White Rock Medical Center

All Charges

Charge

Type

Setting

Price

US Intraoperative

Facility

$1,502.00

Service Code	HCPCS 76998
Hospital Charge Code	3520012
Hospital Revenue Code	402
Min. Negotiated Rate	$107.63
Max. Negotiated Rate	$1,081.44
Rate for Payer: Amerigroup CHIP/Medicaid	$135.18
Rate for Payer: BCBS of TX Blue Advantage	$107.63
Rate for Payer: BCBS of TX Blue Essentials	$129.16
Rate for Payer: BCBS of TX PPO	$144.16
Rate for Payer: Cash Price	$1,021.36
Rate for Payer: Cash Price	$1,021.36
Rate for Payer: Cigna Medicaid	$1,081.44
Rate for Payer: Molina CHIP/Medicaid	$1,081.44
Rate for Payer: Multiplan Auto	$976.30
Rate for Payer: Multiplan Commercial	$976.30
Rate for Payer: Multiplan Workers Comp	$976.30
Rate for Payer: Parkland Medicaid	$1,081.44
Rate for Payer: Scott and White EPO/PPO	$751.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,081.44
Rate for Payer: Superior Health Plan EPO	$204.27

US Lower Ext Arterial Duplex Bilateral

Facility

$1,738.00

Service Code	HCPCS 93925
Hospital Charge Code	3500154
Hospital Revenue Code	921
Rate for Payer: Cash Price	$1,181.84

US Lower Ext Arterial Duplex Bilateral

Facility

$1,738.00

Service Code	HCPCS 93925
Hospital Charge Code	3500154
Hospital Revenue Code	921
Min. Negotiated Rate	$156.42
Max. Negotiated Rate	$1,251.36
Rate for Payer: Amerigroup CHIP/Medicaid	$156.42
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$239.69
Rate for Payer: Amerigroup Medicare	$239.69
Rate for Payer: BCBS of TX Blue Advantage	$521.40
Rate for Payer: BCBS of TX Blue Essentials	$625.68
Rate for Payer: BCBS of TX Medicare	$239.69
Rate for Payer: BCBS of TX PPO	$695.20
Rate for Payer: Cash Price	$1,181.84
Rate for Payer: Cash Price	$1,181.84
Rate for Payer: Cash Price	$1,181.84
Rate for Payer: Cigna Commercial	$506.65
Rate for Payer: Cigna Medicaid	$1,251.36
Rate for Payer: Cigna Medicare	$239.69
Rate for Payer: Employer Direct Commercial	$239.69
Rate for Payer: Humana Medicare/TRICARE	$239.69
Rate for Payer: Molina CHIP/Medicaid	$1,251.36
Rate for Payer: Molina Dual Medicare/Medicaid	$239.69
Rate for Payer: Molina Medicare	$239.69
Rate for Payer: Multiplan Auto	$1,129.70
Rate for Payer: Multiplan Commercial	$1,129.70
Rate for Payer: Multiplan Workers Comp	$1,129.70
Rate for Payer: Parkland Medicaid	$1,251.36
Rate for Payer: Scott and White EPO/PPO	$296.71
Rate for Payer: Scott and White Medicare	$239.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,251.36
Rate for Payer: Superior Health Plan EPO	$239.69
Rate for Payer: Superior Health Plan Medicare	$239.69
Rate for Payer: Universal American Dual Medicare/Medicaid	$239.69
Rate for Payer: Universal American Medicare	$239.69
Rate for Payer: Wellcare Medicare	$239.69
Rate for Payer: Wellmed Medicare	$239.69

US Lower Ext Arterial Duplex Left

Facility

$1,391.00

Service Code	HCPCS 93926 LT
Hospital Charge Code	3501079
Hospital Revenue Code	921
Min. Negotiated Rate	$125.19
Max. Negotiated Rate	$1,001.52
Rate for Payer: Amerigroup CHIP/Medicaid	$125.19
Rate for Payer: BCBS of TX Blue Advantage	$417.30
Rate for Payer: BCBS of TX Blue Essentials	$500.76
Rate for Payer: BCBS of TX PPO	$556.40
Rate for Payer: Cash Price	$945.88
Rate for Payer: Cash Price	$945.88
Rate for Payer: Cigna Commercial	$222.00
Rate for Payer: Cigna Medicaid	$1,001.52
Rate for Payer: Molina CHIP/Medicaid	$1,001.52
Rate for Payer: Multiplan Auto	$904.15
Rate for Payer: Multiplan Commercial	$904.15
Rate for Payer: Multiplan Workers Comp	$904.15
Rate for Payer: Parkland Medicaid	$1,001.52
Rate for Payer: Scott and White EPO/PPO	$695.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,001.52
Rate for Payer: Superior Health Plan EPO	$189.18

US Lower Ext Arterial Duplex Left

Facility

$1,391.00

Service Code	HCPCS 93926 LT
Hospital Charge Code	3501079
Hospital Revenue Code	921
Rate for Payer: Cash Price	$945.88

US Lower Ext Arterial Duplex Right

Facility

$1,391.00

Service Code	HCPCS 93926 RT
Hospital Charge Code	3501087
Hospital Revenue Code	921
Min. Negotiated Rate	$125.19
Max. Negotiated Rate	$1,001.52
Rate for Payer: Amerigroup CHIP/Medicaid	$125.19
Rate for Payer: BCBS of TX Blue Advantage	$417.30
Rate for Payer: BCBS of TX Blue Essentials	$500.76
Rate for Payer: BCBS of TX PPO	$556.40
Rate for Payer: Cash Price	$945.88
Rate for Payer: Cash Price	$945.88
Rate for Payer: Cigna Commercial	$222.00
Rate for Payer: Cigna Medicaid	$1,001.52
Rate for Payer: Molina CHIP/Medicaid	$1,001.52
Rate for Payer: Multiplan Auto	$904.15
Rate for Payer: Multiplan Commercial	$904.15
Rate for Payer: Multiplan Workers Comp	$904.15
Rate for Payer: Parkland Medicaid	$1,001.52
Rate for Payer: Scott and White EPO/PPO	$695.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,001.52
Rate for Payer: Superior Health Plan EPO	$189.18

US Lower Ext Arterial Duplex Right

Facility

$1,391.00

Service Code	HCPCS 93926 RT
Hospital Charge Code	3501087
Hospital Revenue Code	921
Rate for Payer: Cash Price	$945.88

US Lower Ext Venous Duplex Bilateral

Facility

$2,850.00

Service Code	HCPCS 93970
Hospital Charge Code	3500246
Hospital Revenue Code	921
Rate for Payer: Cash Price	$1,938.00

US Lower Ext Venous Duplex Bilateral

Facility

$2,850.00

Service Code	HCPCS 93970
Hospital Charge Code	3500246
Hospital Revenue Code	921
Min. Negotiated Rate	$230.86
Max. Negotiated Rate	$2,052.00
Rate for Payer: Amerigroup CHIP/Medicaid	$256.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$239.69
Rate for Payer: Amerigroup Medicare	$239.69
Rate for Payer: BCBS of TX Blue Advantage	$855.00
Rate for Payer: BCBS of TX Blue Essentials	$1,026.00
Rate for Payer: BCBS of TX Medicare	$239.69
Rate for Payer: BCBS of TX PPO	$1,140.00
Rate for Payer: Cash Price	$1,938.00
Rate for Payer: Cash Price	$1,938.00
Rate for Payer: Cash Price	$1,938.00
Rate for Payer: Cigna Commercial	$506.65
Rate for Payer: Cigna Medicaid	$2,052.00
Rate for Payer: Cigna Medicare	$239.69
Rate for Payer: Employer Direct Commercial	$239.69
Rate for Payer: Humana Medicare/TRICARE	$239.69
Rate for Payer: Molina CHIP/Medicaid	$2,052.00
Rate for Payer: Molina Dual Medicare/Medicaid	$239.69
Rate for Payer: Molina Medicare	$239.69
Rate for Payer: Multiplan Auto	$1,852.50
Rate for Payer: Multiplan Commercial	$1,852.50
Rate for Payer: Multiplan Workers Comp	$1,852.50
Rate for Payer: Parkland Medicaid	$2,052.00
Rate for Payer: Scott and White EPO/PPO	$230.86
Rate for Payer: Scott and White Medicare	$239.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,052.00
Rate for Payer: Superior Health Plan EPO	$239.69
Rate for Payer: Superior Health Plan Medicare	$239.69
Rate for Payer: Universal American Dual Medicare/Medicaid	$239.69
Rate for Payer: Universal American Medicare	$239.69
Rate for Payer: Wellcare Medicare	$239.69
Rate for Payer: Wellmed Medicare	$239.69

US Lower Ext Venous Duplex Left

Facility

$1,906.00

Service Code	HCPCS 93971 LT
Hospital Charge Code	3500840
Hospital Revenue Code	921
Min. Negotiated Rate	$171.54
Max. Negotiated Rate	$1,372.32
Rate for Payer: Amerigroup CHIP/Medicaid	$171.54
Rate for Payer: BCBS of TX Blue Advantage	$571.80
Rate for Payer: BCBS of TX Blue Essentials	$686.16
Rate for Payer: BCBS of TX PPO	$762.40
Rate for Payer: Cash Price	$1,296.08
Rate for Payer: Cash Price	$1,296.08
Rate for Payer: Cigna Commercial	$222.00
Rate for Payer: Cigna Medicaid	$1,372.32
Rate for Payer: Molina CHIP/Medicaid	$1,372.32
Rate for Payer: Multiplan Auto	$1,238.90
Rate for Payer: Multiplan Commercial	$1,238.90
Rate for Payer: Multiplan Workers Comp	$1,238.90
Rate for Payer: Parkland Medicaid	$1,372.32
Rate for Payer: Scott and White EPO/PPO	$953.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,372.32
Rate for Payer: Superior Health Plan EPO	$259.22

US Lower Ext Venous Duplex Left

Facility

$1,906.00

Service Code	HCPCS 93971 LT
Hospital Charge Code	3500840
Hospital Revenue Code	921
Rate for Payer: Cash Price	$1,296.08

US Lower Ext Venous Duplex Right

Facility

$1,906.00

Service Code	HCPCS 93971 RT
Hospital Charge Code	3500279
Hospital Revenue Code	921
Min. Negotiated Rate	$171.54
Max. Negotiated Rate	$1,372.32
Rate for Payer: Amerigroup CHIP/Medicaid	$171.54
Rate for Payer: BCBS of TX Blue Advantage	$571.80
Rate for Payer: BCBS of TX Blue Essentials	$686.16
Rate for Payer: BCBS of TX PPO	$762.40
Rate for Payer: Cash Price	$1,296.08
Rate for Payer: Cash Price	$1,296.08
Rate for Payer: Cigna Commercial	$222.00
Rate for Payer: Cigna Medicaid	$1,372.32
Rate for Payer: Molina CHIP/Medicaid	$1,372.32
Rate for Payer: Multiplan Auto	$1,238.90
Rate for Payer: Multiplan Commercial	$1,238.90
Rate for Payer: Multiplan Workers Comp	$1,238.90
Rate for Payer: Parkland Medicaid	$1,372.32
Rate for Payer: Scott and White EPO/PPO	$953.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,372.32
Rate for Payer: Superior Health Plan EPO	$259.22

US Lower Ext Venous Duplex Right

Facility

$1,906.00

Service Code	HCPCS 93971 RT
Hospital Charge Code	3500279
Hospital Revenue Code	921
Rate for Payer: Cash Price	$1,296.08

US OB < 14 weeks TA

Facility

$1,606.00

Service Code	HCPCS 76801
Hospital Charge Code	9339006
Hospital Revenue Code	402
Min. Negotiated Rate	$104.75
Max. Negotiated Rate	$1,156.32
Rate for Payer: Amerigroup CHIP/Medicaid	$104.75
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$105.02
Rate for Payer: Amerigroup Medicare	$105.02
Rate for Payer: BCBS of TX Blue Advantage	$121.31
Rate for Payer: BCBS of TX Blue Essentials	$145.57
Rate for Payer: BCBS of TX Medicare	$105.02
Rate for Payer: BCBS of TX PPO	$162.48
Rate for Payer: Cash Price	$1,092.08
Rate for Payer: Cash Price	$1,092.08
Rate for Payer: Cash Price	$1,092.08
Rate for Payer: Cigna Commercial	$222.00
Rate for Payer: Cigna Medicaid	$1,156.32
Rate for Payer: Cigna Medicare	$105.02
Rate for Payer: Employer Direct Commercial	$105.02
Rate for Payer: Humana Medicare/TRICARE	$105.02
Rate for Payer: Molina CHIP/Medicaid	$1,156.32
Rate for Payer: Molina Dual Medicare/Medicaid	$105.02
Rate for Payer: Molina Medicare	$105.02
Rate for Payer: Multiplan Auto	$1,043.90
Rate for Payer: Multiplan Commercial	$1,043.90
Rate for Payer: Multiplan Workers Comp	$1,043.90
Rate for Payer: Parkland Medicaid	$1,156.32
Rate for Payer: Scott and White EPO/PPO	$144.97
Rate for Payer: Scott and White Medicare	$105.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,156.32
Rate for Payer: Superior Health Plan EPO	$105.02
Rate for Payer: Superior Health Plan Medicare	$105.02
Rate for Payer: Universal American Dual Medicare/Medicaid	$105.02
Rate for Payer: Universal American Medicare	$105.02
Rate for Payer: Wellcare Medicare	$105.02
Rate for Payer: Wellmed Medicare	$105.02

US OB < 14 weeks TA

Facility

$1,606.00

Service Code	HCPCS 76801
Hospital Charge Code	9339006
Hospital Revenue Code	402
Rate for Payer: Cash Price	$1,092.08

US OB < 14 weeks w/ TVS if indicated

Facility

$1,606.00

Service Code	HCPCS 76801
Hospital Charge Code	3511128
Hospital Revenue Code	402
Min. Negotiated Rate	$104.75
Max. Negotiated Rate	$1,156.32
Rate for Payer: Amerigroup CHIP/Medicaid	$104.75
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$105.02
Rate for Payer: Amerigroup Medicare	$105.02
Rate for Payer: BCBS of TX Blue Advantage	$121.31
Rate for Payer: BCBS of TX Blue Essentials	$145.57
Rate for Payer: BCBS of TX Medicare	$105.02
Rate for Payer: BCBS of TX PPO	$162.48
Rate for Payer: Cash Price	$1,092.08
Rate for Payer: Cash Price	$1,092.08
Rate for Payer: Cash Price	$1,092.08
Rate for Payer: Cigna Commercial	$222.00
Rate for Payer: Cigna Medicaid	$1,156.32
Rate for Payer: Cigna Medicare	$105.02
Rate for Payer: Employer Direct Commercial	$105.02
Rate for Payer: Humana Medicare/TRICARE	$105.02
Rate for Payer: Molina CHIP/Medicaid	$1,156.32
Rate for Payer: Molina Dual Medicare/Medicaid	$105.02
Rate for Payer: Molina Medicare	$105.02
Rate for Payer: Multiplan Auto	$1,043.90
Rate for Payer: Multiplan Commercial	$1,043.90
Rate for Payer: Multiplan Workers Comp	$1,043.90
Rate for Payer: Parkland Medicaid	$1,156.32
Rate for Payer: Scott and White EPO/PPO	$144.97
Rate for Payer: Scott and White Medicare	$105.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,156.32
Rate for Payer: Superior Health Plan EPO	$105.02
Rate for Payer: Superior Health Plan Medicare	$105.02
Rate for Payer: Universal American Dual Medicare/Medicaid	$105.02
Rate for Payer: Universal American Medicare	$105.02
Rate for Payer: Wellcare Medicare	$105.02
Rate for Payer: Wellmed Medicare	$105.02

US OB < 14 weeks w/ TVS if indicated

Facility

$1,606.00

Service Code	HCPCS 76801
Hospital Charge Code	3511128
Hospital Revenue Code	402
Rate for Payer: Cash Price	$1,092.08

US OB Follow Up

Facility

$761.00

Service Code	HCPCS 76816
Hospital Charge Code	3500188
Hospital Revenue Code	402
Min. Negotiated Rate	$104.75
Max. Negotiated Rate	$547.92
Rate for Payer: Amerigroup CHIP/Medicaid	$104.75
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$105.02
Rate for Payer: Amerigroup Medicare	$105.02
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 Medicare	$105.02
Rate for Payer: BCBS of TX PPO	$247.70
Rate for Payer: Cash Price	$517.48
Rate for Payer: Cash Price	$517.48
Rate for Payer: Cash Price	$517.48
Rate for Payer: Cigna Commercial	$222.00
Rate for Payer: Cigna Medicaid	$547.92
Rate for Payer: Cigna Medicare	$105.02
Rate for Payer: Employer Direct Commercial	$105.02
Rate for Payer: Humana Medicare/TRICARE	$105.02
Rate for Payer: Molina CHIP/Medicaid	$547.92
Rate for Payer: Molina Dual Medicare/Medicaid	$105.02
Rate for Payer: Molina Medicare	$105.02
Rate for Payer: Multiplan Auto	$494.65
Rate for Payer: Multiplan Commercial	$494.65
Rate for Payer: Multiplan Workers Comp	$494.65
Rate for Payer: Parkland Medicaid	$547.92
Rate for Payer: Scott and White EPO/PPO	$136.00
Rate for Payer: Scott and White Medicare	$105.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$547.92
Rate for Payer: Superior Health Plan EPO	$105.02
Rate for Payer: Superior Health Plan Medicare	$105.02
Rate for Payer: Universal American Dual Medicare/Medicaid	$105.02
Rate for Payer: Universal American Medicare	$105.02
Rate for Payer: Wellcare Medicare	$105.02
Rate for Payer: Wellmed Medicare	$105.02

US OB Follow Up

Facility

$761.00

Service Code	HCPCS 76816
Hospital Charge Code	3500188
Hospital Revenue Code	402
Rate for Payer: Cash Price	$517.48

US OB Follow Up, Add'l Gestation

Facility

$761.00

Service Code	HCPCS 76816
Hospital Charge Code	9341014
Hospital Revenue Code	402
Rate for Payer: Cash Price	$517.48

US OB Follow Up, Add'l Gestation

Facility

$761.00

Service Code	HCPCS 76816
Hospital Charge Code	9341014
Hospital Revenue Code	402
Min. Negotiated Rate	$104.75
Max. Negotiated Rate	$547.92
Rate for Payer: Amerigroup CHIP/Medicaid	$104.75
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$105.02
Rate for Payer: Amerigroup Medicare	$105.02
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 Medicare	$105.02
Rate for Payer: BCBS of TX PPO	$247.70
Rate for Payer: Cash Price	$517.48
Rate for Payer: Cash Price	$517.48
Rate for Payer: Cash Price	$517.48
Rate for Payer: Cigna Commercial	$222.00
Rate for Payer: Cigna Medicaid	$547.92
Rate for Payer: Cigna Medicare	$105.02
Rate for Payer: Employer Direct Commercial	$105.02
Rate for Payer: Humana Medicare/TRICARE	$105.02
Rate for Payer: Molina CHIP/Medicaid	$547.92
Rate for Payer: Molina Dual Medicare/Medicaid	$105.02
Rate for Payer: Molina Medicare	$105.02
Rate for Payer: Multiplan Auto	$494.65
Rate for Payer: Multiplan Commercial	$494.65
Rate for Payer: Multiplan Workers Comp	$494.65
Rate for Payer: Parkland Medicaid	$547.92
Rate for Payer: Scott and White EPO/PPO	$136.00
Rate for Payer: Scott and White Medicare	$105.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$547.92
Rate for Payer: Superior Health Plan EPO	$105.02
Rate for Payer: Superior Health Plan Medicare	$105.02
Rate for Payer: Universal American Dual Medicare/Medicaid	$105.02
Rate for Payer: Universal American Medicare	$105.02
Rate for Payer: Wellcare Medicare	$105.02
Rate for Payer: Wellmed Medicare	$105.02

US OB Greater Than 14 Weeks

Facility

$1,654.00

Service Code	HCPCS 76805
Hospital Charge Code	3500170
Hospital Revenue Code	402
Min. Negotiated Rate	$104.75
Max. Negotiated Rate	$1,190.88
Rate for Payer: Amerigroup CHIP/Medicaid	$104.75
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$105.02
Rate for Payer: Amerigroup Medicare	$105.02
Rate for Payer: BCBS of TX Blue Advantage	$151.04
Rate for Payer: BCBS of TX Blue Essentials	$181.25
Rate for Payer: BCBS of TX Medicare	$105.02
Rate for Payer: BCBS of TX PPO	$202.30
Rate for Payer: Cash Price	$1,124.72
Rate for Payer: Cash Price	$1,124.72
Rate for Payer: Cash Price	$1,124.72
Rate for Payer: Cigna Commercial	$222.00
Rate for Payer: Cigna Medicaid	$1,190.88
Rate for Payer: Cigna Medicare	$105.02
Rate for Payer: Employer Direct Commercial	$105.02
Rate for Payer: Humana Medicare/TRICARE	$105.02
Rate for Payer: Molina CHIP/Medicaid	$1,190.88
Rate for Payer: Molina Dual Medicare/Medicaid	$105.02
Rate for Payer: Molina Medicare	$105.02
Rate for Payer: Multiplan Auto	$1,075.10
Rate for Payer: Multiplan Commercial	$1,075.10
Rate for Payer: Multiplan Workers Comp	$1,075.10
Rate for Payer: Parkland Medicaid	$1,190.88
Rate for Payer: Scott and White EPO/PPO	$167.60
Rate for Payer: Scott and White Medicare	$105.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,190.88
Rate for Payer: Superior Health Plan EPO	$105.02
Rate for Payer: Superior Health Plan Medicare	$105.02
Rate for Payer: Universal American Dual Medicare/Medicaid	$105.02
Rate for Payer: Universal American Medicare	$105.02
Rate for Payer: Wellcare Medicare	$105.02
Rate for Payer: Wellmed Medicare	$105.02

US OB Greater Than 14 Weeks

Facility

$1,654.00

Service Code	HCPCS 76805
Hospital Charge Code	3500170
Hospital Revenue Code	402
Rate for Payer: Cash Price	$1,124.72

US OB Growth or Anat f/u w/ BPP & UA Dop

Facility

$761.00

Service Code	HCPCS 76816
Hospital Charge Code	9331024
Hospital Revenue Code	402
Rate for Payer: Cash Price	$517.48

US OB Growth or Anat f/u w/ BPP & UA Dop

Facility

$761.00

Service Code	HCPCS 76816
Hospital Charge Code	9331024
Hospital Revenue Code	402
Min. Negotiated Rate	$104.75
Max. Negotiated Rate	$547.92
Rate for Payer: Amerigroup CHIP/Medicaid	$104.75
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$105.02
Rate for Payer: Amerigroup Medicare	$105.02
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 Medicare	$105.02
Rate for Payer: BCBS of TX PPO	$247.70
Rate for Payer: Cash Price	$517.48
Rate for Payer: Cash Price	$517.48
Rate for Payer: Cash Price	$517.48
Rate for Payer: Cigna Commercial	$222.00
Rate for Payer: Cigna Medicaid	$547.92
Rate for Payer: Cigna Medicare	$105.02
Rate for Payer: Employer Direct Commercial	$105.02
Rate for Payer: Humana Medicare/TRICARE	$105.02
Rate for Payer: Molina CHIP/Medicaid	$547.92
Rate for Payer: Molina Dual Medicare/Medicaid	$105.02
Rate for Payer: Molina Medicare	$105.02
Rate for Payer: Multiplan Auto	$494.65
Rate for Payer: Multiplan Commercial	$494.65
Rate for Payer: Multiplan Workers Comp	$494.65
Rate for Payer: Parkland Medicaid	$547.92
Rate for Payer: Scott and White EPO/PPO	$136.00
Rate for Payer: Scott and White Medicare	$105.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$547.92
Rate for Payer: Superior Health Plan EPO	$105.02
Rate for Payer: Superior Health Plan Medicare	$105.02
Rate for Payer: Universal American Dual Medicare/Medicaid	$105.02
Rate for Payer: Universal American Medicare	$105.02
Rate for Payer: Wellcare Medicare	$105.02
Rate for Payer: Wellmed Medicare	$105.02

Know your out-of-pocket cost for care.

All Charges