White Rock Medical Center

All Charges

Charge

Type

Setting

Price

HL HAND BABY -- DHF

Facility

$115.36

Hospital Charge Code	81143158
Hospital Revenue Code	270
Rate for Payer: Cash Price	$78.44

HL HAND BABY -- DHF

Facility

$115.36

Hospital Charge Code	81143158
Hospital Revenue Code	270
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$83.06
Rate for Payer: Amerigroup CHIP/Medicaid	$10.38
Rate for Payer: BCBS of TX Blue Advantage	$34.61
Rate for Payer: BCBS of TX Blue Essentials	$41.53
Rate for Payer: BCBS of TX PPO	$46.14
Rate for Payer: Cash Price	$78.44
Rate for Payer: Cigna Medicaid	$83.06
Rate for Payer: Molina CHIP/Medicaid	$83.06
Rate for Payer: Multiplan Auto	$74.98
Rate for Payer: Multiplan Commercial	$74.98
Rate for Payer: Multiplan Workers Comp	$74.98
Rate for Payer: Parkland Medicaid	$83.06
Rate for Payer: Scott and White EPO/PPO	$57.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$83.06
Rate for Payer: Superior Health Plan EPO	$15.69

HL LIMB PR -- DHF

Facility

$225.38

Hospital Charge Code	81143257
Hospital Revenue Code	270
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$162.27
Rate for Payer: Amerigroup CHIP/Medicaid	$20.28
Rate for Payer: BCBS of TX Blue Advantage	$67.61
Rate for Payer: BCBS of TX Blue Essentials	$81.14
Rate for Payer: BCBS of TX PPO	$90.15
Rate for Payer: Cash Price	$153.26
Rate for Payer: Cigna Medicaid	$162.27
Rate for Payer: Molina CHIP/Medicaid	$162.27
Rate for Payer: Multiplan Auto	$146.50
Rate for Payer: Multiplan Commercial	$146.50
Rate for Payer: Multiplan Workers Comp	$146.50
Rate for Payer: Parkland Medicaid	$162.27
Rate for Payer: Scott and White EPO/PPO	$112.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$162.27
Rate for Payer: Superior Health Plan EPO	$30.65

HL LIMB PR -- DHF

Facility

$225.38

Hospital Charge Code	81143257
Hospital Revenue Code	270
Rate for Payer: Cash Price	$153.26

HNDL DISP ALL -- DHF

Facility

$55.64

Hospital Charge Code	82136078
Hospital Revenue Code	270
Rate for Payer: Cash Price	$37.84

HNDL DISP ALL -- DHF

Facility

$55.64

Hospital Charge Code	82136078
Hospital Revenue Code	270
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$40.06
Rate for Payer: Amerigroup CHIP/Medicaid	$5.01
Rate for Payer: BCBS of TX Blue Advantage	$16.69
Rate for Payer: BCBS of TX Blue Essentials	$20.03
Rate for Payer: BCBS of TX PPO	$22.26
Rate for Payer: Cash Price	$37.84
Rate for Payer: Cigna Medicaid	$40.06
Rate for Payer: Molina CHIP/Medicaid	$40.06
Rate for Payer: Multiplan Auto	$36.17
Rate for Payer: Multiplan Commercial	$36.17
Rate for Payer: Multiplan Workers Comp	$36.17
Rate for Payer: Parkland Medicaid	$40.06
Rate for Payer: Scott and White EPO/PPO	$27.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$40.06
Rate for Payer: Superior Health Plan EPO	$7.57

HNDPC ABLATION RF -- DHF

Facility

$4,880.50

Hospital Charge Code	80324114
Hospital Revenue Code	272
Min. Negotiated Rate	$439.25
Max. Negotiated Rate	$3,513.96
Rate for Payer: Amerigroup CHIP/Medicaid	$439.25
Rate for Payer: BCBS of TX Blue Advantage	$1,464.15
Rate for Payer: BCBS of TX Blue Essentials	$1,756.98
Rate for Payer: BCBS of TX PPO	$1,952.20
Rate for Payer: Cash Price	$3,318.74
Rate for Payer: Cigna Medicaid	$3,513.96
Rate for Payer: Molina CHIP/Medicaid	$3,513.96
Rate for Payer: Multiplan Auto	$3,172.32
Rate for Payer: Multiplan Commercial	$3,172.32
Rate for Payer: Multiplan Workers Comp	$3,172.32
Rate for Payer: Parkland Medicaid	$3,513.96
Rate for Payer: Scott and White EPO/PPO	$2,440.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,513.96
Rate for Payer: Superior Health Plan EPO	$663.75

HNDPC ABLATION RF -- DHF

Facility

$4,880.50

Hospital Charge Code	80324114
Hospital Revenue Code	272
Rate for Payer: Cash Price	$3,318.74

HNDPC HYDRO SURG -- DHF

Facility

$235.85

Hospital Charge Code	81748295
Hospital Revenue Code	272
Min. Negotiated Rate	$21.23
Max. Negotiated Rate	$169.81
Rate for Payer: Amerigroup CHIP/Medicaid	$21.23
Rate for Payer: BCBS of TX Blue Advantage	$70.75
Rate for Payer: BCBS of TX Blue Essentials	$84.91
Rate for Payer: BCBS of TX PPO	$94.34
Rate for Payer: Cash Price	$160.38
Rate for Payer: Cigna Medicaid	$169.81
Rate for Payer: Molina CHIP/Medicaid	$169.81
Rate for Payer: Multiplan Auto	$153.30
Rate for Payer: Multiplan Commercial	$153.30
Rate for Payer: Multiplan Workers Comp	$153.30
Rate for Payer: Parkland Medicaid	$169.81
Rate for Payer: Scott and White EPO/PPO	$117.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$169.81
Rate for Payer: Superior Health Plan EPO	$32.08

HNDPC HYDRO SURG -- DHF

Facility

$235.85

Hospital Charge Code	81748295
Hospital Revenue Code	272
Rate for Payer: Cash Price	$160.38

HOLDER ARTHROSCOPIC KNEE FOAM 3 X 11 X 10 1/2

Facility

$35.28

Hospital Charge Code	993050
Hospital Revenue Code	270
Rate for Payer: Cash Price	$23.99

HOLDER ARTHROSCOPIC KNEE FOAM 3 X 11 X 10 1/2

Facility

$35.28

Hospital Charge Code	993050
Hospital Revenue Code	270
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$25.40
Rate for Payer: Amerigroup CHIP/Medicaid	$3.18
Rate for Payer: BCBS of TX Blue Advantage	$10.58
Rate for Payer: BCBS of TX Blue Essentials	$12.70
Rate for Payer: BCBS of TX PPO	$14.11
Rate for Payer: Cash Price	$23.99
Rate for Payer: Cigna Medicaid	$25.40
Rate for Payer: Molina CHIP/Medicaid	$25.40
Rate for Payer: Multiplan Auto	$22.93
Rate for Payer: Multiplan Commercial	$22.93
Rate for Payer: Multiplan Workers Comp	$22.93
Rate for Payer: Parkland Medicaid	$25.40
Rate for Payer: Scott and White EPO/PPO	$17.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$25.40
Rate for Payer: Superior Health Plan EPO	$4.80

HOLDER CANNULA & TUBING 1 DIA FOLD OVER FLAP CLR

Facility

$5.06

Hospital Charge Code	993622
Hospital Revenue Code	270
Rate for Payer: Cash Price	$3.44

HOLDER CANNULA & TUBING 1 DIA FOLD OVER FLAP CLR

Facility

$5.06

Hospital Charge Code	993622
Hospital Revenue Code	270
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$3.64
Rate for Payer: Amerigroup CHIP/Medicaid	$0.46
Rate for Payer: BCBS of TX Blue Advantage	$1.52
Rate for Payer: BCBS of TX Blue Essentials	$1.82
Rate for Payer: BCBS of TX PPO	$2.02
Rate for Payer: Cash Price	$3.44
Rate for Payer: Cigna Medicaid	$3.64
Rate for Payer: Molina CHIP/Medicaid	$3.64
Rate for Payer: Multiplan Auto	$3.29
Rate for Payer: Multiplan Commercial	$3.29
Rate for Payer: Multiplan Workers Comp	$3.29
Rate for Payer: Parkland Medicaid	$3.64
Rate for Payer: Scott and White EPO/PPO	$2.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.64
Rate for Payer: Superior Health Plan EPO	$0.69

HOLDER, LEG OPERATIVE UNCOVERED POLYETHYLN 3X11X7' -- DHF

Facility

$98.26

Hospital Charge Code	80383250
Hospital Revenue Code	272
Rate for Payer: Cash Price	$66.82

HOLDER, LEG OPERATIVE UNCOVERED POLYETHYLN 3X11X7' -- DHF

Facility

$98.26

Hospital Charge Code	80383250
Hospital Revenue Code	272
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$70.75
Rate for Payer: Amerigroup CHIP/Medicaid	$8.84
Rate for Payer: BCBS of TX Blue Advantage	$29.48
Rate for Payer: BCBS of TX Blue Essentials	$35.37
Rate for Payer: BCBS of TX PPO	$39.30
Rate for Payer: Cash Price	$66.82
Rate for Payer: Cigna Medicaid	$70.75
Rate for Payer: Molina CHIP/Medicaid	$70.75
Rate for Payer: Multiplan Auto	$63.87
Rate for Payer: Multiplan Commercial	$63.87
Rate for Payer: Multiplan Workers Comp	$63.87
Rate for Payer: Parkland Medicaid	$70.75
Rate for Payer: Scott and White EPO/PPO	$49.13
Rate for Payer: Superior Health Plan CHIP/Medicaid	$70.75
Rate for Payer: Superior Health Plan EPO	$13.36

HOLDER, NEEDLE BLOOD COLL

Facility

$2.72

Hospital Charge Code	993784
Hospital Revenue Code	279
Rate for Payer: Cash Price	$1.85

HOLDER, NEEDLE BLOOD COLL

Facility

$2.72

Hospital Charge Code	993784
Hospital Revenue Code	279
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$1.96
Rate for Payer: Amerigroup CHIP/Medicaid	$0.24
Rate for Payer: BCBS of TX Blue Advantage	$0.82
Rate for Payer: BCBS of TX Blue Essentials	$0.98
Rate for Payer: BCBS of TX PPO	$1.09
Rate for Payer: Cash Price	$1.85
Rate for Payer: Cigna Medicaid	$1.96
Rate for Payer: Molina CHIP/Medicaid	$1.96
Rate for Payer: Multiplan Auto	$1.77
Rate for Payer: Multiplan Commercial	$1.77
Rate for Payer: Multiplan Workers Comp	$1.77
Rate for Payer: Parkland Medicaid	$1.96
Rate for Payer: Scott and White EPO/PPO	$1.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.96
Rate for Payer: Superior Health Plan EPO	$0.37

HOLDER TUBE ANCH FST 5-10MM LF ET TUBE

Facility

$38.00

Hospital Charge Code	112476
Hospital Revenue Code	272
Rate for Payer: Cash Price	$25.84

HOLDER TUBE ANCH FST 5-10MM LF ET TUBE

Facility

$38.00

Hospital Charge Code	112476
Hospital Revenue Code	272
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$27.36
Rate for Payer: Amerigroup CHIP/Medicaid	$3.42
Rate for Payer: BCBS of TX Blue Advantage	$11.40
Rate for Payer: BCBS of TX Blue Essentials	$13.68
Rate for Payer: BCBS of TX PPO	$15.20
Rate for Payer: Cash Price	$25.84
Rate for Payer: Cigna Medicaid	$27.36
Rate for Payer: Molina CHIP/Medicaid	$27.36
Rate for Payer: Multiplan Auto	$24.70
Rate for Payer: Multiplan Commercial	$24.70
Rate for Payer: Multiplan Workers Comp	$24.70
Rate for Payer: Parkland Medicaid	$27.36
Rate for Payer: Scott and White EPO/PPO	$19.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$27.36
Rate for Payer: Superior Health Plan EPO	$5.17

HOLDER TUBE TRCH UNV

Facility

$4.70

Hospital Charge Code	993473
Hospital Revenue Code	270
Rate for Payer: Cash Price	$3.20

HOLDER TUBE TRCH UNV

Facility

$4.70

Hospital Charge Code	993473
Hospital Revenue Code	270
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$3.38
Rate for Payer: Amerigroup CHIP/Medicaid	$0.42
Rate for Payer: BCBS of TX Blue Advantage	$1.41
Rate for Payer: BCBS of TX Blue Essentials	$1.69
Rate for Payer: BCBS of TX PPO	$1.88
Rate for Payer: Cash Price	$3.20
Rate for Payer: Cigna Medicaid	$3.38
Rate for Payer: Molina CHIP/Medicaid	$3.38
Rate for Payer: Multiplan Auto	$3.06
Rate for Payer: Multiplan Commercial	$3.06
Rate for Payer: Multiplan Workers Comp	$3.06
Rate for Payer: Parkland Medicaid	$3.38
Rate for Payer: Scott and White EPO/PPO	$2.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.38
Rate for Payer: Superior Health Plan EPO	$0.64

Homocyst(e)ine SO

Facility

$527.00

Service Code	HCPCS 83090
Hospital Charge Code	1603513
Hospital Revenue Code	301
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$379.44
Rate for Payer: Amerigroup CHIP/Medicaid	$6.99
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$17.92
Rate for Payer: Amerigroup Medicare	$17.92
Rate for Payer: BCBS of TX Blue Advantage	$158.10
Rate for Payer: BCBS of TX Blue Essentials	$189.72
Rate for Payer: BCBS of TX Medicare	$17.92
Rate for Payer: BCBS of TX PPO	$210.80
Rate for Payer: Cash Price	$358.36
Rate for Payer: Cash Price	$358.36
Rate for Payer: Cigna Medicaid	$379.44
Rate for Payer: Cigna Medicare	$17.92
Rate for Payer: Employer Direct Commercial	$17.92
Rate for Payer: Humana Medicare/TRICARE	$17.92
Rate for Payer: Molina CHIP/Medicaid	$379.44
Rate for Payer: Molina Dual Medicare/Medicaid	$17.92
Rate for Payer: Molina Medicare	$17.92
Rate for Payer: Multiplan Auto	$342.55
Rate for Payer: Multiplan Commercial	$342.55
Rate for Payer: Multiplan Workers Comp	$342.55
Rate for Payer: Parkland Medicaid	$379.44
Rate for Payer: Scott and White EPO/PPO	$22.40
Rate for Payer: Scott and White Medicare	$17.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$379.44
Rate for Payer: Superior Health Plan EPO	$17.92
Rate for Payer: Superior Health Plan Medicare	$17.92
Rate for Payer: Universal American Dual Medicare/Medicaid	$17.92
Rate for Payer: Universal American Medicare	$17.92
Rate for Payer: Wellcare Medicare	$17.92
Rate for Payer: Wellmed Medicare	$17.92

Homocyst(e)ine SO

Facility

$527.00

Service Code	HCPCS 83090
Hospital Charge Code	1603513
Hospital Revenue Code	301
Rate for Payer: Cash Price	$358.36

HOOD SRG STRSHIELD PEEL AWAY

Facility

$115.22

Hospital Charge Code	8428496
Hospital Revenue Code	270
Rate for Payer: Cash Price	$78.35

Know your out-of-pocket cost for care.

All Charges