White Rock Medical Center

All Charges

Charge

Type

Setting

Price

GW HITORQ WHOLY J SYS260 -- DHF

Facility

$678.94

Hospital Charge Code	82466947
Hospital Revenue Code	272
Rate for Payer: Cash Price	$461.68

GW J -- DHF

Facility

$472.16

Hospital Charge Code	80731706
Hospital Revenue Code	272
Rate for Payer: Cash Price	$321.07

GW J -- DHF

Facility

$472.16

Hospital Charge Code	80731706
Hospital Revenue Code	272
Min. Negotiated Rate	$42.49
Max. Negotiated Rate	$339.96
Rate for Payer: Amerigroup CHIP/Medicaid	$42.49
Rate for Payer: BCBS of TX Blue Advantage	$141.65
Rate for Payer: BCBS of TX Blue Essentials	$169.98
Rate for Payer: BCBS of TX PPO	$188.86
Rate for Payer: Cash Price	$321.07
Rate for Payer: Cigna Medicaid	$339.96
Rate for Payer: Molina CHIP/Medicaid	$339.96
Rate for Payer: Multiplan Auto	$306.90
Rate for Payer: Multiplan Commercial	$306.90
Rate for Payer: Multiplan Workers Comp	$306.90
Rate for Payer: Parkland Medicaid	$339.96
Rate for Payer: Scott and White EPO/PPO	$236.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$339.96
Rate for Payer: Superior Health Plan EPO	$64.21

GW PRESSR AERIS AGILE TP -- DHF

Facility

$5,879.30

Hospital Charge Code	80735061
Hospital Revenue Code	272
Min. Negotiated Rate	$529.14
Max. Negotiated Rate	$4,233.10
Rate for Payer: Amerigroup CHIP/Medicaid	$529.14
Rate for Payer: BCBS of TX Blue Advantage	$1,763.79
Rate for Payer: BCBS of TX Blue Essentials	$2,116.55
Rate for Payer: BCBS of TX PPO	$2,351.72
Rate for Payer: Cash Price	$3,997.92
Rate for Payer: Cigna Medicaid	$4,233.10
Rate for Payer: Molina CHIP/Medicaid	$4,233.10
Rate for Payer: Multiplan Auto	$3,821.55
Rate for Payer: Multiplan Commercial	$3,821.55
Rate for Payer: Multiplan Workers Comp	$3,821.55
Rate for Payer: Parkland Medicaid	$4,233.10
Rate for Payer: Scott and White EPO/PPO	$2,939.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,233.10
Rate for Payer: Superior Health Plan EPO	$799.58

GW PRESSR AERIS AGILE TP -- DHF

Facility

$5,879.30

Hospital Charge Code	80735061
Hospital Revenue Code	272
Rate for Payer: Cash Price	$3,997.92

GW PTCA CHOICE 182/300 -- DHF

Facility

$348.56

Hospital Charge Code	82412107
Hospital Revenue Code	272
Min. Negotiated Rate	$31.37
Max. Negotiated Rate	$250.96
Rate for Payer: Amerigroup CHIP/Medicaid	$31.37
Rate for Payer: BCBS of TX Blue Advantage	$104.57
Rate for Payer: BCBS of TX Blue Essentials	$125.48
Rate for Payer: BCBS of TX PPO	$139.42
Rate for Payer: Cash Price	$237.02
Rate for Payer: Cigna Medicaid	$250.96
Rate for Payer: Molina CHIP/Medicaid	$250.96
Rate for Payer: Multiplan Auto	$226.56
Rate for Payer: Multiplan Commercial	$226.56
Rate for Payer: Multiplan Workers Comp	$226.56
Rate for Payer: Parkland Medicaid	$250.96
Rate for Payer: Scott and White EPO/PPO	$174.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$250.96
Rate for Payer: Superior Health Plan EPO	$47.40

GW PTCA CHOICE 182/300 -- DHF

Facility

$348.56

Hospital Charge Code	82412107
Hospital Revenue Code	272
Rate for Payer: Cash Price	$237.02

H12LP ENDPH XCEL BLUNT TIP TROCAR,

Facility

$533.90

Hospital Charge Code	993772
Hospital Revenue Code	272
Rate for Payer: Cash Price	$363.05

H12LP ENDPH XCEL BLUNT TIP TROCAR,

Facility

$533.90

Hospital Charge Code	993772
Hospital Revenue Code	272
Min. Negotiated Rate	$48.05
Max. Negotiated Rate	$384.41
Rate for Payer: Amerigroup CHIP/Medicaid	$48.05
Rate for Payer: BCBS of TX Blue Advantage	$160.17
Rate for Payer: BCBS of TX Blue Essentials	$192.20
Rate for Payer: BCBS of TX PPO	$213.56
Rate for Payer: Cash Price	$363.05
Rate for Payer: Cigna Medicaid	$384.41
Rate for Payer: Molina CHIP/Medicaid	$384.41
Rate for Payer: Multiplan Auto	$347.04
Rate for Payer: Multiplan Commercial	$347.04
Rate for Payer: Multiplan Workers Comp	$347.04
Rate for Payer: Parkland Medicaid	$384.41
Rate for Payer: Scott and White EPO/PPO	$266.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$384.41
Rate for Payer: Superior Health Plan EPO	$72.61

Hallux rigidus correction

Facility

$28,192.28

Service Code	HCPCS 28291
Hospital Charge Code	9900501
Hospital Revenue Code	360
Min. Negotiated Rate	$3,623.98
Max. Negotiated Rate	$20,298.44
Rate for Payer: Amerigroup CHIP/Medicaid	$3,623.98
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	$19,170.75
Rate for Payer: Cash Price	$19,170.75
Rate for Payer: Cash Price	$19,170.75
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicaid	$20,298.44
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	$20,298.44
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	$20,298.44
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	$20,298.44
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

Hallux rigidus correction

Facility

$28,192.28

Service Code	HCPCS 28291
Hospital Charge Code	9900501
Hospital Revenue Code	360
Rate for Payer: Cash Price	$19,170.75

Hallux rigidus correction

Facility

$15,408.22

Service Code	CPT 28291
Hospital Charge Code	36028291
Hospital Revenue Code	360
Min. Negotiated Rate	$3,623.98
Max. Negotiated Rate	$15,408.22
Rate for Payer: Amerigroup CHIP/Medicaid	$3,623.98
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

Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsop

Facility

$10,000.00

Service Code	CPT 28289
Hospital Charge Code	36028289
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

Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsop

Facility

$7,783.60

Service Code	HCPCS 28289
Hospital Charge Code	9900500
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,292.85

Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsop

Facility

$7,783.60

Service Code	HCPCS 28289
Hospital Charge Code	9900500
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	$5,292.85
Rate for Payer: Cash Price	$5,292.85
Rate for Payer: Cash Price	$5,292.85
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicaid	$5,604.19
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	$5,604.19
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	$5,604.19
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	$5,604.19
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

haloperidol 5 mg/mL Inj Soln 1 mL

Facility

$128.17

Service Code	HCPCS J1630
Hospital Charge Code	77602094
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

haloperidol 5 mg/mL Inj Soln 1 mL

Facility

$128.17

Service Code	HCPCS J1630
Hospital Charge Code	77602094
Hospital Revenue Code	636
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$92.28
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$5.76
Rate for Payer: BCBS of TX Blue Essentials	$6.91
Rate for Payer: BCBS of TX PPO	$7.66
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

haloperidol 5 mg Tab

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77602039
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$5.76
Rate for Payer: Amerigroup CHIP/Medicaid	$0.72
Rate for Payer: BCBS of TX Blue Advantage	$2.40
Rate for Payer: BCBS of TX Blue Essentials	$2.88
Rate for Payer: BCBS of TX PPO	$3.20
Rate for Payer: Cash Price	$5.44
Rate for Payer: Cigna Medicaid	$5.76
Rate for Payer: Molina CHIP/Medicaid	$5.76
Rate for Payer: Multiplan Auto	$5.20
Rate for Payer: Multiplan Commercial	$5.20
Rate for Payer: Multiplan Workers Comp	$5.20
Rate for Payer: Parkland Medicaid	$5.76
Rate for Payer: Scott and White EPO/PPO	$4.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.76
Rate for Payer: Superior Health Plan EPO	$1.09

haloperidol 5 mg Tab

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77602039
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.44

HAND AND WRIST PROCEDURES

Facility

$7,381.59

Service Code	APR-DRG 3163
Min. Negotiated Rate	$6,959.62
Max. Negotiated Rate	$7,381.59
Rate for Payer: Amerigroup CHIP/Medicaid	$6,959.62
Rate for Payer: Cigna Medicaid	$6,959.62
Rate for Payer: Molina CHIP/Medicaid	$6,959.62
Rate for Payer: Parkland Medicaid	$6,959.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,381.59

HAND AND WRIST PROCEDURES

Facility

$20,109.45

Service Code	APR-DRG 3164
Min. Negotiated Rate	$18,959.90
Max. Negotiated Rate	$20,109.45
Rate for Payer: Amerigroup CHIP/Medicaid	$18,959.90
Rate for Payer: Cigna Medicaid	$18,959.90
Rate for Payer: Molina CHIP/Medicaid	$18,959.90
Rate for Payer: Parkland Medicaid	$18,959.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$20,109.45

HAND AND WRIST PROCEDURES

Facility

$6,491.05

Service Code	APR-DRG 3162
Min. Negotiated Rate	$6,119.99
Max. Negotiated Rate	$6,491.05
Rate for Payer: Amerigroup CHIP/Medicaid	$6,119.99
Rate for Payer: Cigna Medicaid	$6,119.99
Rate for Payer: Molina CHIP/Medicaid	$6,119.99
Rate for Payer: Parkland Medicaid	$6,119.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,491.05

HAND AND WRIST PROCEDURES

Facility

$4,446.30

Service Code	APR-DRG 3161
Min. Negotiated Rate	$4,192.13
Max. Negotiated Rate	$4,446.30
Rate for Payer: Amerigroup CHIP/Medicaid	$4,192.13
Rate for Payer: Cigna Medicaid	$4,192.13
Rate for Payer: Molina CHIP/Medicaid	$4,192.13
Rate for Payer: Parkland Medicaid	$4,192.13
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,446.30

HANDLE, LARYING, SOLO, BRITE, PRO

Facility

$43.04

Hospital Charge Code	993730
Hospital Revenue Code	272
Rate for Payer: Cash Price	$29.27

HANDLE, LARYING, SOLO, BRITE, PRO

Facility

$43.04

Hospital Charge Code	993730
Hospital Revenue Code	272
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$30.99
Rate for Payer: Amerigroup CHIP/Medicaid	$3.87
Rate for Payer: BCBS of TX Blue Advantage	$12.91
Rate for Payer: BCBS of TX Blue Essentials	$15.49
Rate for Payer: BCBS of TX PPO	$17.22
Rate for Payer: Cash Price	$29.27
Rate for Payer: Cigna Medicaid	$30.99
Rate for Payer: Molina CHIP/Medicaid	$30.99
Rate for Payer: Multiplan Auto	$27.98
Rate for Payer: Multiplan Commercial	$27.98
Rate for Payer: Multiplan Workers Comp	$27.98
Rate for Payer: Parkland Medicaid	$30.99
Rate for Payer: Scott and White EPO/PPO	$21.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$30.99
Rate for Payer: Superior Health Plan EPO	$5.85

Know your out-of-pocket cost for care.

All Charges