White Rock Medical Center

All Charges

Charge

Type

Setting

Price

BLOCKER ENDOBRONCHIAL RUSCH EZ-BLOCK

Facility

$894.38

Hospital Charge Code	145525
Hospital Revenue Code	272
Min. Negotiated Rate	$80.49
Max. Negotiated Rate	$643.95
Rate for Payer: Amerigroup CHIP/Medicaid	$80.49
Rate for Payer: BCBS of TX Blue Advantage	$268.31
Rate for Payer: BCBS of TX Blue Essentials	$321.98
Rate for Payer: BCBS of TX PPO	$357.75
Rate for Payer: Cash Price	$608.18
Rate for Payer: Cigna Medicaid	$643.95
Rate for Payer: Molina CHIP/Medicaid	$643.95
Rate for Payer: Multiplan Auto	$581.35
Rate for Payer: Multiplan Commercial	$581.35
Rate for Payer: Multiplan Workers Comp	$581.35
Rate for Payer: Parkland Medicaid	$643.95
Rate for Payer: Scott and White EPO/PPO	$447.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$643.95
Rate for Payer: Superior Health Plan EPO	$121.64

Blood Administration Charges: -> Blood Administration Complete

Facility

$2,059.00

Service Code	HCPCS 36430
Hospital Charge Code	2408664
Hospital Revenue Code	391
Rate for Payer: Cash Price	$1,400.12

Blood Administration Charges: -> Blood Administration Complete

Facility

$2,059.00

Service Code	HCPCS 36430
Hospital Charge Code	2408664
Hospital Revenue Code	391
Min. Negotiated Rate	$52.19
Max. Negotiated Rate	$1,482.48
Rate for Payer: Amerigroup CHIP/Medicaid	$185.31
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$443.18
Rate for Payer: Amerigroup Medicare	$443.18
Rate for Payer: BCBS of TX Blue Advantage	$58.47
Rate for Payer: BCBS of TX Blue Essentials	$70.02
Rate for Payer: BCBS of TX Medicare	$443.18
Rate for Payer: BCBS of TX PPO	$88.23
Rate for Payer: Cash Price	$1,400.12
Rate for Payer: Cash Price	$1,400.12
Rate for Payer: Cash Price	$1,400.12
Rate for Payer: Cigna Commercial	$936.81
Rate for Payer: Cigna Medicaid	$1,482.48
Rate for Payer: Cigna Medicare	$443.18
Rate for Payer: Employer Direct Commercial	$443.18
Rate for Payer: Humana Medicare/TRICARE	$443.18
Rate for Payer: Molina CHIP/Medicaid	$1,482.48
Rate for Payer: Molina Dual Medicare/Medicaid	$443.18
Rate for Payer: Molina Medicare	$443.18
Rate for Payer: Multiplan Auto	$1,338.35
Rate for Payer: Multiplan Commercial	$1,338.35
Rate for Payer: Multiplan Workers Comp	$1,338.35
Rate for Payer: Parkland Medicaid	$1,482.48
Rate for Payer: Scott and White EPO/PPO	$52.19
Rate for Payer: Scott and White Medicare	$443.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,482.48
Rate for Payer: Superior Health Plan EPO	$443.18
Rate for Payer: Superior Health Plan Medicare	$443.18
Rate for Payer: Universal American Dual Medicare/Medicaid	$443.18
Rate for Payer: Universal American Medicare	$443.18
Rate for Payer: Wellcare Medicare	$443.18
Rate for Payer: Wellmed Medicare	$443.18

BLOOD ADMIN SET KENTEC 039600F

Facility

$65.96

Hospital Charge Code	8568497
Hospital Revenue Code	272
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$47.49
Rate for Payer: Amerigroup CHIP/Medicaid	$5.94
Rate for Payer: BCBS of TX Blue Advantage	$19.79
Rate for Payer: BCBS of TX Blue Essentials	$23.75
Rate for Payer: BCBS of TX PPO	$26.38
Rate for Payer: Cash Price	$44.85
Rate for Payer: Cigna Medicaid	$47.49
Rate for Payer: Molina CHIP/Medicaid	$47.49
Rate for Payer: Multiplan Auto	$42.87
Rate for Payer: Multiplan Commercial	$42.87
Rate for Payer: Multiplan Workers Comp	$42.87
Rate for Payer: Parkland Medicaid	$47.49
Rate for Payer: Scott and White EPO/PPO	$32.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$47.49
Rate for Payer: Superior Health Plan EPO	$8.97

BLOOD ADMIN SET KENTEC 039600F

Facility

$65.96

Hospital Charge Code	8568497
Hospital Revenue Code	272
Rate for Payer: Cash Price	$44.85

Blood Agar Plate, 5% Sheep In Tryptic Soy Agar Base, Eh, 15 x 100 mm plate

Facility

$9.65

Hospital Charge Code	993332
Hospital Revenue Code	272
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$6.95
Rate for Payer: Amerigroup CHIP/Medicaid	$0.87
Rate for Payer: BCBS of TX Blue Advantage	$2.90
Rate for Payer: BCBS of TX Blue Essentials	$3.47
Rate for Payer: BCBS of TX PPO	$3.86
Rate for Payer: Cash Price	$6.56
Rate for Payer: Cigna Medicaid	$6.95
Rate for Payer: Molina CHIP/Medicaid	$6.95
Rate for Payer: Multiplan Auto	$6.27
Rate for Payer: Multiplan Commercial	$6.27
Rate for Payer: Multiplan Workers Comp	$6.27
Rate for Payer: Parkland Medicaid	$6.95
Rate for Payer: Scott and White EPO/PPO	$4.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.95
Rate for Payer: Superior Health Plan EPO	$1.31

Blood Agar Plate, 5% Sheep In Tryptic Soy Agar Base, Eh, 15 x 100 mm plate

Facility

$9.65

Hospital Charge Code	993332
Hospital Revenue Code	272
Rate for Payer: Cash Price	$6.56

Blood Agar Plate Slide, 5% Sheep Blood, Polystyrene Petri, for the Nonselective Cultivation of Microorganisms, Bacteria, Yeast and Fungi

Facility

$3.55

Hospital Charge Code	993340
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2.41

Blood Agar Plate Slide, 5% Sheep Blood, Polystyrene Petri, for the Nonselective Cultivation of Microorganisms, Bacteria, Yeast and Fungi

Facility

$3.55

Hospital Charge Code	993340
Hospital Revenue Code	272
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$2.56
Rate for Payer: Amerigroup CHIP/Medicaid	$0.32
Rate for Payer: BCBS of TX Blue Advantage	$1.06
Rate for Payer: BCBS of TX Blue Essentials	$1.28
Rate for Payer: BCBS of TX PPO	$1.42
Rate for Payer: Cash Price	$2.41
Rate for Payer: Cigna Medicaid	$2.56
Rate for Payer: Molina CHIP/Medicaid	$2.56
Rate for Payer: Multiplan Auto	$2.31
Rate for Payer: Multiplan Commercial	$2.31
Rate for Payer: Multiplan Workers Comp	$2.31
Rate for Payer: Parkland Medicaid	$2.56
Rate for Payer: Scott and White EPO/PPO	$1.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.56
Rate for Payer: Superior Health Plan EPO	$0.48

Blood count; complete (CBC), automated

Facility

$243.00

Service Code	HCPCS 85027
Hospital Charge Code	1600477
Hospital Revenue Code	305
Rate for Payer: Cash Price	$165.24

Blood count; complete (CBC), automated

Facility

$243.00

Service Code	HCPCS 85027
Hospital Charge Code	1600477
Hospital Revenue Code	305
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$174.96
Rate for Payer: Amerigroup CHIP/Medicaid	$2.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6.47
Rate for Payer: Amerigroup Medicare	$6.47
Rate for Payer: BCBS of TX Blue Advantage	$72.90
Rate for Payer: BCBS of TX Blue Essentials	$87.48
Rate for Payer: BCBS of TX Medicare	$6.47
Rate for Payer: BCBS of TX PPO	$97.20
Rate for Payer: Cash Price	$165.24
Rate for Payer: Cash Price	$165.24
Rate for Payer: Cigna Medicaid	$174.96
Rate for Payer: Cigna Medicare	$6.47
Rate for Payer: Employer Direct Commercial	$6.47
Rate for Payer: Humana Medicare/TRICARE	$6.47
Rate for Payer: Molina CHIP/Medicaid	$174.96
Rate for Payer: Molina Dual Medicare/Medicaid	$6.47
Rate for Payer: Molina Medicare	$6.47
Rate for Payer: Multiplan Auto	$157.95
Rate for Payer: Multiplan Commercial	$157.95
Rate for Payer: Multiplan Workers Comp	$157.95
Rate for Payer: Parkland Medicaid	$174.96
Rate for Payer: Scott and White EPO/PPO	$8.09
Rate for Payer: Scott and White Medicare	$6.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$174.96
Rate for Payer: Superior Health Plan EPO	$6.47
Rate for Payer: Superior Health Plan Medicare	$6.47
Rate for Payer: Universal American Dual Medicare/Medicaid	$6.47
Rate for Payer: Universal American Medicare	$6.47
Rate for Payer: Wellcare Medicare	$6.47
Rate for Payer: Wellmed Medicare	$6.47

Blood Culture

Facility

$391.00

Service Code	HCPCS 87040
Hospital Charge Code	4107040
Hospital Revenue Code	306
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$281.52
Rate for Payer: Amerigroup CHIP/Medicaid	$4.02
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10.32
Rate for Payer: Amerigroup Medicare	$10.32
Rate for Payer: BCBS of TX Blue Advantage	$117.30
Rate for Payer: BCBS of TX Blue Essentials	$140.76
Rate for Payer: BCBS of TX Medicare	$10.32
Rate for Payer: BCBS of TX PPO	$156.40
Rate for Payer: Cash Price	$265.88
Rate for Payer: Cash Price	$265.88
Rate for Payer: Cigna Medicaid	$281.52
Rate for Payer: Cigna Medicare	$10.32
Rate for Payer: Employer Direct Commercial	$10.32
Rate for Payer: Humana Medicare/TRICARE	$10.32
Rate for Payer: Molina CHIP/Medicaid	$281.52
Rate for Payer: Molina Dual Medicare/Medicaid	$10.32
Rate for Payer: Molina Medicare	$10.32
Rate for Payer: Multiplan Auto	$254.15
Rate for Payer: Multiplan Commercial	$254.15
Rate for Payer: Multiplan Workers Comp	$254.15
Rate for Payer: Parkland Medicaid	$281.52
Rate for Payer: Scott and White EPO/PPO	$12.90
Rate for Payer: Scott and White Medicare	$10.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$281.52
Rate for Payer: Superior Health Plan EPO	$10.32
Rate for Payer: Superior Health Plan Medicare	$10.32
Rate for Payer: Universal American Dual Medicare/Medicaid	$10.32
Rate for Payer: Universal American Medicare	$10.32
Rate for Payer: Wellcare Medicare	$10.32
Rate for Payer: Wellmed Medicare	$10.32

Blood Culture

Facility

$391.00

Service Code	HCPCS 87040
Hospital Charge Code	4107040
Hospital Revenue Code	306
Rate for Payer: Cash Price	$265.88

BLOOD INFU ST -- DHF

Facility

$53.29

Hospital Charge Code	80313356
Hospital Revenue Code	272
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$38.37
Rate for Payer: Amerigroup CHIP/Medicaid	$4.80
Rate for Payer: BCBS of TX Blue Advantage	$15.99
Rate for Payer: BCBS of TX Blue Essentials	$19.18
Rate for Payer: BCBS of TX PPO	$21.32
Rate for Payer: Cash Price	$36.24
Rate for Payer: Cigna Medicaid	$38.37
Rate for Payer: Molina CHIP/Medicaid	$38.37
Rate for Payer: Multiplan Auto	$34.64
Rate for Payer: Multiplan Commercial	$34.64
Rate for Payer: Multiplan Workers Comp	$34.64
Rate for Payer: Parkland Medicaid	$38.37
Rate for Payer: Scott and White EPO/PPO	$26.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$38.37
Rate for Payer: Superior Health Plan EPO	$7.25

BLOOD INFU ST -- DHF

Facility

$53.29

Hospital Charge Code	80313356
Hospital Revenue Code	272
Rate for Payer: Cash Price	$36.24

Blood, occult, by fecal

Facility

$173.60

Service Code	HCPCS 82274
Hospital Charge Code	993995
Hospital Revenue Code	300
Min. Negotiated Rate	$6.21
Max. Negotiated Rate	$124.99
Rate for Payer: Amerigroup CHIP/Medicaid	$6.21
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15.92
Rate for Payer: Amerigroup Medicare	$15.92
Rate for Payer: BCBS of TX Blue Advantage	$52.08
Rate for Payer: BCBS of TX Blue Essentials	$62.50
Rate for Payer: BCBS of TX Medicare	$15.92
Rate for Payer: BCBS of TX PPO	$69.44
Rate for Payer: Cash Price	$118.05
Rate for Payer: Cash Price	$118.05
Rate for Payer: Cigna Medicaid	$124.99
Rate for Payer: Cigna Medicare	$15.92
Rate for Payer: Employer Direct Commercial	$15.92
Rate for Payer: Humana Medicare/TRICARE	$15.92
Rate for Payer: Molina CHIP/Medicaid	$124.99
Rate for Payer: Molina Dual Medicare/Medicaid	$15.92
Rate for Payer: Molina Medicare	$15.92
Rate for Payer: Multiplan Auto	$112.84
Rate for Payer: Multiplan Commercial	$112.84
Rate for Payer: Multiplan Workers Comp	$112.84
Rate for Payer: Parkland Medicaid	$124.99
Rate for Payer: Scott and White EPO/PPO	$19.90
Rate for Payer: Scott and White Medicare	$15.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$124.99
Rate for Payer: Superior Health Plan EPO	$15.92
Rate for Payer: Superior Health Plan Medicare	$15.92
Rate for Payer: Universal American Dual Medicare/Medicaid	$15.92
Rate for Payer: Universal American Medicare	$15.92
Rate for Payer: Wellcare Medicare	$15.92
Rate for Payer: Wellmed Medicare	$15.92

Blood, occult, by fecal

Facility

$173.60

Service Code	HCPCS 82274
Hospital Charge Code	993995
Hospital Revenue Code	300
Rate for Payer: Cash Price	$118.05

Blood, occult, by peroxidase activity

Facility

$152.00

Service Code	HCPCS 82270
Hospital Charge Code	4102270
Hospital Revenue Code	301
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$109.44
Rate for Payer: Amerigroup CHIP/Medicaid	$1.71
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$4.38
Rate for Payer: Amerigroup Medicare	$4.38
Rate for Payer: BCBS of TX Blue Advantage	$45.60
Rate for Payer: BCBS of TX Blue Essentials	$54.72
Rate for Payer: BCBS of TX Medicare	$4.38
Rate for Payer: BCBS of TX PPO	$60.80
Rate for Payer: Cash Price	$103.36
Rate for Payer: Cash Price	$103.36
Rate for Payer: Cigna Medicaid	$109.44
Rate for Payer: Cigna Medicare	$4.38
Rate for Payer: Employer Direct Commercial	$4.38
Rate for Payer: Humana Medicare/TRICARE	$4.38
Rate for Payer: Molina CHIP/Medicaid	$109.44
Rate for Payer: Molina Dual Medicare/Medicaid	$4.38
Rate for Payer: Molina Medicare	$4.38
Rate for Payer: Multiplan Auto	$98.80
Rate for Payer: Multiplan Commercial	$98.80
Rate for Payer: Multiplan Workers Comp	$98.80
Rate for Payer: Parkland Medicaid	$109.44
Rate for Payer: Scott and White EPO/PPO	$5.47
Rate for Payer: Scott and White Medicare	$4.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$109.44
Rate for Payer: Superior Health Plan EPO	$4.38
Rate for Payer: Superior Health Plan Medicare	$4.38
Rate for Payer: Universal American Dual Medicare/Medicaid	$4.38
Rate for Payer: Universal American Medicare	$4.38
Rate for Payer: Wellcare Medicare	$4.38
Rate for Payer: Wellmed Medicare	$4.38

Blood, occult, by peroxidase activity

Facility

$152.00

Service Code	HCPCS 82270
Hospital Charge Code	4102270
Hospital Revenue Code	301
Rate for Payer: Cash Price	$103.36

Blood, occult, by peroxidase activity

Facility

$152.00

Service Code	HCPCS 82270
Hospital Charge Code	1604073
Hospital Revenue Code	301
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$109.44
Rate for Payer: Amerigroup CHIP/Medicaid	$1.71
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$4.38
Rate for Payer: Amerigroup Medicare	$4.38
Rate for Payer: BCBS of TX Blue Advantage	$45.60
Rate for Payer: BCBS of TX Blue Essentials	$54.72
Rate for Payer: BCBS of TX Medicare	$4.38
Rate for Payer: BCBS of TX PPO	$60.80
Rate for Payer: Cash Price	$103.36
Rate for Payer: Cash Price	$103.36
Rate for Payer: Cigna Medicaid	$109.44
Rate for Payer: Cigna Medicare	$4.38
Rate for Payer: Employer Direct Commercial	$4.38
Rate for Payer: Humana Medicare/TRICARE	$4.38
Rate for Payer: Molina CHIP/Medicaid	$109.44
Rate for Payer: Molina Dual Medicare/Medicaid	$4.38
Rate for Payer: Molina Medicare	$4.38
Rate for Payer: Multiplan Auto	$98.80
Rate for Payer: Multiplan Commercial	$98.80
Rate for Payer: Multiplan Workers Comp	$98.80
Rate for Payer: Parkland Medicaid	$109.44
Rate for Payer: Scott and White EPO/PPO	$5.47
Rate for Payer: Scott and White Medicare	$4.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$109.44
Rate for Payer: Superior Health Plan EPO	$4.38
Rate for Payer: Superior Health Plan Medicare	$4.38
Rate for Payer: Universal American Dual Medicare/Medicaid	$4.38
Rate for Payer: Universal American Medicare	$4.38
Rate for Payer: Wellcare Medicare	$4.38
Rate for Payer: Wellmed Medicare	$4.38

Blood, occult, by peroxidase activity

Facility

$152.00

Service Code	HCPCS 82270
Hospital Charge Code	1604073
Hospital Revenue Code	301
Rate for Payer: Cash Price	$103.36

Blood Pressure Cuff Small 20 / Bx

Facility

$13.84

Hospital Charge Code	993947
Hospital Revenue Code	271
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$9.96
Rate for Payer: Amerigroup CHIP/Medicaid	$1.25
Rate for Payer: BCBS of TX Blue Advantage	$4.15
Rate for Payer: BCBS of TX Blue Essentials	$4.98
Rate for Payer: BCBS of TX PPO	$5.54
Rate for Payer: Cash Price	$9.41
Rate for Payer: Cigna Medicaid	$9.96
Rate for Payer: Molina CHIP/Medicaid	$9.96
Rate for Payer: Multiplan Auto	$9.00
Rate for Payer: Multiplan Commercial	$9.00
Rate for Payer: Multiplan Workers Comp	$9.00
Rate for Payer: Parkland Medicaid	$9.96
Rate for Payer: Scott and White EPO/PPO	$6.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.96
Rate for Payer: Superior Health Plan EPO	$1.88

Blood Pressure Cuff Small 20 / Bx

Facility

$13.84

Hospital Charge Code	993947
Hospital Revenue Code	271
Rate for Payer: Cash Price	$9.41

Blood Urea Nitrogen

Facility

$164.00

Service Code	HCPCS 84520
Hospital Charge Code	1602358
Hospital Revenue Code	301
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$118.08
Rate for Payer: Amerigroup CHIP/Medicaid	$1.54
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3.95
Rate for Payer: Amerigroup Medicare	$3.95
Rate for Payer: BCBS of TX Blue Advantage	$49.20
Rate for Payer: BCBS of TX Blue Essentials	$59.04
Rate for Payer: BCBS of TX Medicare	$3.95
Rate for Payer: BCBS of TX PPO	$65.60
Rate for Payer: Cash Price	$111.52
Rate for Payer: Cash Price	$111.52
Rate for Payer: Cigna Medicaid	$118.08
Rate for Payer: Cigna Medicare	$3.95
Rate for Payer: Employer Direct Commercial	$3.95
Rate for Payer: Humana Medicare/TRICARE	$3.95
Rate for Payer: Molina CHIP/Medicaid	$118.08
Rate for Payer: Molina Dual Medicare/Medicaid	$3.95
Rate for Payer: Molina Medicare	$3.95
Rate for Payer: Multiplan Auto	$106.60
Rate for Payer: Multiplan Commercial	$106.60
Rate for Payer: Multiplan Workers Comp	$106.60
Rate for Payer: Parkland Medicaid	$118.08
Rate for Payer: Scott and White EPO/PPO	$4.94
Rate for Payer: Scott and White Medicare	$3.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$118.08
Rate for Payer: Superior Health Plan EPO	$3.95
Rate for Payer: Superior Health Plan Medicare	$3.95
Rate for Payer: Universal American Dual Medicare/Medicaid	$3.95
Rate for Payer: Universal American Medicare	$3.95
Rate for Payer: Wellcare Medicare	$3.95
Rate for Payer: Wellmed Medicare	$3.95

Blood Urea Nitrogen

Facility

$164.00

Service Code	HCPCS 84520
Hospital Charge Code	1602358
Hospital Revenue Code	301
Rate for Payer: Cash Price	$111.52

Know your out-of-pocket cost for care.

All Charges