White Rock Medical Center

All Charges

Charge

Type

Setting

Price

KIDNEY TRANSPLANT

Facility

$57,083.60

Service Code	MSDRG 652
Min. Negotiated Rate	$24,294.35
Max. Negotiated Rate	$57,083.60
Rate for Payer: Aetna Commercial	$33,799.50
Rate for Payer: Aetna Medicare	$36,441.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$24,294.35
Rate for Payer: Amerigroup Medicare	$24,294.35
Rate for Payer: BCBS of TX Blue Advantage	$28,349.04
Rate for Payer: BCBS of TX Blue Essentials	$34,203.36
Rate for Payer: BCBS of TX Medicare	$24,294.35
Rate for Payer: BCBS of TX PPO	$38,005.20
Rate for Payer: Cigna Commercial	$38,696.67
Rate for Payer: Cigna Medicare	$24,294.35
Rate for Payer: Employer Direct Commercial	$24,294.35
Rate for Payer: Molina Dual Medicare/Medicaid	$24,294.35
Rate for Payer: Molina Medicare	$24,294.35
Rate for Payer: Multiplan Auto	$57,083.60
Rate for Payer: Multiplan Commercial	$57,083.60
Rate for Payer: Multiplan Workers Comp	$57,083.60
Rate for Payer: Scott and White EPO/PPO	$26,288.50
Rate for Payer: Scott and White Medicare	$24,294.35
Rate for Payer: Superior Health Plan EPO	$24,294.35
Rate for Payer: Superior Health Plan Medicare	$24,294.35
Rate for Payer: Universal American Dual Medicare/Medicaid	$24,294.35
Rate for Payer: Universal American Medicare	$24,294.35
Rate for Payer: Wellcare Medicare	$24,294.35
Rate for Payer: Wellmed Medicare	$24,294.35

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC

Facility

$85,452.50

Service Code	MSDRG 650
Min. Negotiated Rate	$34,949.21
Max. Negotiated Rate	$85,452.50
Rate for Payer: Aetna Commercial	$50,596.88
Rate for Payer: Aetna Medicare	$52,423.82
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$34,949.21
Rate for Payer: Amerigroup Medicare	$34,949.21
Rate for Payer: BCBS of TX Medicare	$34,949.21
Rate for Payer: Cigna Commercial	$57,927.80
Rate for Payer: Cigna Medicare	$34,949.21
Rate for Payer: Employer Direct Commercial	$34,949.21
Rate for Payer: Humana Medicare/TRICARE	$34,949.21
Rate for Payer: Molina Dual Medicare/Medicaid	$34,949.21
Rate for Payer: Molina Medicare	$34,949.21
Rate for Payer: Multiplan Auto	$85,452.50
Rate for Payer: Multiplan Commercial	$85,452.50
Rate for Payer: Multiplan Workers Comp	$85,452.50
Rate for Payer: Scott and White EPO/PPO	$39,353.12
Rate for Payer: Scott and White Medicare	$34,949.21
Rate for Payer: Superior Health Plan EPO	$34,949.21
Rate for Payer: Superior Health Plan Medicare	$34,949.21
Rate for Payer: Universal American Dual Medicare/Medicaid	$34,949.21
Rate for Payer: Universal American Medicare	$34,949.21
Rate for Payer: Wellcare Medicare	$34,949.21
Rate for Payer: Wellmed Medicare	$34,949.21

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC

Facility

$65,709.60

Service Code	MSDRG 651
Min. Negotiated Rate	$27,534.13
Max. Negotiated Rate	$65,709.60
Rate for Payer: Aetna Commercial	$38,907.00
Rate for Payer: Aetna Medicare	$41,301.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$27,534.13
Rate for Payer: Amerigroup Medicare	$27,534.13
Rate for Payer: BCBS of TX Medicare	$27,534.13
Rate for Payer: Cigna Commercial	$44,544.19
Rate for Payer: Cigna Medicare	$27,534.13
Rate for Payer: Employer Direct Commercial	$27,534.13
Rate for Payer: Humana Medicare/TRICARE	$27,534.13
Rate for Payer: Molina Dual Medicare/Medicaid	$27,534.13
Rate for Payer: Molina Medicare	$27,534.13
Rate for Payer: Multiplan Auto	$65,709.60
Rate for Payer: Multiplan Commercial	$65,709.60
Rate for Payer: Multiplan Workers Comp	$65,709.60
Rate for Payer: Scott and White EPO/PPO	$30,261.00
Rate for Payer: Scott and White Medicare	$27,534.13
Rate for Payer: Superior Health Plan EPO	$27,534.13
Rate for Payer: Superior Health Plan Medicare	$27,534.13
Rate for Payer: Universal American Dual Medicare/Medicaid	$27,534.13
Rate for Payer: Universal American Medicare	$27,534.13
Rate for Payer: Wellcare Medicare	$27,534.13
Rate for Payer: Wellmed Medicare	$27,534.13

kit 15mm elite fracture inflation

Facility

$9,783.70

Hospital Charge Code	8634509
Hospital Revenue Code	272
Min. Negotiated Rate	$880.53
Max. Negotiated Rate	$6,359.40
Rate for Payer: Aetna Commercial	$5,381.04
Rate for Payer: Amerigroup CHIP/Medicaid	$880.53
Rate for Payer: BCBS of TX Blue Advantage	$2,935.11
Rate for Payer: BCBS of TX Blue Essentials	$3,522.13
Rate for Payer: BCBS of TX PPO	$3,913.48
Rate for Payer: Cash Price	$8,609.66
Rate for Payer: Multiplan Auto	$6,359.40
Rate for Payer: Multiplan Commercial	$6,359.40
Rate for Payer: Multiplan Workers Comp	$6,359.40
Rate for Payer: Scott and White EPO/PPO	$4,891.85
Rate for Payer: Superior Health Plan EPO	$1,330.58

kit 15mm elite fracture inflation

Facility

$9,783.70

Hospital Charge Code	8634509
Hospital Revenue Code	272
Rate for Payer: Cash Price	$8,609.66

KIT, ACCESSORY 3 ARM CANN SEAL W/CAM&INST DRP 8MM -- DHF

Facility

$14,348.05

Hospital Charge Code	81763161
Hospital Revenue Code	272
Rate for Payer: Cash Price	$12,626.28

KIT, ACCESSORY 3 ARM CANN SEAL W/CAM&INST DRP 8MM -- DHF

Facility

$14,348.05

Hospital Charge Code	81763161
Hospital Revenue Code	272
Min. Negotiated Rate	$1,291.32
Max. Negotiated Rate	$9,326.23
Rate for Payer: Aetna Commercial	$7,891.43
Rate for Payer: Amerigroup CHIP/Medicaid	$1,291.32
Rate for Payer: BCBS of TX Blue Advantage	$4,304.42
Rate for Payer: BCBS of TX Blue Essentials	$5,165.30
Rate for Payer: BCBS of TX PPO	$5,739.22
Rate for Payer: Cash Price	$12,626.28
Rate for Payer: Multiplan Auto	$9,326.23
Rate for Payer: Multiplan Commercial	$9,326.23
Rate for Payer: Multiplan Workers Comp	$9,326.23
Rate for Payer: Scott and White EPO/PPO	$7,174.02
Rate for Payer: Superior Health Plan EPO	$1,951.33

KIT ACCESSORY INSTAFIX -- DHF

Facility

$2,111.10

Hospital Charge Code	80899057
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,857.77

KIT ACCESSORY INSTAFIX -- DHF

Facility

$2,111.10

Hospital Charge Code	80899057
Hospital Revenue Code	272
Min. Negotiated Rate	$190.00
Max. Negotiated Rate	$1,372.22
Rate for Payer: Aetna Commercial	$1,161.10
Rate for Payer: Amerigroup CHIP/Medicaid	$190.00
Rate for Payer: BCBS of TX Blue Advantage	$633.33
Rate for Payer: BCBS of TX Blue Essentials	$760.00
Rate for Payer: BCBS of TX PPO	$844.44
Rate for Payer: Cash Price	$1,857.77
Rate for Payer: Multiplan Auto	$1,372.22
Rate for Payer: Multiplan Commercial	$1,372.22
Rate for Payer: Multiplan Workers Comp	$1,372.22
Rate for Payer: Scott and White EPO/PPO	$1,055.55
Rate for Payer: Superior Health Plan EPO	$287.11

KIT ACESSORY DSO6003

Facility

$317.80

Hospital Charge Code	145163
Hospital Revenue Code	272
Rate for Payer: Cash Price	$279.66

KIT ACESSORY DSO6003

Facility

$317.80

Hospital Charge Code	145163
Hospital Revenue Code	272
Min. Negotiated Rate	$28.60
Max. Negotiated Rate	$206.57
Rate for Payer: Aetna Commercial	$174.79
Rate for Payer: Amerigroup CHIP/Medicaid	$28.60
Rate for Payer: BCBS of TX Blue Advantage	$95.34
Rate for Payer: BCBS of TX Blue Essentials	$114.41
Rate for Payer: BCBS of TX PPO	$127.12
Rate for Payer: Cash Price	$279.66
Rate for Payer: Multiplan Auto	$206.57
Rate for Payer: Multiplan Commercial	$206.57
Rate for Payer: Multiplan Workers Comp	$206.57
Rate for Payer: Scott and White EPO/PPO	$158.90
Rate for Payer: Superior Health Plan EPO	$43.22

KIT ACL DISPOSABLE

Facility

$637.69

Hospital Charge Code	145131
Hospital Revenue Code	272
Min. Negotiated Rate	$57.39
Max. Negotiated Rate	$414.50
Rate for Payer: Aetna Commercial	$350.73
Rate for Payer: Amerigroup CHIP/Medicaid	$57.39
Rate for Payer: BCBS of TX Blue Advantage	$191.31
Rate for Payer: BCBS of TX Blue Essentials	$229.57
Rate for Payer: BCBS of TX PPO	$255.08
Rate for Payer: Cash Price	$561.17
Rate for Payer: Multiplan Auto	$414.50
Rate for Payer: Multiplan Commercial	$414.50
Rate for Payer: Multiplan Workers Comp	$414.50
Rate for Payer: Scott and White EPO/PPO	$318.84
Rate for Payer: Superior Health Plan EPO	$86.73

KIT ACL DISPOSABLE

Facility

$637.69

Hospital Charge Code	145131
Hospital Revenue Code	272
Rate for Payer: Cash Price	$561.17

KIT ANESTHESIA PXAVMP

Facility

$127.39

Hospital Charge Code	132498
Hospital Revenue Code	272
Rate for Payer: Cash Price	$112.10

KIT ANESTHESIA PXAVMP

Facility

$127.39

Hospital Charge Code	132498
Hospital Revenue Code	272
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$82.80
Rate for Payer: Aetna Commercial	$70.06
Rate for Payer: Amerigroup CHIP/Medicaid	$11.47
Rate for Payer: BCBS of TX Blue Advantage	$38.22
Rate for Payer: BCBS of TX Blue Essentials	$45.86
Rate for Payer: BCBS of TX PPO	$50.96
Rate for Payer: Cash Price	$112.10
Rate for Payer: Multiplan Auto	$82.80
Rate for Payer: Multiplan Commercial	$82.80
Rate for Payer: Multiplan Workers Comp	$82.80
Rate for Payer: Scott and White EPO/PPO	$63.70
Rate for Payer: Superior Health Plan EPO	$17.33

KIT ATRIAL UNIVERSAL

Facility

$295.10

Hospital Charge Code	8568964
Hospital Revenue Code	272
Min. Negotiated Rate	$26.56
Max. Negotiated Rate	$191.82
Rate for Payer: Aetna Commercial	$162.30
Rate for Payer: Amerigroup CHIP/Medicaid	$26.56
Rate for Payer: BCBS of TX Blue Advantage	$88.53
Rate for Payer: BCBS of TX Blue Essentials	$106.24
Rate for Payer: BCBS of TX PPO	$118.04
Rate for Payer: Cash Price	$259.69
Rate for Payer: Multiplan Auto	$191.82
Rate for Payer: Multiplan Commercial	$191.82
Rate for Payer: Multiplan Workers Comp	$191.82
Rate for Payer: Scott and White EPO/PPO	$147.55
Rate for Payer: Superior Health Plan EPO	$40.13

KIT ATRIAL UNIVERSAL

Facility

$295.10

Hospital Charge Code	8568964
Hospital Revenue Code	272
Rate for Payer: Cash Price	$259.69

KIT AUGMENT INJECTABLE 3CC

Facility

$18,479.04

Service Code	HCPCS C9359
Hospital Charge Code	145482
Hospital Revenue Code	278
Min. Negotiated Rate	$4,619.76
Max. Negotiated Rate	$9,239.52
Rate for Payer: Aetna Commercial	$5,543.71
Rate for Payer: Cash Price	$16,261.56
Rate for Payer: Cigna Commercial	$4,619.76
Rate for Payer: Multiplan Auto	$9,239.52
Rate for Payer: Multiplan Commercial	$9,239.52
Rate for Payer: Multiplan Workers Comp	$9,239.52
Rate for Payer: Scott and White EPO/PPO	$9,239.52

KIT AUGMENT INJECTABLE 3CC

Facility

$18,479.04

Service Code	HCPCS C9359
Hospital Charge Code	145482
Hospital Revenue Code	278
Min. Negotiated Rate	$150.09
Max. Negotiated Rate	$9,239.52
Rate for Payer: Aetna Commercial	$5,543.71
Rate for Payer: Amerigroup CHIP/Medicaid	$1,663.11
Rate for Payer: BCBS of TX Blue Advantage	$5,543.71
Rate for Payer: BCBS of TX Blue Essentials	$6,652.45
Rate for Payer: BCBS of TX PPO	$7,391.62
Rate for Payer: Cash Price	$16,261.56
Rate for Payer: Cash Price	$16,261.56
Rate for Payer: Cigna Medicaid	$150.09
Rate for Payer: Molina CHIP/Medicaid	$150.09
Rate for Payer: Multiplan Auto	$9,239.52
Rate for Payer: Multiplan Commercial	$9,239.52
Rate for Payer: Multiplan Workers Comp	$9,239.52
Rate for Payer: Parkland Medicaid	$150.09
Rate for Payer: Scott and White EPO/PPO	$9,239.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$150.09
Rate for Payer: Superior Health Plan EPO	$2,513.15

kit avaflex balloon 11g

Facility

$11,361.35

Hospital Charge Code	8634512
Hospital Revenue Code	272
Min. Negotiated Rate	$1,022.52
Max. Negotiated Rate	$7,384.88
Rate for Payer: Aetna Commercial	$6,248.74
Rate for Payer: Amerigroup CHIP/Medicaid	$1,022.52
Rate for Payer: BCBS of TX Blue Advantage	$3,408.40
Rate for Payer: BCBS of TX Blue Essentials	$4,090.09
Rate for Payer: BCBS of TX PPO	$4,544.54
Rate for Payer: Cash Price	$9,997.99
Rate for Payer: Multiplan Auto	$7,384.88
Rate for Payer: Multiplan Commercial	$7,384.88
Rate for Payer: Multiplan Workers Comp	$7,384.88
Rate for Payer: Scott and White EPO/PPO	$5,680.68
Rate for Payer: Superior Health Plan EPO	$1,545.14

kit avaflex balloon 11g

Facility

$11,361.35

Hospital Charge Code	8634512
Hospital Revenue Code	272
Rate for Payer: Cash Price	$9,997.99

KIT BONE MARROW ASPIRATION

Facility

$9,080.00

Hospital Charge Code	8394474
Hospital Revenue Code	272
Rate for Payer: Cash Price	$7,990.40

KIT BONE MARROW ASPIRATION

Facility

$9,080.00

Hospital Charge Code	8394474
Hospital Revenue Code	272
Min. Negotiated Rate	$817.20
Max. Negotiated Rate	$5,902.00
Rate for Payer: Aetna Commercial	$4,994.00
Rate for Payer: Amerigroup CHIP/Medicaid	$817.20
Rate for Payer: BCBS of TX Blue Advantage	$2,724.00
Rate for Payer: BCBS of TX Blue Essentials	$3,268.80
Rate for Payer: BCBS of TX PPO	$3,632.00
Rate for Payer: Cash Price	$7,990.40
Rate for Payer: Multiplan Auto	$5,902.00
Rate for Payer: Multiplan Commercial	$5,902.00
Rate for Payer: Multiplan Workers Comp	$5,902.00
Rate for Payer: Scott and White EPO/PPO	$4,540.00
Rate for Payer: Superior Health Plan EPO	$1,234.88

kit cath art 20gx1.75"

Facility

$43.54

Hospital Charge Code	2514602
Hospital Revenue Code	272
Rate for Payer: Cash Price	$38.32

kit cath art 20gx1.75"

Facility

$43.54

Hospital Charge Code	2514602
Hospital Revenue Code	272
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$28.30
Rate for Payer: Aetna Commercial	$23.95
Rate for Payer: Amerigroup CHIP/Medicaid	$3.92
Rate for Payer: BCBS of TX Blue Advantage	$13.06
Rate for Payer: BCBS of TX Blue Essentials	$15.67
Rate for Payer: BCBS of TX PPO	$17.42
Rate for Payer: Cash Price	$38.32
Rate for Payer: Multiplan Auto	$28.30
Rate for Payer: Multiplan Commercial	$28.30
Rate for Payer: Multiplan Workers Comp	$28.30
Rate for Payer: Scott and White EPO/PPO	$21.77
Rate for Payer: Superior Health Plan EPO	$5.92

Know your out-of-pocket cost for care.

All Charges