White Rock Medical Center

All Charges

Charge

Type

Setting

Price

225 - v34 MSDRG

Facility

$49,199.74

Service Code	MSDRG 225
Hospital Charge Code	225
Min. Negotiated Rate	$49,199.74
Max. Negotiated Rate	$49,199.74
Rate for Payer: BCBS of TX Blue Advantage	$49,199.74

225 - v36 MSDRG

Facility

$65,578.64

Service Code	MSDRG 225
Hospital Charge Code	2251
Min. Negotiated Rate	$59,018.49
Max. Negotiated Rate	$65,578.64
Rate for Payer: BCBS of TX Blue Essentials	$59,018.49
Rate for Payer: BCBS of TX PPO	$65,578.64

226 - v34 MSDRG

Facility

$59,292.70

Service Code	MSDRG 226
Hospital Charge Code	226
Min. Negotiated Rate	$59,292.70
Max. Negotiated Rate	$59,292.70
Rate for Payer: BCBS of TX Blue Advantage	$59,292.70

226 - v36 MSDRG

Facility

$78,177.48

Service Code	MSDRG 226
Hospital Charge Code	2261
Min. Negotiated Rate	$70,357.01
Max. Negotiated Rate	$78,177.48
Rate for Payer: BCBS of TX Blue Essentials	$70,357.01
Rate for Payer: BCBS of TX PPO	$78,177.48

227 - v34 MSDRG

Facility

$46,921.60

Service Code	MSDRG 227
Hospital Charge Code	227
Min. Negotiated Rate	$46,921.60
Max. Negotiated Rate	$46,921.60
Rate for Payer: BCBS of TX Blue Advantage	$46,921.60

227 - v36 MSDRG

Facility

$60,961.28

Service Code	MSDRG 227
Hospital Charge Code	2271
Min. Negotiated Rate	$54,863.03
Max. Negotiated Rate	$60,961.28
Rate for Payer: BCBS of TX Blue Essentials	$54,863.03
Rate for Payer: BCBS of TX PPO	$60,961.28

246 - v34 MSDRG

Facility

$27,971.50

Service Code	MSDRG 246
Hospital Charge Code	246
Min. Negotiated Rate	$27,971.50
Max. Negotiated Rate	$27,971.50
Rate for Payer: BCBS of TX Blue Advantage	$27,971.50

246 - v36 MSDRG

Facility

$37,136.08

Service Code	MSDRG 246
Hospital Charge Code	2461
Min. Negotiated Rate	$33,421.18
Max. Negotiated Rate	$37,136.08
Rate for Payer: BCBS of TX Blue Essentials	$33,421.18
Rate for Payer: BCBS of TX PPO	$37,136.08

247 - v34 MSDRG

Facility

$18,254.36

Service Code	MSDRG 247
Hospital Charge Code	247
Min. Negotiated Rate	$18,254.36
Max. Negotiated Rate	$18,254.36
Rate for Payer: BCBS of TX Blue Advantage	$18,254.36

247 - v36 MSDRG

Facility

$23,816.03

Service Code	MSDRG 247
Hospital Charge Code	2471
Min. Negotiated Rate	$21,433.59
Max. Negotiated Rate	$23,816.03
Rate for Payer: BCBS of TX Blue Essentials	$21,433.59
Rate for Payer: BCBS of TX PPO	$23,816.03

248 - v34 MSDRG

Facility

$26,182.70

Service Code	MSDRG 248
Hospital Charge Code	248
Min. Negotiated Rate	$26,182.70
Max. Negotiated Rate	$26,182.70
Rate for Payer: BCBS of TX Blue Advantage	$26,182.70

248 - v36 MSDRG

Facility

$36,377.03

Service Code	MSDRG 248
Hospital Charge Code	2481
Min. Negotiated Rate	$32,738.06
Max. Negotiated Rate	$36,377.03
Rate for Payer: BCBS of TX Blue Essentials	$32,738.06
Rate for Payer: BCBS of TX PPO	$36,377.03

249 - v34 MSDRG

Facility

$16,647.88

Service Code	MSDRG 249
Hospital Charge Code	249
Min. Negotiated Rate	$16,647.88
Max. Negotiated Rate	$16,647.88
Rate for Payer: BCBS of TX Blue Advantage	$16,647.88

249 - v36 MSDRG

Facility

$22,818.49

Service Code	MSDRG 249
Hospital Charge Code	2491
Min. Negotiated Rate	$20,535.84
Max. Negotiated Rate	$22,818.49
Rate for Payer: BCBS of TX Blue Essentials	$20,535.84
Rate for Payer: BCBS of TX PPO	$22,818.49

25-Hydroxyvitamin D LCMS D2+D3 SO

Facility

$521.00

Service Code	CPT 82306
Hospital Charge Code	1620104
Hospital Revenue Code	301
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$338.65
Rate for Payer: Aetna Commercial	$31.08
Rate for Payer: Aetna Medicare	$44.40
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	$48.84
Rate for Payer: BCBS of TX Blue Essentials	$58.61
Rate for Payer: BCBS of TX Medicare	$29.60
Rate for Payer: BCBS of TX PPO	$65.42
Rate for Payer: Cash Price	$458.48
Rate for Payer: Cash Price	$458.48
Rate for Payer: Cigna Medicaid	$29.60
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	$29.60
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	$29.60
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	$29.60
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

30 Day Event Monitor Recording 93270

Facility

$522.71

Service Code	CPT 93270
Hospital Charge Code	2800076
Hospital Revenue Code	480
Rate for Payer: Cash Price	$459.98

30 Day Event Monitor Recording 93270

Facility

$522.71

Service Code	CPT 93270
Hospital Charge Code	2800076
Hospital Revenue Code	480
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$339.76
Rate for Payer: Aetna Commercial	$14.16
Rate for Payer: Aetna Medicare	$51.74
Rate for Payer: Amerigroup CHIP/Medicaid	$47.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$34.49
Rate for Payer: Amerigroup Medicare	$34.49
Rate for Payer: BCBS of TX Blue Advantage	$63.08
Rate for Payer: BCBS of TX Blue Essentials	$75.40
Rate for Payer: BCBS of TX Medicare	$34.49
Rate for Payer: BCBS of TX PPO	$84.10
Rate for Payer: Cash Price	$459.98
Rate for Payer: Cash Price	$459.98
Rate for Payer: Cash Price	$459.98
Rate for Payer: Cigna Commercial	$78.13
Rate for Payer: Cigna Medicare	$34.49
Rate for Payer: Employer Direct Commercial	$34.49
Rate for Payer: Humana Medicare/TRICARE	$34.49
Rate for Payer: Molina Dual Medicare/Medicaid	$34.49
Rate for Payer: Molina Medicare	$34.49
Rate for Payer: Multiplan Auto	$339.76
Rate for Payer: Multiplan Commercial	$339.76
Rate for Payer: Multiplan Workers Comp	$339.76
Rate for Payer: Scott and White EPO/PPO	$0.62
Rate for Payer: Scott and White Medicare	$34.49
Rate for Payer: Superior Health Plan EPO	$34.49
Rate for Payer: Superior Health Plan Medicare	$34.49
Rate for Payer: Universal American Dual Medicare/Medicaid	$34.49
Rate for Payer: Universal American Medicare	$34.49
Rate for Payer: Wellcare Medicare	$34.49
Rate for Payer: Wellmed Medicare	$34.49

338 - v34 MSDRG

Facility

$24,635.56

Service Code	MSDRG 338
Hospital Charge Code	338
Min. Negotiated Rate	$24,635.56
Max. Negotiated Rate	$24,635.56
Rate for Payer: BCBS of TX Blue Advantage	$24,635.56

338 - v36 MSDRG

Facility

$32,847.80

Service Code	MSDRG 338
Hospital Charge Code	3381
Min. Negotiated Rate	$29,561.87
Max. Negotiated Rate	$32,847.80
Rate for Payer: BCBS of TX Blue Essentials	$29,561.87
Rate for Payer: BCBS of TX PPO	$32,847.80

339 - v34 MSDRG

Facility

$14,512.50

Service Code	MSDRG 339
Hospital Charge Code	339
Min. Negotiated Rate	$14,512.50
Max. Negotiated Rate	$14,512.50
Rate for Payer: BCBS of TX Blue Advantage	$14,512.50

339 - v36 MSDRG

Facility

$19,957.72

Service Code	MSDRG 339
Hospital Charge Code	3391
Min. Negotiated Rate	$17,961.25
Max. Negotiated Rate	$19,957.72
Rate for Payer: BCBS of TX Blue Essentials	$17,961.25
Rate for Payer: BCBS of TX PPO	$19,957.72

340 - v34 MSDRG

Facility

$10,410.30

Service Code	MSDRG 340
Hospital Charge Code	340
Min. Negotiated Rate	$10,410.30
Max. Negotiated Rate	$10,410.30
Rate for Payer: BCBS of TX Blue Advantage	$10,410.30

340 - v36 MSDRG

Facility

$13,619.31

Service Code	MSDRG 340
Hospital Charge Code	3401
Min. Negotiated Rate	$12,256.91
Max. Negotiated Rate	$13,619.31
Rate for Payer: BCBS of TX Blue Essentials	$12,256.91
Rate for Payer: BCBS of TX PPO	$13,619.31

341 - v34 MSDRG

Facility

$19,104.04

Service Code	MSDRG 341
Hospital Charge Code	341
Min. Negotiated Rate	$19,104.04
Max. Negotiated Rate	$19,104.04
Rate for Payer: BCBS of TX Blue Advantage	$19,104.04

341 - v36 MSDRG

Facility

$26,194.08

Service Code	MSDRG 341
Hospital Charge Code	3411
Min. Negotiated Rate	$23,573.76
Max. Negotiated Rate	$26,194.08
Rate for Payer: BCBS of TX Blue Essentials	$23,573.76
Rate for Payer: BCBS of TX PPO	$26,194.08

Know your out-of-pocket cost for care.

All Charges