White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Labor Level Simple Additional Hour BCE

Facility

$430.00

Hospital Charge Code	300020
Hospital Revenue Code	720
Rate for Payer: Cash Price	$378.40

Labor Level Simple Additional Hour BCE

Facility

$430.00

Hospital Charge Code	300020
Hospital Revenue Code	720
Min. Negotiated Rate	$38.70
Max. Negotiated Rate	$279.50
Rate for Payer: Aetna Commercial	$236.50
Rate for Payer: Amerigroup CHIP/Medicaid	$38.70
Rate for Payer: BCBS of TX Blue Advantage	$129.00
Rate for Payer: BCBS of TX Blue Essentials	$154.80
Rate for Payer: BCBS of TX PPO	$172.00
Rate for Payer: Cash Price	$378.40
Rate for Payer: Multiplan Auto	$279.50
Rate for Payer: Multiplan Commercial	$279.50
Rate for Payer: Multiplan Workers Comp	$279.50
Rate for Payer: Scott and White EPO/PPO	$215.00
Rate for Payer: Superior Health Plan EPO	$58.48

lacosamide 50 mg Tab

Facility

$19.60

Service Code	HCPCS J3490
Hospital Charge Code	77650647
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.33

lacosamide 50 mg Tab

Facility

$19.60

Service Code	HCPCS J3490
Hospital Charge Code	77650647
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$12.74
Rate for Payer: Amerigroup CHIP/Medicaid	$1.76
Rate for Payer: BCBS of TX Blue Advantage	$5.88
Rate for Payer: BCBS of TX Blue Essentials	$7.06
Rate for Payer: BCBS of TX PPO	$7.84
Rate for Payer: Cash Price	$13.33
Rate for Payer: Multiplan Auto	$12.74
Rate for Payer: Multiplan Commercial	$12.74
Rate for Payer: Multiplan Workers Comp	$12.74
Rate for Payer: Scott and White EPO/PPO	$9.80
Rate for Payer: Superior Health Plan EPO	$2.67

Lacosamide SO

Facility

$196.00

Service Code	CPT 80235
Hospital Charge Code	8486565
Hospital Revenue Code	301
Min. Negotiated Rate	$10.57
Max. Negotiated Rate	$127.40
Rate for Payer: Aetna Commercial	$28.47
Rate for Payer: Aetna Medicare	$40.66
Rate for Payer: Amerigroup CHIP/Medicaid	$10.57
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$27.11
Rate for Payer: Amerigroup Medicare	$27.11
Rate for Payer: BCBS of TX Blue Advantage	$44.73
Rate for Payer: BCBS of TX Blue Essentials	$53.68
Rate for Payer: BCBS of TX Medicare	$27.11
Rate for Payer: BCBS of TX PPO	$59.91
Rate for Payer: Cash Price	$172.48
Rate for Payer: Cash Price	$172.48
Rate for Payer: Cigna Medicaid	$27.11
Rate for Payer: Cigna Medicare	$27.11
Rate for Payer: Employer Direct Commercial	$27.11
Rate for Payer: Humana Medicare/TRICARE	$27.11
Rate for Payer: Molina CHIP/Medicaid	$27.11
Rate for Payer: Molina Dual Medicare/Medicaid	$27.11
Rate for Payer: Molina Medicare	$27.11
Rate for Payer: Multiplan Auto	$127.40
Rate for Payer: Multiplan Commercial	$127.40
Rate for Payer: Multiplan Workers Comp	$127.40
Rate for Payer: Parkland Medicaid	$27.11
Rate for Payer: Scott and White EPO/PPO	$33.89
Rate for Payer: Scott and White Medicare	$27.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$27.11
Rate for Payer: Superior Health Plan EPO	$27.11
Rate for Payer: Superior Health Plan Medicare	$27.11
Rate for Payer: Universal American Dual Medicare/Medicaid	$27.11
Rate for Payer: Universal American Medicare	$27.11
Rate for Payer: Wellcare Medicare	$27.11
Rate for Payer: Wellmed Medicare	$27.11

Lacosamide SO

Facility

$196.00

Service Code	CPT 80235
Hospital Charge Code	8486565
Hospital Revenue Code	301
Rate for Payer: Cash Price	$172.48

Lactate Dehydrogenase

Facility

$254.00

Service Code	CPT 83615
Hospital Charge Code	1602093
Hospital Revenue Code	301
Rate for Payer: Cash Price	$223.52

Lactate Dehydrogenase

Facility

$254.00

Service Code	CPT 83615
Hospital Charge Code	1602093
Hospital Revenue Code	301
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$165.10
Rate for Payer: Aetna Commercial	$6.33
Rate for Payer: Aetna Medicare	$9.06
Rate for Payer: Amerigroup CHIP/Medicaid	$2.36
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6.04
Rate for Payer: Amerigroup Medicare	$6.04
Rate for Payer: BCBS of TX Blue Advantage	$9.97
Rate for Payer: BCBS of TX Blue Essentials	$11.96
Rate for Payer: BCBS of TX Medicare	$6.04
Rate for Payer: BCBS of TX PPO	$13.35
Rate for Payer: Cash Price	$223.52
Rate for Payer: Cash Price	$223.52
Rate for Payer: Cigna Medicaid	$6.04
Rate for Payer: Cigna Medicare	$6.04
Rate for Payer: Employer Direct Commercial	$6.04
Rate for Payer: Humana Medicare/TRICARE	$6.04
Rate for Payer: Molina CHIP/Medicaid	$6.04
Rate for Payer: Molina Dual Medicare/Medicaid	$6.04
Rate for Payer: Molina Medicare	$6.04
Rate for Payer: Multiplan Auto	$165.10
Rate for Payer: Multiplan Commercial	$165.10
Rate for Payer: Multiplan Workers Comp	$165.10
Rate for Payer: Parkland Medicaid	$6.04
Rate for Payer: Scott and White EPO/PPO	$7.55
Rate for Payer: Scott and White Medicare	$6.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.04
Rate for Payer: Superior Health Plan EPO	$6.04
Rate for Payer: Superior Health Plan Medicare	$6.04
Rate for Payer: Universal American Dual Medicare/Medicaid	$6.04
Rate for Payer: Universal American Medicare	$6.04
Rate for Payer: Wellcare Medicare	$6.04
Rate for Payer: Wellmed Medicare	$6.04

Lactate Dehydrogenase Body Fluid

Facility

$254.00

Service Code	CPT 83615
Hospital Charge Code	4103615
Hospital Revenue Code	301
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$165.10
Rate for Payer: Aetna Commercial	$6.33
Rate for Payer: Aetna Medicare	$9.06
Rate for Payer: Amerigroup CHIP/Medicaid	$2.36
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6.04
Rate for Payer: Amerigroup Medicare	$6.04
Rate for Payer: BCBS of TX Blue Advantage	$9.97
Rate for Payer: BCBS of TX Blue Essentials	$11.96
Rate for Payer: BCBS of TX Medicare	$6.04
Rate for Payer: BCBS of TX PPO	$13.35
Rate for Payer: Cash Price	$223.52
Rate for Payer: Cash Price	$223.52
Rate for Payer: Cigna Medicaid	$6.04
Rate for Payer: Cigna Medicare	$6.04
Rate for Payer: Employer Direct Commercial	$6.04
Rate for Payer: Humana Medicare/TRICARE	$6.04
Rate for Payer: Molina CHIP/Medicaid	$6.04
Rate for Payer: Molina Dual Medicare/Medicaid	$6.04
Rate for Payer: Molina Medicare	$6.04
Rate for Payer: Multiplan Auto	$165.10
Rate for Payer: Multiplan Commercial	$165.10
Rate for Payer: Multiplan Workers Comp	$165.10
Rate for Payer: Parkland Medicaid	$6.04
Rate for Payer: Scott and White EPO/PPO	$7.55
Rate for Payer: Scott and White Medicare	$6.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.04
Rate for Payer: Superior Health Plan EPO	$6.04
Rate for Payer: Superior Health Plan Medicare	$6.04
Rate for Payer: Universal American Dual Medicare/Medicaid	$6.04
Rate for Payer: Universal American Medicare	$6.04
Rate for Payer: Wellcare Medicare	$6.04
Rate for Payer: Wellmed Medicare	$6.04

Lactate Dehydrogenase Body Fluid

Facility

$254.00

Service Code	CPT 83615
Hospital Charge Code	4103615
Hospital Revenue Code	301
Rate for Payer: Cash Price	$223.52

Lactated Ringers IV Soln 1000 mL

Facility

$128.17

Service Code	HCPCS J7120
Hospital Charge Code	77340307
Hospital Revenue Code	258
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$83.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$8.61
Rate for Payer: BCBS of TX Blue Essentials	$10.34
Rate for Payer: BCBS of TX PPO	$11.46
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cash Price	$87.16
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: Scott and White EPO/PPO	$3.24
Rate for Payer: Superior Health Plan EPO	$17.43

Lactated Ringers IV Soln 1000 mL

Facility

$128.17

Service Code	HCPCS J7120
Hospital Charge Code	77340307
Hospital Revenue Code	258
Rate for Payer: Cash Price	$87.16

Lactation Consultant BCE

Facility

$60.00

Service Code	HCPCS S9443
Hospital Charge Code	10116
Hospital Revenue Code	510
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna Commercial	$33.00
Rate for Payer: Amerigroup CHIP/Medicaid	$5.40
Rate for Payer: BCBS of TX Blue Advantage	$18.00
Rate for Payer: BCBS of TX Blue Essentials	$21.60
Rate for Payer: BCBS of TX PPO	$24.00
Rate for Payer: Cash Price	$52.80
Rate for Payer: Multiplan Auto	$39.00
Rate for Payer: Multiplan Commercial	$39.00
Rate for Payer: Multiplan Workers Comp	$39.00
Rate for Payer: Scott and White EPO/PPO	$30.00

Lactation Consultant BCE

Facility

$60.00

Service Code	HCPCS S9443
Hospital Charge Code	10116
Hospital Revenue Code	510
Rate for Payer: Cash Price	$52.80

Lactation Consultant Duration of Contact: 15 Minutes

Facility

$60.00

Service Code	HCPCS S9443
Hospital Charge Code	10116
Hospital Revenue Code	510
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna Commercial	$33.00
Rate for Payer: Amerigroup CHIP/Medicaid	$5.40
Rate for Payer: BCBS of TX Blue Advantage	$18.00
Rate for Payer: BCBS of TX Blue Essentials	$21.60
Rate for Payer: BCBS of TX PPO	$24.00
Rate for Payer: Cash Price	$52.80
Rate for Payer: Multiplan Auto	$39.00
Rate for Payer: Multiplan Commercial	$39.00
Rate for Payer: Multiplan Workers Comp	$39.00
Rate for Payer: Scott and White EPO/PPO	$30.00

Lactation Consultant Duration of Contact:30 Minutes

Facility

$60.00

Service Code	HCPCS S9443
Hospital Charge Code	10116
Hospital Revenue Code	510
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna Commercial	$33.00
Rate for Payer: Amerigroup CHIP/Medicaid	$5.40
Rate for Payer: BCBS of TX Blue Advantage	$18.00
Rate for Payer: BCBS of TX Blue Essentials	$21.60
Rate for Payer: BCBS of TX PPO	$24.00
Rate for Payer: Cash Price	$52.80
Rate for Payer: Multiplan Auto	$39.00
Rate for Payer: Multiplan Commercial	$39.00
Rate for Payer: Multiplan Workers Comp	$39.00
Rate for Payer: Scott and White EPO/PPO	$30.00

Lactation Consultant Duration of Contact:45 Minutes

Facility

$60.00

Service Code	HCPCS S9443
Hospital Charge Code	10116
Hospital Revenue Code	510
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna Commercial	$33.00
Rate for Payer: Amerigroup CHIP/Medicaid	$5.40
Rate for Payer: BCBS of TX Blue Advantage	$18.00
Rate for Payer: BCBS of TX Blue Essentials	$21.60
Rate for Payer: BCBS of TX PPO	$24.00
Rate for Payer: Cash Price	$52.80
Rate for Payer: Multiplan Auto	$39.00
Rate for Payer: Multiplan Commercial	$39.00
Rate for Payer: Multiplan Workers Comp	$39.00
Rate for Payer: Scott and White EPO/PPO	$30.00

Lactation Consultant Duration of Contact:60 Minutes or more

Facility

$60.00

Service Code	HCPCS S9443
Hospital Charge Code	10116
Hospital Revenue Code	510
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna Commercial	$33.00
Rate for Payer: Amerigroup CHIP/Medicaid	$5.40
Rate for Payer: BCBS of TX Blue Advantage	$18.00
Rate for Payer: BCBS of TX Blue Essentials	$21.60
Rate for Payer: BCBS of TX PPO	$24.00
Rate for Payer: Cash Price	$52.80
Rate for Payer: Multiplan Auto	$39.00
Rate for Payer: Multiplan Commercial	$39.00
Rate for Payer: Multiplan Workers Comp	$39.00
Rate for Payer: Scott and White EPO/PPO	$30.00

Lactic Acid Level

Facility

$270.00

Service Code	CPT 83605
Hospital Charge Code	1602085
Hospital Revenue Code	301
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna Commercial	$12.14
Rate for Payer: Aetna Medicare	$17.36
Rate for Payer: Amerigroup CHIP/Medicaid	$4.51
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11.57
Rate for Payer: Amerigroup Medicare	$11.57
Rate for Payer: BCBS of TX Blue Advantage	$19.09
Rate for Payer: BCBS of TX Blue Essentials	$22.91
Rate for Payer: BCBS of TX Medicare	$11.57
Rate for Payer: BCBS of TX PPO	$25.57
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cigna Medicaid	$11.57
Rate for Payer: Cigna Medicare	$11.57
Rate for Payer: Employer Direct Commercial	$11.57
Rate for Payer: Humana Medicare/TRICARE	$11.57
Rate for Payer: Molina CHIP/Medicaid	$11.57
Rate for Payer: Molina Dual Medicare/Medicaid	$11.57
Rate for Payer: Molina Medicare	$11.57
Rate for Payer: Multiplan Auto	$175.50
Rate for Payer: Multiplan Commercial	$175.50
Rate for Payer: Multiplan Workers Comp	$175.50
Rate for Payer: Parkland Medicaid	$11.57
Rate for Payer: Scott and White EPO/PPO	$14.46
Rate for Payer: Scott and White Medicare	$11.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11.57
Rate for Payer: Superior Health Plan EPO	$11.57
Rate for Payer: Superior Health Plan Medicare	$11.57
Rate for Payer: Universal American Dual Medicare/Medicaid	$11.57
Rate for Payer: Universal American Medicare	$11.57
Rate for Payer: Wellcare Medicare	$11.57
Rate for Payer: Wellmed Medicare	$11.57

Lactic Acid Level

Facility

$270.00

Service Code	CPT 83605
Hospital Charge Code	1602085
Hospital Revenue Code	301
Rate for Payer: Cash Price	$237.60

lactobacillus acidophilus and bulgaricus Chew Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77651483
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$4.97
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.29
Rate for Payer: BCBS of TX Blue Essentials	$2.75
Rate for Payer: BCBS of TX PPO	$3.06
Rate for Payer: Cash Price	$5.20
Rate for Payer: Multiplan Auto	$4.97
Rate for Payer: Multiplan Commercial	$4.97
Rate for Payer: Multiplan Workers Comp	$4.97
Rate for Payer: Scott and White EPO/PPO	$3.83
Rate for Payer: Superior Health Plan EPO	$1.04

lactobacillus acidophilus and bulgaricus Chew Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77651483
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

lactobacillus acidophilus Cap

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77651589
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$4.97
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.29
Rate for Payer: BCBS of TX Blue Essentials	$2.75
Rate for Payer: BCBS of TX PPO	$3.06
Rate for Payer: Cash Price	$5.20
Rate for Payer: Multiplan Auto	$4.97
Rate for Payer: Multiplan Commercial	$4.97
Rate for Payer: Multiplan Workers Comp	$4.97
Rate for Payer: Scott and White EPO/PPO	$3.83
Rate for Payer: Superior Health Plan EPO	$1.04

lactobacillus acidophilus Cap

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77651589
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

lactulose 10 g/15 mL Oral Syrup 30 mL

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77652409
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$4.97
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.29
Rate for Payer: BCBS of TX Blue Essentials	$2.75
Rate for Payer: BCBS of TX PPO	$3.06
Rate for Payer: Cash Price	$5.20
Rate for Payer: Multiplan Auto	$4.97
Rate for Payer: Multiplan Commercial	$4.97
Rate for Payer: Multiplan Workers Comp	$4.97
Rate for Payer: Scott and White EPO/PPO	$3.83
Rate for Payer: Superior Health Plan EPO	$1.04

Know your out-of-pocket cost for care.

All Charges