White Rock Medical Center

All Charges

Charge

Type

Setting

Price

TRY CATH TL NRS MXBR PSS -- DHF

Facility

$1,179.03

Service Code	HCPCS C1751
Hospital Charge Code	80570260
Hospital Revenue Code	278
Min. Negotiated Rate	$106.11
Max. Negotiated Rate	$589.52
Rate for Payer: Aetna Commercial	$353.71
Rate for Payer: Amerigroup CHIP/Medicaid	$106.11
Rate for Payer: BCBS of TX Blue Advantage	$353.71
Rate for Payer: BCBS of TX Blue Essentials	$424.45
Rate for Payer: BCBS of TX PPO	$471.61
Rate for Payer: Cash Price	$1,037.55
Rate for Payer: Multiplan Auto	$589.52
Rate for Payer: Multiplan Commercial	$589.52
Rate for Payer: Multiplan Workers Comp	$589.52
Rate for Payer: Scott and White EPO/PPO	$589.52
Rate for Payer: Superior Health Plan EPO	$160.35

TRY CATH TL NRS MXBR PSS -- DHF

Facility

$1,179.03

Service Code	HCPCS C1751
Hospital Charge Code	80570260
Hospital Revenue Code	278
Min. Negotiated Rate	$294.76
Max. Negotiated Rate	$589.52
Rate for Payer: Aetna Commercial	$353.71
Rate for Payer: Cash Price	$1,037.55
Rate for Payer: Cigna Commercial	$294.76
Rate for Payer: Multiplan Auto	$589.52
Rate for Payer: Multiplan Commercial	$589.52
Rate for Payer: Multiplan Workers Comp	$589.52
Rate for Payer: Scott and White EPO/PPO	$589.52

TRY CIRCUM DISP -- DHF

Facility

$48.01

Hospital Charge Code	80832306
Hospital Revenue Code	272
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$31.21
Rate for Payer: Aetna Commercial	$26.41
Rate for Payer: Amerigroup CHIP/Medicaid	$4.32
Rate for Payer: BCBS of TX Blue Advantage	$14.40
Rate for Payer: BCBS of TX Blue Essentials	$17.28
Rate for Payer: BCBS of TX PPO	$19.20
Rate for Payer: Cash Price	$42.25
Rate for Payer: Multiplan Auto	$31.21
Rate for Payer: Multiplan Commercial	$31.21
Rate for Payer: Multiplan Workers Comp	$31.21
Rate for Payer: Scott and White EPO/PPO	$24.00
Rate for Payer: Superior Health Plan EPO	$6.53

TRY CIRCUM DISP -- DHF

Facility

$48.01

Hospital Charge Code	80832306
Hospital Revenue Code	272
Rate for Payer: Cash Price	$42.25

TRY FEM INST -- DHF

Facility

$278.74

Hospital Charge Code	80835374
Hospital Revenue Code	270
Rate for Payer: Cash Price	$245.29

TRY FEM INST -- DHF

Facility

$278.74

Hospital Charge Code	80835374
Hospital Revenue Code	270
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$181.18
Rate for Payer: Aetna Commercial	$153.31
Rate for Payer: Amerigroup CHIP/Medicaid	$25.09
Rate for Payer: BCBS of TX Blue Advantage	$83.62
Rate for Payer: BCBS of TX Blue Essentials	$100.35
Rate for Payer: BCBS of TX PPO	$111.50
Rate for Payer: Cash Price	$245.29
Rate for Payer: Multiplan Auto	$181.18
Rate for Payer: Multiplan Commercial	$181.18
Rate for Payer: Multiplan Workers Comp	$181.18
Rate for Payer: Scott and White EPO/PPO	$139.37
Rate for Payer: Superior Health Plan EPO	$37.91

TRY GASTRC LAV -- DHF

Facility

$436.21

Hospital Charge Code	80835655
Hospital Revenue Code	270
Min. Negotiated Rate	$39.26
Max. Negotiated Rate	$283.54
Rate for Payer: Aetna Commercial	$239.92
Rate for Payer: Amerigroup CHIP/Medicaid	$39.26
Rate for Payer: BCBS of TX Blue Advantage	$130.86
Rate for Payer: BCBS of TX Blue Essentials	$157.04
Rate for Payer: BCBS of TX PPO	$174.48
Rate for Payer: Cash Price	$383.86
Rate for Payer: Multiplan Auto	$283.54
Rate for Payer: Multiplan Commercial	$283.54
Rate for Payer: Multiplan Workers Comp	$283.54
Rate for Payer: Scott and White EPO/PPO	$218.10
Rate for Payer: Superior Health Plan EPO	$59.32

TRY GASTRC LAV -- DHF

Facility

$436.21

Hospital Charge Code	80835655
Hospital Revenue Code	270
Rate for Payer: Cash Price	$383.86

TRY HYPERAL -- DHF

Facility

$362.11

Hospital Charge Code	80836208
Hospital Revenue Code	270
Min. Negotiated Rate	$32.59
Max. Negotiated Rate	$235.37
Rate for Payer: Aetna Commercial	$199.16
Rate for Payer: Amerigroup CHIP/Medicaid	$32.59
Rate for Payer: BCBS of TX Blue Advantage	$108.63
Rate for Payer: BCBS of TX Blue Essentials	$130.36
Rate for Payer: BCBS of TX PPO	$144.84
Rate for Payer: Cash Price	$318.66
Rate for Payer: Multiplan Auto	$235.37
Rate for Payer: Multiplan Commercial	$235.37
Rate for Payer: Multiplan Workers Comp	$235.37
Rate for Payer: Scott and White EPO/PPO	$181.06
Rate for Payer: Superior Health Plan EPO	$49.25

TRY HYPERAL -- DHF

Facility

$362.11

Hospital Charge Code	80836208
Hospital Revenue Code	270
Rate for Payer: Cash Price	$318.66

TRY LUMB PUNCT -- DHF

Facility

$47.23

Hospital Charge Code	80838055
Hospital Revenue Code	272
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$30.70
Rate for Payer: Aetna Commercial	$25.98
Rate for Payer: Amerigroup CHIP/Medicaid	$4.25
Rate for Payer: BCBS of TX Blue Advantage	$14.17
Rate for Payer: BCBS of TX Blue Essentials	$17.00
Rate for Payer: BCBS of TX PPO	$18.89
Rate for Payer: Cash Price	$41.56
Rate for Payer: Multiplan Auto	$30.70
Rate for Payer: Multiplan Commercial	$30.70
Rate for Payer: Multiplan Workers Comp	$30.70
Rate for Payer: Scott and White EPO/PPO	$23.62
Rate for Payer: Superior Health Plan EPO	$6.42

TRY LUMB PUNCT -- DHF

Facility

$47.23

Hospital Charge Code	80838055
Hospital Revenue Code	272
Rate for Payer: Cash Price	$41.56

TRY MAJ ORTHO -- DHF

Facility

$1,891.20

Hospital Charge Code	80838402
Hospital Revenue Code	272
Min. Negotiated Rate	$170.21
Max. Negotiated Rate	$1,229.28
Rate for Payer: Aetna Commercial	$1,040.16
Rate for Payer: Amerigroup CHIP/Medicaid	$170.21
Rate for Payer: BCBS of TX Blue Advantage	$567.36
Rate for Payer: BCBS of TX Blue Essentials	$680.83
Rate for Payer: BCBS of TX PPO	$756.48
Rate for Payer: Cash Price	$1,664.26
Rate for Payer: Multiplan Auto	$1,229.28
Rate for Payer: Multiplan Commercial	$1,229.28
Rate for Payer: Multiplan Workers Comp	$1,229.28
Rate for Payer: Scott and White EPO/PPO	$945.60
Rate for Payer: Superior Health Plan EPO	$257.20

TRY MAJ ORTHO -- DHF

Facility

$1,891.20

Hospital Charge Code	80838402
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,664.26

TRY MYELOGRAM -- DHF

Facility

$575.58

Hospital Charge Code	80839004
Hospital Revenue Code	272
Rate for Payer: Cash Price	$506.51

TRY MYELOGRAM -- DHF

Facility

$575.58

Hospital Charge Code	80839004
Hospital Revenue Code	272
Min. Negotiated Rate	$51.80
Max. Negotiated Rate	$374.13
Rate for Payer: Aetna Commercial	$316.57
Rate for Payer: Amerigroup CHIP/Medicaid	$51.80
Rate for Payer: BCBS of TX Blue Advantage	$172.67
Rate for Payer: BCBS of TX Blue Essentials	$207.21
Rate for Payer: BCBS of TX PPO	$230.23
Rate for Payer: Cash Price	$506.51
Rate for Payer: Multiplan Auto	$374.13
Rate for Payer: Multiplan Commercial	$374.13
Rate for Payer: Multiplan Workers Comp	$374.13
Rate for Payer: Scott and White EPO/PPO	$287.79
Rate for Payer: Superior Health Plan EPO	$78.28

Tryptase SO

Facility

$222.00

Service Code	CPT 83520
Hospital Charge Code	1706332
Hospital Revenue Code	301
Rate for Payer: Cash Price	$195.36

Tryptase SO

Facility

$222.00

Service Code	CPT 83520
Hospital Charge Code	1706332
Hospital Revenue Code	301
Min. Negotiated Rate	$6.74
Max. Negotiated Rate	$144.30
Rate for Payer: Aetna Commercial	$18.13
Rate for Payer: Aetna Medicare	$25.90
Rate for Payer: Amerigroup CHIP/Medicaid	$6.74
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$17.27
Rate for Payer: Amerigroup Medicare	$17.27
Rate for Payer: BCBS of TX Blue Advantage	$28.50
Rate for Payer: BCBS of TX Blue Essentials	$34.19
Rate for Payer: BCBS of TX Medicare	$17.27
Rate for Payer: BCBS of TX PPO	$38.17
Rate for Payer: Cash Price	$195.36
Rate for Payer: Cash Price	$195.36
Rate for Payer: Cigna Medicaid	$17.27
Rate for Payer: Cigna Medicare	$17.27
Rate for Payer: Employer Direct Commercial	$17.27
Rate for Payer: Humana Medicare/TRICARE	$17.27
Rate for Payer: Molina CHIP/Medicaid	$17.27
Rate for Payer: Molina Dual Medicare/Medicaid	$17.27
Rate for Payer: Molina Medicare	$17.27
Rate for Payer: Multiplan Auto	$144.30
Rate for Payer: Multiplan Commercial	$144.30
Rate for Payer: Multiplan Workers Comp	$144.30
Rate for Payer: Parkland Medicaid	$17.27
Rate for Payer: Scott and White EPO/PPO	$21.59
Rate for Payer: Scott and White Medicare	$17.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.27
Rate for Payer: Superior Health Plan EPO	$17.27
Rate for Payer: Superior Health Plan Medicare	$17.27
Rate for Payer: Universal American Dual Medicare/Medicaid	$17.27
Rate for Payer: Universal American Medicare	$17.27
Rate for Payer: Wellcare Medicare	$17.27
Rate for Payer: Wellmed Medicare	$17.27

TRY REMV SUT -- DHF

Facility

$98.82

Hospital Charge Code	80841307
Hospital Revenue Code	272
Min. Negotiated Rate	$8.89
Max. Negotiated Rate	$64.23
Rate for Payer: Aetna Commercial	$54.35
Rate for Payer: Amerigroup CHIP/Medicaid	$8.89
Rate for Payer: BCBS of TX Blue Advantage	$29.65
Rate for Payer: BCBS of TX Blue Essentials	$35.58
Rate for Payer: BCBS of TX PPO	$39.53
Rate for Payer: Cash Price	$86.96
Rate for Payer: Multiplan Auto	$64.23
Rate for Payer: Multiplan Commercial	$64.23
Rate for Payer: Multiplan Workers Comp	$64.23
Rate for Payer: Scott and White EPO/PPO	$49.41
Rate for Payer: Superior Health Plan EPO	$13.44

TRY REMV SUT -- DHF

Facility

$98.82

Hospital Charge Code	80841307
Hospital Revenue Code	272
Rate for Payer: Cash Price	$86.96

TRY THORACENTES -- DHF

Facility

$755.53

Hospital Charge Code	80843105
Hospital Revenue Code	272
Rate for Payer: Cash Price	$664.87

TRY THORACENTES -- DHF

Facility

$755.53

Hospital Charge Code	80843105
Hospital Revenue Code	272
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$491.09
Rate for Payer: Aetna Commercial	$415.54
Rate for Payer: Amerigroup CHIP/Medicaid	$68.00
Rate for Payer: BCBS of TX Blue Advantage	$226.66
Rate for Payer: BCBS of TX Blue Essentials	$271.99
Rate for Payer: BCBS of TX PPO	$302.21
Rate for Payer: Cash Price	$664.87
Rate for Payer: Multiplan Auto	$491.09
Rate for Payer: Multiplan Commercial	$491.09
Rate for Payer: Multiplan Workers Comp	$491.09
Rate for Payer: Scott and White EPO/PPO	$377.76
Rate for Payer: Superior Health Plan EPO	$102.75

TRY TRACH CLEAN -- DHF

Facility

$202.44

Hospital Charge Code	80843501
Hospital Revenue Code	270
Rate for Payer: Cash Price	$178.15

TRY TRACH CLEAN -- DHF

Facility

$202.44

Hospital Charge Code	80843501
Hospital Revenue Code	270
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$131.59
Rate for Payer: Aetna Commercial	$111.34
Rate for Payer: Amerigroup CHIP/Medicaid	$18.22
Rate for Payer: BCBS of TX Blue Advantage	$60.73
Rate for Payer: BCBS of TX Blue Essentials	$72.88
Rate for Payer: BCBS of TX PPO	$80.98
Rate for Payer: Cash Price	$178.15
Rate for Payer: Multiplan Auto	$131.59
Rate for Payer: Multiplan Commercial	$131.59
Rate for Payer: Multiplan Workers Comp	$131.59
Rate for Payer: Scott and White EPO/PPO	$101.22
Rate for Payer: Superior Health Plan EPO	$27.53

TRY TRIP/LUMEN -- DHF

Facility

$838.67

Service Code	HCPCS C1751
Hospital Charge Code	80843709
Hospital Revenue Code	278
Min. Negotiated Rate	$75.48
Max. Negotiated Rate	$419.34
Rate for Payer: Aetna Commercial	$251.60
Rate for Payer: Amerigroup CHIP/Medicaid	$75.48
Rate for Payer: BCBS of TX Blue Advantage	$251.60
Rate for Payer: BCBS of TX Blue Essentials	$301.92
Rate for Payer: BCBS of TX PPO	$335.47
Rate for Payer: Cash Price	$738.03
Rate for Payer: Multiplan Auto	$419.34
Rate for Payer: Multiplan Commercial	$419.34
Rate for Payer: Multiplan Workers Comp	$419.34
Rate for Payer: Scott and White EPO/PPO	$419.34
Rate for Payer: Superior Health Plan EPO	$114.06

Know your out-of-pocket cost for care.

All Charges