White Rock Medical Center

All Charges

Charge

Type

Setting

Price

MENISCUS CUTTER -- DHF

Facility

$274.09

Hospital Charge Code	81753105
Hospital Revenue Code	272
Rate for Payer: Cash Price	$186.38

MENISCUS CUTTER -- DHF

Facility

$274.09

Hospital Charge Code	81753105
Hospital Revenue Code	272
Min. Negotiated Rate	$24.67
Max. Negotiated Rate	$197.34
Rate for Payer: Amerigroup CHIP/Medicaid	$24.67
Rate for Payer: BCBS of TX Blue Advantage	$82.23
Rate for Payer: BCBS of TX Blue Essentials	$98.67
Rate for Payer: BCBS of TX PPO	$109.64
Rate for Payer: Cash Price	$186.38
Rate for Payer: Cigna Medicaid	$197.34
Rate for Payer: Molina CHIP/Medicaid	$197.34
Rate for Payer: Multiplan Auto	$178.16
Rate for Payer: Multiplan Commercial	$178.16
Rate for Payer: Multiplan Workers Comp	$178.16
Rate for Payer: Parkland Medicaid	$197.34
Rate for Payer: Scott and White EPO/PPO	$137.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$197.34
Rate for Payer: Superior Health Plan EPO	$37.28

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS

Facility

$10,593.35

Service Code	APR-DRG 5324
Min. Negotiated Rate	$9,987.78
Max. Negotiated Rate	$10,593.35
Rate for Payer: Amerigroup CHIP/Medicaid	$9,987.78
Rate for Payer: Cigna Medicaid	$9,987.78
Rate for Payer: Molina CHIP/Medicaid	$9,987.78
Rate for Payer: Parkland Medicaid	$9,987.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,593.35

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS

Facility

$2,048.51

Service Code	APR-DRG 5321
Min. Negotiated Rate	$1,931.41
Max. Negotiated Rate	$2,048.51
Rate for Payer: Amerigroup CHIP/Medicaid	$1,931.41
Rate for Payer: Cigna Medicaid	$1,931.41
Rate for Payer: Molina CHIP/Medicaid	$1,931.41
Rate for Payer: Parkland Medicaid	$1,931.41
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,048.51

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS

Facility

$6,663.04

Service Code	APR-DRG 5323
Min. Negotiated Rate	$6,282.15
Max. Negotiated Rate	$6,663.04
Rate for Payer: Amerigroup CHIP/Medicaid	$6,282.15
Rate for Payer: Cigna Medicaid	$6,282.15
Rate for Payer: Molina CHIP/Medicaid	$6,282.15
Rate for Payer: Parkland Medicaid	$6,282.15
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,663.04

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS

Facility

$2,326.12

Service Code	APR-DRG 5322
Min. Negotiated Rate	$2,193.15
Max. Negotiated Rate	$2,326.12
Rate for Payer: Amerigroup CHIP/Medicaid	$2,193.15
Rate for Payer: Cigna Medicaid	$2,193.15
Rate for Payer: Molina CHIP/Medicaid	$2,193.15
Rate for Payer: Parkland Medicaid	$2,193.15
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,326.12

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC

Facility

$18,365.40

Service Code	MSDRG 760
Min. Negotiated Rate	$7,496.62
Max. Negotiated Rate	$18,365.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,144.08
Rate for Payer: Amerigroup Medicare	$12,144.08
Rate for Payer: BCBS of TX Medicare	$12,144.08
Rate for Payer: Cigna Commercial	$12,976.60
Rate for Payer: Cigna Medicare	$12,144.08
Rate for Payer: Employer Direct Commercial	$12,144.08
Rate for Payer: Humana Medicare/TRICARE	$12,144.08
Rate for Payer: Molina Dual Medicare/Medicaid	$12,144.08
Rate for Payer: Molina Medicare	$12,144.08
Rate for Payer: Multiplan Auto	$18,365.40
Rate for Payer: Multiplan Commercial	$18,365.40
Rate for Payer: Multiplan Workers Comp	$18,365.40
Rate for Payer: Scott and White EPO/PPO	$8,457.75
Rate for Payer: Scott and White Medicare	$12,144.08
Rate for Payer: Superior Health Plan EPO	$12,144.08
Rate for Payer: Superior Health Plan Medicare	$12,144.08
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,144.08
Rate for Payer: Universal American Medicare	$12,144.08
Rate for Payer: Wellcare Medicare	$12,144.08
Rate for Payer: Wellmed Medicare	$12,144.08

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$10,748.30

Service Code	MSDRG 761
Min. Negotiated Rate	$4,724.84
Max. Negotiated Rate	$10,748.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8,941.29
Rate for Payer: Amerigroup Medicare	$8,941.29
Rate for Payer: BCBS of TX Medicare	$8,941.29
Rate for Payer: Cigna Commercial	$7,336.45
Rate for Payer: Cigna Medicare	$8,941.29
Rate for Payer: Employer Direct Commercial	$8,941.29
Rate for Payer: Humana Medicare/TRICARE	$8,941.29
Rate for Payer: Molina Dual Medicare/Medicaid	$8,941.29
Rate for Payer: Molina Medicare	$8,941.29
Rate for Payer: Multiplan Auto	$10,748.30
Rate for Payer: Multiplan Commercial	$10,748.30
Rate for Payer: Multiplan Workers Comp	$10,748.30
Rate for Payer: Scott and White EPO/PPO	$4,949.88
Rate for Payer: Scott and White Medicare	$8,941.29
Rate for Payer: Superior Health Plan EPO	$8,941.29
Rate for Payer: Superior Health Plan Medicare	$8,941.29
Rate for Payer: Universal American Dual Medicare/Medicaid	$8,941.29
Rate for Payer: Universal American Medicare	$8,941.29
Rate for Payer: Wellcare Medicare	$8,941.29
Rate for Payer: Wellmed Medicare	$8,941.29

MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W CC/MCC

Facility

$18,365.40

Service Code	MSDRG 760
Min. Negotiated Rate	$7,496.62
Max. Negotiated Rate	$18,365.40
Rate for Payer: BCBS of TX Blue Advantage	$7,496.62
Rate for Payer: BCBS of TX Blue Essentials	$8,995.07
Rate for Payer: BCBS of TX PPO	$9,994.91

MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W/O CC/MCC

Facility

$10,748.30

Service Code	MSDRG 761
Min. Negotiated Rate	$4,724.84
Max. Negotiated Rate	$10,748.30
Rate for Payer: BCBS of TX Blue Advantage	$4,724.84
Rate for Payer: BCBS of TX Blue Essentials	$5,669.26
Rate for Payer: BCBS of TX PPO	$6,299.42

MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE

Facility

$26,266.31

Service Code	APR-DRG 7404
Min. Negotiated Rate	$24,764.80
Max. Negotiated Rate	$26,266.31
Rate for Payer: Amerigroup CHIP/Medicaid	$24,764.80
Rate for Payer: Cigna Medicaid	$24,764.80
Rate for Payer: Molina CHIP/Medicaid	$24,764.80
Rate for Payer: Parkland Medicaid	$24,764.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$26,266.31

MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE

Facility

$14,887.65

Service Code	APR-DRG 7403
Min. Negotiated Rate	$14,036.60
Max. Negotiated Rate	$14,887.65
Rate for Payer: Amerigroup CHIP/Medicaid	$14,036.60
Rate for Payer: Cigna Medicaid	$14,036.60
Rate for Payer: Molina CHIP/Medicaid	$14,036.60
Rate for Payer: Parkland Medicaid	$14,036.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14,887.65

MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE

Facility

$7,374.42

Service Code	APR-DRG 7401
Min. Negotiated Rate	$6,952.86
Max. Negotiated Rate	$7,374.42
Rate for Payer: Amerigroup CHIP/Medicaid	$6,952.86
Rate for Payer: Cigna Medicaid	$6,952.86
Rate for Payer: Molina CHIP/Medicaid	$6,952.86
Rate for Payer: Parkland Medicaid	$6,952.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,374.42

MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE

Facility

$7,626.76

Service Code	APR-DRG 7402
Min. Negotiated Rate	$7,190.78
Max. Negotiated Rate	$7,626.76
Rate for Payer: Amerigroup CHIP/Medicaid	$7,190.78
Rate for Payer: Cigna Medicaid	$7,190.78
Rate for Payer: Molina CHIP/Medicaid	$7,190.78
Rate for Payer: Parkland Medicaid	$7,190.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,626.76

menthol-methyl salicylate 10%-15% Topical Cream

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77887939
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.44

menthol-methyl salicylate 10%-15% Topical Cream

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77887939
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

meperidine 25 mg/mL Inj Soln 1 mL

Facility

$128.17

Service Code	HCPCS J2175
Hospital Charge Code	5200
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

meperidine 25 mg/mL Inj Soln 1 mL

Facility

$128.17

Service Code	HCPCS J2175
Hospital Charge Code	5200
Hospital Revenue Code	636
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$92.28
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$2.64
Rate for Payer: BCBS of TX Blue Essentials	$3.17
Rate for Payer: BCBS of TX PPO	$3.51
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

Mercury, Blood SO

Facility

$155.23

Service Code	HCPCS 83825
Hospital Charge Code	1703230
Hospital Revenue Code	301
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$111.77
Rate for Payer: Amerigroup CHIP/Medicaid	$6.34
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16.26
Rate for Payer: Amerigroup Medicare	$16.26
Rate for Payer: BCBS of TX Blue Advantage	$46.57
Rate for Payer: BCBS of TX Blue Essentials	$55.88
Rate for Payer: BCBS of TX Medicare	$16.26
Rate for Payer: BCBS of TX PPO	$62.09
Rate for Payer: Cash Price	$105.56
Rate for Payer: Cash Price	$105.56
Rate for Payer: Cigna Medicaid	$111.77
Rate for Payer: Cigna Medicare	$16.26
Rate for Payer: Employer Direct Commercial	$16.26
Rate for Payer: Humana Medicare/TRICARE	$16.26
Rate for Payer: Molina CHIP/Medicaid	$111.77
Rate for Payer: Molina Dual Medicare/Medicaid	$16.26
Rate for Payer: Molina Medicare	$16.26
Rate for Payer: Multiplan Auto	$100.90
Rate for Payer: Multiplan Commercial	$100.90
Rate for Payer: Multiplan Workers Comp	$100.90
Rate for Payer: Parkland Medicaid	$111.77
Rate for Payer: Scott and White EPO/PPO	$20.32
Rate for Payer: Scott and White Medicare	$16.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$111.77
Rate for Payer: Superior Health Plan EPO	$16.26
Rate for Payer: Superior Health Plan Medicare	$16.26
Rate for Payer: Universal American Dual Medicare/Medicaid	$16.26
Rate for Payer: Universal American Medicare	$16.26
Rate for Payer: Wellcare Medicare	$16.26
Rate for Payer: Wellmed Medicare	$16.26

Mercury, Blood SO

Facility

$155.23

Service Code	HCPCS 83825
Hospital Charge Code	1703230
Hospital Revenue Code	301
Rate for Payer: Cash Price	$105.56

Merit Prelude 6F 13cm

Facility

$227.00

Hospital Charge Code	993903
Hospital Revenue Code	272
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$163.44
Rate for Payer: Amerigroup CHIP/Medicaid	$20.43
Rate for Payer: BCBS of TX Blue Advantage	$68.10
Rate for Payer: BCBS of TX Blue Essentials	$81.72
Rate for Payer: BCBS of TX PPO	$90.80
Rate for Payer: Cash Price	$154.36
Rate for Payer: Cigna Medicaid	$163.44
Rate for Payer: Molina CHIP/Medicaid	$163.44
Rate for Payer: Multiplan Auto	$147.55
Rate for Payer: Multiplan Commercial	$147.55
Rate for Payer: Multiplan Workers Comp	$147.55
Rate for Payer: Parkland Medicaid	$163.44
Rate for Payer: Scott and White EPO/PPO	$113.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$163.44
Rate for Payer: Superior Health Plan EPO	$30.87

Merit Prelude 6F 13cm

Facility

$227.00

Hospital Charge Code	993903
Hospital Revenue Code	272
Rate for Payer: Cash Price	$154.36

merit transducer

Facility

$35.75

Hospital Charge Code	993576
Hospital Revenue Code	270
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$25.74
Rate for Payer: Amerigroup CHIP/Medicaid	$3.22
Rate for Payer: BCBS of TX Blue Advantage	$10.72
Rate for Payer: BCBS of TX Blue Essentials	$12.87
Rate for Payer: BCBS of TX PPO	$14.30
Rate for Payer: Cash Price	$24.31
Rate for Payer: Cigna Medicaid	$25.74
Rate for Payer: Molina CHIP/Medicaid	$25.74
Rate for Payer: Multiplan Auto	$23.24
Rate for Payer: Multiplan Commercial	$23.24
Rate for Payer: Multiplan Workers Comp	$23.24
Rate for Payer: Parkland Medicaid	$25.74
Rate for Payer: Scott and White EPO/PPO	$17.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$25.74
Rate for Payer: Superior Health Plan EPO	$4.86

merit transducer

Facility

$35.75

Hospital Charge Code	993576
Hospital Revenue Code	270
Rate for Payer: Cash Price	$24.31

meropenem 500 mg and NS; 100 mL connect

Facility

$128.00

Service Code	HCPCS j3490
Hospital Charge Code	79477223
Hospital Revenue Code	250
Rate for Payer: Cash Price	$87.04

Know your out-of-pocket cost for care.

All Charges