White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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
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 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 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 HALFPIPE JUGGERSTITCH

Facility

$385.90

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

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 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 ivas 11g bn bx

Facility

$336.41

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

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 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
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 MICROFILTER CO2 SAMPL/DEL

Facility

$52.52

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

CANNULA NSL PED

Facility

$4.14

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

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, 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

CANNULA OXIMIZER PENDANT STERILE DISPOSABLE

Facility

$100.08

Hospital Charge Code	993516
Hospital Revenue Code	270
Rate for Payer: Cash Price	$68.05

CANNULA OXIMIZER PENDANT STERILE DISPOSABLE

Facility

$100.08

Hospital Charge Code	993516
Hospital Revenue Code	270
Min. Negotiated Rate	$9.01
Max. Negotiated Rate	$72.06
Rate for Payer: Amerigroup CHIP/Medicaid	$9.01
Rate for Payer: BCBS of TX Blue Advantage	$30.02
Rate for Payer: BCBS of TX Blue Essentials	$36.03
Rate for Payer: BCBS of TX PPO	$40.03
Rate for Payer: Cash Price	$68.05
Rate for Payer: Cigna Medicaid	$72.06
Rate for Payer: Molina CHIP/Medicaid	$72.06
Rate for Payer: Multiplan Auto	$65.05
Rate for Payer: Multiplan Commercial	$65.05
Rate for Payer: Multiplan Workers Comp	$65.05
Rate for Payer: Parkland Medicaid	$72.06
Rate for Payer: Scott and White EPO/PPO	$50.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$72.06
Rate for Payer: Superior Health Plan EPO	$13.61

cannula reducer endowrist 12-8mm

Facility

$113.50

Hospital Charge Code	8690516
Hospital Revenue Code	272
Min. Negotiated Rate	$10.21
Max. Negotiated Rate	$81.72
Rate for Payer: Amerigroup CHIP/Medicaid	$10.21
Rate for Payer: BCBS of TX Blue Advantage	$34.05
Rate for Payer: BCBS of TX Blue Essentials	$40.86
Rate for Payer: BCBS of TX PPO	$45.40
Rate for Payer: Cash Price	$77.18
Rate for Payer: Cigna Medicaid	$81.72
Rate for Payer: Molina CHIP/Medicaid	$81.72
Rate for Payer: Multiplan Auto	$73.78
Rate for Payer: Multiplan Commercial	$73.78
Rate for Payer: Multiplan Workers Comp	$73.78
Rate for Payer: Parkland Medicaid	$81.72
Rate for Payer: Scott and White EPO/PPO	$56.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$81.72
Rate for Payer: Superior Health Plan EPO	$15.44

cannula reducer endowrist 12-8mm

Facility

$113.50

Hospital Charge Code	8690516
Hospital Revenue Code	272
Rate for Payer: Cash Price	$77.18

CANNULA, SEAL 8MM FOR DAVINCI SURGICAL SYSTEM -- DHF

Facility

$939.78

Hospital Charge Code	81813875
Hospital Revenue Code	270
Rate for Payer: Cash Price	$639.05

CANNULA, SEAL 8MM FOR DAVINCI SURGICAL SYSTEM -- DHF

Facility

$939.78

Hospital Charge Code	81813875
Hospital Revenue Code	270
Min. Negotiated Rate	$84.58
Max. Negotiated Rate	$676.64
Rate for Payer: Amerigroup CHIP/Medicaid	$84.58
Rate for Payer: BCBS of TX Blue Advantage	$281.93
Rate for Payer: BCBS of TX Blue Essentials	$338.32
Rate for Payer: BCBS of TX PPO	$375.91
Rate for Payer: Cash Price	$639.05
Rate for Payer: Cigna Medicaid	$676.64
Rate for Payer: Molina CHIP/Medicaid	$676.64
Rate for Payer: Multiplan Auto	$610.86
Rate for Payer: Multiplan Commercial	$610.86
Rate for Payer: Multiplan Workers Comp	$610.86
Rate for Payer: Parkland Medicaid	$676.64
Rate for Payer: Scott and White EPO/PPO	$469.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$676.64
Rate for Payer: Superior Health Plan EPO	$127.81

Know your out-of-pocket cost for care.

All Charges