White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CONTROL, CLINITEX, UF-II, EACH

Facility

$2,734.81

Hospital Charge Code	993352
Hospital Revenue Code	270
Rate for Payer: Cash Price	$1,859.67

CONTROL, CLINITEX, UF-II, EACH

Facility

$2,734.81

Hospital Charge Code	993352
Hospital Revenue Code	270
Min. Negotiated Rate	$246.13
Max. Negotiated Rate	$1,969.06
Rate for Payer: Amerigroup CHIP/Medicaid	$246.13
Rate for Payer: BCBS of TX Blue Advantage	$820.44
Rate for Payer: BCBS of TX Blue Essentials	$984.53
Rate for Payer: BCBS of TX PPO	$1,093.92
Rate for Payer: Cash Price	$1,859.67
Rate for Payer: Cigna Medicaid	$1,969.06
Rate for Payer: Molina CHIP/Medicaid	$1,969.06
Rate for Payer: Multiplan Auto	$1,777.63
Rate for Payer: Multiplan Commercial	$1,777.63
Rate for Payer: Multiplan Workers Comp	$1,777.63
Rate for Payer: Parkland Medicaid	$1,969.06
Rate for Payer: Scott and White EPO/PPO	$1,367.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,969.06
Rate for Payer: Superior Health Plan EPO	$371.93

CONTROL, LINEARITY W/TUBE

Facility

$1,311.61

Hospital Charge Code	993804
Hospital Revenue Code	270
Min. Negotiated Rate	$118.04
Max. Negotiated Rate	$944.36
Rate for Payer: Amerigroup CHIP/Medicaid	$118.04
Rate for Payer: BCBS of TX Blue Advantage	$393.48
Rate for Payer: BCBS of TX Blue Essentials	$472.18
Rate for Payer: BCBS of TX PPO	$524.64
Rate for Payer: Cash Price	$891.89
Rate for Payer: Cigna Medicaid	$944.36
Rate for Payer: Molina CHIP/Medicaid	$944.36
Rate for Payer: Multiplan Auto	$852.55
Rate for Payer: Multiplan Commercial	$852.55
Rate for Payer: Multiplan Workers Comp	$852.55
Rate for Payer: Parkland Medicaid	$944.36
Rate for Payer: Scott and White EPO/PPO	$655.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$944.36
Rate for Payer: Superior Health Plan EPO	$178.38

CONTROL, LINEARITY W/TUBE

Facility

$1,311.61

Hospital Charge Code	993804
Hospital Revenue Code	270
Rate for Payer: Cash Price	$891.89

CONTRST EVAL EXISTNG CVD

Facility

$921.00

Service Code	HCPCS 36598
Hospital Charge Code	4616598
Hospital Revenue Code	361
Rate for Payer: Cash Price	$626.28

CONTRST EVAL EXISTNG CVD

Facility

$921.00

Service Code	HCPCS 36598
Hospital Charge Code	4616598
Hospital Revenue Code	361
Min. Negotiated Rate	$79.46
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$79.46
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$213.67
Rate for Payer: Amerigroup Medicare	$213.67
Rate for Payer: BCBS of TX Blue Advantage	$155.04
Rate for Payer: BCBS of TX Blue Essentials	$185.68
Rate for Payer: BCBS of TX Medicare	$213.67
Rate for Payer: BCBS of TX PPO	$233.96
Rate for Payer: Cash Price	$626.28
Rate for Payer: Cash Price	$626.28
Rate for Payer: Cash Price	$626.28
Rate for Payer: Cigna Commercial	$451.67
Rate for Payer: Cigna Medicaid	$663.12
Rate for Payer: Cigna Medicare	$213.67
Rate for Payer: Employer Direct Commercial	$213.67
Rate for Payer: Humana Medicare/TRICARE	$213.67
Rate for Payer: Molina CHIP/Medicaid	$663.12
Rate for Payer: Molina Dual Medicare/Medicaid	$213.67
Rate for Payer: Molina Medicare	$213.67
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	$663.12
Rate for Payer: Scott and White EPO/PPO	$362.64
Rate for Payer: Scott and White Medicare	$213.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$663.12
Rate for Payer: Superior Health Plan EPO	$213.67
Rate for Payer: Superior Health Plan Medicare	$213.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$213.67
Rate for Payer: Universal American Medicare	$213.67
Rate for Payer: Wellcare Medicare	$213.67
Rate for Payer: Wellmed Medicare	$213.67

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$18,333.65

Service Code	APR-DRG 3844
Min. Negotiated Rate	$17,285.61
Max. Negotiated Rate	$18,333.65
Rate for Payer: Amerigroup CHIP/Medicaid	$17,285.61
Rate for Payer: Cigna Medicaid	$17,285.61
Rate for Payer: Molina CHIP/Medicaid	$17,285.61
Rate for Payer: Parkland Medicaid	$17,285.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18,333.65

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$3,925.03

Service Code	APR-DRG 3842
Min. Negotiated Rate	$3,700.65
Max. Negotiated Rate	$3,925.03
Rate for Payer: Amerigroup CHIP/Medicaid	$3,700.65
Rate for Payer: Cigna Medicaid	$3,700.65
Rate for Payer: Molina CHIP/Medicaid	$3,700.65
Rate for Payer: Parkland Medicaid	$3,700.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,925.03

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$2,409.86

Service Code	APR-DRG 3841
Min. Negotiated Rate	$2,272.10
Max. Negotiated Rate	$2,409.86
Rate for Payer: Amerigroup CHIP/Medicaid	$2,272.10
Rate for Payer: Cigna Medicaid	$2,272.10
Rate for Payer: Molina CHIP/Medicaid	$2,272.10
Rate for Payer: Parkland Medicaid	$2,272.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,409.86

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$5,918.47

Service Code	APR-DRG 3843
Min. Negotiated Rate	$5,580.14
Max. Negotiated Rate	$5,918.47
Rate for Payer: Amerigroup CHIP/Medicaid	$5,580.14
Rate for Payer: Cigna Medicaid	$5,580.14
Rate for Payer: Molina CHIP/Medicaid	$5,580.14
Rate for Payer: Parkland Medicaid	$5,580.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,918.47

Copier Paper

Facility

$16.74

Hospital Charge Code	993191
Hospital Revenue Code	270
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$12.05
Rate for Payer: Amerigroup CHIP/Medicaid	$1.51
Rate for Payer: BCBS of TX Blue Advantage	$5.02
Rate for Payer: BCBS of TX Blue Essentials	$6.03
Rate for Payer: BCBS of TX PPO	$6.70
Rate for Payer: Cash Price	$11.38
Rate for Payer: Cigna Medicaid	$12.05
Rate for Payer: Molina CHIP/Medicaid	$12.05
Rate for Payer: Multiplan Auto	$10.88
Rate for Payer: Multiplan Commercial	$10.88
Rate for Payer: Multiplan Workers Comp	$10.88
Rate for Payer: Parkland Medicaid	$12.05
Rate for Payer: Scott and White EPO/PPO	$8.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.05
Rate for Payer: Superior Health Plan EPO	$2.28

Copier Paper

Facility

$16.74

Hospital Charge Code	993191
Hospital Revenue Code	270
Rate for Payer: Cash Price	$11.38

Copper, Urine SO

Facility

$148.00

Service Code	HCPCS 82525
Hospital Charge Code	1700426
Hospital Revenue Code	301
Rate for Payer: Cash Price	$100.64

Copper, Urine SO

Facility

$148.00

Service Code	HCPCS 82525
Hospital Charge Code	1700426
Hospital Revenue Code	301
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$106.56
Rate for Payer: Amerigroup CHIP/Medicaid	$4.84
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12.41
Rate for Payer: Amerigroup Medicare	$12.41
Rate for Payer: BCBS of TX Blue Advantage	$44.40
Rate for Payer: BCBS of TX Blue Essentials	$53.28
Rate for Payer: BCBS of TX Medicare	$12.41
Rate for Payer: BCBS of TX PPO	$59.20
Rate for Payer: Cash Price	$100.64
Rate for Payer: Cash Price	$100.64
Rate for Payer: Cigna Medicaid	$106.56
Rate for Payer: Cigna Medicare	$12.41
Rate for Payer: Employer Direct Commercial	$12.41
Rate for Payer: Humana Medicare/TRICARE	$12.41
Rate for Payer: Molina CHIP/Medicaid	$106.56
Rate for Payer: Molina Dual Medicare/Medicaid	$12.41
Rate for Payer: Molina Medicare	$12.41
Rate for Payer: Multiplan Auto	$96.20
Rate for Payer: Multiplan Commercial	$96.20
Rate for Payer: Multiplan Workers Comp	$96.20
Rate for Payer: Parkland Medicaid	$106.56
Rate for Payer: Scott and White EPO/PPO	$15.51
Rate for Payer: Scott and White Medicare	$12.41
Rate for Payer: Superior Health Plan CHIP/Medicaid	$106.56
Rate for Payer: Superior Health Plan EPO	$12.41
Rate for Payer: Superior Health Plan Medicare	$12.41
Rate for Payer: Universal American Dual Medicare/Medicaid	$12.41
Rate for Payer: Universal American Medicare	$12.41
Rate for Payer: Wellcare Medicare	$12.41
Rate for Payer: Wellmed Medicare	$12.41

COR ANGIO CATH INLUD INJ IMAG

Facility

$19,325.00

Service Code	HCPCS 93454
Hospital Charge Code	2320523
Hospital Revenue Code	481
Rate for Payer: Cash Price	$13,141.00

COR ANGIO CATH INLUD INJ IMAG

Facility

$19,325.00

Service Code	HCPCS 93454
Hospital Charge Code	2320523
Hospital Revenue Code	481
Min. Negotiated Rate	$1,098.04
Max. Negotiated Rate	$13,914.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,739.25
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,256.70
Rate for Payer: Amerigroup Medicare	$3,256.70
Rate for Payer: BCBS of TX Blue Advantage	$4,759.42
Rate for Payer: BCBS of TX Blue Essentials	$5,699.90
Rate for Payer: BCBS of TX Medicare	$3,256.70
Rate for Payer: BCBS of TX PPO	$7,181.87
Rate for Payer: Cash Price	$13,141.00
Rate for Payer: Cash Price	$13,141.00
Rate for Payer: Cash Price	$13,141.00
Rate for Payer: Cigna Commercial	$6,884.08
Rate for Payer: Cigna Medicaid	$13,914.00
Rate for Payer: Cigna Medicare	$3,256.70
Rate for Payer: Employer Direct Commercial	$3,256.70
Rate for Payer: Humana Medicare/TRICARE	$3,256.70
Rate for Payer: Molina CHIP/Medicaid	$13,914.00
Rate for Payer: Molina Dual Medicare/Medicaid	$3,256.70
Rate for Payer: Molina Medicare	$3,256.70
Rate for Payer: Multiplan Auto	$12,561.25
Rate for Payer: Multiplan Commercial	$12,561.25
Rate for Payer: Multiplan Workers Comp	$12,561.25
Rate for Payer: Parkland Medicaid	$13,914.00
Rate for Payer: Scott and White EPO/PPO	$1,098.04
Rate for Payer: Scott and White Medicare	$3,256.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13,914.00
Rate for Payer: Superior Health Plan EPO	$3,256.70
Rate for Payer: Superior Health Plan Medicare	$3,256.70
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,256.70
Rate for Payer: Universal American Medicare	$3,256.70
Rate for Payer: Wellcare Medicare	$3,256.70
Rate for Payer: Wellmed Medicare	$3,256.70

COR ANGIO CATH+LT HT CATH+LVCG+GRAF

Facility

$22,774.00

Service Code	HCPCS 93459
Hospital Charge Code	2320528
Hospital Revenue Code	481
Rate for Payer: Cash Price	$15,486.32

COR ANGIO CATH+LT HT CATH+LVCG+GRAF

Facility

$22,774.00

Service Code	HCPCS 93459
Hospital Charge Code	2320528
Hospital Revenue Code	481
Min. Negotiated Rate	$1,358.15
Max. Negotiated Rate	$16,397.28
Rate for Payer: Amerigroup CHIP/Medicaid	$2,049.66
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,256.70
Rate for Payer: Amerigroup Medicare	$3,256.70
Rate for Payer: BCBS of TX Blue Advantage	$4,759.42
Rate for Payer: BCBS of TX Blue Essentials	$5,699.90
Rate for Payer: BCBS of TX Medicare	$3,256.70
Rate for Payer: BCBS of TX PPO	$7,181.87
Rate for Payer: Cash Price	$15,486.32
Rate for Payer: Cash Price	$15,486.32
Rate for Payer: Cash Price	$15,486.32
Rate for Payer: Cigna Commercial	$6,884.08
Rate for Payer: Cigna Medicaid	$16,397.28
Rate for Payer: Cigna Medicare	$3,256.70
Rate for Payer: Employer Direct Commercial	$3,256.70
Rate for Payer: Humana Medicare/TRICARE	$3,256.70
Rate for Payer: Molina CHIP/Medicaid	$16,397.28
Rate for Payer: Molina Dual Medicare/Medicaid	$3,256.70
Rate for Payer: Molina Medicare	$3,256.70
Rate for Payer: Multiplan Auto	$14,803.10
Rate for Payer: Multiplan Commercial	$14,803.10
Rate for Payer: Multiplan Workers Comp	$14,803.10
Rate for Payer: Parkland Medicaid	$16,397.28
Rate for Payer: Scott and White EPO/PPO	$1,358.15
Rate for Payer: Scott and White Medicare	$3,256.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,397.28
Rate for Payer: Superior Health Plan EPO	$3,256.70
Rate for Payer: Superior Health Plan Medicare	$3,256.70
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,256.70
Rate for Payer: Universal American Medicare	$3,256.70
Rate for Payer: Wellcare Medicare	$3,256.70
Rate for Payer: Wellmed Medicare	$3,256.70

CORD BI-POLAR -- DHF

Facility

$198.05

Hospital Charge Code	81739005
Hospital Revenue Code	272
Min. Negotiated Rate	$17.82
Max. Negotiated Rate	$142.60
Rate for Payer: Amerigroup CHIP/Medicaid	$17.82
Rate for Payer: BCBS of TX Blue Advantage	$59.41
Rate for Payer: BCBS of TX Blue Essentials	$71.30
Rate for Payer: BCBS of TX PPO	$79.22
Rate for Payer: Cash Price	$134.67
Rate for Payer: Cigna Medicaid	$142.60
Rate for Payer: Molina CHIP/Medicaid	$142.60
Rate for Payer: Multiplan Auto	$128.73
Rate for Payer: Multiplan Commercial	$128.73
Rate for Payer: Multiplan Workers Comp	$128.73
Rate for Payer: Parkland Medicaid	$142.60
Rate for Payer: Scott and White EPO/PPO	$99.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$142.60
Rate for Payer: Superior Health Plan EPO	$26.93

CORD BI-POLAR -- DHF

Facility

$198.05

Hospital Charge Code	81739005
Hospital Revenue Code	272
Rate for Payer: Cash Price	$134.67

CORD DISP -- DHF

Facility

$722.01

Hospital Charge Code	80318504
Hospital Revenue Code	270
Rate for Payer: Cash Price	$490.97

CORD DISP -- DHF

Facility

$722.01

Hospital Charge Code	80318504
Hospital Revenue Code	270
Min. Negotiated Rate	$64.98
Max. Negotiated Rate	$519.85
Rate for Payer: Amerigroup CHIP/Medicaid	$64.98
Rate for Payer: BCBS of TX Blue Advantage	$216.60
Rate for Payer: BCBS of TX Blue Essentials	$259.92
Rate for Payer: BCBS of TX PPO	$288.80
Rate for Payer: Cash Price	$490.97
Rate for Payer: Cigna Medicaid	$519.85
Rate for Payer: Molina CHIP/Medicaid	$519.85
Rate for Payer: Multiplan Auto	$469.31
Rate for Payer: Multiplan Commercial	$469.31
Rate for Payer: Multiplan Workers Comp	$469.31
Rate for Payer: Parkland Medicaid	$519.85
Rate for Payer: Scott and White EPO/PPO	$361.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$519.85
Rate for Payer: Superior Health Plan EPO	$98.19

CORD, FOR BIPOLAR FORCEPS 12' DISPOSABLE STERILE -- DHF

Facility

$75.90

Hospital Charge Code	81739021
Hospital Revenue Code	270
Rate for Payer: Cash Price	$51.61

CORD, FOR BIPOLAR FORCEPS 12' DISPOSABLE STERILE -- DHF

Facility

$75.90

Hospital Charge Code	81739021
Hospital Revenue Code	270
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$54.65
Rate for Payer: Amerigroup CHIP/Medicaid	$6.83
Rate for Payer: BCBS of TX Blue Advantage	$22.77
Rate for Payer: BCBS of TX Blue Essentials	$27.32
Rate for Payer: BCBS of TX PPO	$30.36
Rate for Payer: Cash Price	$51.61
Rate for Payer: Cigna Medicaid	$54.65
Rate for Payer: Molina CHIP/Medicaid	$54.65
Rate for Payer: Multiplan Auto	$49.34
Rate for Payer: Multiplan Commercial	$49.34
Rate for Payer: Multiplan Workers Comp	$49.34
Rate for Payer: Parkland Medicaid	$54.65
Rate for Payer: Scott and White EPO/PPO	$37.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$54.65
Rate for Payer: Superior Health Plan EPO	$10.32

CORO CATH ANGIO+RT HT CATH

Facility

$23,666.00

Service Code	HCPCS 93456
Hospital Charge Code	2320525
Hospital Revenue Code	481
Min. Negotiated Rate	$1,365.97
Max. Negotiated Rate	$17,039.52
Rate for Payer: Amerigroup CHIP/Medicaid	$2,129.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,256.70
Rate for Payer: Amerigroup Medicare	$3,256.70
Rate for Payer: BCBS of TX Blue Advantage	$4,759.42
Rate for Payer: BCBS of TX Blue Essentials	$5,699.90
Rate for Payer: BCBS of TX Medicare	$3,256.70
Rate for Payer: BCBS of TX PPO	$7,181.87
Rate for Payer: Cash Price	$16,092.88
Rate for Payer: Cash Price	$16,092.88
Rate for Payer: Cash Price	$16,092.88
Rate for Payer: Cigna Commercial	$6,884.08
Rate for Payer: Cigna Medicaid	$17,039.52
Rate for Payer: Cigna Medicare	$3,256.70
Rate for Payer: Employer Direct Commercial	$3,256.70
Rate for Payer: Humana Medicare/TRICARE	$3,256.70
Rate for Payer: Molina CHIP/Medicaid	$17,039.52
Rate for Payer: Molina Dual Medicare/Medicaid	$3,256.70
Rate for Payer: Molina Medicare	$3,256.70
Rate for Payer: Multiplan Auto	$15,382.90
Rate for Payer: Multiplan Commercial	$15,382.90
Rate for Payer: Multiplan Workers Comp	$15,382.90
Rate for Payer: Parkland Medicaid	$17,039.52
Rate for Payer: Scott and White EPO/PPO	$1,365.97
Rate for Payer: Scott and White Medicare	$3,256.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17,039.52
Rate for Payer: Superior Health Plan EPO	$3,256.70
Rate for Payer: Superior Health Plan Medicare	$3,256.70
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,256.70
Rate for Payer: Universal American Medicare	$3,256.70
Rate for Payer: Wellcare Medicare	$3,256.70
Rate for Payer: Wellmed Medicare	$3,256.70

Know your out-of-pocket cost for care.

All Charges