White Rock Medical Center

All Charges

Charge

Type

Setting

Price

COVER, C-ARM, 41 X 74

Facility

$19.27

Hospital Charge Code	993785
Hospital Revenue Code	272
Rate for Payer: Cash Price	$13.10

COVER, C-ARM, 41 X 74

Facility

$19.27

Hospital Charge Code	993785
Hospital Revenue Code	272
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$13.87
Rate for Payer: Amerigroup CHIP/Medicaid	$1.73
Rate for Payer: BCBS of TX Blue Advantage	$5.78
Rate for Payer: BCBS of TX Blue Essentials	$6.94
Rate for Payer: BCBS of TX PPO	$7.71
Rate for Payer: Cash Price	$13.10
Rate for Payer: Cigna Medicaid	$13.87
Rate for Payer: Molina CHIP/Medicaid	$13.87
Rate for Payer: Multiplan Auto	$12.53
Rate for Payer: Multiplan Commercial	$12.53
Rate for Payer: Multiplan Workers Comp	$12.53
Rate for Payer: Parkland Medicaid	$13.87
Rate for Payer: Scott and White EPO/PPO	$9.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.87
Rate for Payer: Superior Health Plan EPO	$2.62

COVER, HANDLE LEGT TOP, ICHRO

Facility

$681.00

Hospital Charge Code	992619
Hospital Revenue Code	272
Rate for Payer: Cash Price	$463.08

COVER, HANDLE LEGT TOP, ICHRO

Facility

$681.00

Hospital Charge Code	992619
Hospital Revenue Code	272
Min. Negotiated Rate	$61.29
Max. Negotiated Rate	$490.32
Rate for Payer: Amerigroup CHIP/Medicaid	$61.29
Rate for Payer: BCBS of TX Blue Advantage	$204.30
Rate for Payer: BCBS of TX Blue Essentials	$245.16
Rate for Payer: BCBS of TX PPO	$272.40
Rate for Payer: Cash Price	$463.08
Rate for Payer: Cigna Medicaid	$490.32
Rate for Payer: Molina CHIP/Medicaid	$490.32
Rate for Payer: Multiplan Auto	$442.65
Rate for Payer: Multiplan Commercial	$442.65
Rate for Payer: Multiplan Workers Comp	$442.65
Rate for Payer: Parkland Medicaid	$490.32
Rate for Payer: Scott and White EPO/PPO	$340.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$490.32
Rate for Payer: Superior Health Plan EPO	$92.62

COVER, HANDLE RIGHT TOP

Facility

$681.00

Hospital Charge Code	992620
Hospital Revenue Code	272
Min. Negotiated Rate	$61.29
Max. Negotiated Rate	$490.32
Rate for Payer: Amerigroup CHIP/Medicaid	$61.29
Rate for Payer: BCBS of TX Blue Advantage	$204.30
Rate for Payer: BCBS of TX Blue Essentials	$245.16
Rate for Payer: BCBS of TX PPO	$272.40
Rate for Payer: Cash Price	$463.08
Rate for Payer: Cigna Medicaid	$490.32
Rate for Payer: Molina CHIP/Medicaid	$490.32
Rate for Payer: Multiplan Auto	$442.65
Rate for Payer: Multiplan Commercial	$442.65
Rate for Payer: Multiplan Workers Comp	$442.65
Rate for Payer: Parkland Medicaid	$490.32
Rate for Payer: Scott and White EPO/PPO	$340.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$490.32
Rate for Payer: Superior Health Plan EPO	$92.62

COVER, HANDLE RIGHT TOP

Facility

$681.00

Hospital Charge Code	992620
Hospital Revenue Code	272
Rate for Payer: Cash Price	$463.08

COVER LARYNGOSCOPE STAT 0270-0626

Facility

$73.07

Hospital Charge Code	993678
Hospital Revenue Code	270
Min. Negotiated Rate	$6.58
Max. Negotiated Rate	$52.61
Rate for Payer: Amerigroup CHIP/Medicaid	$6.58
Rate for Payer: BCBS of TX Blue Advantage	$21.92
Rate for Payer: BCBS of TX Blue Essentials	$26.31
Rate for Payer: BCBS of TX PPO	$29.23
Rate for Payer: Cash Price	$49.69
Rate for Payer: Cigna Medicaid	$52.61
Rate for Payer: Molina CHIP/Medicaid	$52.61
Rate for Payer: Multiplan Auto	$47.50
Rate for Payer: Multiplan Commercial	$47.50
Rate for Payer: Multiplan Workers Comp	$47.50
Rate for Payer: Parkland Medicaid	$52.61
Rate for Payer: Scott and White EPO/PPO	$36.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$52.61
Rate for Payer: Superior Health Plan EPO	$9.94

COVER LARYNGOSCOPE STAT 0270-0626

Facility

$73.07

Hospital Charge Code	993678
Hospital Revenue Code	270
Rate for Payer: Cash Price	$49.69

COVER LARYNGOSCOPE STAT 0270-0628

Facility

$73.07

Hospital Charge Code	993672
Hospital Revenue Code	270
Min. Negotiated Rate	$6.58
Max. Negotiated Rate	$52.61
Rate for Payer: Amerigroup CHIP/Medicaid	$6.58
Rate for Payer: BCBS of TX Blue Advantage	$21.92
Rate for Payer: BCBS of TX Blue Essentials	$26.31
Rate for Payer: BCBS of TX PPO	$29.23
Rate for Payer: Cash Price	$49.69
Rate for Payer: Cigna Medicaid	$52.61
Rate for Payer: Molina CHIP/Medicaid	$52.61
Rate for Payer: Multiplan Auto	$47.50
Rate for Payer: Multiplan Commercial	$47.50
Rate for Payer: Multiplan Workers Comp	$47.50
Rate for Payer: Parkland Medicaid	$52.61
Rate for Payer: Scott and White EPO/PPO	$36.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$52.61
Rate for Payer: Superior Health Plan EPO	$9.94

COVER LARYNGOSCOPE STAT 0270-0628

Facility

$73.07

Hospital Charge Code	993672
Hospital Revenue Code	270
Rate for Payer: Cash Price	$49.69

COVER, LIGHT HANDLE, FLEXIBLE, SOFT, 1/PK

Facility

$2.61

Hospital Charge Code	992752
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1.77

COVER, LIGHT HANDLE, FLEXIBLE, SOFT, 1/PK

Facility

$2.61

Hospital Charge Code	992752
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$1.88
Rate for Payer: Amerigroup CHIP/Medicaid	$0.23
Rate for Payer: BCBS of TX Blue Advantage	$0.78
Rate for Payer: BCBS of TX Blue Essentials	$0.94
Rate for Payer: BCBS of TX PPO	$1.04
Rate for Payer: Cash Price	$1.77
Rate for Payer: Cigna Medicaid	$1.88
Rate for Payer: Molina CHIP/Medicaid	$1.88
Rate for Payer: Multiplan Auto	$1.70
Rate for Payer: Multiplan Commercial	$1.70
Rate for Payer: Multiplan Workers Comp	$1.70
Rate for Payer: Parkland Medicaid	$1.88
Rate for Payer: Scott and White EPO/PPO	$1.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.88
Rate for Payer: Superior Health Plan EPO	$0.35

COVER, MAYO STAND, XL, ST, 22/CS

Facility

$6.69

Hospital Charge Code	992807
Hospital Revenue Code	272
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$4.82
Rate for Payer: Amerigroup CHIP/Medicaid	$0.60
Rate for Payer: BCBS of TX Blue Advantage	$2.01
Rate for Payer: BCBS of TX Blue Essentials	$2.41
Rate for Payer: BCBS of TX PPO	$2.68
Rate for Payer: Cash Price	$4.55
Rate for Payer: Cigna Medicaid	$4.82
Rate for Payer: Molina CHIP/Medicaid	$4.82
Rate for Payer: Multiplan Auto	$4.35
Rate for Payer: Multiplan Commercial	$4.35
Rate for Payer: Multiplan Workers Comp	$4.35
Rate for Payer: Parkland Medicaid	$4.82
Rate for Payer: Scott and White EPO/PPO	$3.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.82
Rate for Payer: Superior Health Plan EPO	$0.91

COVER, MAYO STAND, XL, ST, 22/CS

Facility

$6.69

Hospital Charge Code	992807
Hospital Revenue Code	272
Rate for Payer: Cash Price	$4.55

COVER PAD BILICOCOON KANGAROO DISP

Facility

$55.02

Hospital Charge Code	144850
Hospital Revenue Code	272
Rate for Payer: Cash Price	$37.41

COVER PAD BILICOCOON KANGAROO DISP

Facility

$55.02

Hospital Charge Code	144850
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$39.61
Rate for Payer: Amerigroup CHIP/Medicaid	$4.95
Rate for Payer: BCBS of TX Blue Advantage	$16.51
Rate for Payer: BCBS of TX Blue Essentials	$19.81
Rate for Payer: BCBS of TX PPO	$22.01
Rate for Payer: Cash Price	$37.41
Rate for Payer: Cigna Medicaid	$39.61
Rate for Payer: Molina CHIP/Medicaid	$39.61
Rate for Payer: Multiplan Auto	$35.76
Rate for Payer: Multiplan Commercial	$35.76
Rate for Payer: Multiplan Workers Comp	$35.76
Rate for Payer: Parkland Medicaid	$39.61
Rate for Payer: Scott and White EPO/PPO	$27.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$39.61
Rate for Payer: Superior Health Plan EPO	$7.48

COVER PROBE ECLIPSE LATEX FREE 2.5X 1.75X 9.5

Facility

$0.30

Hospital Charge Code	993438
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.22
Rate for Payer: Amerigroup CHIP/Medicaid	$0.03
Rate for Payer: BCBS of TX Blue Advantage	$0.09
Rate for Payer: BCBS of TX Blue Essentials	$0.11
Rate for Payer: BCBS of TX PPO	$0.12
Rate for Payer: Cash Price	$0.20
Rate for Payer: Cigna Medicaid	$0.22
Rate for Payer: Molina CHIP/Medicaid	$0.22
Rate for Payer: Multiplan Auto	$0.20
Rate for Payer: Multiplan Commercial	$0.20
Rate for Payer: Multiplan Workers Comp	$0.20
Rate for Payer: Parkland Medicaid	$0.22
Rate for Payer: Scott and White EPO/PPO	$0.15
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.22
Rate for Payer: Superior Health Plan EPO	$0.04

COVER PROBE ECLIPSE LATEX FREE 2.5X 1.75X 9.5

Facility

$0.30

Hospital Charge Code	993438
Hospital Revenue Code	272
Rate for Payer: Cash Price	$0.20

COVER, PROBE, FLEXIFEEL, W/STERILE GEL, 6X58

Facility

$48.75

Hospital Charge Code	992828
Hospital Revenue Code	272
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$35.10
Rate for Payer: Amerigroup CHIP/Medicaid	$4.39
Rate for Payer: BCBS of TX Blue Advantage	$14.62
Rate for Payer: BCBS of TX Blue Essentials	$17.55
Rate for Payer: BCBS of TX PPO	$19.50
Rate for Payer: Cash Price	$33.15
Rate for Payer: Cigna Medicaid	$35.10
Rate for Payer: Molina CHIP/Medicaid	$35.10
Rate for Payer: Multiplan Auto	$31.69
Rate for Payer: Multiplan Commercial	$31.69
Rate for Payer: Multiplan Workers Comp	$31.69
Rate for Payer: Parkland Medicaid	$35.10
Rate for Payer: Scott and White EPO/PPO	$24.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$35.10
Rate for Payer: Superior Health Plan EPO	$6.63

COVER, PROBE, FLEXIFEEL, W/STERILE GEL, 6X58

Facility

$48.75

Hospital Charge Code	992828
Hospital Revenue Code	272
Rate for Payer: Cash Price	$33.15

COVER, PROBE, FOR SURE TEMP, 25/PK

Facility

$0.14

Hospital Charge Code	993196
Hospital Revenue Code	271
Rate for Payer: Cash Price	$0.10

COVER, PROBE, FOR SURE TEMP, 25/PK

Facility

$0.14

Hospital Charge Code	993196
Hospital Revenue Code	271
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.10
Rate for Payer: Amerigroup CHIP/Medicaid	$0.01
Rate for Payer: BCBS of TX Blue Advantage	$0.04
Rate for Payer: BCBS of TX Blue Essentials	$0.05
Rate for Payer: BCBS of TX PPO	$0.06
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna Medicaid	$0.10
Rate for Payer: Molina CHIP/Medicaid	$0.10
Rate for Payer: Multiplan Auto	$0.09
Rate for Payer: Multiplan Commercial	$0.09
Rate for Payer: Multiplan Workers Comp	$0.09
Rate for Payer: Parkland Medicaid	$0.10
Rate for Payer: Scott and White EPO/PPO	$0.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.10
Rate for Payer: Superior Health Plan EPO	$0.02

COVER, SHOE, SPP, NONSKID, BLUE, 2XL

Facility

$0.75

Hospital Charge Code	993004
Hospital Revenue Code	270
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.54
Rate for Payer: Amerigroup CHIP/Medicaid	$0.07
Rate for Payer: BCBS of TX Blue Advantage	$0.23
Rate for Payer: BCBS of TX Blue Essentials	$0.27
Rate for Payer: BCBS of TX PPO	$0.30
Rate for Payer: Cash Price	$0.51
Rate for Payer: Cigna Medicaid	$0.54
Rate for Payer: Molina CHIP/Medicaid	$0.54
Rate for Payer: Multiplan Auto	$0.49
Rate for Payer: Multiplan Commercial	$0.49
Rate for Payer: Multiplan Workers Comp	$0.49
Rate for Payer: Parkland Medicaid	$0.54
Rate for Payer: Scott and White EPO/PPO	$0.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.54
Rate for Payer: Superior Health Plan EPO	$0.10

COVER, SHOE, SPP, NONSKID, BLUE, 2XL

Facility

$0.75

Hospital Charge Code	993004
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.51

COVER TIP HOT SHR MNPLR CRV SCSR

Facility

$953.40

Hospital Charge Code	992732
Hospital Revenue Code	270
Min. Negotiated Rate	$85.81
Max. Negotiated Rate	$686.45
Rate for Payer: Amerigroup CHIP/Medicaid	$85.81
Rate for Payer: BCBS of TX Blue Advantage	$286.02
Rate for Payer: BCBS of TX Blue Essentials	$343.22
Rate for Payer: BCBS of TX PPO	$381.36
Rate for Payer: Cash Price	$648.31
Rate for Payer: Cigna Medicaid	$686.45
Rate for Payer: Molina CHIP/Medicaid	$686.45
Rate for Payer: Multiplan Auto	$619.71
Rate for Payer: Multiplan Commercial	$619.71
Rate for Payer: Multiplan Workers Comp	$619.71
Rate for Payer: Parkland Medicaid	$686.45
Rate for Payer: Scott and White EPO/PPO	$476.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$686.45
Rate for Payer: Superior Health Plan EPO	$129.66

Know your out-of-pocket cost for care.

All Charges