White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CHWR DOBHOFF TUBE FEEDING TUBE BCE

Facility

$64.05

Hospital Charge Code	8034690
Hospital Revenue Code	270
Rate for Payer: Cash Price	$56.36

CHWR DOBHOFF TUBE FEEDING TUBE BCE

Facility

$64.05

Hospital Charge Code	8034690
Hospital Revenue Code	270
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$41.63
Rate for Payer: Aetna Commercial	$35.23
Rate for Payer: Amerigroup CHIP/Medicaid	$5.76
Rate for Payer: BCBS of TX Blue Advantage	$19.22
Rate for Payer: BCBS of TX Blue Essentials	$23.06
Rate for Payer: BCBS of TX PPO	$25.62
Rate for Payer: Cash Price	$56.36
Rate for Payer: Multiplan Auto	$41.63
Rate for Payer: Multiplan Commercial	$41.63
Rate for Payer: Multiplan Workers Comp	$41.63
Rate for Payer: Scott and White EPO/PPO	$32.02
Rate for Payer: Superior Health Plan EPO	$8.71

CHWR DRAIN BAG

Facility

$90.80

Hospital Charge Code	8041055
Hospital Revenue Code	272
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$59.02
Rate for Payer: Aetna Commercial	$49.94
Rate for Payer: Amerigroup CHIP/Medicaid	$8.17
Rate for Payer: BCBS of TX Blue Advantage	$27.24
Rate for Payer: BCBS of TX Blue Essentials	$32.69
Rate for Payer: BCBS of TX PPO	$36.32
Rate for Payer: Cash Price	$79.90
Rate for Payer: Multiplan Auto	$59.02
Rate for Payer: Multiplan Commercial	$59.02
Rate for Payer: Multiplan Workers Comp	$59.02
Rate for Payer: Scott and White EPO/PPO	$45.40
Rate for Payer: Superior Health Plan EPO	$12.35

CHWR DRAIN BAG BCE

Facility

$90.80

Hospital Charge Code	8041055
Hospital Revenue Code	272
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$59.02
Rate for Payer: Aetna Commercial	$49.94
Rate for Payer: Amerigroup CHIP/Medicaid	$8.17
Rate for Payer: BCBS of TX Blue Advantage	$27.24
Rate for Payer: BCBS of TX Blue Essentials	$32.69
Rate for Payer: BCBS of TX PPO	$36.32
Rate for Payer: Cash Price	$79.90
Rate for Payer: Multiplan Auto	$59.02
Rate for Payer: Multiplan Commercial	$59.02
Rate for Payer: Multiplan Workers Comp	$59.02
Rate for Payer: Scott and White EPO/PPO	$45.40
Rate for Payer: Superior Health Plan EPO	$12.35

CHWR DRAIN BAG BCE

Facility

$90.80

Hospital Charge Code	8041055
Hospital Revenue Code	272
Rate for Payer: Cash Price	$79.90

CHWR DRAPE NEEDLE GUIDANCE

Facility

$98.82

Hospital Charge Code	8082253
Hospital Revenue Code	272
Min. Negotiated Rate	$8.89
Max. Negotiated Rate	$64.23
Rate for Payer: Aetna Commercial	$54.35
Rate for Payer: Amerigroup CHIP/Medicaid	$8.89
Rate for Payer: BCBS of TX Blue Advantage	$29.65
Rate for Payer: BCBS of TX Blue Essentials	$35.58
Rate for Payer: BCBS of TX PPO	$39.53
Rate for Payer: Cash Price	$86.96
Rate for Payer: Multiplan Auto	$64.23
Rate for Payer: Multiplan Commercial	$64.23
Rate for Payer: Multiplan Workers Comp	$64.23
Rate for Payer: Scott and White EPO/PPO	$49.41
Rate for Payer: Superior Health Plan EPO	$13.44

CHWR DRAPE NEEDLE GUIDANCE BCE

Facility

$98.82

Hospital Charge Code	8082253
Hospital Revenue Code	272
Min. Negotiated Rate	$8.89
Max. Negotiated Rate	$64.23
Rate for Payer: Aetna Commercial	$54.35
Rate for Payer: Amerigroup CHIP/Medicaid	$8.89
Rate for Payer: BCBS of TX Blue Advantage	$29.65
Rate for Payer: BCBS of TX Blue Essentials	$35.58
Rate for Payer: BCBS of TX PPO	$39.53
Rate for Payer: Cash Price	$86.96
Rate for Payer: Multiplan Auto	$64.23
Rate for Payer: Multiplan Commercial	$64.23
Rate for Payer: Multiplan Workers Comp	$64.23
Rate for Payer: Scott and White EPO/PPO	$49.41
Rate for Payer: Superior Health Plan EPO	$13.44

CHWR DRESSING 3X4 STERILE

Facility

$9.12

Hospital Charge Code	8024927
Hospital Revenue Code	270
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$5.93
Rate for Payer: Aetna Commercial	$5.02
Rate for Payer: Amerigroup CHIP/Medicaid	$0.82
Rate for Payer: BCBS of TX Blue Advantage	$2.74
Rate for Payer: BCBS of TX Blue Essentials	$3.28
Rate for Payer: BCBS of TX PPO	$3.65
Rate for Payer: Cash Price	$8.03
Rate for Payer: Multiplan Auto	$5.93
Rate for Payer: Multiplan Commercial	$5.93
Rate for Payer: Multiplan Workers Comp	$5.93
Rate for Payer: Scott and White EPO/PPO	$4.56
Rate for Payer: Superior Health Plan EPO	$1.24

CHWR DRESSING 3X4 STERILE BCE

Facility

$9.12

Hospital Charge Code	8024927
Hospital Revenue Code	270
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$5.93
Rate for Payer: Aetna Commercial	$5.02
Rate for Payer: Amerigroup CHIP/Medicaid	$0.82
Rate for Payer: BCBS of TX Blue Advantage	$2.74
Rate for Payer: BCBS of TX Blue Essentials	$3.28
Rate for Payer: BCBS of TX PPO	$3.65
Rate for Payer: Cash Price	$8.03
Rate for Payer: Multiplan Auto	$5.93
Rate for Payer: Multiplan Commercial	$5.93
Rate for Payer: Multiplan Workers Comp	$5.93
Rate for Payer: Scott and White EPO/PPO	$4.56
Rate for Payer: Superior Health Plan EPO	$1.24

CHWR DRESSING 3X4 STERILE BCE

Facility

$9.12

Hospital Charge Code	8024927
Hospital Revenue Code	270
Rate for Payer: Cash Price	$8.03

CHWR ECG MRI QUADTRODE PAD

Facility

$68.92

Hospital Charge Code	8203025
Hospital Revenue Code	270
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$44.80
Rate for Payer: Aetna Commercial	$37.91
Rate for Payer: Amerigroup CHIP/Medicaid	$6.20
Rate for Payer: BCBS of TX Blue Advantage	$20.68
Rate for Payer: BCBS of TX Blue Essentials	$24.81
Rate for Payer: BCBS of TX PPO	$27.57
Rate for Payer: Cash Price	$60.65
Rate for Payer: Multiplan Auto	$44.80
Rate for Payer: Multiplan Commercial	$44.80
Rate for Payer: Multiplan Workers Comp	$44.80
Rate for Payer: Scott and White EPO/PPO	$34.46
Rate for Payer: Superior Health Plan EPO	$9.37

CHWR ECG MRI QUADTRODE PAD BCE

Facility

$68.92

Hospital Charge Code	8203025
Hospital Revenue Code	270
Rate for Payer: Cash Price	$60.65

CHWR ECG MRI QUADTRODE PAD BCE

Facility

$68.92

Hospital Charge Code	8203025
Hospital Revenue Code	270
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$44.80
Rate for Payer: Aetna Commercial	$37.91
Rate for Payer: Amerigroup CHIP/Medicaid	$6.20
Rate for Payer: BCBS of TX Blue Advantage	$20.68
Rate for Payer: BCBS of TX Blue Essentials	$24.81
Rate for Payer: BCBS of TX PPO	$27.57
Rate for Payer: Cash Price	$60.65
Rate for Payer: Multiplan Auto	$44.80
Rate for Payer: Multiplan Commercial	$44.80
Rate for Payer: Multiplan Workers Comp	$44.80
Rate for Payer: Scott and White EPO/PPO	$34.46
Rate for Payer: Superior Health Plan EPO	$9.37

CHWR FEEDING TUBE

Facility

$134.88

Hospital Charge Code	8034688
Hospital Revenue Code	272
Min. Negotiated Rate	$12.14
Max. Negotiated Rate	$87.67
Rate for Payer: Aetna Commercial	$74.18
Rate for Payer: Amerigroup CHIP/Medicaid	$12.14
Rate for Payer: BCBS of TX Blue Advantage	$40.46
Rate for Payer: BCBS of TX Blue Essentials	$48.56
Rate for Payer: BCBS of TX PPO	$53.95
Rate for Payer: Cash Price	$118.69
Rate for Payer: Multiplan Auto	$87.67
Rate for Payer: Multiplan Commercial	$87.67
Rate for Payer: Multiplan Workers Comp	$87.67
Rate for Payer: Scott and White EPO/PPO	$67.44
Rate for Payer: Superior Health Plan EPO	$18.34

CHWR FEEDING TUBE BCE

Facility

$134.88

Hospital Charge Code	8034688
Hospital Revenue Code	272
Min. Negotiated Rate	$12.14
Max. Negotiated Rate	$87.67
Rate for Payer: Aetna Commercial	$74.18
Rate for Payer: Amerigroup CHIP/Medicaid	$12.14
Rate for Payer: BCBS of TX Blue Advantage	$40.46
Rate for Payer: BCBS of TX Blue Essentials	$48.56
Rate for Payer: BCBS of TX PPO	$53.95
Rate for Payer: Cash Price	$118.69
Rate for Payer: Multiplan Auto	$87.67
Rate for Payer: Multiplan Commercial	$87.67
Rate for Payer: Multiplan Workers Comp	$87.67
Rate for Payer: Scott and White EPO/PPO	$67.44
Rate for Payer: Superior Health Plan EPO	$18.34

CHWR FEEDING TUBE BCE

Facility

$134.88

Hospital Charge Code	8034688
Hospital Revenue Code	272
Rate for Payer: Cash Price	$118.69

CHWR FILTER BIOPSY BREAST TISSUE

Facility

$18.44

Hospital Charge Code	8174682
Hospital Revenue Code	272
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$11.99
Rate for Payer: Aetna Commercial	$10.14
Rate for Payer: Amerigroup CHIP/Medicaid	$1.66
Rate for Payer: BCBS of TX Blue Advantage	$5.53
Rate for Payer: BCBS of TX Blue Essentials	$6.64
Rate for Payer: BCBS of TX PPO	$7.38
Rate for Payer: Cash Price	$16.23
Rate for Payer: Multiplan Auto	$11.99
Rate for Payer: Multiplan Commercial	$11.99
Rate for Payer: Multiplan Workers Comp	$11.99
Rate for Payer: Scott and White EPO/PPO	$9.22
Rate for Payer: Superior Health Plan EPO	$2.51

CHWR FILTER BIOPSY BREAST TISSUE BCE

Facility

$18.44

Hospital Charge Code	8174682
Hospital Revenue Code	272
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$11.99
Rate for Payer: Aetna Commercial	$10.14
Rate for Payer: Amerigroup CHIP/Medicaid	$1.66
Rate for Payer: BCBS of TX Blue Advantage	$5.53
Rate for Payer: BCBS of TX Blue Essentials	$6.64
Rate for Payer: BCBS of TX PPO	$7.38
Rate for Payer: Cash Price	$16.23
Rate for Payer: Multiplan Auto	$11.99
Rate for Payer: Multiplan Commercial	$11.99
Rate for Payer: Multiplan Workers Comp	$11.99
Rate for Payer: Scott and White EPO/PPO	$9.22
Rate for Payer: Superior Health Plan EPO	$2.51

CHWR FILTER BIOPSY BREAST TISSUE BCE

Facility

$18.44

Hospital Charge Code	8174682
Hospital Revenue Code	272
Rate for Payer: Cash Price	$16.23

CHWR FNA BX W/US GDN EA ADDL

Facility

$1,037.00

Service Code	CPT 10006
Hospital Charge Code	8734522
Hospital Revenue Code	361
Min. Negotiated Rate	$93.33
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$570.35
Rate for Payer: Amerigroup CHIP/Medicaid	$93.33
Rate for Payer: Cash Price	$912.56
Rate for Payer: Cash Price	$912.56
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	$518.50
Rate for Payer: Superior Health Plan EPO	$141.03

CHWR FNA BX W/US GDN EA ADDL BCE

Facility

$1,037.00

Service Code	CPT 10006
Hospital Charge Code	8734522
Hospital Revenue Code	361
Rate for Payer: Cash Price	$912.56

CHWR FNA BX W/US GDN EA ADDL BCE

Facility

$1,037.00

Service Code	CPT 10006
Hospital Charge Code	8734522
Hospital Revenue Code	361
Min. Negotiated Rate	$93.33
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$570.35
Rate for Payer: Amerigroup CHIP/Medicaid	$93.33
Rate for Payer: Cash Price	$912.56
Rate for Payer: Cash Price	$912.56
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	$518.50
Rate for Payer: Superior Health Plan EPO	$141.03

CHWR FOLEY CATH 2 WAY 5CC

Facility

$88.06

Hospital Charge Code	8041150
Hospital Revenue Code	272
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$57.24
Rate for Payer: Aetna Commercial	$48.43
Rate for Payer: Amerigroup CHIP/Medicaid	$7.93
Rate for Payer: BCBS of TX Blue Advantage	$26.42
Rate for Payer: BCBS of TX Blue Essentials	$31.70
Rate for Payer: BCBS of TX PPO	$35.22
Rate for Payer: Cash Price	$77.49
Rate for Payer: Multiplan Auto	$57.24
Rate for Payer: Multiplan Commercial	$57.24
Rate for Payer: Multiplan Workers Comp	$57.24
Rate for Payer: Scott and White EPO/PPO	$44.03
Rate for Payer: Superior Health Plan EPO	$11.98

CHWR FOLEY CATHETER ANY SIZE

Facility

$88.06

Hospital Charge Code	8041150
Hospital Revenue Code	272
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$57.24
Rate for Payer: Aetna Commercial	$48.43
Rate for Payer: Amerigroup CHIP/Medicaid	$7.93
Rate for Payer: BCBS of TX Blue Advantage	$26.42
Rate for Payer: BCBS of TX Blue Essentials	$31.70
Rate for Payer: BCBS of TX PPO	$35.22
Rate for Payer: Cash Price	$77.49
Rate for Payer: Multiplan Auto	$57.24
Rate for Payer: Multiplan Commercial	$57.24
Rate for Payer: Multiplan Workers Comp	$57.24
Rate for Payer: Scott and White EPO/PPO	$44.03
Rate for Payer: Superior Health Plan EPO	$11.98

CHWR FOLEY CATHETER ANY SIZE BCE

Facility

$88.06

Hospital Charge Code	8041150
Hospital Revenue Code	272
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$57.24
Rate for Payer: Aetna Commercial	$48.43
Rate for Payer: Amerigroup CHIP/Medicaid	$7.93
Rate for Payer: BCBS of TX Blue Advantage	$26.42
Rate for Payer: BCBS of TX Blue Essentials	$31.70
Rate for Payer: BCBS of TX PPO	$35.22
Rate for Payer: Cash Price	$77.49
Rate for Payer: Multiplan Auto	$57.24
Rate for Payer: Multiplan Commercial	$57.24
Rate for Payer: Multiplan Workers Comp	$57.24
Rate for Payer: Scott and White EPO/PPO	$44.03
Rate for Payer: Superior Health Plan EPO	$11.98

Know your out-of-pocket cost for care.

All Charges