White Rock Medical Center

All Charges

Charge

Type

Setting

Price

TB TRACH RT -- DHF

Facility

$308.38

Hospital Charge Code	82073131
Hospital Revenue Code	272
Rate for Payer: Cash Price	$271.37

TB TRACH SHILEY CUFFLESS SX 6

Facility

$276.30

Hospital Charge Code	112383
Hospital Revenue Code	272
Rate for Payer: Cash Price	$243.14

TB TRACH SHILEY CUFFLESS SX 6

Facility

$276.30

Hospital Charge Code	112383
Hospital Revenue Code	272
Min. Negotiated Rate	$24.87
Max. Negotiated Rate	$179.60
Rate for Payer: Aetna Commercial	$151.96
Rate for Payer: Amerigroup CHIP/Medicaid	$24.87
Rate for Payer: BCBS of TX Blue Advantage	$82.89
Rate for Payer: BCBS of TX Blue Essentials	$99.47
Rate for Payer: BCBS of TX PPO	$110.52
Rate for Payer: Cash Price	$243.14
Rate for Payer: Multiplan Auto	$179.60
Rate for Payer: Multiplan Commercial	$179.60
Rate for Payer: Multiplan Workers Comp	$179.60
Rate for Payer: Scott and White EPO/PPO	$138.15
Rate for Payer: Superior Health Plan EPO	$37.58

TB TRACH SHILEY XLT CUFF 7.0MM

Facility

$274.76

Hospital Charge Code	112395
Hospital Revenue Code	272
Min. Negotiated Rate	$24.73
Max. Negotiated Rate	$178.59
Rate for Payer: Aetna Commercial	$151.12
Rate for Payer: Amerigroup CHIP/Medicaid	$24.73
Rate for Payer: BCBS of TX Blue Advantage	$82.43
Rate for Payer: BCBS of TX Blue Essentials	$98.91
Rate for Payer: BCBS of TX PPO	$109.90
Rate for Payer: Cash Price	$241.79
Rate for Payer: Multiplan Auto	$178.59
Rate for Payer: Multiplan Commercial	$178.59
Rate for Payer: Multiplan Workers Comp	$178.59
Rate for Payer: Scott and White EPO/PPO	$137.38
Rate for Payer: Superior Health Plan EPO	$37.37

TB TRACH SHILEY XLT CUFF 7.0MM

Facility

$274.76

Hospital Charge Code	112395
Hospital Revenue Code	272
Rate for Payer: Cash Price	$241.79

TB TRACH SUCT. PORTEX BLUE 8MM

Facility

$184.51

Hospital Charge Code	134147
Hospital Revenue Code	272
Min. Negotiated Rate	$16.61
Max. Negotiated Rate	$119.93
Rate for Payer: Aetna Commercial	$101.48
Rate for Payer: Amerigroup CHIP/Medicaid	$16.61
Rate for Payer: BCBS of TX Blue Advantage	$55.35
Rate for Payer: BCBS of TX Blue Essentials	$66.42
Rate for Payer: BCBS of TX PPO	$73.80
Rate for Payer: Cash Price	$162.37
Rate for Payer: Multiplan Auto	$119.93
Rate for Payer: Multiplan Commercial	$119.93
Rate for Payer: Multiplan Workers Comp	$119.93
Rate for Payer: Scott and White EPO/PPO	$92.26
Rate for Payer: Superior Health Plan EPO	$25.09

TB TRACH SUCT. PORTEX BLUE 8MM

Facility

$184.51

Hospital Charge Code	134147
Hospital Revenue Code	272
Rate for Payer: Cash Price	$162.37

TB TRACH UNCUFFED HYPERFLEX SZ 6

Facility

$502.03

Hospital Charge Code	112441
Hospital Revenue Code	272
Rate for Payer: Cash Price	$441.79

TB TRACH UNCUFFED HYPERFLEX SZ 6

Facility

$502.03

Hospital Charge Code	112441
Hospital Revenue Code	272
Min. Negotiated Rate	$45.18
Max. Negotiated Rate	$326.32
Rate for Payer: Aetna Commercial	$276.12
Rate for Payer: Amerigroup CHIP/Medicaid	$45.18
Rate for Payer: BCBS of TX Blue Advantage	$150.61
Rate for Payer: BCBS of TX Blue Essentials	$180.73
Rate for Payer: BCBS of TX PPO	$200.81
Rate for Payer: Cash Price	$441.79
Rate for Payer: Multiplan Auto	$326.32
Rate for Payer: Multiplan Commercial	$326.32
Rate for Payer: Multiplan Workers Comp	$326.32
Rate for Payer: Scott and White EPO/PPO	$251.02
Rate for Payer: Superior Health Plan EPO	$68.28

TB TRACH W CUF

Facility

$832.36

Hospital Charge Code	82073255
Hospital Revenue Code	272
Rate for Payer: Cash Price	$732.48

TB TRACH W CUF

Facility

$832.36

Hospital Charge Code	82073255
Hospital Revenue Code	272
Min. Negotiated Rate	$74.91
Max. Negotiated Rate	$541.03
Rate for Payer: Aetna Commercial	$457.80
Rate for Payer: Amerigroup CHIP/Medicaid	$74.91
Rate for Payer: BCBS of TX Blue Advantage	$249.71
Rate for Payer: BCBS of TX Blue Essentials	$299.65
Rate for Payer: BCBS of TX PPO	$332.94
Rate for Payer: Cash Price	$732.48
Rate for Payer: Multiplan Auto	$541.03
Rate for Payer: Multiplan Commercial	$541.03
Rate for Payer: Multiplan Workers Comp	$541.03
Rate for Payer: Scott and White EPO/PPO	$416.18
Rate for Payer: Superior Health Plan EPO	$113.20

TB URET CONNCT -- DHF

Facility

$66.89

Hospital Charge Code	81775454
Hospital Revenue Code	270
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$43.48
Rate for Payer: Aetna Commercial	$36.79
Rate for Payer: Amerigroup CHIP/Medicaid	$6.02
Rate for Payer: BCBS of TX Blue Advantage	$20.07
Rate for Payer: BCBS of TX Blue Essentials	$24.08
Rate for Payer: BCBS of TX PPO	$26.76
Rate for Payer: Cash Price	$58.86
Rate for Payer: Multiplan Auto	$43.48
Rate for Payer: Multiplan Commercial	$43.48
Rate for Payer: Multiplan Workers Comp	$43.48
Rate for Payer: Scott and White EPO/PPO	$33.44
Rate for Payer: Superior Health Plan EPO	$9.10

TB URET CONNCT -- DHF

Facility

$66.89

Hospital Charge Code	81775454
Hospital Revenue Code	270
Rate for Payer: Cash Price	$58.86

TCATH RETRV IVASC FB

Facility

$12,765.00

Service Code	CPT 37197
Hospital Charge Code	4617197
Hospital Revenue Code	361
Min. Negotiated Rate	$64.30
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$4,635.00
Rate for Payer: Aetna Medicare	$4,372.65
Rate for Payer: Amerigroup CHIP/Medicaid	$1,118.22
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,915.10
Rate for Payer: Amerigroup Medicare	$2,915.10
Rate for Payer: BCBS of TX Blue Advantage	$4,628.04
Rate for Payer: BCBS of TX Blue Essentials	$5,542.56
Rate for Payer: BCBS of TX Medicare	$2,915.10
Rate for Payer: BCBS of TX PPO	$6,983.63
Rate for Payer: Cash Price	$11,233.20
Rate for Payer: Cash Price	$11,233.20
Rate for Payer: Cigna Commercial	$6,603.56
Rate for Payer: Cigna Medicaid	$1,118.22
Rate for Payer: Cigna Medicare	$2,915.10
Rate for Payer: Employer Direct Commercial	$2,915.10
Rate for Payer: Humana Medicare/TRICARE	$2,915.10
Rate for Payer: Molina CHIP/Medicaid	$1,118.22
Rate for Payer: Molina Dual Medicare/Medicaid	$2,915.10
Rate for Payer: Molina Medicare	$2,915.10
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	$1,118.22
Rate for Payer: Scott and White EPO/PPO	$64.30
Rate for Payer: Scott and White Medicare	$2,915.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,118.22
Rate for Payer: Superior Health Plan EPO	$2,915.10
Rate for Payer: Superior Health Plan Medicare	$2,915.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,915.10
Rate for Payer: Universal American Medicare	$2,915.10
Rate for Payer: Wellcare Medicare	$2,915.10
Rate for Payer: Wellmed Medicare	$2,915.10

TCATH RETRV IVASC FB

Facility

$12,765.00

Service Code	CPT 37197
Hospital Charge Code	4617197
Hospital Revenue Code	361
Rate for Payer: Cash Price	$11,233.20

TCATH TX A/V NONCOR SUBS

Facility

$7,372.00

Service Code	CPT 37213
Hospital Charge Code	4617213
Hospital Revenue Code	360
Rate for Payer: Cash Price	$6,487.36

TCATH TX A/V NONCOR SUBS

Facility

$7,372.00

Service Code	CPT 37213
Hospital Charge Code	4617213
Hospital Revenue Code	360
Min. Negotiated Rate	$64.30
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$4,372.65
Rate for Payer: Amerigroup CHIP/Medicaid	$663.48
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,915.10
Rate for Payer: Amerigroup Medicare	$2,915.10
Rate for Payer: BCBS of TX Blue Advantage	$2,723.99
Rate for Payer: BCBS of TX Blue Essentials	$3,262.26
Rate for Payer: BCBS of TX Medicare	$2,915.10
Rate for Payer: BCBS of TX PPO	$4,110.45
Rate for Payer: Cash Price	$6,487.36
Rate for Payer: Cash Price	$6,487.36
Rate for Payer: Cash Price	$6,487.36
Rate for Payer: Cigna Commercial	$6,603.56
Rate for Payer: Cigna Medicare	$2,915.10
Rate for Payer: Employer Direct Commercial	$2,915.10
Rate for Payer: Humana Medicare/TRICARE	$2,915.10
Rate for Payer: Molina Dual Medicare/Medicaid	$2,915.10
Rate for Payer: Molina Medicare	$2,915.10
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	$64.30
Rate for Payer: Scott and White Medicare	$2,915.10
Rate for Payer: Superior Health Plan EPO	$2,915.10
Rate for Payer: Superior Health Plan Medicare	$2,915.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,915.10
Rate for Payer: Universal American Medicare	$2,915.10
Rate for Payer: Wellcare Medicare	$2,915.10
Rate for Payer: Wellmed Medicare	$2,915.10

TCATH TX CESSATION

Facility

$4,915.00

Service Code	CPT 37214
Hospital Charge Code	4617214
Hospital Revenue Code	360
Rate for Payer: Cash Price	$4,325.20

TCATH TX CESSATION

Facility

$4,915.00

Service Code	CPT 37214
Hospital Charge Code	4617214
Hospital Revenue Code	360
Min. Negotiated Rate	$64.30
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$4,372.65
Rate for Payer: Amerigroup CHIP/Medicaid	$442.35
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,915.10
Rate for Payer: Amerigroup Medicare	$2,915.10
Rate for Payer: BCBS of TX Blue Advantage	$2,723.99
Rate for Payer: BCBS of TX Blue Essentials	$3,262.26
Rate for Payer: BCBS of TX Medicare	$2,915.10
Rate for Payer: BCBS of TX PPO	$4,110.45
Rate for Payer: Cash Price	$4,325.20
Rate for Payer: Cash Price	$4,325.20
Rate for Payer: Cash Price	$4,325.20
Rate for Payer: Cigna Commercial	$6,603.56
Rate for Payer: Cigna Medicare	$2,915.10
Rate for Payer: Employer Direct Commercial	$2,915.10
Rate for Payer: Humana Medicare/TRICARE	$2,915.10
Rate for Payer: Molina Dual Medicare/Medicaid	$2,915.10
Rate for Payer: Molina Medicare	$2,915.10
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	$64.30
Rate for Payer: Scott and White Medicare	$2,915.10
Rate for Payer: Superior Health Plan EPO	$2,915.10
Rate for Payer: Superior Health Plan Medicare	$2,915.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,915.10
Rate for Payer: Universal American Medicare	$2,915.10
Rate for Payer: Wellcare Medicare	$2,915.10
Rate for Payer: Wellmed Medicare	$2,915.10

TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR

Facility

$72,924.00

Service Code	CPT 33289
Hospital Charge Code	8398465
Hospital Revenue Code	481
Min. Negotiated Rate	$475.37
Max. Negotiated Rate	$71,874.26
Rate for Payer: Aetna Commercial	$7,287.00
Rate for Payer: Aetna Medicare	$39,871.34
Rate for Payer: Amerigroup CHIP/Medicaid	$6,563.16
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$26,580.89
Rate for Payer: Amerigroup Medicare	$26,580.89
Rate for Payer: BCBS of TX Blue Advantage	$47,630.96
Rate for Payer: BCBS of TX Blue Essentials	$57,043.06
Rate for Payer: BCBS of TX Medicare	$26,580.89
Rate for Payer: BCBS of TX PPO	$71,874.26
Rate for Payer: Cash Price	$64,173.12
Rate for Payer: Cash Price	$64,173.12
Rate for Payer: Cash Price	$64,173.12
Rate for Payer: Cigna Commercial	$60,213.41
Rate for Payer: Cigna Medicare	$26,580.89
Rate for Payer: Employer Direct Commercial	$26,580.89
Rate for Payer: Humana Medicare/TRICARE	$26,580.89
Rate for Payer: Molina Dual Medicare/Medicaid	$26,580.89
Rate for Payer: Molina Medicare	$26,580.89
Rate for Payer: Multiplan Auto	$47,400.60
Rate for Payer: Multiplan Commercial	$47,400.60
Rate for Payer: Multiplan Workers Comp	$47,400.60
Rate for Payer: Scott and White EPO/PPO	$475.37
Rate for Payer: Scott and White Medicare	$26,580.89
Rate for Payer: Superior Health Plan EPO	$26,580.89
Rate for Payer: Superior Health Plan Medicare	$26,580.89
Rate for Payer: Universal American Dual Medicare/Medicaid	$26,580.89
Rate for Payer: Universal American Medicare	$26,580.89
Rate for Payer: Wellcare Medicare	$26,580.89
Rate for Payer: Wellmed Medicare	$26,580.89

TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR

Facility

$72,924.00

Service Code	CPT 33289
Hospital Charge Code	8398465
Hospital Revenue Code	481
Rate for Payer: Cash Price	$64,173.12

T-CELL TOTAL COUNT

Facility

$47.00

Service Code	CPT 86359
Hospital Charge Code	1702950
Hospital Revenue Code	302
Min. Negotiated Rate	$14.71
Max. Negotiated Rate	$83.38
Rate for Payer: Aetna Commercial	$39.62
Rate for Payer: Aetna Medicare	$56.60
Rate for Payer: Amerigroup CHIP/Medicaid	$14.71
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$37.73
Rate for Payer: Amerigroup Medicare	$37.73
Rate for Payer: BCBS of TX Blue Advantage	$62.25
Rate for Payer: BCBS of TX Blue Essentials	$74.71
Rate for Payer: BCBS of TX Medicare	$37.73
Rate for Payer: BCBS of TX PPO	$83.38
Rate for Payer: Cash Price	$41.36
Rate for Payer: Cash Price	$41.36
Rate for Payer: Cigna Medicaid	$37.73
Rate for Payer: Cigna Medicare	$37.73
Rate for Payer: Employer Direct Commercial	$37.73
Rate for Payer: Humana Medicare/TRICARE	$37.73
Rate for Payer: Molina CHIP/Medicaid	$37.73
Rate for Payer: Molina Dual Medicare/Medicaid	$37.73
Rate for Payer: Molina Medicare	$37.73
Rate for Payer: Multiplan Auto	$30.55
Rate for Payer: Multiplan Commercial	$30.55
Rate for Payer: Multiplan Workers Comp	$30.55
Rate for Payer: Parkland Medicaid	$37.73
Rate for Payer: Scott and White EPO/PPO	$47.16
Rate for Payer: Scott and White Medicare	$37.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$37.73
Rate for Payer: Superior Health Plan EPO	$37.73
Rate for Payer: Superior Health Plan Medicare	$37.73
Rate for Payer: Universal American Dual Medicare/Medicaid	$37.73
Rate for Payer: Universal American Medicare	$37.73
Rate for Payer: Wellcare Medicare	$37.73
Rate for Payer: Wellmed Medicare	$37.73

T-CELL TOTAL COUNT

Facility

$47.00

Service Code	CPT 86359
Hospital Charge Code	1702950
Hospital Revenue Code	302
Rate for Payer: Cash Price	$41.36

TEE w/ Probe w/o Contrast 93312

Facility

$3,210.00

Service Code	CPT 93312
Hospital Charge Code	2800498
Hospital Revenue Code	480
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$2,086.50
Rate for Payer: Aetna Commercial	$230.32
Rate for Payer: Aetna Medicare	$756.80
Rate for Payer: Amerigroup CHIP/Medicaid	$288.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$504.53
Rate for Payer: Amerigroup Medicare	$504.53
Rate for Payer: BCBS of TX Blue Advantage	$242.05
Rate for Payer: BCBS of TX Blue Essentials	$289.35
Rate for Payer: BCBS of TX Medicare	$504.53
Rate for Payer: BCBS of TX PPO	$322.74
Rate for Payer: Cash Price	$2,824.80
Rate for Payer: Cash Price	$2,824.80
Rate for Payer: Cash Price	$2,824.80
Rate for Payer: Cigna Commercial	$1,142.91
Rate for Payer: Cigna Medicaid	$235.90
Rate for Payer: Cigna Medicare	$504.53
Rate for Payer: Employer Direct Commercial	$504.53
Rate for Payer: Humana Medicare/TRICARE	$504.53
Rate for Payer: Molina CHIP/Medicaid	$235.90
Rate for Payer: Molina Dual Medicare/Medicaid	$504.53
Rate for Payer: Molina Medicare	$504.53
Rate for Payer: Multiplan Auto	$2,086.50
Rate for Payer: Multiplan Commercial	$2,086.50
Rate for Payer: Multiplan Workers Comp	$2,086.50
Rate for Payer: Parkland Medicaid	$235.90
Rate for Payer: Scott and White EPO/PPO	$9.02
Rate for Payer: Scott and White Medicare	$504.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$235.90
Rate for Payer: Superior Health Plan EPO	$504.53
Rate for Payer: Superior Health Plan Medicare	$504.53
Rate for Payer: Universal American Dual Medicare/Medicaid	$504.53
Rate for Payer: Universal American Medicare	$504.53
Rate for Payer: Wellcare Medicare	$504.53
Rate for Payer: Wellmed Medicare	$504.53

TEE w/ Probe w/o Contrast 93312 BCE

Facility

$3,210.00

Service Code	CPT 93312
Hospital Charge Code	2800498
Hospital Revenue Code	480
Rate for Payer: Cash Price	$2,824.80

Know your out-of-pocket cost for care.

All Charges