White Rock Medical Center

All Charges

Charge

Type

Setting

Price

ELCTRD PACING -- DHF

Facility

$340.05

Hospital Charge Code	82030552
Hospital Revenue Code	271
Rate for Payer: Cash Price	$231.23

ELCTRD PACING -- DHF

Facility

$340.05

Hospital Charge Code	82030552
Hospital Revenue Code	271
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$244.84
Rate for Payer: Amerigroup CHIP/Medicaid	$30.60
Rate for Payer: BCBS of TX Blue Advantage	$102.02
Rate for Payer: BCBS of TX Blue Essentials	$122.42
Rate for Payer: BCBS of TX PPO	$136.02
Rate for Payer: Cash Price	$231.23
Rate for Payer: Cigna Medicaid	$244.84
Rate for Payer: Molina CHIP/Medicaid	$244.84
Rate for Payer: Multiplan Auto	$221.03
Rate for Payer: Multiplan Commercial	$221.03
Rate for Payer: Multiplan Workers Comp	$221.03
Rate for Payer: Parkland Medicaid	$244.84
Rate for Payer: Scott and White EPO/PPO	$170.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$244.84
Rate for Payer: Superior Health Plan EPO	$46.25

ELECTIVE HIP JOINT REPLACEMENT

Facility

$7,280.50

Service Code	APR-DRG 3241
Min. Negotiated Rate	$6,864.31
Max. Negotiated Rate	$7,280.50
Rate for Payer: Amerigroup CHIP/Medicaid	$6,864.31
Rate for Payer: Cigna Medicaid	$6,864.31
Rate for Payer: Molina CHIP/Medicaid	$6,864.31
Rate for Payer: Parkland Medicaid	$6,864.31
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,280.50

ELECTIVE HIP JOINT REPLACEMENT

Facility

$18,983.92

Service Code	APR-DRG 3244
Min. Negotiated Rate	$17,898.71
Max. Negotiated Rate	$18,983.92
Rate for Payer: Amerigroup CHIP/Medicaid	$17,898.71
Rate for Payer: Cigna Medicaid	$17,898.71
Rate for Payer: Molina CHIP/Medicaid	$17,898.71
Rate for Payer: Parkland Medicaid	$17,898.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18,983.92

ELECTIVE HIP JOINT REPLACEMENT

Facility

$7,652.79

Service Code	APR-DRG 3242
Min. Negotiated Rate	$7,215.32
Max. Negotiated Rate	$7,652.79
Rate for Payer: Amerigroup CHIP/Medicaid	$7,215.32
Rate for Payer: Cigna Medicaid	$7,215.32
Rate for Payer: Molina CHIP/Medicaid	$7,215.32
Rate for Payer: Parkland Medicaid	$7,215.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,652.79

ELECTIVE HIP JOINT REPLACEMENT

Facility

$13,244.99

Service Code	APR-DRG 3243
Min. Negotiated Rate	$12,487.84
Max. Negotiated Rate	$13,244.99
Rate for Payer: Amerigroup CHIP/Medicaid	$12,487.84
Rate for Payer: Cigna Medicaid	$12,487.84
Rate for Payer: Molina CHIP/Medicaid	$12,487.84
Rate for Payer: Parkland Medicaid	$12,487.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13,244.99

ELECTIVE KNEE JOINT REPLACEMENT

Facility

$16,436.01

Service Code	APR-DRG 3264
Min. Negotiated Rate	$15,496.45
Max. Negotiated Rate	$16,436.01
Rate for Payer: Amerigroup CHIP/Medicaid	$15,496.45
Rate for Payer: Cigna Medicaid	$15,496.45
Rate for Payer: Molina CHIP/Medicaid	$15,496.45
Rate for Payer: Parkland Medicaid	$15,496.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,436.01

ELECTIVE KNEE JOINT REPLACEMENT

Facility

$6,682.66

Service Code	APR-DRG 3261
Min. Negotiated Rate	$6,300.64
Max. Negotiated Rate	$6,682.66
Rate for Payer: Amerigroup CHIP/Medicaid	$6,300.64
Rate for Payer: Cigna Medicaid	$6,300.64
Rate for Payer: Molina CHIP/Medicaid	$6,300.64
Rate for Payer: Parkland Medicaid	$6,300.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,682.66

ELECTIVE KNEE JOINT REPLACEMENT

Facility

$9,805.78

Service Code	APR-DRG 3263
Min. Negotiated Rate	$9,245.24
Max. Negotiated Rate	$9,805.78
Rate for Payer: Amerigroup CHIP/Medicaid	$9,245.24
Rate for Payer: Cigna Medicaid	$9,245.24
Rate for Payer: Molina CHIP/Medicaid	$9,245.24
Rate for Payer: Parkland Medicaid	$9,245.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,805.78

ELECTIVE KNEE JOINT REPLACEMENT

Facility

$7,079.84

Service Code	APR-DRG 3262
Min. Negotiated Rate	$6,675.12
Max. Negotiated Rate	$7,079.84
Rate for Payer: Amerigroup CHIP/Medicaid	$6,675.12
Rate for Payer: Cigna Medicaid	$6,675.12
Rate for Payer: Molina CHIP/Medicaid	$6,675.12
Rate for Payer: Parkland Medicaid	$6,675.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,079.84

ELECTRODE, ABLATION HIP SUCTION COOLPULSE 90 -- DHF

Facility

$908.00

Hospital Charge Code	80826449
Hospital Revenue Code	272
Rate for Payer: Cash Price	$617.44

ELECTRODE, ABLATION HIP SUCTION COOLPULSE 90 -- DHF

Facility

$908.00

Hospital Charge Code	80826449
Hospital Revenue Code	272
Min. Negotiated Rate	$81.72
Max. Negotiated Rate	$653.76
Rate for Payer: Amerigroup CHIP/Medicaid	$81.72
Rate for Payer: BCBS of TX Blue Advantage	$272.40
Rate for Payer: BCBS of TX Blue Essentials	$326.88
Rate for Payer: BCBS of TX PPO	$363.20
Rate for Payer: Cash Price	$617.44
Rate for Payer: Cigna Medicaid	$653.76
Rate for Payer: Molina CHIP/Medicaid	$653.76
Rate for Payer: Multiplan Auto	$590.20
Rate for Payer: Multiplan Commercial	$590.20
Rate for Payer: Multiplan Workers Comp	$590.20
Rate for Payer: Parkland Medicaid	$653.76
Rate for Payer: Scott and White EPO/PPO	$454.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$653.76
Rate for Payer: Superior Health Plan EPO	$123.49

ELECTRODE, BLADE EXTENDED 6.50' STERILE DISPOSABLE -- DHF

Facility

$27.56

Hospital Charge Code	81723272
Hospital Revenue Code	272
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$19.84
Rate for Payer: Amerigroup CHIP/Medicaid	$2.48
Rate for Payer: BCBS of TX Blue Advantage	$8.27
Rate for Payer: BCBS of TX Blue Essentials	$9.92
Rate for Payer: BCBS of TX PPO	$11.02
Rate for Payer: Cash Price	$18.74
Rate for Payer: Cigna Medicaid	$19.84
Rate for Payer: Molina CHIP/Medicaid	$19.84
Rate for Payer: Multiplan Auto	$17.91
Rate for Payer: Multiplan Commercial	$17.91
Rate for Payer: Multiplan Workers Comp	$17.91
Rate for Payer: Parkland Medicaid	$19.84
Rate for Payer: Scott and White EPO/PPO	$13.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$19.84
Rate for Payer: Superior Health Plan EPO	$3.75

ELECTRODE, BLADE EXTENDED 6.50' STERILE DISPOSABLE -- DHF

Facility

$27.56

Hospital Charge Code	81723272
Hospital Revenue Code	272
Rate for Payer: Cash Price	$18.74

ELECTRODE, DISPERSIVE DUAL FOIL W/10' CABLE DISP -- DHF

Facility

$33.71

Hospital Charge Code	82121799
Hospital Revenue Code	270
Rate for Payer: Cash Price	$22.92

ELECTRODE, DISPERSIVE DUAL FOIL W/10' CABLE DISP -- DHF

Facility

$33.71

Hospital Charge Code	82121799
Hospital Revenue Code	270
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$24.27
Rate for Payer: Amerigroup CHIP/Medicaid	$3.03
Rate for Payer: BCBS of TX Blue Advantage	$10.11
Rate for Payer: BCBS of TX Blue Essentials	$12.14
Rate for Payer: BCBS of TX PPO	$13.48
Rate for Payer: Cash Price	$22.92
Rate for Payer: Cigna Medicaid	$24.27
Rate for Payer: Molina CHIP/Medicaid	$24.27
Rate for Payer: Multiplan Auto	$21.91
Rate for Payer: Multiplan Commercial	$21.91
Rate for Payer: Multiplan Workers Comp	$21.91
Rate for Payer: Parkland Medicaid	$24.27
Rate for Payer: Scott and White EPO/PPO	$16.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$24.27
Rate for Payer: Superior Health Plan EPO	$4.58

ELECTRODE, ECG, RESTNG, TABSTYL, 10/CARD

Facility

$0.20

Hospital Charge Code	993229
Hospital Revenue Code	270
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.14
Rate for Payer: Amerigroup CHIP/Medicaid	$0.02
Rate for Payer: BCBS of TX Blue Advantage	$0.06
Rate for Payer: BCBS of TX Blue Essentials	$0.07
Rate for Payer: BCBS of TX PPO	$0.08
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cigna Medicaid	$0.14
Rate for Payer: Molina CHIP/Medicaid	$0.14
Rate for Payer: Multiplan Auto	$0.13
Rate for Payer: Multiplan Commercial	$0.13
Rate for Payer: Multiplan Workers Comp	$0.13
Rate for Payer: Parkland Medicaid	$0.14
Rate for Payer: Scott and White EPO/PPO	$0.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.14
Rate for Payer: Superior Health Plan EPO	$0.03

ELECTRODE, ECG, RESTNG, TABSTYL, 10/CARD

Facility

$0.20

Hospital Charge Code	993229
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.14

ELECTRODE, FOAM 455 SERIES FLUID RESISTANT -- DHF

Facility

$68.92

Hospital Charge Code	82030255
Hospital Revenue Code	270
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$49.62
Rate for Payer: Amerigroup CHIP/Medicaid	$6.20
Rate for Payer: BCBS of TX Blue Advantage	$20.68
Rate for Payer: BCBS of TX Blue Essentials	$24.81
Rate for Payer: BCBS of TX PPO	$27.57
Rate for Payer: Cash Price	$46.87
Rate for Payer: Cigna Medicaid	$49.62
Rate for Payer: Molina CHIP/Medicaid	$49.62
Rate for Payer: Multiplan Auto	$44.80
Rate for Payer: Multiplan Commercial	$44.80
Rate for Payer: Multiplan Workers Comp	$44.80
Rate for Payer: Parkland Medicaid	$49.62
Rate for Payer: Scott and White EPO/PPO	$34.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$49.62
Rate for Payer: Superior Health Plan EPO	$9.37

ELECTRODE, FOAM 455 SERIES FLUID RESISTANT -- DHF

Facility

$68.92

Hospital Charge Code	82030255
Hospital Revenue Code	270
Rate for Payer: Cash Price	$46.87

ELECTRODE LAPARASCOPIC WIRE L HOOK 44CM

Facility

$73.85

Hospital Charge Code	993951
Hospital Revenue Code	272
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$53.17
Rate for Payer: Amerigroup CHIP/Medicaid	$6.65
Rate for Payer: BCBS of TX Blue Advantage	$22.16
Rate for Payer: BCBS of TX Blue Essentials	$26.59
Rate for Payer: BCBS of TX PPO	$29.54
Rate for Payer: Cash Price	$50.22
Rate for Payer: Cigna Medicaid	$53.17
Rate for Payer: Molina CHIP/Medicaid	$53.17
Rate for Payer: Multiplan Auto	$48.00
Rate for Payer: Multiplan Commercial	$48.00
Rate for Payer: Multiplan Workers Comp	$48.00
Rate for Payer: Parkland Medicaid	$53.17
Rate for Payer: Scott and White EPO/PPO	$36.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$53.17
Rate for Payer: Superior Health Plan EPO	$10.04

ELECTRODE LAPARASCOPIC WIRE L HOOK 44CM

Facility

$73.85

Hospital Charge Code	993951
Hospital Revenue Code	272
Rate for Payer: Cash Price	$50.22

ELECTRODE, LAPARASCOPIC WIRE L HOOK 44CM -- DHF

Facility

$244.05

Hospital Charge Code	82121831
Hospital Revenue Code	271
Rate for Payer: Cash Price	$165.95

ELECTRODE, LAPARASCOPIC WIRE L HOOK 44CM -- DHF

Facility

$244.05

Hospital Charge Code	82121831
Hospital Revenue Code	271
Min. Negotiated Rate	$21.96
Max. Negotiated Rate	$175.72
Rate for Payer: Amerigroup CHIP/Medicaid	$21.96
Rate for Payer: BCBS of TX Blue Advantage	$73.22
Rate for Payer: BCBS of TX Blue Essentials	$87.86
Rate for Payer: BCBS of TX PPO	$97.62
Rate for Payer: Cash Price	$165.95
Rate for Payer: Cigna Medicaid	$175.72
Rate for Payer: Molina CHIP/Medicaid	$175.72
Rate for Payer: Multiplan Auto	$158.63
Rate for Payer: Multiplan Commercial	$158.63
Rate for Payer: Multiplan Workers Comp	$158.63
Rate for Payer: Parkland Medicaid	$175.72
Rate for Payer: Scott and White EPO/PPO	$122.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$175.72
Rate for Payer: Superior Health Plan EPO	$33.19

Electrolyte Panel

Facility

$272.00

Service Code	HCPCS 80051 QW
Hospital Charge Code	1602804
Hospital Revenue Code	301
Rate for Payer: Cash Price	$184.96

Know your out-of-pocket cost for care.

All Charges