White Rock Medical Center

All Charges

Charge

Type

Setting

Price

GW 80730559 -- DHF

Facility

$487.79

Hospital Charge Code	80730559
Hospital Revenue Code	272
Rate for Payer: Cash Price	$331.70

GW 80730609 -- DHF

Facility

$161.55

Hospital Charge Code	80730609
Hospital Revenue Code	272
Rate for Payer: Cash Price	$109.85

GW 80730609 -- DHF

Facility

$161.55

Hospital Charge Code	80730609
Hospital Revenue Code	272
Min. Negotiated Rate	$14.54
Max. Negotiated Rate	$116.32
Rate for Payer: Amerigroup CHIP/Medicaid	$14.54
Rate for Payer: BCBS of TX Blue Advantage	$48.47
Rate for Payer: BCBS of TX Blue Essentials	$58.16
Rate for Payer: BCBS of TX PPO	$64.62
Rate for Payer: Cash Price	$109.85
Rate for Payer: Cigna Medicaid	$116.32
Rate for Payer: Molina CHIP/Medicaid	$116.32
Rate for Payer: Multiplan Auto	$105.01
Rate for Payer: Multiplan Commercial	$105.01
Rate for Payer: Multiplan Workers Comp	$105.01
Rate for Payer: Parkland Medicaid	$116.32
Rate for Payer: Scott and White EPO/PPO	$80.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$116.32
Rate for Payer: Superior Health Plan EPO	$21.97

GW 80730757 -- DHF

Facility

$225.38

Hospital Charge Code	80730757
Hospital Revenue Code	272
Rate for Payer: Cash Price	$153.26

GW 80730757 -- DHF

Facility

$225.38

Hospital Charge Code	80730757
Hospital Revenue Code	272
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$162.27
Rate for Payer: Amerigroup CHIP/Medicaid	$20.28
Rate for Payer: BCBS of TX Blue Advantage	$67.61
Rate for Payer: BCBS of TX Blue Essentials	$81.14
Rate for Payer: BCBS of TX PPO	$90.15
Rate for Payer: Cash Price	$153.26
Rate for Payer: Cigna Medicaid	$162.27
Rate for Payer: Molina CHIP/Medicaid	$162.27
Rate for Payer: Multiplan Auto	$146.50
Rate for Payer: Multiplan Commercial	$146.50
Rate for Payer: Multiplan Workers Comp	$146.50
Rate for Payer: Parkland Medicaid	$162.27
Rate for Payer: Scott and White EPO/PPO	$112.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$162.27
Rate for Payer: Superior Health Plan EPO	$30.65

GW 80730856 -- DHF

Facility

$759.06

Hospital Charge Code	80730856
Hospital Revenue Code	272
Rate for Payer: Cash Price	$516.16

GW 80730856 -- DHF

Facility

$759.06

Hospital Charge Code	80730856
Hospital Revenue Code	272
Min. Negotiated Rate	$68.32
Max. Negotiated Rate	$546.52
Rate for Payer: Amerigroup CHIP/Medicaid	$68.32
Rate for Payer: BCBS of TX Blue Advantage	$227.72
Rate for Payer: BCBS of TX Blue Essentials	$273.26
Rate for Payer: BCBS of TX PPO	$303.62
Rate for Payer: Cash Price	$516.16
Rate for Payer: Cigna Medicaid	$546.52
Rate for Payer: Molina CHIP/Medicaid	$546.52
Rate for Payer: Multiplan Auto	$493.39
Rate for Payer: Multiplan Commercial	$493.39
Rate for Payer: Multiplan Workers Comp	$493.39
Rate for Payer: Parkland Medicaid	$546.52
Rate for Payer: Scott and White EPO/PPO	$379.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$546.52
Rate for Payer: Superior Health Plan EPO	$103.23

GW 80730864 -- DHF

Facility

$267.72

Hospital Charge Code	80730864
Hospital Revenue Code	272
Rate for Payer: Cash Price	$182.05

GW 80730864 -- DHF

Facility

$267.72

Hospital Charge Code	80730864
Hospital Revenue Code	272
Min. Negotiated Rate	$24.09
Max. Negotiated Rate	$192.76
Rate for Payer: Amerigroup CHIP/Medicaid	$24.09
Rate for Payer: BCBS of TX Blue Advantage	$80.32
Rate for Payer: BCBS of TX Blue Essentials	$96.38
Rate for Payer: BCBS of TX PPO	$107.09
Rate for Payer: Cash Price	$182.05
Rate for Payer: Cigna Medicaid	$192.76
Rate for Payer: Molina CHIP/Medicaid	$192.76
Rate for Payer: Multiplan Auto	$174.02
Rate for Payer: Multiplan Commercial	$174.02
Rate for Payer: Multiplan Workers Comp	$174.02
Rate for Payer: Parkland Medicaid	$192.76
Rate for Payer: Scott and White EPO/PPO	$133.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$192.76
Rate for Payer: Superior Health Plan EPO	$36.41

GW DRILL TIP -- DHF

Facility

$53.01

Hospital Charge Code	80731441
Hospital Revenue Code	272
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$38.17
Rate for Payer: Amerigroup CHIP/Medicaid	$4.77
Rate for Payer: BCBS of TX Blue Advantage	$15.90
Rate for Payer: BCBS of TX Blue Essentials	$19.08
Rate for Payer: BCBS of TX PPO	$21.20
Rate for Payer: Cash Price	$36.05
Rate for Payer: Cigna Medicaid	$38.17
Rate for Payer: Molina CHIP/Medicaid	$38.17
Rate for Payer: Multiplan Auto	$34.46
Rate for Payer: Multiplan Commercial	$34.46
Rate for Payer: Multiplan Workers Comp	$34.46
Rate for Payer: Parkland Medicaid	$38.17
Rate for Payer: Scott and White EPO/PPO	$26.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$38.17
Rate for Payer: Superior Health Plan EPO	$7.21

GW DRILL TIP -- DHF

Facility

$53.01

Hospital Charge Code	80731441
Hospital Revenue Code	272
Rate for Payer: Cash Price	$36.05

GW EMBOSHIELD

Facility

$544.80

Hospital Charge Code	8452478
Hospital Revenue Code	272
Min. Negotiated Rate	$49.03
Max. Negotiated Rate	$392.26
Rate for Payer: Amerigroup CHIP/Medicaid	$49.03
Rate for Payer: BCBS of TX Blue Advantage	$163.44
Rate for Payer: BCBS of TX Blue Essentials	$196.13
Rate for Payer: BCBS of TX PPO	$217.92
Rate for Payer: Cash Price	$370.46
Rate for Payer: Cigna Medicaid	$392.26
Rate for Payer: Molina CHIP/Medicaid	$392.26
Rate for Payer: Multiplan Auto	$354.12
Rate for Payer: Multiplan Commercial	$354.12
Rate for Payer: Multiplan Workers Comp	$354.12
Rate for Payer: Parkland Medicaid	$392.26
Rate for Payer: Scott and White EPO/PPO	$272.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$392.26
Rate for Payer: Superior Health Plan EPO	$74.09

GW EMBOSHIELD

Facility

$544.80

Hospital Charge Code	8452478
Hospital Revenue Code	272
Rate for Payer: Cash Price	$370.46

GW GLIDEWIRE GOLD -- DHF

Facility

$567.50

Hospital Charge Code	82466657
Hospital Revenue Code	272
Rate for Payer: Cash Price	$385.90

GW GLIDEWIRE GOLD -- DHF

Facility

$567.50

Hospital Charge Code	82466657
Hospital Revenue Code	272
Min. Negotiated Rate	$51.08
Max. Negotiated Rate	$408.60
Rate for Payer: Amerigroup CHIP/Medicaid	$51.08
Rate for Payer: BCBS of TX Blue Advantage	$170.25
Rate for Payer: BCBS of TX Blue Essentials	$204.30
Rate for Payer: BCBS of TX PPO	$227.00
Rate for Payer: Cash Price	$385.90
Rate for Payer: Cigna Medicaid	$408.60
Rate for Payer: Molina CHIP/Medicaid	$408.60
Rate for Payer: Multiplan Auto	$368.88
Rate for Payer: Multiplan Commercial	$368.88
Rate for Payer: Multiplan Workers Comp	$368.88
Rate for Payer: Parkland Medicaid	$408.60
Rate for Payer: Scott and White EPO/PPO	$283.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$408.60
Rate for Payer: Superior Health Plan EPO	$77.18

GW HI-TORQ BALANCE MW -- DHF

Facility

$354.12

Hospital Charge Code	82412545
Hospital Revenue Code	272
Rate for Payer: Cash Price	$240.80

GW HI-TORQ BALANCE MW -- DHF

Facility

$354.12

Hospital Charge Code	82412545
Hospital Revenue Code	272
Min. Negotiated Rate	$31.87
Max. Negotiated Rate	$254.97
Rate for Payer: Amerigroup CHIP/Medicaid	$31.87
Rate for Payer: BCBS of TX Blue Advantage	$106.24
Rate for Payer: BCBS of TX Blue Essentials	$127.48
Rate for Payer: BCBS of TX PPO	$141.65
Rate for Payer: Cash Price	$240.80
Rate for Payer: Cigna Medicaid	$254.97
Rate for Payer: Molina CHIP/Medicaid	$254.97
Rate for Payer: Multiplan Auto	$230.18
Rate for Payer: Multiplan Commercial	$230.18
Rate for Payer: Multiplan Workers Comp	$230.18
Rate for Payer: Parkland Medicaid	$254.97
Rate for Payer: Scott and White EPO/PPO	$177.06
Rate for Payer: Superior Health Plan CHIP/Medicaid	$254.97
Rate for Payer: Superior Health Plan EPO	$48.16

GW HI-TORQ IRONMAN -- DHF

Facility

$354.12

Hospital Charge Code	82412701
Hospital Revenue Code	272
Rate for Payer: Cash Price	$240.80

GW HI-TORQ IRONMAN -- DHF

Facility

$354.12

Hospital Charge Code	82412701
Hospital Revenue Code	272
Min. Negotiated Rate	$31.87
Max. Negotiated Rate	$254.97
Rate for Payer: Amerigroup CHIP/Medicaid	$31.87
Rate for Payer: BCBS of TX Blue Advantage	$106.24
Rate for Payer: BCBS of TX Blue Essentials	$127.48
Rate for Payer: BCBS of TX PPO	$141.65
Rate for Payer: Cash Price	$240.80
Rate for Payer: Cigna Medicaid	$254.97
Rate for Payer: Molina CHIP/Medicaid	$254.97
Rate for Payer: Multiplan Auto	$230.18
Rate for Payer: Multiplan Commercial	$230.18
Rate for Payer: Multiplan Workers Comp	$230.18
Rate for Payer: Parkland Medicaid	$254.97
Rate for Payer: Scott and White EPO/PPO	$177.06
Rate for Payer: Superior Health Plan CHIP/Medicaid	$254.97
Rate for Payer: Superior Health Plan EPO	$48.16

GW HITORQ WHOLY J SYS260 -- DHF

Facility

$678.94

Hospital Charge Code	82466947
Hospital Revenue Code	272
Min. Negotiated Rate	$61.10
Max. Negotiated Rate	$488.84
Rate for Payer: Amerigroup CHIP/Medicaid	$61.10
Rate for Payer: BCBS of TX Blue Advantage	$203.68
Rate for Payer: BCBS of TX Blue Essentials	$244.42
Rate for Payer: BCBS of TX PPO	$271.58
Rate for Payer: Cash Price	$461.68
Rate for Payer: Cigna Medicaid	$488.84
Rate for Payer: Molina CHIP/Medicaid	$488.84
Rate for Payer: Multiplan Auto	$441.31
Rate for Payer: Multiplan Commercial	$441.31
Rate for Payer: Multiplan Workers Comp	$441.31
Rate for Payer: Parkland Medicaid	$488.84
Rate for Payer: Scott and White EPO/PPO	$339.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$488.84
Rate for Payer: Superior Health Plan EPO	$92.34

GW HITORQ WHOLY J SYS260 -- DHF

Facility

$678.94

Hospital Charge Code	82466947
Hospital Revenue Code	272
Rate for Payer: Cash Price	$461.68

GW J -- DHF

Facility

$472.16

Hospital Charge Code	80731706
Hospital Revenue Code	272
Rate for Payer: Cash Price	$321.07

GW J -- DHF

Facility

$472.16

Hospital Charge Code	80731706
Hospital Revenue Code	272
Min. Negotiated Rate	$42.49
Max. Negotiated Rate	$339.96
Rate for Payer: Amerigroup CHIP/Medicaid	$42.49
Rate for Payer: BCBS of TX Blue Advantage	$141.65
Rate for Payer: BCBS of TX Blue Essentials	$169.98
Rate for Payer: BCBS of TX PPO	$188.86
Rate for Payer: Cash Price	$321.07
Rate for Payer: Cigna Medicaid	$339.96
Rate for Payer: Molina CHIP/Medicaid	$339.96
Rate for Payer: Multiplan Auto	$306.90
Rate for Payer: Multiplan Commercial	$306.90
Rate for Payer: Multiplan Workers Comp	$306.90
Rate for Payer: Parkland Medicaid	$339.96
Rate for Payer: Scott and White EPO/PPO	$236.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$339.96
Rate for Payer: Superior Health Plan EPO	$64.21

GW PRESSR AERIS AGILE TP -- DHF

Facility

$5,879.30

Hospital Charge Code	80735061
Hospital Revenue Code	272
Rate for Payer: Cash Price	$3,997.92

GW PRESSR AERIS AGILE TP -- DHF

Facility

$5,879.30

Hospital Charge Code	80735061
Hospital Revenue Code	272
Min. Negotiated Rate	$529.14
Max. Negotiated Rate	$4,233.10
Rate for Payer: Amerigroup CHIP/Medicaid	$529.14
Rate for Payer: BCBS of TX Blue Advantage	$1,763.79
Rate for Payer: BCBS of TX Blue Essentials	$2,116.55
Rate for Payer: BCBS of TX PPO	$2,351.72
Rate for Payer: Cash Price	$3,997.92
Rate for Payer: Cigna Medicaid	$4,233.10
Rate for Payer: Molina CHIP/Medicaid	$4,233.10
Rate for Payer: Multiplan Auto	$3,821.55
Rate for Payer: Multiplan Commercial	$3,821.55
Rate for Payer: Multiplan Workers Comp	$3,821.55
Rate for Payer: Parkland Medicaid	$4,233.10
Rate for Payer: Scott and White EPO/PPO	$2,939.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,233.10
Rate for Payer: Superior Health Plan EPO	$799.58

Know your out-of-pocket cost for care.

All Charges