White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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	$92.28
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: Cigna Medicaid	$92.28
Rate for Payer: Molina CHIP/Medicaid	$92.28
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: Parkland Medicaid	$92.28
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$92.28
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 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 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	$92.28
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: Cigna Medicaid	$92.28
Rate for Payer: Molina CHIP/Medicaid	$92.28
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: Parkland Medicaid	$92.28
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$92.28
Rate for Payer: Superior Health Plan EPO	$17.43

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	$92.28
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: Cigna Medicaid	$92.28
Rate for Payer: Molina CHIP/Medicaid	$92.28
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: Parkland Medicaid	$92.28
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$92.28
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

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	$92.28
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: Cigna Medicaid	$92.28
Rate for Payer: Molina CHIP/Medicaid	$92.28
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: Parkland Medicaid	$92.28
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$92.28
Rate for Payer: Superior Health Plan EPO	$17.43

ENSEAL, CURVED JAW, 45CM

Facility

$2,249.10

Hospital Charge Code	992754
Hospital Revenue Code	272
Min. Negotiated Rate	$202.42
Max. Negotiated Rate	$1,619.35
Rate for Payer: Amerigroup CHIP/Medicaid	$202.42
Rate for Payer: BCBS of TX Blue Advantage	$674.73
Rate for Payer: BCBS of TX Blue Essentials	$809.68
Rate for Payer: BCBS of TX PPO	$899.64
Rate for Payer: Cash Price	$1,529.39
Rate for Payer: Cigna Medicaid	$1,619.35
Rate for Payer: Molina CHIP/Medicaid	$1,619.35
Rate for Payer: Multiplan Auto	$1,461.91
Rate for Payer: Multiplan Commercial	$1,461.91
Rate for Payer: Multiplan Workers Comp	$1,461.91
Rate for Payer: Parkland Medicaid	$1,619.35
Rate for Payer: Scott and White EPO/PPO	$1,124.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,619.35
Rate for Payer: Superior Health Plan EPO	$305.88

ENSEAL, CURVED JAW, 45CM

Facility

$2,249.10

Hospital Charge Code	992754
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,529.39

Enseal Tip, 5 mm Round, 45 cm

Facility

$2,068.10

Hospital Charge Code	992859
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,406.31

Enseal Tip, 5 mm Round, 45 cm

Facility

$2,068.10

Hospital Charge Code	992859
Hospital Revenue Code	272
Min. Negotiated Rate	$186.13
Max. Negotiated Rate	$1,489.03
Rate for Payer: Amerigroup CHIP/Medicaid	$186.13
Rate for Payer: BCBS of TX Blue Advantage	$620.43
Rate for Payer: BCBS of TX Blue Essentials	$744.52
Rate for Payer: BCBS of TX PPO	$827.24
Rate for Payer: Cash Price	$1,406.31
Rate for Payer: Cigna Medicaid	$1,489.03
Rate for Payer: Molina CHIP/Medicaid	$1,489.03
Rate for Payer: Multiplan Auto	$1,344.27
Rate for Payer: Multiplan Commercial	$1,344.27
Rate for Payer: Multiplan Workers Comp	$1,344.27
Rate for Payer: Parkland Medicaid	$1,489.03
Rate for Payer: Scott and White EPO/PPO	$1,034.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,489.03
Rate for Payer: Superior Health Plan EPO	$281.26

ENSEAL X1 CURVED JAW 45CM

Facility

$2,225.74

Hospital Charge Code	8720598
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,513.50

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	$1,602.53
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	$1,513.50
Rate for Payer: Cigna Medicaid	$1,602.53
Rate for Payer: Molina CHIP/Medicaid	$1,602.53
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: Parkland Medicaid	$1,602.53
Rate for Payer: Scott and White EPO/PPO	$1,112.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,602.53
Rate for Payer: Superior Health Plan EPO	$302.70

Enterectomy, resection of small intestine; single resection and anastomosis

Facility

$64,200.00

Service Code	HCPCS 44120
Hospital Charge Code	991015
Hospital Revenue Code	360
Min. Negotiated Rate	$2,135.38
Max. Negotiated Rate	$46,224.00
Rate for Payer: Amerigroup CHIP/Medicaid	$5,778.00
Rate for Payer: BCBS of TX Blue Advantage	$2,135.38
Rate for Payer: BCBS of TX Blue Essentials	$2,557.34
Rate for Payer: BCBS of TX PPO	$3,222.25
Rate for Payer: Cash Price	$43,656.00
Rate for Payer: Cash Price	$43,656.00
Rate for Payer: Cash Price	$43,656.00
Rate for Payer: Cigna Medicaid	$46,224.00
Rate for Payer: Molina CHIP/Medicaid	$46,224.00
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	$46,224.00
Rate for Payer: Scott and White EPO/PPO	$32,100.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$46,224.00
Rate for Payer: Superior Health Plan EPO	$8,731.20

Enterectomy, resection of small intestine; single resection and anastomosis

Facility

$64,200.00

Service Code	HCPCS 44120
Hospital Charge Code	991015
Hospital Revenue Code	360
Rate for Payer: Cash Price	$43,656.00

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

Facility

$5,062.10

Service Code	HCPCS 44021
Hospital Charge Code	9900694
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,442.23

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	$1,181.84
Max. Negotiated Rate	$10,000.00
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
Rate for Payer: Scott and White EPO/PPO	$1,181.84

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

Facility

$5,062.10

Service Code	HCPCS 44021
Hospital Charge Code	9900694
Hospital Revenue Code	360
Min. Negotiated Rate	$455.59
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$455.59
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: Cash Price	$3,442.23
Rate for Payer: Cash Price	$3,442.23
Rate for Payer: Cash Price	$3,442.23
Rate for Payer: Cigna Medicaid	$3,644.71
Rate for Payer: Molina CHIP/Medicaid	$3,644.71
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	$3,644.71
Rate for Payer: Scott and White EPO/PPO	$2,531.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,644.71
Rate for Payer: Superior Health Plan EPO	$688.45

Enterovirus RT-PCR SO

Facility

$243.00

Service Code	HCPCS 87498
Hospital Charge Code	1720028
Hospital Revenue Code	300
Rate for Payer: Cash Price	$165.24

Enterovirus RT-PCR SO

Facility

$243.00

Service Code	HCPCS 87498
Hospital Charge Code	1720028
Hospital Revenue Code	300
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$174.96
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	$72.90
Rate for Payer: BCBS of TX Blue Essentials	$87.48
Rate for Payer: BCBS of TX Medicare	$35.09
Rate for Payer: BCBS of TX PPO	$97.20
Rate for Payer: Cash Price	$165.24
Rate for Payer: Cash Price	$165.24
Rate for Payer: Cigna Medicaid	$174.96
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	$174.96
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	$174.96
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	$174.96
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

ENTRY REAMER

Facility

$681.00

Hospital Charge Code	145216
Hospital Revenue Code	272
Rate for Payer: Cash Price	$463.08

ENTRY REAMER

Facility

$681.00

Hospital Charge Code	145216
Hospital Revenue Code	272
Min. Negotiated Rate	$61.29
Max. Negotiated Rate	$490.32
Rate for Payer: Amerigroup CHIP/Medicaid	$61.29
Rate for Payer: BCBS of TX Blue Advantage	$204.30
Rate for Payer: BCBS of TX Blue Essentials	$245.16
Rate for Payer: BCBS of TX PPO	$272.40
Rate for Payer: Cash Price	$463.08
Rate for Payer: Cigna Medicaid	$490.32
Rate for Payer: Molina CHIP/Medicaid	$490.32
Rate for Payer: Multiplan Auto	$442.65
Rate for Payer: Multiplan Commercial	$442.65
Rate for Payer: Multiplan Workers Comp	$442.65
Rate for Payer: Parkland Medicaid	$490.32
Rate for Payer: Scott and White EPO/PPO	$340.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$490.32
Rate for Payer: Superior Health Plan EPO	$92.62

Eosinophil Respiratory

Facility

$102.00

Service Code	HCPCS 89190
Hospital Charge Code	1600402
Hospital Revenue Code	300
Rate for Payer: Cash Price	$69.36

Eosinophil Respiratory

Facility

$102.00

Service Code	HCPCS 89190
Hospital Charge Code	1600402
Hospital Revenue Code	300
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$73.44
Rate for Payer: Amerigroup CHIP/Medicaid	$2.26
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.79
Rate for Payer: Amerigroup Medicare	$5.79
Rate for Payer: BCBS of TX Blue Advantage	$30.60
Rate for Payer: BCBS of TX Blue Essentials	$36.72
Rate for Payer: BCBS of TX Medicare	$5.79
Rate for Payer: BCBS of TX PPO	$40.80
Rate for Payer: Cash Price	$69.36
Rate for Payer: Cash Price	$69.36
Rate for Payer: Cigna Medicaid	$73.44
Rate for Payer: Cigna Medicare	$5.79
Rate for Payer: Employer Direct Commercial	$5.79
Rate for Payer: Humana Medicare/TRICARE	$5.79
Rate for Payer: Molina CHIP/Medicaid	$73.44
Rate for Payer: Molina Dual Medicare/Medicaid	$5.79
Rate for Payer: Molina Medicare	$5.79
Rate for Payer: Multiplan Auto	$66.30
Rate for Payer: Multiplan Commercial	$66.30
Rate for Payer: Multiplan Workers Comp	$66.30
Rate for Payer: Parkland Medicaid	$73.44
Rate for Payer: Scott and White EPO/PPO	$7.24
Rate for Payer: Scott and White Medicare	$5.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$73.44
Rate for Payer: Superior Health Plan EPO	$5.79
Rate for Payer: Superior Health Plan Medicare	$5.79
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.79
Rate for Payer: Universal American Medicare	$5.79
Rate for Payer: Wellcare Medicare	$5.79
Rate for Payer: Wellmed Medicare	$5.79

Know your out-of-pocket cost for care.

All Charges