White Rock Medical Center

All Charges

Charge

Type

Setting

Price

TRANSURETHRAL PROSTATECTOMY

Facility

$3,989.53

Service Code	APR-DRG 4821
Min. Negotiated Rate	$3,761.47
Max. Negotiated Rate	$3,989.53
Rate for Payer: Amerigroup CHIP/Medicaid	$3,761.47
Rate for Payer: Cigna Medicaid	$3,761.47
Rate for Payer: Molina CHIP/Medicaid	$3,761.47
Rate for Payer: Parkland Medicaid	$3,761.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,989.53

TRANSURETHRAL PROSTATECTOMY W CC/MCC

Facility

$28,156.10

Service Code	MSDRG 713
Min. Negotiated Rate	$12,585.24
Max. Negotiated Rate	$28,156.10
Rate for Payer: BCBS of TX Blue Advantage	$12,585.24
Rate for Payer: BCBS of TX Blue Essentials	$15,100.82
Rate for Payer: BCBS of TX PPO	$16,779.34

TRANSURETHRAL PROSTATECTOMY WITH CC/MCC

Facility

$28,156.10

Service Code	MSDRG 713
Min. Negotiated Rate	$12,585.24
Max. Negotiated Rate	$28,156.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15,778.54
Rate for Payer: Amerigroup Medicare	$15,778.54
Rate for Payer: BCBS of TX Medicare	$15,778.54
Rate for Payer: Cigna Commercial	$19,363.79
Rate for Payer: Cigna Medicare	$15,778.54
Rate for Payer: Employer Direct Commercial	$15,778.54
Rate for Payer: Humana Medicare/TRICARE	$15,778.54
Rate for Payer: Molina Dual Medicare/Medicaid	$15,778.54
Rate for Payer: Molina Medicare	$15,778.54
Rate for Payer: Multiplan Auto	$28,156.10
Rate for Payer: Multiplan Commercial	$28,156.10
Rate for Payer: Multiplan Workers Comp	$28,156.10
Rate for Payer: Scott and White EPO/PPO	$12,966.62
Rate for Payer: Scott and White Medicare	$15,778.54
Rate for Payer: Superior Health Plan EPO	$15,778.54
Rate for Payer: Superior Health Plan Medicare	$15,778.54
Rate for Payer: Universal American Dual Medicare/Medicaid	$15,778.54
Rate for Payer: Universal American Medicare	$15,778.54
Rate for Payer: Wellcare Medicare	$15,778.54
Rate for Payer: Wellmed Medicare	$15,778.54

TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC

Facility

$18,205.80

Service Code	MSDRG 714
Min. Negotiated Rate	$7,830.30
Max. Negotiated Rate	$18,205.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,509.79
Rate for Payer: Amerigroup Medicare	$12,509.79
Rate for Payer: BCBS of TX Medicare	$12,509.79
Rate for Payer: Cigna Commercial	$13,619.31
Rate for Payer: Cigna Medicare	$12,509.79
Rate for Payer: Employer Direct Commercial	$12,509.79
Rate for Payer: Humana Medicare/TRICARE	$12,509.79
Rate for Payer: Molina Dual Medicare/Medicaid	$12,509.79
Rate for Payer: Molina Medicare	$12,509.79
Rate for Payer: Multiplan Auto	$18,205.80
Rate for Payer: Multiplan Commercial	$18,205.80
Rate for Payer: Multiplan Workers Comp	$18,205.80
Rate for Payer: Scott and White EPO/PPO	$8,384.25
Rate for Payer: Scott and White Medicare	$12,509.79
Rate for Payer: Superior Health Plan EPO	$12,509.79
Rate for Payer: Superior Health Plan Medicare	$12,509.79
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,509.79
Rate for Payer: Universal American Medicare	$12,509.79
Rate for Payer: Wellcare Medicare	$12,509.79
Rate for Payer: Wellmed Medicare	$12,509.79

TRANSURETHRAL PROSTATECTOMY W/O CC/MCC

Facility

$18,205.80

Service Code	MSDRG 714
Min. Negotiated Rate	$7,830.30
Max. Negotiated Rate	$18,205.80
Rate for Payer: BCBS of TX Blue Advantage	$7,830.30
Rate for Payer: BCBS of TX Blue Essentials	$9,395.45
Rate for Payer: BCBS of TX PPO	$10,439.79

Transvaginal Ultrasound Transducer

Facility

$17,002.30

Hospital Charge Code	992622
Hospital Revenue Code	272
Min. Negotiated Rate	$1,530.21
Max. Negotiated Rate	$12,241.66
Rate for Payer: Amerigroup CHIP/Medicaid	$1,530.21
Rate for Payer: BCBS of TX Blue Advantage	$5,100.69
Rate for Payer: BCBS of TX Blue Essentials	$6,120.83
Rate for Payer: BCBS of TX PPO	$6,800.92
Rate for Payer: Cash Price	$11,561.56
Rate for Payer: Cigna Medicaid	$12,241.66
Rate for Payer: Molina CHIP/Medicaid	$12,241.66
Rate for Payer: Multiplan Auto	$11,051.50
Rate for Payer: Multiplan Commercial	$11,051.50
Rate for Payer: Multiplan Workers Comp	$11,051.50
Rate for Payer: Parkland Medicaid	$12,241.66
Rate for Payer: Scott and White EPO/PPO	$8,501.15
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,241.66
Rate for Payer: Superior Health Plan EPO	$2,312.31

Transvaginal Ultrasound Transducer

Facility

$17,002.30

Hospital Charge Code	992622
Hospital Revenue Code	272
Rate for Payer: Cash Price	$11,561.56

Transverse Laparotomy T-Drape, Sterile

Facility

$23.36

Hospital Charge Code	992782
Hospital Revenue Code	272
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$16.82
Rate for Payer: Amerigroup CHIP/Medicaid	$2.10
Rate for Payer: BCBS of TX Blue Advantage	$7.01
Rate for Payer: BCBS of TX Blue Essentials	$8.41
Rate for Payer: BCBS of TX PPO	$9.34
Rate for Payer: Cash Price	$15.88
Rate for Payer: Cigna Medicaid	$16.82
Rate for Payer: Molina CHIP/Medicaid	$16.82
Rate for Payer: Multiplan Auto	$15.18
Rate for Payer: Multiplan Commercial	$15.18
Rate for Payer: Multiplan Workers Comp	$15.18
Rate for Payer: Parkland Medicaid	$16.82
Rate for Payer: Scott and White EPO/PPO	$11.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16.82
Rate for Payer: Superior Health Plan EPO	$3.18

Transverse Laparotomy T-Drape, Sterile

Facility

$23.36

Hospital Charge Code	992782
Hospital Revenue Code	272
Rate for Payer: Cash Price	$15.88

Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by i

Facility

$10,000.00

Service Code	CPT 64488
Hospital Charge Code	36064488
Hospital Revenue Code	360
Min. Negotiated Rate	$51.26
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$51.26
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	$83.24

Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by i

Facility

$1,567.02

Service Code	HCPCS 64488
Hospital Charge Code	9900799
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,065.57

Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by i

Facility

$1,567.02

Service Code	HCPCS 64488
Hospital Charge Code	9900799
Hospital Revenue Code	360
Min. Negotiated Rate	$51.26
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$51.26
Rate for Payer: BCBS of TX Blue Advantage	$470.11
Rate for Payer: BCBS of TX Blue Essentials	$564.13
Rate for Payer: BCBS of TX PPO	$626.81
Rate for Payer: Cash Price	$1,065.57
Rate for Payer: Cash Price	$1,065.57
Rate for Payer: Cigna Medicaid	$1,128.25
Rate for Payer: Molina CHIP/Medicaid	$1,128.25
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	$1,128.25
Rate for Payer: Scott and White EPO/PPO	$783.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,128.25
Rate for Payer: Superior Health Plan EPO	$213.11

Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral by

Facility

$10,882.70

Service Code	HCPCS 64486
Hospital Charge Code	9900798
Hospital Revenue Code	360
Min. Negotiated Rate	$41.42
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$41.42
Rate for Payer: BCBS of TX Blue Advantage	$3,264.81
Rate for Payer: BCBS of TX Blue Essentials	$3,917.77
Rate for Payer: BCBS of TX PPO	$4,353.08
Rate for Payer: Cash Price	$7,400.24
Rate for Payer: Cash Price	$7,400.24
Rate for Payer: Cigna Medicaid	$7,835.54
Rate for Payer: Molina CHIP/Medicaid	$7,835.54
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	$7,835.54
Rate for Payer: Scott and White EPO/PPO	$5,441.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,835.54
Rate for Payer: Superior Health Plan EPO	$1,480.05

Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral by

Facility

$10,882.70

Service Code	HCPCS 64486
Hospital Charge Code	9900798
Hospital Revenue Code	360
Rate for Payer: Cash Price	$7,400.24

Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral by

Facility

$10,000.00

Service Code	CPT 64486
Hospital Charge Code	36064486
Hospital Revenue Code	360
Min. Negotiated Rate	$41.42
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$41.42
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	$66.80

transwarmer infant transport mattress

Facility

$105.01

Hospital Charge Code	8630564
Hospital Revenue Code	272
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$75.61
Rate for Payer: Amerigroup CHIP/Medicaid	$9.45
Rate for Payer: BCBS of TX Blue Advantage	$31.50
Rate for Payer: BCBS of TX Blue Essentials	$37.80
Rate for Payer: BCBS of TX PPO	$42.00
Rate for Payer: Cash Price	$71.41
Rate for Payer: Cigna Medicaid	$75.61
Rate for Payer: Molina CHIP/Medicaid	$75.61
Rate for Payer: Multiplan Auto	$68.26
Rate for Payer: Multiplan Commercial	$68.26
Rate for Payer: Multiplan Workers Comp	$68.26
Rate for Payer: Parkland Medicaid	$75.61
Rate for Payer: Scott and White EPO/PPO	$52.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$75.61
Rate for Payer: Superior Health Plan EPO	$14.28

transwarmer infant transport mattress

Facility

$105.01

Hospital Charge Code	8630564
Hospital Revenue Code	272
Rate for Payer: Cash Price	$71.41

TRAP, TISSUE COLLECTION BERKELEY SAFETOUCH -- DHF

Facility

$45.04

Hospital Charge Code	80316458
Hospital Revenue Code	272
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$32.43
Rate for Payer: Amerigroup CHIP/Medicaid	$4.05
Rate for Payer: BCBS of TX Blue Advantage	$13.51
Rate for Payer: BCBS of TX Blue Essentials	$16.21
Rate for Payer: BCBS of TX PPO	$18.02
Rate for Payer: Cash Price	$30.63
Rate for Payer: Cigna Medicaid	$32.43
Rate for Payer: Molina CHIP/Medicaid	$32.43
Rate for Payer: Multiplan Auto	$29.28
Rate for Payer: Multiplan Commercial	$29.28
Rate for Payer: Multiplan Workers Comp	$29.28
Rate for Payer: Parkland Medicaid	$32.43
Rate for Payer: Scott and White EPO/PPO	$22.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$32.43
Rate for Payer: Superior Health Plan EPO	$6.13

TRAP, TISSUE COLLECTION BERKELEY SAFETOUCH -- DHF

Facility

$45.04

Hospital Charge Code	80316458
Hospital Revenue Code	272
Rate for Payer: Cash Price	$30.63

TRAUMATIC INJURY WITH MCC

Facility

$28,767.90

Service Code	MSDRG 913
Min. Negotiated Rate	$12,658.34
Max. Negotiated Rate	$28,767.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16,740.10
Rate for Payer: Amerigroup Medicare	$16,740.10
Rate for Payer: BCBS of TX Medicare	$16,740.10
Rate for Payer: Cigna Commercial	$21,053.65
Rate for Payer: Cigna Medicare	$16,740.10
Rate for Payer: Employer Direct Commercial	$16,740.10
Rate for Payer: Humana Medicare/TRICARE	$16,740.10
Rate for Payer: Molina Dual Medicare/Medicaid	$16,740.10
Rate for Payer: Molina Medicare	$16,740.10
Rate for Payer: Multiplan Auto	$28,767.90
Rate for Payer: Multiplan Commercial	$28,767.90
Rate for Payer: Multiplan Workers Comp	$28,767.90
Rate for Payer: Scott and White EPO/PPO	$13,248.38
Rate for Payer: Scott and White Medicare	$16,740.10
Rate for Payer: Superior Health Plan EPO	$16,740.10
Rate for Payer: Superior Health Plan Medicare	$16,740.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$16,740.10
Rate for Payer: Universal American Medicare	$16,740.10
Rate for Payer: Wellcare Medicare	$16,740.10
Rate for Payer: Wellmed Medicare	$16,740.10

TRAUMATIC INJURY WITHOUT MCC

Facility

$16,892.90

Service Code	MSDRG 914
Min. Negotiated Rate	$7,205.08
Max. Negotiated Rate	$16,892.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,249.94
Rate for Payer: Amerigroup Medicare	$11,249.94
Rate for Payer: BCBS of TX Medicare	$11,249.94
Rate for Payer: Cigna Commercial	$11,405.24
Rate for Payer: Cigna Medicare	$11,249.94
Rate for Payer: Employer Direct Commercial	$11,249.94
Rate for Payer: Humana Medicare/TRICARE	$11,249.94
Rate for Payer: Molina Dual Medicare/Medicaid	$11,249.94
Rate for Payer: Molina Medicare	$11,249.94
Rate for Payer: Multiplan Auto	$16,892.90
Rate for Payer: Multiplan Commercial	$16,892.90
Rate for Payer: Multiplan Workers Comp	$16,892.90
Rate for Payer: Scott and White EPO/PPO	$7,779.62
Rate for Payer: Scott and White Medicare	$11,249.94
Rate for Payer: Superior Health Plan EPO	$11,249.94
Rate for Payer: Superior Health Plan Medicare	$11,249.94
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,249.94
Rate for Payer: Universal American Medicare	$11,249.94
Rate for Payer: Wellcare Medicare	$11,249.94
Rate for Payer: Wellmed Medicare	$11,249.94

TRAUMATIC INJURY W MCC

Facility

$28,767.90

Service Code	MSDRG 913
Min. Negotiated Rate	$12,658.34
Max. Negotiated Rate	$28,767.90
Rate for Payer: BCBS of TX Blue Advantage	$12,658.34
Rate for Payer: BCBS of TX Blue Essentials	$15,188.54
Rate for Payer: BCBS of TX PPO	$16,876.81

TRAUMATIC INJURY W/O MCC

Facility

$16,892.90

Service Code	MSDRG 914
Min. Negotiated Rate	$7,205.08
Max. Negotiated Rate	$16,892.90
Rate for Payer: BCBS of TX Blue Advantage	$7,205.08
Rate for Payer: BCBS of TX Blue Essentials	$8,645.26
Rate for Payer: BCBS of TX PPO	$9,606.21

TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC

Facility

$24,694.30

Service Code	MSDRG 086
Min. Negotiated Rate	$10,690.66
Max. Negotiated Rate	$24,694.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14,307.61
Rate for Payer: Amerigroup Medicare	$14,307.61
Rate for Payer: BCBS of TX Medicare	$14,307.61
Rate for Payer: Cigna Commercial	$16,778.78
Rate for Payer: Cigna Medicare	$14,307.61
Rate for Payer: Employer Direct Commercial	$14,307.61
Rate for Payer: Humana Medicare/TRICARE	$14,307.61
Rate for Payer: Molina Dual Medicare/Medicaid	$14,307.61
Rate for Payer: Molina Medicare	$14,307.61
Rate for Payer: Multiplan Auto	$24,694.30
Rate for Payer: Multiplan Commercial	$24,694.30
Rate for Payer: Multiplan Workers Comp	$24,694.30
Rate for Payer: Scott and White EPO/PPO	$11,372.38
Rate for Payer: Scott and White Medicare	$14,307.61
Rate for Payer: Superior Health Plan EPO	$14,307.61
Rate for Payer: Superior Health Plan Medicare	$14,307.61
Rate for Payer: Universal American Dual Medicare/Medicaid	$14,307.61
Rate for Payer: Universal American Medicare	$14,307.61
Rate for Payer: Wellcare Medicare	$14,307.61
Rate for Payer: Wellmed Medicare	$14,307.61

TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC

Facility

$25,615.80

Service Code	MSDRG 083
Min. Negotiated Rate	$11,137.00
Max. Negotiated Rate	$25,615.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14,989.94
Rate for Payer: Amerigroup Medicare	$14,989.94
Rate for Payer: BCBS of TX Medicare	$14,989.94
Rate for Payer: Cigna Commercial	$17,977.90
Rate for Payer: Cigna Medicare	$14,989.94
Rate for Payer: Employer Direct Commercial	$14,989.94
Rate for Payer: Humana Medicare/TRICARE	$14,989.94
Rate for Payer: Molina Dual Medicare/Medicaid	$14,989.94
Rate for Payer: Molina Medicare	$14,989.94
Rate for Payer: Multiplan Auto	$25,615.80
Rate for Payer: Multiplan Commercial	$25,615.80
Rate for Payer: Multiplan Workers Comp	$25,615.80
Rate for Payer: Scott and White EPO/PPO	$11,796.75
Rate for Payer: Scott and White Medicare	$14,989.94
Rate for Payer: Superior Health Plan EPO	$14,989.94
Rate for Payer: Superior Health Plan Medicare	$14,989.94
Rate for Payer: Universal American Dual Medicare/Medicaid	$14,989.94
Rate for Payer: Universal American Medicare	$14,989.94
Rate for Payer: Wellcare Medicare	$14,989.94
Rate for Payer: Wellmed Medicare	$14,989.94

Know your out-of-pocket cost for care.

All Charges