White Rock Medical Center

All Charges

Charge

Type

Setting

Price

VIRAL MENINGITIS

Facility

$14,157.79

Service Code	APR-DRG 0514
Min. Negotiated Rate	$13,348.46
Max. Negotiated Rate	$14,157.79
Rate for Payer: Amerigroup CHIP/Medicaid	$13,348.46
Rate for Payer: Cigna Medicaid	$13,348.46
Rate for Payer: Molina CHIP/Medicaid	$13,348.46
Rate for Payer: Parkland Medicaid	$13,348.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14,157.79

VIRAL MENINGITIS

Facility

$4,758.99

Service Code	APR-DRG 0513
Min. Negotiated Rate	$4,486.95
Max. Negotiated Rate	$4,758.99
Rate for Payer: Amerigroup CHIP/Medicaid	$4,486.95
Rate for Payer: Cigna Medicaid	$4,486.95
Rate for Payer: Molina CHIP/Medicaid	$4,486.95
Rate for Payer: Parkland Medicaid	$4,486.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,758.99

VIRAL MENINGITIS W CC/MCC

Facility

$34,675.00

Service Code	MSDRG 075
Min. Negotiated Rate	$12,741.76
Max. Negotiated Rate	$34,675.00
Rate for Payer: BCBS of TX Blue Advantage	$12,741.76
Rate for Payer: BCBS of TX Blue Essentials	$15,288.63
Rate for Payer: BCBS of TX PPO	$16,988.03

VIRAL MENINGITIS WITH CC/MCC

Facility

$34,675.00

Service Code	MSDRG 075
Min. Negotiated Rate	$12,741.76
Max. Negotiated Rate	$34,675.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$18,813.49
Rate for Payer: Amerigroup Medicare	$18,813.49
Rate for Payer: BCBS of TX Medicare	$18,813.49
Rate for Payer: Cigna Commercial	$24,697.40
Rate for Payer: Cigna Medicare	$18,813.49
Rate for Payer: Employer Direct Commercial	$18,813.49
Rate for Payer: Humana Medicare/TRICARE	$18,813.49
Rate for Payer: Molina Dual Medicare/Medicaid	$18,813.49
Rate for Payer: Molina Medicare	$18,813.49
Rate for Payer: Multiplan Auto	$34,675.00
Rate for Payer: Multiplan Commercial	$34,675.00
Rate for Payer: Multiplan Workers Comp	$34,675.00
Rate for Payer: Scott and White EPO/PPO	$15,968.75
Rate for Payer: Scott and White Medicare	$18,813.49
Rate for Payer: Superior Health Plan EPO	$18,813.49
Rate for Payer: Superior Health Plan Medicare	$18,813.49
Rate for Payer: Universal American Dual Medicare/Medicaid	$18,813.49
Rate for Payer: Universal American Medicare	$18,813.49
Rate for Payer: Wellcare Medicare	$18,813.49
Rate for Payer: Wellmed Medicare	$18,813.49

VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$18,758.70

Service Code	MSDRG 076
Min. Negotiated Rate	$7,093.28
Max. Negotiated Rate	$18,758.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,807.99
Rate for Payer: Amerigroup Medicare	$10,807.99
Rate for Payer: BCBS of TX Medicare	$10,807.99
Rate for Payer: Cigna Commercial	$9,644.54
Rate for Payer: Cigna Medicare	$10,807.99
Rate for Payer: Employer Direct Commercial	$10,807.99
Rate for Payer: Humana Medicare/TRICARE	$10,807.99
Rate for Payer: Molina Dual Medicare/Medicaid	$10,807.99
Rate for Payer: Molina Medicare	$10,807.99
Rate for Payer: Multiplan Auto	$18,758.70
Rate for Payer: Multiplan Commercial	$18,758.70
Rate for Payer: Multiplan Workers Comp	$18,758.70
Rate for Payer: Scott and White EPO/PPO	$8,638.88
Rate for Payer: Scott and White Medicare	$10,807.99
Rate for Payer: Superior Health Plan EPO	$10,807.99
Rate for Payer: Superior Health Plan Medicare	$10,807.99
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,807.99
Rate for Payer: Universal American Medicare	$10,807.99
Rate for Payer: Wellcare Medicare	$10,807.99
Rate for Payer: Wellmed Medicare	$10,807.99

VIRAL MENINGITIS W/O CC/MCC

Facility

$18,758.70

Service Code	MSDRG 076
Min. Negotiated Rate	$7,093.28
Max. Negotiated Rate	$18,758.70
Rate for Payer: BCBS of TX Blue Advantage	$7,093.28
Rate for Payer: BCBS of TX Blue Essentials	$8,511.11
Rate for Payer: BCBS of TX PPO	$9,457.16

VISCERAL SELECT/SUPRA

Facility

$4,398.00

Service Code	HCPCS 75726
Hospital Charge Code	4615727
Hospital Revenue Code	323
Rate for Payer: Cash Price	$2,990.64

VISCERAL SELECT/SUPRA

Facility

$4,398.00

Service Code	HCPCS 75726
Hospital Charge Code	4615727
Hospital Revenue Code	323
Min. Negotiated Rate	$170.08
Max. Negotiated Rate	$11,815.91
Rate for Payer: Amerigroup CHIP/Medicaid	$170.08
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Amerigroup Medicare	$5,589.84
Rate for Payer: BCBS of TX Blue Advantage	$7,583.71
Rate for Payer: BCBS of TX Blue Essentials	$9,100.46
Rate for Payer: BCBS of TX Medicare	$5,589.84
Rate for Payer: BCBS of TX PPO	$10,157.58
Rate for Payer: Cash Price	$2,990.64
Rate for Payer: Cash Price	$2,990.64
Rate for Payer: Cash Price	$2,990.64
Rate for Payer: Cigna Commercial	$11,815.91
Rate for Payer: Cigna Medicaid	$3,166.56
Rate for Payer: Cigna Medicare	$5,589.84
Rate for Payer: Employer Direct Commercial	$5,589.84
Rate for Payer: Humana Medicare/TRICARE	$5,589.84
Rate for Payer: Molina CHIP/Medicaid	$3,166.56
Rate for Payer: Molina Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Molina Medicare	$5,589.84
Rate for Payer: Multiplan Auto	$2,858.70
Rate for Payer: Multiplan Commercial	$2,858.70
Rate for Payer: Multiplan Workers Comp	$2,858.70
Rate for Payer: Parkland Medicaid	$3,166.56
Rate for Payer: Scott and White EPO/PPO	$209.22
Rate for Payer: Scott and White Medicare	$5,589.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,166.56
Rate for Payer: Superior Health Plan EPO	$5,589.84
Rate for Payer: Superior Health Plan Medicare	$5,589.84
Rate for Payer: Universal American Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Universal American Medicare	$5,589.84
Rate for Payer: Wellcare Medicare	$5,589.84
Rate for Payer: Wellmed Medicare	$5,589.84

Viscosity, Serum SO

Facility

$109.12

Service Code	HCPCS 85810
Hospital Charge Code	1701580
Hospital Revenue Code	305
Rate for Payer: Cash Price	$74.20

Viscosity, Serum SO

Facility

$109.12

Service Code	HCPCS 85810
Hospital Charge Code	1701580
Hospital Revenue Code	305
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$78.57
Rate for Payer: Amerigroup CHIP/Medicaid	$4.55
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11.67
Rate for Payer: Amerigroup Medicare	$11.67
Rate for Payer: BCBS of TX Blue Advantage	$32.74
Rate for Payer: BCBS of TX Blue Essentials	$39.28
Rate for Payer: BCBS of TX Medicare	$11.67
Rate for Payer: BCBS of TX PPO	$43.65
Rate for Payer: Cash Price	$74.20
Rate for Payer: Cash Price	$74.20
Rate for Payer: Cigna Medicaid	$78.57
Rate for Payer: Cigna Medicare	$11.67
Rate for Payer: Employer Direct Commercial	$11.67
Rate for Payer: Humana Medicare/TRICARE	$11.67
Rate for Payer: Molina CHIP/Medicaid	$78.57
Rate for Payer: Molina Dual Medicare/Medicaid	$11.67
Rate for Payer: Molina Medicare	$11.67
Rate for Payer: Multiplan Auto	$70.93
Rate for Payer: Multiplan Commercial	$70.93
Rate for Payer: Multiplan Workers Comp	$70.93
Rate for Payer: Parkland Medicaid	$78.57
Rate for Payer: Scott and White EPO/PPO	$14.59
Rate for Payer: Scott and White Medicare	$11.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$78.57
Rate for Payer: Superior Health Plan EPO	$11.67
Rate for Payer: Superior Health Plan Medicare	$11.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$11.67
Rate for Payer: Universal American Medicare	$11.67
Rate for Payer: Wellcare Medicare	$11.67
Rate for Payer: Wellmed Medicare	$11.67

vitamin A & D Topical Oint 120 g

Facility

$14.32

Service Code	HCPCS J3490
Hospital Charge Code	77874604
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$10.31
Rate for Payer: Amerigroup CHIP/Medicaid	$1.29
Rate for Payer: BCBS of TX Blue Advantage	$4.30
Rate for Payer: BCBS of TX Blue Essentials	$5.16
Rate for Payer: BCBS of TX PPO	$5.73
Rate for Payer: Cash Price	$9.74
Rate for Payer: Cigna Medicaid	$10.31
Rate for Payer: Molina CHIP/Medicaid	$10.31
Rate for Payer: Multiplan Auto	$9.31
Rate for Payer: Multiplan Commercial	$9.31
Rate for Payer: Multiplan Workers Comp	$9.31
Rate for Payer: Parkland Medicaid	$10.31
Rate for Payer: Scott and White EPO/PPO	$7.16
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10.31
Rate for Payer: Superior Health Plan EPO	$1.95

vitamin A & D Topical Oint 120 g

Facility

$14.32

Service Code	HCPCS J3490
Hospital Charge Code	77874604
Hospital Revenue Code	250
Rate for Payer: Cash Price	$9.74

Vitamin A, Serum SO

Facility

$198.00

Service Code	HCPCS 84590
Hospital Charge Code	1701598
Hospital Revenue Code	301
Rate for Payer: Cash Price	$134.64

Vitamin A, Serum SO

Facility

$198.00

Service Code	HCPCS 84590
Hospital Charge Code	1701598
Hospital Revenue Code	301
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$142.56
Rate for Payer: Amerigroup CHIP/Medicaid	$4.53
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11.61
Rate for Payer: Amerigroup Medicare	$11.61
Rate for Payer: BCBS of TX Blue Advantage	$59.40
Rate for Payer: BCBS of TX Blue Essentials	$71.28
Rate for Payer: BCBS of TX Medicare	$11.61
Rate for Payer: BCBS of TX PPO	$79.20
Rate for Payer: Cash Price	$134.64
Rate for Payer: Cash Price	$134.64
Rate for Payer: Cigna Medicaid	$142.56
Rate for Payer: Cigna Medicare	$11.61
Rate for Payer: Employer Direct Commercial	$11.61
Rate for Payer: Humana Medicare/TRICARE	$11.61
Rate for Payer: Molina CHIP/Medicaid	$142.56
Rate for Payer: Molina Dual Medicare/Medicaid	$11.61
Rate for Payer: Molina Medicare	$11.61
Rate for Payer: Multiplan Auto	$128.70
Rate for Payer: Multiplan Commercial	$128.70
Rate for Payer: Multiplan Workers Comp	$128.70
Rate for Payer: Parkland Medicaid	$142.56
Rate for Payer: Scott and White EPO/PPO	$14.51
Rate for Payer: Scott and White Medicare	$11.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$142.56
Rate for Payer: Superior Health Plan EPO	$11.61
Rate for Payer: Superior Health Plan Medicare	$11.61
Rate for Payer: Universal American Dual Medicare/Medicaid	$11.61
Rate for Payer: Universal American Medicare	$11.61
Rate for Payer: Wellcare Medicare	$11.61
Rate for Payer: Wellmed Medicare	$11.61

Vitamin B12 Level

Facility

$322.00

Service Code	HCPCS 82607
Hospital Charge Code	1602382
Hospital Revenue Code	301
Min. Negotiated Rate	$5.88
Max. Negotiated Rate	$231.84
Rate for Payer: Amerigroup CHIP/Medicaid	$5.88
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15.08
Rate for Payer: Amerigroup Medicare	$15.08
Rate for Payer: BCBS of TX Blue Advantage	$96.60
Rate for Payer: BCBS of TX Blue Essentials	$115.92
Rate for Payer: BCBS of TX Medicare	$15.08
Rate for Payer: BCBS of TX PPO	$128.80
Rate for Payer: Cash Price	$218.96
Rate for Payer: Cash Price	$218.96
Rate for Payer: Cigna Medicaid	$231.84
Rate for Payer: Cigna Medicare	$15.08
Rate for Payer: Employer Direct Commercial	$15.08
Rate for Payer: Humana Medicare/TRICARE	$15.08
Rate for Payer: Molina CHIP/Medicaid	$231.84
Rate for Payer: Molina Dual Medicare/Medicaid	$15.08
Rate for Payer: Molina Medicare	$15.08
Rate for Payer: Multiplan Auto	$209.30
Rate for Payer: Multiplan Commercial	$209.30
Rate for Payer: Multiplan Workers Comp	$209.30
Rate for Payer: Parkland Medicaid	$231.84
Rate for Payer: Scott and White EPO/PPO	$18.85
Rate for Payer: Scott and White Medicare	$15.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$231.84
Rate for Payer: Superior Health Plan EPO	$15.08
Rate for Payer: Superior Health Plan Medicare	$15.08
Rate for Payer: Universal American Dual Medicare/Medicaid	$15.08
Rate for Payer: Universal American Medicare	$15.08
Rate for Payer: Wellcare Medicare	$15.08
Rate for Payer: Wellmed Medicare	$15.08

Vitamin B12 Level

Facility

$322.00

Service Code	HCPCS 82607
Hospital Charge Code	1602382
Hospital Revenue Code	301
Rate for Payer: Cash Price	$218.96

Vitamin B1 (Thiamine), Blood SO

Facility

$190.00

Service Code	HCPCS 84425
Hospital Charge Code	1708726
Hospital Revenue Code	301
Min. Negotiated Rate	$8.28
Max. Negotiated Rate	$136.80
Rate for Payer: Amerigroup CHIP/Medicaid	$8.28
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$21.23
Rate for Payer: Amerigroup Medicare	$21.23
Rate for Payer: BCBS of TX Blue Advantage	$57.00
Rate for Payer: BCBS of TX Blue Essentials	$68.40
Rate for Payer: BCBS of TX Medicare	$21.23
Rate for Payer: BCBS of TX PPO	$76.00
Rate for Payer: Cash Price	$129.20
Rate for Payer: Cash Price	$129.20
Rate for Payer: Cigna Medicaid	$136.80
Rate for Payer: Cigna Medicare	$21.23
Rate for Payer: Employer Direct Commercial	$21.23
Rate for Payer: Humana Medicare/TRICARE	$21.23
Rate for Payer: Molina CHIP/Medicaid	$136.80
Rate for Payer: Molina Dual Medicare/Medicaid	$21.23
Rate for Payer: Molina Medicare	$21.23
Rate for Payer: Multiplan Auto	$123.50
Rate for Payer: Multiplan Commercial	$123.50
Rate for Payer: Multiplan Workers Comp	$123.50
Rate for Payer: Parkland Medicaid	$136.80
Rate for Payer: Scott and White EPO/PPO	$26.54
Rate for Payer: Scott and White Medicare	$21.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$136.80
Rate for Payer: Superior Health Plan EPO	$21.23
Rate for Payer: Superior Health Plan Medicare	$21.23
Rate for Payer: Universal American Dual Medicare/Medicaid	$21.23
Rate for Payer: Universal American Medicare	$21.23
Rate for Payer: Wellcare Medicare	$21.23
Rate for Payer: Wellmed Medicare	$21.23

Vitamin B1 (Thiamine), Blood SO

Facility

$190.00

Service Code	HCPCS 84425
Hospital Charge Code	1708726
Hospital Revenue Code	301
Rate for Payer: Cash Price	$129.20

Vitamin B2, Whole Blood SO

Facility

$208.00

Service Code	HCPCS 84252
Hospital Charge Code	1706720
Hospital Revenue Code	301
Rate for Payer: Cash Price	$141.44

Vitamin B2, Whole Blood SO

Facility

$208.00

Service Code	HCPCS 84252
Hospital Charge Code	1706720
Hospital Revenue Code	301
Min. Negotiated Rate	$7.89
Max. Negotiated Rate	$149.76
Rate for Payer: Amerigroup CHIP/Medicaid	$7.89
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$20.24
Rate for Payer: Amerigroup Medicare	$20.24
Rate for Payer: BCBS of TX Blue Advantage	$62.40
Rate for Payer: BCBS of TX Blue Essentials	$74.88
Rate for Payer: BCBS of TX Medicare	$20.24
Rate for Payer: BCBS of TX PPO	$83.20
Rate for Payer: Cash Price	$141.44
Rate for Payer: Cash Price	$141.44
Rate for Payer: Cigna Medicaid	$149.76
Rate for Payer: Cigna Medicare	$20.24
Rate for Payer: Employer Direct Commercial	$20.24
Rate for Payer: Humana Medicare/TRICARE	$20.24
Rate for Payer: Molina CHIP/Medicaid	$149.76
Rate for Payer: Molina Dual Medicare/Medicaid	$20.24
Rate for Payer: Molina Medicare	$20.24
Rate for Payer: Multiplan Auto	$135.20
Rate for Payer: Multiplan Commercial	$135.20
Rate for Payer: Multiplan Workers Comp	$135.20
Rate for Payer: Parkland Medicaid	$149.76
Rate for Payer: Scott and White EPO/PPO	$25.30
Rate for Payer: Scott and White Medicare	$20.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$149.76
Rate for Payer: Superior Health Plan EPO	$20.24
Rate for Payer: Superior Health Plan Medicare	$20.24
Rate for Payer: Universal American Dual Medicare/Medicaid	$20.24
Rate for Payer: Universal American Medicare	$20.24
Rate for Payer: Wellcare Medicare	$20.24
Rate for Payer: Wellmed Medicare	$20.24

Vitamin B6, Plasma SO

Facility

$272.00

Service Code	HCPCS 84207
Hospital Charge Code	1706134
Hospital Revenue Code	301
Rate for Payer: Cash Price	$184.96

Vitamin B6, Plasma SO

Facility

$272.00

Service Code	HCPCS 84207
Hospital Charge Code	1706134
Hospital Revenue Code	301
Min. Negotiated Rate	$10.96
Max. Negotiated Rate	$195.84
Rate for Payer: Amerigroup CHIP/Medicaid	$10.96
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$28.10
Rate for Payer: Amerigroup Medicare	$28.10
Rate for Payer: BCBS of TX Blue Advantage	$81.60
Rate for Payer: BCBS of TX Blue Essentials	$97.92
Rate for Payer: BCBS of TX Medicare	$28.10
Rate for Payer: BCBS of TX PPO	$108.80
Rate for Payer: Cash Price	$184.96
Rate for Payer: Cash Price	$184.96
Rate for Payer: Cigna Medicaid	$195.84
Rate for Payer: Cigna Medicare	$28.10
Rate for Payer: Employer Direct Commercial	$28.10
Rate for Payer: Humana Medicare/TRICARE	$28.10
Rate for Payer: Molina CHIP/Medicaid	$195.84
Rate for Payer: Molina Dual Medicare/Medicaid	$28.10
Rate for Payer: Molina Medicare	$28.10
Rate for Payer: Multiplan Auto	$176.80
Rate for Payer: Multiplan Commercial	$176.80
Rate for Payer: Multiplan Workers Comp	$176.80
Rate for Payer: Parkland Medicaid	$195.84
Rate for Payer: Scott and White EPO/PPO	$35.12
Rate for Payer: Scott and White Medicare	$28.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$195.84
Rate for Payer: Superior Health Plan EPO	$28.10
Rate for Payer: Superior Health Plan Medicare	$28.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$28.10
Rate for Payer: Universal American Medicare	$28.10
Rate for Payer: Wellcare Medicare	$28.10
Rate for Payer: Wellmed Medicare	$28.10

Vitamin C SO

Facility

$133.00

Service Code	HCPCS 82180
Hospital Charge Code	1705961
Hospital Revenue Code	301
Rate for Payer: Cash Price	$90.44

Vitamin C SO

Facility

$133.00

Service Code	HCPCS 82180
Hospital Charge Code	1705961
Hospital Revenue Code	301
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$95.76
Rate for Payer: Amerigroup CHIP/Medicaid	$3.86
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$9.89
Rate for Payer: Amerigroup Medicare	$9.89
Rate for Payer: BCBS of TX Blue Advantage	$39.90
Rate for Payer: BCBS of TX Blue Essentials	$47.88
Rate for Payer: BCBS of TX Medicare	$9.89
Rate for Payer: BCBS of TX PPO	$53.20
Rate for Payer: Cash Price	$90.44
Rate for Payer: Cash Price	$90.44
Rate for Payer: Cigna Medicaid	$95.76
Rate for Payer: Cigna Medicare	$9.89
Rate for Payer: Employer Direct Commercial	$9.89
Rate for Payer: Humana Medicare/TRICARE	$9.89
Rate for Payer: Molina CHIP/Medicaid	$95.76
Rate for Payer: Molina Dual Medicare/Medicaid	$9.89
Rate for Payer: Molina Medicare	$9.89
Rate for Payer: Multiplan Auto	$86.45
Rate for Payer: Multiplan Commercial	$86.45
Rate for Payer: Multiplan Workers Comp	$86.45
Rate for Payer: Parkland Medicaid	$95.76
Rate for Payer: Scott and White EPO/PPO	$12.36
Rate for Payer: Scott and White Medicare	$9.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$95.76
Rate for Payer: Superior Health Plan EPO	$9.89
Rate for Payer: Superior Health Plan Medicare	$9.89
Rate for Payer: Universal American Dual Medicare/Medicaid	$9.89
Rate for Payer: Universal American Medicare	$9.89
Rate for Payer: Wellcare Medicare	$9.89
Rate for Payer: Wellmed Medicare	$9.89

Vitamin D, 25-Hydroxy

Facility

$521.00

Service Code	HCPCS 82306
Hospital Charge Code	7254595
Hospital Revenue Code	301
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$375.12
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$29.60
Rate for Payer: Amerigroup Medicare	$29.60
Rate for Payer: BCBS of TX Blue Advantage	$156.30
Rate for Payer: BCBS of TX Blue Essentials	$187.56
Rate for Payer: BCBS of TX Medicare	$29.60
Rate for Payer: BCBS of TX PPO	$208.40
Rate for Payer: Cash Price	$354.28
Rate for Payer: Cash Price	$354.28
Rate for Payer: Cigna Medicaid	$375.12
Rate for Payer: Cigna Medicare	$29.60
Rate for Payer: Employer Direct Commercial	$29.60
Rate for Payer: Humana Medicare/TRICARE	$29.60
Rate for Payer: Molina CHIP/Medicaid	$375.12
Rate for Payer: Molina Dual Medicare/Medicaid	$29.60
Rate for Payer: Molina Medicare	$29.60
Rate for Payer: Multiplan Auto	$338.65
Rate for Payer: Multiplan Commercial	$338.65
Rate for Payer: Multiplan Workers Comp	$338.65
Rate for Payer: Parkland Medicaid	$375.12
Rate for Payer: Scott and White EPO/PPO	$37.00
Rate for Payer: Scott and White Medicare	$29.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$375.12
Rate for Payer: Superior Health Plan EPO	$29.60
Rate for Payer: Superior Health Plan Medicare	$29.60
Rate for Payer: Universal American Dual Medicare/Medicaid	$29.60
Rate for Payer: Universal American Medicare	$29.60
Rate for Payer: Wellcare Medicare	$29.60
Rate for Payer: Wellmed Medicare	$29.60

Know your out-of-pocket cost for care.

All Charges