White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CHWR SUCTION CANISTER SET

Facility

$170.09

Hospital Charge Code	8034290
Hospital Revenue Code	270
Min. Negotiated Rate	$15.31
Max. Negotiated Rate	$110.56
Rate for Payer: Aetna Commercial	$93.55
Rate for Payer: Amerigroup CHIP/Medicaid	$15.31
Rate for Payer: BCBS of TX Blue Advantage	$51.03
Rate for Payer: BCBS of TX Blue Essentials	$61.23
Rate for Payer: BCBS of TX PPO	$68.04
Rate for Payer: Cash Price	$149.68
Rate for Payer: Multiplan Auto	$110.56
Rate for Payer: Multiplan Commercial	$110.56
Rate for Payer: Multiplan Workers Comp	$110.56
Rate for Payer: Scott and White EPO/PPO	$85.04
Rate for Payer: Superior Health Plan EPO	$23.13

CHWR SUCTION CANISTER SET BCE

Facility

$170.09

Hospital Charge Code	8034290
Hospital Revenue Code	270
Min. Negotiated Rate	$15.31
Max. Negotiated Rate	$110.56
Rate for Payer: Aetna Commercial	$93.55
Rate for Payer: Amerigroup CHIP/Medicaid	$15.31
Rate for Payer: BCBS of TX Blue Advantage	$51.03
Rate for Payer: BCBS of TX Blue Essentials	$61.23
Rate for Payer: BCBS of TX PPO	$68.04
Rate for Payer: Cash Price	$149.68
Rate for Payer: Multiplan Auto	$110.56
Rate for Payer: Multiplan Commercial	$110.56
Rate for Payer: Multiplan Workers Comp	$110.56
Rate for Payer: Scott and White EPO/PPO	$85.04
Rate for Payer: Superior Health Plan EPO	$23.13

CHWR SUCTION CANISTER SET BCE

Facility

$170.09

Hospital Charge Code	8034290
Hospital Revenue Code	270
Rate for Payer: Cash Price	$149.68

CHWR SUTURE NYLON

Facility

$234.19

Hospital Charge Code	8194145
Hospital Revenue Code	272
Min. Negotiated Rate	$21.08
Max. Negotiated Rate	$152.22
Rate for Payer: Aetna Commercial	$128.80
Rate for Payer: Amerigroup CHIP/Medicaid	$21.08
Rate for Payer: BCBS of TX Blue Advantage	$70.26
Rate for Payer: BCBS of TX Blue Essentials	$84.31
Rate for Payer: BCBS of TX PPO	$93.68
Rate for Payer: Cash Price	$206.09
Rate for Payer: Multiplan Auto	$152.22
Rate for Payer: Multiplan Commercial	$152.22
Rate for Payer: Multiplan Workers Comp	$152.22
Rate for Payer: Scott and White EPO/PPO	$117.10
Rate for Payer: Superior Health Plan EPO	$31.85

CHWR SUTURE NYLON BCE

Facility

$234.19

Hospital Charge Code	8194145
Hospital Revenue Code	272
Rate for Payer: Cash Price	$206.09

CHWR SUTURE NYLON BCE

Facility

$234.19

Hospital Charge Code	8194145
Hospital Revenue Code	272
Min. Negotiated Rate	$21.08
Max. Negotiated Rate	$152.22
Rate for Payer: Aetna Commercial	$128.80
Rate for Payer: Amerigroup CHIP/Medicaid	$21.08
Rate for Payer: BCBS of TX Blue Advantage	$70.26
Rate for Payer: BCBS of TX Blue Essentials	$84.31
Rate for Payer: BCBS of TX PPO	$93.68
Rate for Payer: Cash Price	$206.09
Rate for Payer: Multiplan Auto	$152.22
Rate for Payer: Multiplan Commercial	$152.22
Rate for Payer: Multiplan Workers Comp	$152.22
Rate for Payer: Scott and White EPO/PPO	$117.10
Rate for Payer: Superior Health Plan EPO	$31.85

CHWR SUTURE REMOVAL KIT

Facility

$98.82

Hospital Charge Code	8084130
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 SUTURE REMOVAL KIT BCE

Facility

$98.82

Hospital Charge Code	8084130
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 SUTURE REMOVAL KIT BCE

Facility

$98.82

Hospital Charge Code	8084130
Hospital Revenue Code	272
Rate for Payer: Cash Price	$86.96

CHWR TEGADERM

Facility

$73.38

Hospital Charge Code	8024885
Hospital Revenue Code	270
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna Commercial	$40.36
Rate for Payer: Amerigroup CHIP/Medicaid	$6.60
Rate for Payer: BCBS of TX Blue Advantage	$22.01
Rate for Payer: BCBS of TX Blue Essentials	$26.42
Rate for Payer: BCBS of TX PPO	$29.35
Rate for Payer: Cash Price	$64.57
Rate for Payer: Multiplan Auto	$47.70
Rate for Payer: Multiplan Commercial	$47.70
Rate for Payer: Multiplan Workers Comp	$47.70
Rate for Payer: Scott and White EPO/PPO	$36.69
Rate for Payer: Superior Health Plan EPO	$9.98

CHWR TEGADERM BCE

Facility

$73.38

Hospital Charge Code	8024885
Hospital Revenue Code	270
Rate for Payer: Cash Price	$64.57

CHWR TEGADERM BCE

Facility

$73.38

Hospital Charge Code	8024885
Hospital Revenue Code	270
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna Commercial	$40.36
Rate for Payer: Amerigroup CHIP/Medicaid	$6.60
Rate for Payer: BCBS of TX Blue Advantage	$22.01
Rate for Payer: BCBS of TX Blue Essentials	$26.42
Rate for Payer: BCBS of TX PPO	$29.35
Rate for Payer: Cash Price	$64.57
Rate for Payer: Multiplan Auto	$47.70
Rate for Payer: Multiplan Commercial	$47.70
Rate for Payer: Multiplan Workers Comp	$47.70
Rate for Payer: Scott and White EPO/PPO	$36.69
Rate for Payer: Superior Health Plan EPO	$9.98

CHWR THORACENTESIS 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 THORACENTESIS TRAY BCE

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 THORACENTESIS TRAY BCE

Facility

$755.53

Hospital Charge Code	8084310
Hospital Revenue Code	272
Rate for Payer: Cash Price	$664.87

CHWR TIRALYSIS KIT

Facility

$2,210.51

Hospital Charge Code	8056390
Hospital Revenue Code	272
Min. Negotiated Rate	$198.95
Max. Negotiated Rate	$1,436.83
Rate for Payer: Aetna Commercial	$1,215.78
Rate for Payer: Amerigroup CHIP/Medicaid	$198.95
Rate for Payer: BCBS of TX Blue Advantage	$663.15
Rate for Payer: BCBS of TX Blue Essentials	$795.78
Rate for Payer: BCBS of TX PPO	$884.20
Rate for Payer: Cash Price	$1,945.25
Rate for Payer: Multiplan Auto	$1,436.83
Rate for Payer: Multiplan Commercial	$1,436.83
Rate for Payer: Multiplan Workers Comp	$1,436.83
Rate for Payer: Scott and White EPO/PPO	$1,105.26
Rate for Payer: Superior Health Plan EPO	$300.63

CHWR TIRALYSIS KIT BCE

Facility

$2,210.51

Hospital Charge Code	8056390
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,945.25

CHWR TIRALYSIS KIT BCE

Facility

$2,210.51

Hospital Charge Code	8056390
Hospital Revenue Code	272
Min. Negotiated Rate	$198.95
Max. Negotiated Rate	$1,436.83
Rate for Payer: Aetna Commercial	$1,215.78
Rate for Payer: Amerigroup CHIP/Medicaid	$198.95
Rate for Payer: BCBS of TX Blue Advantage	$663.15
Rate for Payer: BCBS of TX Blue Essentials	$795.78
Rate for Payer: BCBS of TX PPO	$884.20
Rate for Payer: Cash Price	$1,945.25
Rate for Payer: Multiplan Auto	$1,436.83
Rate for Payer: Multiplan Commercial	$1,436.83
Rate for Payer: Multiplan Workers Comp	$1,436.83
Rate for Payer: Scott and White EPO/PPO	$1,105.26
Rate for Payer: Superior Health Plan EPO	$300.63

CHWR TRANSDUCER NEEDLE GUIDE w/ GEL

Facility

$98.82

Hospital Charge Code	8082253
Hospital Revenue Code	272
Rate for Payer: Cash Price	$86.96

CHWR TRANSDUCER NEEDLE GUIDE w/ GEL

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 URETERAL CATHETER 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 URETERAL CATHETER TRAY BCE

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 URETERAL CATHETER TRAY BCE

Facility

$254.05

Hospital Charge Code	8083175
Hospital Revenue Code	272
Rate for Payer: Cash Price	$223.56

CHWR US BREAST BX/LOC/SPECIMEN EA ADD

Facility

$1,974.00

Service Code	CPT 19084
Hospital Charge Code	5069184
Hospital Revenue Code	361
Min. Negotiated Rate	$60.14
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$1,085.70
Rate for Payer: Amerigroup CHIP/Medicaid	$177.66
Rate for Payer: Cash Price	$1,737.12
Rate for Payer: Cash Price	$1,737.12
Rate for Payer: Cash Price	$1,737.12
Rate for Payer: Cigna Medicaid	$60.14
Rate for Payer: Molina CHIP/Medicaid	$60.14
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: Parkland Medicaid	$60.14
Rate for Payer: Scott and White EPO/PPO	$987.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$60.14
Rate for Payer: Superior Health Plan EPO	$268.46

CHWR US BREAST BX/LOC/SPECIMEN EA ADD BCE

Facility

$1,974.00

Service Code	CPT 19084
Hospital Charge Code	5069184
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,737.12

Know your out-of-pocket cost for care.

All Charges