White Rock Medical Center

All Charges

Charge

Type

Setting

Price

kit avaflex balloon 11g

Facility

$11,361.35

Hospital Charge Code	8634512
Hospital Revenue Code	272
Rate for Payer: Cash Price	$7,725.72

kit avaflex balloon 11g

Facility

$11,361.35

Hospital Charge Code	8634512
Hospital Revenue Code	272
Min. Negotiated Rate	$1,022.52
Max. Negotiated Rate	$8,180.17
Rate for Payer: Amerigroup CHIP/Medicaid	$1,022.52
Rate for Payer: BCBS of TX Blue Advantage	$3,408.41
Rate for Payer: BCBS of TX Blue Essentials	$4,090.09
Rate for Payer: BCBS of TX PPO	$4,544.54
Rate for Payer: Cash Price	$7,725.72
Rate for Payer: Cigna Medicaid	$8,180.17
Rate for Payer: Molina CHIP/Medicaid	$8,180.17
Rate for Payer: Multiplan Auto	$7,384.88
Rate for Payer: Multiplan Commercial	$7,384.88
Rate for Payer: Multiplan Workers Comp	$7,384.88
Rate for Payer: Parkland Medicaid	$8,180.17
Rate for Payer: Scott and White EPO/PPO	$5,680.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,180.17
Rate for Payer: Superior Health Plan EPO	$1,545.14

KIT BIOPSY BASIC W/O NEEDLESAFETY

Facility

$174.93

Hospital Charge Code	993749
Hospital Revenue Code	272
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$125.95
Rate for Payer: Amerigroup CHIP/Medicaid	$15.74
Rate for Payer: BCBS of TX Blue Advantage	$52.48
Rate for Payer: BCBS of TX Blue Essentials	$62.97
Rate for Payer: BCBS of TX PPO	$69.97
Rate for Payer: Cash Price	$118.95
Rate for Payer: Cigna Medicaid	$125.95
Rate for Payer: Molina CHIP/Medicaid	$125.95
Rate for Payer: Multiplan Auto	$113.70
Rate for Payer: Multiplan Commercial	$113.70
Rate for Payer: Multiplan Workers Comp	$113.70
Rate for Payer: Parkland Medicaid	$125.95
Rate for Payer: Scott and White EPO/PPO	$87.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$125.95
Rate for Payer: Superior Health Plan EPO	$23.79

KIT BIOPSY BASIC W/O NEEDLESAFETY

Facility

$174.93

Hospital Charge Code	993749
Hospital Revenue Code	272
Rate for Payer: Cash Price	$118.95

KIT, BLOOD SAMPLING, PRO-VENT PLUS

Facility

$9.88

Hospital Charge Code	993080
Hospital Revenue Code	270
Rate for Payer: Cash Price	$6.72

KIT, BLOOD SAMPLING, PRO-VENT PLUS

Facility

$9.88

Hospital Charge Code	993080
Hospital Revenue Code	270
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$7.11
Rate for Payer: Amerigroup CHIP/Medicaid	$0.89
Rate for Payer: BCBS of TX Blue Advantage	$2.96
Rate for Payer: BCBS of TX Blue Essentials	$3.56
Rate for Payer: BCBS of TX PPO	$3.95
Rate for Payer: Cash Price	$6.72
Rate for Payer: Cigna Medicaid	$7.11
Rate for Payer: Molina CHIP/Medicaid	$7.11
Rate for Payer: Multiplan Auto	$6.42
Rate for Payer: Multiplan Commercial	$6.42
Rate for Payer: Multiplan Workers Comp	$6.42
Rate for Payer: Parkland Medicaid	$7.11
Rate for Payer: Scott and White EPO/PPO	$4.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.11
Rate for Payer: Superior Health Plan EPO	$1.34

KIT BONE MARROW ASPIRATION

Facility

$9,080.00

Hospital Charge Code	8394474
Hospital Revenue Code	272
Min. Negotiated Rate	$817.20
Max. Negotiated Rate	$6,537.60
Rate for Payer: Amerigroup CHIP/Medicaid	$817.20
Rate for Payer: BCBS of TX Blue Advantage	$2,724.00
Rate for Payer: BCBS of TX Blue Essentials	$3,268.80
Rate for Payer: BCBS of TX PPO	$3,632.00
Rate for Payer: Cash Price	$6,174.40
Rate for Payer: Cigna Medicaid	$6,537.60
Rate for Payer: Molina CHIP/Medicaid	$6,537.60
Rate for Payer: Multiplan Auto	$5,902.00
Rate for Payer: Multiplan Commercial	$5,902.00
Rate for Payer: Multiplan Workers Comp	$5,902.00
Rate for Payer: Parkland Medicaid	$6,537.60
Rate for Payer: Scott and White EPO/PPO	$4,540.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,537.60
Rate for Payer: Superior Health Plan EPO	$1,234.88

KIT BONE MARROW ASPIRATION

Facility

$9,080.00

Hospital Charge Code	8394474
Hospital Revenue Code	272
Rate for Payer: Cash Price	$6,174.40

KIT CALIBRATOR S-CAL 1 X 3.3ML

Facility

$326.88

Hospital Charge Code	993801
Hospital Revenue Code	270
Min. Negotiated Rate	$29.42
Max. Negotiated Rate	$235.35
Rate for Payer: Amerigroup CHIP/Medicaid	$29.42
Rate for Payer: BCBS of TX Blue Advantage	$98.06
Rate for Payer: BCBS of TX Blue Essentials	$117.68
Rate for Payer: BCBS of TX PPO	$130.75
Rate for Payer: Cash Price	$222.28
Rate for Payer: Cigna Medicaid	$235.35
Rate for Payer: Molina CHIP/Medicaid	$235.35
Rate for Payer: Multiplan Auto	$212.47
Rate for Payer: Multiplan Commercial	$212.47
Rate for Payer: Multiplan Workers Comp	$212.47
Rate for Payer: Parkland Medicaid	$235.35
Rate for Payer: Scott and White EPO/PPO	$163.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$235.35
Rate for Payer: Superior Health Plan EPO	$44.46

KIT CALIBRATOR S-CAL 1 X 3.3ML

Facility

$326.88

Hospital Charge Code	993801
Hospital Revenue Code	270
Rate for Payer: Cash Price	$222.28

KIT, CATH 4FR DL PROVENA

Facility

$1,429.03

Hospital Charge Code	993417
Hospital Revenue Code	272
Min. Negotiated Rate	$128.61
Max. Negotiated Rate	$1,028.90
Rate for Payer: Amerigroup CHIP/Medicaid	$128.61
Rate for Payer: BCBS of TX Blue Advantage	$428.71
Rate for Payer: BCBS of TX Blue Essentials	$514.45
Rate for Payer: BCBS of TX PPO	$571.61
Rate for Payer: Cash Price	$971.74
Rate for Payer: Cigna Medicaid	$1,028.90
Rate for Payer: Molina CHIP/Medicaid	$1,028.90
Rate for Payer: Multiplan Auto	$928.87
Rate for Payer: Multiplan Commercial	$928.87
Rate for Payer: Multiplan Workers Comp	$928.87
Rate for Payer: Parkland Medicaid	$1,028.90
Rate for Payer: Scott and White EPO/PPO	$714.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,028.90
Rate for Payer: Superior Health Plan EPO	$194.35

KIT, CATH 4FR DL PROVENA

Facility

$1,429.03

Hospital Charge Code	993417
Hospital Revenue Code	272
Rate for Payer: Cash Price	$971.74

kit cath art 20gx1.75'

Facility

$43.54

Hospital Charge Code	2514602
Hospital Revenue Code	272
Rate for Payer: Cash Price	$29.61

kit cath art 20gx1.75'

Facility

$43.54

Hospital Charge Code	2514602
Hospital Revenue Code	272
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$31.35
Rate for Payer: Amerigroup CHIP/Medicaid	$3.92
Rate for Payer: BCBS of TX Blue Advantage	$13.06
Rate for Payer: BCBS of TX Blue Essentials	$15.67
Rate for Payer: BCBS of TX PPO	$17.42
Rate for Payer: Cash Price	$29.61
Rate for Payer: Cigna Medicaid	$31.35
Rate for Payer: Molina CHIP/Medicaid	$31.35
Rate for Payer: Multiplan Auto	$28.30
Rate for Payer: Multiplan Commercial	$28.30
Rate for Payer: Multiplan Workers Comp	$28.30
Rate for Payer: Parkland Medicaid	$31.35
Rate for Payer: Scott and White EPO/PPO	$21.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$31.35
Rate for Payer: Superior Health Plan EPO	$5.92

KIT CATH DX DXTERITY JL-JR4.0 100 PGTL STR 110 6F

Facility

$136.20

Hospital Charge Code	80325772
Hospital Revenue Code	270
Rate for Payer: Cash Price	$92.62

KIT CATH DX DXTERITY JL-JR4.0 100 PGTL STR 110 6F

Facility

$136.20

Hospital Charge Code	80325772
Hospital Revenue Code	270
Min. Negotiated Rate	$12.26
Max. Negotiated Rate	$98.06
Rate for Payer: Amerigroup CHIP/Medicaid	$12.26
Rate for Payer: BCBS of TX Blue Advantage	$40.86
Rate for Payer: BCBS of TX Blue Essentials	$49.03
Rate for Payer: BCBS of TX PPO	$54.48
Rate for Payer: Cash Price	$92.62
Rate for Payer: Cigna Medicaid	$98.06
Rate for Payer: Molina CHIP/Medicaid	$98.06
Rate for Payer: Multiplan Auto	$88.53
Rate for Payer: Multiplan Commercial	$88.53
Rate for Payer: Multiplan Workers Comp	$88.53
Rate for Payer: Parkland Medicaid	$98.06
Rate for Payer: Scott and White EPO/PPO	$68.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$98.06
Rate for Payer: Superior Health Plan EPO	$18.52

KIT, CATHETER ARTERIAL PE

Facility

$88.80

Hospital Charge Code	135266
Hospital Revenue Code	272
Rate for Payer: Cash Price	$60.38

KIT, CATHETER ARTERIAL PE

Facility

$88.80

Hospital Charge Code	135266
Hospital Revenue Code	272
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$63.94
Rate for Payer: Amerigroup CHIP/Medicaid	$7.99
Rate for Payer: BCBS of TX Blue Advantage	$26.64
Rate for Payer: BCBS of TX Blue Essentials	$31.97
Rate for Payer: BCBS of TX PPO	$35.52
Rate for Payer: Cash Price	$60.38
Rate for Payer: Cigna Medicaid	$63.94
Rate for Payer: Molina CHIP/Medicaid	$63.94
Rate for Payer: Multiplan Auto	$57.72
Rate for Payer: Multiplan Commercial	$57.72
Rate for Payer: Multiplan Workers Comp	$57.72
Rate for Payer: Parkland Medicaid	$63.94
Rate for Payer: Scott and White EPO/PPO	$44.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$63.94
Rate for Payer: Superior Health Plan EPO	$12.08

KIT CATHETER ARTERIAL PED 20GA 6 NDL 21GA X 2

Facility

$121.67

Hospital Charge Code	993441
Hospital Revenue Code	272
Rate for Payer: Cash Price	$82.74

KIT CATHETER ARTERIAL PED 20GA 6 NDL 21GA X 2

Facility

$121.67

Hospital Charge Code	993441
Hospital Revenue Code	272
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$87.60
Rate for Payer: Amerigroup CHIP/Medicaid	$10.95
Rate for Payer: BCBS of TX Blue Advantage	$36.50
Rate for Payer: BCBS of TX Blue Essentials	$43.80
Rate for Payer: BCBS of TX PPO	$48.67
Rate for Payer: Cash Price	$82.74
Rate for Payer: Cigna Medicaid	$87.60
Rate for Payer: Molina CHIP/Medicaid	$87.60
Rate for Payer: Multiplan Auto	$79.09
Rate for Payer: Multiplan Commercial	$79.09
Rate for Payer: Multiplan Workers Comp	$79.09
Rate for Payer: Parkland Medicaid	$87.60
Rate for Payer: Scott and White EPO/PPO	$60.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$87.60
Rate for Payer: Superior Health Plan EPO	$16.55

KIT CATH VENOUS VANTEX CVC BUNDLE, 7FR 17CM

Facility

$1,118.84

Hospital Charge Code	993598
Hospital Revenue Code	270
Min. Negotiated Rate	$100.70
Max. Negotiated Rate	$805.56
Rate for Payer: Amerigroup CHIP/Medicaid	$100.70
Rate for Payer: BCBS of TX Blue Advantage	$335.65
Rate for Payer: BCBS of TX Blue Essentials	$402.78
Rate for Payer: BCBS of TX PPO	$447.54
Rate for Payer: Cash Price	$760.81
Rate for Payer: Cigna Medicaid	$805.56
Rate for Payer: Molina CHIP/Medicaid	$805.56
Rate for Payer: Multiplan Auto	$727.25
Rate for Payer: Multiplan Commercial	$727.25
Rate for Payer: Multiplan Workers Comp	$727.25
Rate for Payer: Parkland Medicaid	$805.56
Rate for Payer: Scott and White EPO/PPO	$559.42
Rate for Payer: Superior Health Plan CHIP/Medicaid	$805.56
Rate for Payer: Superior Health Plan EPO	$152.16

KIT CATH VENOUS VANTEX CVC BUNDLE, 7FR 17CM

Facility

$1,118.84

Hospital Charge Code	993598
Hospital Revenue Code	270
Rate for Payer: Cash Price	$760.81

KIT CENT VEN CATH 3 LMN 7F 16CM EXP INTERSAFETY

Facility

$267.24

Service Code	HCPCS C1725
Hospital Charge Code	993590
Hospital Revenue Code	270
Min. Negotiated Rate	$24.05
Max. Negotiated Rate	$192.41
Rate for Payer: Amerigroup CHIP/Medicaid	$24.05
Rate for Payer: BCBS of TX Blue Advantage	$80.17
Rate for Payer: BCBS of TX Blue Essentials	$96.21
Rate for Payer: BCBS of TX PPO	$106.90
Rate for Payer: Cash Price	$181.72
Rate for Payer: Cigna Medicaid	$192.41
Rate for Payer: Molina CHIP/Medicaid	$192.41
Rate for Payer: Multiplan Auto	$173.71
Rate for Payer: Multiplan Commercial	$173.71
Rate for Payer: Multiplan Workers Comp	$173.71
Rate for Payer: Parkland Medicaid	$192.41
Rate for Payer: Scott and White EPO/PPO	$133.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$192.41
Rate for Payer: Superior Health Plan EPO	$36.34

KIT CENT VEN CATH 3 LMN 7F 16CM EXP INTERSAFETY

Facility

$267.24

Service Code	HCPCS C1725
Hospital Charge Code	993466
Hospital Revenue Code	270
Rate for Payer: Cash Price	$181.72

KIT CENT VEN CATH 3 LMN 7F 16CM EXP INTERSAFETY

Facility

$267.24

Service Code	HCPCS C1725
Hospital Charge Code	993466
Hospital Revenue Code	270
Min. Negotiated Rate	$24.05
Max. Negotiated Rate	$192.41
Rate for Payer: Amerigroup CHIP/Medicaid	$24.05
Rate for Payer: BCBS of TX Blue Advantage	$80.17
Rate for Payer: BCBS of TX Blue Essentials	$96.21
Rate for Payer: BCBS of TX PPO	$106.90
Rate for Payer: Cash Price	$181.72
Rate for Payer: Cigna Medicaid	$192.41
Rate for Payer: Molina CHIP/Medicaid	$192.41
Rate for Payer: Multiplan Auto	$173.71
Rate for Payer: Multiplan Commercial	$173.71
Rate for Payer: Multiplan Workers Comp	$173.71
Rate for Payer: Parkland Medicaid	$192.41
Rate for Payer: Scott and White EPO/PPO	$133.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$192.41
Rate for Payer: Superior Health Plan EPO	$36.34

Know your out-of-pocket cost for care.

All Charges