White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CEMT BN INJECT -- DHF

Facility

$3,558.00

Service Code	HCPCS C1713
Hospital Charge Code	81735086
Hospital Revenue Code	278
Min. Negotiated Rate	$320.22
Max. Negotiated Rate	$2,561.76
Rate for Payer: Amerigroup CHIP/Medicaid	$320.22
Rate for Payer: BCBS of TX Blue Advantage	$1,067.40
Rate for Payer: BCBS of TX Blue Essentials	$1,280.88
Rate for Payer: BCBS of TX PPO	$1,423.20
Rate for Payer: Cash Price	$2,419.44
Rate for Payer: Cigna Medicaid	$2,561.76
Rate for Payer: Molina CHIP/Medicaid	$2,561.76
Rate for Payer: Multiplan Auto	$1,779.00
Rate for Payer: Multiplan Commercial	$1,779.00
Rate for Payer: Multiplan Workers Comp	$1,779.00
Rate for Payer: Parkland Medicaid	$2,561.76
Rate for Payer: Scott and White EPO/PPO	$1,779.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,561.76
Rate for Payer: Superior Health Plan EPO	$483.89

CEMT BN INJECT -- DHF

Facility

$3,558.00

Service Code	HCPCS C1713
Hospital Charge Code	81735086
Hospital Revenue Code	278
Min. Negotiated Rate	$889.50
Max. Negotiated Rate	$1,779.00
Rate for Payer: Cash Price	$2,419.44
Rate for Payer: Cigna Commercial	$889.50
Rate for Payer: Multiplan Auto	$1,779.00
Rate for Payer: Multiplan Commercial	$1,779.00
Rate for Payer: Multiplan Workers Comp	$1,779.00
Rate for Payer: Scott and White EPO/PPO	$1,779.00

CEMT BN W/ANTIBIOTIC -- DHF

Facility

$1,491.00

Service Code	HCPCS C1713
Hospital Charge Code	81315228
Hospital Revenue Code	278
Min. Negotiated Rate	$372.75
Max. Negotiated Rate	$745.50
Rate for Payer: Cash Price	$1,013.88
Rate for Payer: Cigna Commercial	$372.75
Rate for Payer: Multiplan Auto	$745.50
Rate for Payer: Multiplan Commercial	$745.50
Rate for Payer: Multiplan Workers Comp	$745.50
Rate for Payer: Scott and White EPO/PPO	$745.50

CEMT BN W/ANTIBIOTIC -- DHF

Facility

$1,491.00

Service Code	HCPCS C1713
Hospital Charge Code	81315228
Hospital Revenue Code	278
Min. Negotiated Rate	$134.19
Max. Negotiated Rate	$1,073.52
Rate for Payer: Amerigroup CHIP/Medicaid	$134.19
Rate for Payer: BCBS of TX Blue Advantage	$447.30
Rate for Payer: BCBS of TX Blue Essentials	$536.76
Rate for Payer: BCBS of TX PPO	$596.40
Rate for Payer: Cash Price	$1,013.88
Rate for Payer: Cigna Medicaid	$1,073.52
Rate for Payer: Molina CHIP/Medicaid	$1,073.52
Rate for Payer: Multiplan Auto	$745.50
Rate for Payer: Multiplan Commercial	$745.50
Rate for Payer: Multiplan Workers Comp	$745.50
Rate for Payer: Parkland Medicaid	$1,073.52
Rate for Payer: Scott and White EPO/PPO	$745.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,073.52
Rate for Payer: Superior Health Plan EPO	$202.78

CEMT CARTRIDGE -- DHF

Facility

$2,207.79

Hospital Charge Code	81735151
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,501.30

CEMT CARTRIDGE -- DHF

Facility

$2,207.79

Hospital Charge Code	81735151
Hospital Revenue Code	272
Min. Negotiated Rate	$198.70
Max. Negotiated Rate	$1,589.61
Rate for Payer: Amerigroup CHIP/Medicaid	$198.70
Rate for Payer: BCBS of TX Blue Advantage	$662.34
Rate for Payer: BCBS of TX Blue Essentials	$794.80
Rate for Payer: BCBS of TX PPO	$883.12
Rate for Payer: Cash Price	$1,501.30
Rate for Payer: Cigna Medicaid	$1,589.61
Rate for Payer: Molina CHIP/Medicaid	$1,589.61
Rate for Payer: Multiplan Auto	$1,435.06
Rate for Payer: Multiplan Commercial	$1,435.06
Rate for Payer: Multiplan Workers Comp	$1,435.06
Rate for Payer: Parkland Medicaid	$1,589.61
Rate for Payer: Scott and White EPO/PPO	$1,103.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,589.61
Rate for Payer: Superior Health Plan EPO	$300.26

CEMT MIX-E-VAL -- DHF

Facility

$469.81

Hospital Charge Code	81735409
Hospital Revenue Code	272
Min. Negotiated Rate	$42.28
Max. Negotiated Rate	$338.26
Rate for Payer: Amerigroup CHIP/Medicaid	$42.28
Rate for Payer: BCBS of TX Blue Advantage	$140.94
Rate for Payer: BCBS of TX Blue Essentials	$169.13
Rate for Payer: BCBS of TX PPO	$187.92
Rate for Payer: Cash Price	$319.47
Rate for Payer: Cigna Medicaid	$338.26
Rate for Payer: Molina CHIP/Medicaid	$338.26
Rate for Payer: Multiplan Auto	$305.38
Rate for Payer: Multiplan Commercial	$305.38
Rate for Payer: Multiplan Workers Comp	$305.38
Rate for Payer: Parkland Medicaid	$338.26
Rate for Payer: Scott and White EPO/PPO	$234.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$338.26
Rate for Payer: Superior Health Plan EPO	$63.89

CEMT MIX-E-VAL -- DHF

Facility

$469.81

Hospital Charge Code	81735409
Hospital Revenue Code	272
Rate for Payer: Cash Price	$319.47

CEMT RESTRC RG -- DHF

Facility

$279.14

Hospital Charge Code	81735607
Hospital Revenue Code	272
Min. Negotiated Rate	$25.12
Max. Negotiated Rate	$200.98
Rate for Payer: Amerigroup CHIP/Medicaid	$25.12
Rate for Payer: BCBS of TX Blue Advantage	$83.74
Rate for Payer: BCBS of TX Blue Essentials	$100.49
Rate for Payer: BCBS of TX PPO	$111.66
Rate for Payer: Cash Price	$189.82
Rate for Payer: Cigna Medicaid	$200.98
Rate for Payer: Molina CHIP/Medicaid	$200.98
Rate for Payer: Multiplan Auto	$181.44
Rate for Payer: Multiplan Commercial	$181.44
Rate for Payer: Multiplan Workers Comp	$181.44
Rate for Payer: Parkland Medicaid	$200.98
Rate for Payer: Scott and White EPO/PPO	$139.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$200.98
Rate for Payer: Superior Health Plan EPO	$37.96

CEMT RESTRC RG -- DHF

Facility

$279.14

Hospital Charge Code	81735607
Hospital Revenue Code	272
Rate for Payer: Cash Price	$189.82

cephalexin 125 mg/5 mL Oral Liquid 100 mL

Facility

$40.00

Service Code	HCPCS J3490
Hospital Charge Code	77451451
Hospital Revenue Code	250
Rate for Payer: Cash Price	$27.20

cephalexin 125 mg/5 mL Oral Liquid 100 mL

Facility

$40.00

Service Code	HCPCS J3490
Hospital Charge Code	77451451
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$28.80
Rate for Payer: Amerigroup CHIP/Medicaid	$3.60
Rate for Payer: BCBS of TX Blue Advantage	$12.00
Rate for Payer: BCBS of TX Blue Essentials	$14.40
Rate for Payer: BCBS of TX PPO	$16.00
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cigna Medicaid	$28.80
Rate for Payer: Molina CHIP/Medicaid	$28.80
Rate for Payer: Multiplan Auto	$26.00
Rate for Payer: Multiplan Commercial	$26.00
Rate for Payer: Multiplan Workers Comp	$26.00
Rate for Payer: Parkland Medicaid	$28.80
Rate for Payer: Scott and White EPO/PPO	$20.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$28.80
Rate for Payer: Superior Health Plan EPO	$5.44

cephalexin 250 mg capsule

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77451557
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$5.51
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.29
Rate for Payer: BCBS of TX Blue Essentials	$2.75
Rate for Payer: BCBS of TX PPO	$3.06
Rate for Payer: Cash Price	$5.20
Rate for Payer: Cigna Medicaid	$5.51
Rate for Payer: Molina CHIP/Medicaid	$5.51
Rate for Payer: Multiplan Auto	$4.97
Rate for Payer: Multiplan Commercial	$4.97
Rate for Payer: Multiplan Workers Comp	$4.97
Rate for Payer: Parkland Medicaid	$5.51
Rate for Payer: Scott and White EPO/PPO	$3.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.51
Rate for Payer: Superior Health Plan EPO	$1.04

cephalexin 250 mg capsule

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77451557
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

cephalexin 500 mg Cap

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77451769
Hospital Revenue Code	450
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$3,520.00
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.29
Rate for Payer: BCBS of TX Blue Essentials	$2.75
Rate for Payer: BCBS of TX PPO	$3,520.00
Rate for Payer: Cash Price	$5.20
Rate for Payer: Cash Price	$5.20
Rate for Payer: Cigna Medicaid	$5.51
Rate for Payer: Molina CHIP/Medicaid	$5.51
Rate for Payer: Multiplan Auto	$4.97
Rate for Payer: Multiplan Commercial	$4.97
Rate for Payer: Multiplan Workers Comp	$4.97
Rate for Payer: Parkland Medicaid	$5.51
Rate for Payer: Scott and White EPO/PPO	$3.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.51
Rate for Payer: Superior Health Plan EPO	$1.04

cephalexin 500 mg Cap

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77451769
Hospital Revenue Code	450
Rate for Payer: Cash Price	$5.20

Ceramic femoral head

Facility

$6,626.51

Service Code	HCPCS C1734
Hospital Charge Code	992209
Hospital Revenue Code	278
Min. Negotiated Rate	$1,656.63
Max. Negotiated Rate	$3,313.26
Rate for Payer: Cash Price	$4,506.03
Rate for Payer: Cigna Commercial	$1,656.63
Rate for Payer: Multiplan Auto	$3,313.26
Rate for Payer: Multiplan Commercial	$3,313.26
Rate for Payer: Multiplan Workers Comp	$3,313.26
Rate for Payer: Scott and White EPO/PPO	$3,313.26

Ceramic femoral head

Facility

$6,626.51

Service Code	HCPCS C1734
Hospital Charge Code	992209
Hospital Revenue Code	278
Min. Negotiated Rate	$596.39
Max. Negotiated Rate	$4,771.09
Rate for Payer: Amerigroup CHIP/Medicaid	$596.39
Rate for Payer: BCBS of TX Blue Advantage	$1,987.95
Rate for Payer: BCBS of TX Blue Essentials	$2,385.54
Rate for Payer: BCBS of TX PPO	$2,650.60
Rate for Payer: Cash Price	$4,506.03
Rate for Payer: Cigna Medicaid	$4,771.09
Rate for Payer: Molina CHIP/Medicaid	$4,771.09
Rate for Payer: Multiplan Auto	$3,313.26
Rate for Payer: Multiplan Commercial	$3,313.26
Rate for Payer: Multiplan Workers Comp	$3,313.26
Rate for Payer: Parkland Medicaid	$4,771.09
Rate for Payer: Scott and White EPO/PPO	$3,313.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,771.09
Rate for Payer: Superior Health Plan EPO	$901.21

Cerebrospinal Fluid Culture

Facility

$309.00

Service Code	HCPCS 87070
Hospital Charge Code	4107078
Hospital Revenue Code	306
Rate for Payer: Cash Price	$210.12

Cerebrospinal Fluid Culture

Facility

$309.00

Service Code	HCPCS 87070
Hospital Charge Code	4107078
Hospital Revenue Code	306
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$222.48
Rate for Payer: Amerigroup CHIP/Medicaid	$3.36
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8.62
Rate for Payer: Amerigroup Medicare	$8.62
Rate for Payer: BCBS of TX Blue Advantage	$92.70
Rate for Payer: BCBS of TX Blue Essentials	$111.24
Rate for Payer: BCBS of TX Medicare	$8.62
Rate for Payer: BCBS of TX PPO	$123.60
Rate for Payer: Cash Price	$210.12
Rate for Payer: Cash Price	$210.12
Rate for Payer: Cigna Medicaid	$222.48
Rate for Payer: Cigna Medicare	$8.62
Rate for Payer: Employer Direct Commercial	$8.62
Rate for Payer: Humana Medicare/TRICARE	$8.62
Rate for Payer: Molina CHIP/Medicaid	$222.48
Rate for Payer: Molina Dual Medicare/Medicaid	$8.62
Rate for Payer: Molina Medicare	$8.62
Rate for Payer: Multiplan Auto	$200.85
Rate for Payer: Multiplan Commercial	$200.85
Rate for Payer: Multiplan Workers Comp	$200.85
Rate for Payer: Parkland Medicaid	$222.48
Rate for Payer: Scott and White EPO/PPO	$10.78
Rate for Payer: Scott and White Medicare	$8.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$222.48
Rate for Payer: Superior Health Plan EPO	$8.62
Rate for Payer: Superior Health Plan Medicare	$8.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$8.62
Rate for Payer: Universal American Medicare	$8.62
Rate for Payer: Wellcare Medicare	$8.62
Rate for Payer: Wellmed Medicare	$8.62

Ceruloplasmin SO

Facility

$155.00

Service Code	HCPCS 82390
Hospital Charge Code	1701325
Hospital Revenue Code	301
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$111.60
Rate for Payer: Amerigroup CHIP/Medicaid	$4.19
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10.74
Rate for Payer: Amerigroup Medicare	$10.74
Rate for Payer: BCBS of TX Blue Advantage	$46.50
Rate for Payer: BCBS of TX Blue Essentials	$55.80
Rate for Payer: BCBS of TX Medicare	$10.74
Rate for Payer: BCBS of TX PPO	$62.00
Rate for Payer: Cash Price	$105.40
Rate for Payer: Cash Price	$105.40
Rate for Payer: Cigna Medicaid	$111.60
Rate for Payer: Cigna Medicare	$10.74
Rate for Payer: Employer Direct Commercial	$10.74
Rate for Payer: Humana Medicare/TRICARE	$10.74
Rate for Payer: Molina CHIP/Medicaid	$111.60
Rate for Payer: Molina Dual Medicare/Medicaid	$10.74
Rate for Payer: Molina Medicare	$10.74
Rate for Payer: Multiplan Auto	$100.75
Rate for Payer: Multiplan Commercial	$100.75
Rate for Payer: Multiplan Workers Comp	$100.75
Rate for Payer: Parkland Medicaid	$111.60
Rate for Payer: Scott and White EPO/PPO	$13.43
Rate for Payer: Scott and White Medicare	$10.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$111.60
Rate for Payer: Superior Health Plan EPO	$10.74
Rate for Payer: Superior Health Plan Medicare	$10.74
Rate for Payer: Universal American Dual Medicare/Medicaid	$10.74
Rate for Payer: Universal American Medicare	$10.74
Rate for Payer: Wellcare Medicare	$10.74
Rate for Payer: Wellmed Medicare	$10.74

Ceruloplasmin SO

Facility

$155.00

Service Code	HCPCS 82390
Hospital Charge Code	1701325
Hospital Revenue Code	301
Rate for Payer: Cash Price	$105.40

Cervical Ripening Method -> Double balloon catheter

Facility

$891.00

Service Code	HCPCS 59200
Hospital Charge Code	300277
Hospital Revenue Code	361
Rate for Payer: Cash Price	$605.88

Cervical Ripening Method -> Double balloon catheter

Facility

$891.00

Service Code	HCPCS 59200
Hospital Charge Code	300277
Hospital Revenue Code	361
Min. Negotiated Rate	$80.19
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$80.19
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$306.12
Rate for Payer: Amerigroup Medicare	$306.12
Rate for Payer: BCBS of TX Blue Advantage	$94.02
Rate for Payer: BCBS of TX Blue Essentials	$112.60
Rate for Payer: BCBS of TX Medicare	$306.12
Rate for Payer: BCBS of TX PPO	$141.88
Rate for Payer: Cash Price	$605.88
Rate for Payer: Cash Price	$605.88
Rate for Payer: Cash Price	$605.88
Rate for Payer: Cigna Commercial	$647.08
Rate for Payer: Cigna Medicaid	$641.52
Rate for Payer: Cigna Medicare	$306.12
Rate for Payer: Employer Direct Commercial	$306.12
Rate for Payer: Humana Medicare/TRICARE	$306.12
Rate for Payer: Molina CHIP/Medicaid	$641.52
Rate for Payer: Molina Dual Medicare/Medicaid	$306.12
Rate for Payer: Molina Medicare	$306.12
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	$641.52
Rate for Payer: Scott and White EPO/PPO	$542.77
Rate for Payer: Scott and White Medicare	$306.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$641.52
Rate for Payer: Superior Health Plan EPO	$306.12
Rate for Payer: Superior Health Plan Medicare	$306.12
Rate for Payer: Universal American Dual Medicare/Medicaid	$306.12
Rate for Payer: Universal American Medicare	$306.12
Rate for Payer: Wellcare Medicare	$306.12
Rate for Payer: Wellmed Medicare	$306.12

CERVICAL SPINAL FUSION W CC

Facility

$58,349.00

Service Code	MSDRG 472
Min. Negotiated Rate	$25,342.48
Max. Negotiated Rate	$58,349.00
Rate for Payer: BCBS of TX Blue Advantage	$25,342.48
Rate for Payer: BCBS of TX Blue Essentials	$30,408.03
Rate for Payer: BCBS of TX PPO	$33,788.01

Know your out-of-pocket cost for care.

All Charges