White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CAUT COAG SUCT -- DHF

Facility

$413.28

Hospital Charge Code	81814105
Hospital Revenue Code	272
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$268.63
Rate for Payer: Aetna Commercial	$227.30
Rate for Payer: Amerigroup CHIP/Medicaid	$37.20
Rate for Payer: BCBS of TX Blue Advantage	$123.98
Rate for Payer: BCBS of TX Blue Essentials	$148.78
Rate for Payer: BCBS of TX PPO	$165.31
Rate for Payer: Cash Price	$363.69
Rate for Payer: Multiplan Auto	$268.63
Rate for Payer: Multiplan Commercial	$268.63
Rate for Payer: Multiplan Workers Comp	$268.63
Rate for Payer: Scott and White EPO/PPO	$206.64
Rate for Payer: Superior Health Plan EPO	$56.21

CAUT COAG SUCT -- DHF

Facility

$413.28

Hospital Charge Code	81814105
Hospital Revenue Code	272
Rate for Payer: Cash Price	$363.69

CAUT EYESTAT -- DHF

Facility

$722.01

Hospital Charge Code	81814204
Hospital Revenue Code	272
Rate for Payer: Cash Price	$635.37

CAUT EYESTAT -- DHF

Facility

$722.01

Hospital Charge Code	81814204
Hospital Revenue Code	272
Min. Negotiated Rate	$64.98
Max. Negotiated Rate	$469.31
Rate for Payer: Aetna Commercial	$397.11
Rate for Payer: Amerigroup CHIP/Medicaid	$64.98
Rate for Payer: BCBS of TX Blue Advantage	$216.60
Rate for Payer: BCBS of TX Blue Essentials	$259.92
Rate for Payer: BCBS of TX PPO	$288.80
Rate for Payer: Cash Price	$635.37
Rate for Payer: Multiplan Auto	$469.31
Rate for Payer: Multiplan Commercial	$469.31
Rate for Payer: Multiplan Workers Comp	$469.31
Rate for Payer: Scott and White EPO/PPO	$361.00
Rate for Payer: Superior Health Plan EPO	$98.19

CAUT PEN+TIP -- DHF

Facility

$23.22

Hospital Charge Code	81814402
Hospital Revenue Code	272
Rate for Payer: Cash Price	$20.43

CAUT PEN+TIP -- DHF

Facility

$23.22

Hospital Charge Code	81814402
Hospital Revenue Code	272
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$15.09
Rate for Payer: Aetna Commercial	$12.77
Rate for Payer: Amerigroup CHIP/Medicaid	$2.09
Rate for Payer: BCBS of TX Blue Advantage	$6.97
Rate for Payer: BCBS of TX Blue Essentials	$8.36
Rate for Payer: BCBS of TX PPO	$9.29
Rate for Payer: Cash Price	$20.43
Rate for Payer: Multiplan Auto	$15.09
Rate for Payer: Multiplan Commercial	$15.09
Rate for Payer: Multiplan Workers Comp	$15.09
Rate for Payer: Scott and White EPO/PPO	$11.61
Rate for Payer: Superior Health Plan EPO	$3.16

CAUT TIP BAL/NED -- DHF

Facility

$326.37

Hospital Charge Code	81814501
Hospital Revenue Code	272
Rate for Payer: Cash Price	$287.21

CAUT TIP BAL/NED -- DHF

Facility

$326.37

Hospital Charge Code	81814501
Hospital Revenue Code	272
Min. Negotiated Rate	$29.37
Max. Negotiated Rate	$212.14
Rate for Payer: Aetna Commercial	$179.50
Rate for Payer: Amerigroup CHIP/Medicaid	$29.37
Rate for Payer: BCBS of TX Blue Advantage	$97.91
Rate for Payer: BCBS of TX Blue Essentials	$117.49
Rate for Payer: BCBS of TX PPO	$130.55
Rate for Payer: Cash Price	$287.21
Rate for Payer: Multiplan Auto	$212.14
Rate for Payer: Multiplan Commercial	$212.14
Rate for Payer: Multiplan Workers Comp	$212.14
Rate for Payer: Scott and White EPO/PPO	$163.18
Rate for Payer: Superior Health Plan EPO	$44.39

CBC W/AUTOMATED DIFFERENTIAL

Facility

$187.00

Service Code	CPT 85025
Hospital Charge Code	1600386
Hospital Revenue Code	305
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$121.55
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$11.66
Rate for Payer: Amerigroup CHIP/Medicaid	$3.03
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7.77
Rate for Payer: Amerigroup Medicare	$7.77
Rate for Payer: BCBS of TX Blue Advantage	$12.82
Rate for Payer: BCBS of TX Blue Essentials	$15.38
Rate for Payer: BCBS of TX Medicare	$7.77
Rate for Payer: BCBS of TX PPO	$17.17
Rate for Payer: Cash Price	$164.56
Rate for Payer: Cash Price	$164.56
Rate for Payer: Cigna Medicaid	$7.77
Rate for Payer: Cigna Medicare	$7.77
Rate for Payer: Employer Direct Commercial	$7.77
Rate for Payer: Humana Medicare/TRICARE	$7.77
Rate for Payer: Molina CHIP/Medicaid	$7.77
Rate for Payer: Molina Dual Medicare/Medicaid	$7.77
Rate for Payer: Molina Medicare	$7.77
Rate for Payer: Multiplan Auto	$121.55
Rate for Payer: Multiplan Commercial	$121.55
Rate for Payer: Multiplan Workers Comp	$121.55
Rate for Payer: Parkland Medicaid	$7.77
Rate for Payer: Scott and White EPO/PPO	$9.71
Rate for Payer: Scott and White Medicare	$7.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.77
Rate for Payer: Superior Health Plan EPO	$7.77
Rate for Payer: Superior Health Plan Medicare	$7.77
Rate for Payer: Universal American Dual Medicare/Medicaid	$7.77
Rate for Payer: Universal American Medicare	$7.77
Rate for Payer: Wellcare Medicare	$7.77
Rate for Payer: Wellmed Medicare	$7.77

CBC w/ Diff

Facility

$187.00

Service Code	CPT 85025
Hospital Charge Code	1600386
Hospital Revenue Code	305
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$121.55
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$11.66
Rate for Payer: Amerigroup CHIP/Medicaid	$3.03
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7.77
Rate for Payer: Amerigroup Medicare	$7.77
Rate for Payer: BCBS of TX Blue Advantage	$12.82
Rate for Payer: BCBS of TX Blue Essentials	$15.38
Rate for Payer: BCBS of TX Medicare	$7.77
Rate for Payer: BCBS of TX PPO	$17.17
Rate for Payer: Cash Price	$164.56
Rate for Payer: Cash Price	$164.56
Rate for Payer: Cigna Medicaid	$7.77
Rate for Payer: Cigna Medicare	$7.77
Rate for Payer: Employer Direct Commercial	$7.77
Rate for Payer: Humana Medicare/TRICARE	$7.77
Rate for Payer: Molina CHIP/Medicaid	$7.77
Rate for Payer: Molina Dual Medicare/Medicaid	$7.77
Rate for Payer: Molina Medicare	$7.77
Rate for Payer: Multiplan Auto	$121.55
Rate for Payer: Multiplan Commercial	$121.55
Rate for Payer: Multiplan Workers Comp	$121.55
Rate for Payer: Parkland Medicaid	$7.77
Rate for Payer: Scott and White EPO/PPO	$9.71
Rate for Payer: Scott and White Medicare	$7.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.77
Rate for Payer: Superior Health Plan EPO	$7.77
Rate for Payer: Superior Health Plan Medicare	$7.77
Rate for Payer: Universal American Dual Medicare/Medicaid	$7.77
Rate for Payer: Universal American Medicare	$7.77
Rate for Payer: Wellcare Medicare	$7.77
Rate for Payer: Wellmed Medicare	$7.77

CBC w/ Diff

Facility

$187.00

Service Code	CPT 85025
Hospital Charge Code	1600386
Hospital Revenue Code	305
Rate for Payer: Cash Price	$164.56

CBC without Differential

Facility

$243.00

Service Code	CPT 85027
Hospital Charge Code	1600477
Hospital Revenue Code	305
Rate for Payer: Cash Price	$213.84

CBC without Differential

Facility

$243.00

Service Code	CPT 85027
Hospital Charge Code	1600477
Hospital Revenue Code	305
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$157.95
Rate for Payer: Aetna Commercial	$6.79
Rate for Payer: Aetna Medicare	$9.70
Rate for Payer: Amerigroup CHIP/Medicaid	$2.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6.47
Rate for Payer: Amerigroup Medicare	$6.47
Rate for Payer: BCBS of TX Blue Advantage	$10.68
Rate for Payer: BCBS of TX Blue Essentials	$12.81
Rate for Payer: BCBS of TX Medicare	$6.47
Rate for Payer: BCBS of TX PPO	$14.30
Rate for Payer: Cash Price	$213.84
Rate for Payer: Cash Price	$213.84
Rate for Payer: Cigna Medicaid	$6.47
Rate for Payer: Cigna Medicare	$6.47
Rate for Payer: Employer Direct Commercial	$6.47
Rate for Payer: Humana Medicare/TRICARE	$6.47
Rate for Payer: Molina CHIP/Medicaid	$6.47
Rate for Payer: Molina Dual Medicare/Medicaid	$6.47
Rate for Payer: Molina Medicare	$6.47
Rate for Payer: Multiplan Auto	$157.95
Rate for Payer: Multiplan Commercial	$157.95
Rate for Payer: Multiplan Workers Comp	$157.95
Rate for Payer: Parkland Medicaid	$6.47
Rate for Payer: Scott and White EPO/PPO	$8.09
Rate for Payer: Scott and White Medicare	$6.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.47
Rate for Payer: Superior Health Plan EPO	$6.47
Rate for Payer: Superior Health Plan Medicare	$6.47
Rate for Payer: Universal American Dual Medicare/Medicaid	$6.47
Rate for Payer: Universal American Medicare	$6.47
Rate for Payer: Wellcare Medicare	$6.47
Rate for Payer: Wellmed Medicare	$6.47

CBC w/ Manual Differential

Facility

$243.00

Service Code	CPT 85027
Hospital Charge Code	1600477
Hospital Revenue Code	305
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$157.95
Rate for Payer: Aetna Commercial	$6.79
Rate for Payer: Aetna Medicare	$9.70
Rate for Payer: Amerigroup CHIP/Medicaid	$2.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6.47
Rate for Payer: Amerigroup Medicare	$6.47
Rate for Payer: BCBS of TX Blue Advantage	$10.68
Rate for Payer: BCBS of TX Blue Essentials	$12.81
Rate for Payer: BCBS of TX Medicare	$6.47
Rate for Payer: BCBS of TX PPO	$14.30
Rate for Payer: Cash Price	$213.84
Rate for Payer: Cash Price	$213.84
Rate for Payer: Cigna Medicaid	$6.47
Rate for Payer: Cigna Medicare	$6.47
Rate for Payer: Employer Direct Commercial	$6.47
Rate for Payer: Humana Medicare/TRICARE	$6.47
Rate for Payer: Molina CHIP/Medicaid	$6.47
Rate for Payer: Molina Dual Medicare/Medicaid	$6.47
Rate for Payer: Molina Medicare	$6.47
Rate for Payer: Multiplan Auto	$157.95
Rate for Payer: Multiplan Commercial	$157.95
Rate for Payer: Multiplan Workers Comp	$157.95
Rate for Payer: Parkland Medicaid	$6.47
Rate for Payer: Scott and White EPO/PPO	$8.09
Rate for Payer: Scott and White Medicare	$6.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.47
Rate for Payer: Superior Health Plan EPO	$6.47
Rate for Payer: Superior Health Plan Medicare	$6.47
Rate for Payer: Universal American Dual Medicare/Medicaid	$6.47
Rate for Payer: Universal American Medicare	$6.47
Rate for Payer: Wellcare Medicare	$6.47
Rate for Payer: Wellmed Medicare	$6.47

CBLE FIX BN SLEVE -- DHF

Facility

$162.29

Service Code	HCPCS C1713
Hospital Charge Code	81315145
Hospital Revenue Code	278
Min. Negotiated Rate	$14.61
Max. Negotiated Rate	$81.14
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Amerigroup CHIP/Medicaid	$14.61
Rate for Payer: BCBS of TX Blue Advantage	$48.69
Rate for Payer: BCBS of TX Blue Essentials	$58.42
Rate for Payer: BCBS of TX PPO	$64.92
Rate for Payer: Cash Price	$142.82
Rate for Payer: Multiplan Auto	$81.14
Rate for Payer: Multiplan Commercial	$81.14
Rate for Payer: Multiplan Workers Comp	$81.14
Rate for Payer: Scott and White EPO/PPO	$81.14
Rate for Payer: Superior Health Plan EPO	$22.07

CBLE FIX BN SLEVE -- DHF

Facility

$162.29

Service Code	HCPCS C1713
Hospital Charge Code	81315145
Hospital Revenue Code	278
Min. Negotiated Rate	$40.57
Max. Negotiated Rate	$81.14
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Cash Price	$142.82
Rate for Payer: Cigna Commercial	$40.57
Rate for Payer: Multiplan Auto	$81.14
Rate for Payer: Multiplan Commercial	$81.14
Rate for Payer: Multiplan Workers Comp	$81.14
Rate for Payer: Scott and White EPO/PPO	$81.14

CCHD Screen Result, Initial

Facility

$122.00

Service Code	CPT 94760
Hospital Charge Code	10108
Hospital Revenue Code	410
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$67.10
Rate for Payer: Amerigroup CHIP/Medicaid	$10.98
Rate for Payer: BCBS of TX Blue Advantage	$4.38
Rate for Payer: BCBS of TX Blue Essentials	$5.24
Rate for Payer: BCBS of TX PPO	$5.85
Rate for Payer: Cash Price	$107.36
Rate for Payer: Cash Price	$107.36
Rate for Payer: Cash Price	$107.36
Rate for Payer: Multiplan Auto	$79.30
Rate for Payer: Multiplan Commercial	$79.30
Rate for Payer: Multiplan Workers Comp	$79.30
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Superior Health Plan EPO	$16.59

CCHD Screen Result, Initial BCE

Facility

$122.00

Service Code	CPT 94760
Hospital Charge Code	10108
Hospital Revenue Code	410
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$67.10
Rate for Payer: Amerigroup CHIP/Medicaid	$10.98
Rate for Payer: BCBS of TX Blue Advantage	$4.38
Rate for Payer: BCBS of TX Blue Essentials	$5.24
Rate for Payer: BCBS of TX PPO	$5.85
Rate for Payer: Cash Price	$107.36
Rate for Payer: Cash Price	$107.36
Rate for Payer: Cash Price	$107.36
Rate for Payer: Multiplan Auto	$79.30
Rate for Payer: Multiplan Commercial	$79.30
Rate for Payer: Multiplan Workers Comp	$79.30
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Superior Health Plan EPO	$16.59

CCHD Screen Result, Initial BCE

Facility

$122.00

Service Code	CPT 94760
Hospital Charge Code	10108
Hospital Revenue Code	410
Rate for Payer: Cash Price	$107.36

CCP Antibodies IgG/IgA SO

Facility

$65.00

Service Code	CPT 86200
Hospital Charge Code	1740356
Hospital Revenue Code	302
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$42.25
Rate for Payer: Aetna Commercial	$13.60
Rate for Payer: Aetna Medicare	$19.42
Rate for Payer: Amerigroup CHIP/Medicaid	$5.05
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12.95
Rate for Payer: Amerigroup Medicare	$12.95
Rate for Payer: BCBS of TX Blue Advantage	$21.37
Rate for Payer: BCBS of TX Blue Essentials	$25.64
Rate for Payer: BCBS of TX Medicare	$12.95
Rate for Payer: BCBS of TX PPO	$28.62
Rate for Payer: Cash Price	$57.20
Rate for Payer: Cash Price	$57.20
Rate for Payer: Cigna Medicaid	$12.95
Rate for Payer: Cigna Medicare	$12.95
Rate for Payer: Employer Direct Commercial	$12.95
Rate for Payer: Humana Medicare/TRICARE	$12.95
Rate for Payer: Molina CHIP/Medicaid	$12.95
Rate for Payer: Molina Dual Medicare/Medicaid	$12.95
Rate for Payer: Molina Medicare	$12.95
Rate for Payer: Multiplan Auto	$42.25
Rate for Payer: Multiplan Commercial	$42.25
Rate for Payer: Multiplan Workers Comp	$42.25
Rate for Payer: Parkland Medicaid	$12.95
Rate for Payer: Scott and White EPO/PPO	$16.19
Rate for Payer: Scott and White Medicare	$12.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.95
Rate for Payer: Superior Health Plan EPO	$12.95
Rate for Payer: Superior Health Plan Medicare	$12.95
Rate for Payer: Universal American Dual Medicare/Medicaid	$12.95
Rate for Payer: Universal American Medicare	$12.95
Rate for Payer: Wellcare Medicare	$12.95
Rate for Payer: Wellmed Medicare	$12.95

CCP Antibodies IgG/IgA SO

Facility

$65.00

Service Code	CPT 86200
Hospital Charge Code	1740356
Hospital Revenue Code	302
Rate for Payer: Cash Price	$57.20

CD4/CD8 Ratio Profile SO

Facility

$764.00

Service Code	CPT 86360
Hospital Charge Code	1708981
Hospital Revenue Code	302
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$496.60
Rate for Payer: Aetna Commercial	$49.33
Rate for Payer: Aetna Medicare	$70.47
Rate for Payer: Amerigroup CHIP/Medicaid	$18.32
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$46.98
Rate for Payer: Amerigroup Medicare	$46.98
Rate for Payer: BCBS of TX Blue Advantage	$77.52
Rate for Payer: BCBS of TX Blue Essentials	$93.02
Rate for Payer: BCBS of TX Medicare	$46.98
Rate for Payer: BCBS of TX PPO	$103.83
Rate for Payer: Cash Price	$672.32
Rate for Payer: Cash Price	$672.32
Rate for Payer: Cigna Medicaid	$46.98
Rate for Payer: Cigna Medicare	$46.98
Rate for Payer: Employer Direct Commercial	$46.98
Rate for Payer: Humana Medicare/TRICARE	$46.98
Rate for Payer: Molina CHIP/Medicaid	$46.98
Rate for Payer: Molina Dual Medicare/Medicaid	$46.98
Rate for Payer: Molina Medicare	$46.98
Rate for Payer: Multiplan Auto	$496.60
Rate for Payer: Multiplan Commercial	$496.60
Rate for Payer: Multiplan Workers Comp	$496.60
Rate for Payer: Parkland Medicaid	$46.98
Rate for Payer: Scott and White EPO/PPO	$58.72
Rate for Payer: Scott and White Medicare	$46.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$46.98
Rate for Payer: Superior Health Plan EPO	$46.98
Rate for Payer: Superior Health Plan Medicare	$46.98
Rate for Payer: Universal American Dual Medicare/Medicaid	$46.98
Rate for Payer: Universal American Medicare	$46.98
Rate for Payer: Wellcare Medicare	$46.98
Rate for Payer: Wellmed Medicare	$46.98

CEA, Fluid SO

Facility

$405.00

Service Code	CPT 82378
Hospital Charge Code	1700145
Hospital Revenue Code	301
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$263.25
Rate for Payer: Aetna Commercial	$19.92
Rate for Payer: Aetna Medicare	$28.44
Rate for Payer: Amerigroup CHIP/Medicaid	$7.39
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$18.96
Rate for Payer: Amerigroup Medicare	$18.96
Rate for Payer: BCBS of TX Blue Advantage	$31.28
Rate for Payer: BCBS of TX Blue Essentials	$37.54
Rate for Payer: BCBS of TX Medicare	$18.96
Rate for Payer: BCBS of TX PPO	$41.90
Rate for Payer: Cash Price	$356.40
Rate for Payer: Cash Price	$356.40
Rate for Payer: Cigna Medicaid	$18.96
Rate for Payer: Cigna Medicare	$18.96
Rate for Payer: Employer Direct Commercial	$18.96
Rate for Payer: Humana Medicare/TRICARE	$18.96
Rate for Payer: Molina CHIP/Medicaid	$18.96
Rate for Payer: Molina Dual Medicare/Medicaid	$18.96
Rate for Payer: Molina Medicare	$18.96
Rate for Payer: Multiplan Auto	$263.25
Rate for Payer: Multiplan Commercial	$263.25
Rate for Payer: Multiplan Workers Comp	$263.25
Rate for Payer: Parkland Medicaid	$18.96
Rate for Payer: Scott and White EPO/PPO	$23.70
Rate for Payer: Scott and White Medicare	$18.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18.96
Rate for Payer: Superior Health Plan EPO	$18.96
Rate for Payer: Superior Health Plan Medicare	$18.96
Rate for Payer: Universal American Dual Medicare/Medicaid	$18.96
Rate for Payer: Universal American Medicare	$18.96
Rate for Payer: Wellcare Medicare	$18.96
Rate for Payer: Wellmed Medicare	$18.96

CEA, Fluid SO

Facility

$405.00

Service Code	CPT 82378
Hospital Charge Code	1700145
Hospital Revenue Code	301
Rate for Payer: Cash Price	$356.40

CEA SO

Facility

$405.00

Service Code	CPT 82378
Hospital Charge Code	1700145
Hospital Revenue Code	301
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$263.25
Rate for Payer: Aetna Commercial	$19.92
Rate for Payer: Aetna Medicare	$28.44
Rate for Payer: Amerigroup CHIP/Medicaid	$7.39
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$18.96
Rate for Payer: Amerigroup Medicare	$18.96
Rate for Payer: BCBS of TX Blue Advantage	$31.28
Rate for Payer: BCBS of TX Blue Essentials	$37.54
Rate for Payer: BCBS of TX Medicare	$18.96
Rate for Payer: BCBS of TX PPO	$41.90
Rate for Payer: Cash Price	$356.40
Rate for Payer: Cash Price	$356.40
Rate for Payer: Cigna Medicaid	$18.96
Rate for Payer: Cigna Medicare	$18.96
Rate for Payer: Employer Direct Commercial	$18.96
Rate for Payer: Humana Medicare/TRICARE	$18.96
Rate for Payer: Molina CHIP/Medicaid	$18.96
Rate for Payer: Molina Dual Medicare/Medicaid	$18.96
Rate for Payer: Molina Medicare	$18.96
Rate for Payer: Multiplan Auto	$263.25
Rate for Payer: Multiplan Commercial	$263.25
Rate for Payer: Multiplan Workers Comp	$263.25
Rate for Payer: Parkland Medicaid	$18.96
Rate for Payer: Scott and White EPO/PPO	$23.70
Rate for Payer: Scott and White Medicare	$18.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18.96
Rate for Payer: Superior Health Plan EPO	$18.96
Rate for Payer: Superior Health Plan Medicare	$18.96
Rate for Payer: Universal American Dual Medicare/Medicaid	$18.96
Rate for Payer: Universal American Medicare	$18.96
Rate for Payer: Wellcare Medicare	$18.96
Rate for Payer: Wellmed Medicare	$18.96

Know your out-of-pocket cost for care.

All Charges