White Rock Medical Center

All Charges

Charge

Type

Setting

Price

NDL ELECTRD INSULATED -- DHF

Facility

$64.94

Hospital Charge Code	80328073
Hospital Revenue Code	272
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$42.21
Rate for Payer: Aetna Commercial	$35.72
Rate for Payer: Amerigroup CHIP/Medicaid	$5.84
Rate for Payer: BCBS of TX Blue Advantage	$19.48
Rate for Payer: BCBS of TX Blue Essentials	$23.38
Rate for Payer: BCBS of TX PPO	$25.98
Rate for Payer: Cash Price	$57.15
Rate for Payer: Multiplan Auto	$42.21
Rate for Payer: Multiplan Commercial	$42.21
Rate for Payer: Multiplan Workers Comp	$42.21
Rate for Payer: Scott and White EPO/PPO	$32.47
Rate for Payer: Superior Health Plan EPO	$8.83

NDL EPIDURAL -- DHF

Facility

$30.36

Hospital Charge Code	80328081
Hospital Revenue Code	272
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$19.73
Rate for Payer: Aetna Commercial	$16.70
Rate for Payer: Amerigroup CHIP/Medicaid	$2.73
Rate for Payer: BCBS of TX Blue Advantage	$9.11
Rate for Payer: BCBS of TX Blue Essentials	$10.93
Rate for Payer: BCBS of TX PPO	$12.14
Rate for Payer: Cash Price	$26.72
Rate for Payer: Multiplan Auto	$19.73
Rate for Payer: Multiplan Commercial	$19.73
Rate for Payer: Multiplan Workers Comp	$19.73
Rate for Payer: Scott and White EPO/PPO	$15.18
Rate for Payer: Superior Health Plan EPO	$4.13

NDL EPIDURAL -- DHF

Facility

$30.36

Hospital Charge Code	80328081
Hospital Revenue Code	272
Rate for Payer: Cash Price	$26.72

NDL HUBER -- DHF

Facility

$28.85

Hospital Charge Code	80328206
Hospital Revenue Code	272
Rate for Payer: Cash Price	$25.39

NDL HUBER -- DHF

Facility

$28.85

Hospital Charge Code	80328206
Hospital Revenue Code	272
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$18.75
Rate for Payer: Aetna Commercial	$15.87
Rate for Payer: Amerigroup CHIP/Medicaid	$2.60
Rate for Payer: BCBS of TX Blue Advantage	$8.66
Rate for Payer: BCBS of TX Blue Essentials	$10.39
Rate for Payer: BCBS of TX PPO	$11.54
Rate for Payer: Cash Price	$25.39
Rate for Payer: Multiplan Auto	$18.75
Rate for Payer: Multiplan Commercial	$18.75
Rate for Payer: Multiplan Workers Comp	$18.75
Rate for Payer: Scott and White EPO/PPO	$14.42
Rate for Payer: Superior Health Plan EPO	$3.92

NDL SCLERO -- DHF

Facility

$1,185.97

Hospital Charge Code	80328701
Hospital Revenue Code	272
Min. Negotiated Rate	$106.74
Max. Negotiated Rate	$770.88
Rate for Payer: Aetna Commercial	$652.28
Rate for Payer: Amerigroup CHIP/Medicaid	$106.74
Rate for Payer: BCBS of TX Blue Advantage	$355.79
Rate for Payer: BCBS of TX Blue Essentials	$426.95
Rate for Payer: BCBS of TX PPO	$474.39
Rate for Payer: Cash Price	$1,043.65
Rate for Payer: Multiplan Auto	$770.88
Rate for Payer: Multiplan Commercial	$770.88
Rate for Payer: Multiplan Workers Comp	$770.88
Rate for Payer: Scott and White EPO/PPO	$592.98
Rate for Payer: Superior Health Plan EPO	$161.29

NDL SCLERO -- DHF

Facility

$1,185.97

Hospital Charge Code	80328701
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,043.65

NDL SPINAL EPIDURAL

Facility

$95.34

Service Code	HCPCS C1713
Hospital Charge Code	8452480
Hospital Revenue Code	278
Min. Negotiated Rate	$23.84
Max. Negotiated Rate	$47.67
Rate for Payer: Aetna Commercial	$28.60
Rate for Payer: Cash Price	$83.90
Rate for Payer: Cigna Commercial	$23.84
Rate for Payer: Multiplan Auto	$47.67
Rate for Payer: Multiplan Commercial	$47.67
Rate for Payer: Multiplan Workers Comp	$47.67
Rate for Payer: Scott and White EPO/PPO	$47.67

NDL SPINAL EPIDURAL

Facility

$95.34

Service Code	HCPCS C1713
Hospital Charge Code	8452480
Hospital Revenue Code	278
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$47.67
Rate for Payer: Aetna Commercial	$28.60
Rate for Payer: Amerigroup CHIP/Medicaid	$8.58
Rate for Payer: BCBS of TX Blue Advantage	$28.60
Rate for Payer: BCBS of TX Blue Essentials	$34.32
Rate for Payer: BCBS of TX PPO	$38.14
Rate for Payer: Cash Price	$83.90
Rate for Payer: Multiplan Auto	$47.67
Rate for Payer: Multiplan Commercial	$47.67
Rate for Payer: Multiplan Workers Comp	$47.67
Rate for Payer: Scott and White EPO/PPO	$47.67
Rate for Payer: Superior Health Plan EPO	$12.97

NEB PREFIL 150CC -- DHF

Facility

$68.92

Hospital Charge Code	82060054
Hospital Revenue Code	270
Rate for Payer: Cash Price	$60.65

NEB PREFIL 150CC -- DHF

Facility

$68.92

Hospital Charge Code	82060054
Hospital Revenue Code	270
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$44.80
Rate for Payer: Aetna Commercial	$37.91
Rate for Payer: Amerigroup CHIP/Medicaid	$6.20
Rate for Payer: BCBS of TX Blue Advantage	$20.68
Rate for Payer: BCBS of TX Blue Essentials	$24.81
Rate for Payer: BCBS of TX PPO	$27.57
Rate for Payer: Cash Price	$60.65
Rate for Payer: Multiplan Auto	$44.80
Rate for Payer: Multiplan Commercial	$44.80
Rate for Payer: Multiplan Workers Comp	$44.80
Rate for Payer: Scott and White EPO/PPO	$34.46
Rate for Payer: Superior Health Plan EPO	$9.37

NECKSCREW ASSEMBLY

Facility

$4,518.07

Service Code	HCPCS C1713
Hospital Charge Code	145472
Hospital Revenue Code	278
Min. Negotiated Rate	$1,129.52
Max. Negotiated Rate	$2,259.04
Rate for Payer: Aetna Commercial	$1,355.42
Rate for Payer: Cash Price	$3,975.90
Rate for Payer: Cigna Commercial	$1,129.52
Rate for Payer: Multiplan Auto	$2,259.04
Rate for Payer: Multiplan Commercial	$2,259.04
Rate for Payer: Multiplan Workers Comp	$2,259.04
Rate for Payer: Scott and White EPO/PPO	$2,259.04

NECKSCREW ASSEMBLY

Facility

$4,518.07

Service Code	HCPCS C1713
Hospital Charge Code	145472
Hospital Revenue Code	278
Min. Negotiated Rate	$406.63
Max. Negotiated Rate	$2,259.04
Rate for Payer: Aetna Commercial	$1,355.42
Rate for Payer: Amerigroup CHIP/Medicaid	$406.63
Rate for Payer: BCBS of TX Blue Advantage	$1,355.42
Rate for Payer: BCBS of TX Blue Essentials	$1,626.51
Rate for Payer: BCBS of TX PPO	$1,807.23
Rate for Payer: Cash Price	$3,975.90
Rate for Payer: Multiplan Auto	$2,259.04
Rate for Payer: Multiplan Commercial	$2,259.04
Rate for Payer: Multiplan Workers Comp	$2,259.04
Rate for Payer: Scott and White EPO/PPO	$2,259.04
Rate for Payer: Superior Health Plan EPO	$614.46

NEEDLE, BIOPSY JAMSHIDI 8 X 6 CONTOUR HANDLE DISP -- DHF

Facility

$138.28

Hospital Charge Code	80327406
Hospital Revenue Code	272
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$89.88
Rate for Payer: Aetna Commercial	$76.05
Rate for Payer: Amerigroup CHIP/Medicaid	$12.45
Rate for Payer: BCBS of TX Blue Advantage	$41.48
Rate for Payer: BCBS of TX Blue Essentials	$49.78
Rate for Payer: BCBS of TX PPO	$55.31
Rate for Payer: Cash Price	$121.69
Rate for Payer: Multiplan Auto	$89.88
Rate for Payer: Multiplan Commercial	$89.88
Rate for Payer: Multiplan Workers Comp	$89.88
Rate for Payer: Scott and White EPO/PPO	$69.14
Rate for Payer: Superior Health Plan EPO	$18.81

NEEDLE, BLOCK REGIONAL 22G X 1 1/2'''' -- DHF

Facility

$75.03

Hospital Charge Code	80328743
Hospital Revenue Code	272
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$48.77
Rate for Payer: Aetna Commercial	$41.27
Rate for Payer: Amerigroup CHIP/Medicaid	$6.75
Rate for Payer: BCBS of TX Blue Advantage	$22.51
Rate for Payer: BCBS of TX Blue Essentials	$27.01
Rate for Payer: BCBS of TX PPO	$30.01
Rate for Payer: Cash Price	$66.03
Rate for Payer: Multiplan Auto	$48.77
Rate for Payer: Multiplan Commercial	$48.77
Rate for Payer: Multiplan Workers Comp	$48.77
Rate for Payer: Scott and White EPO/PPO	$37.52
Rate for Payer: Superior Health Plan EPO	$10.20

NEEDLE, BLOCK REGIONAL 22G X 1 1/2'''' -- DHF

Facility

$75.03

Hospital Charge Code	80328743
Hospital Revenue Code	272
Rate for Payer: Cash Price	$66.03

NEEDLE, BONE BIOPSY KYPHON SZ2

Facility

$407.69

Hospital Charge Code	8568492
Hospital Revenue Code	272
Min. Negotiated Rate	$36.69
Max. Negotiated Rate	$265.00
Rate for Payer: Aetna Commercial	$224.23
Rate for Payer: Amerigroup CHIP/Medicaid	$36.69
Rate for Payer: BCBS of TX Blue Advantage	$122.31
Rate for Payer: BCBS of TX Blue Essentials	$146.77
Rate for Payer: BCBS of TX PPO	$163.08
Rate for Payer: Cash Price	$358.77
Rate for Payer: Multiplan Auto	$265.00
Rate for Payer: Multiplan Commercial	$265.00
Rate for Payer: Multiplan Workers Comp	$265.00
Rate for Payer: Scott and White EPO/PPO	$203.84
Rate for Payer: Superior Health Plan EPO	$55.45

NEEDLE, BONE BIOPSY KYPHON SZ2

Facility

$407.69

Hospital Charge Code	8568492
Hospital Revenue Code	272
Rate for Payer: Cash Price	$358.77

NEEDLE INJECTION CARRLOCK

Facility

$286.02

Hospital Charge Code	116162
Hospital Revenue Code	272
Rate for Payer: Cash Price	$251.70

NEEDLE INJECTION CARRLOCK

Facility

$286.02

Hospital Charge Code	116162
Hospital Revenue Code	272
Min. Negotiated Rate	$25.74
Max. Negotiated Rate	$185.91
Rate for Payer: Aetna Commercial	$157.31
Rate for Payer: Amerigroup CHIP/Medicaid	$25.74
Rate for Payer: BCBS of TX Blue Advantage	$85.81
Rate for Payer: BCBS of TX Blue Essentials	$102.97
Rate for Payer: BCBS of TX PPO	$114.41
Rate for Payer: Cash Price	$251.70
Rate for Payer: Multiplan Auto	$185.91
Rate for Payer: Multiplan Commercial	$185.91
Rate for Payer: Multiplan Workers Comp	$185.91
Rate for Payer: Scott and White EPO/PPO	$143.01
Rate for Payer: Superior Health Plan EPO	$38.90

NEEDLE, MICRO DISSECTION INSULATED 3CM STERILE -- DHF

Facility

$899.29

Hospital Charge Code	80822554
Hospital Revenue Code	270
Min. Negotiated Rate	$80.94
Max. Negotiated Rate	$584.54
Rate for Payer: Aetna Commercial	$494.61
Rate for Payer: Amerigroup CHIP/Medicaid	$80.94
Rate for Payer: BCBS of TX Blue Advantage	$269.79
Rate for Payer: BCBS of TX Blue Essentials	$323.74
Rate for Payer: BCBS of TX PPO	$359.72
Rate for Payer: Cash Price	$791.38
Rate for Payer: Multiplan Auto	$584.54
Rate for Payer: Multiplan Commercial	$584.54
Rate for Payer: Multiplan Workers Comp	$584.54
Rate for Payer: Scott and White EPO/PPO	$449.64
Rate for Payer: Superior Health Plan EPO	$122.30

NEEDLE, MICRO DISSECTION INSULATED 3CM STERILE -- DHF

Facility

$899.29

Hospital Charge Code	80822554
Hospital Revenue Code	270
Rate for Payer: Cash Price	$791.38

NEEDLE, NERVE STIMULATOR INSULATD W/EXT SET 21GX4'''' -- DHF

Facility

$73.38

Hospital Charge Code	80329154
Hospital Revenue Code	272
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna Commercial	$40.36
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	$64.57
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: Scott and White EPO/PPO	$36.69
Rate for Payer: Superior Health Plan EPO	$9.98

NEEDLE, NERVE STIMULATOR INSULATD W/EXT SET 21GX4'''' -- DHF

Facility

$73.38

Hospital Charge Code	80329154
Hospital Revenue Code	272
Rate for Payer: Cash Price	$64.57

NEEDLE, PNEUMOPERITONEUM DISP -- DHF

Facility

$138.28

Hospital Charge Code	80327406
Hospital Revenue Code	272
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$89.88
Rate for Payer: Aetna Commercial	$76.05
Rate for Payer: Amerigroup CHIP/Medicaid	$12.45
Rate for Payer: BCBS of TX Blue Advantage	$41.48
Rate for Payer: BCBS of TX Blue Essentials	$49.78
Rate for Payer: BCBS of TX PPO	$55.31
Rate for Payer: Cash Price	$121.69
Rate for Payer: Multiplan Auto	$89.88
Rate for Payer: Multiplan Commercial	$89.88
Rate for Payer: Multiplan Workers Comp	$89.88
Rate for Payer: Scott and White EPO/PPO	$69.14
Rate for Payer: Superior Health Plan EPO	$18.81

Know your out-of-pocket cost for care.

All Charges