White Rock Medical Center

All Charges

Charge

Type

Setting

Price

NEEDLE, PNEUMOPERITONEUM DISP -- DHF

Facility

$138.28

Hospital Charge Code	80327406
Hospital Revenue Code	272
Rate for Payer: Cash Price	$121.69

NEEDLE SCORPION AR13995N

Facility

$1,103.22

Hospital Charge Code	8524477
Hospital Revenue Code	272
Rate for Payer: Cash Price	$970.83

NEEDLE SCORPION AR13995N

Facility

$1,103.22

Hospital Charge Code	8524477
Hospital Revenue Code	272
Min. Negotiated Rate	$99.29
Max. Negotiated Rate	$717.09
Rate for Payer: Aetna Commercial	$606.77
Rate for Payer: Amerigroup CHIP/Medicaid	$99.29
Rate for Payer: BCBS of TX Blue Advantage	$330.97
Rate for Payer: BCBS of TX Blue Essentials	$397.16
Rate for Payer: BCBS of TX PPO	$441.29
Rate for Payer: Cash Price	$970.83
Rate for Payer: Multiplan Auto	$717.09
Rate for Payer: Multiplan Commercial	$717.09
Rate for Payer: Multiplan Workers Comp	$717.09
Rate for Payer: Scott and White EPO/PPO	$551.61
Rate for Payer: Superior Health Plan EPO	$150.04

NEEDLE SET INTRAOSSEOUS 15MM

Facility

$620.16

Hospital Charge Code	8612538
Hospital Revenue Code	272
Min. Negotiated Rate	$55.81
Max. Negotiated Rate	$403.10
Rate for Payer: Aetna Commercial	$341.09
Rate for Payer: Amerigroup CHIP/Medicaid	$55.81
Rate for Payer: BCBS of TX Blue Advantage	$186.05
Rate for Payer: BCBS of TX Blue Essentials	$223.26
Rate for Payer: BCBS of TX PPO	$248.06
Rate for Payer: Cash Price	$545.74
Rate for Payer: Multiplan Auto	$403.10
Rate for Payer: Multiplan Commercial	$403.10
Rate for Payer: Multiplan Workers Comp	$403.10
Rate for Payer: Scott and White EPO/PPO	$310.08
Rate for Payer: Superior Health Plan EPO	$84.34

NEEDLE SET INTRAOSSEOUS 15MM

Facility

$620.16

Hospital Charge Code	8612538
Hospital Revenue Code	272
Rate for Payer: Cash Price	$545.74

NEEDLE SET INTRAOSSEOUS 25MM

Facility

$627.43

Hospital Charge Code	8612532
Hospital Revenue Code	272
Rate for Payer: Cash Price	$552.14

NEEDLE SET INTRAOSSEOUS 25MM

Facility

$627.43

Hospital Charge Code	8612532
Hospital Revenue Code	272
Min. Negotiated Rate	$56.47
Max. Negotiated Rate	$407.83
Rate for Payer: Aetna Commercial	$345.09
Rate for Payer: Amerigroup CHIP/Medicaid	$56.47
Rate for Payer: BCBS of TX Blue Advantage	$188.23
Rate for Payer: BCBS of TX Blue Essentials	$225.87
Rate for Payer: BCBS of TX PPO	$250.97
Rate for Payer: Cash Price	$552.14
Rate for Payer: Multiplan Auto	$407.83
Rate for Payer: Multiplan Commercial	$407.83
Rate for Payer: Multiplan Workers Comp	$407.83
Rate for Payer: Scott and White EPO/PPO	$313.72
Rate for Payer: Superior Health Plan EPO	$85.33

NEEDLE SET INTRAOSSEOUS 45MM

Facility

$627.43

Hospital Charge Code	8612537
Hospital Revenue Code	272
Rate for Payer: Cash Price	$552.14

NEEDLE SET INTRAOSSEOUS 45MM

Facility

$627.43

Hospital Charge Code	8612537
Hospital Revenue Code	272
Min. Negotiated Rate	$56.47
Max. Negotiated Rate	$407.83
Rate for Payer: Aetna Commercial	$345.09
Rate for Payer: Amerigroup CHIP/Medicaid	$56.47
Rate for Payer: BCBS of TX Blue Advantage	$188.23
Rate for Payer: BCBS of TX Blue Essentials	$225.87
Rate for Payer: BCBS of TX PPO	$250.97
Rate for Payer: Cash Price	$552.14
Rate for Payer: Multiplan Auto	$407.83
Rate for Payer: Multiplan Commercial	$407.83
Rate for Payer: Multiplan Workers Comp	$407.83
Rate for Payer: Scott and White EPO/PPO	$313.72
Rate for Payer: Superior Health Plan EPO	$85.33

needle spectrum autopass

Facility

$776.06

Hospital Charge Code	8646515
Hospital Revenue Code	272
Min. Negotiated Rate	$69.85
Max. Negotiated Rate	$504.44
Rate for Payer: Aetna Commercial	$426.83
Rate for Payer: Amerigroup CHIP/Medicaid	$69.85
Rate for Payer: BCBS of TX Blue Advantage	$232.82
Rate for Payer: BCBS of TX Blue Essentials	$279.38
Rate for Payer: BCBS of TX PPO	$310.42
Rate for Payer: Cash Price	$682.93
Rate for Payer: Multiplan Auto	$504.44
Rate for Payer: Multiplan Commercial	$504.44
Rate for Payer: Multiplan Workers Comp	$504.44
Rate for Payer: Scott and White EPO/PPO	$388.03
Rate for Payer: Superior Health Plan EPO	$105.54

needle spectrum autopass

Facility

$776.06

Hospital Charge Code	8646515
Hospital Revenue Code	272
Rate for Payer: Cash Price	$682.93

NEEDLE, SPINAL YALE 18GA X 3 1/2'''' PINK -- DHF

Facility

$78.04

Hospital Charge Code	80328750
Hospital Revenue Code	272
Rate for Payer: Cash Price	$68.68

NEEDLE, SPINAL YALE 18GA X 3 1/2'''' PINK -- DHF

Facility

$78.04

Hospital Charge Code	80328750
Hospital Revenue Code	272
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$50.73
Rate for Payer: Aetna Commercial	$42.92
Rate for Payer: Amerigroup CHIP/Medicaid	$7.02
Rate for Payer: BCBS of TX Blue Advantage	$23.41
Rate for Payer: BCBS of TX Blue Essentials	$28.09
Rate for Payer: BCBS of TX PPO	$31.22
Rate for Payer: Cash Price	$68.68
Rate for Payer: Multiplan Auto	$50.73
Rate for Payer: Multiplan Commercial	$50.73
Rate for Payer: Multiplan Workers Comp	$50.73
Rate for Payer: Scott and White EPO/PPO	$39.02
Rate for Payer: Superior Health Plan EPO	$10.61

NEEDLE, SUTURE PASSER EXPRESSEW III -- DHF

Facility

$1,139.54

Hospital Charge Code	81754590
Hospital Revenue Code	272
Min. Negotiated Rate	$102.56
Max. Negotiated Rate	$740.70
Rate for Payer: Aetna Commercial	$626.75
Rate for Payer: Amerigroup CHIP/Medicaid	$102.56
Rate for Payer: BCBS of TX Blue Advantage	$341.86
Rate for Payer: BCBS of TX Blue Essentials	$410.23
Rate for Payer: BCBS of TX PPO	$455.82
Rate for Payer: Cash Price	$1,002.80
Rate for Payer: Multiplan Auto	$740.70
Rate for Payer: Multiplan Commercial	$740.70
Rate for Payer: Multiplan Workers Comp	$740.70
Rate for Payer: Scott and White EPO/PPO	$569.77
Rate for Payer: Superior Health Plan EPO	$154.98

NEEDLE, SUTURE PASSER EXPRESSEW III -- DHF

Facility

$1,139.54

Hospital Charge Code	81754590
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,002.80

NEEDLE, TROCAR 1/2 CIRCLE CUT #5 DISP -- DHF

Facility

$29.68

Hospital Charge Code	80328347
Hospital Revenue Code	272
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$19.29
Rate for Payer: Aetna Commercial	$16.32
Rate for Payer: Amerigroup CHIP/Medicaid	$2.67
Rate for Payer: BCBS of TX Blue Advantage	$8.90
Rate for Payer: BCBS of TX Blue Essentials	$10.68
Rate for Payer: BCBS of TX PPO	$11.87
Rate for Payer: Cash Price	$26.12
Rate for Payer: Multiplan Auto	$19.29
Rate for Payer: Multiplan Commercial	$19.29
Rate for Payer: Multiplan Workers Comp	$19.29
Rate for Payer: Scott and White EPO/PPO	$14.84
Rate for Payer: Superior Health Plan EPO	$4.04

NEEDLE, TROCAR 1/2 CIRCLE CUT #5 DISP -- DHF

Facility

$29.68

Hospital Charge Code	80328347
Hospital Revenue Code	272
Rate for Payer: Cash Price	$26.12

Neisseria gonorrhoeae Culture

Facility

$229.00

Service Code	CPT 87081
Hospital Charge Code	4107160
Hospital Revenue Code	306
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$148.85
Rate for Payer: Aetna Commercial	$6.96
Rate for Payer: Aetna Medicare	$9.94
Rate for Payer: Amerigroup CHIP/Medicaid	$2.59
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6.63
Rate for Payer: Amerigroup Medicare	$6.63
Rate for Payer: BCBS of TX Blue Advantage	$10.94
Rate for Payer: BCBS of TX Blue Essentials	$13.13
Rate for Payer: BCBS of TX Medicare	$6.63
Rate for Payer: BCBS of TX PPO	$14.65
Rate for Payer: Cash Price	$201.52
Rate for Payer: Cash Price	$201.52
Rate for Payer: Cigna Medicaid	$6.63
Rate for Payer: Cigna Medicare	$6.63
Rate for Payer: Employer Direct Commercial	$6.63
Rate for Payer: Humana Medicare/TRICARE	$6.63
Rate for Payer: Molina CHIP/Medicaid	$6.63
Rate for Payer: Molina Dual Medicare/Medicaid	$6.63
Rate for Payer: Molina Medicare	$6.63
Rate for Payer: Multiplan Auto	$148.85
Rate for Payer: Multiplan Commercial	$148.85
Rate for Payer: Multiplan Workers Comp	$148.85
Rate for Payer: Parkland Medicaid	$6.63
Rate for Payer: Scott and White EPO/PPO	$8.29
Rate for Payer: Scott and White Medicare	$6.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.63
Rate for Payer: Superior Health Plan EPO	$6.63
Rate for Payer: Superior Health Plan Medicare	$6.63
Rate for Payer: Universal American Dual Medicare/Medicaid	$6.63
Rate for Payer: Universal American Medicare	$6.63
Rate for Payer: Wellcare Medicare	$6.63
Rate for Payer: Wellmed Medicare	$6.63

Neisseria gonorrhoeae Culture

Facility

$229.00

Service Code	CPT 87081
Hospital Charge Code	4107160
Hospital Revenue Code	306
Rate for Payer: Cash Price	$201.52

Neisseria gonorrhoeae, NAA SO

Facility

$245.00

Service Code	CPT 87591
Hospital Charge Code	1709179
Hospital Revenue Code	306
Rate for Payer: Cash Price	$215.60

Neisseria gonorrhoeae, NAA SO

Facility

$245.00

Service Code	CPT 87591
Hospital Charge Code	1709179
Hospital Revenue Code	306
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$159.25
Rate for Payer: Aetna Commercial	$36.84
Rate for Payer: Aetna Medicare	$52.64
Rate for Payer: Amerigroup CHIP/Medicaid	$13.69
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$35.09
Rate for Payer: Amerigroup Medicare	$35.09
Rate for Payer: BCBS of TX Blue Advantage	$57.90
Rate for Payer: BCBS of TX Blue Essentials	$69.48
Rate for Payer: BCBS of TX Medicare	$35.09
Rate for Payer: BCBS of TX PPO	$77.55
Rate for Payer: Cash Price	$215.60
Rate for Payer: Cash Price	$215.60
Rate for Payer: Cigna Medicaid	$35.09
Rate for Payer: Cigna Medicare	$35.09
Rate for Payer: Employer Direct Commercial	$35.09
Rate for Payer: Humana Medicare/TRICARE	$35.09
Rate for Payer: Molina CHIP/Medicaid	$35.09
Rate for Payer: Molina Dual Medicare/Medicaid	$35.09
Rate for Payer: Molina Medicare	$35.09
Rate for Payer: Multiplan Auto	$159.25
Rate for Payer: Multiplan Commercial	$159.25
Rate for Payer: Multiplan Workers Comp	$159.25
Rate for Payer: Parkland Medicaid	$35.09
Rate for Payer: Scott and White EPO/PPO	$43.86
Rate for Payer: Scott and White Medicare	$35.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$35.09
Rate for Payer: Superior Health Plan EPO	$35.09
Rate for Payer: Superior Health Plan Medicare	$35.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$35.09
Rate for Payer: Universal American Medicare	$35.09
Rate for Payer: Wellcare Medicare	$35.09
Rate for Payer: Wellmed Medicare	$35.09

neomycin-polymyxin B sulfate 40 mg-200,000 units/mL irrigation Soln 20 mL

Facility

$290.70

Service Code	HCPCS J3490
Hospital Charge Code	77723036
Hospital Revenue Code	250
Rate for Payer: Cash Price	$197.68

neomycin-polymyxin B sulfate 40 mg-200,000 units/mL irrigation Soln 20 mL

Facility

$290.70

Service Code	HCPCS J3490
Hospital Charge Code	77723036
Hospital Revenue Code	250
Min. Negotiated Rate	$26.16
Max. Negotiated Rate	$188.96
Rate for Payer: Amerigroup CHIP/Medicaid	$26.16
Rate for Payer: BCBS of TX Blue Advantage	$87.21
Rate for Payer: BCBS of TX Blue Essentials	$104.65
Rate for Payer: BCBS of TX PPO	$116.28
Rate for Payer: Cash Price	$197.68
Rate for Payer: Multiplan Auto	$188.96
Rate for Payer: Multiplan Commercial	$188.96
Rate for Payer: Multiplan Workers Comp	$188.96
Rate for Payer: Scott and White EPO/PPO	$145.35
Rate for Payer: Superior Health Plan EPO	$39.54

Neonate ABO/Rh

Facility

$152.00

Service Code	CPT 86900
Hospital Charge Code	2400406
Hospital Revenue Code	302
Rate for Payer: Cash Price	$133.76

Neonate ABO/Rh

Facility

$152.00

Service Code	CPT 86900
Hospital Charge Code	2400406
Hospital Revenue Code	302
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$264.63
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna Medicare	$175.23
Rate for Payer: Amerigroup CHIP/Medicaid	$1.17
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$116.82
Rate for Payer: Amerigroup Medicare	$116.82
Rate for Payer: BCBS of TX Blue Advantage	$179.90
Rate for Payer: BCBS of TX Blue Essentials	$215.88
Rate for Payer: BCBS of TX Medicare	$116.82
Rate for Payer: BCBS of TX PPO	$240.96
Rate for Payer: Cash Price	$133.76
Rate for Payer: Cash Price	$133.76
Rate for Payer: Cash Price	$133.76
Rate for Payer: Cigna Commercial	$264.63
Rate for Payer: Cigna Medicaid	$2.99
Rate for Payer: Cigna Medicare	$116.82
Rate for Payer: Employer Direct Commercial	$116.82
Rate for Payer: Humana Medicare/TRICARE	$116.82
Rate for Payer: Molina CHIP/Medicaid	$2.99
Rate for Payer: Molina Dual Medicare/Medicaid	$116.82
Rate for Payer: Molina Medicare	$116.82
Rate for Payer: Multiplan Auto	$98.80
Rate for Payer: Multiplan Commercial	$98.80
Rate for Payer: Multiplan Workers Comp	$98.80
Rate for Payer: Parkland Medicaid	$2.99
Rate for Payer: Scott and White EPO/PPO	$3.74
Rate for Payer: Scott and White Medicare	$116.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.99
Rate for Payer: Superior Health Plan EPO	$116.82
Rate for Payer: Superior Health Plan Medicare	$116.82
Rate for Payer: Universal American Dual Medicare/Medicaid	$116.82
Rate for Payer: Universal American Medicare	$116.82
Rate for Payer: Wellcare Medicare	$116.82
Rate for Payer: Wellmed Medicare	$116.82

Know your out-of-pocket cost for care.

All Charges