for Payer: Cigna Commercial	$188.25
Rate for Payer: Cigna Medicaid	$33.75
Rate for Payer: Molina CHIP/Medicaid	$33.75
Rate for Payer: Multiplan Auto	$183.95
Rate for Payer: Multiplan Commercial	$183.95
Rate for Payer: Multiplan Workers Comp	$183.95
Rate for Payer: Parkland Medicaid	$33.75
Rate for Payer: Scott and White EPO/PPO	$141.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$33.75
Rate for Payer: Superior Health Plan EPO	$38.49

XR Sternum 2+ Views BCE

Facility

$283.00

Service Code	CPT 71120 FY
Hospital Charge Code	3100328
Hospital Revenue Code	320
Rate for Payer: Cash Price	$249.04

XR Surgical Specimen

Facility

$333.00

Service Code	CPT 76098 FY
Hospital Charge Code	3170074
Hospital Revenue Code	320
Min. Negotiated Rate	$12.03
Max. Negotiated Rate	$1,142.91
Rate for Payer: Aetna Commercial	$29.10
Rate for Payer: Aetna Medicare	$756.79
Rate for Payer: Amerigroup CHIP/Medicaid	$42.10
Rate for Payer: BCBS of TX Blue Advantage	$794.61
Rate for Payer: BCBS of TX Blue Essentials	$953.53
Rate for Payer: BCBS of TX PPO	$1,064.29
Rate for Payer: Cash Price	$293.04
Rate for Payer: Cash Price	$293.04
Rate for Payer: Cash Price	$293.04
Rate for Payer: Cigna Commercial	$1,142.91
Rate for Payer: Cigna Medicaid	$12.03
Rate for Payer: Molina CHIP/Medicaid	$12.03
Rate for Payer: Multiplan Auto	$216.45
Rate for Payer: Multiplan Commercial	$216.45
Rate for Payer: Multiplan Workers Comp	$216.45
Rate for Payer: Parkland Medicaid	$12.03
Rate for Payer: Scott and White EPO/PPO	$166.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.03
Rate for Payer: Superior Health Plan EPO	$45.29

XR Surgical Specimen BCE

Facility

$333.00

Service Code	CPT 76098 FY
Hospital Charge Code	3170074
Hospital Revenue Code	320
Rate for Payer: Cash Price	$293.04

XR Surgical Specimen BCE

Facility

$333.00

Service Code	CPT 76098 FY
Hospital Charge Code	3170074
Hospital Revenue Code	320
Min. Negotiated Rate	$12.03
Max. Negotiated Rate	$1,142.91
Rate for Payer: Aetna Commercial	$29.10
Rate for Payer: Aetna Medicare	$756.79
Rate for Payer: Amerigroup CHIP/Medicaid	$42.10
Rate for Payer: BCBS of TX Blue Advantage	$794.61
Rate for Payer: BCBS of TX Blue Essentials	$953.53
Rate for Payer: BCBS of TX PPO	$1,064.29
Rate for Payer: Cash Price	$293.04
Rate for Payer: Cash Price	$293.04
Rate for Payer: Cash Price	$293.04
Rate for Payer: Cigna Commercial	$1,142.91
Rate for Payer: Cigna Medicaid	$12.03
Rate for Payer: Molina CHIP/Medicaid	$12.03
Rate for Payer: Multiplan Auto	$216.45
Rate for Payer: Multiplan Commercial	$216.45
Rate for Payer: Multiplan Workers Comp	$216.45
Rate for Payer: Parkland Medicaid	$12.03
Rate for Payer: Scott and White EPO/PPO	$166.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.03
Rate for Payer: Superior Health Plan EPO	$45.29

XR Swallowing Function w/ Speech

Facility

$788.00

Service Code	CPT 74230 FY
Hospital Charge Code	3101102
Hospital Revenue Code	320
Min. Negotiated Rate	$107.17
Max. Negotiated Rate	$512.20
Rate for Payer: Aetna Commercial	$120.78
Rate for Payer: Aetna Medicare	$252.04
Rate for Payer: Amerigroup CHIP/Medicaid	$127.64
Rate for Payer: BCBS of TX Blue Advantage	$300.66
Rate for Payer: BCBS of TX Blue Essentials	$360.80
Rate for Payer: BCBS of TX PPO	$402.71
Rate for Payer: Cash Price	$693.44
Rate for Payer: Cash Price	$693.44
Rate for Payer: Cash Price	$693.44
Rate for Payer: Cigna Commercial	$380.65
Rate for Payer: Cigna Medicaid	$127.64
Rate for Payer: Molina CHIP/Medicaid	$127.64
Rate for Payer: Multiplan Auto	$512.20
Rate for Payer: Multiplan Commercial	$512.20
Rate for Payer: Multiplan Workers Comp	$512.20
Rate for Payer: Parkland Medicaid	$127.64
Rate for Payer: Scott and White EPO/PPO	$394.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$127.64
Rate for Payer: Superior Health Plan EPO	$107.17

XR Swallowing Function w/ Speech BCE

Facility

$788.00

Service Code	CPT 74230 FY
Hospital Charge Code	3101102
Hospital Revenue Code	320
Rate for Payer: Cash Price	$693.44

XR Swallowing Function w/ Speech BCE

Facility

$788.00

Service Code	CPT 74230 FY
Hospital Charge Code	3101102
Hospital Revenue Code	320
Min. Negotiated Rate	$107.17
Max. Negotiated Rate	$512.20
Rate for Payer: Aetna Commercial	$120.78
Rate for Payer: Aetna Medicare	$252.04
Rate for Payer: Amerigroup CHIP/Medicaid	$127.64
Rate for Payer: BCBS of TX Blue Advantage	$300.66
Rate for Payer: BCBS of TX Blue Essentials	$360.80
Rate for Payer: BCBS of TX PPO	$402.71
Rate for Payer: Cash Price	$693.44
Rate for Payer: Cash Price	$693.44
Rate for Payer: Cash Price	$693.44
Rate for Payer: Cigna Commercial	$380.65
Rate for Payer: Cigna Medicaid	$127.64
Rate for Payer: Molina CHIP/Medicaid	$127.64
Rate for Payer: Multiplan Auto	$512.20
Rate for Payer: Multiplan Commercial	$512.20
Rate for Payer: Multiplan Workers Comp	$512.20
Rate for Payer: Parkland Medicaid	$127.64
Rate for Payer: Scott and White EPO/PPO	$394.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$127.64
Rate for Payer: Superior Health Plan EPO	$107.17

XR Thoracostomy Tube Left

Facility

$819.00

Service Code	CPT 32551 LT,FY
Hospital Charge Code	4907772
Hospital Revenue Code	361
Min. Negotiated Rate	$73.71
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$2,197.02
Rate for Payer: Amerigroup CHIP/Medicaid	$73.71
Rate for Payer: BCBS of TX Blue Advantage	$2,723.99
Rate for Payer: BCBS of TX Blue Essentials	$3,262.26
Rate for Payer: BCBS of TX PPO	$4,110.45
Rate for Payer: Cash Price	$720.72
Rate for Payer: Cash Price	$720.72
Rate for Payer: Cash Price	$720.72
Rate for Payer: Cigna Commercial	$3,317.93
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	$409.50
Rate for Payer: Superior Health Plan EPO	$111.38

XR Thoracostomy Tube Left BCE

Facility

$819.00

Service Code	CPT 32551 LT,FY
Hospital Charge Code	4907772
Hospital Revenue Code	361
Min. Negotiated Rate	$73.71
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$2,197.02
Rate for Payer: Amerigroup CHIP/Medicaid	$73.71
Rate for Payer: BCBS of TX Blue Advantage	$2,723.99
Rate for Payer: BCBS of TX Blue Essentials	$3,262.26
Rate for Payer: BCBS of TX PPO	$4,110.45
Rate for Payer: Cash Price	$720.72
Rate for Payer: Cash Price	$720.72
Rate for Payer: Cash Price	$720.72
Rate for Payer: Cigna Commercial	$3,317.93
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	$409.50
Rate for Payer: Superior Health Plan EPO	$111.38

XR Thoracostomy Tube Right

Facility

$819.00

Service Code	CPT 32551 RT,FY
Hospital Charge Code	4907772
Hospital Revenue Code	361
Min. Negotiated Rate	$73.71
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$2,197.02
Rate for Payer: Amerigroup CHIP/Medicaid	$73.71
Rate for Payer: BCBS of TX Blue Advantage	$2,723.99
Rate for Payer: BCBS of TX Blue Essentials	$3,262.26
Rate for Payer: BCBS of TX PPO	$4,110.45
Rate for Payer: Cash Price	$720.72
Rate for Payer: Cash Price	$720.72
Rate for Payer: Cash Price	$720.72
Rate for Payer: Cigna Commercial	$3,317.93
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	$409.50
Rate for Payer: Superior Health Plan EPO	$111.38

XR Thoracostomy Tube Right BCE

Facility

$819.00

Service Code	CPT 32551 RT,FY
Hospital Charge Code	4907772
Hospital Revenue Code	361
Rate for Payer: Cash Price	$720.72

XR Thoracostomy Tube Right BCE

Facility

$819.00

Service Code	CPT 32551 RT,FY
Hospital Charge Code	4907772
Hospital Revenue Code	361
Min. Negotiated Rate	$73.71
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$2,197.02
Rate for Payer: Amerigroup CHIP/Medicaid	$73.71
Rate for Payer: BCBS of TX Blue Advantage	$2,723.99
Rate for Payer: BCBS of TX Blue Essentials	$3,262.26
Rate for Payer: BCBS of TX PPO	$4,110.45
Rate for Payer: Cash Price	$720.72
Rate for Payer: Cash Price	$720.72
Rate for Payer: Cash Price	$720.72
Rate for Payer: Cigna Commercial	$3,317.93
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	$409.50
Rate for Payer: Superior Health Plan EPO	$111.38

XR Tibia/Fibula Left

Facility

$535.00

Service Code	CPT 73590 LT,FY
Hospital Charge Code	3100930
Hospital Revenue Code	320
Min. Negotiated Rate	$27.18
Max. Negotiated Rate	$347.75
Rate for Payer: Aetna Commercial	$27.18
Rate for Payer: Aetna Medicare	$124.65
Rate for Payer: Amerigroup CHIP/Medicaid	$31.74
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	$470.80
Rate for Payer: Cash Price	$470.80
Rate for Payer: Cash Price	$470.80
Rate for Payer: Cigna Commercial	$188.25
Rate for Payer: Cigna Medicaid	$31.74
Rate for Payer: Molina CHIP/Medicaid	$31.74
Rate for Payer: Multiplan Auto	$347.75
Rate for Payer: Multiplan Commercial	$347.75
Rate for Payer: Multiplan Workers Comp	$347.75
Rate for Payer: Parkland Medicaid	$31.74
Rate for Payer: Scott and White EPO/PPO	$267.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$31.74
Rate for Payer: Superior Health Plan EPO	$72.76

XR Tibia/Fibula Left BCE

Facility

$535.00

Service Code	CPT 73590 LT,FY
Hospital Charge Code	3100930
Hospital Revenue Code	320
Rate for Payer: Cash Price	$470.80

XR Tibia/Fibula Left BCE

Facility

$535.00

Service Code	CPT 73590 LT,FY
Hospital Charge Code	3100930
Hospital Revenue Code	320
Min. Negotiated Rate	$27.18
Max. Negotiated Rate	$347.75
Rate for Payer: Aetna Commercial	$27.18
Rate for Payer: Aetna Medicare	$124.65
Rate for Payer: Amerigroup CHIP/Medicaid	$31.74
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	$470.80
Rate for Payer: Cash Price	$470.80
Rate for Payer: Cash Price	$470.80
Rate for Payer: Cigna Commercial	$188.25
Rate for Payer: Cigna Medicaid	$31.74
Rate for Payer: Molina CHIP/Medicaid	$31.74
Rate for Payer: Multiplan Auto	$347.75
Rate for Payer: Multiplan Commercial	$347.75
Rate for Payer: Multiplan Workers Comp	$347.75
Rate for Payer: Parkland Medicaid	$31.74
Rate for Payer: Scott and White EPO/PPO	$267.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$31.74
Rate for Payer: Superior Health Plan EPO	$72.76

XR Tibia/Fibula Right

Facility

$535.00

Service Code	CPT 73590 RT,FY
Hospital Charge Code	3100948
Hospital Revenue Code	320
Min. Negotiated Rate	$27.18
Max. Negotiated Rate	$347.75
Rate for Payer: Aetna Commercial	$27.18
Rate for Payer: Aetna Medicare	$124.65
Rate for Payer: Amerigroup CHIP/Medicaid	$31.74
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	$470.80
Rate for Payer: Cash Price	$470.80
Rate for Payer: Cash Price	$470.80
Rate for Payer: Cigna Commercial	$188.25
Rate for Payer: Cigna Medicaid	$31.74
Rate for Payer: Molina CHIP/Medicaid	$31.74
Rate for Payer: Multiplan Auto	$347.75
Rate for Payer: Multiplan Commercial	$347.75
Rate for Payer: Multiplan Workers Comp	$347.75
Rate for Payer: Parkland Medicaid	$31.74
Rate for Payer: Scott and White EPO/PPO	$267.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$31.74
Rate for Payer: Superior Health Plan EPO	$72.76

XR Tibia/Fibula Right BCE

Facility

$535.00

Service Code	CPT 73590 RT,FY
Hospital Charge Code	3100948
Hospital Revenue Code	320
Rate for Payer: Cash Price	$470.80

XR Tibia/Fibula Right BCE

Facility

$535.00

Service Code	CPT 73590 RT,FY
Hospital Charge Code	3100948
Hospital Revenue Code	320
Min. Negotiated Rate	$27.18
Max. Negotiated Rate	$347.75
Rate for Payer: Aetna Commercial	$27.18
Rate for Payer: Aetna Medicare	$124.65
Rate for Payer: Amerigroup CHIP/Medicaid	$31.74
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	$470.80
Rate for Payer: Cash Price	$470.80
Rate for Payer: Cash Price	$470.80
Rate for Payer: Cigna Commercial	$188.25
Rate for Payer: Cigna Medicaid	$31.74
Rate for Payer: Molina CHIP/Medicaid	$31.74
Rate for Payer: Multiplan Auto	$347.75
Rate for Payer: Multiplan Commercial	$347.75
Rate for Payer: Multiplan Workers Comp	$347.75
Rate for Payer: Parkland Medicaid	$31.74
Rate for Payer: Scott and White EPO/PPO	$267.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$31.74
Rate for Payer: Superior Health Plan EPO	$72.76

XR Tilt Table

Facility

$1,399.00

Service Code	CPT 93660 FY
Hospital Charge Code	3170085
Hospital Revenue Code	480
Min. Negotiated Rate	$56.13
Max. Negotiated Rate	$1,110.40
Rate for Payer: Aetna Commercial	$769.45
Rate for Payer: Aetna Medicare	$735.27
Rate for Payer: Amerigroup CHIP/Medicaid	$125.91
Rate for Payer: BCBS of TX Blue Advantage	$115.38
Rate for Payer: BCBS of TX Blue Essentials	$137.92
Rate for Payer: BCBS of TX PPO	$153.84
Rate for Payer: Cash Price	$1,231.12
Rate for Payer: Cash Price	$1,231.12
Rate for Payer: Cash Price	$1,231.12
Rate for Payer: Cigna Commercial	$1,110.40
Rate for Payer: Cigna Medicaid	$56.13
Rate for Payer: Molina CHIP/Medicaid	$56.13
Rate for Payer: Multiplan Auto	$909.35
Rate for Payer: Multiplan Commercial	$909.35
Rate for Payer: Multiplan Workers Comp	$909.35
Rate for Payer: Parkland Medicaid	$56.13
Rate for Payer: Scott and White EPO/PPO	$699.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$56.13
Rate for Payer: Superior Health Plan EPO	$190.26

Know your out-of-pocket cost for care.

All Charges