White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CHWR BASIC GRAVITY ADM SET

Facility

$118.74

Hospital Charge Code	5420020
Hospital Revenue Code	270
Min. Negotiated Rate	$10.69
Max. Negotiated Rate	$77.18
Rate for Payer: Aetna Commercial	$65.31
Rate for Payer: Amerigroup CHIP/Medicaid	$10.69
Rate for Payer: BCBS of TX Blue Advantage	$35.62
Rate for Payer: BCBS of TX Blue Essentials	$42.75
Rate for Payer: BCBS of TX PPO	$47.50
Rate for Payer: Cash Price	$104.49
Rate for Payer: Multiplan Auto	$77.18
Rate for Payer: Multiplan Commercial	$77.18
Rate for Payer: Multiplan Workers Comp	$77.18
Rate for Payer: Scott and White EPO/PPO	$59.37
Rate for Payer: Superior Health Plan EPO	$16.15

CHWR BD NEXIVA IV CATH 22g

Facility

$57.27

Hospital Charge Code	5420150
Hospital Revenue Code	270
Min. Negotiated Rate	$5.15
Max. Negotiated Rate	$37.23
Rate for Payer: Aetna Commercial	$31.50
Rate for Payer: Amerigroup CHIP/Medicaid	$5.15
Rate for Payer: BCBS of TX Blue Advantage	$17.18
Rate for Payer: BCBS of TX Blue Essentials	$20.62
Rate for Payer: BCBS of TX PPO	$22.91
Rate for Payer: Cash Price	$50.40
Rate for Payer: Multiplan Auto	$37.23
Rate for Payer: Multiplan Commercial	$37.23
Rate for Payer: Multiplan Workers Comp	$37.23
Rate for Payer: Scott and White EPO/PPO	$28.64
Rate for Payer: Superior Health Plan EPO	$7.79

CHWR BD NEXIVA IV CATH 22g BCE

Facility

$57.27

Hospital Charge Code	5420150
Hospital Revenue Code	270
Rate for Payer: Cash Price	$50.40

CHWR BD NEXIVA IV CATH 22g BCE

Facility

$57.27

Hospital Charge Code	5420150
Hospital Revenue Code	270
Min. Negotiated Rate	$5.15
Max. Negotiated Rate	$37.23
Rate for Payer: Aetna Commercial	$31.50
Rate for Payer: Amerigroup CHIP/Medicaid	$5.15
Rate for Payer: BCBS of TX Blue Advantage	$17.18
Rate for Payer: BCBS of TX Blue Essentials	$20.62
Rate for Payer: BCBS of TX PPO	$22.91
Rate for Payer: Cash Price	$50.40
Rate for Payer: Multiplan Auto	$37.23
Rate for Payer: Multiplan Commercial	$37.23
Rate for Payer: Multiplan Workers Comp	$37.23
Rate for Payer: Scott and White EPO/PPO	$28.64
Rate for Payer: Superior Health Plan EPO	$7.79

CHWR BIOPSY CORE CONTAINER

Facility

$107.83

Hospital Charge Code	8031834
Hospital Revenue Code	272
Rate for Payer: Cash Price	$94.89

CHWR BIOPSY CORE CONTAINER

Facility

$107.83

Hospital Charge Code	8031834
Hospital Revenue Code	272
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$70.09
Rate for Payer: Aetna Commercial	$59.31
Rate for Payer: Amerigroup CHIP/Medicaid	$9.70
Rate for Payer: BCBS of TX Blue Advantage	$32.35
Rate for Payer: BCBS of TX Blue Essentials	$38.82
Rate for Payer: BCBS of TX PPO	$43.13
Rate for Payer: Cash Price	$94.89
Rate for Payer: Multiplan Auto	$70.09
Rate for Payer: Multiplan Commercial	$70.09
Rate for Payer: Multiplan Workers Comp	$70.09
Rate for Payer: Scott and White EPO/PPO	$53.92
Rate for Payer: Superior Health Plan EPO	$14.66

CHWR BIOPSY NEEDLE

Facility

$249.70

Hospital Charge Code	8081229
Hospital Revenue Code	272
Min. Negotiated Rate	$22.47
Max. Negotiated Rate	$162.30
Rate for Payer: Aetna Commercial	$137.34
Rate for Payer: Amerigroup CHIP/Medicaid	$22.47
Rate for Payer: BCBS of TX Blue Advantage	$74.91
Rate for Payer: BCBS of TX Blue Essentials	$89.89
Rate for Payer: BCBS of TX PPO	$99.88
Rate for Payer: Cash Price	$219.74
Rate for Payer: Multiplan Auto	$162.30
Rate for Payer: Multiplan Commercial	$162.30
Rate for Payer: Multiplan Workers Comp	$162.30
Rate for Payer: Scott and White EPO/PPO	$124.85
Rate for Payer: Superior Health Plan EPO	$33.96

CHWR BREAST LOC NEEDLE ALL

Facility

$67.90

Hospital Charge Code	8032780
Hospital Revenue Code	272
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$44.14
Rate for Payer: Aetna Commercial	$37.34
Rate for Payer: Amerigroup CHIP/Medicaid	$6.11
Rate for Payer: BCBS of TX Blue Advantage	$20.37
Rate for Payer: BCBS of TX Blue Essentials	$24.44
Rate for Payer: BCBS of TX PPO	$27.16
Rate for Payer: Cash Price	$59.75
Rate for Payer: Multiplan Auto	$44.14
Rate for Payer: Multiplan Commercial	$44.14
Rate for Payer: Multiplan Workers Comp	$44.14
Rate for Payer: Scott and White EPO/PPO	$33.95
Rate for Payer: Superior Health Plan EPO	$9.23

CHWR BREAST LOC NEEDLE ALL BCE

Facility

$67.90

Hospital Charge Code	8032780
Hospital Revenue Code	272
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$44.14
Rate for Payer: Aetna Commercial	$37.34
Rate for Payer: Amerigroup CHIP/Medicaid	$6.11
Rate for Payer: BCBS of TX Blue Advantage	$20.37
Rate for Payer: BCBS of TX Blue Essentials	$24.44
Rate for Payer: BCBS of TX PPO	$27.16
Rate for Payer: Cash Price	$59.75
Rate for Payer: Multiplan Auto	$44.14
Rate for Payer: Multiplan Commercial	$44.14
Rate for Payer: Multiplan Workers Comp	$44.14
Rate for Payer: Scott and White EPO/PPO	$33.95
Rate for Payer: Superior Health Plan EPO	$9.23

CHWR BS FLEXIMA APD CATH DRAINAGE - All

Facility

$590.11

Service Code	HCPCS C1729
Hospital Charge Code	8240082
Hospital Revenue Code	278
Min. Negotiated Rate	$53.11
Max. Negotiated Rate	$295.06
Rate for Payer: Aetna Commercial	$177.03
Rate for Payer: Amerigroup CHIP/Medicaid	$53.11
Rate for Payer: BCBS of TX Blue Advantage	$177.03
Rate for Payer: BCBS of TX Blue Essentials	$212.44
Rate for Payer: BCBS of TX PPO	$236.04
Rate for Payer: Cash Price	$519.30
Rate for Payer: Multiplan Auto	$295.06
Rate for Payer: Multiplan Commercial	$295.06
Rate for Payer: Multiplan Workers Comp	$295.06
Rate for Payer: Scott and White EPO/PPO	$295.06
Rate for Payer: Superior Health Plan EPO	$80.25

CHWR BS FLEXIMA APD CATH DRAINAGE - All

Facility

$590.11

Service Code	HCPCS C1729
Hospital Charge Code	8240082
Hospital Revenue Code	278
Min. Negotiated Rate	$147.53
Max. Negotiated Rate	$295.06
Rate for Payer: Aetna Commercial	$177.03
Rate for Payer: Cash Price	$519.30
Rate for Payer: Cigna Commercial	$147.53
Rate for Payer: Multiplan Auto	$295.06
Rate for Payer: Multiplan Commercial	$295.06
Rate for Payer: Multiplan Workers Comp	$295.06
Rate for Payer: Scott and White EPO/PPO	$295.06

CHWR BS FLEXIMA APD CATH DRAINAGE - All BCE

Facility

$590.11

Service Code	HCPCS C1729
Hospital Charge Code	8240082
Hospital Revenue Code	278
Min. Negotiated Rate	$53.11
Max. Negotiated Rate	$295.06
Rate for Payer: Aetna Commercial	$177.03
Rate for Payer: Amerigroup CHIP/Medicaid	$53.11
Rate for Payer: BCBS of TX Blue Advantage	$177.03
Rate for Payer: BCBS of TX Blue Essentials	$212.44
Rate for Payer: BCBS of TX PPO	$236.04
Rate for Payer: Cash Price	$519.30
Rate for Payer: Multiplan Auto	$295.06
Rate for Payer: Multiplan Commercial	$295.06
Rate for Payer: Multiplan Workers Comp	$295.06
Rate for Payer: Scott and White EPO/PPO	$295.06
Rate for Payer: Superior Health Plan EPO	$80.25

CHWR BS FLEXIMA APD CATH DRAINAGE - All BCE

Facility

$590.11

Service Code	HCPCS C1729
Hospital Charge Code	8240082
Hospital Revenue Code	278
Min. Negotiated Rate	$147.53
Max. Negotiated Rate	$295.06
Rate for Payer: Aetna Commercial	$177.03
Rate for Payer: Cash Price	$519.30
Rate for Payer: Cigna Commercial	$147.53
Rate for Payer: Multiplan Auto	$295.06
Rate for Payer: Multiplan Commercial	$295.06
Rate for Payer: Multiplan Workers Comp	$295.06
Rate for Payer: Scott and White EPO/PPO	$295.06

CHWR BX CORE GUN ALL

Facility

$1,211.05

Hospital Charge Code	8174828
Hospital Revenue Code	272
Min. Negotiated Rate	$108.99
Max. Negotiated Rate	$787.18
Rate for Payer: Aetna Commercial	$666.08
Rate for Payer: Amerigroup CHIP/Medicaid	$108.99
Rate for Payer: BCBS of TX Blue Advantage	$363.32
Rate for Payer: BCBS of TX Blue Essentials	$435.98
Rate for Payer: BCBS of TX PPO	$484.42
Rate for Payer: Cash Price	$1,065.72
Rate for Payer: Multiplan Auto	$787.18
Rate for Payer: Multiplan Commercial	$787.18
Rate for Payer: Multiplan Workers Comp	$787.18
Rate for Payer: Scott and White EPO/PPO	$605.52
Rate for Payer: Superior Health Plan EPO	$164.70

CHWR BX CORE GUN ALL BCE

Facility

$1,211.05

Hospital Charge Code	8174828
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,065.72

CHWR BX CORE GUN ALL BCE

Facility

$1,211.05

Hospital Charge Code	8174828
Hospital Revenue Code	272
Min. Negotiated Rate	$108.99
Max. Negotiated Rate	$787.18
Rate for Payer: Aetna Commercial	$666.08
Rate for Payer: Amerigroup CHIP/Medicaid	$108.99
Rate for Payer: BCBS of TX Blue Advantage	$363.32
Rate for Payer: BCBS of TX Blue Essentials	$435.98
Rate for Payer: BCBS of TX PPO	$484.42
Rate for Payer: Cash Price	$1,065.72
Rate for Payer: Multiplan Auto	$787.18
Rate for Payer: Multiplan Commercial	$787.18
Rate for Payer: Multiplan Workers Comp	$787.18
Rate for Payer: Scott and White EPO/PPO	$605.52
Rate for Payer: Superior Health Plan EPO	$164.70

CHWR BX NEEDLE KIT MAX CORE 14G X 10CM

Facility

$176.60

Hospital Charge Code	8082741
Hospital Revenue Code	272
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$114.79
Rate for Payer: Aetna Commercial	$97.13
Rate for Payer: Amerigroup CHIP/Medicaid	$15.89
Rate for Payer: BCBS of TX Blue Advantage	$52.98
Rate for Payer: BCBS of TX Blue Essentials	$63.58
Rate for Payer: BCBS of TX PPO	$70.64
Rate for Payer: Cash Price	$155.41
Rate for Payer: Multiplan Auto	$114.79
Rate for Payer: Multiplan Commercial	$114.79
Rate for Payer: Multiplan Workers Comp	$114.79
Rate for Payer: Scott and White EPO/PPO	$88.30
Rate for Payer: Superior Health Plan EPO	$24.02

CHWR BX NEEDLE KIT MAX CORE 14G X 10CM BCE

Facility

$176.60

Hospital Charge Code	8082741
Hospital Revenue Code	272
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$114.79
Rate for Payer: Aetna Commercial	$97.13
Rate for Payer: Amerigroup CHIP/Medicaid	$15.89
Rate for Payer: BCBS of TX Blue Advantage	$52.98
Rate for Payer: BCBS of TX Blue Essentials	$63.58
Rate for Payer: BCBS of TX PPO	$70.64
Rate for Payer: Cash Price	$155.41
Rate for Payer: Multiplan Auto	$114.79
Rate for Payer: Multiplan Commercial	$114.79
Rate for Payer: Multiplan Workers Comp	$114.79
Rate for Payer: Scott and White EPO/PPO	$88.30
Rate for Payer: Superior Health Plan EPO	$24.02

CHWR BX NEEDLE KIT MAX CORE 14G X 10CM BCE

Facility

$176.60

Hospital Charge Code	8082741
Hospital Revenue Code	272
Rate for Payer: Cash Price	$155.41

CHWR BX TISSUE CORE 17Gx 10CM

Facility

$422.05

Hospital Charge Code	8182909
Hospital Revenue Code	272
Min. Negotiated Rate	$37.98
Max. Negotiated Rate	$274.33
Rate for Payer: Aetna Commercial	$232.13
Rate for Payer: Amerigroup CHIP/Medicaid	$37.98
Rate for Payer: BCBS of TX Blue Advantage	$126.62
Rate for Payer: BCBS of TX Blue Essentials	$151.94
Rate for Payer: BCBS of TX PPO	$168.82
Rate for Payer: Cash Price	$371.40
Rate for Payer: Multiplan Auto	$274.33
Rate for Payer: Multiplan Commercial	$274.33
Rate for Payer: Multiplan Workers Comp	$274.33
Rate for Payer: Scott and White EPO/PPO	$211.02
Rate for Payer: Superior Health Plan EPO	$57.40

CHWR BX TISSUE CORE 17Gx 10CM

Facility

$422.05

Hospital Charge Code	8182909
Hospital Revenue Code	272
Rate for Payer: Cash Price	$371.40

CHWR CATH DRAINAGE SAFE TTRAY 6FR16CM

Facility

$279.02

Service Code	HCPCS C1729
Hospital Charge Code	8081990
Hospital Revenue Code	278
Min. Negotiated Rate	$69.76
Max. Negotiated Rate	$139.51
Rate for Payer: Aetna Commercial	$83.71
Rate for Payer: Cash Price	$245.54
Rate for Payer: Cigna Commercial	$69.76
Rate for Payer: Multiplan Auto	$139.51
Rate for Payer: Multiplan Commercial	$139.51
Rate for Payer: Multiplan Workers Comp	$139.51
Rate for Payer: Scott and White EPO/PPO	$139.51

CHWR CATH DRAINAGE SAFE TTRAY 6FR16CM

Facility

$279.02

Service Code	HCPCS C1729
Hospital Charge Code	8081990
Hospital Revenue Code	278
Min. Negotiated Rate	$25.11
Max. Negotiated Rate	$139.51
Rate for Payer: Aetna Commercial	$83.71
Rate for Payer: Amerigroup CHIP/Medicaid	$25.11
Rate for Payer: BCBS of TX Blue Advantage	$83.71
Rate for Payer: BCBS of TX Blue Essentials	$100.45
Rate for Payer: BCBS of TX PPO	$111.61
Rate for Payer: Cash Price	$245.54
Rate for Payer: Multiplan Auto	$139.51
Rate for Payer: Multiplan Commercial	$139.51
Rate for Payer: Multiplan Workers Comp	$139.51
Rate for Payer: Scott and White EPO/PPO	$139.51
Rate for Payer: Superior Health Plan EPO	$37.95

CHWR CATH DRAINAGE SAFE TTRAY 6FR16CM BCE

Facility

$279.02

Service Code	HCPCS C1729
Hospital Charge Code	8081990
Hospital Revenue Code	278
Min. Negotiated Rate	$25.11
Max. Negotiated Rate	$139.51
Rate for Payer: Aetna Commercial	$83.71
Rate for Payer: Amerigroup CHIP/Medicaid	$25.11
Rate for Payer: BCBS of TX Blue Advantage	$83.71
Rate for Payer: BCBS of TX Blue Essentials	$100.45
Rate for Payer: BCBS of TX PPO	$111.61
Rate for Payer: Cash Price	$245.54
Rate for Payer: Multiplan Auto	$139.51
Rate for Payer: Multiplan Commercial	$139.51
Rate for Payer: Multiplan Workers Comp	$139.51
Rate for Payer: Scott and White EPO/PPO	$139.51
Rate for Payer: Superior Health Plan EPO	$37.95

CHWR CATH DRAINAGE SAFE TTRAY 6FR16CM BCE

Facility

$279.02

Service Code	HCPCS C1729
Hospital Charge Code	8081990
Hospital Revenue Code	278
Min. Negotiated Rate	$69.76
Max. Negotiated Rate	$139.51
Rate for Payer: Aetna Commercial	$83.71
Rate for Payer: Cash Price	$245.54
Rate for Payer: Cigna Commercial	$69.76
Rate for Payer: Multiplan Auto	$139.51
Rate for Payer: Multiplan Commercial	$139.51
Rate for Payer: Multiplan Workers Comp	$139.51
Rate for Payer: Scott and White EPO/PPO	$139.51

Know your out-of-pocket cost for care.

All Charges