White Rock Medical Center

All Charges

Charge

Type

Setting

Price

HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$19,423.70

Service Code	MSDRG 514
Min. Negotiated Rate	$8,598.28
Max. Negotiated Rate	$19,423.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,252.53
Rate for Payer: Amerigroup Medicare	$12,252.53
Rate for Payer: BCBS of TX Medicare	$12,252.53
Rate for Payer: Cigna Commercial	$13,167.22
Rate for Payer: Cigna Medicare	$12,252.53
Rate for Payer: Employer Direct Commercial	$12,252.53
Rate for Payer: Humana Medicare/TRICARE	$12,252.53
Rate for Payer: Molina Dual Medicare/Medicaid	$12,252.53
Rate for Payer: Molina Medicare	$12,252.53
Rate for Payer: Multiplan Auto	$19,423.70
Rate for Payer: Multiplan Commercial	$19,423.70
Rate for Payer: Multiplan Workers Comp	$19,423.70
Rate for Payer: Scott and White EPO/PPO	$8,945.12
Rate for Payer: Scott and White Medicare	$12,252.53
Rate for Payer: Superior Health Plan EPO	$12,252.53
Rate for Payer: Superior Health Plan Medicare	$12,252.53
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,252.53
Rate for Payer: Universal American Medicare	$12,252.53
Rate for Payer: Wellcare Medicare	$12,252.53
Rate for Payer: Wellmed Medicare	$12,252.53

HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W CC/MCC

Facility

$29,911.70

Service Code	MSDRG 513
Min. Negotiated Rate	$13,775.12
Max. Negotiated Rate	$29,911.70
Rate for Payer: BCBS of TX Blue Advantage	$14,100.56
Rate for Payer: BCBS of TX Blue Essentials	$16,919.03
Rate for Payer: BCBS of TX PPO	$18,799.65

HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W/O CC/MCC

Facility

$19,423.70

Service Code	MSDRG 514
Min. Negotiated Rate	$8,598.28
Max. Negotiated Rate	$19,423.70
Rate for Payer: BCBS of TX Blue Advantage	$8,598.28
Rate for Payer: BCBS of TX Blue Essentials	$10,316.94
Rate for Payer: BCBS of TX PPO	$11,463.71

HANDPIECE, MINIPAK ENDOMETNAL ABLATION SYSTEM

Facility

$122.58

Hospital Charge Code	993865
Hospital Revenue Code	279
Rate for Payer: Cash Price	$83.35

HANDPIECE, MINIPAK ENDOMETNAL ABLATION SYSTEM

Facility

$122.58

Hospital Charge Code	993865
Hospital Revenue Code	279
Min. Negotiated Rate	$11.03
Max. Negotiated Rate	$88.26
Rate for Payer: Amerigroup CHIP/Medicaid	$11.03
Rate for Payer: BCBS of TX Blue Advantage	$36.77
Rate for Payer: BCBS of TX Blue Essentials	$44.13
Rate for Payer: BCBS of TX PPO	$49.03
Rate for Payer: Cash Price	$83.35
Rate for Payer: Cigna Medicaid	$88.26
Rate for Payer: Molina CHIP/Medicaid	$88.26
Rate for Payer: Multiplan Auto	$79.68
Rate for Payer: Multiplan Commercial	$79.68
Rate for Payer: Multiplan Workers Comp	$79.68
Rate for Payer: Parkland Medicaid	$88.26
Rate for Payer: Scott and White EPO/PPO	$61.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$88.26
Rate for Payer: Superior Health Plan EPO	$16.67

HANDPIECE, VESSEL SEALER OPEN FINE JAW 9CM SCISSOR -- DHF

Facility

$2,043.00

Hospital Charge Code	81748345
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,389.24

HANDPIECE, VESSEL SEALER OPEN FINE JAW 9CM SCISSOR -- DHF

Facility

$2,043.00

Hospital Charge Code	81748345
Hospital Revenue Code	272
Min. Negotiated Rate	$183.87
Max. Negotiated Rate	$1,470.96
Rate for Payer: Amerigroup CHIP/Medicaid	$183.87
Rate for Payer: BCBS of TX Blue Advantage	$612.90
Rate for Payer: BCBS of TX Blue Essentials	$735.48
Rate for Payer: BCBS of TX PPO	$817.20
Rate for Payer: Cash Price	$1,389.24
Rate for Payer: Cigna Medicaid	$1,470.96
Rate for Payer: Molina CHIP/Medicaid	$1,470.96
Rate for Payer: Multiplan Auto	$1,327.95
Rate for Payer: Multiplan Commercial	$1,327.95
Rate for Payer: Multiplan Workers Comp	$1,327.95
Rate for Payer: Parkland Medicaid	$1,470.96
Rate for Payer: Scott and White EPO/PPO	$1,021.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,470.96
Rate for Payer: Superior Health Plan EPO	$277.85

HAND PROCEDURES FOR INJURIES

Facility

$33,485.60

Service Code	MSDRG 906
Min. Negotiated Rate	$15,421.00
Max. Negotiated Rate	$33,485.60
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$19,156.49
Rate for Payer: Amerigroup Medicare	$19,156.49
Rate for Payer: BCBS of TX Blue Advantage	$15,851.52
Rate for Payer: BCBS of TX Blue Essentials	$19,019.98
Rate for Payer: BCBS of TX Medicare	$19,156.49
Rate for Payer: BCBS of TX PPO	$21,134.13
Rate for Payer: Cigna Commercial	$22,699.71
Rate for Payer: Cigna Medicare	$19,156.49
Rate for Payer: Employer Direct Commercial	$19,156.49
Rate for Payer: Humana Medicare/TRICARE	$19,156.49
Rate for Payer: Molina Dual Medicare/Medicaid	$19,156.49
Rate for Payer: Molina Medicare	$19,156.49
Rate for Payer: Multiplan Auto	$33,485.60
Rate for Payer: Multiplan Commercial	$33,485.60
Rate for Payer: Multiplan Workers Comp	$33,485.60
Rate for Payer: Scott and White EPO/PPO	$15,421.00
Rate for Payer: Scott and White Medicare	$19,156.49
Rate for Payer: Superior Health Plan EPO	$19,156.49
Rate for Payer: Superior Health Plan Medicare	$19,156.49
Rate for Payer: Universal American Dual Medicare/Medicaid	$19,156.49
Rate for Payer: Universal American Medicare	$19,156.49
Rate for Payer: Wellcare Medicare	$19,156.49
Rate for Payer: Wellmed Medicare	$19,156.49

HARDYCHROM MRSA, 15 X 100MM PLATE

Facility

$86.84

Hospital Charge Code	993105
Hospital Revenue Code	270
Rate for Payer: Cash Price	$59.05

HARDYCHROM MRSA, 15 X 100MM PLATE

Facility

$86.84

Hospital Charge Code	993105
Hospital Revenue Code	270
Min. Negotiated Rate	$7.82
Max. Negotiated Rate	$62.52
Rate for Payer: Amerigroup CHIP/Medicaid	$7.82
Rate for Payer: BCBS of TX Blue Advantage	$26.05
Rate for Payer: BCBS of TX Blue Essentials	$31.26
Rate for Payer: BCBS of TX PPO	$34.74
Rate for Payer: Cash Price	$59.05
Rate for Payer: Cigna Medicaid	$62.52
Rate for Payer: Molina CHIP/Medicaid	$62.52
Rate for Payer: Multiplan Auto	$56.45
Rate for Payer: Multiplan Commercial	$56.45
Rate for Payer: Multiplan Workers Comp	$56.45
Rate for Payer: Parkland Medicaid	$62.52
Rate for Payer: Scott and White EPO/PPO	$43.42
Rate for Payer: Superior Health Plan CHIP/Medicaid	$62.52
Rate for Payer: Superior Health Plan EPO	$11.81

harmonic enseals

Facility

$2,508.35

Hospital Charge Code	992682
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,705.68

harmonic enseals

Facility

$2,508.35

Hospital Charge Code	992682
Hospital Revenue Code	272
Min. Negotiated Rate	$225.75
Max. Negotiated Rate	$1,806.01
Rate for Payer: Amerigroup CHIP/Medicaid	$225.75
Rate for Payer: BCBS of TX Blue Advantage	$752.50
Rate for Payer: BCBS of TX Blue Essentials	$903.01
Rate for Payer: BCBS of TX PPO	$1,003.34
Rate for Payer: Cash Price	$1,705.68
Rate for Payer: Cigna Medicaid	$1,806.01
Rate for Payer: Molina CHIP/Medicaid	$1,806.01
Rate for Payer: Multiplan Auto	$1,630.43
Rate for Payer: Multiplan Commercial	$1,630.43
Rate for Payer: Multiplan Workers Comp	$1,630.43
Rate for Payer: Parkland Medicaid	$1,806.01
Rate for Payer: Scott and White EPO/PPO	$1,254.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,806.01
Rate for Payer: Superior Health Plan EPO	$341.14

Harvest of skin for tissue cultured autograft 100 sq cm or less

Facility

$7,316.92

Service Code	HCPCS 15040
Hospital Charge Code	994054
Hospital Revenue Code	361
Rate for Payer: Cash Price	$4,975.51

Harvest of skin for tissue cultured autograft 100 sq cm or less

Facility

$7,316.92

Service Code	HCPCS 15040
Hospital Charge Code	994054
Hospital Revenue Code	361
Min. Negotiated Rate	$784.87
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$784.87
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Amerigroup Medicare	$2,072.68
Rate for Payer: BCBS of TX Blue Advantage	$2,709.98
Rate for Payer: BCBS of TX Blue Essentials	$3,245.48
Rate for Payer: BCBS of TX Medicare	$2,072.68
Rate for Payer: BCBS of TX PPO	$4,089.30
Rate for Payer: Cash Price	$4,975.51
Rate for Payer: Cash Price	$4,975.51
Rate for Payer: Cash Price	$4,975.51
Rate for Payer: Cigna Commercial	$4,381.27
Rate for Payer: Cigna Medicaid	$5,268.18
Rate for Payer: Cigna Medicare	$2,072.68
Rate for Payer: Employer Direct Commercial	$2,072.68
Rate for Payer: Humana Medicare/TRICARE	$2,072.68
Rate for Payer: Molina CHIP/Medicaid	$5,268.18
Rate for Payer: Molina Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Molina Medicare	$2,072.68
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	$5,268.18
Rate for Payer: Scott and White EPO/PPO	$3,834.46
Rate for Payer: Scott and White Medicare	$2,072.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,268.18
Rate for Payer: Superior Health Plan EPO	$2,072.68
Rate for Payer: Superior Health Plan Medicare	$2,072.68
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,072.68
Rate for Payer: Universal American Medicare	$2,072.68
Rate for Payer: Wellcare Medicare	$2,072.68
Rate for Payer: Wellmed Medicare	$2,072.68

HAV, HBV, HCV SO

Facility

$242.00

Hospital Charge Code	8884622
Hospital Revenue Code	300
Min. Negotiated Rate	$21.78
Max. Negotiated Rate	$174.24
Rate for Payer: Amerigroup CHIP/Medicaid	$21.78
Rate for Payer: BCBS of TX Blue Advantage	$72.60
Rate for Payer: BCBS of TX Blue Essentials	$87.12
Rate for Payer: BCBS of TX PPO	$96.80
Rate for Payer: Cash Price	$164.56
Rate for Payer: Cigna Medicaid	$174.24
Rate for Payer: Molina CHIP/Medicaid	$174.24
Rate for Payer: Multiplan Auto	$157.30
Rate for Payer: Multiplan Commercial	$157.30
Rate for Payer: Multiplan Workers Comp	$157.30
Rate for Payer: Parkland Medicaid	$174.24
Rate for Payer: Scott and White EPO/PPO	$121.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$174.24
Rate for Payer: Superior Health Plan EPO	$32.91

HAV, HBV, HCV SO

Facility

$242.00

Hospital Charge Code	8884622
Hospital Revenue Code	300
Rate for Payer: Cash Price	$164.56

HBsAg Screen SO

Facility

$242.00

Service Code	HCPCS 87340
Hospital Charge Code	1700150
Hospital Revenue Code	300
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$174.24
Rate for Payer: Amerigroup CHIP/Medicaid	$4.03
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10.33
Rate for Payer: Amerigroup Medicare	$10.33
Rate for Payer: BCBS of TX Blue Advantage	$72.60
Rate for Payer: BCBS of TX Blue Essentials	$87.12
Rate for Payer: BCBS of TX Medicare	$10.33
Rate for Payer: BCBS of TX PPO	$96.80
Rate for Payer: Cash Price	$164.56
Rate for Payer: Cash Price	$164.56
Rate for Payer: Cigna Medicaid	$174.24
Rate for Payer: Cigna Medicare	$10.33
Rate for Payer: Employer Direct Commercial	$10.33
Rate for Payer: Humana Medicare/TRICARE	$10.33
Rate for Payer: Molina CHIP/Medicaid	$174.24
Rate for Payer: Molina Dual Medicare/Medicaid	$10.33
Rate for Payer: Molina Medicare	$10.33
Rate for Payer: Multiplan Auto	$157.30
Rate for Payer: Multiplan Commercial	$157.30
Rate for Payer: Multiplan Workers Comp	$157.30
Rate for Payer: Parkland Medicaid	$174.24
Rate for Payer: Scott and White EPO/PPO	$12.91
Rate for Payer: Scott and White Medicare	$10.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$174.24
Rate for Payer: Superior Health Plan EPO	$10.33
Rate for Payer: Superior Health Plan Medicare	$10.33
Rate for Payer: Universal American Dual Medicare/Medicaid	$10.33
Rate for Payer: Universal American Medicare	$10.33
Rate for Payer: Wellcare Medicare	$10.33
Rate for Payer: Wellmed Medicare	$10.33

HBsAg Screen SO

Facility

$242.00

Service Code	HCPCS 87340
Hospital Charge Code	1700150
Hospital Revenue Code	300
Rate for Payer: Cash Price	$164.56

HCG Qualitative Serum

Facility

$237.00

Service Code	HCPCS 84703 QW
Hospital Charge Code	1602580
Hospital Revenue Code	301
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$170.64
Rate for Payer: Amerigroup CHIP/Medicaid	$2.93
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7.52
Rate for Payer: Amerigroup Medicare	$7.52
Rate for Payer: BCBS of TX Blue Advantage	$71.10
Rate for Payer: BCBS of TX Blue Essentials	$85.32
Rate for Payer: BCBS of TX Medicare	$7.52
Rate for Payer: BCBS of TX PPO	$94.80
Rate for Payer: Cash Price	$161.16
Rate for Payer: Cash Price	$161.16
Rate for Payer: Cigna Medicaid	$170.64
Rate for Payer: Cigna Medicare	$7.52
Rate for Payer: Employer Direct Commercial	$7.52
Rate for Payer: Humana Medicare/TRICARE	$7.52
Rate for Payer: Molina CHIP/Medicaid	$170.64
Rate for Payer: Molina Dual Medicare/Medicaid	$7.52
Rate for Payer: Molina Medicare	$7.52
Rate for Payer: Multiplan Auto	$154.05
Rate for Payer: Multiplan Commercial	$154.05
Rate for Payer: Multiplan Workers Comp	$154.05
Rate for Payer: Parkland Medicaid	$170.64
Rate for Payer: Scott and White EPO/PPO	$9.40
Rate for Payer: Scott and White Medicare	$7.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$170.64
Rate for Payer: Superior Health Plan EPO	$7.52
Rate for Payer: Superior Health Plan Medicare	$7.52
Rate for Payer: Universal American Dual Medicare/Medicaid	$7.52
Rate for Payer: Universal American Medicare	$7.52
Rate for Payer: Wellcare Medicare	$7.52
Rate for Payer: Wellmed Medicare	$7.52

HCG Qualitative Serum

Facility

$237.00

Service Code	HCPCS 84703 QW
Hospital Charge Code	1602580
Hospital Revenue Code	301
Rate for Payer: Cash Price	$161.16

HCG Qualitative Urine

Facility

$367.00

Service Code	HCPCS 81025
Hospital Charge Code	1605187
Hospital Revenue Code	307
Rate for Payer: Cash Price	$249.56

HCG Qualitative Urine

Facility

$367.00

Service Code	HCPCS 81025
Hospital Charge Code	1605187
Hospital Revenue Code	307
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$264.24
Rate for Payer: Amerigroup CHIP/Medicaid	$3.36
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8.61
Rate for Payer: Amerigroup Medicare	$8.61
Rate for Payer: BCBS of TX Blue Advantage	$110.10
Rate for Payer: BCBS of TX Blue Essentials	$132.12
Rate for Payer: BCBS of TX Medicare	$8.61
Rate for Payer: BCBS of TX PPO	$146.80
Rate for Payer: Cash Price	$249.56
Rate for Payer: Cash Price	$249.56
Rate for Payer: Cigna Medicaid	$264.24
Rate for Payer: Cigna Medicare	$8.61
Rate for Payer: Employer Direct Commercial	$8.61
Rate for Payer: Humana Medicare/TRICARE	$8.61
Rate for Payer: Molina CHIP/Medicaid	$264.24
Rate for Payer: Molina Dual Medicare/Medicaid	$8.61
Rate for Payer: Molina Medicare	$8.61
Rate for Payer: Multiplan Auto	$238.55
Rate for Payer: Multiplan Commercial	$238.55
Rate for Payer: Multiplan Workers Comp	$238.55
Rate for Payer: Parkland Medicaid	$264.24
Rate for Payer: Scott and White EPO/PPO	$10.76
Rate for Payer: Scott and White Medicare	$8.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$264.24
Rate for Payer: Superior Health Plan EPO	$8.61
Rate for Payer: Superior Health Plan Medicare	$8.61
Rate for Payer: Universal American Dual Medicare/Medicaid	$8.61
Rate for Payer: Universal American Medicare	$8.61
Rate for Payer: Wellcare Medicare	$8.61
Rate for Payer: Wellmed Medicare	$8.61

(HCG) Quantitative

Facility

$431.00

Service Code	HCPCS 84702
Hospital Charge Code	8222373
Hospital Revenue Code	301
Min. Negotiated Rate	$5.87
Max. Negotiated Rate	$310.32
Rate for Payer: Amerigroup CHIP/Medicaid	$5.87
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15.05
Rate for Payer: Amerigroup Medicare	$15.05
Rate for Payer: BCBS of TX Blue Advantage	$129.30
Rate for Payer: BCBS of TX Blue Essentials	$155.16
Rate for Payer: BCBS of TX Medicare	$15.05
Rate for Payer: BCBS of TX PPO	$172.40
Rate for Payer: Cash Price	$293.08
Rate for Payer: Cash Price	$293.08
Rate for Payer: Cigna Medicaid	$310.32
Rate for Payer: Cigna Medicare	$15.05
Rate for Payer: Employer Direct Commercial	$15.05
Rate for Payer: Humana Medicare/TRICARE	$15.05
Rate for Payer: Molina CHIP/Medicaid	$310.32
Rate for Payer: Molina Dual Medicare/Medicaid	$15.05
Rate for Payer: Molina Medicare	$15.05
Rate for Payer: Multiplan Auto	$280.15
Rate for Payer: Multiplan Commercial	$280.15
Rate for Payer: Multiplan Workers Comp	$280.15
Rate for Payer: Parkland Medicaid	$310.32
Rate for Payer: Scott and White EPO/PPO	$18.81
Rate for Payer: Scott and White Medicare	$15.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$310.32
Rate for Payer: Superior Health Plan EPO	$15.05
Rate for Payer: Superior Health Plan Medicare	$15.05
Rate for Payer: Universal American Dual Medicare/Medicaid	$15.05
Rate for Payer: Universal American Medicare	$15.05
Rate for Payer: Wellcare Medicare	$15.05
Rate for Payer: Wellmed Medicare	$15.05

(HCG) Quantitative

Facility

$431.00

Service Code	HCPCS 84702
Hospital Charge Code	8222373
Hospital Revenue Code	301
Rate for Payer: Cash Price	$293.08

.HCG Urine (POCT)

Facility

$431.00

Service Code	HCPCS 81025
Hospital Charge Code	1602598
Hospital Revenue Code	301
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$310.32
Rate for Payer: Amerigroup CHIP/Medicaid	$3.36
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8.61
Rate for Payer: Amerigroup Medicare	$8.61
Rate for Payer: BCBS of TX Blue Advantage	$129.30
Rate for Payer: BCBS of TX Blue Essentials	$155.16
Rate for Payer: BCBS of TX Medicare	$8.61
Rate for Payer: BCBS of TX PPO	$172.40
Rate for Payer: Cash Price	$293.08
Rate for Payer: Cash Price	$293.08
Rate for Payer: Cigna Medicaid	$310.32
Rate for Payer: Cigna Medicare	$8.61
Rate for Payer: Employer Direct Commercial	$8.61
Rate for Payer: Humana Medicare/TRICARE	$8.61
Rate for Payer: Molina CHIP/Medicaid	$310.32
Rate for Payer: Molina Dual Medicare/Medicaid	$8.61
Rate for Payer: Molina Medicare	$8.61
Rate for Payer: Multiplan Auto	$280.15
Rate for Payer: Multiplan Commercial	$280.15
Rate for Payer: Multiplan Workers Comp	$280.15
Rate for Payer: Parkland Medicaid	$310.32
Rate for Payer: Scott and White EPO/PPO	$10.76
Rate for Payer: Scott and White Medicare	$8.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$310.32
Rate for Payer: Superior Health Plan EPO	$8.61
Rate for Payer: Superior Health Plan Medicare	$8.61
Rate for Payer: Universal American Dual Medicare/Medicaid	$8.61
Rate for Payer: Universal American Medicare	$8.61
Rate for Payer: Wellcare Medicare	$8.61
Rate for Payer: Wellmed Medicare	$8.61

Know your out-of-pocket cost for care.

All Charges