White Rock Medical Center

All Charges

Charge

Type

Setting

Price

ENDOSTITCH SUTURE DEVICE

Facility

$1,955.55

Hospital Charge Code	8538527
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,720.88

Endotracheal Intubation Emergency Procedure

Facility

$1,049.00

Service Code	CPT 31500
Hospital Charge Code	300533
Hospital Revenue Code	361
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$576.95
Rate for Payer: Aetna Medicare	$335.08
Rate for Payer: Amerigroup CHIP/Medicaid	$87.58
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$223.39
Rate for Payer: Amerigroup Medicare	$223.39
Rate for Payer: BCBS of TX Blue Advantage	$340.08
Rate for Payer: BCBS of TX Blue Essentials	$407.28
Rate for Payer: BCBS of TX Medicare	$223.39
Rate for Payer: BCBS of TX PPO	$513.17
Rate for Payer: Cash Price	$923.12
Rate for Payer: Cash Price	$923.12
Rate for Payer: Cash Price	$923.12
Rate for Payer: Cigna Commercial	$506.05
Rate for Payer: Cigna Medicaid	$87.58
Rate for Payer: Cigna Medicare	$223.39
Rate for Payer: Employer Direct Commercial	$223.39
Rate for Payer: Humana Medicare/TRICARE	$223.39
Rate for Payer: Molina CHIP/Medicaid	$87.58
Rate for Payer: Molina Dual Medicare/Medicaid	$223.39
Rate for Payer: Molina Medicare	$223.39
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	$87.58
Rate for Payer: Scott and White EPO/PPO	$4.93
Rate for Payer: Scott and White Medicare	$223.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$87.58
Rate for Payer: Superior Health Plan EPO	$223.39
Rate for Payer: Superior Health Plan Medicare	$223.39
Rate for Payer: Universal American Dual Medicare/Medicaid	$223.39
Rate for Payer: Universal American Medicare	$223.39
Rate for Payer: Wellcare Medicare	$223.39
Rate for Payer: Wellmed Medicare	$223.39

Endotracheal Intubation Emergency Procedure

Facility

$1,049.00

Service Code	CPT 31500
Hospital Charge Code	300533
Hospital Revenue Code	361
Rate for Payer: Cash Price	$923.12

ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC

Facility

$118,675.90

Service Code	MSDRG 266
Min. Negotiated Rate	$47,427.33
Max. Negotiated Rate	$118,675.90
Rate for Payer: Aetna Commercial	$70,268.62
Rate for Payer: Aetna Medicare	$71,141.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$47,427.33
Rate for Payer: Amerigroup Medicare	$47,427.33
Rate for Payer: BCBS of TX Blue Advantage	$72,182.38
Rate for Payer: BCBS of TX Blue Essentials	$74,209.09
Rate for Payer: BCBS of TX Medicare	$47,427.33
Rate for Payer: BCBS of TX PPO	$82,457.74
Rate for Payer: Cigna Commercial	$80,449.77
Rate for Payer: Cigna Medicare	$47,427.33
Rate for Payer: Employer Direct Commercial	$47,427.33
Rate for Payer: Humana Medicare/TRICARE	$47,427.33
Rate for Payer: Molina Dual Medicare/Medicaid	$47,427.33
Rate for Payer: Molina Medicare	$47,427.33
Rate for Payer: Multiplan Auto	$118,675.90
Rate for Payer: Multiplan Commercial	$118,675.90
Rate for Payer: Multiplan Workers Comp	$118,675.90
Rate for Payer: Scott and White EPO/PPO	$54,653.38
Rate for Payer: Scott and White Medicare	$47,427.33
Rate for Payer: Superior Health Plan EPO	$47,427.33
Rate for Payer: Superior Health Plan Medicare	$47,427.33
Rate for Payer: Universal American Dual Medicare/Medicaid	$47,427.33
Rate for Payer: Universal American Medicare	$47,427.33
Rate for Payer: Wellcare Medicare	$47,427.33
Rate for Payer: Wellmed Medicare	$47,427.33

ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC

Facility

$92,723.80

Service Code	MSDRG 267
Min. Negotiated Rate	$37,680.18
Max. Negotiated Rate	$92,723.80
Rate for Payer: Aetna Commercial	$54,902.25
Rate for Payer: Aetna Medicare	$56,520.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$37,680.18
Rate for Payer: Amerigroup Medicare	$37,680.18
Rate for Payer: BCBS of TX Blue Advantage	$55,659.20
Rate for Payer: BCBS of TX Blue Essentials	$60,346.54
Rate for Payer: BCBS of TX Medicare	$37,680.18
Rate for Payer: BCBS of TX PPO	$67,054.31
Rate for Payer: Cigna Commercial	$62,856.98
Rate for Payer: Cigna Medicare	$37,680.18
Rate for Payer: Employer Direct Commercial	$37,680.18
Rate for Payer: Humana Medicare/TRICARE	$37,680.18
Rate for Payer: Molina Dual Medicare/Medicaid	$37,680.18
Rate for Payer: Molina Medicare	$37,680.18
Rate for Payer: Multiplan Auto	$92,723.80
Rate for Payer: Multiplan Commercial	$92,723.80
Rate for Payer: Multiplan Workers Comp	$92,723.80
Rate for Payer: Scott and White EPO/PPO	$42,701.75
Rate for Payer: Scott and White Medicare	$37,680.18
Rate for Payer: Superior Health Plan EPO	$37,680.18
Rate for Payer: Superior Health Plan Medicare	$37,680.18
Rate for Payer: Universal American Dual Medicare/Medicaid	$37,680.18
Rate for Payer: Universal American Medicare	$37,680.18
Rate for Payer: Wellcare Medicare	$37,680.18
Rate for Payer: Wellmed Medicare	$37,680.18

ENEMA ADMIN ST -- DHF

Facility

$87.80

Hospital Charge Code	80321508
Hospital Revenue Code	270
Rate for Payer: Cash Price	$77.26

ENEMA ADMIN ST -- DHF

Facility

$87.80

Hospital Charge Code	80321508
Hospital Revenue Code	270
Min. Negotiated Rate	$7.90
Max. Negotiated Rate	$57.07
Rate for Payer: Aetna Commercial	$48.29
Rate for Payer: Amerigroup CHIP/Medicaid	$7.90
Rate for Payer: BCBS of TX Blue Advantage	$26.34
Rate for Payer: BCBS of TX Blue Essentials	$31.61
Rate for Payer: BCBS of TX PPO	$35.12
Rate for Payer: Cash Price	$77.26
Rate for Payer: Multiplan Auto	$57.07
Rate for Payer: Multiplan Commercial	$57.07
Rate for Payer: Multiplan Workers Comp	$57.07
Rate for Payer: Scott and White EPO/PPO	$43.90
Rate for Payer: Superior Health Plan EPO	$11.94

enoxaparin 100 mg/mL Inj Soln 1 mL

Facility

$128.17

Service Code	HCPCS J1650
Hospital Charge Code	77545925
Hospital Revenue Code	636
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$83.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$1.77
Rate for Payer: BCBS of TX Blue Essentials	$2.12
Rate for Payer: BCBS of TX PPO	$2.35
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cash Price	$87.16
Rate for Payer: Multiplan Auto	$83.31
Rate for Payer: Multiplan Commercial	$83.31
Rate for Payer: Multiplan Workers Comp	$83.31
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan EPO	$17.43

enoxaparin 100 mg/mL Inj Soln 1 mL

Facility

$128.17

Service Code	HCPCS J1650
Hospital Charge Code	77545925
Hospital Revenue Code	636
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$64.08
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cigna Commercial	$32.04
Rate for Payer: Scott and White EPO/PPO	$64.08

enoxaparin 120 mg/0.8 mL Inj Soln 0.8 mL

Facility

$128.17

Service Code	HCPCS J1650
Hospital Charge Code	77545982
Hospital Revenue Code	636
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$64.08
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cigna Commercial	$32.04
Rate for Payer: Scott and White EPO/PPO	$64.08

enoxaparin 120 mg/0.8 mL Inj Soln 0.8 mL

Facility

$128.17

Service Code	HCPCS J1650
Hospital Charge Code	77545982
Hospital Revenue Code	636
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$83.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$1.77
Rate for Payer: BCBS of TX Blue Essentials	$2.12
Rate for Payer: BCBS of TX PPO	$2.35
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cash Price	$87.16
Rate for Payer: Multiplan Auto	$83.31
Rate for Payer: Multiplan Commercial	$83.31
Rate for Payer: Multiplan Workers Comp	$83.31
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan EPO	$17.43

enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL

Facility

$128.17

Service Code	HCPCS J1650
Hospital Charge Code	77546094
Hospital Revenue Code	636
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$64.08
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cigna Commercial	$32.04
Rate for Payer: Scott and White EPO/PPO	$64.08

enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL

Facility

$128.17

Service Code	HCPCS J1650
Hospital Charge Code	77546094
Hospital Revenue Code	636
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$83.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$1.77
Rate for Payer: BCBS of TX Blue Essentials	$2.12
Rate for Payer: BCBS of TX PPO	$2.35
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cash Price	$87.16
Rate for Payer: Multiplan Auto	$83.31
Rate for Payer: Multiplan Commercial	$83.31
Rate for Payer: Multiplan Workers Comp	$83.31
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan EPO	$17.43

enoxaparin 40 mg/0.4 mL Inj Soln 0.4 mL

Facility

$128.17

Service Code	HCPCS J1650
Hospital Charge Code	77546202
Hospital Revenue Code	636
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$83.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$1.77
Rate for Payer: BCBS of TX Blue Essentials	$2.12
Rate for Payer: BCBS of TX PPO	$2.35
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cash Price	$87.16
Rate for Payer: Multiplan Auto	$83.31
Rate for Payer: Multiplan Commercial	$83.31
Rate for Payer: Multiplan Workers Comp	$83.31
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan EPO	$17.43

enoxaparin 40 mg/0.4 mL Inj Soln 0.4 mL

Facility

$128.17

Service Code	HCPCS J1650
Hospital Charge Code	77546202
Hospital Revenue Code	636
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$64.08
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cigna Commercial	$32.04
Rate for Payer: Scott and White EPO/PPO	$64.08

enoxaparin 60 mg/0.6 mL Inj Soln 0.6 mL

Facility

$128.17

Service Code	HCPCS J1650
Hospital Charge Code	77546257
Hospital Revenue Code	636
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$64.08
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cigna Commercial	$32.04
Rate for Payer: Scott and White EPO/PPO	$64.08

enoxaparin 60 mg/0.6 mL Inj Soln 0.6 mL

Facility

$128.17

Service Code	HCPCS J1650
Hospital Charge Code	77546257
Hospital Revenue Code	636
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$83.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$1.77
Rate for Payer: BCBS of TX Blue Essentials	$2.12
Rate for Payer: BCBS of TX PPO	$2.35
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cash Price	$87.16
Rate for Payer: Multiplan Auto	$83.31
Rate for Payer: Multiplan Commercial	$83.31
Rate for Payer: Multiplan Workers Comp	$83.31
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan EPO	$17.43

enoxaparin 80 mg/0.8 mL Inj Soln 0.8 mL

Facility

$128.17

Service Code	HCPCS J1650
Hospital Charge Code	77546312
Hospital Revenue Code	636
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$83.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$1.77
Rate for Payer: BCBS of TX Blue Essentials	$2.12
Rate for Payer: BCBS of TX PPO	$2.35
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cash Price	$87.16
Rate for Payer: Multiplan Auto	$83.31
Rate for Payer: Multiplan Commercial	$83.31
Rate for Payer: Multiplan Workers Comp	$83.31
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan EPO	$17.43

enoxaparin 80 mg/0.8 mL Inj Soln 0.8 mL

Facility

$128.17

Service Code	HCPCS J1650
Hospital Charge Code	77546312
Hospital Revenue Code	636
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$64.08
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cigna Commercial	$32.04
Rate for Payer: Scott and White EPO/PPO	$64.08

ENSEAL X1 CURVED JAW 45CM

Facility

$2,225.74

Hospital Charge Code	8720598
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,958.65

ENSEAL X1 CURVED JAW 45CM

Facility

$2,225.74

Hospital Charge Code	8720598
Hospital Revenue Code	272
Min. Negotiated Rate	$200.32
Max. Negotiated Rate	$1,446.73
Rate for Payer: Aetna Commercial	$1,224.16
Rate for Payer: Amerigroup CHIP/Medicaid	$200.32
Rate for Payer: BCBS of TX Blue Advantage	$667.72
Rate for Payer: BCBS of TX Blue Essentials	$801.27
Rate for Payer: BCBS of TX PPO	$890.30
Rate for Payer: Cash Price	$1,958.65
Rate for Payer: Multiplan Auto	$1,446.73
Rate for Payer: Multiplan Commercial	$1,446.73
Rate for Payer: Multiplan Workers Comp	$1,446.73
Rate for Payer: Scott and White EPO/PPO	$1,112.87
Rate for Payer: Superior Health Plan EPO	$302.70

Enterotomy, small intestine, other than duodenum; for decompression (eg, Baker tube)

Facility

$10,000.00

Service Code	CPT 44021
Hospital Charge Code	36044021
Hospital Revenue Code	360
Min. Negotiated Rate	$1,703.25
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$4,017.00
Rate for Payer: BCBS of TX Blue Advantage	$1,703.25
Rate for Payer: BCBS of TX Blue Essentials	$2,039.82
Rate for Payer: BCBS of TX PPO	$2,570.17
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

Enterovirus RT-PCR SO

Facility

$243.00

Service Code	CPT 87498
Hospital Charge Code	1720028
Hospital Revenue Code	300
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$157.95
Rate for Payer: Aetna Commercial	$36.84
Rate for Payer: Aetna Medicare	$52.64
Rate for Payer: Amerigroup CHIP/Medicaid	$13.69
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$35.09
Rate for Payer: Amerigroup Medicare	$35.09
Rate for Payer: BCBS of TX Blue Advantage	$57.90
Rate for Payer: BCBS of TX Blue Essentials	$69.48
Rate for Payer: BCBS of TX Medicare	$35.09
Rate for Payer: BCBS of TX PPO	$77.55
Rate for Payer: Cash Price	$213.84
Rate for Payer: Cash Price	$213.84
Rate for Payer: Cigna Medicaid	$35.09
Rate for Payer: Cigna Medicare	$35.09
Rate for Payer: Employer Direct Commercial	$35.09
Rate for Payer: Humana Medicare/TRICARE	$35.09
Rate for Payer: Molina CHIP/Medicaid	$35.09
Rate for Payer: Molina Dual Medicare/Medicaid	$35.09
Rate for Payer: Molina Medicare	$35.09
Rate for Payer: Multiplan Auto	$157.95
Rate for Payer: Multiplan Commercial	$157.95
Rate for Payer: Multiplan Workers Comp	$157.95
Rate for Payer: Parkland Medicaid	$35.09
Rate for Payer: Scott and White EPO/PPO	$43.86
Rate for Payer: Scott and White Medicare	$35.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$35.09
Rate for Payer: Superior Health Plan EPO	$35.09
Rate for Payer: Superior Health Plan Medicare	$35.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$35.09
Rate for Payer: Universal American Medicare	$35.09
Rate for Payer: Wellcare Medicare	$35.09
Rate for Payer: Wellmed Medicare	$35.09

Enterovirus RT-PCR SO

Facility

$243.00

Service Code	CPT 87498
Hospital Charge Code	1720028
Hospital Revenue Code	300
Rate for Payer: Cash Price	$213.84

ENTRY REAMER

Facility

$681.00

Hospital Charge Code	145216
Hospital Revenue Code	272
Rate for Payer: Cash Price	$599.28

Know your out-of-pocket cost for care.

All Charges