White Rock Medical Center

All Charges

Charge

Type

Setting

Price

RT CHARGE Chest Physiotherapy -> Manipulate chest PT initial

Facility

$225.00

Service Code	HCPCS 94667
Hospital Charge Code	4000055
Hospital Revenue Code	410
Rate for Payer: Cash Price	$153.00

RT CHARGE Chest Physiotherapy -> Manipulate chest PT initial

Facility

$225.00

Service Code	HCPCS 94667
Hospital Charge Code	4000055
Hospital Revenue Code	410
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$282.53
Rate for Payer: Amerigroup CHIP/Medicaid	$20.25
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$133.65
Rate for Payer: Amerigroup Medicare	$133.65
Rate for Payer: BCBS of TX Blue Advantage	$67.50
Rate for Payer: BCBS of TX Blue Essentials	$81.00
Rate for Payer: BCBS of TX Medicare	$133.65
Rate for Payer: BCBS of TX PPO	$90.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cigna Commercial	$282.53
Rate for Payer: Cigna Medicaid	$162.00
Rate for Payer: Cigna Medicare	$133.65
Rate for Payer: Employer Direct Commercial	$133.65
Rate for Payer: Humana Medicare/TRICARE	$133.65
Rate for Payer: Molina CHIP/Medicaid	$162.00
Rate for Payer: Molina Dual Medicare/Medicaid	$133.65
Rate for Payer: Molina Medicare	$133.65
Rate for Payer: Multiplan Auto	$146.25
Rate for Payer: Multiplan Commercial	$146.25
Rate for Payer: Multiplan Workers Comp	$146.25
Rate for Payer: Parkland Medicaid	$162.00
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Scott and White Medicare	$133.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$162.00
Rate for Payer: Superior Health Plan EPO	$133.65
Rate for Payer: Superior Health Plan Medicare	$133.65
Rate for Payer: Universal American Dual Medicare/Medicaid	$133.65
Rate for Payer: Universal American Medicare	$133.65
Rate for Payer: Wellcare Medicare	$133.65
Rate for Payer: Wellmed Medicare	$133.65

RT CHARGE Chest Physiotherapy -> Manipulate chest PT subsequent

Facility

$135.00

Service Code	HCPCS 94668
Hospital Charge Code	4000337
Hospital Revenue Code	410
Rate for Payer: Cash Price	$91.80

RT CHARGE Chest Physiotherapy -> Manipulate chest PT subsequent

Facility

$135.00

Service Code	HCPCS 94668
Hospital Charge Code	4000337
Hospital Revenue Code	410
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$282.53
Rate for Payer: Amerigroup CHIP/Medicaid	$12.15
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$133.65
Rate for Payer: Amerigroup Medicare	$133.65
Rate for Payer: BCBS of TX Blue Advantage	$40.50
Rate for Payer: BCBS of TX Blue Essentials	$48.60
Rate for Payer: BCBS of TX Medicare	$133.65
Rate for Payer: BCBS of TX PPO	$54.00
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna Commercial	$282.53
Rate for Payer: Cigna Medicaid	$97.20
Rate for Payer: Cigna Medicare	$133.65
Rate for Payer: Employer Direct Commercial	$133.65
Rate for Payer: Humana Medicare/TRICARE	$133.65
Rate for Payer: Molina CHIP/Medicaid	$97.20
Rate for Payer: Molina Dual Medicare/Medicaid	$133.65
Rate for Payer: Molina Medicare	$133.65
Rate for Payer: Multiplan Auto	$87.75
Rate for Payer: Multiplan Commercial	$87.75
Rate for Payer: Multiplan Workers Comp	$87.75
Rate for Payer: Parkland Medicaid	$97.20
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Scott and White Medicare	$133.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$97.20
Rate for Payer: Superior Health Plan EPO	$133.65
Rate for Payer: Superior Health Plan Medicare	$133.65
Rate for Payer: Universal American Dual Medicare/Medicaid	$133.65
Rate for Payer: Universal American Medicare	$133.65
Rate for Payer: Wellcare Medicare	$133.65
Rate for Payer: Wellmed Medicare	$133.65

RT CHARGE Continuous Ea Additional Hr

Facility

$455.00

Service Code	HCPCS 94645
Hospital Charge Code	4000568
Hospital Revenue Code	410
Min. Negotiated Rate	$40.95
Max. Negotiated Rate	$327.60
Rate for Payer: Amerigroup CHIP/Medicaid	$40.95
Rate for Payer: BCBS of TX Blue Advantage	$136.50
Rate for Payer: BCBS of TX Blue Essentials	$163.80
Rate for Payer: BCBS of TX PPO	$182.00
Rate for Payer: Cash Price	$309.40
Rate for Payer: Cash Price	$309.40
Rate for Payer: Cigna Medicaid	$327.60
Rate for Payer: Molina CHIP/Medicaid	$327.60
Rate for Payer: Multiplan Auto	$295.75
Rate for Payer: Multiplan Commercial	$295.75
Rate for Payer: Multiplan Workers Comp	$295.75
Rate for Payer: Parkland Medicaid	$327.60
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$327.60
Rate for Payer: Superior Health Plan EPO	$61.88

RT CHARGE Continuous Ea Additional Hr

Facility

$455.00

Service Code	HCPCS 94645
Hospital Charge Code	4000568
Hospital Revenue Code	410
Rate for Payer: Cash Price	$309.40

RT CHARGE Continuous First Hour -> Yes

Facility

$478.00

Service Code	HCPCS 94644
Hospital Charge Code	4000550
Hospital Revenue Code	410
Rate for Payer: Cash Price	$325.04

RT CHARGE Continuous First Hour -> Yes

Facility

$478.00

Service Code	HCPCS 94644
Hospital Charge Code	4000550
Hospital Revenue Code	410
Min. Negotiated Rate	$43.02
Max. Negotiated Rate	$344.16
Rate for Payer: Amerigroup CHIP/Medicaid	$43.02
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$133.65
Rate for Payer: Amerigroup Medicare	$133.65
Rate for Payer: BCBS of TX Blue Advantage	$143.40
Rate for Payer: BCBS of TX Blue Essentials	$172.08
Rate for Payer: BCBS of TX Medicare	$133.65
Rate for Payer: BCBS of TX PPO	$191.20
Rate for Payer: Cash Price	$325.04
Rate for Payer: Cash Price	$325.04
Rate for Payer: Cash Price	$325.04
Rate for Payer: Cigna Commercial	$282.53
Rate for Payer: Cigna Medicaid	$344.16
Rate for Payer: Cigna Medicare	$133.65
Rate for Payer: Employer Direct Commercial	$133.65
Rate for Payer: Humana Medicare/TRICARE	$133.65
Rate for Payer: Molina CHIP/Medicaid	$344.16
Rate for Payer: Molina Dual Medicare/Medicaid	$133.65
Rate for Payer: Molina Medicare	$133.65
Rate for Payer: Multiplan Auto	$310.70
Rate for Payer: Multiplan Commercial	$310.70
Rate for Payer: Multiplan Workers Comp	$310.70
Rate for Payer: Parkland Medicaid	$344.16
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Scott and White Medicare	$133.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$344.16
Rate for Payer: Superior Health Plan EPO	$133.65
Rate for Payer: Superior Health Plan Medicare	$133.65
Rate for Payer: Universal American Dual Medicare/Medicaid	$133.65
Rate for Payer: Universal American Medicare	$133.65
Rate for Payer: Wellcare Medicare	$133.65
Rate for Payer: Wellmed Medicare	$133.65

RT CHARGE CPAP -> Subsequent

Facility

$699.00

Service Code	HCPCS 94660
Hospital Charge Code	4000105
Hospital Revenue Code	410
Rate for Payer: Cash Price	$475.32

RT CHARGE CPAP -> Subsequent

Facility

$699.00

Service Code	HCPCS 94660
Hospital Charge Code	4000105
Hospital Revenue Code	410
Min. Negotiated Rate	$62.91
Max. Negotiated Rate	$503.28
Rate for Payer: Amerigroup CHIP/Medicaid	$62.91
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$219.97
Rate for Payer: Amerigroup Medicare	$219.97
Rate for Payer: BCBS of TX Blue Advantage	$209.70
Rate for Payer: BCBS of TX Blue Essentials	$251.64
Rate for Payer: BCBS of TX Medicare	$219.97
Rate for Payer: BCBS of TX PPO	$279.60
Rate for Payer: Cash Price	$475.32
Rate for Payer: Cash Price	$475.32
Rate for Payer: Cash Price	$475.32
Rate for Payer: Cigna Commercial	$464.99
Rate for Payer: Cigna Medicaid	$503.28
Rate for Payer: Cigna Medicare	$219.97
Rate for Payer: Employer Direct Commercial	$219.97
Rate for Payer: Humana Medicare/TRICARE	$219.97
Rate for Payer: Molina CHIP/Medicaid	$503.28
Rate for Payer: Molina Dual Medicare/Medicaid	$219.97
Rate for Payer: Molina Medicare	$219.97
Rate for Payer: Multiplan Auto	$454.35
Rate for Payer: Multiplan Commercial	$454.35
Rate for Payer: Multiplan Workers Comp	$454.35
Rate for Payer: Parkland Medicaid	$503.28
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Scott and White Medicare	$219.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$503.28
Rate for Payer: Superior Health Plan EPO	$219.97
Rate for Payer: Superior Health Plan Medicare	$219.97
Rate for Payer: Universal American Dual Medicare/Medicaid	$219.97
Rate for Payer: Universal American Medicare	$219.97
Rate for Payer: Wellcare Medicare	$219.97
Rate for Payer: Wellmed Medicare	$219.97

RT CHARGE IPPB -> Yes

Facility

$170.00

Service Code	HCPCS 94640
Hospital Charge Code	4000576
Hospital Revenue Code	410
Rate for Payer: Cash Price	$115.60

RT CHARGE IPPB -> Yes

Facility

$170.00

Service Code	HCPCS 94640
Hospital Charge Code	4000576
Hospital Revenue Code	410
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$464.99
Rate for Payer: Amerigroup CHIP/Medicaid	$15.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$219.97
Rate for Payer: Amerigroup Medicare	$219.97
Rate for Payer: BCBS of TX Blue Advantage	$51.00
Rate for Payer: BCBS of TX Blue Essentials	$61.20
Rate for Payer: BCBS of TX Medicare	$219.97
Rate for Payer: BCBS of TX PPO	$68.00
Rate for Payer: Cash Price	$115.60
Rate for Payer: Cash Price	$115.60
Rate for Payer: Cash Price	$115.60
Rate for Payer: Cigna Commercial	$464.99
Rate for Payer: Cigna Medicaid	$122.40
Rate for Payer: Cigna Medicare	$219.97
Rate for Payer: Employer Direct Commercial	$219.97
Rate for Payer: Humana Medicare/TRICARE	$219.97
Rate for Payer: Molina CHIP/Medicaid	$122.40
Rate for Payer: Molina Dual Medicare/Medicaid	$219.97
Rate for Payer: Molina Medicare	$219.97
Rate for Payer: Multiplan Auto	$110.50
Rate for Payer: Multiplan Commercial	$110.50
Rate for Payer: Multiplan Workers Comp	$110.50
Rate for Payer: Parkland Medicaid	$122.40
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Scott and White Medicare	$219.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$122.40
Rate for Payer: Superior Health Plan EPO	$219.97
Rate for Payer: Superior Health Plan Medicare	$219.97
Rate for Payer: Universal American Dual Medicare/Medicaid	$219.97
Rate for Payer: Universal American Medicare	$219.97
Rate for Payer: Wellcare Medicare	$219.97
Rate for Payer: Wellmed Medicare	$219.97

RT CHARGE MDI -> Demo/Initial

Facility

$170.00

Service Code	HCPCS 94640
Hospital Charge Code	4049128
Hospital Revenue Code	410
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$464.99
Rate for Payer: Amerigroup CHIP/Medicaid	$15.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$219.97
Rate for Payer: Amerigroup Medicare	$219.97
Rate for Payer: BCBS of TX Blue Advantage	$51.00
Rate for Payer: BCBS of TX Blue Essentials	$61.20
Rate for Payer: BCBS of TX Medicare	$219.97
Rate for Payer: BCBS of TX PPO	$68.00
Rate for Payer: Cash Price	$115.60
Rate for Payer: Cash Price	$115.60
Rate for Payer: Cash Price	$115.60
Rate for Payer: Cigna Commercial	$464.99
Rate for Payer: Cigna Medicaid	$122.40
Rate for Payer: Cigna Medicare	$219.97
Rate for Payer: Employer Direct Commercial	$219.97
Rate for Payer: Humana Medicare/TRICARE	$219.97
Rate for Payer: Molina CHIP/Medicaid	$122.40
Rate for Payer: Molina Dual Medicare/Medicaid	$219.97
Rate for Payer: Molina Medicare	$219.97
Rate for Payer: Multiplan Auto	$110.50
Rate for Payer: Multiplan Commercial	$110.50
Rate for Payer: Multiplan Workers Comp	$110.50
Rate for Payer: Parkland Medicaid	$122.40
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Scott and White Medicare	$219.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$122.40
Rate for Payer: Superior Health Plan EPO	$219.97
Rate for Payer: Superior Health Plan Medicare	$219.97
Rate for Payer: Universal American Dual Medicare/Medicaid	$219.97
Rate for Payer: Universal American Medicare	$219.97
Rate for Payer: Wellcare Medicare	$219.97
Rate for Payer: Wellmed Medicare	$219.97

RT CHARGE MDI -> Demo/Initial

Facility

$170.00

Service Code	HCPCS 94640
Hospital Charge Code	4049128
Hospital Revenue Code	410
Rate for Payer: Cash Price	$115.60

RT CHARGE PFT -> Body plethysmography (throacic gas volume)

Facility

$527.00

Service Code	HCPCS 94726
Hospital Charge Code	4049201
Hospital Revenue Code	460
Rate for Payer: Cash Price	$358.36

RT CHARGE PFT -> Body plethysmography (throacic gas volume)

Facility

$527.00

Service Code	HCPCS 94726
Hospital Charge Code	4049201
Hospital Revenue Code	460
Min. Negotiated Rate	$47.43
Max. Negotiated Rate	$792.38
Rate for Payer: Amerigroup CHIP/Medicaid	$47.43
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$374.86
Rate for Payer: Amerigroup Medicare	$374.86
Rate for Payer: BCBS of TX Blue Advantage	$158.10
Rate for Payer: BCBS of TX Blue Essentials	$189.72
Rate for Payer: BCBS of TX Medicare	$374.86
Rate for Payer: BCBS of TX PPO	$210.80
Rate for Payer: Cash Price	$358.36
Rate for Payer: Cash Price	$358.36
Rate for Payer: Cash Price	$358.36
Rate for Payer: Cigna Commercial	$792.38
Rate for Payer: Cigna Medicaid	$379.44
Rate for Payer: Cigna Medicare	$374.86
Rate for Payer: Employer Direct Commercial	$374.86
Rate for Payer: Humana Medicare/TRICARE	$374.86
Rate for Payer: Molina CHIP/Medicaid	$379.44
Rate for Payer: Molina Dual Medicare/Medicaid	$374.86
Rate for Payer: Molina Medicare	$374.86
Rate for Payer: Multiplan Auto	$342.55
Rate for Payer: Multiplan Commercial	$342.55
Rate for Payer: Multiplan Workers Comp	$342.55
Rate for Payer: Parkland Medicaid	$379.44
Rate for Payer: Scott and White EPO/PPO	$263.50
Rate for Payer: Scott and White Medicare	$374.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$379.44
Rate for Payer: Superior Health Plan EPO	$374.86
Rate for Payer: Superior Health Plan Medicare	$374.86
Rate for Payer: Universal American Dual Medicare/Medicaid	$374.86
Rate for Payer: Universal American Medicare	$374.86
Rate for Payer: Wellcare Medicare	$374.86
Rate for Payer: Wellmed Medicare	$374.86

RT CHARGE PFT -> Diffusion (DLCO)

Facility

$491.00

Service Code	HCPCS 94729
Hospital Charge Code	4049204
Hospital Revenue Code	460
Min. Negotiated Rate	$44.19
Max. Negotiated Rate	$353.52
Rate for Payer: Amerigroup CHIP/Medicaid	$44.19
Rate for Payer: BCBS of TX Blue Advantage	$147.30
Rate for Payer: BCBS of TX Blue Essentials	$176.76
Rate for Payer: BCBS of TX PPO	$196.40
Rate for Payer: Cash Price	$333.88
Rate for Payer: Cigna Medicaid	$353.52
Rate for Payer: Molina CHIP/Medicaid	$353.52
Rate for Payer: Multiplan Auto	$319.15
Rate for Payer: Multiplan Commercial	$319.15
Rate for Payer: Multiplan Workers Comp	$319.15
Rate for Payer: Parkland Medicaid	$353.52
Rate for Payer: Scott and White EPO/PPO	$245.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$353.52
Rate for Payer: Superior Health Plan EPO	$66.78

RT CHARGE PFT -> Diffusion (DLCO)

Facility

$491.00

Service Code	HCPCS 94729
Hospital Charge Code	4049204
Hospital Revenue Code	460
Rate for Payer: Cash Price	$333.88

RT CHARGE PFT -> Flow volume loop

Facility

$360.00

Service Code	HCPCS 94375
Hospital Charge Code	4049086
Hospital Revenue Code	460
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$458.51
Rate for Payer: Amerigroup CHIP/Medicaid	$32.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$216.91
Rate for Payer: Amerigroup Medicare	$216.91
Rate for Payer: BCBS of TX Blue Advantage	$108.00
Rate for Payer: BCBS of TX Blue Essentials	$129.60
Rate for Payer: BCBS of TX Medicare	$216.91
Rate for Payer: BCBS of TX PPO	$144.00
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cigna Commercial	$458.51
Rate for Payer: Cigna Medicaid	$259.20
Rate for Payer: Cigna Medicare	$216.91
Rate for Payer: Employer Direct Commercial	$216.91
Rate for Payer: Humana Medicare/TRICARE	$216.91
Rate for Payer: Molina CHIP/Medicaid	$259.20
Rate for Payer: Molina Dual Medicare/Medicaid	$216.91
Rate for Payer: Molina Medicare	$216.91
Rate for Payer: Multiplan Auto	$234.00
Rate for Payer: Multiplan Commercial	$234.00
Rate for Payer: Multiplan Workers Comp	$234.00
Rate for Payer: Parkland Medicaid	$259.20
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Scott and White Medicare	$216.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$259.20
Rate for Payer: Superior Health Plan EPO	$216.91
Rate for Payer: Superior Health Plan Medicare	$216.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$216.91
Rate for Payer: Universal American Medicare	$216.91
Rate for Payer: Wellcare Medicare	$216.91
Rate for Payer: Wellmed Medicare	$216.91

RT CHARGE PFT -> Flow volume loop

Facility

$360.00

Service Code	HCPCS 94375
Hospital Charge Code	4049086
Hospital Revenue Code	460
Rate for Payer: Cash Price	$244.80

RT CHARGE PFT -> O2 Uptake CO2 Output 94681

Facility

$843.00

Service Code	HCPCS 94681
Hospital Charge Code	5504681
Hospital Revenue Code	460
Min. Negotiated Rate	$75.87
Max. Negotiated Rate	$792.38
Rate for Payer: Amerigroup CHIP/Medicaid	$75.87
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$374.86
Rate for Payer: Amerigroup Medicare	$374.86
Rate for Payer: BCBS of TX Blue Advantage	$252.90
Rate for Payer: BCBS of TX Blue Essentials	$303.48
Rate for Payer: BCBS of TX Medicare	$374.86
Rate for Payer: BCBS of TX PPO	$337.20
Rate for Payer: Cash Price	$573.24
Rate for Payer: Cash Price	$573.24
Rate for Payer: Cash Price	$573.24
Rate for Payer: Cigna Commercial	$792.38
Rate for Payer: Cigna Medicaid	$606.96
Rate for Payer: Cigna Medicare	$374.86
Rate for Payer: Employer Direct Commercial	$374.86
Rate for Payer: Humana Medicare/TRICARE	$374.86
Rate for Payer: Molina CHIP/Medicaid	$606.96
Rate for Payer: Molina Dual Medicare/Medicaid	$374.86
Rate for Payer: Molina Medicare	$374.86
Rate for Payer: Multiplan Auto	$547.95
Rate for Payer: Multiplan Commercial	$547.95
Rate for Payer: Multiplan Workers Comp	$547.95
Rate for Payer: Parkland Medicaid	$606.96
Rate for Payer: Scott and White EPO/PPO	$421.50
Rate for Payer: Scott and White Medicare	$374.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$606.96
Rate for Payer: Superior Health Plan EPO	$374.86
Rate for Payer: Superior Health Plan Medicare	$374.86
Rate for Payer: Universal American Dual Medicare/Medicaid	$374.86
Rate for Payer: Universal American Medicare	$374.86
Rate for Payer: Wellcare Medicare	$374.86
Rate for Payer: Wellmed Medicare	$374.86

RT CHARGE PFT -> O2 Uptake CO2 Output 94681

Facility

$843.00

Service Code	HCPCS 94681
Hospital Charge Code	5504681
Hospital Revenue Code	460
Rate for Payer: Cash Price	$573.24

RT CHARGE PFT -> Spirometry

Facility

$295.00

Service Code	HCPCS 94010
Hospital Charge Code	4000162
Hospital Revenue Code	460
Rate for Payer: Cash Price	$200.60

RT CHARGE PFT -> Spirometry

Facility

$295.00

Service Code	HCPCS 94010
Hospital Charge Code	4000162
Hospital Revenue Code	460
Min. Negotiated Rate	$26.55
Max. Negotiated Rate	$458.51
Rate for Payer: Amerigroup CHIP/Medicaid	$26.55
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$216.91
Rate for Payer: Amerigroup Medicare	$216.91
Rate for Payer: BCBS of TX Blue Advantage	$88.50
Rate for Payer: BCBS of TX Blue Essentials	$106.20
Rate for Payer: BCBS of TX Medicare	$216.91
Rate for Payer: BCBS of TX PPO	$118.00
Rate for Payer: Cash Price	$200.60
Rate for Payer: Cash Price	$200.60
Rate for Payer: Cash Price	$200.60
Rate for Payer: Cigna Commercial	$458.51
Rate for Payer: Cigna Medicaid	$212.40
Rate for Payer: Cigna Medicare	$216.91
Rate for Payer: Employer Direct Commercial	$216.91
Rate for Payer: Humana Medicare/TRICARE	$216.91
Rate for Payer: Molina CHIP/Medicaid	$212.40
Rate for Payer: Molina Dual Medicare/Medicaid	$216.91
Rate for Payer: Molina Medicare	$216.91
Rate for Payer: Multiplan Auto	$191.75
Rate for Payer: Multiplan Commercial	$191.75
Rate for Payer: Multiplan Workers Comp	$191.75
Rate for Payer: Parkland Medicaid	$212.40
Rate for Payer: Scott and White EPO/PPO	$147.50
Rate for Payer: Scott and White Medicare	$216.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$212.40
Rate for Payer: Superior Health Plan EPO	$216.91
Rate for Payer: Superior Health Plan Medicare	$216.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$216.91
Rate for Payer: Universal American Medicare	$216.91
Rate for Payer: Wellcare Medicare	$216.91
Rate for Payer: Wellmed Medicare	$216.91

RT CHARGE PFT -> Spirometry before & after

Facility

$694.00

Service Code	HCPCS 94060
Hospital Charge Code	4000170
Hospital Revenue Code	460
Rate for Payer: Cash Price	$471.92

Know your out-of-pocket cost for care.

All Charges