White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CHWR BREAST LOC NEEDLE ALL

Facility

$67.90

Hospital Charge Code	8032780
Hospital Revenue Code	272
Rate for Payer: Cash Price	$46.17

CHWR BREAST LOC NEEDLE ALL

Facility

$67.90

Hospital Charge Code	8032780
Hospital Revenue Code	272
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$48.89
Rate for Payer: Amerigroup CHIP/Medicaid	$6.11
Rate for Payer: BCBS of TX Blue Advantage	$20.37
Rate for Payer: BCBS of TX Blue Essentials	$24.44
Rate for Payer: BCBS of TX PPO	$27.16
Rate for Payer: Cash Price	$46.17
Rate for Payer: Cigna Medicaid	$48.89
Rate for Payer: Molina CHIP/Medicaid	$48.89
Rate for Payer: Multiplan Auto	$44.13
Rate for Payer: Multiplan Commercial	$44.13
Rate for Payer: Multiplan Workers Comp	$44.13
Rate for Payer: Parkland Medicaid	$48.89
Rate for Payer: Scott and White EPO/PPO	$33.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$48.89
Rate for Payer: Superior Health Plan EPO	$9.23

CHWR BX CORE GUN ALL

Facility

$1,211.05

Hospital Charge Code	8174828
Hospital Revenue Code	272
Min. Negotiated Rate	$108.99
Max. Negotiated Rate	$871.96
Rate for Payer: Amerigroup CHIP/Medicaid	$108.99
Rate for Payer: BCBS of TX Blue Advantage	$363.31
Rate for Payer: BCBS of TX Blue Essentials	$435.98
Rate for Payer: BCBS of TX PPO	$484.42
Rate for Payer: Cash Price	$823.51
Rate for Payer: Cigna Medicaid	$871.96
Rate for Payer: Molina CHIP/Medicaid	$871.96
Rate for Payer: Multiplan Auto	$787.18
Rate for Payer: Multiplan Commercial	$787.18
Rate for Payer: Multiplan Workers Comp	$787.18
Rate for Payer: Parkland Medicaid	$871.96
Rate for Payer: Scott and White EPO/PPO	$605.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$871.96
Rate for Payer: Superior Health Plan EPO	$164.70

CHWR BX CORE GUN ALL

Facility

$1,211.05

Hospital Charge Code	8174828
Hospital Revenue Code	272
Rate for Payer: Cash Price	$823.51

CHWR BX NEEDLE KIT MAX CORE 14G X 10CM

Facility

$176.60

Hospital Charge Code	8082741
Hospital Revenue Code	272
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$127.15
Rate for Payer: Amerigroup CHIP/Medicaid	$15.89
Rate for Payer: BCBS of TX Blue Advantage	$52.98
Rate for Payer: BCBS of TX Blue Essentials	$63.58
Rate for Payer: BCBS of TX PPO	$70.64
Rate for Payer: Cash Price	$120.09
Rate for Payer: Cigna Medicaid	$127.15
Rate for Payer: Molina CHIP/Medicaid	$127.15
Rate for Payer: Multiplan Auto	$114.79
Rate for Payer: Multiplan Commercial	$114.79
Rate for Payer: Multiplan Workers Comp	$114.79
Rate for Payer: Parkland Medicaid	$127.15
Rate for Payer: Scott and White EPO/PPO	$88.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$127.15
Rate for Payer: Superior Health Plan EPO	$24.02

CHWR BX NEEDLE KIT MAX CORE 14G X 10CM

Facility

$176.60

Hospital Charge Code	8082741
Hospital Revenue Code	272
Rate for Payer: Cash Price	$120.09

CHWR BX TISSUE CORE 17Gx 10CM

Facility

$422.05

Hospital Charge Code	8182909
Hospital Revenue Code	272
Rate for Payer: Cash Price	$286.99

CHWR BX TISSUE CORE 17Gx 10CM

Facility

$422.05

Hospital Charge Code	8182909
Hospital Revenue Code	272
Min. Negotiated Rate	$37.98
Max. Negotiated Rate	$303.88
Rate for Payer: Amerigroup CHIP/Medicaid	$37.98
Rate for Payer: BCBS of TX Blue Advantage	$126.61
Rate for Payer: BCBS of TX Blue Essentials	$151.94
Rate for Payer: BCBS of TX PPO	$168.82
Rate for Payer: Cash Price	$286.99
Rate for Payer: Cigna Medicaid	$303.88
Rate for Payer: Molina CHIP/Medicaid	$303.88
Rate for Payer: Multiplan Auto	$274.33
Rate for Payer: Multiplan Commercial	$274.33
Rate for Payer: Multiplan Workers Comp	$274.33
Rate for Payer: Parkland Medicaid	$303.88
Rate for Payer: Scott and White EPO/PPO	$211.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$303.88
Rate for Payer: Superior Health Plan EPO	$57.40

CHWR CATH DRAINAGE SAFE TTRAY 6FR16CM

Facility

$279.00

Service Code	HCPCS C1729
Hospital Charge Code	8081990
Hospital Revenue Code	278
Min. Negotiated Rate	$25.11
Max. Negotiated Rate	$200.88
Rate for Payer: Amerigroup CHIP/Medicaid	$25.11
Rate for Payer: BCBS of TX Blue Advantage	$83.70
Rate for Payer: BCBS of TX Blue Essentials	$100.44
Rate for Payer: BCBS of TX PPO	$111.60
Rate for Payer: Cash Price	$189.72
Rate for Payer: Cigna Medicaid	$200.88
Rate for Payer: Molina CHIP/Medicaid	$200.88
Rate for Payer: Multiplan Auto	$139.50
Rate for Payer: Multiplan Commercial	$139.50
Rate for Payer: Multiplan Workers Comp	$139.50
Rate for Payer: Parkland Medicaid	$200.88
Rate for Payer: Scott and White EPO/PPO	$139.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$200.88
Rate for Payer: Superior Health Plan EPO	$37.94

CHWR CATH DRAINAGE SAFE TTRAY 6FR16CM

Facility

$279.00

Service Code	HCPCS C1729
Hospital Charge Code	8081990
Hospital Revenue Code	278
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$139.50
Rate for Payer: Cash Price	$189.72
Rate for Payer: Cigna Commercial	$69.75
Rate for Payer: Multiplan Auto	$139.50
Rate for Payer: Multiplan Commercial	$139.50
Rate for Payer: Multiplan Workers Comp	$139.50
Rate for Payer: Scott and White EPO/PPO	$139.50

CHWR COBAN WRAP

Facility

$45.82

Hospital Charge Code	8024031
Hospital Revenue Code	270
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$32.99
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	$31.16
Rate for Payer: Cigna Medicaid	$32.99
Rate for Payer: Molina CHIP/Medicaid	$32.99
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: Parkland Medicaid	$32.99
Rate for Payer: Scott and White EPO/PPO	$22.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$32.99
Rate for Payer: Superior Health Plan EPO	$6.23

CHWR COBAN WRAP

Facility

$45.82

Hospital Charge Code	8024031
Hospital Revenue Code	270
Rate for Payer: Cash Price	$31.16

CHWR CONNECTING TUBE

Facility

$66.89

Hospital Charge Code	8177545
Hospital Revenue Code	270
Rate for Payer: Cash Price	$45.49

CHWR CONNECTING TUBE

Facility

$66.89

Hospital Charge Code	8177545
Hospital Revenue Code	270
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$48.16
Rate for Payer: Amerigroup CHIP/Medicaid	$6.02
Rate for Payer: BCBS of TX Blue Advantage	$20.07
Rate for Payer: BCBS of TX Blue Essentials	$24.08
Rate for Payer: BCBS of TX PPO	$26.76
Rate for Payer: Cash Price	$45.49
Rate for Payer: Cigna Medicaid	$48.16
Rate for Payer: Molina CHIP/Medicaid	$48.16
Rate for Payer: Multiplan Auto	$43.48
Rate for Payer: Multiplan Commercial	$43.48
Rate for Payer: Multiplan Workers Comp	$43.48
Rate for Payer: Parkland Medicaid	$48.16
Rate for Payer: Scott and White EPO/PPO	$33.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$48.16
Rate for Payer: Superior Health Plan EPO	$9.10

CHWR CONNECTION TUBING

Facility

$87.80

Hospital Charge Code	8185585
Hospital Revenue Code	272
Rate for Payer: Cash Price	$59.70

CHWR CONNECTION TUBING

Facility

$87.80

Hospital Charge Code	8185585
Hospital Revenue Code	272
Min. Negotiated Rate	$7.90
Max. Negotiated Rate	$63.22
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	$59.70
Rate for Payer: Cigna Medicaid	$63.22
Rate for Payer: Molina CHIP/Medicaid	$63.22
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: Parkland Medicaid	$63.22
Rate for Payer: Scott and White EPO/PPO	$43.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$63.22
Rate for Payer: Superior Health Plan EPO	$11.94

CHWR CT GUIDE NEEDLE PLACEMENT

Facility

$4,508.00

Service Code	HCPCS 77012
Hospital Charge Code	5056361
Hospital Revenue Code	350
Rate for Payer: Cash Price	$3,065.44

CHWR CT GUIDE NEEDLE PLACEMENT

Facility

$4,508.00

Service Code	HCPCS 77012
Hospital Charge Code	5056361
Hospital Revenue Code	350
Min. Negotiated Rate	$129.03
Max. Negotiated Rate	$3,245.76
Rate for Payer: Amerigroup CHIP/Medicaid	$405.72
Rate for Payer: BCBS of TX Blue Advantage	$129.03
Rate for Payer: BCBS of TX Blue Essentials	$154.84
Rate for Payer: BCBS of TX PPO	$172.82
Rate for Payer: Cash Price	$3,065.44
Rate for Payer: Cash Price	$3,065.44
Rate for Payer: Cigna Medicaid	$3,245.76
Rate for Payer: Molina CHIP/Medicaid	$3,245.76
Rate for Payer: Multiplan Auto	$2,930.20
Rate for Payer: Multiplan Commercial	$2,930.20
Rate for Payer: Multiplan Workers Comp	$2,930.20
Rate for Payer: Parkland Medicaid	$3,245.76
Rate for Payer: Scott and White EPO/PPO	$2,254.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,245.76
Rate for Payer: Superior Health Plan EPO	$613.09

CHWR DILATOR ANY SIZE

Facility

$77.63

Hospital Charge Code	8174035
Hospital Revenue Code	272
Rate for Payer: Cash Price	$52.79

CHWR DILATOR ANY SIZE

Facility

$77.63

Hospital Charge Code	8174035
Hospital Revenue Code	272
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$55.89
Rate for Payer: Amerigroup CHIP/Medicaid	$6.99
Rate for Payer: BCBS of TX Blue Advantage	$23.29
Rate for Payer: BCBS of TX Blue Essentials	$27.95
Rate for Payer: BCBS of TX PPO	$31.05
Rate for Payer: Cash Price	$52.79
Rate for Payer: Cigna Medicaid	$55.89
Rate for Payer: Molina CHIP/Medicaid	$55.89
Rate for Payer: Multiplan Auto	$50.46
Rate for Payer: Multiplan Commercial	$50.46
Rate for Payer: Multiplan Workers Comp	$50.46
Rate for Payer: Parkland Medicaid	$55.89
Rate for Payer: Scott and White EPO/PPO	$38.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$55.89
Rate for Payer: Superior Health Plan EPO	$10.56

CHWR DOBHOFF TUBE FEEDING TUBE

Facility

$64.05

Service Code	HCPCS B4148
Hospital Charge Code	8034690
Hospital Revenue Code	270
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$46.12
Rate for Payer: Amerigroup CHIP/Medicaid	$5.76
Rate for Payer: BCBS of TX Blue Advantage	$13.24
Rate for Payer: BCBS of TX Blue Essentials	$15.89
Rate for Payer: BCBS of TX PPO	$17.62
Rate for Payer: Cash Price	$43.55
Rate for Payer: Cash Price	$43.55
Rate for Payer: Cigna Medicaid	$46.12
Rate for Payer: Molina CHIP/Medicaid	$46.12
Rate for Payer: Multiplan Auto	$41.63
Rate for Payer: Multiplan Commercial	$41.63
Rate for Payer: Multiplan Workers Comp	$41.63
Rate for Payer: Parkland Medicaid	$46.12
Rate for Payer: Scott and White EPO/PPO	$32.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$46.12
Rate for Payer: Superior Health Plan EPO	$8.71

CHWR DOBHOFF TUBE FEEDING TUBE

Facility

$64.05

Service Code	HCPCS B4148
Hospital Charge Code	8034690
Hospital Revenue Code	270
Rate for Payer: Cash Price	$43.55

CHWR DRAIN BAG

Facility

$90.80

Hospital Charge Code	8041055
Hospital Revenue Code	272
Rate for Payer: Cash Price	$61.74

CHWR DRAIN BAG

Facility

$90.80

Hospital Charge Code	8041055
Hospital Revenue Code	272
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$65.38
Rate for Payer: Amerigroup CHIP/Medicaid	$8.17
Rate for Payer: BCBS of TX Blue Advantage	$27.24
Rate for Payer: BCBS of TX Blue Essentials	$32.69
Rate for Payer: BCBS of TX PPO	$36.32
Rate for Payer: Cash Price	$61.74
Rate for Payer: Cigna Medicaid	$65.38
Rate for Payer: Molina CHIP/Medicaid	$65.38
Rate for Payer: Multiplan Auto	$59.02
Rate for Payer: Multiplan Commercial	$59.02
Rate for Payer: Multiplan Workers Comp	$59.02
Rate for Payer: Parkland Medicaid	$65.38
Rate for Payer: Scott and White EPO/PPO	$45.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$65.38
Rate for Payer: Superior Health Plan EPO	$12.35

CHWR DRESSING 3X4 STERILE

Facility

$9.12

Hospital Charge Code	8024927
Hospital Revenue Code	270
Rate for Payer: Cash Price	$6.20

Know your out-of-pocket cost for care.

All Charges