White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CANNULA ARTHROSCOPIC

Facility

$319.84

Hospital Charge Code	8414484
Hospital Revenue Code	272
Rate for Payer: Cash Price	$217.49

CANNULA, ARTHROSCOPIC THREADED 7.0MM X 75MM DISP -- DHF

Facility

$190.68

Hospital Charge Code	81730608
Hospital Revenue Code	272
Min. Negotiated Rate	$17.16
Max. Negotiated Rate	$137.29
Rate for Payer: Amerigroup CHIP/Medicaid	$17.16
Rate for Payer: BCBS of TX Blue Advantage	$57.20
Rate for Payer: BCBS of TX Blue Essentials	$68.64
Rate for Payer: BCBS of TX PPO	$76.27
Rate for Payer: Cash Price	$129.66
Rate for Payer: Cigna Medicaid	$137.29
Rate for Payer: Molina CHIP/Medicaid	$137.29
Rate for Payer: Multiplan Auto	$123.94
Rate for Payer: Multiplan Commercial	$123.94
Rate for Payer: Multiplan Workers Comp	$123.94
Rate for Payer: Parkland Medicaid	$137.29
Rate for Payer: Scott and White EPO/PPO	$95.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$137.29
Rate for Payer: Superior Health Plan EPO	$25.93

CANNULA, ARTHROSCOPIC THREADED 7.0MM X 75MM DISP -- DHF

Facility

$190.68

Hospital Charge Code	81730608
Hospital Revenue Code	272
Rate for Payer: Cash Price	$129.66

CANNULA, BONE GRAFT ACCUPORT END DELIVRY 11GX120MM

Facility

$3,012.05

Service Code	HCPCS C1734
Hospital Charge Code	992118
Hospital Revenue Code	278
Min. Negotiated Rate	$271.08
Max. Negotiated Rate	$2,168.68
Rate for Payer: Amerigroup CHIP/Medicaid	$271.08
Rate for Payer: BCBS of TX Blue Advantage	$903.62
Rate for Payer: BCBS of TX Blue Essentials	$1,084.34
Rate for Payer: BCBS of TX PPO	$1,204.82
Rate for Payer: Cash Price	$2,048.19
Rate for Payer: Cigna Medicaid	$2,168.68
Rate for Payer: Molina CHIP/Medicaid	$2,168.68
Rate for Payer: Multiplan Auto	$1,506.03
Rate for Payer: Multiplan Commercial	$1,506.03
Rate for Payer: Multiplan Workers Comp	$1,506.03
Rate for Payer: Parkland Medicaid	$2,168.68
Rate for Payer: Scott and White EPO/PPO	$1,506.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,168.68
Rate for Payer: Superior Health Plan EPO	$409.64

CANNULA, BONE GRAFT ACCUPORT END DELIVRY 11GX120MM

Facility

$3,012.05

Service Code	HCPCS C1734
Hospital Charge Code	992118
Hospital Revenue Code	278
Min. Negotiated Rate	$753.01
Max. Negotiated Rate	$1,506.03
Rate for Payer: Cash Price	$2,048.19
Rate for Payer: Cigna Commercial	$753.01
Rate for Payer: Multiplan Auto	$1,506.03
Rate for Payer: Multiplan Commercial	$1,506.03
Rate for Payer: Multiplan Workers Comp	$1,506.03
Rate for Payer: Scott and White EPO/PPO	$1,506.03

CANNULA CO2 MICROFILTER SAMPLING

Facility

$45.85

Hospital Charge Code	144832
Hospital Revenue Code	272
Min. Negotiated Rate	$4.13
Max. Negotiated Rate	$33.01
Rate for Payer: Amerigroup CHIP/Medicaid	$4.13
Rate for Payer: BCBS of TX Blue Advantage	$13.76
Rate for Payer: BCBS of TX Blue Essentials	$16.51
Rate for Payer: BCBS of TX PPO	$18.34
Rate for Payer: Cash Price	$31.18
Rate for Payer: Cigna Medicaid	$33.01
Rate for Payer: Molina CHIP/Medicaid	$33.01
Rate for Payer: Multiplan Auto	$29.80
Rate for Payer: Multiplan Commercial	$29.80
Rate for Payer: Multiplan Workers Comp	$29.80
Rate for Payer: Parkland Medicaid	$33.01
Rate for Payer: Scott and White EPO/PPO	$22.93
Rate for Payer: Superior Health Plan CHIP/Medicaid	$33.01
Rate for Payer: Superior Health Plan EPO	$6.24

CANNULA CO2 MICROFILTER SAMPLING

Facility

$45.85

Hospital Charge Code	144832
Hospital Revenue Code	272
Rate for Payer: Cash Price	$31.18

CANNULA, DRY DOC TRNSLCNT W/OBTRTR 7.0MMX85MM DISP

Facility

$124.76

Hospital Charge Code	140711
Hospital Revenue Code	272
Rate for Payer: Cash Price	$84.84

CANNULA, DRY DOC TRNSLCNT W/OBTRTR 7.0MMX85MM DISP

Facility

$124.76

Hospital Charge Code	140711
Hospital Revenue Code	272
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$89.83
Rate for Payer: Amerigroup CHIP/Medicaid	$11.23
Rate for Payer: BCBS of TX Blue Advantage	$37.43
Rate for Payer: BCBS of TX Blue Essentials	$44.91
Rate for Payer: BCBS of TX PPO	$49.90
Rate for Payer: Cash Price	$84.84
Rate for Payer: Cigna Medicaid	$89.83
Rate for Payer: Molina CHIP/Medicaid	$89.83
Rate for Payer: Multiplan Auto	$81.09
Rate for Payer: Multiplan Commercial	$81.09
Rate for Payer: Multiplan Workers Comp	$81.09
Rate for Payer: Parkland Medicaid	$89.83
Rate for Payer: Scott and White EPO/PPO	$62.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$89.83
Rate for Payer: Superior Health Plan EPO	$16.97

CANNULA DRY DOC W/OB 8.0 X75

Facility

$161.71

Hospital Charge Code	145531
Hospital Revenue Code	272
Rate for Payer: Cash Price	$109.96

CANNULA DRY DOC W/OB 8.0 X75

Facility

$161.71

Hospital Charge Code	145531
Hospital Revenue Code	272
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$116.43
Rate for Payer: Amerigroup CHIP/Medicaid	$14.55
Rate for Payer: BCBS of TX Blue Advantage	$48.51
Rate for Payer: BCBS of TX Blue Essentials	$58.22
Rate for Payer: BCBS of TX PPO	$64.68
Rate for Payer: Cash Price	$109.96
Rate for Payer: Cigna Medicaid	$116.43
Rate for Payer: Molina CHIP/Medicaid	$116.43
Rate for Payer: Multiplan Auto	$105.11
Rate for Payer: Multiplan Commercial	$105.11
Rate for Payer: Multiplan Workers Comp	$105.11
Rate for Payer: Parkland Medicaid	$116.43
Rate for Payer: Scott and White EPO/PPO	$80.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$116.43
Rate for Payer: Superior Health Plan EPO	$21.99

CANNULA HALFPIPE JUGGERSTITCH

Facility

$385.90

Hospital Charge Code	145085
Hospital Revenue Code	272
Rate for Payer: Cash Price	$262.41

CANNULA HALFPIPE JUGGERSTITCH

Facility

$385.90

Hospital Charge Code	145085
Hospital Revenue Code	272
Min. Negotiated Rate	$34.73
Max. Negotiated Rate	$277.85
Rate for Payer: Amerigroup CHIP/Medicaid	$34.73
Rate for Payer: BCBS of TX Blue Advantage	$115.77
Rate for Payer: BCBS of TX Blue Essentials	$138.92
Rate for Payer: BCBS of TX PPO	$154.36
Rate for Payer: Cash Price	$262.41
Rate for Payer: Cigna Medicaid	$277.85
Rate for Payer: Molina CHIP/Medicaid	$277.85
Rate for Payer: Multiplan Auto	$250.84
Rate for Payer: Multiplan Commercial	$250.84
Rate for Payer: Multiplan Workers Comp	$250.84
Rate for Payer: Parkland Medicaid	$277.85
Rate for Payer: Scott and White EPO/PPO	$192.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$277.85
Rate for Payer: Superior Health Plan EPO	$52.48

CANNULA INNR SHLY 6 6.4MM TRCH TUBE

Facility

$11.74

Hospital Charge Code	993619
Hospital Revenue Code	270
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$8.45
Rate for Payer: Amerigroup CHIP/Medicaid	$1.06
Rate for Payer: BCBS of TX Blue Advantage	$3.52
Rate for Payer: BCBS of TX Blue Essentials	$4.23
Rate for Payer: BCBS of TX PPO	$4.70
Rate for Payer: Cash Price	$7.98
Rate for Payer: Cigna Medicaid	$8.45
Rate for Payer: Molina CHIP/Medicaid	$8.45
Rate for Payer: Multiplan Auto	$7.63
Rate for Payer: Multiplan Commercial	$7.63
Rate for Payer: Multiplan Workers Comp	$7.63
Rate for Payer: Parkland Medicaid	$8.45
Rate for Payer: Scott and White EPO/PPO	$5.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.45
Rate for Payer: Superior Health Plan EPO	$1.60

CANNULA INNR SHLY 6 6.4MM TRCH TUBE

Facility

$11.74

Hospital Charge Code	993619
Hospital Revenue Code	270
Rate for Payer: Cash Price	$7.98

cannula ivas 11g bn bx

Facility

$336.41

Hospital Charge Code	8634510
Hospital Revenue Code	272
Min. Negotiated Rate	$30.28
Max. Negotiated Rate	$242.22
Rate for Payer: Amerigroup CHIP/Medicaid	$30.28
Rate for Payer: BCBS of TX Blue Advantage	$100.92
Rate for Payer: BCBS of TX Blue Essentials	$121.11
Rate for Payer: BCBS of TX PPO	$134.56
Rate for Payer: Cash Price	$228.76
Rate for Payer: Cigna Medicaid	$242.22
Rate for Payer: Molina CHIP/Medicaid	$242.22
Rate for Payer: Multiplan Auto	$218.67
Rate for Payer: Multiplan Commercial	$218.67
Rate for Payer: Multiplan Workers Comp	$218.67
Rate for Payer: Parkland Medicaid	$242.22
Rate for Payer: Scott and White EPO/PPO	$168.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$242.22
Rate for Payer: Superior Health Plan EPO	$45.75

cannula ivas 11g bn bx

Facility

$336.41

Hospital Charge Code	8634510
Hospital Revenue Code	272
Rate for Payer: Cash Price	$228.76

Cannula ivas access 11g

Facility

$321.66

Hospital Charge Code	8602530
Hospital Revenue Code	272
Rate for Payer: Cash Price	$218.73

Cannula ivas access 11g

Facility

$321.66

Hospital Charge Code	8602530
Hospital Revenue Code	272
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$231.60
Rate for Payer: Amerigroup CHIP/Medicaid	$28.95
Rate for Payer: BCBS of TX Blue Advantage	$96.50
Rate for Payer: BCBS of TX Blue Essentials	$115.80
Rate for Payer: BCBS of TX PPO	$128.66
Rate for Payer: Cash Price	$218.73
Rate for Payer: Cigna Medicaid	$231.60
Rate for Payer: Molina CHIP/Medicaid	$231.60
Rate for Payer: Multiplan Auto	$209.08
Rate for Payer: Multiplan Commercial	$209.08
Rate for Payer: Multiplan Workers Comp	$209.08
Rate for Payer: Parkland Medicaid	$231.60
Rate for Payer: Scott and White EPO/PPO	$160.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$231.60
Rate for Payer: Superior Health Plan EPO	$43.75

CANNULA MICROFILTER CO2 SAMPL/DEL

Facility

$52.52

Hospital Charge Code	145097
Hospital Revenue Code	272
Rate for Payer: Cash Price	$35.71

CANNULA MICROFILTER CO2 SAMPL/DEL

Facility

$52.52

Hospital Charge Code	145097
Hospital Revenue Code	272
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$37.81
Rate for Payer: Amerigroup CHIP/Medicaid	$4.73
Rate for Payer: BCBS of TX Blue Advantage	$15.76
Rate for Payer: BCBS of TX Blue Essentials	$18.91
Rate for Payer: BCBS of TX PPO	$21.01
Rate for Payer: Cash Price	$35.71
Rate for Payer: Cigna Medicaid	$37.81
Rate for Payer: Molina CHIP/Medicaid	$37.81
Rate for Payer: Multiplan Auto	$34.14
Rate for Payer: Multiplan Commercial	$34.14
Rate for Payer: Multiplan Workers Comp	$34.14
Rate for Payer: Parkland Medicaid	$37.81
Rate for Payer: Scott and White EPO/PPO	$26.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$37.81
Rate for Payer: Superior Health Plan EPO	$7.14

CANNULA NSL PED

Facility

$4.14

Hospital Charge Code	993606
Hospital Revenue Code	270
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$2.98
Rate for Payer: Amerigroup CHIP/Medicaid	$0.37
Rate for Payer: BCBS of TX Blue Advantage	$1.24
Rate for Payer: BCBS of TX Blue Essentials	$1.49
Rate for Payer: BCBS of TX PPO	$1.66
Rate for Payer: Cash Price	$2.82
Rate for Payer: Cigna Medicaid	$2.98
Rate for Payer: Molina CHIP/Medicaid	$2.98
Rate for Payer: Multiplan Auto	$2.69
Rate for Payer: Multiplan Commercial	$2.69
Rate for Payer: Multiplan Workers Comp	$2.69
Rate for Payer: Parkland Medicaid	$2.98
Rate for Payer: Scott and White EPO/PPO	$2.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.98
Rate for Payer: Superior Health Plan EPO	$0.56

CANNULA NSL PED

Facility

$4.14

Hospital Charge Code	993606
Hospital Revenue Code	270
Rate for Payer: Cash Price	$2.82

CANNULA, OPTIFLOW+, MEDIUM

Facility

$98.43

Hospital Charge Code	993254
Hospital Revenue Code	270
Rate for Payer: Cash Price	$66.93

CANNULA, OPTIFLOW+, MEDIUM

Facility

$98.43

Hospital Charge Code	993254
Hospital Revenue Code	270
Min. Negotiated Rate	$8.86
Max. Negotiated Rate	$70.87
Rate for Payer: Amerigroup CHIP/Medicaid	$8.86
Rate for Payer: BCBS of TX Blue Advantage	$29.53
Rate for Payer: BCBS of TX Blue Essentials	$35.43
Rate for Payer: BCBS of TX PPO	$39.37
Rate for Payer: Cash Price	$66.93
Rate for Payer: Cigna Medicaid	$70.87
Rate for Payer: Molina CHIP/Medicaid	$70.87
Rate for Payer: Multiplan Auto	$63.98
Rate for Payer: Multiplan Commercial	$63.98
Rate for Payer: Multiplan Workers Comp	$63.98
Rate for Payer: Parkland Medicaid	$70.87
Rate for Payer: Scott and White EPO/PPO	$49.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$70.87
Rate for Payer: Superior Health Plan EPO	$13.39

Know your out-of-pocket cost for care.

All Charges