White Rock Medical Center

All Charges

Charge

Type

Setting

Price

WRNR SLP Auditory Processing Tx Individual BCE

Facility

$326.00

Service Code	HCPCS 92507
Hospital Charge Code	9310574
Hospital Revenue Code	440
Min. Negotiated Rate	$29.34
Max. Negotiated Rate	$234.72
Rate for Payer: Amerigroup CHIP/Medicaid	$29.34
Rate for Payer: BCBS of TX Blue Advantage	$97.80
Rate for Payer: BCBS of TX Blue Essentials	$117.36
Rate for Payer: BCBS of TX PPO	$130.40
Rate for Payer: Cash Price	$221.68
Rate for Payer: Cash Price	$221.68
Rate for Payer: Cash Price	$221.68
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$234.72
Rate for Payer: Molina CHIP/Medicaid	$234.72
Rate for Payer: Multiplan Auto	$211.90
Rate for Payer: Multiplan Commercial	$211.90
Rate for Payer: Multiplan Workers Comp	$211.90
Rate for Payer: Parkland Medicaid	$234.72
Rate for Payer: Scott and White EPO/PPO	$94.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$234.72
Rate for Payer: Superior Health Plan EPO	$44.34

WRNR SLP Behavioral, Qualitative Analysis Units BCE

Facility

$521.00

Service Code	HCPCS 92524
Hospital Charge Code	9310567
Hospital Revenue Code	440
Min. Negotiated Rate	$46.89
Max. Negotiated Rate	$375.12
Rate for Payer: Amerigroup CHIP/Medicaid	$46.89
Rate for Payer: BCBS of TX Blue Advantage	$156.30
Rate for Payer: BCBS of TX Blue Essentials	$187.56
Rate for Payer: BCBS of TX PPO	$208.40
Rate for Payer: Cash Price	$354.28
Rate for Payer: Cash Price	$354.28
Rate for Payer: Cash Price	$354.28
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$375.12
Rate for Payer: Molina CHIP/Medicaid	$375.12
Rate for Payer: Multiplan Auto	$338.65
Rate for Payer: Multiplan Commercial	$338.65
Rate for Payer: Multiplan Workers Comp	$338.65
Rate for Payer: Parkland Medicaid	$375.12
Rate for Payer: Scott and White EPO/PPO	$135.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$375.12
Rate for Payer: Superior Health Plan EPO	$70.86

WRNR SLP Behavioral, Qualitative Analysis Units BCE

Facility

$521.00

Service Code	HCPCS 92524
Hospital Charge Code	9310567
Hospital Revenue Code	440
Rate for Payer: Cash Price	$354.28

WRNR SLP Cog Func Ther Inter Adtl 15m Units BCE

Facility

$227.47

Service Code	HCPCS 97130
Hospital Charge Code	9310578
Hospital Revenue Code	440
Min. Negotiated Rate	$20.47
Max. Negotiated Rate	$200.00
Rate for Payer: Amerigroup CHIP/Medicaid	$20.47
Rate for Payer: BCBS of TX Blue Advantage	$68.24
Rate for Payer: BCBS of TX Blue Essentials	$81.89
Rate for Payer: BCBS of TX PPO	$90.99
Rate for Payer: Cash Price	$154.68
Rate for Payer: Cash Price	$154.68
Rate for Payer: Cash Price	$154.68
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$163.78
Rate for Payer: Molina CHIP/Medicaid	$163.78
Rate for Payer: Multiplan Auto	$147.86
Rate for Payer: Multiplan Commercial	$147.86
Rate for Payer: Multiplan Workers Comp	$147.86
Rate for Payer: Parkland Medicaid	$163.78
Rate for Payer: Scott and White EPO/PPO	$25.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$163.78
Rate for Payer: Superior Health Plan EPO	$30.94

WRNR SLP Cog Func Ther Inter Adtl 15m Units BCE

Facility

$227.47

Service Code	HCPCS 97130
Hospital Charge Code	9310578
Hospital Revenue Code	440
Rate for Payer: Cash Price	$154.68

WRNR SLP Cog Func Ther Inter Intl 15m Units BCE

Facility

$227.47

Service Code	HCPCS 97129
Hospital Charge Code	9310577
Hospital Revenue Code	440
Rate for Payer: Cash Price	$154.68

WRNR SLP Cog Func Ther Inter Intl 15m Units BCE

Facility

$227.47

Service Code	HCPCS 97129
Hospital Charge Code	9310577
Hospital Revenue Code	440
Min. Negotiated Rate	$20.47
Max. Negotiated Rate	$200.00
Rate for Payer: Amerigroup CHIP/Medicaid	$20.47
Rate for Payer: BCBS of TX Blue Advantage	$68.24
Rate for Payer: BCBS of TX Blue Essentials	$81.89
Rate for Payer: BCBS of TX PPO	$90.99
Rate for Payer: Cash Price	$154.68
Rate for Payer: Cash Price	$154.68
Rate for Payer: Cash Price	$154.68
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$163.78
Rate for Payer: Molina CHIP/Medicaid	$163.78
Rate for Payer: Multiplan Auto	$147.86
Rate for Payer: Multiplan Commercial	$147.86
Rate for Payer: Multiplan Workers Comp	$147.86
Rate for Payer: Parkland Medicaid	$163.78
Rate for Payer: Scott and White EPO/PPO	$27.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$163.78
Rate for Payer: Superior Health Plan EPO	$30.94

WRNR SLP EVAL for use or fitting of voice prosth device BCE

Facility

$601.14

Service Code	HCPCS 92597
Hospital Charge Code	9310572
Hospital Revenue Code	440
Min. Negotiated Rate	$54.10
Max. Negotiated Rate	$432.82
Rate for Payer: Amerigroup CHIP/Medicaid	$54.10
Rate for Payer: BCBS of TX Blue Advantage	$180.34
Rate for Payer: BCBS of TX Blue Essentials	$216.41
Rate for Payer: BCBS of TX PPO	$240.46
Rate for Payer: Cash Price	$408.78
Rate for Payer: Cash Price	$408.78
Rate for Payer: Cash Price	$408.78
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$432.82
Rate for Payer: Molina CHIP/Medicaid	$432.82
Rate for Payer: Multiplan Auto	$390.74
Rate for Payer: Multiplan Commercial	$390.74
Rate for Payer: Multiplan Workers Comp	$390.74
Rate for Payer: Parkland Medicaid	$432.82
Rate for Payer: Scott and White EPO/PPO	$89.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$432.82
Rate for Payer: Superior Health Plan EPO	$81.76

WRNR SLP EVAL for use or fitting of voice prosth device BCE

Facility

$601.14

Service Code	HCPCS 92597
Hospital Charge Code	9310572
Hospital Revenue Code	440
Rate for Payer: Cash Price	$408.78

WRNR SLP Eval Lang Comprehension, Express Unit BCE

Facility

$396.00

Service Code	HCPCS 92523
Hospital Charge Code	9310566
Hospital Revenue Code	440
Min. Negotiated Rate	$35.64
Max. Negotiated Rate	$285.12
Rate for Payer: Amerigroup CHIP/Medicaid	$35.64
Rate for Payer: BCBS of TX Blue Advantage	$118.80
Rate for Payer: BCBS of TX Blue Essentials	$142.56
Rate for Payer: BCBS of TX PPO	$158.40
Rate for Payer: Cash Price	$269.28
Rate for Payer: Cash Price	$269.28
Rate for Payer: Cash Price	$269.28
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$285.12
Rate for Payer: Molina CHIP/Medicaid	$285.12
Rate for Payer: Multiplan Auto	$257.40
Rate for Payer: Multiplan Commercial	$257.40
Rate for Payer: Multiplan Workers Comp	$257.40
Rate for Payer: Parkland Medicaid	$285.12
Rate for Payer: Scott and White EPO/PPO	$282.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$285.12
Rate for Payer: Superior Health Plan EPO	$53.86

WRNR SLP Eval Lang Comprehension, Express Unit BCE

Facility

$396.00

Service Code	HCPCS 92523
Hospital Charge Code	9310566
Hospital Revenue Code	440
Rate for Payer: Cash Price	$269.28

WRNR SLP Eval of Speech Sound Prod Units BCE

Facility

$364.00

Service Code	HCPCS 92522
Hospital Charge Code	9280544
Hospital Revenue Code	444
Rate for Payer: Cash Price	$247.52

WRNR SLP Eval of Speech Sound Prod Units BCE

Facility

$364.00

Service Code	HCPCS 92522
Hospital Charge Code	9280544
Hospital Revenue Code	444
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$262.08
Rate for Payer: Amerigroup CHIP/Medicaid	$80.00
Rate for Payer: BCBS of TX Blue Advantage	$109.20
Rate for Payer: BCBS of TX Blue Essentials	$131.04
Rate for Payer: BCBS of TX PPO	$145.60
Rate for Payer: Cash Price	$247.52
Rate for Payer: Cash Price	$247.52
Rate for Payer: Cash Price	$247.52
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$262.08
Rate for Payer: Molina CHIP/Medicaid	$262.08
Rate for Payer: Multiplan Auto	$236.60
Rate for Payer: Multiplan Commercial	$236.60
Rate for Payer: Multiplan Workers Comp	$236.60
Rate for Payer: Parkland Medicaid	$262.08
Rate for Payer: Scott and White EPO/PPO	$137.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$262.08
Rate for Payer: Superior Health Plan EPO	$49.50

WRNR SLP Evaluation of Speech Fluency Units BCE

Facility

$462.00

Service Code	HCPCS 92521
Hospital Charge Code	9280543
Hospital Revenue Code	444
Min. Negotiated Rate	$62.83
Max. Negotiated Rate	$332.64
Rate for Payer: Amerigroup CHIP/Medicaid	$80.00
Rate for Payer: BCBS of TX Blue Advantage	$138.60
Rate for Payer: BCBS of TX Blue Essentials	$166.32
Rate for Payer: BCBS of TX PPO	$184.80
Rate for Payer: Cash Price	$314.16
Rate for Payer: Cash Price	$314.16
Rate for Payer: Cash Price	$314.16
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$332.64
Rate for Payer: Molina CHIP/Medicaid	$332.64
Rate for Payer: Multiplan Auto	$300.30
Rate for Payer: Multiplan Commercial	$300.30
Rate for Payer: Multiplan Workers Comp	$300.30
Rate for Payer: Parkland Medicaid	$332.64
Rate for Payer: Scott and White EPO/PPO	$164.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$332.64
Rate for Payer: Superior Health Plan EPO	$62.83

WRNR SLP Evaluation of Speech Fluency Units BCE

Facility

$462.00

Service Code	HCPCS 92521
Hospital Charge Code	9280543
Hospital Revenue Code	444
Rate for Payer: Cash Price	$314.16

WRNR SLP Fluoroscopic Evaluation Units BCE

Facility

$506.00

Service Code	HCPCS 92611
Hospital Charge Code	9310571
Hospital Revenue Code	440
Min. Negotiated Rate	$45.54
Max. Negotiated Rate	$364.32
Rate for Payer: Amerigroup CHIP/Medicaid	$45.54
Rate for Payer: BCBS of TX Blue Advantage	$151.80
Rate for Payer: BCBS of TX Blue Essentials	$182.16
Rate for Payer: BCBS of TX PPO	$202.40
Rate for Payer: Cash Price	$344.08
Rate for Payer: Cash Price	$344.08
Rate for Payer: Cash Price	$344.08
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$364.32
Rate for Payer: Molina CHIP/Medicaid	$364.32
Rate for Payer: Multiplan Auto	$328.90
Rate for Payer: Multiplan Commercial	$328.90
Rate for Payer: Multiplan Workers Comp	$328.90
Rate for Payer: Parkland Medicaid	$364.32
Rate for Payer: Scott and White EPO/PPO	$113.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$364.32
Rate for Payer: Superior Health Plan EPO	$68.82

WRNR SLP Fluoroscopic Evaluation Units BCE

Facility

$506.00

Service Code	HCPCS 92611
Hospital Charge Code	9310571
Hospital Revenue Code	440
Rate for Payer: Cash Price	$344.08

WRNR SLP Non-Speech AAC Device Eval Units BCE

Facility

$403.57

Service Code	HCPCS 92605
Hospital Charge Code	9310568
Hospital Revenue Code	440
Rate for Payer: Cash Price	$274.43

WRNR SLP Non-Speech AAC Device Eval Units BCE

Facility

$403.57

Service Code	HCPCS 92605
Hospital Charge Code	9310568
Hospital Revenue Code	440
Min. Negotiated Rate	$36.32
Max. Negotiated Rate	$290.57
Rate for Payer: Amerigroup CHIP/Medicaid	$36.32
Rate for Payer: BCBS of TX Blue Advantage	$121.07
Rate for Payer: BCBS of TX Blue Essentials	$145.29
Rate for Payer: BCBS of TX PPO	$161.43
Rate for Payer: Cash Price	$274.43
Rate for Payer: Cash Price	$274.43
Rate for Payer: Cash Price	$274.43
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$290.57
Rate for Payer: Molina CHIP/Medicaid	$290.57
Rate for Payer: Multiplan Auto	$262.32
Rate for Payer: Multiplan Commercial	$262.32
Rate for Payer: Multiplan Workers Comp	$262.32
Rate for Payer: Parkland Medicaid	$290.57
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$290.57
Rate for Payer: Superior Health Plan EPO	$54.89

WRNR SLP NON-SPEECH DEVICE SERVICE (AAC) BCE

Facility

$351.00

Service Code	HCPCS 92606
Hospital Charge Code	9310573
Hospital Revenue Code	440
Rate for Payer: Cash Price	$238.68

WRNR SLP NON-SPEECH DEVICE SERVICE (AAC) BCE

Facility

$351.00

Service Code	HCPCS 92606
Hospital Charge Code	9310573
Hospital Revenue Code	440
Min. Negotiated Rate	$31.59
Max. Negotiated Rate	$252.72
Rate for Payer: Amerigroup CHIP/Medicaid	$31.59
Rate for Payer: BCBS of TX Blue Advantage	$105.30
Rate for Payer: BCBS of TX Blue Essentials	$126.36
Rate for Payer: BCBS of TX PPO	$140.40
Rate for Payer: Cash Price	$238.68
Rate for Payer: Cash Price	$238.68
Rate for Payer: Cash Price	$238.68
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$252.72
Rate for Payer: Molina CHIP/Medicaid	$252.72
Rate for Payer: Multiplan Auto	$228.15
Rate for Payer: Multiplan Commercial	$228.15
Rate for Payer: Multiplan Workers Comp	$228.15
Rate for Payer: Parkland Medicaid	$252.72
Rate for Payer: Scott and White EPO/PPO	$180.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$252.72
Rate for Payer: Superior Health Plan EPO	$47.74

WRNR SLP Pharyngeal Swallow Eval Units BCE

Facility

$448.00

Service Code	HCPCS 92610
Hospital Charge Code	9310570
Hospital Revenue Code	440
Rate for Payer: Cash Price	$304.64

WRNR SLP Pharyngeal Swallow Eval Units BCE

Facility

$448.00

Service Code	HCPCS 92610
Hospital Charge Code	9280549
Hospital Revenue Code	440
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$322.56
Rate for Payer: Amerigroup CHIP/Medicaid	$40.32
Rate for Payer: BCBS of TX Blue Advantage	$134.40
Rate for Payer: BCBS of TX Blue Essentials	$161.28
Rate for Payer: BCBS of TX PPO	$179.20
Rate for Payer: Cash Price	$304.64
Rate for Payer: Cash Price	$304.64
Rate for Payer: Cash Price	$304.64
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$322.56
Rate for Payer: Molina CHIP/Medicaid	$322.56
Rate for Payer: Multiplan Auto	$291.20
Rate for Payer: Multiplan Commercial	$291.20
Rate for Payer: Multiplan Workers Comp	$291.20
Rate for Payer: Parkland Medicaid	$322.56
Rate for Payer: Scott and White EPO/PPO	$86.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$322.56
Rate for Payer: Superior Health Plan EPO	$60.93

WRNR SLP Pharyngeal Swallow Eval Units BCE

Facility

$448.00

Service Code	HCPCS 92610
Hospital Charge Code	9310570
Hospital Revenue Code	440
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$322.56
Rate for Payer: Amerigroup CHIP/Medicaid	$40.32
Rate for Payer: BCBS of TX Blue Advantage	$134.40
Rate for Payer: BCBS of TX Blue Essentials	$161.28
Rate for Payer: BCBS of TX PPO	$179.20
Rate for Payer: Cash Price	$304.64
Rate for Payer: Cash Price	$304.64
Rate for Payer: Cash Price	$304.64
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$322.56
Rate for Payer: Molina CHIP/Medicaid	$322.56
Rate for Payer: Multiplan Auto	$291.20
Rate for Payer: Multiplan Commercial	$291.20
Rate for Payer: Multiplan Workers Comp	$291.20
Rate for Payer: Parkland Medicaid	$322.56
Rate for Payer: Scott and White EPO/PPO	$86.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$322.56
Rate for Payer: Superior Health Plan EPO	$60.93

WRNR SLP Pharyngeal Swallow Eval Units BCE

Facility

$448.00

Service Code	HCPCS 92610
Hospital Charge Code	9280549
Hospital Revenue Code	440
Rate for Payer: Cash Price	$304.64

Know your out-of-pocket cost for care.

All Charges