White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CUFF TRNQT 24IN STRL DISP

Facility

$48.85

Hospital Charge Code	993052
Hospital Revenue Code	270
Rate for Payer: Cash Price	$33.22

CUFF TRNQT 24IN STRL DISP

Facility

$48.85

Hospital Charge Code	993052
Hospital Revenue Code	270
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$35.17
Rate for Payer: Amerigroup CHIP/Medicaid	$4.40
Rate for Payer: BCBS of TX Blue Advantage	$14.65
Rate for Payer: BCBS of TX Blue Essentials	$17.59
Rate for Payer: BCBS of TX PPO	$19.54
Rate for Payer: Cash Price	$33.22
Rate for Payer: Cigna Medicaid	$35.17
Rate for Payer: Molina CHIP/Medicaid	$35.17
Rate for Payer: Multiplan Auto	$31.75
Rate for Payer: Multiplan Commercial	$31.75
Rate for Payer: Multiplan Workers Comp	$31.75
Rate for Payer: Parkland Medicaid	$35.17
Rate for Payer: Scott and White EPO/PPO	$24.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$35.17
Rate for Payer: Superior Health Plan EPO	$6.64

CUFF TRNQT 30IN STRL DISP

Facility

$123.53

Hospital Charge Code	992915
Hospital Revenue Code	270
Min. Negotiated Rate	$11.12
Max. Negotiated Rate	$88.94
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	$49.41
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cigna Medicaid	$88.94
Rate for Payer: Molina CHIP/Medicaid	$88.94
Rate for Payer: Multiplan Auto	$80.29
Rate for Payer: Multiplan Commercial	$80.29
Rate for Payer: Multiplan Workers Comp	$80.29
Rate for Payer: Parkland Medicaid	$88.94
Rate for Payer: Scott and White EPO/PPO	$61.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$88.94
Rate for Payer: Superior Health Plan EPO	$16.80

CUFF TRNQT 30IN STRL DISP

Facility

$123.53

Hospital Charge Code	992915
Hospital Revenue Code	270
Rate for Payer: Cash Price	$84.00

CUFF TRNQT 34IN STRL DISP

Facility

$82.27

Hospital Charge Code	993046
Hospital Revenue Code	270
Rate for Payer: Cash Price	$55.94

CUFF TRNQT 34IN STRL DISP

Facility

$82.27

Hospital Charge Code	993046
Hospital Revenue Code	270
Min. Negotiated Rate	$7.40
Max. Negotiated Rate	$59.23
Rate for Payer: Amerigroup CHIP/Medicaid	$7.40
Rate for Payer: BCBS of TX Blue Advantage	$24.68
Rate for Payer: BCBS of TX Blue Essentials	$29.62
Rate for Payer: BCBS of TX PPO	$32.91
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cigna Medicaid	$59.23
Rate for Payer: Molina CHIP/Medicaid	$59.23
Rate for Payer: Multiplan Auto	$53.48
Rate for Payer: Multiplan Commercial	$53.48
Rate for Payer: Multiplan Workers Comp	$53.48
Rate for Payer: Parkland Medicaid	$59.23
Rate for Payer: Scott and White EPO/PPO	$41.13
Rate for Payer: Superior Health Plan CHIP/Medicaid	$59.23
Rate for Payer: Superior Health Plan EPO	$11.19

CUFF TRNQT 42IN 2 PORT 1 BLDR CONN ATS

Facility

$48.85

Hospital Charge Code	993053
Hospital Revenue Code	270
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$35.17
Rate for Payer: Amerigroup CHIP/Medicaid	$4.40
Rate for Payer: BCBS of TX Blue Advantage	$14.65
Rate for Payer: BCBS of TX Blue Essentials	$17.59
Rate for Payer: BCBS of TX PPO	$19.54
Rate for Payer: Cash Price	$33.22
Rate for Payer: Cigna Medicaid	$35.17
Rate for Payer: Molina CHIP/Medicaid	$35.17
Rate for Payer: Multiplan Auto	$31.75
Rate for Payer: Multiplan Commercial	$31.75
Rate for Payer: Multiplan Workers Comp	$31.75
Rate for Payer: Parkland Medicaid	$35.17
Rate for Payer: Scott and White EPO/PPO	$24.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$35.17
Rate for Payer: Superior Health Plan EPO	$6.64

CUFF TRNQT 42IN 2 PORT 1 BLDR CONN ATS

Facility

$48.85

Hospital Charge Code	993053
Hospital Revenue Code	270
Rate for Payer: Cash Price	$33.22

Culture, bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates, each plate

Facility

$374.00

Service Code	HCPCS 87046
Hospital Charge Code	8220508
Hospital Revenue Code	301
Rate for Payer: Cash Price	$254.32

Culture, bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates, each plate

Facility

$374.00

Service Code	HCPCS 87046
Hospital Charge Code	8220508
Hospital Revenue Code	301
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$269.28
Rate for Payer: Amerigroup CHIP/Medicaid	$3.68
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$9.44
Rate for Payer: Amerigroup Medicare	$9.44
Rate for Payer: BCBS of TX Blue Advantage	$112.20
Rate for Payer: BCBS of TX Blue Essentials	$134.64
Rate for Payer: BCBS of TX Medicare	$9.44
Rate for Payer: BCBS of TX PPO	$149.60
Rate for Payer: Cash Price	$254.32
Rate for Payer: Cash Price	$254.32
Rate for Payer: Cigna Medicaid	$269.28
Rate for Payer: Cigna Medicare	$9.44
Rate for Payer: Employer Direct Commercial	$9.44
Rate for Payer: Humana Medicare/TRICARE	$9.44
Rate for Payer: Molina CHIP/Medicaid	$269.28
Rate for Payer: Molina Dual Medicare/Medicaid	$9.44
Rate for Payer: Molina Medicare	$9.44
Rate for Payer: Multiplan Auto	$243.10
Rate for Payer: Multiplan Commercial	$243.10
Rate for Payer: Multiplan Workers Comp	$243.10
Rate for Payer: Parkland Medicaid	$269.28
Rate for Payer: Scott and White EPO/PPO	$11.80
Rate for Payer: Scott and White Medicare	$9.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$269.28
Rate for Payer: Superior Health Plan EPO	$9.44
Rate for Payer: Superior Health Plan Medicare	$9.44
Rate for Payer: Universal American Dual Medicare/Medicaid	$9.44
Rate for Payer: Universal American Medicare	$9.44
Rate for Payer: Wellcare Medicare	$9.44
Rate for Payer: Wellmed Medicare	$9.44

CULTURE CHOCOLATE AGAR PLATE 100/PK

Facility

$10.48

Hospital Charge Code	993651
Hospital Revenue Code	270
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$7.55
Rate for Payer: Amerigroup CHIP/Medicaid	$0.94
Rate for Payer: BCBS of TX Blue Advantage	$3.14
Rate for Payer: BCBS of TX Blue Essentials	$3.77
Rate for Payer: BCBS of TX PPO	$4.19
Rate for Payer: Cash Price	$7.13
Rate for Payer: Cigna Medicaid	$7.55
Rate for Payer: Molina CHIP/Medicaid	$7.55
Rate for Payer: Multiplan Auto	$6.81
Rate for Payer: Multiplan Commercial	$6.81
Rate for Payer: Multiplan Workers Comp	$6.81
Rate for Payer: Parkland Medicaid	$7.55
Rate for Payer: Scott and White EPO/PPO	$5.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.55
Rate for Payer: Superior Health Plan EPO	$1.43

CULTURE CHOCOLATE AGAR PLATE 100/PK

Facility

$10.48

Hospital Charge Code	993651
Hospital Revenue Code	270
Rate for Payer: Cash Price	$7.13

Culture Urine Colony BCE

Facility

$299.00

Service Code	HCPCS 87086
Hospital Charge Code	4107086
Hospital Revenue Code	306
Rate for Payer: Cash Price	$203.32

Culture Urine Colony BCE

Facility

$299.00

Service Code	HCPCS 87086
Hospital Charge Code	4107086
Hospital Revenue Code	306
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$215.28
Rate for Payer: Amerigroup CHIP/Medicaid	$3.15
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8.07
Rate for Payer: Amerigroup Medicare	$8.07
Rate for Payer: BCBS of TX Blue Advantage	$89.70
Rate for Payer: BCBS of TX Blue Essentials	$107.64
Rate for Payer: BCBS of TX Medicare	$8.07
Rate for Payer: BCBS of TX PPO	$119.60
Rate for Payer: Cash Price	$203.32
Rate for Payer: Cash Price	$203.32
Rate for Payer: Cigna Medicaid	$215.28
Rate for Payer: Cigna Medicare	$8.07
Rate for Payer: Employer Direct Commercial	$8.07
Rate for Payer: Humana Medicare/TRICARE	$8.07
Rate for Payer: Molina CHIP/Medicaid	$215.28
Rate for Payer: Molina Dual Medicare/Medicaid	$8.07
Rate for Payer: Molina Medicare	$8.07
Rate for Payer: Multiplan Auto	$194.35
Rate for Payer: Multiplan Commercial	$194.35
Rate for Payer: Multiplan Workers Comp	$194.35
Rate for Payer: Parkland Medicaid	$215.28
Rate for Payer: Scott and White EPO/PPO	$10.09
Rate for Payer: Scott and White Medicare	$8.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$215.28
Rate for Payer: Superior Health Plan EPO	$8.07
Rate for Payer: Superior Health Plan Medicare	$8.07
Rate for Payer: Universal American Dual Medicare/Medicaid	$8.07
Rate for Payer: Universal American Medicare	$8.07
Rate for Payer: Wellcare Medicare	$8.07
Rate for Payer: Wellmed Medicare	$8.07

CUP, ASSAY MINI HEMO CONS

Facility

$1,021.50

Hospital Charge Code	993974
Hospital Revenue Code	270
Min. Negotiated Rate	$91.94
Max. Negotiated Rate	$735.48
Rate for Payer: Amerigroup CHIP/Medicaid	$91.94
Rate for Payer: BCBS of TX Blue Advantage	$306.45
Rate for Payer: BCBS of TX Blue Essentials	$367.74
Rate for Payer: BCBS of TX PPO	$408.60
Rate for Payer: Cash Price	$694.62
Rate for Payer: Cigna Medicaid	$735.48
Rate for Payer: Molina CHIP/Medicaid	$735.48
Rate for Payer: Multiplan Auto	$663.98
Rate for Payer: Multiplan Commercial	$663.98
Rate for Payer: Multiplan Workers Comp	$663.98
Rate for Payer: Parkland Medicaid	$735.48
Rate for Payer: Scott and White EPO/PPO	$510.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$735.48
Rate for Payer: Superior Health Plan EPO	$138.92

CUP, ASSAY MINI HEMO CONS

Facility

$1,021.50

Hospital Charge Code	993974
Hospital Revenue Code	270
Rate for Payer: Cash Price	$694.62

CUP, FOAM, 12 OZ

Facility

$0.33

Hospital Charge Code	993966
Hospital Revenue Code	270
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.24
Rate for Payer: Amerigroup CHIP/Medicaid	$0.03
Rate for Payer: BCBS of TX Blue Advantage	$0.10
Rate for Payer: BCBS of TX Blue Essentials	$0.12
Rate for Payer: BCBS of TX PPO	$0.13
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna Medicaid	$0.24
Rate for Payer: Molina CHIP/Medicaid	$0.24
Rate for Payer: Multiplan Auto	$0.21
Rate for Payer: Multiplan Commercial	$0.21
Rate for Payer: Multiplan Workers Comp	$0.21
Rate for Payer: Parkland Medicaid	$0.24
Rate for Payer: Scott and White EPO/PPO	$0.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.24
Rate for Payer: Superior Health Plan EPO	$0.04

CUP, FOAM, 12 OZ

Facility

$0.33

Hospital Charge Code	993966
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.22

CUP, FOAM, 8 OZ

Facility

$2.28

Hospital Charge Code	993222
Hospital Revenue Code	270
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$1.64
Rate for Payer: Amerigroup CHIP/Medicaid	$0.21
Rate for Payer: BCBS of TX Blue Advantage	$0.68
Rate for Payer: BCBS of TX Blue Essentials	$0.82
Rate for Payer: BCBS of TX PPO	$0.91
Rate for Payer: Cash Price	$1.55
Rate for Payer: Cigna Medicaid	$1.64
Rate for Payer: Molina CHIP/Medicaid	$1.64
Rate for Payer: Multiplan Auto	$1.48
Rate for Payer: Multiplan Commercial	$1.48
Rate for Payer: Multiplan Workers Comp	$1.48
Rate for Payer: Parkland Medicaid	$1.64
Rate for Payer: Scott and White EPO/PPO	$1.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.64
Rate for Payer: Superior Health Plan EPO	$0.31

CUP, FOAM, 8 OZ

Facility

$2.28

Hospital Charge Code	993222
Hospital Revenue Code	270
Rate for Payer: Cash Price	$1.55

CUP, MEDICINE, GRAD, PLASTIC, 1OZ

Facility

$0.03

Hospital Charge Code	992976
Hospital Revenue Code	272
Max. Negotiated Rate	$0.02
Rate for Payer: Amerigroup CHIP/Medicaid	$0.00
Rate for Payer: BCBS of TX Blue Advantage	$0.01
Rate for Payer: BCBS of TX Blue Essentials	$0.01
Rate for Payer: BCBS of TX PPO	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna Medicaid	$0.02
Rate for Payer: Molina CHIP/Medicaid	$0.02
Rate for Payer: Multiplan Auto	$0.02
Rate for Payer: Multiplan Commercial	$0.02
Rate for Payer: Multiplan Workers Comp	$0.02
Rate for Payer: Parkland Medicaid	$0.02
Rate for Payer: Scott and White EPO/PPO	$0.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.02
Rate for Payer: Superior Health Plan EPO	$0.00

CUP, MEDICINE, GRAD, PLASTIC, 1OZ

Facility

$0.03

Hospital Charge Code	992976
Hospital Revenue Code	272
Rate for Payer: Cash Price	$0.02

CUP STYROFOAM 12 OZ DISP

Facility

$0.86

Hospital Charge Code	993190
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.58

CUP STYROFOAM 12 OZ DISP

Facility

$0.86

Hospital Charge Code	993190
Hospital Revenue Code	270
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.62
Rate for Payer: Amerigroup CHIP/Medicaid	$0.08
Rate for Payer: BCBS of TX Blue Advantage	$0.26
Rate for Payer: BCBS of TX Blue Essentials	$0.31
Rate for Payer: BCBS of TX PPO	$0.34
Rate for Payer: Cash Price	$0.58
Rate for Payer: Cigna Medicaid	$0.62
Rate for Payer: Molina CHIP/Medicaid	$0.62
Rate for Payer: Multiplan Auto	$0.56
Rate for Payer: Multiplan Commercial	$0.56
Rate for Payer: Multiplan Workers Comp	$0.56
Rate for Payer: Parkland Medicaid	$0.62
Rate for Payer: Scott and White EPO/PPO	$0.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.62
Rate for Payer: Superior Health Plan EPO	$0.12

CURAD Xeroform gauze dressing sterile 1x8

Facility

$2.61

Hospital Charge Code	992945
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

Know your out-of-pocket cost for care.

All Charges