White Rock Medical Center

All Charges

Charge

Type

Setting

Price

ENDOCRINE DISORDERS W CC

Facility

$19,362.90

Service Code	MSDRG 644
Min. Negotiated Rate	$8,707.50
Max. Negotiated Rate	$19,362.90
Rate for Payer: BCBS of TX Blue Advantage	$8,707.50
Rate for Payer: BCBS of TX Blue Essentials	$10,447.99
Rate for Payer: BCBS of TX PPO	$11,609.33

ENDOCRINE DISORDERS WITH CC

Facility

$19,362.90

Service Code	MSDRG 644
Min. Negotiated Rate	$8,707.50
Max. Negotiated Rate	$19,362.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,272.34
Rate for Payer: Amerigroup Medicare	$12,272.34
Rate for Payer: BCBS of TX Medicare	$12,272.34
Rate for Payer: Cigna Commercial	$13,202.00
Rate for Payer: Cigna Medicare	$12,272.34
Rate for Payer: Employer Direct Commercial	$12,272.34
Rate for Payer: Humana Medicare/TRICARE	$12,272.34
Rate for Payer: Molina Dual Medicare/Medicaid	$12,272.34
Rate for Payer: Molina Medicare	$12,272.34
Rate for Payer: Multiplan Auto	$19,362.90
Rate for Payer: Multiplan Commercial	$19,362.90
Rate for Payer: Multiplan Workers Comp	$19,362.90
Rate for Payer: Scott and White EPO/PPO	$8,917.12
Rate for Payer: Scott and White Medicare	$12,272.34
Rate for Payer: Superior Health Plan EPO	$12,272.34
Rate for Payer: Superior Health Plan Medicare	$12,272.34
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,272.34
Rate for Payer: Universal American Medicare	$12,272.34
Rate for Payer: Wellcare Medicare	$12,272.34
Rate for Payer: Wellmed Medicare	$12,272.34

ENDOCRINE DISORDERS WITH MCC

Facility

$31,230.30

Service Code	MSDRG 643
Min. Negotiated Rate	$14,053.26
Max. Negotiated Rate	$31,230.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16,824.38
Rate for Payer: Amerigroup Medicare	$16,824.38
Rate for Payer: BCBS of TX Medicare	$16,824.38
Rate for Payer: Cigna Commercial	$21,201.77
Rate for Payer: Cigna Medicare	$16,824.38
Rate for Payer: Employer Direct Commercial	$16,824.38
Rate for Payer: Humana Medicare/TRICARE	$16,824.38
Rate for Payer: Molina Dual Medicare/Medicaid	$16,824.38
Rate for Payer: Molina Medicare	$16,824.38
Rate for Payer: Multiplan Auto	$31,230.30
Rate for Payer: Multiplan Commercial	$31,230.30
Rate for Payer: Multiplan Workers Comp	$31,230.30
Rate for Payer: Scott and White EPO/PPO	$14,382.38
Rate for Payer: Scott and White Medicare	$16,824.38
Rate for Payer: Superior Health Plan EPO	$16,824.38
Rate for Payer: Superior Health Plan Medicare	$16,824.38
Rate for Payer: Universal American Dual Medicare/Medicaid	$16,824.38
Rate for Payer: Universal American Medicare	$16,824.38
Rate for Payer: Wellcare Medicare	$16,824.38
Rate for Payer: Wellmed Medicare	$16,824.38

ENDOCRINE DISORDERS WITHOUT CC/MCC

Facility

$14,109.40

Service Code	MSDRG 645
Min. Negotiated Rate	$6,388.94
Max. Negotiated Rate	$14,109.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,390.97
Rate for Payer: Amerigroup Medicare	$10,390.97
Rate for Payer: BCBS of TX Medicare	$10,390.97
Rate for Payer: Cigna Commercial	$9,895.70
Rate for Payer: Cigna Medicare	$10,390.97
Rate for Payer: Employer Direct Commercial	$10,390.97
Rate for Payer: Humana Medicare/TRICARE	$10,390.97
Rate for Payer: Molina Dual Medicare/Medicaid	$10,390.97
Rate for Payer: Molina Medicare	$10,390.97
Rate for Payer: Multiplan Auto	$14,109.40
Rate for Payer: Multiplan Commercial	$14,109.40
Rate for Payer: Multiplan Workers Comp	$14,109.40
Rate for Payer: Scott and White EPO/PPO	$6,497.75
Rate for Payer: Scott and White Medicare	$10,390.97
Rate for Payer: Superior Health Plan EPO	$10,390.97
Rate for Payer: Superior Health Plan Medicare	$10,390.97
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,390.97
Rate for Payer: Universal American Medicare	$10,390.97
Rate for Payer: Wellcare Medicare	$10,390.97
Rate for Payer: Wellmed Medicare	$10,390.97

ENDOCRINE DISORDERS W MCC

Facility

$31,230.30

Service Code	MSDRG 643
Min. Negotiated Rate	$14,053.26
Max. Negotiated Rate	$31,230.30
Rate for Payer: BCBS of TX Blue Advantage	$14,053.26
Rate for Payer: BCBS of TX Blue Essentials	$16,862.28
Rate for Payer: BCBS of TX PPO	$18,736.59

ENDOCRINE DISORDERS W/O CC/MCC

Facility

$14,109.40

Service Code	MSDRG 645
Min. Negotiated Rate	$6,388.94
Max. Negotiated Rate	$14,109.40
Rate for Payer: BCBS of TX Blue Advantage	$6,388.94
Rate for Payer: BCBS of TX Blue Essentials	$7,665.99
Rate for Payer: BCBS of TX PPO	$8,518.09

ENDO GIA RELOAD PURPLE

Facility

$464.36

Hospital Charge Code	992368
Hospital Revenue Code	272
Rate for Payer: Cash Price	$315.76

ENDO GIA RELOAD PURPLE

Facility

$464.36

Hospital Charge Code	992368
Hospital Revenue Code	272
Min. Negotiated Rate	$41.79
Max. Negotiated Rate	$334.34
Rate for Payer: Amerigroup CHIP/Medicaid	$41.79
Rate for Payer: BCBS of TX Blue Advantage	$139.31
Rate for Payer: BCBS of TX Blue Essentials	$167.17
Rate for Payer: BCBS of TX PPO	$185.74
Rate for Payer: Cash Price	$315.76
Rate for Payer: Cigna Medicaid	$334.34
Rate for Payer: Molina CHIP/Medicaid	$334.34
Rate for Payer: Multiplan Auto	$301.83
Rate for Payer: Multiplan Commercial	$301.83
Rate for Payer: Multiplan Workers Comp	$301.83
Rate for Payer: Parkland Medicaid	$334.34
Rate for Payer: Scott and White EPO/PPO	$232.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$334.34
Rate for Payer: Superior Health Plan EPO	$63.15

Endo Gla articulating stapler device, medium to thick staple, purple, 45mm

Facility

$820.60

Hospital Charge Code	992797
Hospital Revenue Code	272
Min. Negotiated Rate	$73.85
Max. Negotiated Rate	$590.83
Rate for Payer: Amerigroup CHIP/Medicaid	$73.85
Rate for Payer: BCBS of TX Blue Advantage	$246.18
Rate for Payer: BCBS of TX Blue Essentials	$295.42
Rate for Payer: BCBS of TX PPO	$328.24
Rate for Payer: Cash Price	$558.01
Rate for Payer: Cigna Medicaid	$590.83
Rate for Payer: Molina CHIP/Medicaid	$590.83
Rate for Payer: Multiplan Auto	$533.39
Rate for Payer: Multiplan Commercial	$533.39
Rate for Payer: Multiplan Workers Comp	$533.39
Rate for Payer: Parkland Medicaid	$590.83
Rate for Payer: Scott and White EPO/PPO	$410.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$590.83
Rate for Payer: Superior Health Plan EPO	$111.60

Endo Gla articulating stapler device, medium to thick staple, purple, 45mm

Facility

$820.60

Hospital Charge Code	992797
Hospital Revenue Code	272
Rate for Payer: Cash Price	$558.01

Endo Gla articulating stapler device, medium to thick staple, purple, 60mm

Facility

$1,079.68

Hospital Charge Code	992798
Hospital Revenue Code	272
Min. Negotiated Rate	$97.17
Max. Negotiated Rate	$777.37
Rate for Payer: Amerigroup CHIP/Medicaid	$97.17
Rate for Payer: BCBS of TX Blue Advantage	$323.90
Rate for Payer: BCBS of TX Blue Essentials	$388.68
Rate for Payer: BCBS of TX PPO	$431.87
Rate for Payer: Cash Price	$734.18
Rate for Payer: Cigna Medicaid	$777.37
Rate for Payer: Molina CHIP/Medicaid	$777.37
Rate for Payer: Multiplan Auto	$701.79
Rate for Payer: Multiplan Commercial	$701.79
Rate for Payer: Multiplan Workers Comp	$701.79
Rate for Payer: Parkland Medicaid	$777.37
Rate for Payer: Scott and White EPO/PPO	$539.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$777.37
Rate for Payer: Superior Health Plan EPO	$146.84

Endo Gla articulating stapler device, medium to thick staple, purple, 60mm

Facility

$1,079.68

Hospital Charge Code	992798
Hospital Revenue Code	272
Rate for Payer: Cash Price	$734.18

ENDOJAWAGTR LC W/NDL 2.8MM 230CM 20/BX

Facility

$889.98

Hospital Charge Code	993909
Hospital Revenue Code	272
Min. Negotiated Rate	$80.10
Max. Negotiated Rate	$640.79
Rate for Payer: Amerigroup CHIP/Medicaid	$80.10
Rate for Payer: BCBS of TX Blue Advantage	$266.99
Rate for Payer: BCBS of TX Blue Essentials	$320.39
Rate for Payer: BCBS of TX PPO	$355.99
Rate for Payer: Cash Price	$605.19
Rate for Payer: Cigna Medicaid	$640.79
Rate for Payer: Molina CHIP/Medicaid	$640.79
Rate for Payer: Multiplan Auto	$578.49
Rate for Payer: Multiplan Commercial	$578.49
Rate for Payer: Multiplan Workers Comp	$578.49
Rate for Payer: Parkland Medicaid	$640.79
Rate for Payer: Scott and White EPO/PPO	$444.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$640.79
Rate for Payer: Superior Health Plan EPO	$121.04

ENDOJAWAGTR LC W/NDL 2.8MM 230CM 20/BX

Facility

$889.98

Hospital Charge Code	993909
Hospital Revenue Code	272
Rate for Payer: Cash Price	$605.19

ENDOPATH ECHELON RELOAD 60MM

Facility

$548.19

Hospital Charge Code	992366
Hospital Revenue Code	272
Rate for Payer: Cash Price	$372.77

ENDOPATH ECHELON RELOAD 60MM

Facility

$548.19

Hospital Charge Code	992366
Hospital Revenue Code	272
Min. Negotiated Rate	$49.34
Max. Negotiated Rate	$394.70
Rate for Payer: Amerigroup CHIP/Medicaid	$49.34
Rate for Payer: BCBS of TX Blue Advantage	$164.46
Rate for Payer: BCBS of TX Blue Essentials	$197.35
Rate for Payer: BCBS of TX PPO	$219.28
Rate for Payer: Cash Price	$372.77
Rate for Payer: Cigna Medicaid	$394.70
Rate for Payer: Molina CHIP/Medicaid	$394.70
Rate for Payer: Multiplan Auto	$356.32
Rate for Payer: Multiplan Commercial	$356.32
Rate for Payer: Multiplan Workers Comp	$356.32
Rate for Payer: Parkland Medicaid	$394.70
Rate for Payer: Scott and White EPO/PPO	$274.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$394.70
Rate for Payer: Superior Health Plan EPO	$74.55

ENDOQUICK DETERGENT 3 BTLS/CASE

Facility

$509.43

Hospital Charge Code	993940
Hospital Revenue Code	271
Min. Negotiated Rate	$45.85
Max. Negotiated Rate	$366.79
Rate for Payer: Amerigroup CHIP/Medicaid	$45.85
Rate for Payer: BCBS of TX Blue Advantage	$152.83
Rate for Payer: BCBS of TX Blue Essentials	$183.39
Rate for Payer: BCBS of TX PPO	$203.77
Rate for Payer: Cash Price	$346.41
Rate for Payer: Cigna Medicaid	$366.79
Rate for Payer: Molina CHIP/Medicaid	$366.79
Rate for Payer: Multiplan Auto	$331.13
Rate for Payer: Multiplan Commercial	$331.13
Rate for Payer: Multiplan Workers Comp	$331.13
Rate for Payer: Parkland Medicaid	$366.79
Rate for Payer: Scott and White EPO/PPO	$254.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$366.79
Rate for Payer: Superior Health Plan EPO	$69.28

ENDOQUICK DETERGENT 3 BTLS/CASE

Facility

$509.43

Hospital Charge Code	993940
Hospital Revenue Code	271
Rate for Payer: Cash Price	$346.41

Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, f

Facility

$83,065.62

Service Code	HCPCS 62380
Hospital Charge Code	9900759
Hospital Revenue Code	360
Min. Negotiated Rate	$2,398.52
Max. Negotiated Rate	$59,807.25
Rate for Payer: Amerigroup CHIP/Medicaid	$2,398.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Amerigroup Medicare	$7,289.28
Rate for Payer: BCBS of TX Blue Advantage	$9,989.86
Rate for Payer: BCBS of TX Blue Essentials	$11,963.90
Rate for Payer: BCBS of TX Medicare	$7,289.28
Rate for Payer: BCBS of TX PPO	$15,074.51
Rate for Payer: Cash Price	$56,484.62
Rate for Payer: Cash Price	$56,484.62
Rate for Payer: Cash Price	$56,484.62
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicaid	$59,807.25
Rate for Payer: Cigna Medicare	$7,289.28
Rate for Payer: Employer Direct Commercial	$7,289.28
Rate for Payer: Humana Medicare/TRICARE	$7,289.28
Rate for Payer: Molina CHIP/Medicaid	$59,807.25
Rate for Payer: Molina Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Molina Medicare	$7,289.28
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	$59,807.25
Rate for Payer: Scott and White EPO/PPO	$12,104.03
Rate for Payer: Scott and White Medicare	$7,289.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$59,807.25
Rate for Payer: Superior Health Plan EPO	$7,289.28
Rate for Payer: Superior Health Plan Medicare	$7,289.28
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Universal American Medicare	$7,289.28
Rate for Payer: Wellcare Medicare	$7,289.28
Rate for Payer: Wellmed Medicare	$7,289.28

Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, f

Facility

$83,065.62

Service Code	HCPCS 62380
Hospital Charge Code	9900759
Hospital Revenue Code	360
Rate for Payer: Cash Price	$56,484.62

Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, f

Facility

$15,408.22

Service Code	CPT 62380
Hospital Charge Code	36062380
Hospital Revenue Code	360
Min. Negotiated Rate	$2,398.52
Max. Negotiated Rate	$15,408.22
Rate for Payer: Amerigroup CHIP/Medicaid	$2,398.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Amerigroup Medicare	$7,289.28
Rate for Payer: BCBS of TX Blue Advantage	$9,989.86
Rate for Payer: BCBS of TX Blue Essentials	$11,963.90
Rate for Payer: BCBS of TX Medicare	$7,289.28
Rate for Payer: BCBS of TX PPO	$15,074.51
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicare	$7,289.28
Rate for Payer: Employer Direct Commercial	$7,289.28
Rate for Payer: Humana Medicare/TRICARE	$7,289.28
Rate for Payer: Molina Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Molina Medicare	$7,289.28
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: Scott and White EPO/PPO	$12,104.03
Rate for Payer: Scott and White Medicare	$7,289.28
Rate for Payer: Superior Health Plan EPO	$7,289.28
Rate for Payer: Superior Health Plan Medicare	$7,289.28
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Universal American Medicare	$7,289.28
Rate for Payer: Wellcare Medicare	$7,289.28
Rate for Payer: Wellmed Medicare	$7,289.28

Endoscopic plantar fasciotomy

Facility

$8,640.00

Service Code	HCPCS 29893
Hospital Charge Code	9900582
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
Rate for Payer: BCBS of TX Blue Advantage	$4,571.54
Rate for Payer: BCBS of TX Blue Essentials	$5,474.90
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cash Price	$5,875.20
Rate for Payer: Cash Price	$5,875.20
Rate for Payer: Cash Price	$5,875.20
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicaid	$6,220.80
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina CHIP/Medicaid	$6,220.80
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
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	$6,220.80
Rate for Payer: Scott and White EPO/PPO	$5,476.44
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,220.80
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Endoscopic plantar fasciotomy

Facility

$10,000.00

Service Code	CPT 29893
Hospital Charge Code	36029893
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
Rate for Payer: BCBS of TX Blue Advantage	$4,571.54
Rate for Payer: BCBS of TX Blue Essentials	$5,474.90
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
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: Scott and White EPO/PPO	$5,476.44
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Endoscopic plantar fasciotomy

Facility

$8,640.00

Service Code	HCPCS 29893
Hospital Charge Code	9900582
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,875.20

Endoscopy, wrist, surgical, with release of transverse carpal ligament

Facility

$11,138.80

Service Code	HCPCS 29848
Hospital Charge Code	9900560
Hospital Revenue Code	360
Rate for Payer: Cash Price	$7,574.38

Know your out-of-pocket cost for care.

All Charges