White Rock Medical Center

All Charges

Charge

Type

Setting

Price

WRNR OT Neuromuscular Reeducation BCE

Facility

$186.67

Service Code	HCPCS 97112
Hospital Charge Code	9310552
Hospital Revenue Code	430
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$200.00
Rate for Payer: Amerigroup CHIP/Medicaid	$16.80
Rate for Payer: BCBS of TX Blue Advantage	$56.00
Rate for Payer: BCBS of TX Blue Essentials	$67.20
Rate for Payer: BCBS of TX PPO	$74.67
Rate for Payer: Cash Price	$126.94
Rate for Payer: Cash Price	$126.94
Rate for Payer: Cash Price	$126.94
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$134.40
Rate for Payer: Molina CHIP/Medicaid	$134.40
Rate for Payer: Multiplan Auto	$121.34
Rate for Payer: Multiplan Commercial	$121.34
Rate for Payer: Multiplan Workers Comp	$121.34
Rate for Payer: Parkland Medicaid	$134.40
Rate for Payer: Scott and White EPO/PPO	$41.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$134.40
Rate for Payer: Superior Health Plan EPO	$25.39

WRNR OT Neuromuscular Reeducation BCE

Facility

$186.67

Service Code	HCPCS 97112
Hospital Charge Code	9310552
Hospital Revenue Code	430
Rate for Payer: Cash Price	$126.94

WRNR OT Orthotic Management and Training BCE

Facility

$175.00

Service Code	HCPCS 97760
Hospital Charge Code	9310561
Hospital Revenue Code	430
Rate for Payer: Cash Price	$119.00

WRNR OT Orthotic Management and Training BCE

Facility

$175.00

Service Code	HCPCS 97760
Hospital Charge Code	9310561
Hospital Revenue Code	430
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$200.00
Rate for Payer: Amerigroup CHIP/Medicaid	$15.75
Rate for Payer: BCBS of TX Blue Advantage	$52.50
Rate for Payer: BCBS of TX Blue Essentials	$63.00
Rate for Payer: BCBS of TX PPO	$70.00
Rate for Payer: Cash Price	$119.00
Rate for Payer: Cash Price	$119.00
Rate for Payer: Cash Price	$119.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$126.00
Rate for Payer: Molina CHIP/Medicaid	$126.00
Rate for Payer: Multiplan Auto	$113.75
Rate for Payer: Multiplan Commercial	$113.75
Rate for Payer: Multiplan Workers Comp	$113.75
Rate for Payer: Parkland Medicaid	$126.00
Rate for Payer: Scott and White EPO/PPO	$58.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$126.00
Rate for Payer: Superior Health Plan EPO	$23.80

WRNR OT ORTH/PROSTH MGMT SBSQ ENCTR 15 MIN BCE

Facility

$202.00

Service Code	HCPCS 97763
Hospital Charge Code	9310560
Hospital Revenue Code	430
Min. Negotiated Rate	$18.18
Max. Negotiated Rate	$200.00
Rate for Payer: Amerigroup CHIP/Medicaid	$18.18
Rate for Payer: BCBS of TX Blue Advantage	$60.60
Rate for Payer: BCBS of TX Blue Essentials	$72.72
Rate for Payer: BCBS of TX PPO	$80.80
Rate for Payer: Cash Price	$137.36
Rate for Payer: Cash Price	$137.36
Rate for Payer: Cash Price	$137.36
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$145.44
Rate for Payer: Molina CHIP/Medicaid	$145.44
Rate for Payer: Multiplan Auto	$131.30
Rate for Payer: Multiplan Commercial	$131.30
Rate for Payer: Multiplan Workers Comp	$131.30
Rate for Payer: Parkland Medicaid	$145.44
Rate for Payer: Scott and White EPO/PPO	$64.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$145.44
Rate for Payer: Superior Health Plan EPO	$27.47

WRNR OT ORTH/PROSTH MGMT SBSQ ENCTR 15 MIN BCE

Facility

$202.00

Service Code	HCPCS 97763
Hospital Charge Code	9310560
Hospital Revenue Code	430
Rate for Payer: Cash Price	$137.36

WRNR OT PROSTHETICS TRAINING INIT EA 15 MIN BCE

Facility

$163.50

Service Code	HCPCS 97761
Hospital Charge Code	8997098
Hospital Revenue Code	430
Rate for Payer: Cash Price	$111.18

WRNR OT PROSTHETICS TRAINING INIT EA 15 MIN BCE

Facility

$163.50

Service Code	HCPCS 97761
Hospital Charge Code	8997098
Hospital Revenue Code	430
Min. Negotiated Rate	$14.71
Max. Negotiated Rate	$200.00
Rate for Payer: Amerigroup CHIP/Medicaid	$14.71
Rate for Payer: BCBS of TX Blue Advantage	$49.05
Rate for Payer: BCBS of TX Blue Essentials	$58.86
Rate for Payer: BCBS of TX PPO	$65.40
Rate for Payer: Cash Price	$111.18
Rate for Payer: Cash Price	$111.18
Rate for Payer: Cash Price	$111.18
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$117.72
Rate for Payer: Molina CHIP/Medicaid	$117.72
Rate for Payer: Multiplan Auto	$106.28
Rate for Payer: Multiplan Commercial	$106.28
Rate for Payer: Multiplan Workers Comp	$106.28
Rate for Payer: Parkland Medicaid	$117.72
Rate for Payer: Scott and White EPO/PPO	$51.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$117.72
Rate for Payer: Superior Health Plan EPO	$22.24

WRNR OT PROSTHETICS TRAINING INIT EA 15 MIN BCE

Facility

$163.50

Service Code	HCPCS 97761
Hospital Charge Code	9308550
Hospital Revenue Code	430
Min. Negotiated Rate	$14.71
Max. Negotiated Rate	$200.00
Rate for Payer: Amerigroup CHIP/Medicaid	$14.71
Rate for Payer: BCBS of TX Blue Advantage	$49.05
Rate for Payer: BCBS of TX Blue Essentials	$58.86
Rate for Payer: BCBS of TX PPO	$65.40
Rate for Payer: Cash Price	$111.18
Rate for Payer: Cash Price	$111.18
Rate for Payer: Cash Price	$111.18
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$117.72
Rate for Payer: Molina CHIP/Medicaid	$117.72
Rate for Payer: Multiplan Auto	$106.28
Rate for Payer: Multiplan Commercial	$106.28
Rate for Payer: Multiplan Workers Comp	$106.28
Rate for Payer: Parkland Medicaid	$117.72
Rate for Payer: Scott and White EPO/PPO	$51.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$117.72
Rate for Payer: Superior Health Plan EPO	$22.24

WRNR OT PROSTHETICS TRAINING INIT EA 15 MIN BCE

Facility

$163.50

Service Code	HCPCS 97761
Hospital Charge Code	9308550
Hospital Revenue Code	430
Rate for Payer: Cash Price	$111.18

WRNR OT RE-EVAL BCE

Facility

$181.00

Service Code	HCPCS 97168
Hospital Charge Code	9310550
Hospital Revenue Code	434
Rate for Payer: Cash Price	$123.08

WRNR OT RE-EVAL BCE

Facility

$181.00

Service Code	HCPCS 97168
Hospital Charge Code	9310550
Hospital Revenue Code	434
Min. Negotiated Rate	$24.62
Max. Negotiated Rate	$200.00
Rate for Payer: Amerigroup CHIP/Medicaid	$80.00
Rate for Payer: BCBS of TX Blue Advantage	$54.30
Rate for Payer: BCBS of TX Blue Essentials	$65.16
Rate for Payer: BCBS of TX PPO	$72.40
Rate for Payer: Cash Price	$123.08
Rate for Payer: Cash Price	$123.08
Rate for Payer: Cash Price	$123.08
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$130.32
Rate for Payer: Molina CHIP/Medicaid	$130.32
Rate for Payer: Multiplan Auto	$117.65
Rate for Payer: Multiplan Commercial	$117.65
Rate for Payer: Multiplan Workers Comp	$117.65
Rate for Payer: Parkland Medicaid	$130.32
Rate for Payer: Scott and White EPO/PPO	$86.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$130.32
Rate for Payer: Superior Health Plan EPO	$24.62

WRNR OT SELF-CARE/HOME MGMT TRAINING EA 15 MIN BCE

Facility

$185.25

Service Code	HCPCS 97535
Hospital Charge Code	9310556
Hospital Revenue Code	430
Rate for Payer: Cash Price	$125.97

WRNR OT SELF-CARE/HOME MGMT TRAINING EA 15 MIN BCE

Facility

$185.25

Service Code	HCPCS 97535
Hospital Charge Code	9310556
Hospital Revenue Code	430
Min. Negotiated Rate	$16.67
Max. Negotiated Rate	$200.00
Rate for Payer: Amerigroup CHIP/Medicaid	$16.67
Rate for Payer: BCBS of TX Blue Advantage	$55.58
Rate for Payer: BCBS of TX Blue Essentials	$66.69
Rate for Payer: BCBS of TX PPO	$74.10
Rate for Payer: Cash Price	$125.97
Rate for Payer: Cash Price	$125.97
Rate for Payer: Cash Price	$125.97
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$133.38
Rate for Payer: Molina CHIP/Medicaid	$133.38
Rate for Payer: Multiplan Auto	$120.41
Rate for Payer: Multiplan Commercial	$120.41
Rate for Payer: Multiplan Workers Comp	$120.41
Rate for Payer: Parkland Medicaid	$133.38
Rate for Payer: Scott and White EPO/PPO	$40.41
Rate for Payer: Superior Health Plan CHIP/Medicaid	$133.38
Rate for Payer: Superior Health Plan EPO	$25.19

WRNR OT SENSORY INTEGRATIVE TECH EA 15 MIN BCE

Facility

$185.25

Service Code	HCPCS 97533
Hospital Charge Code	9310562
Hospital Revenue Code	430
Rate for Payer: Cash Price	$125.97

WRNR OT SENSORY INTEGRATIVE TECH EA 15 MIN BCE

Facility

$185.25

Service Code	HCPCS 97533
Hospital Charge Code	9310562
Hospital Revenue Code	430
Min. Negotiated Rate	$16.67
Max. Negotiated Rate	$200.00
Rate for Payer: Amerigroup CHIP/Medicaid	$16.67
Rate for Payer: BCBS of TX Blue Advantage	$55.58
Rate for Payer: BCBS of TX Blue Essentials	$66.69
Rate for Payer: BCBS of TX PPO	$74.10
Rate for Payer: Cash Price	$125.97
Rate for Payer: Cash Price	$125.97
Rate for Payer: Cash Price	$125.97
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$133.38
Rate for Payer: Molina CHIP/Medicaid	$133.38
Rate for Payer: Multiplan Auto	$120.41
Rate for Payer: Multiplan Commercial	$120.41
Rate for Payer: Multiplan Workers Comp	$120.41
Rate for Payer: Parkland Medicaid	$133.38
Rate for Payer: Scott and White EPO/PPO	$77.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$133.38
Rate for Payer: Superior Health Plan EPO	$25.19

WRNR OT THERAPEUT ACTVITY DIRECT PT CNTCT EA 15 MIN BCE

Facility

$188.41

Service Code	HCPCS 97530
Hospital Charge Code	9310555
Hospital Revenue Code	430
Min. Negotiated Rate	$16.96
Max. Negotiated Rate	$200.00
Rate for Payer: Amerigroup CHIP/Medicaid	$16.96
Rate for Payer: BCBS of TX Blue Advantage	$56.52
Rate for Payer: BCBS of TX Blue Essentials	$67.83
Rate for Payer: BCBS of TX PPO	$75.36
Rate for Payer: Cash Price	$128.12
Rate for Payer: Cash Price	$128.12
Rate for Payer: Cash Price	$128.12
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$135.66
Rate for Payer: Molina CHIP/Medicaid	$135.66
Rate for Payer: Multiplan Auto	$122.47
Rate for Payer: Multiplan Commercial	$122.47
Rate for Payer: Multiplan Workers Comp	$122.47
Rate for Payer: Parkland Medicaid	$135.66
Rate for Payer: Scott and White EPO/PPO	$45.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$135.66
Rate for Payer: Superior Health Plan EPO	$25.62

WRNR OT THERAPEUT ACTVITY DIRECT PT CNTCT EA 15 MIN BCE

Facility

$188.41

Service Code	HCPCS 97530
Hospital Charge Code	9310555
Hospital Revenue Code	430
Rate for Payer: Cash Price	$128.12

WRNR OT Therapeutic Exercise Units BCE

Facility

$152.00

Service Code	HCPCS 97110
Hospital Charge Code	9310551
Hospital Revenue Code	430
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$200.00
Rate for Payer: Amerigroup CHIP/Medicaid	$13.68
Rate for Payer: BCBS of TX Blue Advantage	$45.60
Rate for Payer: BCBS of TX Blue Essentials	$54.72
Rate for Payer: BCBS of TX PPO	$60.80
Rate for Payer: Cash Price	$103.36
Rate for Payer: Cash Price	$103.36
Rate for Payer: Cash Price	$103.36
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$109.44
Rate for Payer: Molina CHIP/Medicaid	$109.44
Rate for Payer: Multiplan Auto	$98.80
Rate for Payer: Multiplan Commercial	$98.80
Rate for Payer: Multiplan Workers Comp	$98.80
Rate for Payer: Parkland Medicaid	$109.44
Rate for Payer: Scott and White EPO/PPO	$36.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$109.44
Rate for Payer: Superior Health Plan EPO	$20.67

WRNR OT Therapeutic Exercise Units BCE

Facility

$152.00

Service Code	HCPCS 97110
Hospital Charge Code	9310551
Hospital Revenue Code	430
Rate for Payer: Cash Price	$103.36

WRNR OT THERAPEUTIC PROC GROUP 2/> INDIVIDUALS BCE

Facility

$191.00

Service Code	HCPCS 97150
Hospital Charge Code	9310554
Hospital Revenue Code	430
Rate for Payer: Cash Price	$129.88

WRNR OT THERAPEUTIC PROC GROUP 2/> INDIVIDUALS BCE

Facility

$191.00

Service Code	HCPCS 97150
Hospital Charge Code	9310554
Hospital Revenue Code	430
Min. Negotiated Rate	$17.19
Max. Negotiated Rate	$200.00
Rate for Payer: Amerigroup CHIP/Medicaid	$17.19
Rate for Payer: BCBS of TX Blue Advantage	$57.30
Rate for Payer: BCBS of TX Blue Essentials	$68.76
Rate for Payer: BCBS of TX PPO	$76.40
Rate for Payer: Cash Price	$129.88
Rate for Payer: Cash Price	$129.88
Rate for Payer: Cash Price	$129.88
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$137.52
Rate for Payer: Molina CHIP/Medicaid	$137.52
Rate for Payer: Multiplan Auto	$124.15
Rate for Payer: Multiplan Commercial	$124.15
Rate for Payer: Multiplan Workers Comp	$124.15
Rate for Payer: Parkland Medicaid	$137.52
Rate for Payer: Scott and White EPO/PPO	$22.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$137.52
Rate for Payer: Superior Health Plan EPO	$25.98

WRNR OT Ultrasound Units BCE

Facility

$110.00

Service Code	HCPCS 97035
Hospital Charge Code	9038973
Hospital Revenue Code	430
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$200.00
Rate for Payer: Amerigroup CHIP/Medicaid	$9.90
Rate for Payer: BCBS of TX Blue Advantage	$33.00
Rate for Payer: BCBS of TX Blue Essentials	$39.60
Rate for Payer: BCBS of TX PPO	$44.00
Rate for Payer: Cash Price	$74.80
Rate for Payer: Cash Price	$74.80
Rate for Payer: Cash Price	$74.80
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$79.20
Rate for Payer: Molina CHIP/Medicaid	$79.20
Rate for Payer: Multiplan Auto	$71.50
Rate for Payer: Multiplan Commercial	$71.50
Rate for Payer: Multiplan Workers Comp	$71.50
Rate for Payer: Parkland Medicaid	$79.20
Rate for Payer: Scott and White EPO/PPO	$17.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$79.20
Rate for Payer: Superior Health Plan EPO	$14.96

WRNR OT Ultrasound Units BCE

Facility

$110.00

Service Code	HCPCS 97035
Hospital Charge Code	9038973
Hospital Revenue Code	430
Rate for Payer: Cash Price	$74.80

WRNR OT Unattended E-Stim BCE

Facility

$160.00

Service Code	HCPCS 97014
Hospital Charge Code	8993230
Hospital Revenue Code	430
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$200.00
Rate for Payer: Amerigroup CHIP/Medicaid	$14.40
Rate for Payer: BCBS of TX Blue Advantage	$48.00
Rate for Payer: BCBS of TX Blue Essentials	$57.60
Rate for Payer: BCBS of TX PPO	$64.00
Rate for Payer: Cash Price	$108.80
Rate for Payer: Cash Price	$108.80
Rate for Payer: Cash Price	$108.80
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$115.20
Rate for Payer: Molina CHIP/Medicaid	$115.20
Rate for Payer: Multiplan Auto	$104.00
Rate for Payer: Multiplan Commercial	$104.00
Rate for Payer: Multiplan Workers Comp	$104.00
Rate for Payer: Parkland Medicaid	$115.20
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$115.20
Rate for Payer: Superior Health Plan EPO	$21.76

Know your out-of-pocket cost for care.

All Charges