White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Cardioversion 92960

Facility

$1,363.00

Service Code	CPT 92960
Hospital Charge Code	2800381
Hospital Revenue Code	480
Min. Negotiated Rate	$10.64
Max. Negotiated Rate	$1,400.00
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$892.82
Rate for Payer: Amerigroup CHIP/Medicaid	$122.67
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$595.21
Rate for Payer: Amerigroup Medicare	$595.21
Rate for Payer: BCBS of TX Blue Advantage	$895.89
Rate for Payer: BCBS of TX Blue Essentials	$1,072.92
Rate for Payer: BCBS of TX Medicare	$595.21
Rate for Payer: BCBS of TX PPO	$1,351.88
Rate for Payer: Cash Price	$1,199.44
Rate for Payer: Cash Price	$1,199.44
Rate for Payer: Cash Price	$1,199.44
Rate for Payer: Cigna Commercial	$1,348.32
Rate for Payer: Cigna Medicare	$595.21
Rate for Payer: Employer Direct Commercial	$595.21
Rate for Payer: Humana Medicare/TRICARE	$595.21
Rate for Payer: Molina Dual Medicare/Medicaid	$595.21
Rate for Payer: Molina Medicare	$595.21
Rate for Payer: Multiplan Auto	$885.95
Rate for Payer: Multiplan Commercial	$885.95
Rate for Payer: Multiplan Workers Comp	$885.95
Rate for Payer: Scott and White EPO/PPO	$10.64
Rate for Payer: Scott and White Medicare	$595.21
Rate for Payer: Superior Health Plan EPO	$595.21
Rate for Payer: Superior Health Plan Medicare	$595.21
Rate for Payer: Universal American Dual Medicare/Medicaid	$595.21
Rate for Payer: Universal American Medicare	$595.21
Rate for Payer: Wellcare Medicare	$595.21
Rate for Payer: Wellmed Medicare	$595.21

Cardioversion 92960

Facility

$1,363.00

Service Code	CPT 92960
Hospital Charge Code	2800381
Hospital Revenue Code	480
Rate for Payer: Cash Price	$1,199.44

Cardioversion 92960 BCE

Facility

$1,363.00

Service Code	CPT 92960
Hospital Charge Code	2800381
Hospital Revenue Code	480
Min. Negotiated Rate	$10.64
Max. Negotiated Rate	$1,400.00
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$892.82
Rate for Payer: Amerigroup CHIP/Medicaid	$122.67
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$595.21
Rate for Payer: Amerigroup Medicare	$595.21
Rate for Payer: BCBS of TX Blue Advantage	$895.89
Rate for Payer: BCBS of TX Blue Essentials	$1,072.92
Rate for Payer: BCBS of TX Medicare	$595.21
Rate for Payer: BCBS of TX PPO	$1,351.88
Rate for Payer: Cash Price	$1,199.44
Rate for Payer: Cash Price	$1,199.44
Rate for Payer: Cash Price	$1,199.44
Rate for Payer: Cigna Commercial	$1,348.32
Rate for Payer: Cigna Medicare	$595.21
Rate for Payer: Employer Direct Commercial	$595.21
Rate for Payer: Humana Medicare/TRICARE	$595.21
Rate for Payer: Molina Dual Medicare/Medicaid	$595.21
Rate for Payer: Molina Medicare	$595.21
Rate for Payer: Multiplan Auto	$885.95
Rate for Payer: Multiplan Commercial	$885.95
Rate for Payer: Multiplan Workers Comp	$885.95
Rate for Payer: Scott and White EPO/PPO	$10.64
Rate for Payer: Scott and White Medicare	$595.21
Rate for Payer: Superior Health Plan EPO	$595.21
Rate for Payer: Superior Health Plan Medicare	$595.21
Rate for Payer: Universal American Dual Medicare/Medicaid	$595.21
Rate for Payer: Universal American Medicare	$595.21
Rate for Payer: Wellcare Medicare	$595.21
Rate for Payer: Wellmed Medicare	$595.21

CARDIOVERSION - CATH LAB

Facility

$1,363.00

Service Code	CPT 92960
Hospital Charge Code	2300077
Hospital Revenue Code	481
Min. Negotiated Rate	$10.64
Max. Negotiated Rate	$1,400.00
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$892.82
Rate for Payer: Amerigroup CHIP/Medicaid	$122.67
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$595.21
Rate for Payer: Amerigroup Medicare	$595.21
Rate for Payer: BCBS of TX Blue Advantage	$895.89
Rate for Payer: BCBS of TX Blue Essentials	$1,072.92
Rate for Payer: BCBS of TX Medicare	$595.21
Rate for Payer: BCBS of TX PPO	$1,351.88
Rate for Payer: Cash Price	$1,199.44
Rate for Payer: Cash Price	$1,199.44
Rate for Payer: Cash Price	$1,199.44
Rate for Payer: Cigna Commercial	$1,348.32
Rate for Payer: Cigna Medicare	$595.21
Rate for Payer: Employer Direct Commercial	$595.21
Rate for Payer: Humana Medicare/TRICARE	$595.21
Rate for Payer: Molina Dual Medicare/Medicaid	$595.21
Rate for Payer: Molina Medicare	$595.21
Rate for Payer: Multiplan Auto	$885.95
Rate for Payer: Multiplan Commercial	$885.95
Rate for Payer: Multiplan Workers Comp	$885.95
Rate for Payer: Scott and White EPO/PPO	$10.64
Rate for Payer: Scott and White Medicare	$595.21
Rate for Payer: Superior Health Plan EPO	$595.21
Rate for Payer: Superior Health Plan Medicare	$595.21
Rate for Payer: Universal American Dual Medicare/Medicaid	$595.21
Rate for Payer: Universal American Medicare	$595.21
Rate for Payer: Wellcare Medicare	$595.21
Rate for Payer: Wellmed Medicare	$595.21

CARDIOVERSION - CATH LAB

Facility

$1,363.00

Service Code	CPT 92960
Hospital Charge Code	2300077
Hospital Revenue Code	481
Rate for Payer: Cash Price	$1,199.44

CAROTID ARTERY STENT PROCEDURES WITH CC

Facility

$43,690.50

Service Code	MSDRG 035
Min. Negotiated Rate	$19,264.16
Max. Negotiated Rate	$43,690.50
Rate for Payer: Aetna Commercial	$25,869.38
Rate for Payer: Aetna Medicare	$28,896.24
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$19,264.16
Rate for Payer: Amerigroup Medicare	$19,264.16
Rate for Payer: BCBS of TX Blue Advantage	$20,093.90
Rate for Payer: BCBS of TX Blue Essentials	$22,911.28
Rate for Payer: BCBS of TX Medicare	$19,264.16
Rate for Payer: BCBS of TX PPO	$25,457.96
Rate for Payer: Cigna Commercial	$29,617.56
Rate for Payer: Cigna Medicare	$19,264.16
Rate for Payer: Employer Direct Commercial	$19,264.16
Rate for Payer: Humana Medicare/TRICARE	$19,264.16
Rate for Payer: Molina Dual Medicare/Medicaid	$19,264.16
Rate for Payer: Molina Medicare	$19,264.16
Rate for Payer: Multiplan Auto	$43,690.50
Rate for Payer: Multiplan Commercial	$43,690.50
Rate for Payer: Multiplan Workers Comp	$43,690.50
Rate for Payer: Scott and White EPO/PPO	$20,120.62
Rate for Payer: Scott and White Medicare	$19,264.16
Rate for Payer: Superior Health Plan EPO	$19,264.16
Rate for Payer: Superior Health Plan Medicare	$19,264.16
Rate for Payer: Universal American Dual Medicare/Medicaid	$19,264.16
Rate for Payer: Universal American Medicare	$19,264.16
Rate for Payer: Wellcare Medicare	$19,264.16
Rate for Payer: Wellmed Medicare	$19,264.16

CAROTID ARTERY STENT PROCEDURES WITH MCC

Facility

$74,126.60

Service Code	MSDRG 034
Min. Negotiated Rate	$30,695.41
Max. Negotiated Rate	$74,126.60
Rate for Payer: Aetna Commercial	$43,890.75
Rate for Payer: Aetna Medicare	$46,043.12
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$30,695.41
Rate for Payer: Amerigroup Medicare	$30,695.41
Rate for Payer: BCBS of TX Blue Advantage	$33,112.58
Rate for Payer: BCBS of TX Blue Essentials	$37,146.34
Rate for Payer: BCBS of TX Medicare	$30,695.41
Rate for Payer: BCBS of TX PPO	$41,275.31
Rate for Payer: Cigna Commercial	$50,250.03
Rate for Payer: Cigna Medicare	$30,695.41
Rate for Payer: Employer Direct Commercial	$30,695.41
Rate for Payer: Humana Medicare/TRICARE	$30,695.41
Rate for Payer: Molina Dual Medicare/Medicaid	$30,695.41
Rate for Payer: Molina Medicare	$30,695.41
Rate for Payer: Multiplan Auto	$74,126.60
Rate for Payer: Multiplan Commercial	$74,126.60
Rate for Payer: Multiplan Workers Comp	$74,126.60
Rate for Payer: Scott and White EPO/PPO	$34,137.25
Rate for Payer: Scott and White Medicare	$30,695.41
Rate for Payer: Superior Health Plan EPO	$30,695.41
Rate for Payer: Superior Health Plan Medicare	$30,695.41
Rate for Payer: Universal American Dual Medicare/Medicaid	$30,695.41
Rate for Payer: Universal American Medicare	$30,695.41
Rate for Payer: Wellcare Medicare	$30,695.41
Rate for Payer: Wellmed Medicare	$30,695.41

CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC

Facility

$34,355.80

Service Code	MSDRG 036
Min. Negotiated Rate	$15,038.82
Max. Negotiated Rate	$34,355.80
Rate for Payer: Aetna Commercial	$20,342.25
Rate for Payer: Aetna Medicare	$23,637.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15,758.20
Rate for Payer: Amerigroup Medicare	$15,758.20
Rate for Payer: BCBS of TX Blue Advantage	$15,038.82
Rate for Payer: BCBS of TX Blue Essentials	$17,810.59
Rate for Payer: BCBS of TX Medicare	$15,758.20
Rate for Payer: BCBS of TX PPO	$19,790.32
Rate for Payer: Cigna Commercial	$23,289.62
Rate for Payer: Cigna Medicare	$15,758.20
Rate for Payer: Employer Direct Commercial	$15,758.20
Rate for Payer: Humana Medicare/TRICARE	$15,758.20
Rate for Payer: Molina Dual Medicare/Medicaid	$15,758.20
Rate for Payer: Molina Medicare	$15,758.20
Rate for Payer: Multiplan Auto	$34,355.80
Rate for Payer: Multiplan Commercial	$34,355.80
Rate for Payer: Multiplan Workers Comp	$34,355.80
Rate for Payer: Scott and White EPO/PPO	$15,821.75
Rate for Payer: Scott and White Medicare	$15,758.20
Rate for Payer: Superior Health Plan EPO	$15,758.20
Rate for Payer: Superior Health Plan Medicare	$15,758.20
Rate for Payer: Universal American Dual Medicare/Medicaid	$15,758.20
Rate for Payer: Universal American Medicare	$15,758.20
Rate for Payer: Wellcare Medicare	$15,758.20
Rate for Payer: Wellmed Medicare	$15,758.20

Carpal tunnel surgery

Facility

$10,000.00

Service Code	CPT 64721
Hospital Charge Code	36064721
Hospital Revenue Code	360
Min. Negotiated Rate	$38.95
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$3,090.00
Rate for Payer: Aetna Medicare	$2,648.68
Rate for Payer: Amerigroup CHIP/Medicaid	$659.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,765.79
Rate for Payer: Amerigroup Medicare	$1,765.79
Rate for Payer: BCBS of TX Blue Advantage	$2,871.31
Rate for Payer: BCBS of TX Blue Essentials	$3,438.70
Rate for Payer: BCBS of TX Medicare	$1,765.79
Rate for Payer: BCBS of TX PPO	$4,332.76
Rate for Payer: Cigna Commercial	$4,000.01
Rate for Payer: Cigna Medicaid	$659.94
Rate for Payer: Cigna Medicare	$1,765.79
Rate for Payer: Employer Direct Commercial	$1,765.79
Rate for Payer: Humana Medicare/TRICARE	$1,765.79
Rate for Payer: Molina CHIP/Medicaid	$659.94
Rate for Payer: Molina Dual Medicare/Medicaid	$1,765.79
Rate for Payer: Molina Medicare	$1,765.79
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	$659.94
Rate for Payer: Scott and White EPO/PPO	$38.95
Rate for Payer: Scott and White Medicare	$1,765.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$659.94
Rate for Payer: Superior Health Plan EPO	$1,765.79
Rate for Payer: Superior Health Plan Medicare	$1,765.79
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,765.79
Rate for Payer: Universal American Medicare	$1,765.79
Rate for Payer: Wellcare Medicare	$1,765.79
Rate for Payer: Wellmed Medicare	$1,765.79

Carpectomy; all bones of proximal row

Facility

$10,000.00

Service Code	CPT 25215
Hospital Charge Code	36025215
Hospital Revenue Code	360
Min. Negotiated Rate	$65.29
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$4,635.00
Rate for Payer: Aetna Medicare	$4,440.36
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,960.24
Rate for Payer: Amerigroup Medicare	$2,960.24
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	$2,960.24
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cigna Commercial	$6,705.80
Rate for Payer: Cigna Medicaid	$1,088.27
Rate for Payer: Cigna Medicare	$2,960.24
Rate for Payer: Employer Direct Commercial	$2,960.24
Rate for Payer: Humana Medicare/TRICARE	$2,960.24
Rate for Payer: Molina CHIP/Medicaid	$1,088.27
Rate for Payer: Molina Dual Medicare/Medicaid	$2,960.24
Rate for Payer: Molina Medicare	$2,960.24
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	$1,088.27
Rate for Payer: Scott and White EPO/PPO	$65.29
Rate for Payer: Scott and White Medicare	$2,960.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,088.27
Rate for Payer: Superior Health Plan EPO	$2,960.24
Rate for Payer: Superior Health Plan Medicare	$2,960.24
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,960.24
Rate for Payer: Universal American Medicare	$2,960.24
Rate for Payer: Wellcare Medicare	$2,960.24
Rate for Payer: Wellmed Medicare	$2,960.24

Car Seat Challenge Duration Ea Addl 30 Min BCE

Facility

$50.00

Service Code	CPT 94781
Hospital Charge Code	10132
Hospital Revenue Code	920
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$32.50
Rate for Payer: Aetna Commercial	$27.50
Rate for Payer: Amerigroup CHIP/Medicaid	$4.50
Rate for Payer: BCBS of TX Blue Advantage	$15.05
Rate for Payer: BCBS of TX Blue Essentials	$17.99
Rate for Payer: BCBS of TX PPO	$20.07
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Multiplan Auto	$32.50
Rate for Payer: Multiplan Commercial	$32.50
Rate for Payer: Multiplan Workers Comp	$32.50
Rate for Payer: Scott and White EPO/PPO	$25.00
Rate for Payer: Superior Health Plan EPO	$6.80

Car Seat Challenge Duration Ea Addl 30 Min BCE

Facility

$50.00

Service Code	CPT 94781
Hospital Charge Code	10132
Hospital Revenue Code	920
Rate for Payer: Cash Price	$44.00

Car Seat Challenge Duration First 60 Min BCE

Facility

$68.00

Service Code	CPT 94780
Hospital Charge Code	10124
Hospital Revenue Code	920
Rate for Payer: Cash Price	$59.84

Car Seat Challenge Duration First 60 Min BCE

Facility

$68.00

Service Code	CPT 94780
Hospital Charge Code	10124
Hospital Revenue Code	920
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$83.09
Rate for Payer: Aetna Commercial	$37.40
Rate for Payer: Aetna Medicare	$55.02
Rate for Payer: Amerigroup CHIP/Medicaid	$6.12
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$36.68
Rate for Payer: Amerigroup Medicare	$36.68
Rate for Payer: BCBS of TX Blue Advantage	$58.17
Rate for Payer: BCBS of TX Blue Essentials	$69.53
Rate for Payer: BCBS of TX Medicare	$36.68
Rate for Payer: BCBS of TX PPO	$77.56
Rate for Payer: Cash Price	$59.84
Rate for Payer: Cash Price	$59.84
Rate for Payer: Cash Price	$59.84
Rate for Payer: Cigna Commercial	$83.09
Rate for Payer: Cigna Medicare	$36.68
Rate for Payer: Employer Direct Commercial	$36.68
Rate for Payer: Humana Medicare/TRICARE	$36.68
Rate for Payer: Molina Dual Medicare/Medicaid	$36.68
Rate for Payer: Molina Medicare	$36.68
Rate for Payer: Multiplan Auto	$44.20
Rate for Payer: Multiplan Commercial	$44.20
Rate for Payer: Multiplan Workers Comp	$44.20
Rate for Payer: Scott and White EPO/PPO	$0.66
Rate for Payer: Scott and White Medicare	$36.68
Rate for Payer: Superior Health Plan EPO	$36.68
Rate for Payer: Superior Health Plan Medicare	$36.68
Rate for Payer: Universal American Dual Medicare/Medicaid	$36.68
Rate for Payer: Universal American Medicare	$36.68
Rate for Payer: Wellcare Medicare	$36.68
Rate for Payer: Wellmed Medicare	$36.68

CARTDGE ORBT ARHRCM 125 MICRO 145CM

Facility

$10,215.00

Service Code	HCPCS C1724
Hospital Charge Code	8582476
Hospital Revenue Code	272
Rate for Payer: Cash Price	$8,989.20

CARTDGE ORBT ARHRCM 125 MICRO 145CM

Facility

$10,215.00

Service Code	HCPCS C1724
Hospital Charge Code	8582476
Hospital Revenue Code	272
Min. Negotiated Rate	$919.35
Max. Negotiated Rate	$6,639.75
Rate for Payer: Aetna Commercial	$5,618.25
Rate for Payer: Amerigroup CHIP/Medicaid	$919.35
Rate for Payer: BCBS of TX Blue Advantage	$3,064.50
Rate for Payer: BCBS of TX Blue Essentials	$3,677.40
Rate for Payer: BCBS of TX PPO	$4,086.00
Rate for Payer: Cash Price	$8,989.20
Rate for Payer: Multiplan Auto	$6,639.75
Rate for Payer: Multiplan Commercial	$6,639.75
Rate for Payer: Multiplan Workers Comp	$6,639.75
Rate for Payer: Scott and White EPO/PPO	$5,107.50
Rate for Payer: Superior Health Plan EPO	$1,389.24

CARTDGE ORBT ARHRCM 1.5 CLSS 145CM

Facility

$10,215.00

Service Code	HCPCS C1724
Hospital Charge Code	8582474
Hospital Revenue Code	272
Rate for Payer: Cash Price	$8,989.20

CARTDGE ORBT ARHRCM 1.5 CLSS 145CM

Facility

$10,215.00

Service Code	HCPCS C1724
Hospital Charge Code	8582474
Hospital Revenue Code	272
Min. Negotiated Rate	$919.35
Max. Negotiated Rate	$6,639.75
Rate for Payer: Aetna Commercial	$5,618.25
Rate for Payer: Amerigroup CHIP/Medicaid	$919.35
Rate for Payer: BCBS of TX Blue Advantage	$3,064.50
Rate for Payer: BCBS of TX Blue Essentials	$3,677.40
Rate for Payer: BCBS of TX PPO	$4,086.00
Rate for Payer: Cash Price	$8,989.20
Rate for Payer: Multiplan Auto	$6,639.75
Rate for Payer: Multiplan Commercial	$6,639.75
Rate for Payer: Multiplan Workers Comp	$6,639.75
Rate for Payer: Scott and White EPO/PPO	$5,107.50
Rate for Payer: Superior Health Plan EPO	$1,389.24

CARTRIDGE COAG -- DHF

Facility

$602.48

Hospital Charge Code	81731556
Hospital Revenue Code	270
Min. Negotiated Rate	$54.22
Max. Negotiated Rate	$391.61
Rate for Payer: Aetna Commercial	$331.36
Rate for Payer: Amerigroup CHIP/Medicaid	$54.22
Rate for Payer: BCBS of TX Blue Advantage	$180.74
Rate for Payer: BCBS of TX Blue Essentials	$216.89
Rate for Payer: BCBS of TX PPO	$240.99
Rate for Payer: Cash Price	$530.18
Rate for Payer: Multiplan Auto	$391.61
Rate for Payer: Multiplan Commercial	$391.61
Rate for Payer: Multiplan Workers Comp	$391.61
Rate for Payer: Scott and White EPO/PPO	$301.24
Rate for Payer: Superior Health Plan EPO	$81.94

CARTRIDGE COAG -- DHF

Facility

$602.48

Hospital Charge Code	81731556
Hospital Revenue Code	270
Rate for Payer: Cash Price	$530.18

carvedilol 25 mg Tab

Facility

$9.30

Service Code	HCPCS J3490
Hospital Charge Code	77444538
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$6.04
Rate for Payer: Amerigroup CHIP/Medicaid	$0.84
Rate for Payer: BCBS of TX Blue Advantage	$2.79
Rate for Payer: BCBS of TX Blue Essentials	$3.35
Rate for Payer: BCBS of TX PPO	$3.72
Rate for Payer: Cash Price	$6.32
Rate for Payer: Multiplan Auto	$6.04
Rate for Payer: Multiplan Commercial	$6.04
Rate for Payer: Multiplan Workers Comp	$6.04
Rate for Payer: Scott and White EPO/PPO	$4.65
Rate for Payer: Superior Health Plan EPO	$1.26

carvedilol 25 mg Tab

Facility

$9.30

Service Code	HCPCS J3490
Hospital Charge Code	77444538
Hospital Revenue Code	250
Rate for Payer: Cash Price	$6.32

carvedilol 3.125 mg Tab

Facility

$9.30

Service Code	HCPCS J3490
Hospital Charge Code	78422803
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$6.04
Rate for Payer: Amerigroup CHIP/Medicaid	$0.84
Rate for Payer: BCBS of TX Blue Advantage	$2.79
Rate for Payer: BCBS of TX Blue Essentials	$3.35
Rate for Payer: BCBS of TX PPO	$3.72
Rate for Payer: Cash Price	$6.32
Rate for Payer: Multiplan Auto	$6.04
Rate for Payer: Multiplan Commercial	$6.04
Rate for Payer: Multiplan Workers Comp	$6.04
Rate for Payer: Scott and White EPO/PPO	$4.65
Rate for Payer: Superior Health Plan EPO	$1.26

carvedilol 3.125 mg Tab

Facility

$9.30

Service Code	HCPCS J3490
Hospital Charge Code	78422803
Hospital Revenue Code	250
Rate for Payer: Cash Price	$6.32

carvedilol 6.25 mg Tab

Facility

$9.30

Service Code	HCPCS J3490
Hospital Charge Code	78404151
Hospital Revenue Code	250
Rate for Payer: Cash Price	$6.32

Know your out-of-pocket cost for care.

All Charges