White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CABLE, CONNECTING, 400 SERIES, C400MP-M C02

Facility

$121.08

Hospital Charge Code	992887
Hospital Revenue Code	272
Rate for Payer: Cash Price	$82.33

Cable CPM ECG Patient Harness, US

Facility

$2,265.46

Hospital Charge Code	993838
Hospital Revenue Code	279
Rate for Payer: Cash Price	$1,540.51

Cable CPM ECG Patient Harness, US

Facility

$2,265.46

Hospital Charge Code	993838
Hospital Revenue Code	279
Min. Negotiated Rate	$203.89
Max. Negotiated Rate	$1,631.13
Rate for Payer: Amerigroup CHIP/Medicaid	$203.89
Rate for Payer: BCBS of TX Blue Advantage	$679.64
Rate for Payer: BCBS of TX Blue Essentials	$815.57
Rate for Payer: BCBS of TX PPO	$906.18
Rate for Payer: Cash Price	$1,540.51
Rate for Payer: Cigna Medicaid	$1,631.13
Rate for Payer: Molina CHIP/Medicaid	$1,631.13
Rate for Payer: Multiplan Auto	$1,472.55
Rate for Payer: Multiplan Commercial	$1,472.55
Rate for Payer: Multiplan Workers Comp	$1,472.55
Rate for Payer: Parkland Medicaid	$1,631.13
Rate for Payer: Scott and White EPO/PPO	$1,132.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,631.13
Rate for Payer: Superior Health Plan EPO	$308.10

CABLE PACING

Facility

$136.20

Hospital Charge Code	8414452
Hospital Revenue Code	272
Rate for Payer: Cash Price	$92.62

CABLE PACING

Facility

$136.20

Hospital Charge Code	8414452
Hospital Revenue Code	272
Min. Negotiated Rate	$12.26
Max. Negotiated Rate	$98.06
Rate for Payer: Amerigroup CHIP/Medicaid	$12.26
Rate for Payer: BCBS of TX Blue Advantage	$40.86
Rate for Payer: BCBS of TX Blue Essentials	$49.03
Rate for Payer: BCBS of TX PPO	$54.48
Rate for Payer: Cash Price	$92.62
Rate for Payer: Cigna Medicaid	$98.06
Rate for Payer: Molina CHIP/Medicaid	$98.06
Rate for Payer: Multiplan Auto	$88.53
Rate for Payer: Multiplan Commercial	$88.53
Rate for Payer: Multiplan Workers Comp	$88.53
Rate for Payer: Parkland Medicaid	$98.06
Rate for Payer: Scott and White EPO/PPO	$68.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$98.06
Rate for Payer: Superior Health Plan EPO	$18.52

CABLE PACING 4051I

Facility

$127.71

Hospital Charge Code	8478522
Hospital Revenue Code	272
Min. Negotiated Rate	$11.49
Max. Negotiated Rate	$91.95
Rate for Payer: Amerigroup CHIP/Medicaid	$11.49
Rate for Payer: BCBS of TX Blue Advantage	$38.31
Rate for Payer: BCBS of TX Blue Essentials	$45.98
Rate for Payer: BCBS of TX PPO	$51.08
Rate for Payer: Cash Price	$86.84
Rate for Payer: Cigna Medicaid	$91.95
Rate for Payer: Molina CHIP/Medicaid	$91.95
Rate for Payer: Multiplan Auto	$83.01
Rate for Payer: Multiplan Commercial	$83.01
Rate for Payer: Multiplan Workers Comp	$83.01
Rate for Payer: Parkland Medicaid	$91.95
Rate for Payer: Scott and White EPO/PPO	$63.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$91.95
Rate for Payer: Superior Health Plan EPO	$17.37

CABLE PACING 4051I

Facility

$127.71

Hospital Charge Code	8478522
Hospital Revenue Code	272
Rate for Payer: Cash Price	$86.84

CABLE PCNG 12FT SFTY ALGTR CLIP TEMP

Facility

$272.40

Hospital Charge Code	110177
Hospital Revenue Code	272
Min. Negotiated Rate	$24.52
Max. Negotiated Rate	$196.13
Rate for Payer: Amerigroup CHIP/Medicaid	$24.52
Rate for Payer: BCBS of TX Blue Advantage	$81.72
Rate for Payer: BCBS of TX Blue Essentials	$98.06
Rate for Payer: BCBS of TX PPO	$108.96
Rate for Payer: Cash Price	$185.23
Rate for Payer: Cigna Medicaid	$196.13
Rate for Payer: Molina CHIP/Medicaid	$196.13
Rate for Payer: Multiplan Auto	$177.06
Rate for Payer: Multiplan Commercial	$177.06
Rate for Payer: Multiplan Workers Comp	$177.06
Rate for Payer: Parkland Medicaid	$196.13
Rate for Payer: Scott and White EPO/PPO	$136.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$196.13
Rate for Payer: Superior Health Plan EPO	$37.05

CABLE PCNG 12FT SFTY ALGTR CLIP TEMP

Facility

$272.40

Hospital Charge Code	110177
Hospital Revenue Code	272
Rate for Payer: Cash Price	$185.23

CABLE THRESHOLD PM SJ4 -- DHF

Facility

$136.20

Hospital Charge Code	40082505
Hospital Revenue Code	272
Min. Negotiated Rate	$12.26
Max. Negotiated Rate	$98.06
Rate for Payer: Amerigroup CHIP/Medicaid	$12.26
Rate for Payer: BCBS of TX Blue Advantage	$40.86
Rate for Payer: BCBS of TX Blue Essentials	$49.03
Rate for Payer: BCBS of TX PPO	$54.48
Rate for Payer: Cash Price	$92.62
Rate for Payer: Cigna Medicaid	$98.06
Rate for Payer: Molina CHIP/Medicaid	$98.06
Rate for Payer: Multiplan Auto	$88.53
Rate for Payer: Multiplan Commercial	$88.53
Rate for Payer: Multiplan Workers Comp	$88.53
Rate for Payer: Parkland Medicaid	$98.06
Rate for Payer: Scott and White EPO/PPO	$68.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$98.06
Rate for Payer: Superior Health Plan EPO	$18.52

CABLE THRESHOLD PM SJ4 -- DHF

Facility

$136.20

Hospital Charge Code	40082505
Hospital Revenue Code	272
Rate for Payer: Cash Price	$92.62

CAGE ACIF

Facility

$10,241.00

Service Code	HCPCS C1831
Hospital Charge Code	8420465
Hospital Revenue Code	278
Min. Negotiated Rate	$2,560.25
Max. Negotiated Rate	$5,120.50
Rate for Payer: Cash Price	$6,963.88
Rate for Payer: Cigna Commercial	$2,560.25
Rate for Payer: Multiplan Auto	$5,120.50
Rate for Payer: Multiplan Commercial	$5,120.50
Rate for Payer: Multiplan Workers Comp	$5,120.50
Rate for Payer: Scott and White EPO/PPO	$5,120.50

CAGE ACIF

Facility

$10,241.00

Service Code	HCPCS C1831
Hospital Charge Code	8420465
Hospital Revenue Code	278
Min. Negotiated Rate	$921.69
Max. Negotiated Rate	$7,373.52
Rate for Payer: Amerigroup CHIP/Medicaid	$921.69
Rate for Payer: Cash Price	$6,963.88
Rate for Payer: Cigna Medicaid	$7,373.52
Rate for Payer: Molina CHIP/Medicaid	$7,373.52
Rate for Payer: Multiplan Auto	$5,120.50
Rate for Payer: Multiplan Commercial	$5,120.50
Rate for Payer: Multiplan Workers Comp	$5,120.50
Rate for Payer: Parkland Medicaid	$7,373.52
Rate for Payer: Scott and White EPO/PPO	$5,120.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,373.52
Rate for Payer: Superior Health Plan EPO	$1,392.78

cage interbody acif

Facility

$7,831.00

Service Code	HCPCS C1831
Hospital Charge Code	8672536
Hospital Revenue Code	278
Min. Negotiated Rate	$704.79
Max. Negotiated Rate	$5,638.32
Rate for Payer: Amerigroup CHIP/Medicaid	$704.79
Rate for Payer: Cash Price	$5,325.08
Rate for Payer: Cigna Medicaid	$5,638.32
Rate for Payer: Molina CHIP/Medicaid	$5,638.32
Rate for Payer: Multiplan Auto	$3,915.50
Rate for Payer: Multiplan Commercial	$3,915.50
Rate for Payer: Multiplan Workers Comp	$3,915.50
Rate for Payer: Parkland Medicaid	$5,638.32
Rate for Payer: Scott and White EPO/PPO	$3,915.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,638.32
Rate for Payer: Superior Health Plan EPO	$1,065.02

cage interbody acif

Facility

$7,831.00

Service Code	HCPCS C1831
Hospital Charge Code	8672536
Hospital Revenue Code	278
Min. Negotiated Rate	$1,957.75
Max. Negotiated Rate	$3,915.50
Rate for Payer: Cash Price	$5,325.08
Rate for Payer: Cigna Commercial	$1,957.75
Rate for Payer: Multiplan Auto	$3,915.50
Rate for Payer: Multiplan Commercial	$3,915.50
Rate for Payer: Multiplan Workers Comp	$3,915.50
Rate for Payer: Scott and White EPO/PPO	$3,915.50

CAGE PEEK VAULT 32MMX8X15MM

Facility

$36,145.00

Service Code	HCPCS C1831
Hospital Charge Code	8394470
Hospital Revenue Code	278
Min. Negotiated Rate	$3,253.05
Max. Negotiated Rate	$26,024.40
Rate for Payer: Amerigroup CHIP/Medicaid	$3,253.05
Rate for Payer: Cash Price	$24,578.60
Rate for Payer: Cigna Medicaid	$26,024.40
Rate for Payer: Molina CHIP/Medicaid	$26,024.40
Rate for Payer: Multiplan Auto	$18,072.50
Rate for Payer: Multiplan Commercial	$18,072.50
Rate for Payer: Multiplan Workers Comp	$18,072.50
Rate for Payer: Parkland Medicaid	$26,024.40
Rate for Payer: Scott and White EPO/PPO	$18,072.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$26,024.40
Rate for Payer: Superior Health Plan EPO	$4,915.72

CAGE PEEK VAULT 32MMX8X15MM

Facility

$36,145.00

Service Code	HCPCS C1831
Hospital Charge Code	8394470
Hospital Revenue Code	278
Min. Negotiated Rate	$9,036.25
Max. Negotiated Rate	$18,072.50
Rate for Payer: Cash Price	$24,578.60
Rate for Payer: Cigna Commercial	$9,036.25
Rate for Payer: Multiplan Auto	$18,072.50
Rate for Payer: Multiplan Commercial	$18,072.50
Rate for Payer: Multiplan Workers Comp	$18,072.50
Rate for Payer: Scott and White EPO/PPO	$18,072.50

cage vault peek 32mmx15x15mm

Facility

$36,145.00

Service Code	HCPCS C1831
Hospital Charge Code	8394463
Hospital Revenue Code	278
Min. Negotiated Rate	$3,253.05
Max. Negotiated Rate	$26,024.40
Rate for Payer: Amerigroup CHIP/Medicaid	$3,253.05
Rate for Payer: Cash Price	$24,578.60
Rate for Payer: Cigna Medicaid	$26,024.40
Rate for Payer: Molina CHIP/Medicaid	$26,024.40
Rate for Payer: Multiplan Auto	$18,072.50
Rate for Payer: Multiplan Commercial	$18,072.50
Rate for Payer: Multiplan Workers Comp	$18,072.50
Rate for Payer: Parkland Medicaid	$26,024.40
Rate for Payer: Scott and White EPO/PPO	$18,072.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$26,024.40
Rate for Payer: Superior Health Plan EPO	$4,915.72

cage vault peek 32mmx15x15mm

Facility

$36,145.00

Service Code	HCPCS C1831
Hospital Charge Code	8394463
Hospital Revenue Code	278
Min. Negotiated Rate	$9,036.25
Max. Negotiated Rate	$18,072.50
Rate for Payer: Cash Price	$24,578.60
Rate for Payer: Cigna Commercial	$9,036.25
Rate for Payer: Multiplan Auto	$18,072.50
Rate for Payer: Multiplan Commercial	$18,072.50
Rate for Payer: Multiplan Workers Comp	$18,072.50
Rate for Payer: Scott and White EPO/PPO	$18,072.50

CALCFX PERCPLT,STD ANT PROC/POST TUBER,R

Facility

$8,285.50

Service Code	HCPCS C1734
Hospital Charge Code	992596
Hospital Revenue Code	278
Min. Negotiated Rate	$745.70
Max. Negotiated Rate	$5,965.56
Rate for Payer: Amerigroup CHIP/Medicaid	$745.70
Rate for Payer: BCBS of TX Blue Advantage	$2,485.65
Rate for Payer: BCBS of TX Blue Essentials	$2,982.78
Rate for Payer: BCBS of TX PPO	$3,314.20
Rate for Payer: Cash Price	$5,634.14
Rate for Payer: Cigna Medicaid	$5,965.56
Rate for Payer: Molina CHIP/Medicaid	$5,965.56
Rate for Payer: Multiplan Auto	$4,142.75
Rate for Payer: Multiplan Commercial	$4,142.75
Rate for Payer: Multiplan Workers Comp	$4,142.75
Rate for Payer: Parkland Medicaid	$5,965.56
Rate for Payer: Scott and White EPO/PPO	$4,142.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,965.56
Rate for Payer: Superior Health Plan EPO	$1,126.83

CALCFX PERCPLT,STD ANT PROC/POST TUBER,R

Facility

$8,285.50

Service Code	HCPCS C1734
Hospital Charge Code	992596
Hospital Revenue Code	278
Min. Negotiated Rate	$2,071.38
Max. Negotiated Rate	$4,142.75
Rate for Payer: Cash Price	$5,634.14
Rate for Payer: Cigna Commercial	$2,071.38
Rate for Payer: Multiplan Auto	$4,142.75
Rate for Payer: Multiplan Commercial	$4,142.75
Rate for Payer: Multiplan Workers Comp	$4,142.75
Rate for Payer: Scott and White EPO/PPO	$4,142.75

calcitonin-salmon

Facility

$1,641.60

Service Code	HCPCS J0630
Hospital Charge Code	78435496
Hospital Revenue Code	636
Min. Negotiated Rate	$147.74
Max. Negotiated Rate	$5,216.93
Rate for Payer: Amerigroup CHIP/Medicaid	$147.74
Rate for Payer: BCBS of TX Blue Advantage	$3,919.45
Rate for Payer: BCBS of TX Blue Essentials	$4,703.34
Rate for Payer: BCBS of TX PPO	$5,216.93
Rate for Payer: Cash Price	$1,116.29
Rate for Payer: Cash Price	$1,116.29
Rate for Payer: Cigna Medicaid	$1,181.95
Rate for Payer: Molina CHIP/Medicaid	$1,181.95
Rate for Payer: Multiplan Auto	$1,067.04
Rate for Payer: Multiplan Commercial	$1,067.04
Rate for Payer: Multiplan Workers Comp	$1,067.04
Rate for Payer: Parkland Medicaid	$1,181.95
Rate for Payer: Scott and White EPO/PPO	$820.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,181.95
Rate for Payer: Superior Health Plan EPO	$223.26

calcitonin-salmon

Facility

$1,641.60

Service Code	HCPCS J0630
Hospital Charge Code	78435496
Hospital Revenue Code	636
Min. Negotiated Rate	$410.40
Max. Negotiated Rate	$820.80
Rate for Payer: Cash Price	$1,116.29
Rate for Payer: Cigna Commercial	$410.40
Rate for Payer: Scott and White EPO/PPO	$820.80

Calcitonin, Serum SO

Facility

$419.00

Service Code	HCPCS 82308
Hospital Charge Code	1701564
Hospital Revenue Code	301
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$301.68
Rate for Payer: Amerigroup CHIP/Medicaid	$10.45
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$26.79
Rate for Payer: Amerigroup Medicare	$26.79
Rate for Payer: BCBS of TX Blue Advantage	$125.70
Rate for Payer: BCBS of TX Blue Essentials	$150.84
Rate for Payer: BCBS of TX Medicare	$26.79
Rate for Payer: BCBS of TX PPO	$167.60
Rate for Payer: Cash Price	$284.92
Rate for Payer: Cash Price	$284.92
Rate for Payer: Cigna Medicaid	$301.68
Rate for Payer: Cigna Medicare	$26.79
Rate for Payer: Employer Direct Commercial	$26.79
Rate for Payer: Humana Medicare/TRICARE	$26.79
Rate for Payer: Molina CHIP/Medicaid	$301.68
Rate for Payer: Molina Dual Medicare/Medicaid	$26.79
Rate for Payer: Molina Medicare	$26.79
Rate for Payer: Multiplan Auto	$272.35
Rate for Payer: Multiplan Commercial	$272.35
Rate for Payer: Multiplan Workers Comp	$272.35
Rate for Payer: Parkland Medicaid	$301.68
Rate for Payer: Scott and White EPO/PPO	$33.49
Rate for Payer: Scott and White Medicare	$26.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$301.68
Rate for Payer: Superior Health Plan EPO	$26.79
Rate for Payer: Superior Health Plan Medicare	$26.79
Rate for Payer: Universal American Dual Medicare/Medicaid	$26.79
Rate for Payer: Universal American Medicare	$26.79
Rate for Payer: Wellcare Medicare	$26.79
Rate for Payer: Wellmed Medicare	$26.79

Calcitonin, Serum SO

Facility

$419.00

Service Code	HCPCS 82308
Hospital Charge Code	1701564
Hospital Revenue Code	301
Rate for Payer: Cash Price	$284.92

Know your out-of-pocket cost for care.

All Charges