White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CHWR FOLEY CATHETER ANY SIZE BCE

Facility

$88.06

Hospital Charge Code	8041150
Hospital Revenue Code	272
Rate for Payer: Cash Price	$77.49

CHWR HUBER NEEDLE

Facility

$39.41

Hospital Charge Code	8034546
Hospital Revenue Code	272
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$25.62
Rate for Payer: Aetna Commercial	$21.68
Rate for Payer: Amerigroup CHIP/Medicaid	$3.55
Rate for Payer: BCBS of TX Blue Advantage	$11.82
Rate for Payer: BCBS of TX Blue Essentials	$14.19
Rate for Payer: BCBS of TX PPO	$15.76
Rate for Payer: Cash Price	$34.68
Rate for Payer: Multiplan Auto	$25.62
Rate for Payer: Multiplan Commercial	$25.62
Rate for Payer: Multiplan Workers Comp	$25.62
Rate for Payer: Scott and White EPO/PPO	$19.70
Rate for Payer: Superior Health Plan EPO	$5.36

CHWR HYSTERSALPINGOGRAM TRAY

Facility

$254.05

Hospital Charge Code	8083175
Hospital Revenue Code	272
Min. Negotiated Rate	$22.86
Max. Negotiated Rate	$165.13
Rate for Payer: Aetna Commercial	$139.73
Rate for Payer: Amerigroup CHIP/Medicaid	$22.86
Rate for Payer: BCBS of TX Blue Advantage	$76.22
Rate for Payer: BCBS of TX Blue Essentials	$91.46
Rate for Payer: BCBS of TX PPO	$101.62
Rate for Payer: Cash Price	$223.56
Rate for Payer: Multiplan Auto	$165.13
Rate for Payer: Multiplan Commercial	$165.13
Rate for Payer: Multiplan Workers Comp	$165.13
Rate for Payer: Scott and White EPO/PPO	$127.02
Rate for Payer: Superior Health Plan EPO	$34.55

CHWR INJECTOR CT DOUBLE

Facility

$39.41

Hospital Charge Code	8034546
Hospital Revenue Code	272
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$25.62
Rate for Payer: Aetna Commercial	$21.68
Rate for Payer: Amerigroup CHIP/Medicaid	$3.55
Rate for Payer: BCBS of TX Blue Advantage	$11.82
Rate for Payer: BCBS of TX Blue Essentials	$14.19
Rate for Payer: BCBS of TX PPO	$15.76
Rate for Payer: Cash Price	$34.68
Rate for Payer: Multiplan Auto	$25.62
Rate for Payer: Multiplan Commercial	$25.62
Rate for Payer: Multiplan Workers Comp	$25.62
Rate for Payer: Scott and White EPO/PPO	$19.70
Rate for Payer: Superior Health Plan EPO	$5.36

CHWR INJECTOR MRI DOUBLE

Facility

$39.41

Hospital Charge Code	8034546
Hospital Revenue Code	272
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$25.62
Rate for Payer: Aetna Commercial	$21.68
Rate for Payer: Amerigroup CHIP/Medicaid	$3.55
Rate for Payer: BCBS of TX Blue Advantage	$11.82
Rate for Payer: BCBS of TX Blue Essentials	$14.19
Rate for Payer: BCBS of TX PPO	$15.76
Rate for Payer: Cash Price	$34.68
Rate for Payer: Multiplan Auto	$25.62
Rate for Payer: Multiplan Commercial	$25.62
Rate for Payer: Multiplan Workers Comp	$25.62
Rate for Payer: Scott and White EPO/PPO	$19.70
Rate for Payer: Superior Health Plan EPO	$5.36

CHWR INJECTOR SYRINGE MEDRAD

Facility

$47.03

Hospital Charge Code	8034546
Hospital Revenue Code	272
Rate for Payer: Cash Price	$41.39

CHWR INJECTOR SYRINGE MEDRAD

Facility

$47.03

Hospital Charge Code	8034546
Hospital Revenue Code	272
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$30.57
Rate for Payer: Aetna Commercial	$25.87
Rate for Payer: Amerigroup CHIP/Medicaid	$4.23
Rate for Payer: BCBS of TX Blue Advantage	$14.11
Rate for Payer: BCBS of TX Blue Essentials	$16.93
Rate for Payer: BCBS of TX PPO	$18.81
Rate for Payer: Cash Price	$41.39
Rate for Payer: Multiplan Auto	$30.57
Rate for Payer: Multiplan Commercial	$30.57
Rate for Payer: Multiplan Workers Comp	$30.57
Rate for Payer: Scott and White EPO/PPO	$23.52
Rate for Payer: Superior Health Plan EPO	$6.40

CHWR INJECTOR SYRINGE MEDRAD BCE

Facility

$39.41

Hospital Charge Code	8034546
Hospital Revenue Code	272
Rate for Payer: Cash Price	$34.68

CHWR INJECTOR SYRINGE MEDRAD BCE

Facility

$39.41

Hospital Charge Code	8034546
Hospital Revenue Code	272
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$25.62
Rate for Payer: Aetna Commercial	$21.68
Rate for Payer: Amerigroup CHIP/Medicaid	$3.55
Rate for Payer: BCBS of TX Blue Advantage	$11.82
Rate for Payer: BCBS of TX Blue Essentials	$14.19
Rate for Payer: BCBS of TX PPO	$15.76
Rate for Payer: Cash Price	$34.68
Rate for Payer: Multiplan Auto	$25.62
Rate for Payer: Multiplan Commercial	$25.62
Rate for Payer: Multiplan Workers Comp	$25.62
Rate for Payer: Scott and White EPO/PPO	$19.70
Rate for Payer: Superior Health Plan EPO	$5.36

CHWR IV START KIT

Facility

$110.27

Hospital Charge Code	5420101
Hospital Revenue Code	270
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$71.68
Rate for Payer: Aetna Commercial	$60.65
Rate for Payer: Amerigroup CHIP/Medicaid	$9.92
Rate for Payer: BCBS of TX Blue Advantage	$33.08
Rate for Payer: BCBS of TX Blue Essentials	$39.70
Rate for Payer: BCBS of TX PPO	$44.11
Rate for Payer: Cash Price	$97.04
Rate for Payer: Multiplan Auto	$71.68
Rate for Payer: Multiplan Commercial	$71.68
Rate for Payer: Multiplan Workers Comp	$71.68
Rate for Payer: Scott and White EPO/PPO	$55.14
Rate for Payer: Superior Health Plan EPO	$15.00

CHWR IV START KIT BCE

Facility

$110.27

Hospital Charge Code	5420101
Hospital Revenue Code	270
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$71.68
Rate for Payer: Aetna Commercial	$60.65
Rate for Payer: Amerigroup CHIP/Medicaid	$9.92
Rate for Payer: BCBS of TX Blue Advantage	$33.08
Rate for Payer: BCBS of TX Blue Essentials	$39.70
Rate for Payer: BCBS of TX PPO	$44.11
Rate for Payer: Cash Price	$97.04
Rate for Payer: Multiplan Auto	$71.68
Rate for Payer: Multiplan Commercial	$71.68
Rate for Payer: Multiplan Workers Comp	$71.68
Rate for Payer: Scott and White EPO/PPO	$55.14
Rate for Payer: Superior Health Plan EPO	$15.00

CHWR IV START KIT BCE

Facility

$110.27

Hospital Charge Code	5420101
Hospital Revenue Code	270
Rate for Payer: Cash Price	$97.04

CHWR IV TUBING PRIMARY

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 IV TUBING PRIMARY BCE

Facility

$118.74

Hospital Charge Code	5420020
Hospital Revenue Code	270
Rate for Payer: Cash Price	$104.49

CHWR IV TUBING PRIMARY BCE

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 JAMSHIDI NEEDLE - ALL

Facility

$138.28

Hospital Charge Code	8032740
Hospital Revenue Code	272
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$89.88
Rate for Payer: Aetna Commercial	$76.05
Rate for Payer: Amerigroup CHIP/Medicaid	$12.45
Rate for Payer: BCBS of TX Blue Advantage	$41.48
Rate for Payer: BCBS of TX Blue Essentials	$49.78
Rate for Payer: BCBS of TX PPO	$55.31
Rate for Payer: Cash Price	$121.69
Rate for Payer: Multiplan Auto	$89.88
Rate for Payer: Multiplan Commercial	$89.88
Rate for Payer: Multiplan Workers Comp	$89.88
Rate for Payer: Scott and White EPO/PPO	$69.14
Rate for Payer: Superior Health Plan EPO	$18.81

CHWR JAMSHIDI NEEDLE - ALL BCE

Facility

$138.28

Hospital Charge Code	8032740
Hospital Revenue Code	272
Rate for Payer: Cash Price	$121.69

CHWR JAMSHIDI NEEDLE - ALL BCE

Facility

$138.28

Hospital Charge Code	8032740
Hospital Revenue Code	272
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$89.88
Rate for Payer: Aetna Commercial	$76.05
Rate for Payer: Amerigroup CHIP/Medicaid	$12.45
Rate for Payer: BCBS of TX Blue Advantage	$41.48
Rate for Payer: BCBS of TX Blue Essentials	$49.78
Rate for Payer: BCBS of TX PPO	$55.31
Rate for Payer: Cash Price	$121.69
Rate for Payer: Multiplan Auto	$89.88
Rate for Payer: Multiplan Commercial	$89.88
Rate for Payer: Multiplan Workers Comp	$89.88
Rate for Payer: Scott and White EPO/PPO	$69.14
Rate for Payer: Superior Health Plan EPO	$18.81

CHWR JAMSHIDI TRAY BAK 4511

Facility

$137.10

Hospital Charge Code	8083005
Hospital Revenue Code	272
Min. Negotiated Rate	$12.34
Max. Negotiated Rate	$89.12
Rate for Payer: Aetna Commercial	$75.40
Rate for Payer: Amerigroup CHIP/Medicaid	$12.34
Rate for Payer: BCBS of TX Blue Advantage	$41.13
Rate for Payer: BCBS of TX Blue Essentials	$49.36
Rate for Payer: BCBS of TX PPO	$54.84
Rate for Payer: Cash Price	$120.65
Rate for Payer: Multiplan Auto	$89.12
Rate for Payer: Multiplan Commercial	$89.12
Rate for Payer: Multiplan Workers Comp	$89.12
Rate for Payer: Scott and White EPO/PPO	$68.55
Rate for Payer: Superior Health Plan EPO	$18.65

CHWR JAMSHIDI TRAY BAK 4511 BCE

Facility

$137.10

Hospital Charge Code	8083005
Hospital Revenue Code	272
Rate for Payer: Cash Price	$120.65

CHWR JAMSHIDI TRAY BAK 4511 BCE

Facility

$137.10

Hospital Charge Code	8083005
Hospital Revenue Code	272
Min. Negotiated Rate	$12.34
Max. Negotiated Rate	$89.12
Rate for Payer: Aetna Commercial	$75.40
Rate for Payer: Amerigroup CHIP/Medicaid	$12.34
Rate for Payer: BCBS of TX Blue Advantage	$41.13
Rate for Payer: BCBS of TX Blue Essentials	$49.36
Rate for Payer: BCBS of TX PPO	$54.84
Rate for Payer: Cash Price	$120.65
Rate for Payer: Multiplan Auto	$89.12
Rate for Payer: Multiplan Commercial	$89.12
Rate for Payer: Multiplan Workers Comp	$89.12
Rate for Payer: Scott and White EPO/PPO	$68.55
Rate for Payer: Superior Health Plan EPO	$18.65

CHWR LACERATION TRAY

Facility

$87.56

Hospital Charge Code	8083645
Hospital Revenue Code	272
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$56.91
Rate for Payer: Aetna Commercial	$48.16
Rate for Payer: Amerigroup CHIP/Medicaid	$7.88
Rate for Payer: BCBS of TX Blue Advantage	$26.27
Rate for Payer: BCBS of TX Blue Essentials	$31.52
Rate for Payer: BCBS of TX PPO	$35.02
Rate for Payer: Cash Price	$77.05
Rate for Payer: Multiplan Auto	$56.91
Rate for Payer: Multiplan Commercial	$56.91
Rate for Payer: Multiplan Workers Comp	$56.91
Rate for Payer: Scott and White EPO/PPO	$43.78
Rate for Payer: Superior Health Plan EPO	$11.91

CHWR LACERATION TRAY BCE

Facility

$87.56

Hospital Charge Code	8083645
Hospital Revenue Code	272
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$56.91
Rate for Payer: Aetna Commercial	$48.16
Rate for Payer: Amerigroup CHIP/Medicaid	$7.88
Rate for Payer: BCBS of TX Blue Advantage	$26.27
Rate for Payer: BCBS of TX Blue Essentials	$31.52
Rate for Payer: BCBS of TX PPO	$35.02
Rate for Payer: Cash Price	$77.05
Rate for Payer: Multiplan Auto	$56.91
Rate for Payer: Multiplan Commercial	$56.91
Rate for Payer: Multiplan Workers Comp	$56.91
Rate for Payer: Scott and White EPO/PPO	$43.78
Rate for Payer: Superior Health Plan EPO	$11.91

CHWR LACERATION TRAY BCE

Facility

$87.56

Hospital Charge Code	8083645
Hospital Revenue Code	272
Rate for Payer: Cash Price	$77.05

CHWR LUMBAR PUNCTURE TRAY

Facility

$47.23

Hospital Charge Code	8083805
Hospital Revenue Code	272
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$30.70
Rate for Payer: Aetna Commercial	$25.98
Rate for Payer: Amerigroup CHIP/Medicaid	$4.25
Rate for Payer: BCBS of TX Blue Advantage	$14.17
Rate for Payer: BCBS of TX Blue Essentials	$17.00
Rate for Payer: BCBS of TX PPO	$18.89
Rate for Payer: Cash Price	$41.56
Rate for Payer: Multiplan Auto	$30.70
Rate for Payer: Multiplan Commercial	$30.70
Rate for Payer: Multiplan Workers Comp	$30.70
Rate for Payer: Scott and White EPO/PPO	$23.62
Rate for Payer: Superior Health Plan EPO	$6.42

Know your out-of-pocket cost for care.

All Charges