White Rock Medical Center

All Charges

Charge

Type

Setting

Price

venlafaxine 75mg Tab

Facility

$9.50

Service Code	HCPCS J3490
Hospital Charge Code	1.50278E+11
Hospital Revenue Code	250
Rate for Payer: Cash Price	$6.46

venlafaxine 75mg Tab

Facility

$9.50

Service Code	HCPCS J3490
Hospital Charge Code	78432853
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$6.84
Rate for Payer: Amerigroup CHIP/Medicaid	$0.86
Rate for Payer: BCBS of TX Blue Advantage	$2.85
Rate for Payer: BCBS of TX Blue Essentials	$3.42
Rate for Payer: BCBS of TX PPO	$3.80
Rate for Payer: Cash Price	$6.46
Rate for Payer: Cigna Medicaid	$6.84
Rate for Payer: Molina CHIP/Medicaid	$6.84
Rate for Payer: Multiplan Auto	$6.17
Rate for Payer: Multiplan Commercial	$6.17
Rate for Payer: Multiplan Workers Comp	$6.17
Rate for Payer: Parkland Medicaid	$6.84
Rate for Payer: Scott and White EPO/PPO	$4.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.84
Rate for Payer: Superior Health Plan EPO	$1.29

venlafaxine 75mg Tab

Facility

$9.50

Service Code	HCPCS J3490
Hospital Charge Code	78432853
Hospital Revenue Code	250
Rate for Payer: Cash Price	$6.46

VENOGRAM EXTREMITY BI

Facility

$1,800.00

Service Code	HCPCS 75822
Hospital Charge Code	4615823
Hospital Revenue Code	323
Min. Negotiated Rate	$131.42
Max. Negotiated Rate	$3,342.63
Rate for Payer: Amerigroup CHIP/Medicaid	$133.65
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,581.33
Rate for Payer: Amerigroup Medicare	$1,581.33
Rate for Payer: BCBS of TX Blue Advantage	$131.42
Rate for Payer: BCBS of TX Blue Essentials	$157.71
Rate for Payer: BCBS of TX Medicare	$1,581.33
Rate for Payer: BCBS of TX PPO	$176.03
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Cigna Commercial	$3,342.63
Rate for Payer: Cigna Medicaid	$1,296.00
Rate for Payer: Cigna Medicare	$1,581.33
Rate for Payer: Employer Direct Commercial	$1,581.33
Rate for Payer: Humana Medicare/TRICARE	$1,581.33
Rate for Payer: Molina CHIP/Medicaid	$1,296.00
Rate for Payer: Molina Dual Medicare/Medicaid	$1,581.33
Rate for Payer: Molina Medicare	$1,581.33
Rate for Payer: Multiplan Auto	$1,170.00
Rate for Payer: Multiplan Commercial	$1,170.00
Rate for Payer: Multiplan Workers Comp	$1,170.00
Rate for Payer: Parkland Medicaid	$1,296.00
Rate for Payer: Scott and White EPO/PPO	$164.36
Rate for Payer: Scott and White Medicare	$1,581.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,296.00
Rate for Payer: Superior Health Plan EPO	$1,581.33
Rate for Payer: Superior Health Plan Medicare	$1,581.33
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,581.33
Rate for Payer: Universal American Medicare	$1,581.33
Rate for Payer: Wellcare Medicare	$1,581.33
Rate for Payer: Wellmed Medicare	$1,581.33

VENOGRAM EXTREMITY BI

Facility

$1,800.00

Service Code	HCPCS 75822
Hospital Charge Code	4615823
Hospital Revenue Code	323
Rate for Payer: Cash Price	$1,224.00

VENOGRAM EXTREMITY UNI

Facility

$1,448.00

Service Code	HCPCS 75820
Hospital Charge Code	2330024
Hospital Revenue Code	320
Rate for Payer: Cash Price	$984.64

VENOGRAM EXTREMITY UNI

Facility

$1,448.00

Service Code	HCPCS 75820
Hospital Charge Code	2330024
Hospital Revenue Code	320
Min. Negotiated Rate	$107.93
Max. Negotiated Rate	$3,342.63
Rate for Payer: Amerigroup CHIP/Medicaid	$107.93
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,581.33
Rate for Payer: Amerigroup Medicare	$1,581.33
Rate for Payer: BCBS of TX Blue Advantage	$1,040.34
Rate for Payer: BCBS of TX Blue Essentials	$1,248.41
Rate for Payer: BCBS of TX Medicare	$1,581.33
Rate for Payer: BCBS of TX PPO	$1,393.43
Rate for Payer: Cash Price	$984.64
Rate for Payer: Cash Price	$984.64
Rate for Payer: Cash Price	$984.64
Rate for Payer: Cigna Commercial	$3,342.63
Rate for Payer: Cigna Medicaid	$1,042.56
Rate for Payer: Cigna Medicare	$1,581.33
Rate for Payer: Employer Direct Commercial	$1,581.33
Rate for Payer: Humana Medicare/TRICARE	$1,581.33
Rate for Payer: Molina CHIP/Medicaid	$1,042.56
Rate for Payer: Molina Dual Medicare/Medicaid	$1,581.33
Rate for Payer: Molina Medicare	$1,581.33
Rate for Payer: Multiplan Auto	$941.20
Rate for Payer: Multiplan Commercial	$941.20
Rate for Payer: Multiplan Workers Comp	$941.20
Rate for Payer: Parkland Medicaid	$1,042.56
Rate for Payer: Scott and White EPO/PPO	$132.82
Rate for Payer: Scott and White Medicare	$1,581.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,042.56
Rate for Payer: Superior Health Plan EPO	$1,581.33
Rate for Payer: Superior Health Plan Medicare	$1,581.33
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,581.33
Rate for Payer: Universal American Medicare	$1,581.33
Rate for Payer: Wellcare Medicare	$1,581.33
Rate for Payer: Wellmed Medicare	$1,581.33

VENOGRAPHY EXTREM UNILATERAL RT

Facility

$1,448.00

Service Code	HCPCS 75820
Hospital Charge Code	2303584
Hospital Revenue Code	320
Rate for Payer: Cash Price	$984.64

VENOGRAPHY EXTREM UNILATERAL RT

Facility

$1,448.00

Service Code	HCPCS 75820
Hospital Charge Code	2303584
Hospital Revenue Code	320
Min. Negotiated Rate	$107.93
Max. Negotiated Rate	$3,342.63
Rate for Payer: Amerigroup CHIP/Medicaid	$107.93
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,581.33
Rate for Payer: Amerigroup Medicare	$1,581.33
Rate for Payer: BCBS of TX Blue Advantage	$1,040.34
Rate for Payer: BCBS of TX Blue Essentials	$1,248.41
Rate for Payer: BCBS of TX Medicare	$1,581.33
Rate for Payer: BCBS of TX PPO	$1,393.43
Rate for Payer: Cash Price	$984.64
Rate for Payer: Cash Price	$984.64
Rate for Payer: Cash Price	$984.64
Rate for Payer: Cigna Commercial	$3,342.63
Rate for Payer: Cigna Medicaid	$1,042.56
Rate for Payer: Cigna Medicare	$1,581.33
Rate for Payer: Employer Direct Commercial	$1,581.33
Rate for Payer: Humana Medicare/TRICARE	$1,581.33
Rate for Payer: Molina CHIP/Medicaid	$1,042.56
Rate for Payer: Molina Dual Medicare/Medicaid	$1,581.33
Rate for Payer: Molina Medicare	$1,581.33
Rate for Payer: Multiplan Auto	$941.20
Rate for Payer: Multiplan Commercial	$941.20
Rate for Payer: Multiplan Workers Comp	$941.20
Rate for Payer: Parkland Medicaid	$1,042.56
Rate for Payer: Scott and White EPO/PPO	$132.82
Rate for Payer: Scott and White Medicare	$1,581.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,042.56
Rate for Payer: Superior Health Plan EPO	$1,581.33
Rate for Payer: Superior Health Plan Medicare	$1,581.33
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,581.33
Rate for Payer: Universal American Medicare	$1,581.33
Rate for Payer: Wellcare Medicare	$1,581.33
Rate for Payer: Wellmed Medicare	$1,581.33

VENOGRAPHY IVC

Facility

$3,358.00

Service Code	HCPCS 75825
Hospital Charge Code	2330016
Hospital Revenue Code	320
Min. Negotiated Rate	$114.28
Max. Negotiated Rate	$6,704.76
Rate for Payer: Amerigroup CHIP/Medicaid	$114.28
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Amerigroup Medicare	$3,171.87
Rate for Payer: BCBS of TX Blue Advantage	$4,572.61
Rate for Payer: BCBS of TX Blue Essentials	$5,487.13
Rate for Payer: BCBS of TX Medicare	$3,171.87
Rate for Payer: BCBS of TX PPO	$6,124.53
Rate for Payer: Cash Price	$2,283.44
Rate for Payer: Cash Price	$2,283.44
Rate for Payer: Cash Price	$2,283.44
Rate for Payer: Cigna Commercial	$6,704.76
Rate for Payer: Cigna Medicaid	$2,417.76
Rate for Payer: Cigna Medicare	$3,171.87
Rate for Payer: Employer Direct Commercial	$3,171.87
Rate for Payer: Humana Medicare/TRICARE	$3,171.87
Rate for Payer: Molina CHIP/Medicaid	$2,417.76
Rate for Payer: Molina Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Molina Medicare	$3,171.87
Rate for Payer: Multiplan Auto	$2,182.70
Rate for Payer: Multiplan Commercial	$2,182.70
Rate for Payer: Multiplan Workers Comp	$2,182.70
Rate for Payer: Parkland Medicaid	$2,417.76
Rate for Payer: Scott and White EPO/PPO	$140.35
Rate for Payer: Scott and White Medicare	$3,171.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,417.76
Rate for Payer: Superior Health Plan EPO	$3,171.87
Rate for Payer: Superior Health Plan Medicare	$3,171.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Universal American Medicare	$3,171.87
Rate for Payer: Wellcare Medicare	$3,171.87
Rate for Payer: Wellmed Medicare	$3,171.87

VENOGRAPHY IVC

Facility

$3,358.00

Service Code	HCPCS 75825
Hospital Charge Code	2330016
Hospital Revenue Code	320
Rate for Payer: Cash Price	$2,283.44

VENOUS MECH. THROMB.

Facility

$12,192.00

Service Code	HCPCS 37187
Hospital Charge Code	2330011
Hospital Revenue Code	361
Min. Negotiated Rate	$5,348.63
Max. Negotiated Rate	$24,513.51
Rate for Payer: Amerigroup CHIP/Medicaid	$5,348.63
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,596.79
Rate for Payer: Amerigroup Medicare	$11,596.79
Rate for Payer: BCBS of TX Blue Advantage	$8,273.03
Rate for Payer: BCBS of TX Blue Essentials	$9,907.82
Rate for Payer: BCBS of TX Medicare	$11,596.79
Rate for Payer: BCBS of TX PPO	$12,483.85
Rate for Payer: Cash Price	$8,290.56
Rate for Payer: Cash Price	$8,290.56
Rate for Payer: Cash Price	$8,290.56
Rate for Payer: Cigna Commercial	$24,513.51
Rate for Payer: Cigna Medicaid	$8,778.24
Rate for Payer: Cigna Medicare	$11,596.79
Rate for Payer: Employer Direct Commercial	$11,596.79
Rate for Payer: Humana Medicare/TRICARE	$11,596.79
Rate for Payer: Molina CHIP/Medicaid	$8,778.24
Rate for Payer: Molina Dual Medicare/Medicaid	$11,596.79
Rate for Payer: Molina Medicare	$11,596.79
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	$8,778.24
Rate for Payer: Scott and White EPO/PPO	$18,612.98
Rate for Payer: Scott and White Medicare	$11,596.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,778.24
Rate for Payer: Superior Health Plan EPO	$11,596.79
Rate for Payer: Superior Health Plan Medicare	$11,596.79
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,596.79
Rate for Payer: Universal American Medicare	$11,596.79
Rate for Payer: Wellcare Medicare	$11,596.79
Rate for Payer: Wellmed Medicare	$11,596.79

VENOUS MECH. THROMB.

Facility

$12,192.00

Service Code	HCPCS 37187
Hospital Charge Code	2330011
Hospital Revenue Code	361
Rate for Payer: Cash Price	$8,290.56

Ventilating tube removal requiring general anesthesia

Facility

$9,577.37

Service Code	HCPCS 69424
Hospital Charge Code	9900885
Hospital Revenue Code	360
Rate for Payer: Cash Price	$6,512.61

Ventilating tube removal requiring general anesthesia

Facility

$10,000.00

Service Code	CPT 69424
Hospital Charge Code	36069424
Hospital Revenue Code	360
Min. Negotiated Rate	$81.12
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$81.12
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,330.57
Rate for Payer: Amerigroup Medicare	$3,330.57
Rate for Payer: BCBS of TX Blue Advantage	$160.32
Rate for Payer: BCBS of TX Blue Essentials	$192.00
Rate for Payer: BCBS of TX Medicare	$3,330.57
Rate for Payer: BCBS of TX PPO	$241.92
Rate for Payer: Cigna Commercial	$7,040.22
Rate for Payer: Cigna Medicare	$3,330.57
Rate for Payer: Employer Direct Commercial	$3,330.57
Rate for Payer: Humana Medicare/TRICARE	$3,330.57
Rate for Payer: Molina Dual Medicare/Medicaid	$3,330.57
Rate for Payer: Molina Medicare	$3,330.57
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	$5,447.31
Rate for Payer: Scott and White Medicare	$3,330.57
Rate for Payer: Superior Health Plan EPO	$3,330.57
Rate for Payer: Superior Health Plan Medicare	$3,330.57
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,330.57
Rate for Payer: Universal American Medicare	$3,330.57
Rate for Payer: Wellcare Medicare	$3,330.57
Rate for Payer: Wellmed Medicare	$3,330.57

Ventilating tube removal requiring general anesthesia

Facility

$9,577.37

Service Code	HCPCS 69424
Hospital Charge Code	9900885
Hospital Revenue Code	360
Min. Negotiated Rate	$81.12
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$81.12
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,330.57
Rate for Payer: Amerigroup Medicare	$3,330.57
Rate for Payer: BCBS of TX Blue Advantage	$160.32
Rate for Payer: BCBS of TX Blue Essentials	$192.00
Rate for Payer: BCBS of TX Medicare	$3,330.57
Rate for Payer: BCBS of TX PPO	$241.92
Rate for Payer: Cash Price	$6,512.61
Rate for Payer: Cash Price	$6,512.61
Rate for Payer: Cash Price	$6,512.61
Rate for Payer: Cigna Commercial	$7,040.22
Rate for Payer: Cigna Medicaid	$6,895.71
Rate for Payer: Cigna Medicare	$3,330.57
Rate for Payer: Employer Direct Commercial	$3,330.57
Rate for Payer: Humana Medicare/TRICARE	$3,330.57
Rate for Payer: Molina CHIP/Medicaid	$6,895.71
Rate for Payer: Molina Dual Medicare/Medicaid	$3,330.57
Rate for Payer: Molina Medicare	$3,330.57
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	$6,895.71
Rate for Payer: Scott and White EPO/PPO	$5,447.31
Rate for Payer: Scott and White Medicare	$3,330.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,895.71
Rate for Payer: Superior Health Plan EPO	$3,330.57
Rate for Payer: Superior Health Plan Medicare	$3,330.57
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,330.57
Rate for Payer: Universal American Medicare	$3,330.57
Rate for Payer: Wellcare Medicare	$3,330.57
Rate for Payer: Wellmed Medicare	$3,330.57

Ventilator Circuit, Adut, Unheated, 2-Part, 72'

Facility

$11.99

Hospital Charge Code	993986
Hospital Revenue Code	271
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$8.63
Rate for Payer: Amerigroup CHIP/Medicaid	$1.08
Rate for Payer: BCBS of TX Blue Advantage	$3.60
Rate for Payer: BCBS of TX Blue Essentials	$4.32
Rate for Payer: BCBS of TX PPO	$4.80
Rate for Payer: Cash Price	$8.15
Rate for Payer: Cigna Medicaid	$8.63
Rate for Payer: Molina CHIP/Medicaid	$8.63
Rate for Payer: Multiplan Auto	$7.79
Rate for Payer: Multiplan Commercial	$7.79
Rate for Payer: Multiplan Workers Comp	$7.79
Rate for Payer: Parkland Medicaid	$8.63
Rate for Payer: Scott and White EPO/PPO	$6.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.63
Rate for Payer: Superior Health Plan EPO	$1.63

Ventilator Circuit, Adut, Unheated, 2-Part, 72'

Facility

$11.99

Hospital Charge Code	993986
Hospital Revenue Code	271
Rate for Payer: Cash Price	$8.15

VENTRICULAR SHUNT PROCEDURES

Facility

$10,970.54

Service Code	APR-DRG 0223
Min. Negotiated Rate	$10,343.41
Max. Negotiated Rate	$10,970.54
Rate for Payer: Amerigroup CHIP/Medicaid	$10,343.41
Rate for Payer: Cigna Medicaid	$10,343.41
Rate for Payer: Molina CHIP/Medicaid	$10,343.41
Rate for Payer: Parkland Medicaid	$10,343.41
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,970.54

VENTRICULAR SHUNT PROCEDURES

Facility

$7,362.35

Service Code	APR-DRG 0222
Min. Negotiated Rate	$6,941.48
Max. Negotiated Rate	$7,362.35
Rate for Payer: Amerigroup CHIP/Medicaid	$6,941.48
Rate for Payer: Cigna Medicaid	$6,941.48
Rate for Payer: Molina CHIP/Medicaid	$6,941.48
Rate for Payer: Parkland Medicaid	$6,941.48
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,362.35

VENTRICULAR SHUNT PROCEDURES

Facility

$5,987.88

Service Code	APR-DRG 0221
Min. Negotiated Rate	$5,645.58
Max. Negotiated Rate	$5,987.88
Rate for Payer: Amerigroup CHIP/Medicaid	$5,645.58
Rate for Payer: Cigna Medicaid	$5,645.58
Rate for Payer: Molina CHIP/Medicaid	$5,645.58
Rate for Payer: Parkland Medicaid	$5,645.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,987.88

VENTRICULAR SHUNT PROCEDURES

Facility

$39,718.38

Service Code	APR-DRG 0224
Min. Negotiated Rate	$37,447.88
Max. Negotiated Rate	$39,718.38
Rate for Payer: Amerigroup CHIP/Medicaid	$37,447.88
Rate for Payer: Cigna Medicaid	$37,447.88
Rate for Payer: Molina CHIP/Medicaid	$37,447.88
Rate for Payer: Parkland Medicaid	$37,447.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$39,718.38

VENTRICULAR SHUNT PROCEDURES W CC

Facility

$39,035.50

Service Code	MSDRG 032
Min. Negotiated Rate	$17,976.88
Max. Negotiated Rate	$39,035.50
Rate for Payer: BCBS of TX Blue Advantage	$19,798.06
Rate for Payer: BCBS of TX Blue Essentials	$23,755.37
Rate for Payer: BCBS of TX PPO	$26,395.88

VENTRICULAR SHUNT PROCEDURES WITH CC

Facility

$39,035.50

Service Code	MSDRG 032
Min. Negotiated Rate	$17,976.88
Max. Negotiated Rate	$39,035.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$20,378.24
Rate for Payer: Amerigroup Medicare	$20,378.24
Rate for Payer: BCBS of TX Medicare	$20,378.24
Rate for Payer: Cigna Commercial	$27,447.28
Rate for Payer: Cigna Medicare	$20,378.24
Rate for Payer: Employer Direct Commercial	$20,378.24
Rate for Payer: Humana Medicare/TRICARE	$20,378.24
Rate for Payer: Molina Dual Medicare/Medicaid	$20,378.24
Rate for Payer: Molina Medicare	$20,378.24
Rate for Payer: Multiplan Auto	$39,035.50
Rate for Payer: Multiplan Commercial	$39,035.50
Rate for Payer: Multiplan Workers Comp	$39,035.50
Rate for Payer: Scott and White EPO/PPO	$17,976.88
Rate for Payer: Scott and White Medicare	$20,378.24
Rate for Payer: Superior Health Plan EPO	$20,378.24
Rate for Payer: Superior Health Plan Medicare	$20,378.24
Rate for Payer: Universal American Dual Medicare/Medicaid	$20,378.24
Rate for Payer: Universal American Medicare	$20,378.24
Rate for Payer: Wellcare Medicare	$20,378.24
Rate for Payer: Wellmed Medicare	$20,378.24

VENTRICULAR SHUNT PROCEDURES WITH MCC

Facility

$78,299.00

Service Code	MSDRG 031
Min. Negotiated Rate	$35,972.94
Max. Negotiated Rate	$78,299.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$37,597.77
Rate for Payer: Amerigroup Medicare	$37,597.77
Rate for Payer: BCBS of TX Medicare	$37,597.77
Rate for Payer: Cigna Commercial	$57,708.84
Rate for Payer: Cigna Medicare	$37,597.77
Rate for Payer: Employer Direct Commercial	$37,597.77
Rate for Payer: Humana Medicare/TRICARE	$37,597.77
Rate for Payer: Molina Dual Medicare/Medicaid	$37,597.77
Rate for Payer: Molina Medicare	$37,597.77
Rate for Payer: Multiplan Auto	$78,299.00
Rate for Payer: Multiplan Commercial	$78,299.00
Rate for Payer: Multiplan Workers Comp	$78,299.00
Rate for Payer: Scott and White EPO/PPO	$36,058.75
Rate for Payer: Scott and White Medicare	$37,597.77
Rate for Payer: Superior Health Plan EPO	$37,597.77
Rate for Payer: Superior Health Plan Medicare	$37,597.77
Rate for Payer: Universal American Dual Medicare/Medicaid	$37,597.77
Rate for Payer: Universal American Medicare	$37,597.77
Rate for Payer: Wellcare Medicare	$37,597.77
Rate for Payer: Wellmed Medicare	$37,597.77

Know your out-of-pocket cost for care.

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