White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Thromboendarterectomy, including patch graft, if performed; deep (profunda) femoral

Facility

$64,200.00

Service Code	HCPCS 35372
Hospital Charge Code	991028
Hospital Revenue Code	481
Rate for Payer: Cash Price	$43,656.00

Thromboendarterectomy, including patch graft, if performed; deep (profunda) femoral

Facility

$64,200.00

Service Code	HCPCS 35372
Hospital Charge Code	991028
Hospital Revenue Code	481
Min. Negotiated Rate	$1,157.36
Max. Negotiated Rate	$46,224.00
Rate for Payer: Amerigroup CHIP/Medicaid	$5,778.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Amerigroup Medicare	$5,589.84
Rate for Payer: BCBS of TX Blue Advantage	$1,707.46
Rate for Payer: BCBS of TX Blue Essentials	$2,044.86
Rate for Payer: BCBS of TX Medicare	$5,589.84
Rate for Payer: BCBS of TX PPO	$2,576.52
Rate for Payer: Cash Price	$43,656.00
Rate for Payer: Cash Price	$43,656.00
Rate for Payer: Cash Price	$43,656.00
Rate for Payer: Cigna Commercial	$11,815.91
Rate for Payer: Cigna Medicaid	$46,224.00
Rate for Payer: Cigna Medicare	$5,589.84
Rate for Payer: Employer Direct Commercial	$5,589.84
Rate for Payer: Humana Medicare/TRICARE	$5,589.84
Rate for Payer: Molina CHIP/Medicaid	$46,224.00
Rate for Payer: Molina Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Molina Medicare	$5,589.84
Rate for Payer: Multiplan Auto	$41,730.00
Rate for Payer: Multiplan Commercial	$41,730.00
Rate for Payer: Multiplan Workers Comp	$41,730.00
Rate for Payer: Parkland Medicaid	$46,224.00
Rate for Payer: Scott and White EPO/PPO	$1,157.36
Rate for Payer: Scott and White Medicare	$5,589.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$46,224.00
Rate for Payer: Superior Health Plan EPO	$5,589.84
Rate for Payer: Superior Health Plan Medicare	$5,589.84
Rate for Payer: Universal American Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Universal American Medicare	$5,589.84
Rate for Payer: Wellcare Medicare	$5,589.84
Rate for Payer: Wellmed Medicare	$5,589.84

Thromboendarterectomy, including patch graft, if performed; iliac

Facility

$64,200.00

Service Code	HCPCS 35351
Hospital Charge Code	991027
Hospital Revenue Code	481
Rate for Payer: Cash Price	$43,656.00

Thromboendarterectomy, including patch graft, if performed; iliac

Facility

$64,200.00

Service Code	HCPCS 35351
Hospital Charge Code	991027
Hospital Revenue Code	481
Min. Negotiated Rate	$1,522.86
Max. Negotiated Rate	$46,224.00
Rate for Payer: Amerigroup CHIP/Medicaid	$5,778.00
Rate for Payer: BCBS of TX Blue Advantage	$2,232.27
Rate for Payer: BCBS of TX Blue Essentials	$2,673.38
Rate for Payer: BCBS of TX PPO	$3,368.46
Rate for Payer: Cash Price	$43,656.00
Rate for Payer: Cash Price	$43,656.00
Rate for Payer: Cigna Medicaid	$46,224.00
Rate for Payer: Molina CHIP/Medicaid	$46,224.00
Rate for Payer: Multiplan Auto	$41,730.00
Rate for Payer: Multiplan Commercial	$41,730.00
Rate for Payer: Multiplan Workers Comp	$41,730.00
Rate for Payer: Parkland Medicaid	$46,224.00
Rate for Payer: Scott and White EPO/PPO	$1,522.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$46,224.00
Rate for Payer: Superior Health Plan EPO	$8,731.20

Thromboendarterectomy, including patch graft, if performed; superficial femoral artery

Facility

$64,200.00

Service Code	HCPCS 35302
Hospital Charge Code	991026
Hospital Revenue Code	481
Min. Negotiated Rate	$1,324.42
Max. Negotiated Rate	$46,224.00
Rate for Payer: Amerigroup CHIP/Medicaid	$5,778.00
Rate for Payer: BCBS of TX Blue Advantage	$1,956.02
Rate for Payer: BCBS of TX Blue Essentials	$2,342.54
Rate for Payer: BCBS of TX PPO	$2,951.60
Rate for Payer: Cash Price	$43,656.00
Rate for Payer: Cash Price	$43,656.00
Rate for Payer: Cigna Medicaid	$46,224.00
Rate for Payer: Molina CHIP/Medicaid	$46,224.00
Rate for Payer: Multiplan Auto	$41,730.00
Rate for Payer: Multiplan Commercial	$41,730.00
Rate for Payer: Multiplan Workers Comp	$41,730.00
Rate for Payer: Parkland Medicaid	$46,224.00
Rate for Payer: Scott and White EPO/PPO	$1,324.42
Rate for Payer: Superior Health Plan CHIP/Medicaid	$46,224.00
Rate for Payer: Superior Health Plan EPO	$8,731.20

Thromboendarterectomy, including patch graft, if performed; superficial femoral artery

Facility

$64,200.00

Service Code	HCPCS 35302
Hospital Charge Code	991026
Hospital Revenue Code	481
Rate for Payer: Cash Price	$43,656.00

THROMBOLYSIS ART-INFUS(NON CORONRY)

Facility

$12,089.00

Service Code	HCPCS 37211
Hospital Charge Code	2350020
Hospital Revenue Code	481
Rate for Payer: Cash Price	$8,220.52

THROMBOLYSIS ART-INFUS(NON CORONRY)

Facility

$12,089.00

Service Code	HCPCS 37211
Hospital Charge Code	2350020
Hospital Revenue Code	481
Min. Negotiated Rate	$458.38
Max. Negotiated Rate	$11,815.91
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.01
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Amerigroup Medicare	$5,589.84
Rate for Payer: BCBS of TX Blue Advantage	$7,675.64
Rate for Payer: BCBS of TX Blue Essentials	$9,192.38
Rate for Payer: BCBS of TX Medicare	$5,589.84
Rate for Payer: BCBS of TX PPO	$11,582.40
Rate for Payer: Cash Price	$8,220.52
Rate for Payer: Cash Price	$8,220.52
Rate for Payer: Cash Price	$8,220.52
Rate for Payer: Cigna Commercial	$11,815.91
Rate for Payer: Cigna Medicaid	$8,704.08
Rate for Payer: Cigna Medicare	$5,589.84
Rate for Payer: Employer Direct Commercial	$5,589.84
Rate for Payer: Humana Medicare/TRICARE	$5,589.84
Rate for Payer: Molina CHIP/Medicaid	$8,704.08
Rate for Payer: Molina Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Molina Medicare	$5,589.84
Rate for Payer: Multiplan Auto	$7,857.85
Rate for Payer: Multiplan Commercial	$7,857.85
Rate for Payer: Multiplan Workers Comp	$7,857.85
Rate for Payer: Parkland Medicaid	$8,704.08
Rate for Payer: Scott and White EPO/PPO	$458.38
Rate for Payer: Scott and White Medicare	$5,589.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,704.08
Rate for Payer: Superior Health Plan EPO	$5,589.84
Rate for Payer: Superior Health Plan Medicare	$5,589.84
Rate for Payer: Universal American Dual Medicare/Medicaid	$5,589.84
Rate for Payer: Universal American Medicare	$5,589.84
Rate for Payer: Wellcare Medicare	$5,589.84
Rate for Payer: Wellmed Medicare	$5,589.84

THROMBOLYSIS OF VEIN-INFUSION

Facility

$4,645.00

Service Code	HCPCS 37212
Hospital Charge Code	2350021
Hospital Revenue Code	481
Rate for Payer: Cash Price	$3,158.60

THROMBOLYSIS OF VEIN-INFUSION

Facility

$4,645.00

Service Code	HCPCS 37212
Hospital Charge Code	2350021
Hospital Revenue Code	481
Min. Negotiated Rate	$400.00
Max. Negotiated Rate	$6,983.63
Rate for Payer: Amerigroup CHIP/Medicaid	$418.05
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	$4,628.04
Rate for Payer: BCBS of TX Blue Essentials	$5,542.56
Rate for Payer: BCBS of TX Medicare	$3,171.87
Rate for Payer: BCBS of TX PPO	$6,983.63
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	$400.00
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

Thromboplastin time, partial (PTT); plasma or whole blood

Facility

$220.00

Service Code	HCPCS 85730
Hospital Charge Code	1600535
Hospital Revenue Code	305
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$158.40
Rate for Payer: Amerigroup CHIP/Medicaid	$2.34
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6.01
Rate for Payer: Amerigroup Medicare	$6.01
Rate for Payer: BCBS of TX Blue Advantage	$66.00
Rate for Payer: BCBS of TX Blue Essentials	$79.20
Rate for Payer: BCBS of TX Medicare	$6.01
Rate for Payer: BCBS of TX PPO	$88.00
Rate for Payer: Cash Price	$149.60
Rate for Payer: Cash Price	$149.60
Rate for Payer: Cigna Medicaid	$158.40
Rate for Payer: Cigna Medicare	$6.01
Rate for Payer: Employer Direct Commercial	$6.01
Rate for Payer: Humana Medicare/TRICARE	$6.01
Rate for Payer: Molina CHIP/Medicaid	$158.40
Rate for Payer: Molina Dual Medicare/Medicaid	$6.01
Rate for Payer: Molina Medicare	$6.01
Rate for Payer: Multiplan Auto	$143.00
Rate for Payer: Multiplan Commercial	$143.00
Rate for Payer: Multiplan Workers Comp	$143.00
Rate for Payer: Parkland Medicaid	$158.40
Rate for Payer: Scott and White EPO/PPO	$7.51
Rate for Payer: Scott and White Medicare	$6.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$158.40
Rate for Payer: Superior Health Plan EPO	$6.01
Rate for Payer: Superior Health Plan Medicare	$6.01
Rate for Payer: Universal American Dual Medicare/Medicaid	$6.01
Rate for Payer: Universal American Medicare	$6.01
Rate for Payer: Wellcare Medicare	$6.01
Rate for Payer: Wellmed Medicare	$6.01

Thromboplastin time, partial (PTT); plasma or whole blood

Facility

$220.00

Service Code	HCPCS 85730
Hospital Charge Code	1600535
Hospital Revenue Code	305
Rate for Payer: Cash Price	$149.60

Thunderbeal, Front Grip Type S, 5 mm, 45 cm

Facility

$4,964.22

Hospital Charge Code	992812
Hospital Revenue Code	272
Min. Negotiated Rate	$446.78
Max. Negotiated Rate	$3,574.24
Rate for Payer: Amerigroup CHIP/Medicaid	$446.78
Rate for Payer: BCBS of TX Blue Advantage	$1,489.27
Rate for Payer: BCBS of TX Blue Essentials	$1,787.12
Rate for Payer: BCBS of TX PPO	$1,985.69
Rate for Payer: Cash Price	$3,375.67
Rate for Payer: Cigna Medicaid	$3,574.24
Rate for Payer: Molina CHIP/Medicaid	$3,574.24
Rate for Payer: Multiplan Auto	$3,226.74
Rate for Payer: Multiplan Commercial	$3,226.74
Rate for Payer: Multiplan Workers Comp	$3,226.74
Rate for Payer: Parkland Medicaid	$3,574.24
Rate for Payer: Scott and White EPO/PPO	$2,482.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,574.24
Rate for Payer: Superior Health Plan EPO	$675.13

Thunderbeal, Front Grip Type S, 5 mm, 45 cm

Facility

$4,964.22

Hospital Charge Code	992812
Hospital Revenue Code	272
Rate for Payer: Cash Price	$3,375.67

Thunderbeat

Facility

$14,755.00

Service Code	HCPCS C1889
Hospital Charge Code	992678
Hospital Revenue Code	278
Min. Negotiated Rate	$3,688.75
Max. Negotiated Rate	$7,377.50
Rate for Payer: Cash Price	$10,033.40
Rate for Payer: Cigna Commercial	$3,688.75
Rate for Payer: Multiplan Auto	$7,377.50
Rate for Payer: Multiplan Commercial	$7,377.50
Rate for Payer: Multiplan Workers Comp	$7,377.50
Rate for Payer: Scott and White EPO/PPO	$7,377.50

Thunderbeat

Facility

$14,755.00

Service Code	HCPCS C1889
Hospital Charge Code	992678
Hospital Revenue Code	278
Min. Negotiated Rate	$1,327.95
Max. Negotiated Rate	$10,623.60
Rate for Payer: Amerigroup CHIP/Medicaid	$1,327.95
Rate for Payer: BCBS of TX Blue Advantage	$4,426.50
Rate for Payer: BCBS of TX Blue Essentials	$5,311.80
Rate for Payer: BCBS of TX PPO	$5,902.00
Rate for Payer: Cash Price	$10,033.40
Rate for Payer: Cigna Medicaid	$10,623.60
Rate for Payer: Molina CHIP/Medicaid	$10,623.60
Rate for Payer: Multiplan Auto	$7,377.50
Rate for Payer: Multiplan Commercial	$7,377.50
Rate for Payer: Multiplan Workers Comp	$7,377.50
Rate for Payer: Parkland Medicaid	$10,623.60
Rate for Payer: Scott and White EPO/PPO	$7,377.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,623.60
Rate for Payer: Superior Health Plan EPO	$2,006.68

THUNDERBEAT 5MM 45CM FRONT GRIP TYPE S

Facility

$2,226.08

Service Code	HCPCS C1889
Hospital Charge Code	993930
Hospital Revenue Code	278
Min. Negotiated Rate	$556.52
Max. Negotiated Rate	$1,113.04
Rate for Payer: Cash Price	$1,513.73
Rate for Payer: Cigna Commercial	$556.52
Rate for Payer: Multiplan Auto	$1,113.04
Rate for Payer: Multiplan Commercial	$1,113.04
Rate for Payer: Multiplan Workers Comp	$1,113.04
Rate for Payer: Scott and White EPO/PPO	$1,113.04

THUNDERBEAT 5MM 45CM FRONT GRIP TYPE S

Facility

$2,226.08

Service Code	HCPCS C1889
Hospital Charge Code	993930
Hospital Revenue Code	278
Min. Negotiated Rate	$200.35
Max. Negotiated Rate	$1,602.78
Rate for Payer: Amerigroup CHIP/Medicaid	$200.35
Rate for Payer: BCBS of TX Blue Advantage	$667.82
Rate for Payer: BCBS of TX Blue Essentials	$801.39
Rate for Payer: BCBS of TX PPO	$890.43
Rate for Payer: Cash Price	$1,513.73
Rate for Payer: Cigna Medicaid	$1,602.78
Rate for Payer: Molina CHIP/Medicaid	$1,602.78
Rate for Payer: Multiplan Auto	$1,113.04
Rate for Payer: Multiplan Commercial	$1,113.04
Rate for Payer: Multiplan Workers Comp	$1,113.04
Rate for Payer: Parkland Medicaid	$1,602.78
Rate for Payer: Scott and White EPO/PPO	$1,113.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,602.78
Rate for Payer: Superior Health Plan EPO	$302.75

.Thyroglobulin by RIA 503905 SO

Facility

$119.00

Service Code	HCPCS 84432
Hospital Charge Code	1700954
Hospital Revenue Code	300
Min. Negotiated Rate	$6.26
Max. Negotiated Rate	$85.68
Rate for Payer: Amerigroup CHIP/Medicaid	$6.26
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16.06
Rate for Payer: Amerigroup Medicare	$16.06
Rate for Payer: BCBS of TX Blue Advantage	$35.70
Rate for Payer: BCBS of TX Blue Essentials	$42.84
Rate for Payer: BCBS of TX Medicare	$16.06
Rate for Payer: BCBS of TX PPO	$47.60
Rate for Payer: Cash Price	$80.92
Rate for Payer: Cash Price	$80.92
Rate for Payer: Cigna Medicaid	$85.68
Rate for Payer: Cigna Medicare	$16.06
Rate for Payer: Employer Direct Commercial	$16.06
Rate for Payer: Humana Medicare/TRICARE	$16.06
Rate for Payer: Molina CHIP/Medicaid	$85.68
Rate for Payer: Molina Dual Medicare/Medicaid	$16.06
Rate for Payer: Molina Medicare	$16.06
Rate for Payer: Multiplan Auto	$77.35
Rate for Payer: Multiplan Commercial	$77.35
Rate for Payer: Multiplan Workers Comp	$77.35
Rate for Payer: Parkland Medicaid	$85.68
Rate for Payer: Scott and White EPO/PPO	$20.07
Rate for Payer: Scott and White Medicare	$16.06
Rate for Payer: Superior Health Plan CHIP/Medicaid	$85.68
Rate for Payer: Superior Health Plan EPO	$16.06
Rate for Payer: Superior Health Plan Medicare	$16.06
Rate for Payer: Universal American Dual Medicare/Medicaid	$16.06
Rate for Payer: Universal American Medicare	$16.06
Rate for Payer: Wellcare Medicare	$16.06
Rate for Payer: Wellmed Medicare	$16.06

.Thyroglobulin by RIA 503905 SO

Facility

$119.00

Service Code	HCPCS 84432
Hospital Charge Code	1700954
Hospital Revenue Code	300
Rate for Payer: Cash Price	$80.92

thyroid desiccated 30 mg Tab

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77845819
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

thyroid desiccated 30 mg Tab

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77845819
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.44

THYROID DISORDERS

Facility

$1,889.72

Service Code	APR-DRG 4271
Min. Negotiated Rate	$1,781.69
Max. Negotiated Rate	$1,889.72
Rate for Payer: Amerigroup CHIP/Medicaid	$1,781.69
Rate for Payer: Cigna Medicaid	$1,781.69
Rate for Payer: Molina CHIP/Medicaid	$1,781.69
Rate for Payer: Parkland Medicaid	$1,781.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,889.72

THYROID DISORDERS

Facility

$11,818.84

Service Code	APR-DRG 4274
Min. Negotiated Rate	$11,143.22
Max. Negotiated Rate	$11,818.84
Rate for Payer: Amerigroup CHIP/Medicaid	$11,143.22
Rate for Payer: Cigna Medicaid	$11,143.22
Rate for Payer: Molina CHIP/Medicaid	$11,143.22
Rate for Payer: Parkland Medicaid	$11,143.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,818.84

THYROID DISORDERS

Facility

$3,517.29

Service Code	APR-DRG 4273
Min. Negotiated Rate	$3,316.22
Max. Negotiated Rate	$3,517.29
Rate for Payer: Amerigroup CHIP/Medicaid	$3,316.22
Rate for Payer: Cigna Medicaid	$3,316.22
Rate for Payer: Molina CHIP/Medicaid	$3,316.22
Rate for Payer: Parkland Medicaid	$3,316.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,517.29

Know your out-of-pocket cost for care.

All Charges