| Houston Methodist Baytown Hospital | Baytown | $12 | $24 |
| Houston Methodist Clear Lake Hospital | Nassau Bay | $12 | $24 |
| Houston Methodist Continuing Care Hospital | Katy | $12 | $24 |
| Houston Methodist Cypress Hospital | Cypress | $12 | $24 |
| Houston Methodist Emergency Care Center at Cinco Ranch | Houston | $12 | $24 |
| Houston Methodist Emergency Care Center at Kirby | Houston | $12 | $24 |
| Houston Methodist Emergency Care Center at Voss | Houston | $12 | $24 |
| Houston Methodist Emergency Care Center in Cypress | Houston | $12 | $24 |
| Houston Methodist Emergency Care Center in Deer Park | Nassau Bay | $12 | $24 |
| Houston Methodist Emergency Care Center in League City | Nassau Bay | $12 | $24 |
| Houston Methodist Emergency Care Center in Magnolia | Houston | $12 | $24 |
| Houston Methodist Emergency Care Center in Pearland | Houston | $12 | $24 |
| Houston Methodist Emergency Care Center in Sienna | Houston | $12 | $24 |
| Houston Methodist Emergency Care Center in Spring | The Woodlands | $12 | $24 |
| Houston Methodist Emergency Care Center in The Woodlands | The Woodlands | $12 | $24 |
| Houston Methodist Hospital | Houston | $12 | $24 |
| Houston Methodist Sugar Land Hospital | Sugar Land | $12 | $24 |
| Houston Methodist The Woodlands Hospital | The Woodlands | $12 | $24 |
| Houston Methodist West Hospital | Houston | $12 | $24 |
| Houston Methodist Willowbrook Hospital | Houston | $12 | $24 |
| South Texas Health System Edinburg | Edinburg | $12 | $16 |
| South Texas Health System Heart | McAllen | $12 | $16 |
| South Texas Health System McAllen | McAllen | $12 | $16 |
| Harris Health Ben Taub Hospital | Houston | $13.39 | $221 |
| Harris Health Lyndon B Johnson Hospital | Houston | $13.39 | $221 |
| BSA Hospital | Amarillo | $15.60 | $156 |
| Harrington Cancer Center | Amarillo | $15.60 | $156 |
| University Medical Center Surgical Hospital | El Paso | $22.40 | $112 |
| University Medical Center of El Paso | El Paso | $22.40 | $112 |
| UTHealth East Texas Tyler | Tyler | $27.60 | $276 |
| University Health Dialysis Medical Center | San Antonio | $36.25 | $145 |
| University Health Dialysis South | San Antonio | $36.25 | $145 |
| University Health Dialysis Southeast | San Antonio | $36.25 | $145 |
| University Health Dialysis West at Texas Diabetes Institute | San Antonio | $36.25 | $145 |
| University Health System Children's Kidney Center | San Antonio | $36.25 | $145 |
| University Hospital | San Antonio | $36.25 | $145 |
| UTHealth East Texas North Campus | Tyler | $36.70 | $367 |
| UTHealth East Texas Pittsburg | Pittsburg | $40 | $400 |
| UTHealth East Texas Quitman | Quitman | $40 | $400 |
| UMC Children's Hospital | Lubbock | $43 | $43 |
| UMC Health & Wellness Hospital | Lubbock | $43 | $43 |
| University Medical Center | Lubbock | $43 | $43 |
| Midland County Hospital District | Midland | $48.75 | $65 |
| Midland Memorial Hospital | Midland | $48.75 | $65 |
| UTHealth East Texas Carthage | Carthage | $52.60 | $526 |
| JPS Health Network | Fort Worth | $53.40 | $89 |
| Trinity Spring North | Fort Worth | $53.40 | $89 |
| UTHealth East Texas Rehabilitation Center | Tyler | $63.80 | $638 |
| CHRISTUS Santa Rosa Hospital - Westover Hills | San Antonio | $66.33 | $201 |
| St. Joseph Health Regional Hospital | Bryan | $70.25 | $339 |
| St. Joseph Health College Station Hospital | College Station | $70.69 | $339 |
| William P Clements Jr University Hospital | Dallas | $71 | $142 |
| UTHealth East Texas Athens | Athens | $71.30 | $713 |
| UTHealth East Texas Jacksonville | Jacksonville | $77 | $770 |
| UTHealth East Texas Henderson | Henderson | $79.60 | $796 |
| St. Joseph Health Madison Hospital | Madisonville | $79.87 | $339 |
| St. Joseph Health Burleson Hospital | Caldwell | $80.55 | $339 |
| Covenant Health Emergency Center - Milwaukee Ave | Lubbock | $81.90 | $195 |
| Covenant Health Emergency Center - Quaker Ave | Lubbock | $81.90 | $195 |
| Covenant Medical Center | Lubbock | $81.90 | $195 |
| Ascension Providence | Waco | $95.67 | $265.75 |
| Texas Children's Hospital | Houston | $97.82 | $146 |
| Texas Children's Hospital North Austin Campus | Austin | $97.82 | $146 |
| Texas Children's Hospital The Woodlands | The Woodlands | $97.82 | $146 |
| Texas Children's Hospital West Campus | Houston | $97.82 | $146 |
| CHRISTUS Health - West Beaumont | Beaumont | $102.30 | $310 |
| CHRISTUS Hospital - Orange | Orange | $102.30 | $310 |
| CHRISTUS Southeast Texas - MidCounty | Port Arthur | $102.30 | $310 |
| CHRISTUS Southeast Texas Orthopedic Specialty Center | Port Arthur | $102.30 | $310 |
| CHRISTUS Southeast Texas St. Elizabeth | Beaumont | $102.30 | $310 |
| St. Luke's Health Memorial Livingston | Livingston | $102.36 | $682.38 |
| St. Luke's Health Memorial Lufkin | Lufkin | $102.36 | $682.38 |
| St. Luke's Health Memorial San Augustine | San Augustine | $102.36 | $682.38 |
| Parkland Health | Dallas | $106.40 | $266 |
| Hendrick Medical Center Brownwood | Brownwood | $115.21 | $230.41 |
| Covenant Hospital Levelland | Levelland | $139.02 | $331 |
| Medical City ER White Settlement | Fort Worth | $139.60 | $139.60 |
| Medical City Fort Worth Hospital | Fort Worth | $139.60 | $139.60 |
| Ascension Seton Edgar B. Davis (Ascension Seton) | Luling | $144.72 | $402 |
| Ascension Seton Highland Lakes (Ascension Seton) | Burnet | $144.72 | $402 |
| Methodist Celina Medical Center | Celina | $148.20 | $494 |
| Methodist Dallas Medical Center | Dallas | $148.20 | $494 |
| Methodist Mansfield Medical Center | Mansfield | $148.20 | $494 |
| Methodist Midlothian Medical Center | Midlothian | $148.20 | $494 |
| Methodist Richardson Medical Center | Richardson | $148.20 | $494 |
| Methodist Richardson Medical Center Campus for Continuing Care | Richardson | $148.20 | $494 |
| Methodist Southlake Medical Center | Southlake | $148.20 | $494 |
| Ascension Seton Hays (Ascension Seton) | Kyle | $149.85 | $416.25 |
| Baylor Scott & White Continuing Care Hospital | Temple | $152.30 | $253.84 |
| Baylor Scott & White McLane Children's Medical Center | Temple | $152.30 | $253.84 |
| Baylor Scott & White Medical Center - Brenham | Brenham | $152.30 | $253.84 |
| Baylor Scott & White Medical Center - College Station | College Station | $152.30 | $253.84 |
| Baylor Scott & White Medical Center - Marble Falls | Marble Falls | $152.30 | $253.84 |
| Baylor Scott & White Medical Center - Temple | Temple | $152.30 | $253.84 |
| Baylor Scott & White Medical Center Hillcrest | Waco | $152.30 | $253.84 |
| Baylor Scott & White Pavilion - Temple | Temple | $152.30 | $253.84 |
| Ascension Seton Smithville (Ascension Seton) | Smithville | $155.97 | $433.25 |
| Longview Regional Medical Center | Longview | $164.43 | $609 |
| Covenant Hospital Plainview | Plainview | $168.84 | $402 |
| Baylor Scott & White Emergency Medical Center - Cedar Park | Cedar Park | $193.18 | $321.96 |
| Baylor Scott & White Medical Center - Austin | Austin | $193.18 | $321.96 |
| Baylor Scott & White Medical Center - Buda | Buda | $193.18 | $321.96 |
| Baylor Scott & White Medical Center - Lakeway | Lakeway | $193.18 | $321.96 |
| Baylor Scott & White Medical Center - Pflugerville | Pflugerville | $193.18 | $321.96 |
| Baylor Scott & White Medical Center - Round Rock | Round Rock | $193.18 | $321.96 |
| Baylor Scott & White Medical Center - Taylor | Taylor | $193.18 | $321.96 |
| United Regional Health Care System | Wichita Falls | $202.62 | $228.95 |
| Ascension Seton Medical Center Austin (Ascension Seton) | Austin | $203.31 | $564.75 |
| Ascension Seton Northwest (Ascension Seton) | Austin | $203.31 | $564.75 |
| Ascension Seton Southwest (Ascension Seton) | 1826 Austin | $203.31 | $564.75 |
| Dell Seton Medical Center at The University of Texas (Ascension Seton) | Austin | $203.31 | $564.75 |
| Baylor Scott & White All Saints Medical Center - Fort Worth | Fort Worth | $204.71 | $341.19 |
| Baylor Scott & White Heart and Vascular Hospital - Dallas | Dallas | $204.71 | $341.19 |
| Baylor Scott & White Heart and Vascular Hospital - Waxahachie | Waxahachie | $204.71 | $341.19 |
| Baylor Scott & White Medical Center - Centennial | Frisco | $204.71 | $341.19 |
| Baylor Scott & White Medical Center - Frisco at PGA Parkway | Frisco | $204.71 | $341.19 |
| Baylor Scott & White Medical Center - Grapevine | Grapevine | $204.71 | $341.19 |
| Baylor Scott & White Medical Center - Irving | Irving | $204.71 | $341.19 |
| Baylor Scott & White Medical Center - Lake Pointe | Rowlett | $204.71 | $341.19 |
| Baylor Scott & White Medical Center - McKinney | McKinney | $204.71 | $341.19 |
| Baylor Scott & White Medical Center - Plano | Plano | $204.71 | $341.19 |
| Baylor Scott & White Medical Center - Waxahachie | Waxahachie | $204.71 | $341.19 |
| Baylor Scott & White the Heart Hospital - Denton | Denton | $204.71 | $341.19 |
| Baylor Scott & White the Heart Hospital - McKinney | McKinney | $204.71 | $341.19 |
| Baylor Scott & White the Heart Hospital - Plano | Plano | $204.71 | $341.19 |
| Baylor University Medical Center | Dallas | $204.71 | $341.19 |
| Behavioral Medicine at Renaissance | Edinburg | $246.38 | $246.38 |
| Doctors Hospital at Renaissance | Edinburg | $246.38 | $246.38 |
| Rehab Center at Renaissance | Edinburg | $246.38 | $246.38 |
| Womens Hospitalat Renaissance | Edinburg | $246.38 | $246.38 |
| Shannon Medical Center | San Angelo | $251.50 | $503 |
| Shannon Medical Center Big Spring | Big Spring | $251.50 | $503 |
| Shannon Medical Center South | San Angelo | $251.50 | $503 |
| Shannon Medical Center St John's Campus | San Angelo | $251.50 | $503 |
| Shannon River Crest Hospital | San Angelo | $251.50 | $503 |
| Ascension Seton Cedar Park Hospital | Cedar Park | $255.09 | $708.58 |
| DHR Health Brownsville | Brownsville | $258.70 | $258.70 |
| Hendrick Medical Center | Abilene | $266.10 | $532.19 |
| Hendrick Medical Center South | Abilene | $266.10 | $532.19 |
| Memorial Hermann Greater Heights Hospital | Houston | $267.44 | $835.75 |
| Memorial Hermann Katy Hospital | Katy | $267.44 | $835.75 |
| Memorial Hermann Memorial City Medical Center | Houston | $267.44 | $835.75 |
| Memorial Hermann Northeast Hospital | Humble | $267.44 | $835.75 |
| Memorial Hermann Pearland Hospital | Pearland | $267.44 | $835.75 |
| Memorial Hermann Rehabilitation Hospital-Katy | Katy | $267.44 | $835.75 |
| Memorial Hermann Southeast Hospital | Houston | $267.44 | $835.75 |
| Memorial Hermann Southwest Hospital | Houston | $267.44 | $835.75 |
| Memorial Hermann Sugar Land Hospital | Sugar Land | $267.44 | $835.75 |
| Memorial Hermann The Woodlands Medical Center | The Woodlands | $267.44 | $835.75 |
| TIRR Memorial Hermann | Houston | $267.44 | $835.75 |
| Medical Center Hospital | Odessa | $271 | $271 |
| Medical City Mental Health and Wellness Center Frisco | Frisco | $295.01 | $295.01 |
| Dell Children's Medical Center (Ascension Seton) | Austin | $303.28 | $433.25 |
| Dell Children's Medical Center North Campus (Ascension Seton) | Austin | $303.28 | $433.25 |
| Children's Memorial Hermann Hospital | Houston | $305.68 | $955.25 |
| Memorial Hermann Cypress Hospital | Cypress | $305.68 | $955.25 |
| Memorial Hermann Imaging Center (Bellaire) | Bellaire | $305.68 | $955.25 |
| Memorial Hermann Imaging Center (Cypress) | Cypress | $305.68 | $955.25 |
| Memorial Hermann Imaging Center (Texas Medical Center) | Houston | $305.68 | $955.25 |
| Memorial Hermann Imaging Center (Upper Kirby) | Houston | $305.68 | $955.25 |
| Memorial Hermann Rockets Orthopedic Hospital | Bellaire | $305.68 | $955.25 |
| Memorial Hermann-Texas Medical Center | Houston | $305.68 | $955.25 |
| Medical City Green Oaks Hospital | Dallas | $318.61 | $318.61 |
| Medical City Mental Health and Wellness Center - Alliance | Fort Worth | $318.61 | $318.61 |
| Children's Medical Center of Dallas | Dallas | $326.25 | $435 |
| Children's Medical Center of Plano | Plano | $326.25 | $435 |
| Texas Health Arlington Memorial Hospital | Arlington | $358.50 | $597.50 |
| Texas Health Center for Diagnostics and Surgery Plano | Plano | $358.50 | $597.50 |
| Texas Health Harris Methodist Hospital Alliance | Fort Worth | $358.50 | $597.50 |
| Texas Health Harris Methodist Hospital Azle | Azle | $358.50 | $597.50 |
| Texas Health Harris Methodist Hospital Cleburne | Cleburne | $358.50 | $597.50 |
| Texas Health Harris Methodist Hospital Fort Worth | Fort Worth | $358.50 | $597.50 |
| Texas Health Harris Methodist Hospital Southlake | Southlake | $358.50 | $597.50 |
| Texas Health Harris Methodist Hospital Southwest Fort Worth | Fort Worth | $358.50 | $597.50 |
| Texas Health Harris Methodist Hospital Stephenville | Stephenville | $358.50 | $597.50 |
| Texas Health Heart & Vascular Hospital Arlington | Arlington | $358.50 | $597.50 |
| Texas Health Hospital Clearfork | Fort Worth | $358.50 | $597.50 |
| Texas Health Hospital Frisco | Frisco | $358.50 | $597.50 |
| Texas Health Hospital Rockwall | Rockwall | $358.50 | $597.50 |
| Texas Health Presbyterian Hospital Allen | Allen | $358.50 | $597.50 |
| Texas Health Presbyterian Hospital Dallas | Dallas | $358.50 | $597.50 |
| Texas Health Presbyterian Hospital Denton | Denton | $358.50 | $597.50 |
| Texas Health Presbyterian Hospital Flower Mound | Flower Mound | $358.50 | $597.50 |
| Texas Health Presbyterian Hospital Kaufman | Kaufman | $358.50 | $597.50 |
| Methodist Hospital Atascosa | Jourdanton | $381.52 | $381.52 |
| Methodist Stone Oak Rehabilitation Hospital | San Antonio | $381.52 | $381.52 |
| Cook Children's Medical Center | Fort Worth | $388.33 | $517.77 |
| Texas Health Harris Methodist Hospital Hurst-Euless-Bedford | Bedford | $391.80 | $653 |
| Texas Health Presbyterian Hospital Plano | Plano | $391.80 | $653 |
| Texas Health Specialty Hospital Fort Worth | Fort Worth | $391.80 | $653 |
| Medical City ER Stonebridge | McKinney | $498.82 | $498.82 |
| Medical City McKinney Hospital | McKinney | $498.82 | $498.82 |
| Medical City Frisco Hospital | Frisco | $598.72 | $598.72 |
| Medical City Plano Hospital | Plano | $598.72 | $598.72 |
| Medical City Sachse Hospital | Sachse | $598.72 | $598.72 |
| Round Rock Medical Center | Leander | $807 | $807 |
| St. David's Emergency Center - Leander | Leander | $807 | $807 |
| Medical City Weatherford Hospital | Weatherford | $836.80 | $836.80 |
| Medical City Argyle Hospital | Argyle | $926.04 | $926.04 |
| Medical City Decatur Behavioral Health | Decatur | $926.04 | $926.04 |
| Medical City Decatur Hospital | Decatur | $926.04 | $926.04 |
| Medical City Denton Hospital | Denton | $926.04 | $926.04 |
| Medical City ER Argyle | Denton | $926.04 | $926.04 |
| South Texas Health System Behavioral | Edinburg | $943.50 | $1,258 |
| HCA Houston ER 24/7 - Mission Bend | Houston | $1,045 | $1,045 |
| HCA Houston ER 24/7 - Stafford | Houston | $1,045 | $1,045 |
| HCA Houston ER 24/7 - Westchase | Houston | $1,045 | $1,045 |
| HCA Houston West | Houston | $1,045 | $1,045 |
| Covenant Specialty Hospital | Lubbock | $1,047.48 | $2,494 |
| Heart Hospital of Austin | Austin | $1,106 | $1,106 |
| Heart Hospital of Austin at St. Davids Round Rock | Round Rock | $1,106 | $1,106 |
| St. David's Emergency Center – Manor | Manor | $1,106 | $1,106 |
| St. David's Emergency Center – Mueller | Manor | $1,106 | $1,106 |
| St. David's Emergency Center – Riverside | Manor | $1,106 | $1,106 |
| St. David's Georgetown | Georgetown | $1,106 | $1,106 |
| St. David's Medical Center | Manor | $1,106 | $1,106 |
| St. David's Rehabilitation Hospital | Austin | $1,106 | $1,106 |
| Medical City Lewisville Hospital | Lewisville | $1,107.27 | $1,107.27 |
| Covenant Children's Hospital | Lubbock | $1,141.14 | $2,717 |
| South Austin Medical Center | Bastrop | $1,160 | $1,160 |
| St. David's Emergency Center - Bastrop | Bastrop | $1,160 | $1,160 |
| St. David's Emergency Center - Bee Cave | Bastrop | $1,160 | $1,160 |
| St. David's Emergency Center – South Lamar | Bastrop | $1,160 | $1,160 |
| North Austin Medical Center | Austin | $1,213 | $1,213 |
| St. David's Emergency Center Pflugerville | Austin | $1,213 | $1,213 |
| St. David's Emergency Center – Anderson Mill | Austin | $1,213 | $1,213 |
| St. David's Emergency Center – Arboretum | Austin | $1,213 | $1,213 |
| St. David's Emergency Center – Wells Branch | Austin | $1,213 | $1,213 |
| St. David's Surgical Hospital | Austin | $1,213 | $1,213 |
| Medical City North Hills Hospital | North Richland Hills | $1,245.97 | $1,245.97 |
| HCA Houston ER 24/7 - Cypress/fm 1960 | Houston | $1,335 | $1,335 |
| HCA Houston ER 24/7 – Jersey Village | Houston | $1,335 | $1,335 |
| HCA Houston Tomball | Houston | $1,335 | $1,335 |
| Medical City Alliance Hospital | Fort Worth | $1,428.37 | $1,428.37 |
| Medical City ER Haslet | Fort Worth | $1,428.37 | $1,428.37 |
| Medical City ER Saginaw | Fort Worth | $1,428.37 | $1,428.37 |
| Medical City Surgical Hospital Alliance | Fort Worth | $1,428.37 | $1,428.37 |
| Medical City Las Colinas Hospital | Irving | $1,459.46 | $1,459.46 |
| HCA Houston ER 24/7 - Fort Bend Parkway | Houston | $1,502.01 | $1,502.01 |
| HCA Houston Pearland | Houston | $1,502.01 | $1,502.01 |
| Methodist Childrens Hospital | San Antonio | $1,526.13 | $1,526.13 |
| Methodist ER Alamo Heights | San Antonio | $1,526.13 | $1,526.13 |
| Methodist ER Boerne | San Antonio | $1,526.13 | $1,526.13 |
| Methodist ER Bulverde | Spring Branch | $1,526.13 | $1,526.13 |
| Methodist ER City Base | San Antonio | $1,526.13 | $1,526.13 |
| Methodist ER Converse | San Antonio | $1,526.13 | $1,526.13 |
| Methodist ER De Zavala Rd | San Antonio | $1,526.13 | $1,526.13 |
| Methodist ER Helotes | San Antonio | $1,526.13 | $1,526.13 |
| Methodist ER Legacy Trails | San Antonio | $1,526.13 | $1,526.13 |
| Methodist ER Nacogdoches | San Antonio | $1,526.13 | $1,526.13 |
| Methodist ER Westover Hills | San Antonio | $1,526.13 | $1,526.13 |
| Methodist Hospital | San Antonio | $1,526.13 | $1,526.13 |
| Methodist Hospital Hill Country | Fredericksburg | $1,526.13 | $1,526.13 |
| Methodist Hospital Landmark | San Antonio | $1,526.13 | $1,526.13 |
| Methodist Hospital Stone Oak | Spring Branch | $1,526.13 | $1,526.13 |
| Methodist Hospital Westover Hills | San Antonio | $1,526.13 | $1,526.13 |
| Methodist Rehabilitation Hospital Texsan | San Antonio | $1,526.13 | $1,526.13 |
| Methodist Specialty & Transplant Hospital | San Antonio | $1,526.13 | $1,526.13 |
| Methodist Texsan Hospital | San Antonio | $1,526.13 | $1,526.13 |
| Metropolitan Methodist Hospital | San Antonio | $1,526.13 | $1,526.13 |
| New Braunfels ER | San Antonio | $1,526.13 | $1,526.13 |
| Northeast Methodist Hospital | San Antonio | $1,526.13 | $1,526.13 |
| HCA Houston ER 24/7 Bellaire | Houston | $1,565 | $1,565 |
| HCA Houston ER 24/7 Heights | Houston | $1,565 | $1,565 |
| HCA Houston ER 24/7 Memorial City | Houston | $1,565 | $1,565 |
| HCA Houston ER 24/7 Montrose | Houston | $1,565 | $1,565 |
| HCA Houston Medical Center | Houston | $1,565 | $1,565 |
| HCA Houston ER 24/7 - Atascocita | Humble | $1,622.85 | $1,622.85 |
| HCA Houston ER 24/7 - Cleveland | Humble | $1,622.85 | $1,622.85 |
| HCA Houston ER 24/7 - Fall Creek | Humble | $1,622.85 | $1,622.85 |
| HCA Houston ER 24/7 - Fry Road | Houston | $1,622.85 | $1,622.85 |
| HCA Houston ER 24/7 - Towne Lake | Houston | $1,622.85 | $1,622.85 |
| HCA Houston ER 24/7 Copperfield | Houston | $1,622.85 | $1,622.85 |
| HCA Houston ER 24/7 Willowbrook | Houston | $1,622.85 | $1,622.85 |
| HCA Houston Kingwood | Humble | $1,622.85 | $1,622.85 |
| HCA Houston North Cypress | Houston | $1,622.85 | $1,622.85 |
| HCA Houston Clear Lake | Alvin | $1,726.38 | $1,726.38 |
| HCA Houston ER 24/7 - Alvin | Alvin | $1,726.38 | $1,726.38 |
| HCA Houston ER 24/7 - Friendswood | Alvin | $1,726.38 | $1,726.38 |
| HCA Houston ER 24/7 - Pearland | Alvin | $1,726.38 | $1,726.38 |
| HCA Houston ER 24/7 - Texas City | Alvin | $1,726.38 | $1,726.38 |
| HCA Houston Mainland | Texas City | $1,726.38 | $1,726.38 |
| Medical City Children's Hospital | Garland | $1,734.53 | $1,734.53 |
| Medical City Dallas Hospital | Garland | $1,734.53 | $1,734.53 |
| Medical City ER Garland | Garland | $1,734.53 | $1,734.53 |
| Medical City Heart Hospital | Dallas | $1,734.53 | $1,734.53 |
| Medical City Spine Hospital | Dallas | $1,734.53 | $1,734.53 |
| HCA Houston Conroe | Conroe | $1,806.59 | $1,806.59 |
| ER 24/7 Brownsville | Brownsville | $1,867 | $1,867 |
| ER 24/7 Harlingen | Brownsville | $1,867 | $1,867 |
| Valley Regional Medical Center | Brownsville | $1,867 | $1,867 |
| Medical City Arlington Hospital | Arlington | $1,946.12 | $1,946.12 |
| Medical City ER Grand Prarie | Arlington | $1,946.12 | $1,946.12 |
| Medical City ER Red Oak | Arlington | $1,946.12 | $1,946.12 |
| ER 24/7 Edinburg | Edinburg | $2,045.27 | $2,045.27 |
| ER 24/7 McAllen | Edinburg | $2,045.27 | $2,045.27 |
| ER 24/7 Mission | Edinburg | $2,045.27 | $2,045.27 |
| ER 24/7 San Juan | Edinburg | $2,045.27 | $2,045.27 |
| Rio Grande Regional Hospital | Edinburg | $2,045.27 | $2,045.27 |
| HCA Houston ER 24/7 - Fairmont | Pasadena | $2,850.36 | $2,850.36 |
| HCA Houston ER 24/7 - North Channel | Pasadena | $2,850.36 | $2,850.36 |
| HCA Houston Rehabilitation Hospital Southeast | Pasadena | $2,850.36 | $2,850.36 |
| HCA Houston Southeast | Pasadena | $2,850.36 | $2,850.36 |
| HCA Houston ER 24/7 Fallbrook | Houston | $2,919 | $2,919 |
| HCA Houston ER 24/7 Spring | Houston | $2,919 | $2,919 |
| HCA Houston Northwest | Houston | $2,919 | $2,919 |
| CHRISTUS Santa Rosa Hospital - San Marcos | San Marcos | Not published | Not published |
| Cook Children's Medical Center - Prosper | Prosper | Not published | Not published |
| Northwest Emergency at Eastern, a Service of Northwest Texas Healthcare System | Amarillo | Not published | $263 |
| Northwest Emergency at Tascosa, a Service of Northwest Texas Healthcare System | Amarillo | Not published | $263 |
| Northwest Emergency at Town Square, a Service of Northwest Texas Healthcare System | Amarillo | Not published | $263 |
| Northwest Emergency on Georgia, a Service of Northwest Texas Healthcare System | Amarillo | Not published | $263 |
| Northwest Texas Healthcare System | Amarillo | Not published | $263 |
| Northwest Texas Healthcare System Behavioral Health | Amarillo | Not published | $637 |
| Northwest Texas Healthcare System Surgery Center | Amarillo | Not published | $637 |
| University of Texas MD Anderson Cancer Center | Houston | Not published | $287 |
