White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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
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

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	$1,703.25
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

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

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

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

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

Eosinophil Urine

Facility

$138.00

Service Code	HCPCS 87205
Hospital Charge Code	4108705
Hospital Revenue Code	306
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$99.36
Rate for Payer: Amerigroup CHIP/Medicaid	$1.67
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$4.27
Rate for Payer: Amerigroup Medicare	$4.27
Rate for Payer: BCBS of TX Blue Advantage	$41.40
Rate for Payer: BCBS of TX Blue Essentials	$49.68
Rate for Payer: BCBS of TX Medicare	$4.27
Rate for Payer: BCBS of TX PPO	$55.20
Rate for Payer: Cash Price	$93.84
Rate for Payer: Cash Price	$93.84
Rate for Payer: Cigna Medicaid	$99.36
Rate for Payer: Cigna Medicare	$4.27
Rate for Payer: Employer Direct Commercial	$4.27
Rate for Payer: Humana Medicare/TRICARE	$4.27
Rate for Payer: Molina CHIP/Medicaid	$99.36
Rate for Payer: Molina Dual Medicare/Medicaid	$4.27
Rate for Payer: Molina Medicare	$4.27
Rate for Payer: Multiplan Auto	$89.70
Rate for Payer: Multiplan Commercial	$89.70
Rate for Payer: Multiplan Workers Comp	$89.70
Rate for Payer: Parkland Medicaid	$99.36
Rate for Payer: Scott and White EPO/PPO	$5.34
Rate for Payer: Scott and White Medicare	$4.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$99.36
Rate for Payer: Superior Health Plan EPO	$4.27
Rate for Payer: Superior Health Plan Medicare	$4.27
Rate for Payer: Universal American Dual Medicare/Medicaid	$4.27
Rate for Payer: Universal American Medicare	$4.27
Rate for Payer: Wellcare Medicare	$4.27
Rate for Payer: Wellmed Medicare	$4.27

Eosinophil Urine

Facility

$138.00

Service Code	HCPCS 87205
Hospital Charge Code	4108705
Hospital Revenue Code	306
Rate for Payer: Cash Price	$93.84

EP CARDIAC MAPPING

Facility

$5,323.00

Service Code	HCPCS 93609
Hospital Charge Code	4610600
Hospital Revenue Code	480
Min. Negotiated Rate	$479.07
Max. Negotiated Rate	$3,832.56
Rate for Payer: Amerigroup CHIP/Medicaid	$479.07
Rate for Payer: BCBS of TX Blue Advantage	$1,596.90
Rate for Payer: BCBS of TX Blue Essentials	$1,916.28
Rate for Payer: BCBS of TX PPO	$2,129.20
Rate for Payer: Cash Price	$3,619.64
Rate for Payer: Cigna Medicaid	$3,832.56
Rate for Payer: Molina CHIP/Medicaid	$3,832.56
Rate for Payer: Multiplan Auto	$3,459.95
Rate for Payer: Multiplan Commercial	$3,459.95
Rate for Payer: Multiplan Workers Comp	$3,459.95
Rate for Payer: Parkland Medicaid	$3,832.56
Rate for Payer: Scott and White EPO/PPO	$2,661.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,832.56
Rate for Payer: Superior Health Plan EPO	$723.93

EP CARDIAC MAPPING

Facility

$5,323.00

Service Code	HCPCS 93609
Hospital Charge Code	4610600
Hospital Revenue Code	480
Rate for Payer: Cash Price	$3,619.64

EP COMP STUDY W/INDUCTN

Facility

$10,248.00

Service Code	HCPCS 93620
Hospital Charge Code	4610620
Hospital Revenue Code	480
Min. Negotiated Rate	$922.32
Max. Negotiated Rate	$16,562.21
Rate for Payer: Amerigroup CHIP/Medicaid	$922.32
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,835.21
Rate for Payer: Amerigroup Medicare	$7,835.21
Rate for Payer: BCBS of TX Blue Advantage	$9,829.14
Rate for Payer: BCBS of TX Blue Essentials	$11,771.42
Rate for Payer: BCBS of TX Medicare	$7,835.21
Rate for Payer: BCBS of TX PPO	$14,831.99
Rate for Payer: Cash Price	$6,968.64
Rate for Payer: Cash Price	$6,968.64
Rate for Payer: Cash Price	$6,968.64
Rate for Payer: Cigna Commercial	$16,562.21
Rate for Payer: Cigna Medicaid	$7,378.56
Rate for Payer: Cigna Medicare	$7,835.21
Rate for Payer: Employer Direct Commercial	$7,835.21
Rate for Payer: Humana Medicare/TRICARE	$7,835.21
Rate for Payer: Molina CHIP/Medicaid	$7,378.56
Rate for Payer: Molina Dual Medicare/Medicaid	$7,835.21
Rate for Payer: Molina Medicare	$7,835.21
Rate for Payer: Multiplan Auto	$6,661.20
Rate for Payer: Multiplan Commercial	$6,661.20
Rate for Payer: Multiplan Workers Comp	$6,661.20
Rate for Payer: Parkland Medicaid	$7,378.56
Rate for Payer: Scott and White EPO/PPO	$5,124.00
Rate for Payer: Scott and White Medicare	$7,835.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,378.56
Rate for Payer: Superior Health Plan EPO	$7,835.21
Rate for Payer: Superior Health Plan Medicare	$7,835.21
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,835.21
Rate for Payer: Universal American Medicare	$7,835.21
Rate for Payer: Wellcare Medicare	$7,835.21
Rate for Payer: Wellmed Medicare	$7,835.21

EP COMP STUDY W/INDUCTN

Facility

$10,248.00

Service Code	HCPCS 93620
Hospital Charge Code	4610620
Hospital Revenue Code	480
Rate for Payer: Cash Price	$6,968.64

EP DRUG FOLLOW-UP STUDY

Facility

$7,552.00

Service Code	HCPCS 93624
Hospital Charge Code	4610630
Hospital Revenue Code	480
Rate for Payer: Cash Price	$5,135.36

EP DRUG FOLLOW-UP STUDY

Facility

$7,552.00

Service Code	HCPCS 93624
Hospital Charge Code	4610630
Hospital Revenue Code	480
Min. Negotiated Rate	$679.68
Max. Negotiated Rate	$16,562.21
Rate for Payer: Amerigroup CHIP/Medicaid	$679.68
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,835.21
Rate for Payer: Amerigroup Medicare	$7,835.21
Rate for Payer: BCBS of TX Blue Advantage	$2,265.60
Rate for Payer: BCBS of TX Blue Essentials	$2,718.72
Rate for Payer: BCBS of TX Medicare	$7,835.21
Rate for Payer: BCBS of TX PPO	$3,020.80
Rate for Payer: Cash Price	$5,135.36
Rate for Payer: Cash Price	$5,135.36
Rate for Payer: Cash Price	$5,135.36
Rate for Payer: Cigna Commercial	$16,562.21
Rate for Payer: Cigna Medicaid	$5,437.44
Rate for Payer: Cigna Medicare	$7,835.21
Rate for Payer: Employer Direct Commercial	$7,835.21
Rate for Payer: Humana Medicare/TRICARE	$7,835.21
Rate for Payer: Molina CHIP/Medicaid	$5,437.44
Rate for Payer: Molina Dual Medicare/Medicaid	$7,835.21
Rate for Payer: Molina Medicare	$7,835.21
Rate for Payer: Multiplan Auto	$4,908.80
Rate for Payer: Multiplan Commercial	$4,908.80
Rate for Payer: Multiplan Workers Comp	$4,908.80
Rate for Payer: Parkland Medicaid	$5,437.44
Rate for Payer: Scott and White EPO/PPO	$3,776.00
Rate for Payer: Scott and White Medicare	$7,835.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,437.44
Rate for Payer: Superior Health Plan EPO	$7,835.21
Rate for Payer: Superior Health Plan Medicare	$7,835.21
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,835.21
Rate for Payer: Universal American Medicare	$7,835.21
Rate for Payer: Wellcare Medicare	$7,835.21
Rate for Payer: Wellmed Medicare	$7,835.21

EP EVAL AICD LEADS INIT

Facility

$1,882.00

Service Code	HCPCS 93640
Hospital Charge Code	4610640
Hospital Revenue Code	480
Min. Negotiated Rate	$169.38
Max. Negotiated Rate	$1,355.04
Rate for Payer: Amerigroup CHIP/Medicaid	$169.38
Rate for Payer: BCBS of TX Blue Advantage	$564.60
Rate for Payer: BCBS of TX Blue Essentials	$677.52
Rate for Payer: BCBS of TX PPO	$752.80
Rate for Payer: Cash Price	$1,279.76
Rate for Payer: Cigna Medicaid	$1,355.04
Rate for Payer: Molina CHIP/Medicaid	$1,355.04
Rate for Payer: Multiplan Auto	$1,223.30
Rate for Payer: Multiplan Commercial	$1,223.30
Rate for Payer: Multiplan Workers Comp	$1,223.30
Rate for Payer: Parkland Medicaid	$1,355.04
Rate for Payer: Scott and White EPO/PPO	$941.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,355.04
Rate for Payer: Superior Health Plan EPO	$255.95

Know your out-of-pocket cost for care.

All Charges