White Rock Medical Center

All Charges

Charge

Type

Setting

Price

ANGIOPLASTY EA ADD TIBIAL/PERONEAL

Facility

$9,499.00

Service Code	HCPCS 37232
Hospital Charge Code	2320544
Hospital Revenue Code	480
Min. Negotiated Rate	$234.94
Max. Negotiated Rate	$6,839.28
Rate for Payer: Amerigroup CHIP/Medicaid	$854.91
Rate for Payer: BCBS of TX Blue Advantage	$2,849.70
Rate for Payer: BCBS of TX Blue Essentials	$3,419.64
Rate for Payer: BCBS of TX PPO	$3,799.60
Rate for Payer: Cash Price	$6,459.32
Rate for Payer: Cash Price	$6,459.32
Rate for Payer: Cigna Medicaid	$6,839.28
Rate for Payer: Molina CHIP/Medicaid	$6,839.28
Rate for Payer: Multiplan Auto	$6,174.35
Rate for Payer: Multiplan Commercial	$6,174.35
Rate for Payer: Multiplan Workers Comp	$6,174.35
Rate for Payer: Parkland Medicaid	$6,839.28
Rate for Payer: Scott and White EPO/PPO	$234.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,839.28
Rate for Payer: Superior Health Plan EPO	$1,291.86

ANGIOPLASTY FEMO/POPLTL W STENT

Facility

$24,258.00

Service Code	HCPCS 37226
Hospital Charge Code	2320538
Hospital Revenue Code	361
Rate for Payer: Cash Price	$16,495.44

ANGIOPLASTY FEMO/POPLTL W STENT

Facility

$24,258.00

Service Code	HCPCS 37226
Hospital Charge Code	2320538
Hospital Revenue Code	361
Min. Negotiated Rate	$2,183.22
Max. Negotiated Rate	$24,969.37
Rate for Payer: Amerigroup CHIP/Medicaid	$2,183.22
Rate for Payer: BCBS of TX Blue Advantage	$16,547.16
Rate for Payer: BCBS of TX Blue Essentials	$19,816.96
Rate for Payer: BCBS of TX PPO	$24,969.37
Rate for Payer: Cash Price	$16,495.44
Rate for Payer: Cash Price	$16,495.44
Rate for Payer: Cash Price	$16,495.44
Rate for Payer: Cigna Medicaid	$17,465.76
Rate for Payer: Molina CHIP/Medicaid	$17,465.76
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	$17,465.76
Rate for Payer: Scott and White EPO/PPO	$18,612.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17,465.76
Rate for Payer: Superior Health Plan EPO	$3,299.09

ANGIOPLASTY FEMORAL/POPLITEAL

Facility

$15,930.00

Service Code	HCPCS 37224
Hospital Charge Code	2320536
Hospital Revenue Code	361
Min. Negotiated Rate	$1,433.70
Max. Negotiated Rate	$12,483.85
Rate for Payer: Amerigroup CHIP/Medicaid	$1,433.70
Rate for Payer: BCBS of TX Blue Advantage	$8,273.03
Rate for Payer: BCBS of TX Blue Essentials	$9,907.82
Rate for Payer: BCBS of TX PPO	$12,483.85
Rate for Payer: Cash Price	$10,832.40
Rate for Payer: Cash Price	$10,832.40
Rate for Payer: Cash Price	$10,832.40
Rate for Payer: Cigna Medicaid	$11,469.60
Rate for Payer: Molina CHIP/Medicaid	$11,469.60
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	$11,469.60
Rate for Payer: Scott and White EPO/PPO	$9,670.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,469.60
Rate for Payer: Superior Health Plan EPO	$2,166.48

ANGIOPLASTY FEMORAL/POPLITEAL

Facility

$15,930.00

Service Code	HCPCS 37224
Hospital Charge Code	2320536
Hospital Revenue Code	361
Rate for Payer: Cash Price	$10,832.40

ANGIOPLASTY ILIAC ART EA ADD IPSI L

Facility

$17,715.00

Service Code	HCPCS 37222
Hospital Charge Code	2320534
Hospital Revenue Code	361
Rate for Payer: Cash Price	$12,046.20

ANGIOPLASTY ILIAC ART EA ADD IPSI L

Facility

$17,715.00

Service Code	HCPCS 37222
Hospital Charge Code	2320534
Hospital Revenue Code	361
Min. Negotiated Rate	$1,594.35
Max. Negotiated Rate	$12,754.80
Rate for Payer: Amerigroup CHIP/Medicaid	$1,594.35
Rate for Payer: BCBS of TX Blue Advantage	$5,314.50
Rate for Payer: BCBS of TX Blue Essentials	$6,377.40
Rate for Payer: BCBS of TX PPO	$7,086.00
Rate for Payer: Cash Price	$12,046.20
Rate for Payer: Cash Price	$12,046.20
Rate for Payer: Cigna Medicaid	$12,754.80
Rate for Payer: Molina CHIP/Medicaid	$12,754.80
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	$12,754.80
Rate for Payer: Scott and White EPO/PPO	$8,857.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,754.80
Rate for Payer: Superior Health Plan EPO	$2,409.24

ANGIOPLASTY ILIAC ART EA AD W STENT

Facility

$20,260.00

Service Code	HCPCS 37223
Hospital Charge Code	2320535
Hospital Revenue Code	361
Min. Negotiated Rate	$1,823.40
Max. Negotiated Rate	$14,587.20
Rate for Payer: Amerigroup CHIP/Medicaid	$1,823.40
Rate for Payer: BCBS of TX Blue Advantage	$6,078.00
Rate for Payer: BCBS of TX Blue Essentials	$7,293.60
Rate for Payer: BCBS of TX PPO	$8,104.00
Rate for Payer: Cash Price	$13,776.80
Rate for Payer: Cash Price	$13,776.80
Rate for Payer: Cigna Medicaid	$14,587.20
Rate for Payer: Molina CHIP/Medicaid	$14,587.20
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	$14,587.20
Rate for Payer: Scott and White EPO/PPO	$10,130.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14,587.20
Rate for Payer: Superior Health Plan EPO	$2,755.36

ANGIOPLASTY ILIAC ART EA AD W STENT

Facility

$20,260.00

Service Code	HCPCS 37223
Hospital Charge Code	2320535
Hospital Revenue Code	361
Rate for Payer: Cash Price	$13,776.80

ANGIOPLASTY ILIAC ARTERY+STENT

Facility

$23,790.00

Service Code	HCPCS 37221
Hospital Charge Code	2320533
Hospital Revenue Code	361
Min. Negotiated Rate	$2,141.10
Max. Negotiated Rate	$24,969.37
Rate for Payer: Amerigroup CHIP/Medicaid	$2,141.10
Rate for Payer: BCBS of TX Blue Advantage	$16,547.16
Rate for Payer: BCBS of TX Blue Essentials	$19,816.96
Rate for Payer: BCBS of TX PPO	$24,969.37
Rate for Payer: Cash Price	$16,177.20
Rate for Payer: Cash Price	$16,177.20
Rate for Payer: Cash Price	$16,177.20
Rate for Payer: Cigna Medicaid	$17,128.80
Rate for Payer: Molina CHIP/Medicaid	$17,128.80
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	$17,128.80
Rate for Payer: Scott and White EPO/PPO	$18,612.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17,128.80
Rate for Payer: Superior Health Plan EPO	$3,235.44

ANGIOPLASTY ILIAC ARTERY+STENT

Facility

$23,790.00

Service Code	HCPCS 37221
Hospital Charge Code	2320533
Hospital Revenue Code	361
Rate for Payer: Cash Price	$16,177.20

ANGIOPLASTY ILIAC ARTERY UNI LAT

Facility

$11,511.00

Service Code	HCPCS 37220
Hospital Charge Code	2320532
Hospital Revenue Code	361
Rate for Payer: Cash Price	$7,827.48

ANGIOPLASTY ILIAC ARTERY UNI LAT

Facility

$11,511.00

Service Code	HCPCS 37220
Hospital Charge Code	2320532
Hospital Revenue Code	361
Min. Negotiated Rate	$1,035.99
Max. Negotiated Rate	$12,483.85
Rate for Payer: Amerigroup CHIP/Medicaid	$1,035.99
Rate for Payer: BCBS of TX Blue Advantage	$8,273.03
Rate for Payer: BCBS of TX Blue Essentials	$9,907.82
Rate for Payer: BCBS of TX PPO	$12,483.85
Rate for Payer: Cash Price	$7,827.48
Rate for Payer: Cash Price	$7,827.48
Rate for Payer: Cash Price	$7,827.48
Rate for Payer: Cigna Medicaid	$8,287.92
Rate for Payer: Molina CHIP/Medicaid	$8,287.92
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	$8,287.92
Rate for Payer: Scott and White EPO/PPO	$9,670.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,287.92
Rate for Payer: Superior Health Plan EPO	$1,565.50

ANGIOPLASTY+STENT TIBIAL/PERONEAL

Facility

$37,815.00

Service Code	HCPCS 37230
Hospital Charge Code	2320542
Hospital Revenue Code	361
Min. Negotiated Rate	$3,403.35
Max. Negotiated Rate	$40,168.72
Rate for Payer: Amerigroup CHIP/Medicaid	$3,403.35
Rate for Payer: BCBS of TX Blue Advantage	$26,619.75
Rate for Payer: BCBS of TX Blue Essentials	$31,879.94
Rate for Payer: BCBS of TX PPO	$40,168.72
Rate for Payer: Cash Price	$25,714.20
Rate for Payer: Cash Price	$25,714.20
Rate for Payer: Cash Price	$25,714.20
Rate for Payer: Cigna Medicaid	$27,226.80
Rate for Payer: Molina CHIP/Medicaid	$27,226.80
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	$27,226.80
Rate for Payer: Scott and White EPO/PPO	$29,667.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$27,226.80
Rate for Payer: Superior Health Plan EPO	$5,142.84

ANGIOPLASTY+STENT TIBIAL/PERONEAL

Facility

$37,815.00

Service Code	HCPCS 37230
Hospital Charge Code	2320542
Hospital Revenue Code	361
Rate for Payer: Cash Price	$25,714.20

ANGIOPLASTY TIBIAL/PERONEAL

Facility

$23,790.00

Service Code	HCPCS 37228
Hospital Charge Code	2320540
Hospital Revenue Code	361
Rate for Payer: Cash Price	$16,177.20

ANGIOPLASTY TIBIAL/PERONEAL

Facility

$23,790.00

Service Code	HCPCS 37228
Hospital Charge Code	2320540
Hospital Revenue Code	361
Min. Negotiated Rate	$2,141.10
Max. Negotiated Rate	$24,969.37
Rate for Payer: Amerigroup CHIP/Medicaid	$2,141.10
Rate for Payer: BCBS of TX Blue Advantage	$16,547.16
Rate for Payer: BCBS of TX Blue Essentials	$19,816.96
Rate for Payer: BCBS of TX PPO	$24,969.37
Rate for Payer: Cash Price	$16,177.20
Rate for Payer: Cash Price	$16,177.20
Rate for Payer: Cash Price	$16,177.20
Rate for Payer: Cigna Medicaid	$17,128.80
Rate for Payer: Molina CHIP/Medicaid	$17,128.80
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	$17,128.80
Rate for Payer: Scott and White EPO/PPO	$18,612.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17,128.80
Rate for Payer: Superior Health Plan EPO	$3,235.44

ANGIO PULM NON-SEL CATH

Facility

$4,645.00

Service Code	HCPCS 75746
Hospital Charge Code	4615747
Hospital Revenue Code	323
Rate for Payer: Cash Price	$3,158.60

ANGIO PULM NON-SEL CATH

Facility

$4,645.00

Service Code	HCPCS 75746
Hospital Charge Code	4615747
Hospital Revenue Code	323
Min. Negotiated Rate	$134.99
Max. Negotiated Rate	$6,704.76
Rate for Payer: Amerigroup CHIP/Medicaid	$134.99
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Amerigroup Medicare	$3,171.87
Rate for Payer: BCBS of TX Blue Advantage	$153.42
Rate for Payer: BCBS of TX Blue Essentials	$184.10
Rate for Payer: BCBS of TX Medicare	$3,171.87
Rate for Payer: BCBS of TX PPO	$205.49
Rate for Payer: Cash Price	$3,158.60
Rate for Payer: Cash Price	$3,158.60
Rate for Payer: Cash Price	$3,158.60
Rate for Payer: Cigna Commercial	$6,704.76
Rate for Payer: Cigna Medicaid	$3,344.40
Rate for Payer: Cigna Medicare	$3,171.87
Rate for Payer: Employer Direct Commercial	$3,171.87
Rate for Payer: Humana Medicare/TRICARE	$3,171.87
Rate for Payer: Molina CHIP/Medicaid	$3,344.40
Rate for Payer: Molina Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Molina Medicare	$3,171.87
Rate for Payer: Multiplan Auto	$3,019.25
Rate for Payer: Multiplan Commercial	$3,019.25
Rate for Payer: Multiplan Workers Comp	$3,019.25
Rate for Payer: Parkland Medicaid	$3,344.40
Rate for Payer: Scott and White EPO/PPO	$166.22
Rate for Payer: Scott and White Medicare	$3,171.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,344.40
Rate for Payer: Superior Health Plan EPO	$3,171.87
Rate for Payer: Superior Health Plan Medicare	$3,171.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Universal American Medicare	$3,171.87
Rate for Payer: Wellcare Medicare	$3,171.87
Rate for Payer: Wellmed Medicare	$3,171.87

ANGIO PULM SEL BI

Facility

$4,645.00

Service Code	HCPCS 75743
Hospital Charge Code	4615744
Hospital Revenue Code	323
Min. Negotiated Rate	$147.69
Max. Negotiated Rate	$6,704.76
Rate for Payer: Amerigroup CHIP/Medicaid	$147.69
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Amerigroup Medicare	$3,171.87
Rate for Payer: BCBS of TX Blue Advantage	$4,572.61
Rate for Payer: BCBS of TX Blue Essentials	$5,487.13
Rate for Payer: BCBS of TX Medicare	$3,171.87
Rate for Payer: BCBS of TX PPO	$6,124.53
Rate for Payer: Cash Price	$3,158.60
Rate for Payer: Cash Price	$3,158.60
Rate for Payer: Cash Price	$3,158.60
Rate for Payer: Cigna Commercial	$6,704.76
Rate for Payer: Cigna Medicaid	$3,344.40
Rate for Payer: Cigna Medicare	$3,171.87
Rate for Payer: Employer Direct Commercial	$3,171.87
Rate for Payer: Humana Medicare/TRICARE	$3,171.87
Rate for Payer: Molina CHIP/Medicaid	$3,344.40
Rate for Payer: Molina Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Molina Medicare	$3,171.87
Rate for Payer: Multiplan Auto	$3,019.25
Rate for Payer: Multiplan Commercial	$3,019.25
Rate for Payer: Multiplan Workers Comp	$3,019.25
Rate for Payer: Parkland Medicaid	$3,344.40
Rate for Payer: Scott and White EPO/PPO	$181.70
Rate for Payer: Scott and White Medicare	$3,171.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,344.40
Rate for Payer: Superior Health Plan EPO	$3,171.87
Rate for Payer: Superior Health Plan Medicare	$3,171.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Universal American Medicare	$3,171.87
Rate for Payer: Wellcare Medicare	$3,171.87
Rate for Payer: Wellmed Medicare	$3,171.87

ANGIO PULM SEL BI

Facility

$4,645.00

Service Code	HCPCS 75743
Hospital Charge Code	4615744
Hospital Revenue Code	323
Rate for Payer: Cash Price	$3,158.60

ANGIO SELECT EA ADDTL VESSEL

Facility

$1,095.00

Service Code	HCPCS 75774
Hospital Charge Code	2320364
Hospital Revenue Code	320
Rate for Payer: Cash Price	$744.60

ANGIO SELECT EA ADDTL VESSEL

Facility

$1,095.00

Service Code	HCPCS 75774
Hospital Charge Code	2320364
Hospital Revenue Code	320
Min. Negotiated Rate	$98.55
Max. Negotiated Rate	$788.40
Rate for Payer: Amerigroup CHIP/Medicaid	$98.55
Rate for Payer: BCBS of TX Blue Advantage	$109.41
Rate for Payer: BCBS of TX Blue Essentials	$131.29
Rate for Payer: BCBS of TX PPO	$146.55
Rate for Payer: Cash Price	$744.60
Rate for Payer: Cash Price	$744.60
Rate for Payer: Cigna Medicaid	$788.40
Rate for Payer: Molina CHIP/Medicaid	$788.40
Rate for Payer: Multiplan Auto	$711.75
Rate for Payer: Multiplan Commercial	$711.75
Rate for Payer: Multiplan Workers Comp	$711.75
Rate for Payer: Parkland Medicaid	$788.40
Rate for Payer: Scott and White EPO/PPO	$118.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$788.40
Rate for Payer: Superior Health Plan EPO	$148.92

Angiotensin-Converting Enzyme SO

Facility

$246.00

Service Code	HCPCS 82164
Hospital Charge Code	1701648
Hospital Revenue Code	301
Rate for Payer: Cash Price	$167.28

Angiotensin-Converting Enzyme SO

Facility

$246.00

Service Code	HCPCS 82164
Hospital Charge Code	1701648
Hospital Revenue Code	301
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$177.12
Rate for Payer: Amerigroup CHIP/Medicaid	$5.69
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14.60
Rate for Payer: Amerigroup Medicare	$14.60
Rate for Payer: BCBS of TX Blue Advantage	$73.80
Rate for Payer: BCBS of TX Blue Essentials	$88.56
Rate for Payer: BCBS of TX Medicare	$14.60
Rate for Payer: BCBS of TX PPO	$98.40
Rate for Payer: Cash Price	$167.28
Rate for Payer: Cash Price	$167.28
Rate for Payer: Cigna Medicaid	$177.12
Rate for Payer: Cigna Medicare	$14.60
Rate for Payer: Employer Direct Commercial	$14.60
Rate for Payer: Humana Medicare/TRICARE	$14.60
Rate for Payer: Molina CHIP/Medicaid	$177.12
Rate for Payer: Molina Dual Medicare/Medicaid	$14.60
Rate for Payer: Molina Medicare	$14.60
Rate for Payer: Multiplan Auto	$159.90
Rate for Payer: Multiplan Commercial	$159.90
Rate for Payer: Multiplan Workers Comp	$159.90
Rate for Payer: Parkland Medicaid	$177.12
Rate for Payer: Scott and White EPO/PPO	$18.25
Rate for Payer: Scott and White Medicare	$14.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$177.12
Rate for Payer: Superior Health Plan EPO	$14.60
Rate for Payer: Superior Health Plan Medicare	$14.60
Rate for Payer: Universal American Dual Medicare/Medicaid	$14.60
Rate for Payer: Universal American Medicare	$14.60
Rate for Payer: Wellcare Medicare	$14.60
Rate for Payer: Wellmed Medicare	$14.60

Know your out-of-pocket cost for care.

All Charges