White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CHWR NEEDLE GUIDE 12G

Facility

$42.70

Hospital Charge Code	8073029
Hospital Revenue Code	272
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$27.76
Rate for Payer: Aetna Commercial	$23.48
Rate for Payer: Amerigroup CHIP/Medicaid	$3.84
Rate for Payer: BCBS of TX Blue Advantage	$12.81
Rate for Payer: BCBS of TX Blue Essentials	$15.37
Rate for Payer: BCBS of TX PPO	$17.08
Rate for Payer: Cash Price	$37.58
Rate for Payer: Multiplan Auto	$27.76
Rate for Payer: Multiplan Commercial	$27.76
Rate for Payer: Multiplan Workers Comp	$27.76
Rate for Payer: Scott and White EPO/PPO	$21.35
Rate for Payer: Superior Health Plan EPO	$5.81

CHWR NEEDLE GUIDE 12G BCE

Facility

$42.70

Hospital Charge Code	8073029
Hospital Revenue Code	272
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$27.76
Rate for Payer: Aetna Commercial	$23.48
Rate for Payer: Amerigroup CHIP/Medicaid	$3.84
Rate for Payer: BCBS of TX Blue Advantage	$12.81
Rate for Payer: BCBS of TX Blue Essentials	$15.37
Rate for Payer: BCBS of TX PPO	$17.08
Rate for Payer: Cash Price	$37.58
Rate for Payer: Multiplan Auto	$27.76
Rate for Payer: Multiplan Commercial	$27.76
Rate for Payer: Multiplan Workers Comp	$27.76
Rate for Payer: Scott and White EPO/PPO	$21.35
Rate for Payer: Superior Health Plan EPO	$5.81

CHWR NEEDLE GUIDE 12G BCE

Facility

$42.70

Hospital Charge Code	8073029
Hospital Revenue Code	272
Rate for Payer: Cash Price	$37.58

CHWR NM Tc-99m FILTER SULFUR COOLID

Facility

$133.60

Service Code	HCPCS A9541
Hospital Charge Code	5199242
Hospital Revenue Code	343
Min. Negotiated Rate	$12.02
Max. Negotiated Rate	$86.84
Rate for Payer: Amerigroup CHIP/Medicaid	$12.02
Rate for Payer: BCBS of TX Blue Advantage	$40.08
Rate for Payer: BCBS of TX Blue Essentials	$48.10
Rate for Payer: BCBS of TX PPO	$53.44
Rate for Payer: Cash Price	$117.57
Rate for Payer: Multiplan Auto	$86.84
Rate for Payer: Multiplan Commercial	$86.84
Rate for Payer: Multiplan Workers Comp	$86.84
Rate for Payer: Scott and White EPO/PPO	$66.80
Rate for Payer: Superior Health Plan EPO	$18.17

CHWR NM Tc-99m FILTER SULFUR COOLID BCE

Facility

$133.60

Service Code	HCPCS A9541
Hospital Charge Code	5199242
Hospital Revenue Code	343
Rate for Payer: Cash Price	$117.57

CHWR NM Tc-99m FILTER SULFUR COOLID BCE

Facility

$133.60

Service Code	HCPCS A9541
Hospital Charge Code	5199242
Hospital Revenue Code	343
Min. Negotiated Rate	$12.02
Max. Negotiated Rate	$86.84
Rate for Payer: Amerigroup CHIP/Medicaid	$12.02
Rate for Payer: BCBS of TX Blue Advantage	$40.08
Rate for Payer: BCBS of TX Blue Essentials	$48.10
Rate for Payer: BCBS of TX PPO	$53.44
Rate for Payer: Cash Price	$117.57
Rate for Payer: Multiplan Auto	$86.84
Rate for Payer: Multiplan Commercial	$86.84
Rate for Payer: Multiplan Workers Comp	$86.84
Rate for Payer: Scott and White EPO/PPO	$66.80
Rate for Payer: Superior Health Plan EPO	$18.17

CHWR PARACENTESIS TRAY

Facility

$755.53

Hospital Charge Code	8084310
Hospital Revenue Code	272
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$491.09
Rate for Payer: Aetna Commercial	$415.54
Rate for Payer: Amerigroup CHIP/Medicaid	$68.00
Rate for Payer: BCBS of TX Blue Advantage	$226.66
Rate for Payer: BCBS of TX Blue Essentials	$271.99
Rate for Payer: BCBS of TX PPO	$302.21
Rate for Payer: Cash Price	$664.87
Rate for Payer: Multiplan Auto	$491.09
Rate for Payer: Multiplan Commercial	$491.09
Rate for Payer: Multiplan Workers Comp	$491.09
Rate for Payer: Scott and White EPO/PPO	$377.76
Rate for Payer: Superior Health Plan EPO	$102.75

CHWR PNEUMOTHORAX TRAY BCE

Facility

$903.51

Hospital Charge Code	8082755
Hospital Revenue Code	270
Min. Negotiated Rate	$81.32
Max. Negotiated Rate	$587.28
Rate for Payer: Aetna Commercial	$496.93
Rate for Payer: Amerigroup CHIP/Medicaid	$81.32
Rate for Payer: BCBS of TX Blue Advantage	$271.05
Rate for Payer: BCBS of TX Blue Essentials	$325.26
Rate for Payer: BCBS of TX PPO	$361.40
Rate for Payer: Cash Price	$795.09
Rate for Payer: Multiplan Auto	$587.28
Rate for Payer: Multiplan Commercial	$587.28
Rate for Payer: Multiplan Workers Comp	$587.28
Rate for Payer: Scott and White EPO/PPO	$451.76
Rate for Payer: Superior Health Plan EPO	$122.88

CHWR PROTECTOR WIRE LOC NEEDLE

Facility

$54.74

Service Code	HCPCS C1769
Hospital Charge Code	8073177
Hospital Revenue Code	272
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$35.58
Rate for Payer: Aetna Commercial	$30.11
Rate for Payer: Amerigroup CHIP/Medicaid	$4.93
Rate for Payer: BCBS of TX Blue Advantage	$16.42
Rate for Payer: BCBS of TX Blue Essentials	$19.71
Rate for Payer: BCBS of TX PPO	$21.90
Rate for Payer: Cash Price	$48.17
Rate for Payer: Multiplan Auto	$35.58
Rate for Payer: Multiplan Commercial	$35.58
Rate for Payer: Multiplan Workers Comp	$35.58
Rate for Payer: Scott and White EPO/PPO	$27.37
Rate for Payer: Superior Health Plan EPO	$7.44

CHWR PROTECTOR WIRE LOC NEEDLE BCE

Facility

$54.74

Service Code	HCPCS C1769
Hospital Charge Code	8073177
Hospital Revenue Code	272
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$35.58
Rate for Payer: Aetna Commercial	$30.11
Rate for Payer: Amerigroup CHIP/Medicaid	$4.93
Rate for Payer: BCBS of TX Blue Advantage	$16.42
Rate for Payer: BCBS of TX Blue Essentials	$19.71
Rate for Payer: BCBS of TX PPO	$21.90
Rate for Payer: Cash Price	$48.17
Rate for Payer: Multiplan Auto	$35.58
Rate for Payer: Multiplan Commercial	$35.58
Rate for Payer: Multiplan Workers Comp	$35.58
Rate for Payer: Scott and White EPO/PPO	$27.37
Rate for Payer: Superior Health Plan EPO	$7.44

CHWR PROTECTOR WIRE LOC NEEDLE BCE

Facility

$54.74

Service Code	HCPCS C1769
Hospital Charge Code	8073177
Hospital Revenue Code	272
Rate for Payer: Cash Price	$48.17

CHWR SAFETY SOFT TISSUE BIOPSY TRAY

Facility

$123.54

Hospital Charge Code	8083040
Hospital Revenue Code	272
Min. Negotiated Rate	$11.12
Max. Negotiated Rate	$80.30
Rate for Payer: Aetna Commercial	$67.95
Rate for Payer: Amerigroup CHIP/Medicaid	$11.12
Rate for Payer: BCBS of TX Blue Advantage	$37.06
Rate for Payer: BCBS of TX Blue Essentials	$44.47
Rate for Payer: BCBS of TX PPO	$49.42
Rate for Payer: Cash Price	$108.72
Rate for Payer: Multiplan Auto	$80.30
Rate for Payer: Multiplan Commercial	$80.30
Rate for Payer: Multiplan Workers Comp	$80.30
Rate for Payer: Scott and White EPO/PPO	$61.77
Rate for Payer: Superior Health Plan EPO	$16.80

CHWR SAFETY SOFT TISSUE BIOPSY TRAY BCE

Facility

$123.54

Hospital Charge Code	8083040
Hospital Revenue Code	272
Rate for Payer: Cash Price	$108.72

CHWR SAFETY SOFT TISSUE BIOPSY TRAY BCE

Facility

$123.54

Hospital Charge Code	8083040
Hospital Revenue Code	272
Min. Negotiated Rate	$11.12
Max. Negotiated Rate	$80.30
Rate for Payer: Aetna Commercial	$67.95
Rate for Payer: Amerigroup CHIP/Medicaid	$11.12
Rate for Payer: BCBS of TX Blue Advantage	$37.06
Rate for Payer: BCBS of TX Blue Essentials	$44.47
Rate for Payer: BCBS of TX PPO	$49.42
Rate for Payer: Cash Price	$108.72
Rate for Payer: Multiplan Auto	$80.30
Rate for Payer: Multiplan Commercial	$80.30
Rate for Payer: Multiplan Workers Comp	$80.30
Rate for Payer: Scott and White EPO/PPO	$61.77
Rate for Payer: Superior Health Plan EPO	$16.80

CHWR SPINAL NEEDLE ANY SIZE

Facility

$78.04

Hospital Charge Code	8032875
Hospital Revenue Code	272
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$50.73
Rate for Payer: Aetna Commercial	$42.92
Rate for Payer: Amerigroup CHIP/Medicaid	$7.02
Rate for Payer: BCBS of TX Blue Advantage	$23.41
Rate for Payer: BCBS of TX Blue Essentials	$28.09
Rate for Payer: BCBS of TX PPO	$31.22
Rate for Payer: Cash Price	$68.68
Rate for Payer: Multiplan Auto	$50.73
Rate for Payer: Multiplan Commercial	$50.73
Rate for Payer: Multiplan Workers Comp	$50.73
Rate for Payer: Scott and White EPO/PPO	$39.02
Rate for Payer: Superior Health Plan EPO	$10.61

CHWR SPINAL NEEDLE ANY SIZE BCE

Facility

$78.04

Hospital Charge Code	8032875
Hospital Revenue Code	272
Rate for Payer: Cash Price	$68.68

CHWR SPINAL NEEDLE ANY SIZE BCE

Facility

$78.04

Hospital Charge Code	8032875
Hospital Revenue Code	272
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$50.73
Rate for Payer: Aetna Commercial	$42.92
Rate for Payer: Amerigroup CHIP/Medicaid	$7.02
Rate for Payer: BCBS of TX Blue Advantage	$23.41
Rate for Payer: BCBS of TX Blue Essentials	$28.09
Rate for Payer: BCBS of TX PPO	$31.22
Rate for Payer: Cash Price	$68.68
Rate for Payer: Multiplan Auto	$50.73
Rate for Payer: Multiplan Commercial	$50.73
Rate for Payer: Multiplan Workers Comp	$50.73
Rate for Payer: Scott and White EPO/PPO	$39.02
Rate for Payer: Superior Health Plan EPO	$10.61

CHWR STERI STRIPS

Facility

$55.15

Hospital Charge Code	8185055
Hospital Revenue Code	272
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$35.85
Rate for Payer: Aetna Commercial	$30.33
Rate for Payer: Amerigroup CHIP/Medicaid	$4.96
Rate for Payer: BCBS of TX Blue Advantage	$16.54
Rate for Payer: BCBS of TX Blue Essentials	$19.85
Rate for Payer: BCBS of TX PPO	$22.06
Rate for Payer: Cash Price	$48.53
Rate for Payer: Multiplan Auto	$35.85
Rate for Payer: Multiplan Commercial	$35.85
Rate for Payer: Multiplan Workers Comp	$35.85
Rate for Payer: Scott and White EPO/PPO	$27.58
Rate for Payer: Superior Health Plan EPO	$7.50

CHWR STERI STRIPS BCE

Facility

$55.15

Hospital Charge Code	8185055
Hospital Revenue Code	272
Rate for Payer: Cash Price	$48.53

CHWR STERI STRIPS BCE

Facility

$55.15

Hospital Charge Code	8185055
Hospital Revenue Code	272
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$35.85
Rate for Payer: Aetna Commercial	$30.33
Rate for Payer: Amerigroup CHIP/Medicaid	$4.96
Rate for Payer: BCBS of TX Blue Advantage	$16.54
Rate for Payer: BCBS of TX Blue Essentials	$19.85
Rate for Payer: BCBS of TX PPO	$22.06
Rate for Payer: Cash Price	$48.53
Rate for Payer: Multiplan Auto	$35.85
Rate for Payer: Multiplan Commercial	$35.85
Rate for Payer: Multiplan Workers Comp	$35.85
Rate for Payer: Scott and White EPO/PPO	$27.58
Rate for Payer: Superior Health Plan EPO	$7.50

CHWR STRKER BIOPSY GUIDE

Facility

$67.90

Hospital Charge Code	8032780
Hospital Revenue Code	272
Rate for Payer: Cash Price	$59.75

CHWR STRKER BIOPSY GUIDE

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 STRKER BIOPSY GUN

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 STRKER BIOPSY GUN BCE

Facility

$249.70

Hospital Charge Code	8081229
Hospital Revenue Code	272
Rate for Payer: Cash Price	$219.74

CHWR STRKER BIOPSY GUN BCE

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

Know your out-of-pocket cost for care.

All Charges