White Rock Medical Center

All Charges

Charge

Type

Setting

Price

88104 AP Bill Non-Gyn Cytology

Facility

$202.00

Service Code	CPT 88104
Hospital Charge Code	4308104
Hospital Revenue Code	311
Rate for Payer: Cash Price	$177.76

88108 AP Bill Non-Gyn Cytology Concentration Technique

Facility

$337.00

Service Code	CPT 88108
Hospital Charge Code	4308108
Hospital Revenue Code	311
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$219.05
Rate for Payer: Aetna Commercial	$46.06
Rate for Payer: Aetna Medicare	$55.02
Rate for Payer: Amerigroup CHIP/Medicaid	$24.63
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$36.68
Rate for Payer: Amerigroup Medicare	$36.68
Rate for Payer: BCBS of TX Blue Advantage	$55.16
Rate for Payer: BCBS of TX Blue Essentials	$66.19
Rate for Payer: BCBS of TX Medicare	$36.68
Rate for Payer: BCBS of TX PPO	$73.88
Rate for Payer: Cash Price	$296.56
Rate for Payer: Cash Price	$296.56
Rate for Payer: Cash Price	$296.56
Rate for Payer: Cigna Commercial	$83.09
Rate for Payer: Cigna Medicare	$36.68
Rate for Payer: Employer Direct Commercial	$36.68
Rate for Payer: Humana Medicare/TRICARE	$36.68
Rate for Payer: Molina Dual Medicare/Medicaid	$36.68
Rate for Payer: Molina Medicare	$36.68
Rate for Payer: Multiplan Auto	$219.05
Rate for Payer: Multiplan Commercial	$219.05
Rate for Payer: Multiplan Workers Comp	$219.05
Rate for Payer: Scott and White EPO/PPO	$0.66
Rate for Payer: Scott and White Medicare	$36.68
Rate for Payer: Superior Health Plan EPO	$36.68
Rate for Payer: Superior Health Plan Medicare	$36.68
Rate for Payer: Universal American Dual Medicare/Medicaid	$36.68
Rate for Payer: Universal American Medicare	$36.68
Rate for Payer: Wellcare Medicare	$36.68
Rate for Payer: Wellmed Medicare	$36.68

88108 AP Bill Non-Gyn Cytology Concentration Technique

Facility

$337.00

Service Code	CPT 88108
Hospital Charge Code	4308108
Hospital Revenue Code	311
Rate for Payer: Cash Price	$296.56

88161 AP Bill Cyto Smear prep, cyto path smear

Facility

$167.00

Service Code	CPT 88161
Hospital Charge Code	4308140
Hospital Revenue Code	311
Rate for Payer: Cash Price	$146.96

88161 AP Bill Cyto Smear prep, cyto path smear

Facility

$167.00

Service Code	CPT 88161
Hospital Charge Code	4308140
Hospital Revenue Code	311
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$108.55
Rate for Payer: Aetna Commercial	$53.13
Rate for Payer: Aetna Medicare	$40.84
Rate for Payer: Amerigroup CHIP/Medicaid	$27.16
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$27.23
Rate for Payer: Amerigroup Medicare	$27.23
Rate for Payer: BCBS of TX Blue Advantage	$37.93
Rate for Payer: BCBS of TX Blue Essentials	$45.52
Rate for Payer: BCBS of TX Medicare	$27.23
Rate for Payer: BCBS of TX PPO	$50.81
Rate for Payer: Cash Price	$146.96
Rate for Payer: Cash Price	$146.96
Rate for Payer: Cash Price	$146.96
Rate for Payer: Cigna Commercial	$61.69
Rate for Payer: Cigna Medicare	$27.23
Rate for Payer: Employer Direct Commercial	$27.23
Rate for Payer: Humana Medicare/TRICARE	$27.23
Rate for Payer: Molina Dual Medicare/Medicaid	$27.23
Rate for Payer: Molina Medicare	$27.23
Rate for Payer: Multiplan Auto	$108.55
Rate for Payer: Multiplan Commercial	$108.55
Rate for Payer: Multiplan Workers Comp	$108.55
Rate for Payer: Scott and White EPO/PPO	$0.49
Rate for Payer: Scott and White Medicare	$27.23
Rate for Payer: Superior Health Plan EPO	$27.23
Rate for Payer: Superior Health Plan Medicare	$27.23
Rate for Payer: Universal American Dual Medicare/Medicaid	$27.23
Rate for Payer: Universal American Medicare	$27.23
Rate for Payer: Wellcare Medicare	$27.23
Rate for Payer: Wellmed Medicare	$27.23

88172 AP Bill FNA Immediate Read

Facility

$549.00

Service Code	CPT 88172
Hospital Charge Code	1600014
Hospital Revenue Code	311
Rate for Payer: Cash Price	$483.12

88172 AP Bill FNA Immediate Read

Facility

$549.00

Service Code	CPT 88172
Hospital Charge Code	1600014
Hospital Revenue Code	311
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$356.85
Rate for Payer: Aetna Commercial	$21.07
Rate for Payer: Aetna Medicare	$234.32
Rate for Payer: Amerigroup CHIP/Medicaid	$22.24
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$156.21
Rate for Payer: Amerigroup Medicare	$156.21
Rate for Payer: BCBS of TX Blue Advantage	$236.78
Rate for Payer: BCBS of TX Blue Essentials	$284.13
Rate for Payer: BCBS of TX Medicare	$156.21
Rate for Payer: BCBS of TX PPO	$317.14
Rate for Payer: Cash Price	$483.12
Rate for Payer: Cash Price	$483.12
Rate for Payer: Cash Price	$483.12
Rate for Payer: Cigna Commercial	$353.86
Rate for Payer: Cigna Medicare	$156.21
Rate for Payer: Employer Direct Commercial	$156.21
Rate for Payer: Humana Medicare/TRICARE	$156.21
Rate for Payer: Molina Dual Medicare/Medicaid	$156.21
Rate for Payer: Molina Medicare	$156.21
Rate for Payer: Multiplan Auto	$356.85
Rate for Payer: Multiplan Commercial	$356.85
Rate for Payer: Multiplan Workers Comp	$356.85
Rate for Payer: Scott and White EPO/PPO	$2.79
Rate for Payer: Scott and White Medicare	$156.21
Rate for Payer: Superior Health Plan EPO	$156.21
Rate for Payer: Superior Health Plan Medicare	$156.21
Rate for Payer: Universal American Dual Medicare/Medicaid	$156.21
Rate for Payer: Universal American Medicare	$156.21
Rate for Payer: Wellcare Medicare	$156.21
Rate for Payer: Wellmed Medicare	$156.21

88173 AP Bill FNA Interp and report

Facility

$513.00

Service Code	CPT 88173
Hospital Charge Code	1600154
Hospital Revenue Code	311
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$333.45
Rate for Payer: Aetna Commercial	$95.48
Rate for Payer: Aetna Medicare	$74.34
Rate for Payer: Amerigroup CHIP/Medicaid	$61.37
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$49.56
Rate for Payer: Amerigroup Medicare	$49.56
Rate for Payer: BCBS of TX Blue Advantage	$81.63
Rate for Payer: BCBS of TX Blue Essentials	$97.95
Rate for Payer: BCBS of TX Medicare	$49.56
Rate for Payer: BCBS of TX PPO	$109.33
Rate for Payer: Cash Price	$451.44
Rate for Payer: Cash Price	$451.44
Rate for Payer: Cash Price	$451.44
Rate for Payer: Cigna Commercial	$112.25
Rate for Payer: Cigna Medicare	$49.56
Rate for Payer: Employer Direct Commercial	$49.56
Rate for Payer: Humana Medicare/TRICARE	$49.56
Rate for Payer: Molina Dual Medicare/Medicaid	$49.56
Rate for Payer: Molina Medicare	$49.56
Rate for Payer: Multiplan Auto	$333.45
Rate for Payer: Multiplan Commercial	$333.45
Rate for Payer: Multiplan Workers Comp	$333.45
Rate for Payer: Scott and White EPO/PPO	$0.89
Rate for Payer: Scott and White Medicare	$49.56
Rate for Payer: Superior Health Plan EPO	$49.56
Rate for Payer: Superior Health Plan Medicare	$49.56
Rate for Payer: Universal American Dual Medicare/Medicaid	$49.56
Rate for Payer: Universal American Medicare	$49.56
Rate for Payer: Wellcare Medicare	$49.56
Rate for Payer: Wellmed Medicare	$49.56

88173 AP Bill FNA Interp and report

Facility

$513.00

Service Code	CPT 88173
Hospital Charge Code	1600154
Hospital Revenue Code	311
Rate for Payer: Cash Price	$451.44

88185 FLOWCYTOMETRY TC ADD ON

Facility

$138.00

Service Code	CPT 88185
Hospital Charge Code	1709476
Hospital Revenue Code	311
Min. Negotiated Rate	$8.73
Max. Negotiated Rate	$89.70
Rate for Payer: Aetna Commercial	$23.85
Rate for Payer: Amerigroup CHIP/Medicaid	$8.73
Rate for Payer: BCBS of TX Blue Advantage	$41.04
Rate for Payer: BCBS of TX Blue Essentials	$49.24
Rate for Payer: BCBS of TX PPO	$54.96
Rate for Payer: Cash Price	$121.44
Rate for Payer: Cash Price	$121.44
Rate for Payer: Multiplan Auto	$89.70
Rate for Payer: Multiplan Commercial	$89.70
Rate for Payer: Multiplan Workers Comp	$89.70
Rate for Payer: Scott and White EPO/PPO	$69.00
Rate for Payer: Superior Health Plan EPO	$18.77

88185 FLOWCYTOMETRY TC ADD ON

Facility

$138.00

Service Code	CPT 88185
Hospital Charge Code	1709476
Hospital Revenue Code	311
Rate for Payer: Cash Price	$121.44

88188 AP Bill Send Out Flow Cytometry

Facility

$258.00

Service Code	CPT 88188
Hospital Charge Code	8490466
Hospital Revenue Code	310
Rate for Payer: Cash Price	$227.04

88188 AP Bill Send Out Flow Cytometry

Facility

$258.00

Service Code	CPT 88188
Hospital Charge Code	8490466
Hospital Revenue Code	310
Min. Negotiated Rate	$25.76
Max. Negotiated Rate	$167.70
Rate for Payer: Aetna Commercial	$66.32
Rate for Payer: Amerigroup CHIP/Medicaid	$25.76
Rate for Payer: BCBS of TX Blue Advantage	$108.82
Rate for Payer: BCBS of TX Blue Essentials	$130.58
Rate for Payer: BCBS of TX PPO	$145.75
Rate for Payer: Cash Price	$227.04
Rate for Payer: Cash Price	$227.04
Rate for Payer: Multiplan Auto	$167.70
Rate for Payer: Multiplan Commercial	$167.70
Rate for Payer: Multiplan Workers Comp	$167.70
Rate for Payer: Scott and White EPO/PPO	$129.00
Rate for Payer: Superior Health Plan EPO	$35.09

88189 AP Bill Send Out Flow Cyto

Facility

$407.00

Service Code	CPT 88189
Hospital Charge Code	8852669
Hospital Revenue Code	311
Rate for Payer: Cash Price	$358.16

88189 AP Bill Send Out Flow Cyto

Facility

$407.00

Service Code	CPT 88189
Hospital Charge Code	8852669
Hospital Revenue Code	311
Min. Negotiated Rate	$34.62
Max. Negotiated Rate	$264.55
Rate for Payer: Aetna Commercial	$89.22
Rate for Payer: Amerigroup CHIP/Medicaid	$34.62
Rate for Payer: BCBS of TX Blue Advantage	$145.70
Rate for Payer: BCBS of TX Blue Essentials	$174.83
Rate for Payer: BCBS of TX PPO	$195.14
Rate for Payer: Cash Price	$358.16
Rate for Payer: Cash Price	$358.16
Rate for Payer: Multiplan Auto	$264.55
Rate for Payer: Multiplan Commercial	$264.55
Rate for Payer: Multiplan Workers Comp	$264.55
Rate for Payer: Scott and White EPO/PPO	$203.50
Rate for Payer: Superior Health Plan EPO	$55.35

88237 TISSUE CULTURE NEOPLASTIC DISORDER

Facility

$436.00

Service Code	CPT 88237
Hospital Charge Code	1707298
Hospital Revenue Code	311
Min. Negotiated Rate	$56.06
Max. Negotiated Rate	$317.69
Rate for Payer: Aetna Commercial	$150.94
Rate for Payer: Aetna Medicare	$215.62
Rate for Payer: Amerigroup CHIP/Medicaid	$56.06
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$143.75
Rate for Payer: Amerigroup Medicare	$143.75
Rate for Payer: BCBS of TX Blue Advantage	$237.19
Rate for Payer: BCBS of TX Blue Essentials	$284.62
Rate for Payer: BCBS of TX Medicare	$143.75
Rate for Payer: BCBS of TX PPO	$317.69
Rate for Payer: Cash Price	$383.68
Rate for Payer: Cash Price	$383.68
Rate for Payer: Cigna Medicaid	$143.75
Rate for Payer: Cigna Medicare	$143.75
Rate for Payer: Employer Direct Commercial	$143.75
Rate for Payer: Humana Medicare/TRICARE	$143.75
Rate for Payer: Molina CHIP/Medicaid	$143.75
Rate for Payer: Molina Dual Medicare/Medicaid	$143.75
Rate for Payer: Molina Medicare	$143.75
Rate for Payer: Multiplan Auto	$283.40
Rate for Payer: Multiplan Commercial	$283.40
Rate for Payer: Multiplan Workers Comp	$283.40
Rate for Payer: Parkland Medicaid	$143.75
Rate for Payer: Scott and White EPO/PPO	$179.69
Rate for Payer: Scott and White Medicare	$143.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$143.75
Rate for Payer: Superior Health Plan EPO	$143.75
Rate for Payer: Superior Health Plan Medicare	$143.75
Rate for Payer: Universal American Dual Medicare/Medicaid	$143.75
Rate for Payer: Universal American Medicare	$143.75
Rate for Payer: Wellcare Medicare	$143.75
Rate for Payer: Wellmed Medicare	$143.75

88237 TISSUE CULTURE NEOPLASTIC DISORDER

Facility

$436.00

Service Code	CPT 88237
Hospital Charge Code	1707298
Hospital Revenue Code	311
Rate for Payer: Cash Price	$383.68

88239 AP Bill Send Out Cytogenetic Studies

Facility

$1,131.00

Service Code	CPT 88239
Hospital Charge Code	8490467
Hospital Revenue Code	310
Min. Negotiated Rate	$57.53
Max. Negotiated Rate	$735.15
Rate for Payer: Aetna Commercial	$154.89
Rate for Payer: Aetna Medicare	$221.28
Rate for Payer: Amerigroup CHIP/Medicaid	$57.53
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$147.52
Rate for Payer: Amerigroup Medicare	$147.52
Rate for Payer: BCBS of TX Blue Advantage	$243.41
Rate for Payer: BCBS of TX Blue Essentials	$292.09
Rate for Payer: BCBS of TX Medicare	$147.52
Rate for Payer: BCBS of TX PPO	$326.02
Rate for Payer: Cash Price	$995.28
Rate for Payer: Cash Price	$995.28
Rate for Payer: Cigna Medicaid	$147.52
Rate for Payer: Cigna Medicare	$147.52
Rate for Payer: Employer Direct Commercial	$147.52
Rate for Payer: Humana Medicare/TRICARE	$147.52
Rate for Payer: Molina CHIP/Medicaid	$147.52
Rate for Payer: Molina Dual Medicare/Medicaid	$147.52
Rate for Payer: Molina Medicare	$147.52
Rate for Payer: Multiplan Auto	$735.15
Rate for Payer: Multiplan Commercial	$735.15
Rate for Payer: Multiplan Workers Comp	$735.15
Rate for Payer: Parkland Medicaid	$147.52
Rate for Payer: Scott and White EPO/PPO	$184.40
Rate for Payer: Scott and White Medicare	$147.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$147.52
Rate for Payer: Superior Health Plan EPO	$147.52
Rate for Payer: Superior Health Plan Medicare	$147.52
Rate for Payer: Universal American Dual Medicare/Medicaid	$147.52
Rate for Payer: Universal American Medicare	$147.52
Rate for Payer: Wellcare Medicare	$147.52
Rate for Payer: Wellmed Medicare	$147.52

88239 AP Bill Send Out Cytogenetic Studies

Facility

$1,131.00

Service Code	CPT 88239
Hospital Charge Code	8490467
Hospital Revenue Code	310
Rate for Payer: Cash Price	$995.28

88264 AP Bill Send Out Chromosome Analysis

Facility

$1,074.50

Service Code	CPT 88264
Hospital Charge Code	8852670
Hospital Revenue Code	311
Rate for Payer: Cash Price	$945.56

88264 AP Bill Send Out Chromosome Analysis

Facility

$1,074.50

Service Code	CPT 88264
Hospital Charge Code	8852670
Hospital Revenue Code	311
Min. Negotiated Rate	$56.40
Max. Negotiated Rate	$698.42
Rate for Payer: Aetna Commercial	$151.85
Rate for Payer: Aetna Medicare	$216.92
Rate for Payer: Amerigroup CHIP/Medicaid	$56.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$144.61
Rate for Payer: Amerigroup Medicare	$144.61
Rate for Payer: BCBS of TX Blue Advantage	$238.61
Rate for Payer: BCBS of TX Blue Essentials	$286.33
Rate for Payer: BCBS of TX Medicare	$144.61
Rate for Payer: BCBS of TX PPO	$319.59
Rate for Payer: Cash Price	$945.56
Rate for Payer: Cash Price	$945.56
Rate for Payer: Cigna Medicaid	$144.61
Rate for Payer: Cigna Medicare	$144.61
Rate for Payer: Employer Direct Commercial	$144.61
Rate for Payer: Humana Medicare/TRICARE	$144.61
Rate for Payer: Molina CHIP/Medicaid	$144.61
Rate for Payer: Molina Dual Medicare/Medicaid	$144.61
Rate for Payer: Molina Medicare	$144.61
Rate for Payer: Multiplan Auto	$698.42
Rate for Payer: Multiplan Commercial	$698.42
Rate for Payer: Multiplan Workers Comp	$698.42
Rate for Payer: Parkland Medicaid	$144.61
Rate for Payer: Scott and White EPO/PPO	$180.76
Rate for Payer: Scott and White Medicare	$144.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$144.61
Rate for Payer: Superior Health Plan EPO	$144.61
Rate for Payer: Superior Health Plan Medicare	$144.61
Rate for Payer: Universal American Dual Medicare/Medicaid	$144.61
Rate for Payer: Universal American Medicare	$144.61
Rate for Payer: Wellcare Medicare	$144.61
Rate for Payer: Wellmed Medicare	$144.61

88280 AP Bill Send Out Chromosome Analysis

Facility

$356.88

Service Code	CPT 88280
Hospital Charge Code	8852667
Hospital Revenue Code	311
Rate for Payer: Cash Price	$314.05

88280 AP Bill Send Out Chromosome Analysis

Facility

$356.88

Service Code	CPT 88280
Hospital Charge Code	8852667
Hospital Revenue Code	311
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$231.97
Rate for Payer: Aetna Commercial	$35.14
Rate for Payer: Aetna Medicare	$50.20
Rate for Payer: Amerigroup CHIP/Medicaid	$13.05
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$33.47
Rate for Payer: Amerigroup Medicare	$33.47
Rate for Payer: BCBS of TX Blue Advantage	$55.23
Rate for Payer: BCBS of TX Blue Essentials	$66.27
Rate for Payer: BCBS of TX Medicare	$33.47
Rate for Payer: BCBS of TX PPO	$73.97
Rate for Payer: Cash Price	$314.05
Rate for Payer: Cash Price	$314.05
Rate for Payer: Cigna Medicaid	$33.47
Rate for Payer: Cigna Medicare	$33.47
Rate for Payer: Employer Direct Commercial	$33.47
Rate for Payer: Humana Medicare/TRICARE	$33.47
Rate for Payer: Molina CHIP/Medicaid	$33.47
Rate for Payer: Molina Dual Medicare/Medicaid	$33.47
Rate for Payer: Molina Medicare	$33.47
Rate for Payer: Multiplan Auto	$231.97
Rate for Payer: Multiplan Commercial	$231.97
Rate for Payer: Multiplan Workers Comp	$231.97
Rate for Payer: Parkland Medicaid	$33.47
Rate for Payer: Scott and White EPO/PPO	$41.84
Rate for Payer: Scott and White Medicare	$33.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$33.47
Rate for Payer: Superior Health Plan EPO	$33.47
Rate for Payer: Superior Health Plan Medicare	$33.47
Rate for Payer: Universal American Dual Medicare/Medicaid	$33.47
Rate for Payer: Universal American Medicare	$33.47
Rate for Payer: Wellcare Medicare	$33.47
Rate for Payer: Wellmed Medicare	$33.47

88291 AP Bill Send Out Cytogenetics

Facility

$193.25

Service Code	CPT 88291
Hospital Charge Code	8852668
Hospital Revenue Code	311
Min. Negotiated Rate	$13.51
Max. Negotiated Rate	$125.61
Rate for Payer: Aetna Commercial	$35.40
Rate for Payer: Amerigroup CHIP/Medicaid	$13.51
Rate for Payer: BCBS of TX Blue Advantage	$55.90
Rate for Payer: BCBS of TX Blue Essentials	$67.08
Rate for Payer: BCBS of TX PPO	$74.87
Rate for Payer: Cash Price	$170.06
Rate for Payer: Cash Price	$170.06
Rate for Payer: Multiplan Auto	$125.61
Rate for Payer: Multiplan Commercial	$125.61
Rate for Payer: Multiplan Workers Comp	$125.61
Rate for Payer: Scott and White EPO/PPO	$96.62
Rate for Payer: Superior Health Plan EPO	$26.28

88291 AP Bill Send Out Cytogenetics

Facility

$193.25

Service Code	CPT 88291
Hospital Charge Code	8852668
Hospital Revenue Code	311
Rate for Payer: Cash Price	$170.06

Know your out-of-pocket cost for care.

All Charges