White Rock Medical Center

All Charges

Charge

Type

Setting

Price

DRS SILVERLON 4X6

Facility

$60.34

Hospital Charge Code	131599
Hospital Revenue Code	272
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$39.22
Rate for Payer: Aetna Commercial	$33.19
Rate for Payer: Amerigroup CHIP/Medicaid	$5.43
Rate for Payer: BCBS of TX Blue Advantage	$18.10
Rate for Payer: BCBS of TX Blue Essentials	$21.72
Rate for Payer: BCBS of TX PPO	$24.14
Rate for Payer: Cash Price	$53.10
Rate for Payer: Multiplan Auto	$39.22
Rate for Payer: Multiplan Commercial	$39.22
Rate for Payer: Multiplan Workers Comp	$39.22
Rate for Payer: Scott and White EPO/PPO	$30.17
Rate for Payer: Superior Health Plan EPO	$8.21

DRS SORB 2X2 -- DHF

Facility

$101.36

Hospital Charge Code	80248057
Hospital Revenue Code	270
Rate for Payer: Cash Price	$89.20

DRS SORB 2X2 -- DHF

Facility

$101.36

Hospital Charge Code	80248057
Hospital Revenue Code	270
Min. Negotiated Rate	$9.12
Max. Negotiated Rate	$65.88
Rate for Payer: Aetna Commercial	$55.75
Rate for Payer: Amerigroup CHIP/Medicaid	$9.12
Rate for Payer: BCBS of TX Blue Advantage	$30.41
Rate for Payer: BCBS of TX Blue Essentials	$36.49
Rate for Payer: BCBS of TX PPO	$40.54
Rate for Payer: Cash Price	$89.20
Rate for Payer: Multiplan Auto	$65.88
Rate for Payer: Multiplan Commercial	$65.88
Rate for Payer: Multiplan Workers Comp	$65.88
Rate for Payer: Scott and White EPO/PPO	$50.68
Rate for Payer: Superior Health Plan EPO	$13.78

DRS SORB 4X4 -- DHF

Facility

$87.80

Hospital Charge Code	80248107
Hospital Revenue Code	270
Rate for Payer: Cash Price	$77.26

DRS SORB 4X4 -- DHF

Facility

$87.80

Hospital Charge Code	80248107
Hospital Revenue Code	270
Min. Negotiated Rate	$7.90
Max. Negotiated Rate	$57.07
Rate for Payer: Aetna Commercial	$48.29
Rate for Payer: Amerigroup CHIP/Medicaid	$7.90
Rate for Payer: BCBS of TX Blue Advantage	$26.34
Rate for Payer: BCBS of TX Blue Essentials	$31.61
Rate for Payer: BCBS of TX PPO	$35.12
Rate for Payer: Cash Price	$77.26
Rate for Payer: Multiplan Auto	$57.07
Rate for Payer: Multiplan Commercial	$57.07
Rate for Payer: Multiplan Workers Comp	$57.07
Rate for Payer: Scott and White EPO/PPO	$43.90
Rate for Payer: Superior Health Plan EPO	$11.94

DRS SORB A/S -- DHF

Facility

$96.69

Hospital Charge Code	80248040
Hospital Revenue Code	270
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$62.85
Rate for Payer: Aetna Commercial	$53.18
Rate for Payer: Amerigroup CHIP/Medicaid	$8.70
Rate for Payer: BCBS of TX Blue Advantage	$29.01
Rate for Payer: BCBS of TX Blue Essentials	$34.81
Rate for Payer: BCBS of TX PPO	$38.68
Rate for Payer: Cash Price	$85.09
Rate for Payer: Multiplan Auto	$62.85
Rate for Payer: Multiplan Commercial	$62.85
Rate for Payer: Multiplan Workers Comp	$62.85
Rate for Payer: Scott and White EPO/PPO	$48.34
Rate for Payer: Superior Health Plan EPO	$13.15

DRS SORB A/S -- DHF

Facility

$96.69

Hospital Charge Code	80248040
Hospital Revenue Code	270
Rate for Payer: Cash Price	$85.09

DRS SPEC BURN -- DHF

Facility

$45.82

Hospital Charge Code	80248099
Hospital Revenue Code	272
Rate for Payer: Cash Price	$40.32

DRS SPEC BURN -- DHF

Facility

$45.82

Hospital Charge Code	80248099
Hospital Revenue Code	272
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$29.78
Rate for Payer: Aetna Commercial	$25.20
Rate for Payer: Amerigroup CHIP/Medicaid	$4.12
Rate for Payer: BCBS of TX Blue Advantage	$13.75
Rate for Payer: BCBS of TX Blue Essentials	$16.50
Rate for Payer: BCBS of TX PPO	$18.33
Rate for Payer: Cash Price	$40.32
Rate for Payer: Multiplan Auto	$29.78
Rate for Payer: Multiplan Commercial	$29.78
Rate for Payer: Multiplan Workers Comp	$29.78
Rate for Payer: Scott and White EPO/PPO	$22.91
Rate for Payer: Superior Health Plan EPO	$6.23

DRS SPECIALTY 80248115 -- DHF

Facility

$2,582.77

Hospital Charge Code	80248115
Hospital Revenue Code	270
Min. Negotiated Rate	$232.45
Max. Negotiated Rate	$1,678.80
Rate for Payer: Aetna Commercial	$1,420.52
Rate for Payer: Amerigroup CHIP/Medicaid	$232.45
Rate for Payer: BCBS of TX Blue Advantage	$774.83
Rate for Payer: BCBS of TX Blue Essentials	$929.80
Rate for Payer: BCBS of TX PPO	$1,033.11
Rate for Payer: Cash Price	$2,272.84
Rate for Payer: Multiplan Auto	$1,678.80
Rate for Payer: Multiplan Commercial	$1,678.80
Rate for Payer: Multiplan Workers Comp	$1,678.80
Rate for Payer: Scott and White EPO/PPO	$1,291.38
Rate for Payer: Superior Health Plan EPO	$351.26

DRS SPECIALTY 80248115 -- DHF

Facility

$2,582.77

Hospital Charge Code	80248115
Hospital Revenue Code	270
Rate for Payer: Cash Price	$2,272.84

DRS SPECIALTY 80248131 -- DHF

Facility

$73.38

Hospital Charge Code	80248131
Hospital Revenue Code	270
Rate for Payer: Cash Price	$64.57

DRS SPECIALTY 80248131 -- DHF

Facility

$73.38

Hospital Charge Code	80248131
Hospital Revenue Code	270
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna Commercial	$40.36
Rate for Payer: Amerigroup CHIP/Medicaid	$6.60
Rate for Payer: BCBS of TX Blue Advantage	$22.01
Rate for Payer: BCBS of TX Blue Essentials	$26.42
Rate for Payer: BCBS of TX PPO	$29.35
Rate for Payer: Cash Price	$64.57
Rate for Payer: Multiplan Auto	$47.70
Rate for Payer: Multiplan Commercial	$47.70
Rate for Payer: Multiplan Workers Comp	$47.70
Rate for Payer: Scott and White EPO/PPO	$36.69
Rate for Payer: Superior Health Plan EPO	$9.98

DRS SPECIALTY 80248149 -- DHF

Facility

$62.76

Hospital Charge Code	80248149
Hospital Revenue Code	270
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$40.79
Rate for Payer: Aetna Commercial	$34.52
Rate for Payer: Amerigroup CHIP/Medicaid	$5.65
Rate for Payer: BCBS of TX Blue Advantage	$18.83
Rate for Payer: BCBS of TX Blue Essentials	$22.59
Rate for Payer: BCBS of TX PPO	$25.10
Rate for Payer: Cash Price	$55.23
Rate for Payer: Multiplan Auto	$40.79
Rate for Payer: Multiplan Commercial	$40.79
Rate for Payer: Multiplan Workers Comp	$40.79
Rate for Payer: Scott and White EPO/PPO	$31.38
Rate for Payer: Superior Health Plan EPO	$8.54

DRS SPECIALTY 80248149 -- DHF

Facility

$62.76

Hospital Charge Code	80248149
Hospital Revenue Code	270
Rate for Payer: Cash Price	$55.23

DRS ST ADH 4X8 -- DHF

Facility

$82.50

Hospital Charge Code	80248552
Hospital Revenue Code	270
Rate for Payer: Cash Price	$72.60

DRS ST ADH 4X8 -- DHF

Facility

$82.50

Hospital Charge Code	80248552
Hospital Revenue Code	270
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$53.62
Rate for Payer: Aetna Commercial	$45.38
Rate for Payer: Amerigroup CHIP/Medicaid	$7.42
Rate for Payer: BCBS of TX Blue Advantage	$24.75
Rate for Payer: BCBS of TX Blue Essentials	$29.70
Rate for Payer: BCBS of TX PPO	$33.00
Rate for Payer: Cash Price	$72.60
Rate for Payer: Multiplan Auto	$53.62
Rate for Payer: Multiplan Commercial	$53.62
Rate for Payer: Multiplan Workers Comp	$53.62
Rate for Payer: Scott and White EPO/PPO	$41.25
Rate for Payer: Superior Health Plan EPO	$11.22

DRS TEGDRM 15X20 -- DHF

Facility

$49.41

Hospital Charge Code	80248909
Hospital Revenue Code	270
Rate for Payer: Cash Price	$43.48

DRS TEGDRM 15X20 -- DHF

Facility

$49.41

Hospital Charge Code	80248909
Hospital Revenue Code	270
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$32.12
Rate for Payer: Aetna Commercial	$27.18
Rate for Payer: Amerigroup CHIP/Medicaid	$4.45
Rate for Payer: BCBS of TX Blue Advantage	$14.82
Rate for Payer: BCBS of TX Blue Essentials	$17.79
Rate for Payer: BCBS of TX PPO	$19.76
Rate for Payer: Cash Price	$43.48
Rate for Payer: Multiplan Auto	$32.12
Rate for Payer: Multiplan Commercial	$32.12
Rate for Payer: Multiplan Workers Comp	$32.12
Rate for Payer: Scott and White EPO/PPO	$24.70
Rate for Payer: Superior Health Plan EPO	$6.72

DRS TEGDRM 5X7 -- DHF

Facility

$23.32

Hospital Charge Code	80249055
Hospital Revenue Code	270
Rate for Payer: Cash Price	$20.52

DRS TEGDRM 5X7 -- DHF

Facility

$23.32

Hospital Charge Code	80249055
Hospital Revenue Code	270
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$15.16
Rate for Payer: Aetna Commercial	$12.83
Rate for Payer: Amerigroup CHIP/Medicaid	$2.10
Rate for Payer: BCBS of TX Blue Advantage	$7.00
Rate for Payer: BCBS of TX Blue Essentials	$8.40
Rate for Payer: BCBS of TX PPO	$9.33
Rate for Payer: Cash Price	$20.52
Rate for Payer: Multiplan Auto	$15.16
Rate for Payer: Multiplan Commercial	$15.16
Rate for Payer: Multiplan Workers Comp	$15.16
Rate for Payer: Scott and White EPO/PPO	$11.66
Rate for Payer: Superior Health Plan EPO	$3.17

DRS TEGDRM 6X8 -- DHF

Facility

$174.75

Hospital Charge Code	80249105
Hospital Revenue Code	270
Rate for Payer: Cash Price	$153.78

DRS TEGDRM 6X8 -- DHF

Facility

$174.75

Hospital Charge Code	80249105
Hospital Revenue Code	270
Min. Negotiated Rate	$15.73
Max. Negotiated Rate	$113.59
Rate for Payer: Aetna Commercial	$96.11
Rate for Payer: Amerigroup CHIP/Medicaid	$15.73
Rate for Payer: BCBS of TX Blue Advantage	$52.42
Rate for Payer: BCBS of TX Blue Essentials	$62.91
Rate for Payer: BCBS of TX PPO	$69.90
Rate for Payer: Cash Price	$153.78
Rate for Payer: Multiplan Auto	$113.59
Rate for Payer: Multiplan Commercial	$113.59
Rate for Payer: Multiplan Workers Comp	$113.59
Rate for Payer: Scott and White EPO/PPO	$87.38
Rate for Payer: Superior Health Plan EPO	$23.77

DRS TELFA ISLAND -- DHF

Facility

$27.56

Hospital Charge Code	80249287
Hospital Revenue Code	270
Rate for Payer: Cash Price	$24.25

DRS TELFA ISLAND -- DHF

Facility

$27.56

Hospital Charge Code	80249287
Hospital Revenue Code	270
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$17.91
Rate for Payer: Aetna Commercial	$15.16
Rate for Payer: Amerigroup CHIP/Medicaid	$2.48
Rate for Payer: BCBS of TX Blue Advantage	$8.27
Rate for Payer: BCBS of TX Blue Essentials	$9.92
Rate for Payer: BCBS of TX PPO	$11.02
Rate for Payer: Cash Price	$24.25
Rate for Payer: Multiplan Auto	$17.91
Rate for Payer: Multiplan Commercial	$17.91
Rate for Payer: Multiplan Workers Comp	$17.91
Rate for Payer: Scott and White EPO/PPO	$13.78
Rate for Payer: Superior Health Plan EPO	$3.75

Know your out-of-pocket cost for care.

All Charges