White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CHWR PROTECTOR WIRE LOC NEEDLE

Facility

$54.74

Hospital Charge Code	8073177
Hospital Revenue Code	272
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$39.41
Rate for Payer: Amerigroup CHIP/Medicaid	$4.93
Rate for Payer: BCBS of TX Blue Advantage	$16.42
Rate for Payer: BCBS of TX Blue Essentials	$19.71
Rate for Payer: BCBS of TX PPO	$21.90
Rate for Payer: Cash Price	$37.22
Rate for Payer: Cigna Medicaid	$39.41
Rate for Payer: Molina CHIP/Medicaid	$39.41
Rate for Payer: Multiplan Auto	$35.58
Rate for Payer: Multiplan Commercial	$35.58
Rate for Payer: Multiplan Workers Comp	$35.58
Rate for Payer: Parkland Medicaid	$39.41
Rate for Payer: Scott and White EPO/PPO	$27.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$39.41
Rate for Payer: Superior Health Plan EPO	$7.44

CHWR SAFETY SOFT TISSUE BIOPSY TRAY

Facility

$123.54

Hospital Charge Code	8083040
Hospital Revenue Code	272
Min. Negotiated Rate	$11.12
Max. Negotiated Rate	$88.95
Rate for Payer: Amerigroup CHIP/Medicaid	$11.12
Rate for Payer: BCBS of TX Blue Advantage	$37.06
Rate for Payer: BCBS of TX Blue Essentials	$44.47
Rate for Payer: BCBS of TX PPO	$49.42
Rate for Payer: Cash Price	$84.01
Rate for Payer: Cigna Medicaid	$88.95
Rate for Payer: Molina CHIP/Medicaid	$88.95
Rate for Payer: Multiplan Auto	$80.30
Rate for Payer: Multiplan Commercial	$80.30
Rate for Payer: Multiplan Workers Comp	$80.30
Rate for Payer: Parkland Medicaid	$88.95
Rate for Payer: Scott and White EPO/PPO	$61.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$88.95
Rate for Payer: Superior Health Plan EPO	$16.80

CHWR SAFETY SOFT TISSUE BIOPSY TRAY

Facility

$123.54

Hospital Charge Code	8083040
Hospital Revenue Code	272
Rate for Payer: Cash Price	$84.01

CHWR SPINAL NEEDLE ANY SIZE

Facility

$78.04

Hospital Charge Code	8032875
Hospital Revenue Code	272
Rate for Payer: Cash Price	$53.07

CHWR SPINAL NEEDLE ANY SIZE

Facility

$78.04

Hospital Charge Code	8032875
Hospital Revenue Code	272
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$56.19
Rate for Payer: Amerigroup CHIP/Medicaid	$7.02
Rate for Payer: BCBS of TX Blue Advantage	$23.41
Rate for Payer: BCBS of TX Blue Essentials	$28.09
Rate for Payer: BCBS of TX PPO	$31.22
Rate for Payer: Cash Price	$53.07
Rate for Payer: Cigna Medicaid	$56.19
Rate for Payer: Molina CHIP/Medicaid	$56.19
Rate for Payer: Multiplan Auto	$50.73
Rate for Payer: Multiplan Commercial	$50.73
Rate for Payer: Multiplan Workers Comp	$50.73
Rate for Payer: Parkland Medicaid	$56.19
Rate for Payer: Scott and White EPO/PPO	$39.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$56.19
Rate for Payer: Superior Health Plan EPO	$10.61

CHWR STERI STRIPS

Facility

$55.15

Hospital Charge Code	8185055
Hospital Revenue Code	272
Rate for Payer: Cash Price	$37.50

CHWR STERI STRIPS

Facility

$55.15

Hospital Charge Code	8185055
Hospital Revenue Code	272
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$39.71
Rate for Payer: Amerigroup CHIP/Medicaid	$4.96
Rate for Payer: BCBS of TX Blue Advantage	$16.55
Rate for Payer: BCBS of TX Blue Essentials	$19.85
Rate for Payer: BCBS of TX PPO	$22.06
Rate for Payer: Cash Price	$37.50
Rate for Payer: Cigna Medicaid	$39.71
Rate for Payer: Molina CHIP/Medicaid	$39.71
Rate for Payer: Multiplan Auto	$35.85
Rate for Payer: Multiplan Commercial	$35.85
Rate for Payer: Multiplan Workers Comp	$35.85
Rate for Payer: Parkland Medicaid	$39.71
Rate for Payer: Scott and White EPO/PPO	$27.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$39.71
Rate for Payer: Superior Health Plan EPO	$7.50

CHWR STRKER BIOPSY GUN

Facility

$249.70

Hospital Charge Code	8081229
Hospital Revenue Code	272
Rate for Payer: Cash Price	$169.80

CHWR STRKER BIOPSY GUN

Facility

$249.70

Hospital Charge Code	8081229
Hospital Revenue Code	272
Min. Negotiated Rate	$22.47
Max. Negotiated Rate	$179.78
Rate for Payer: Amerigroup CHIP/Medicaid	$22.47
Rate for Payer: BCBS of TX Blue Advantage	$74.91
Rate for Payer: BCBS of TX Blue Essentials	$89.89
Rate for Payer: BCBS of TX PPO	$99.88
Rate for Payer: Cash Price	$169.80
Rate for Payer: Cigna Medicaid	$179.78
Rate for Payer: Molina CHIP/Medicaid	$179.78
Rate for Payer: Multiplan Auto	$162.31
Rate for Payer: Multiplan Commercial	$162.31
Rate for Payer: Multiplan Workers Comp	$162.31
Rate for Payer: Parkland Medicaid	$179.78
Rate for Payer: Scott and White EPO/PPO	$124.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$179.78
Rate for Payer: Superior Health Plan EPO	$33.96

CHWR SUCTION CANISTER SET

Facility

$170.09

Hospital Charge Code	8034290
Hospital Revenue Code	270
Min. Negotiated Rate	$15.31
Max. Negotiated Rate	$122.46
Rate for Payer: Amerigroup CHIP/Medicaid	$15.31
Rate for Payer: BCBS of TX Blue Advantage	$51.03
Rate for Payer: BCBS of TX Blue Essentials	$61.23
Rate for Payer: BCBS of TX PPO	$68.04
Rate for Payer: Cash Price	$115.66
Rate for Payer: Cigna Medicaid	$122.46
Rate for Payer: Molina CHIP/Medicaid	$122.46
Rate for Payer: Multiplan Auto	$110.56
Rate for Payer: Multiplan Commercial	$110.56
Rate for Payer: Multiplan Workers Comp	$110.56
Rate for Payer: Parkland Medicaid	$122.46
Rate for Payer: Scott and White EPO/PPO	$85.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$122.46
Rate for Payer: Superior Health Plan EPO	$23.13

CHWR SUCTION CANISTER SET

Facility

$170.09

Hospital Charge Code	8034290
Hospital Revenue Code	270
Rate for Payer: Cash Price	$115.66

CHWR SUTURE NYLON

Facility

$234.19

Hospital Charge Code	8194145
Hospital Revenue Code	272
Min. Negotiated Rate	$21.08
Max. Negotiated Rate	$168.62
Rate for Payer: Amerigroup CHIP/Medicaid	$21.08
Rate for Payer: BCBS of TX Blue Advantage	$70.26
Rate for Payer: BCBS of TX Blue Essentials	$84.31
Rate for Payer: BCBS of TX PPO	$93.68
Rate for Payer: Cash Price	$159.25
Rate for Payer: Cigna Medicaid	$168.62
Rate for Payer: Molina CHIP/Medicaid	$168.62
Rate for Payer: Multiplan Auto	$152.22
Rate for Payer: Multiplan Commercial	$152.22
Rate for Payer: Multiplan Workers Comp	$152.22
Rate for Payer: Parkland Medicaid	$168.62
Rate for Payer: Scott and White EPO/PPO	$117.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$168.62
Rate for Payer: Superior Health Plan EPO	$31.85

CHWR SUTURE NYLON

Facility

$234.19

Hospital Charge Code	8194145
Hospital Revenue Code	272
Rate for Payer: Cash Price	$159.25

CHWR SUTURE REMOVAL KIT

Facility

$98.82

Hospital Charge Code	8084130
Hospital Revenue Code	272
Min. Negotiated Rate	$8.89
Max. Negotiated Rate	$71.15
Rate for Payer: Amerigroup CHIP/Medicaid	$8.89
Rate for Payer: BCBS of TX Blue Advantage	$29.65
Rate for Payer: BCBS of TX Blue Essentials	$35.58
Rate for Payer: BCBS of TX PPO	$39.53
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cigna Medicaid	$71.15
Rate for Payer: Molina CHIP/Medicaid	$71.15
Rate for Payer: Multiplan Auto	$64.23
Rate for Payer: Multiplan Commercial	$64.23
Rate for Payer: Multiplan Workers Comp	$64.23
Rate for Payer: Parkland Medicaid	$71.15
Rate for Payer: Scott and White EPO/PPO	$49.41
Rate for Payer: Superior Health Plan CHIP/Medicaid	$71.15
Rate for Payer: Superior Health Plan EPO	$13.44

CHWR SUTURE REMOVAL KIT

Facility

$98.82

Hospital Charge Code	8084130
Hospital Revenue Code	272
Rate for Payer: Cash Price	$67.20

CHWR TEGADERM

Facility

$73.38

Hospital Charge Code	8024885
Hospital Revenue Code	270
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$52.83
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	$49.90
Rate for Payer: Cigna Medicaid	$52.83
Rate for Payer: Molina CHIP/Medicaid	$52.83
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: Parkland Medicaid	$52.83
Rate for Payer: Scott and White EPO/PPO	$36.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$52.83
Rate for Payer: Superior Health Plan EPO	$9.98

CHWR TEGADERM

Facility

$73.38

Hospital Charge Code	8024885
Hospital Revenue Code	270
Rate for Payer: Cash Price	$49.90

CHWR THORACENTESIS TRAY

Facility

$755.53

Hospital Charge Code	8084310
Hospital Revenue Code	272
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$543.98
Rate for Payer: Amerigroup CHIP/Medicaid	$68.00
Rate for Payer: BCBS of TX Blue Advantage	$226.66
Rate for Payer: BCBS of TX Blue Essentials	$271.99
Rate for Payer: BCBS of TX PPO	$302.21
Rate for Payer: Cash Price	$513.76
Rate for Payer: Cigna Medicaid	$543.98
Rate for Payer: Molina CHIP/Medicaid	$543.98
Rate for Payer: Multiplan Auto	$491.09
Rate for Payer: Multiplan Commercial	$491.09
Rate for Payer: Multiplan Workers Comp	$491.09
Rate for Payer: Parkland Medicaid	$543.98
Rate for Payer: Scott and White EPO/PPO	$377.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$543.98
Rate for Payer: Superior Health Plan EPO	$102.75

CHWR THORACENTESIS TRAY

Facility

$755.53

Hospital Charge Code	8084310
Hospital Revenue Code	272
Rate for Payer: Cash Price	$513.76

CHWR TIRALYSIS KIT

Facility

$2,210.51

Hospital Charge Code	8056390
Hospital Revenue Code	272
Min. Negotiated Rate	$198.95
Max. Negotiated Rate	$1,591.57
Rate for Payer: Amerigroup CHIP/Medicaid	$198.95
Rate for Payer: BCBS of TX Blue Advantage	$663.15
Rate for Payer: BCBS of TX Blue Essentials	$795.78
Rate for Payer: BCBS of TX PPO	$884.20
Rate for Payer: Cash Price	$1,503.15
Rate for Payer: Cigna Medicaid	$1,591.57
Rate for Payer: Molina CHIP/Medicaid	$1,591.57
Rate for Payer: Multiplan Auto	$1,436.83
Rate for Payer: Multiplan Commercial	$1,436.83
Rate for Payer: Multiplan Workers Comp	$1,436.83
Rate for Payer: Parkland Medicaid	$1,591.57
Rate for Payer: Scott and White EPO/PPO	$1,105.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,591.57
Rate for Payer: Superior Health Plan EPO	$300.63

CHWR TIRALYSIS KIT

Facility

$2,210.51

Hospital Charge Code	8056390
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,503.15

CHWR TRANSDUCER NEEDLE GUIDE w/ GEL

Facility

$98.82

Hospital Charge Code	8082253
Hospital Revenue Code	272
Min. Negotiated Rate	$8.89
Max. Negotiated Rate	$71.15
Rate for Payer: Amerigroup CHIP/Medicaid	$8.89
Rate for Payer: BCBS of TX Blue Advantage	$29.65
Rate for Payer: BCBS of TX Blue Essentials	$35.58
Rate for Payer: BCBS of TX PPO	$39.53
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cigna Medicaid	$71.15
Rate for Payer: Molina CHIP/Medicaid	$71.15
Rate for Payer: Multiplan Auto	$64.23
Rate for Payer: Multiplan Commercial	$64.23
Rate for Payer: Multiplan Workers Comp	$64.23
Rate for Payer: Parkland Medicaid	$71.15
Rate for Payer: Scott and White EPO/PPO	$49.41
Rate for Payer: Superior Health Plan CHIP/Medicaid	$71.15
Rate for Payer: Superior Health Plan EPO	$13.44

CHWR TRANSDUCER NEEDLE GUIDE w/ GEL

Facility

$98.82

Hospital Charge Code	8082253
Hospital Revenue Code	272
Rate for Payer: Cash Price	$67.20

CHWR US BREAST BX/LOC/SPECIMEN EA ADD

Facility

$1,974.00

Service Code	HCPCS 19084
Hospital Charge Code	5069184
Hospital Revenue Code	361
Min. Negotiated Rate	$177.66
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$177.66
Rate for Payer: BCBS of TX Blue Advantage	$592.20
Rate for Payer: BCBS of TX Blue Essentials	$710.64
Rate for Payer: BCBS of TX PPO	$789.60
Rate for Payer: Cash Price	$1,342.32
Rate for Payer: Cash Price	$1,342.32
Rate for Payer: Cigna Medicaid	$1,421.28
Rate for Payer: Molina CHIP/Medicaid	$1,421.28
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$1,421.28
Rate for Payer: Scott and White EPO/PPO	$987.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,421.28
Rate for Payer: Superior Health Plan EPO	$268.46

CHWR US BREAST BX/LOC/SPECIMEN EA ADD

Facility

$1,974.00

Service Code	HCPCS 19084
Hospital Charge Code	5069184
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,342.32

Know your out-of-pocket cost for care.

All Charges