White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CUTTER, ECHELON, CONTOUR, BLUE

Facility

$3,051.83

Hospital Charge Code	992331
Hospital Revenue Code	272
Min. Negotiated Rate	$274.66
Max. Negotiated Rate	$2,197.32
Rate for Payer: Amerigroup CHIP/Medicaid	$274.66
Rate for Payer: BCBS of TX Blue Advantage	$915.55
Rate for Payer: BCBS of TX Blue Essentials	$1,098.66
Rate for Payer: BCBS of TX PPO	$1,220.73
Rate for Payer: Cash Price	$2,075.24
Rate for Payer: Cigna Medicaid	$2,197.32
Rate for Payer: Molina CHIP/Medicaid	$2,197.32
Rate for Payer: Multiplan Auto	$1,983.69
Rate for Payer: Multiplan Commercial	$1,983.69
Rate for Payer: Multiplan Workers Comp	$1,983.69
Rate for Payer: Parkland Medicaid	$2,197.32
Rate for Payer: Scott and White EPO/PPO	$1,525.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,197.32
Rate for Payer: Superior Health Plan EPO	$415.05

CUTTER, ECHELON, CONTOUR, BLUE

Facility

$3,051.83

Hospital Charge Code	992331
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,075.24

CUTTER, ECHELON, CONTOUR, GREEN BX

Facility

$3,051.83

Hospital Charge Code	992332
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,075.24

CUTTER, ECHELON, CONTOUR, GREEN BX

Facility

$3,051.83

Hospital Charge Code	992332
Hospital Revenue Code	272
Min. Negotiated Rate	$274.66
Max. Negotiated Rate	$2,197.32
Rate for Payer: Amerigroup CHIP/Medicaid	$274.66
Rate for Payer: BCBS of TX Blue Advantage	$915.55
Rate for Payer: BCBS of TX Blue Essentials	$1,098.66
Rate for Payer: BCBS of TX PPO	$1,220.73
Rate for Payer: Cash Price	$2,075.24
Rate for Payer: Cigna Medicaid	$2,197.32
Rate for Payer: Molina CHIP/Medicaid	$2,197.32
Rate for Payer: Multiplan Auto	$1,983.69
Rate for Payer: Multiplan Commercial	$1,983.69
Rate for Payer: Multiplan Workers Comp	$1,983.69
Rate for Payer: Parkland Medicaid	$2,197.32
Rate for Payer: Scott and White EPO/PPO	$1,525.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,197.32
Rate for Payer: Superior Health Plan EPO	$415.05

CUTTER, ENDOSCOPIC LINEAR ARTICULAT 45MM NO RELOAD -- DHF

Facility

$1,581.16

Hospital Charge Code	81911851
Hospital Revenue Code	272
Min. Negotiated Rate	$142.30
Max. Negotiated Rate	$1,138.44
Rate for Payer: Amerigroup CHIP/Medicaid	$142.30
Rate for Payer: BCBS of TX Blue Advantage	$474.35
Rate for Payer: BCBS of TX Blue Essentials	$569.22
Rate for Payer: BCBS of TX PPO	$632.46
Rate for Payer: Cash Price	$1,075.19
Rate for Payer: Cigna Medicaid	$1,138.44
Rate for Payer: Molina CHIP/Medicaid	$1,138.44
Rate for Payer: Multiplan Auto	$1,027.75
Rate for Payer: Multiplan Commercial	$1,027.75
Rate for Payer: Multiplan Workers Comp	$1,027.75
Rate for Payer: Parkland Medicaid	$1,138.44
Rate for Payer: Scott and White EPO/PPO	$790.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,138.44
Rate for Payer: Superior Health Plan EPO	$215.04

CUTTER, ENDOSCOPIC LINEAR ARTICULAT 45MM NO RELOAD -- DHF

Facility

$1,581.16

Hospital Charge Code	81911851
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,075.19

CUTTER, LINEAR, 75MM, SAFETY LOCKOUT

Facility

$460.30

Hospital Charge Code	993820
Hospital Revenue Code	279
Rate for Payer: Cash Price	$313.00

CUTTER, LINEAR, 75MM, SAFETY LOCKOUT

Facility

$460.30

Hospital Charge Code	993820
Hospital Revenue Code	279
Min. Negotiated Rate	$41.43
Max. Negotiated Rate	$331.42
Rate for Payer: Amerigroup CHIP/Medicaid	$41.43
Rate for Payer: BCBS of TX Blue Advantage	$138.09
Rate for Payer: BCBS of TX Blue Essentials	$165.71
Rate for Payer: BCBS of TX PPO	$184.12
Rate for Payer: Cash Price	$313.00
Rate for Payer: Cigna Medicaid	$331.42
Rate for Payer: Molina CHIP/Medicaid	$331.42
Rate for Payer: Multiplan Auto	$299.19
Rate for Payer: Multiplan Commercial	$299.19
Rate for Payer: Multiplan Workers Comp	$299.19
Rate for Payer: Parkland Medicaid	$331.42
Rate for Payer: Scott and White EPO/PPO	$230.15
Rate for Payer: Superior Health Plan CHIP/Medicaid	$331.42
Rate for Payer: Superior Health Plan EPO	$62.60

CUTTER, LINEAR ARTICULATING LONG FLEX 60MM 440MM -- DHF

Facility

$3,181.54

Hospital Charge Code	81945750
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,163.45

CUTTER, LINEAR ARTICULATING LONG FLEX 60MM 440MM -- DHF

Facility

$3,181.54

Hospital Charge Code	81945750
Hospital Revenue Code	272
Min. Negotiated Rate	$286.34
Max. Negotiated Rate	$2,290.71
Rate for Payer: Amerigroup CHIP/Medicaid	$286.34
Rate for Payer: BCBS of TX Blue Advantage	$954.46
Rate for Payer: BCBS of TX Blue Essentials	$1,145.35
Rate for Payer: BCBS of TX PPO	$1,272.62
Rate for Payer: Cash Price	$2,163.45
Rate for Payer: Cigna Medicaid	$2,290.71
Rate for Payer: Molina CHIP/Medicaid	$2,290.71
Rate for Payer: Multiplan Auto	$2,068.00
Rate for Payer: Multiplan Commercial	$2,068.00
Rate for Payer: Multiplan Workers Comp	$2,068.00
Rate for Payer: Parkland Medicaid	$2,290.71
Rate for Payer: Scott and White EPO/PPO	$1,590.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,290.71
Rate for Payer: Superior Health Plan EPO	$432.69

CUTTER SUT/KNOT PUSHER -- DHF

Facility

$726.40

Hospital Charge Code	81739716
Hospital Revenue Code	272
Min. Negotiated Rate	$65.38
Max. Negotiated Rate	$523.01
Rate for Payer: Amerigroup CHIP/Medicaid	$65.38
Rate for Payer: BCBS of TX Blue Advantage	$217.92
Rate for Payer: BCBS of TX Blue Essentials	$261.50
Rate for Payer: BCBS of TX PPO	$290.56
Rate for Payer: Cash Price	$493.95
Rate for Payer: Cigna Medicaid	$523.01
Rate for Payer: Molina CHIP/Medicaid	$523.01
Rate for Payer: Multiplan Auto	$472.16
Rate for Payer: Multiplan Commercial	$472.16
Rate for Payer: Multiplan Workers Comp	$472.16
Rate for Payer: Parkland Medicaid	$523.01
Rate for Payer: Scott and White EPO/PPO	$363.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$523.01
Rate for Payer: Superior Health Plan EPO	$98.79

CUTTER SUT/KNOT PUSHER -- DHF

Facility

$726.40

Hospital Charge Code	81739716
Hospital Revenue Code	272
Rate for Payer: Cash Price	$493.95

CUTTER TOMCAT HC CROSSBLADE 4.0MM

Facility

$518.89

Hospital Charge Code	993202
Hospital Revenue Code	272
Min. Negotiated Rate	$46.70
Max. Negotiated Rate	$373.60
Rate for Payer: Amerigroup CHIP/Medicaid	$46.70
Rate for Payer: BCBS of TX Blue Advantage	$155.67
Rate for Payer: BCBS of TX Blue Essentials	$186.80
Rate for Payer: BCBS of TX PPO	$207.56
Rate for Payer: Cash Price	$352.85
Rate for Payer: Cigna Medicaid	$373.60
Rate for Payer: Molina CHIP/Medicaid	$373.60
Rate for Payer: Multiplan Auto	$337.28
Rate for Payer: Multiplan Commercial	$337.28
Rate for Payer: Multiplan Workers Comp	$337.28
Rate for Payer: Parkland Medicaid	$373.60
Rate for Payer: Scott and White EPO/PPO	$259.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$373.60
Rate for Payer: Superior Health Plan EPO	$70.57

CUTTER TOMCAT HC CROSSBLADE 4.0MM

Facility

$518.89

Hospital Charge Code	993202
Hospital Revenue Code	272
Rate for Payer: Cash Price	$352.85

CUVETTE FOR CS-2500 ANALYZER

Facility

$10.49

Hospital Charge Code	993526
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	$3.15
Rate for Payer: BCBS of TX Blue Essentials	$3.78
Rate for Payer: BCBS of TX PPO	$4.20
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	$6.82
Rate for Payer: Multiplan Commercial	$6.82
Rate for Payer: Multiplan Workers Comp	$6.82
Rate for Payer: Parkland Medicaid	$7.55
Rate for Payer: Scott and White EPO/PPO	$5.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.55
Rate for Payer: Superior Health Plan EPO	$1.43

CUVETTE FOR CS-2500 ANALYZER

Facility

$10.49

Hospital Charge Code	993526
Hospital Revenue Code	270
Rate for Payer: Cash Price	$7.13

CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION

Facility

$7,623.37

Service Code	APR-DRG 0453
Min. Negotiated Rate	$7,187.58
Max. Negotiated Rate	$7,623.37
Rate for Payer: Amerigroup CHIP/Medicaid	$7,187.58
Rate for Payer: Cigna Medicaid	$7,187.58
Rate for Payer: Molina CHIP/Medicaid	$7,187.58
Rate for Payer: Parkland Medicaid	$7,187.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,623.37

CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION

Facility

$5,128.26

Service Code	APR-DRG 0452
Min. Negotiated Rate	$4,835.10
Max. Negotiated Rate	$5,128.26
Rate for Payer: Amerigroup CHIP/Medicaid	$4,835.10
Rate for Payer: Cigna Medicaid	$4,835.10
Rate for Payer: Molina CHIP/Medicaid	$4,835.10
Rate for Payer: Parkland Medicaid	$4,835.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,128.26

CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION

Facility

$13,615.77

Service Code	APR-DRG 0454
Min. Negotiated Rate	$12,837.42
Max. Negotiated Rate	$13,615.77
Rate for Payer: Amerigroup CHIP/Medicaid	$12,837.42
Rate for Payer: Cigna Medicaid	$12,837.42
Rate for Payer: Molina CHIP/Medicaid	$12,837.42
Rate for Payer: Parkland Medicaid	$12,837.42
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13,615.77

CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION

Facility

$3,872.98

Service Code	APR-DRG 0451
Min. Negotiated Rate	$3,651.58
Max. Negotiated Rate	$3,872.98
Rate for Payer: Amerigroup CHIP/Medicaid	$3,651.58
Rate for Payer: Cigna Medicaid	$3,651.58
Rate for Payer: Molina CHIP/Medicaid	$3,651.58
Rate for Payer: Parkland Medicaid	$3,651.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,872.98

CV ECG Acquisition

Facility

$700.00

Service Code	HCPCS 93005
Hospital Charge Code	4603000
Hospital Revenue Code	730
Min. Negotiated Rate	$59.26
Max. Negotiated Rate	$504.00
Rate for Payer: Amerigroup CHIP/Medicaid	$63.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$59.26
Rate for Payer: Amerigroup Medicare	$59.26
Rate for Payer: BCBS of TX Blue Advantage	$210.00
Rate for Payer: BCBS of TX Blue Essentials	$252.00
Rate for Payer: BCBS of TX Medicare	$59.26
Rate for Payer: BCBS of TX PPO	$280.00
Rate for Payer: Cash Price	$476.00
Rate for Payer: Cash Price	$476.00
Rate for Payer: Cash Price	$476.00
Rate for Payer: Cigna Commercial	$125.27
Rate for Payer: Cigna Medicaid	$504.00
Rate for Payer: Cigna Medicare	$59.26
Rate for Payer: Employer Direct Commercial	$59.26
Rate for Payer: Humana Medicare/TRICARE	$59.26
Rate for Payer: Molina CHIP/Medicaid	$504.00
Rate for Payer: Molina Dual Medicare/Medicaid	$59.26
Rate for Payer: Molina Medicare	$59.26
Rate for Payer: Multiplan Auto	$455.00
Rate for Payer: Multiplan Commercial	$455.00
Rate for Payer: Multiplan Workers Comp	$455.00
Rate for Payer: Parkland Medicaid	$504.00
Rate for Payer: Scott and White EPO/PPO	$350.00
Rate for Payer: Scott and White Medicare	$59.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$504.00
Rate for Payer: Superior Health Plan EPO	$59.26
Rate for Payer: Superior Health Plan Medicare	$59.26
Rate for Payer: Universal American Dual Medicare/Medicaid	$59.26
Rate for Payer: Universal American Medicare	$59.26
Rate for Payer: Wellcare Medicare	$59.26
Rate for Payer: Wellmed Medicare	$59.26

CV ECG Acquisition

Facility

$700.00

Service Code	HCPCS 93005
Hospital Charge Code	4603000
Hospital Revenue Code	730
Rate for Payer: Cash Price	$476.00

cyanocobalamin 1000 mcg/mL Inj Soln 1 mL

Facility

$128.17

Service Code	HCPCS J3490
Hospital Charge Code	77487253
Hospital Revenue Code	250
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$92.28
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$38.45
Rate for Payer: BCBS of TX Blue Essentials	$46.14
Rate for Payer: BCBS of TX PPO	$51.27
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cigna Medicaid	$92.28
Rate for Payer: Molina CHIP/Medicaid	$92.28
Rate for Payer: Multiplan Auto	$83.31
Rate for Payer: Multiplan Commercial	$83.31
Rate for Payer: Multiplan Workers Comp	$83.31
Rate for Payer: Parkland Medicaid	$92.28
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$92.28
Rate for Payer: Superior Health Plan EPO	$17.43

cyanocobalamin 1000 mcg/mL Inj Soln 1 mL

Facility

$128.17

Service Code	HCPCS J3490
Hospital Charge Code	77487253
Hospital Revenue Code	250
Rate for Payer: Cash Price	$87.16

cyanocobalamin 1000 mcg Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77487200
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$5.51
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.29
Rate for Payer: BCBS of TX Blue Essentials	$2.75
Rate for Payer: BCBS of TX PPO	$3.06
Rate for Payer: Cash Price	$5.20
Rate for Payer: Cigna Medicaid	$5.51
Rate for Payer: Molina CHIP/Medicaid	$5.51
Rate for Payer: Multiplan Auto	$4.97
Rate for Payer: Multiplan Commercial	$4.97
Rate for Payer: Multiplan Workers Comp	$4.97
Rate for Payer: Parkland Medicaid	$5.51
Rate for Payer: Scott and White EPO/PPO	$3.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.51
Rate for Payer: Superior Health Plan EPO	$1.04

Know your out-of-pocket cost for care.

All Charges