White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CANISTER, SUCTION W/O GEL

Facility

$127.61

Hospital Charge Code	993543
Hospital Revenue Code	270
Rate for Payer: Cash Price	$86.77

CANISTER, SUCTION W/O GEL

Facility

$127.61

Hospital Charge Code	993543
Hospital Revenue Code	270
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$91.88
Rate for Payer: Amerigroup CHIP/Medicaid	$11.48
Rate for Payer: BCBS of TX Blue Advantage	$38.28
Rate for Payer: BCBS of TX Blue Essentials	$45.94
Rate for Payer: BCBS of TX PPO	$51.04
Rate for Payer: Cash Price	$86.77
Rate for Payer: Cigna Medicaid	$91.88
Rate for Payer: Molina CHIP/Medicaid	$91.88
Rate for Payer: Multiplan Auto	$82.95
Rate for Payer: Multiplan Commercial	$82.95
Rate for Payer: Multiplan Workers Comp	$82.95
Rate for Payer: Parkland Medicaid	$91.88
Rate for Payer: Scott and White EPO/PPO	$63.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$91.88
Rate for Payer: Superior Health Plan EPO	$17.35

CANISTER, SUCTION W/O GEL 500ML -- DHF

Facility

$127.66

Hospital Charge Code	80315096
Hospital Revenue Code	272
Rate for Payer: Cash Price	$86.81

CANISTER, SUCTION W/O GEL 500ML -- DHF

Facility

$127.66

Hospital Charge Code	80315096
Hospital Revenue Code	272
Min. Negotiated Rate	$11.49
Max. Negotiated Rate	$91.92
Rate for Payer: Amerigroup CHIP/Medicaid	$11.49
Rate for Payer: BCBS of TX Blue Advantage	$38.30
Rate for Payer: BCBS of TX Blue Essentials	$45.96
Rate for Payer: BCBS of TX PPO	$51.06
Rate for Payer: Cash Price	$86.81
Rate for Payer: Cigna Medicaid	$91.92
Rate for Payer: Molina CHIP/Medicaid	$91.92
Rate for Payer: Multiplan Auto	$82.98
Rate for Payer: Multiplan Commercial	$82.98
Rate for Payer: Multiplan Workers Comp	$82.98
Rate for Payer: Parkland Medicaid	$91.92
Rate for Payer: Scott and White EPO/PPO	$63.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$91.92
Rate for Payer: Superior Health Plan EPO	$17.36

CANISTER WND VAC 1000ML -- DHF

Facility

$247.82

Hospital Charge Code	80315161
Hospital Revenue Code	272
Min. Negotiated Rate	$22.30
Max. Negotiated Rate	$178.43
Rate for Payer: Amerigroup CHIP/Medicaid	$22.30
Rate for Payer: BCBS of TX Blue Advantage	$74.35
Rate for Payer: BCBS of TX Blue Essentials	$89.22
Rate for Payer: BCBS of TX PPO	$99.13
Rate for Payer: Cash Price	$168.52
Rate for Payer: Cigna Medicaid	$178.43
Rate for Payer: Molina CHIP/Medicaid	$178.43
Rate for Payer: Multiplan Auto	$161.08
Rate for Payer: Multiplan Commercial	$161.08
Rate for Payer: Multiplan Workers Comp	$161.08
Rate for Payer: Parkland Medicaid	$178.43
Rate for Payer: Scott and White EPO/PPO	$123.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$178.43
Rate for Payer: Superior Health Plan EPO	$33.70

CANISTER WND VAC 1000ML -- DHF

Facility

$247.82

Hospital Charge Code	80315161
Hospital Revenue Code	272
Rate for Payer: Cash Price	$168.52

CANN DISP INER -- DHF

Facility

$224.92

Hospital Charge Code	82020215
Hospital Revenue Code	272
Min. Negotiated Rate	$20.24
Max. Negotiated Rate	$161.94
Rate for Payer: Amerigroup CHIP/Medicaid	$20.24
Rate for Payer: BCBS of TX Blue Advantage	$67.48
Rate for Payer: BCBS of TX Blue Essentials	$80.97
Rate for Payer: BCBS of TX PPO	$89.97
Rate for Payer: Cash Price	$152.95
Rate for Payer: Cigna Medicaid	$161.94
Rate for Payer: Molina CHIP/Medicaid	$161.94
Rate for Payer: Multiplan Auto	$146.20
Rate for Payer: Multiplan Commercial	$146.20
Rate for Payer: Multiplan Workers Comp	$146.20
Rate for Payer: Parkland Medicaid	$161.94
Rate for Payer: Scott and White EPO/PPO	$112.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$161.94
Rate for Payer: Superior Health Plan EPO	$30.59

CANN DISP INER -- DHF

Facility

$224.92

Hospital Charge Code	82020215
Hospital Revenue Code	272
Rate for Payer: Cash Price	$152.95

CANN NASAL -- DHF

Facility

$96.91

Hospital Charge Code	82020009
Hospital Revenue Code	270
Rate for Payer: Cash Price	$65.90

CANN NASAL -- DHF

Facility

$96.91

Hospital Charge Code	82020009
Hospital Revenue Code	270
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$69.78
Rate for Payer: Amerigroup CHIP/Medicaid	$8.72
Rate for Payer: BCBS of TX Blue Advantage	$29.07
Rate for Payer: BCBS of TX Blue Essentials	$34.89
Rate for Payer: BCBS of TX PPO	$38.76
Rate for Payer: Cash Price	$65.90
Rate for Payer: Cigna Medicaid	$69.78
Rate for Payer: Molina CHIP/Medicaid	$69.78
Rate for Payer: Multiplan Auto	$62.99
Rate for Payer: Multiplan Commercial	$62.99
Rate for Payer: Multiplan Workers Comp	$62.99
Rate for Payer: Parkland Medicaid	$69.78
Rate for Payer: Scott and White EPO/PPO	$48.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$69.78
Rate for Payer: Superior Health Plan EPO	$13.18

CANN ORTHO

Facility

$124.76

Hospital Charge Code	80315104
Hospital Revenue Code	270
Rate for Payer: Cash Price	$84.84

CANN ORTHO

Facility

$124.76

Hospital Charge Code	80315104
Hospital Revenue Code	270
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

CANN STIMULAT ECHOGENIC -- DHF

Facility

$77.61

Hospital Charge Code	80315476
Hospital Revenue Code	272
Min. Negotiated Rate	$6.98
Max. Negotiated Rate	$55.88
Rate for Payer: Amerigroup CHIP/Medicaid	$6.98
Rate for Payer: BCBS of TX Blue Advantage	$23.28
Rate for Payer: BCBS of TX Blue Essentials	$27.94
Rate for Payer: BCBS of TX PPO	$31.04
Rate for Payer: Cash Price	$52.77
Rate for Payer: Cigna Medicaid	$55.88
Rate for Payer: Molina CHIP/Medicaid	$55.88
Rate for Payer: Multiplan Auto	$50.45
Rate for Payer: Multiplan Commercial	$50.45
Rate for Payer: Multiplan Workers Comp	$50.45
Rate for Payer: Parkland Medicaid	$55.88
Rate for Payer: Scott and White EPO/PPO	$38.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$55.88
Rate for Payer: Superior Health Plan EPO	$10.55

CANN STIMULAT ECHOGENIC -- DHF

Facility

$77.61

Hospital Charge Code	80315476
Hospital Revenue Code	272
Rate for Payer: Cash Price	$52.77

CANNULA 75X7MM DIST W OBT CLR

Facility

$187.05

Hospital Charge Code	992666
Hospital Revenue Code	272
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$134.68
Rate for Payer: Amerigroup CHIP/Medicaid	$16.83
Rate for Payer: BCBS of TX Blue Advantage	$56.12
Rate for Payer: BCBS of TX Blue Essentials	$67.34
Rate for Payer: BCBS of TX PPO	$74.82
Rate for Payer: Cash Price	$127.19
Rate for Payer: Cigna Medicaid	$134.68
Rate for Payer: Molina CHIP/Medicaid	$134.68
Rate for Payer: Multiplan Auto	$121.58
Rate for Payer: Multiplan Commercial	$121.58
Rate for Payer: Multiplan Workers Comp	$121.58
Rate for Payer: Parkland Medicaid	$134.68
Rate for Payer: Scott and White EPO/PPO	$93.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$134.68
Rate for Payer: Superior Health Plan EPO	$25.44

CANNULA 75X7MM DIST W OBT CLR

Facility

$187.05

Hospital Charge Code	992666
Hospital Revenue Code	272
Rate for Payer: Cash Price	$127.19

CANNULA 7MM

Facility

$187.05

Hospital Charge Code	992664
Hospital Revenue Code	272
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$134.68
Rate for Payer: Amerigroup CHIP/Medicaid	$16.83
Rate for Payer: BCBS of TX Blue Advantage	$56.12
Rate for Payer: BCBS of TX Blue Essentials	$67.34
Rate for Payer: BCBS of TX PPO	$74.82
Rate for Payer: Cash Price	$127.19
Rate for Payer: Cigna Medicaid	$134.68
Rate for Payer: Molina CHIP/Medicaid	$134.68
Rate for Payer: Multiplan Auto	$121.58
Rate for Payer: Multiplan Commercial	$121.58
Rate for Payer: Multiplan Workers Comp	$121.58
Rate for Payer: Parkland Medicaid	$134.68
Rate for Payer: Scott and White EPO/PPO	$93.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$134.68
Rate for Payer: Superior Health Plan EPO	$25.44

CANNULA 7MM

Facility

$187.05

Hospital Charge Code	992664
Hospital Revenue Code	272
Rate for Payer: Cash Price	$127.19

CANNULA ARTHROSCOPIC

Facility

$319.84

Hospital Charge Code	8414484
Hospital Revenue Code	272
Min. Negotiated Rate	$28.79
Max. Negotiated Rate	$230.28
Rate for Payer: Amerigroup CHIP/Medicaid	$28.79
Rate for Payer: BCBS of TX Blue Advantage	$95.95
Rate for Payer: BCBS of TX Blue Essentials	$115.14
Rate for Payer: BCBS of TX PPO	$127.94
Rate for Payer: Cash Price	$217.49
Rate for Payer: Cigna Medicaid	$230.28
Rate for Payer: Molina CHIP/Medicaid	$230.28
Rate for Payer: Multiplan Auto	$207.90
Rate for Payer: Multiplan Commercial	$207.90
Rate for Payer: Multiplan Workers Comp	$207.90
Rate for Payer: Parkland Medicaid	$230.28
Rate for Payer: Scott and White EPO/PPO	$159.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$230.28
Rate for Payer: Superior Health Plan EPO	$43.50

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

Know your out-of-pocket cost for care.

All Charges