White Rock Medical Center

All Charges

Charge

Type

Setting

Price

KIT, LAVAGE FEM IRRIGATION & OPN SUCT SEPARABL TIP -- DHF

Facility

$431.79

Hospital Charge Code	81775751
Hospital Revenue Code	270
Min. Negotiated Rate	$38.86
Max. Negotiated Rate	$310.89
Rate for Payer: Amerigroup CHIP/Medicaid	$38.86
Rate for Payer: BCBS of TX Blue Advantage	$129.54
Rate for Payer: BCBS of TX Blue Essentials	$155.44
Rate for Payer: BCBS of TX PPO	$172.72
Rate for Payer: Cash Price	$293.62
Rate for Payer: Cigna Medicaid	$310.89
Rate for Payer: Molina CHIP/Medicaid	$310.89
Rate for Payer: Multiplan Auto	$280.66
Rate for Payer: Multiplan Commercial	$280.66
Rate for Payer: Multiplan Workers Comp	$280.66
Rate for Payer: Parkland Medicaid	$310.89
Rate for Payer: Scott and White EPO/PPO	$215.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$310.89
Rate for Payer: Superior Health Plan EPO	$58.72

KIT, LAVAGE FEM IRRIGATION & OPN SUCT SEPARABL TIP -- DHF

Facility

$431.79

Hospital Charge Code	81775751
Hospital Revenue Code	270
Rate for Payer: Cash Price	$293.62

KIT, MICRO INTRODUCER, 6FR DUAL LUME

Facility

$4,263.39

Hospital Charge Code	993021
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,899.11

KIT, MICRO INTRODUCER, 6FR DUAL LUME

Facility

$4,263.39

Hospital Charge Code	993021
Hospital Revenue Code	272
Min. Negotiated Rate	$383.71
Max. Negotiated Rate	$3,069.64
Rate for Payer: Amerigroup CHIP/Medicaid	$383.71
Rate for Payer: BCBS of TX Blue Advantage	$1,279.02
Rate for Payer: BCBS of TX Blue Essentials	$1,534.82
Rate for Payer: BCBS of TX PPO	$1,705.36
Rate for Payer: Cash Price	$2,899.11
Rate for Payer: Cigna Medicaid	$3,069.64
Rate for Payer: Molina CHIP/Medicaid	$3,069.64
Rate for Payer: Multiplan Auto	$2,771.20
Rate for Payer: Multiplan Commercial	$2,771.20
Rate for Payer: Multiplan Workers Comp	$2,771.20
Rate for Payer: Parkland Medicaid	$3,069.64
Rate for Payer: Scott and White EPO/PPO	$2,131.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,069.64
Rate for Payer: Superior Health Plan EPO	$579.82

kit navitracker knee & spine

Facility

$1,452.80

Hospital Charge Code	8702506
Hospital Revenue Code	272
Rate for Payer: Cash Price	$987.90

kit navitracker knee & spine

Facility

$1,452.80

Hospital Charge Code	8702506
Hospital Revenue Code	272
Min. Negotiated Rate	$130.75
Max. Negotiated Rate	$1,046.02
Rate for Payer: Amerigroup CHIP/Medicaid	$130.75
Rate for Payer: BCBS of TX Blue Advantage	$435.84
Rate for Payer: BCBS of TX Blue Essentials	$523.01
Rate for Payer: BCBS of TX PPO	$581.12
Rate for Payer: Cash Price	$987.90
Rate for Payer: Cigna Medicaid	$1,046.02
Rate for Payer: Molina CHIP/Medicaid	$1,046.02
Rate for Payer: Multiplan Auto	$944.32
Rate for Payer: Multiplan Commercial	$944.32
Rate for Payer: Multiplan Workers Comp	$944.32
Rate for Payer: Parkland Medicaid	$1,046.02
Rate for Payer: Scott and White EPO/PPO	$726.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,046.02
Rate for Payer: Superior Health Plan EPO	$197.58

KIT NDL GD 21GA

Facility

$122.17

Hospital Charge Code	80822539
Hospital Revenue Code	272
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$87.96
Rate for Payer: Amerigroup CHIP/Medicaid	$11.00
Rate for Payer: BCBS of TX Blue Advantage	$36.65
Rate for Payer: BCBS of TX Blue Essentials	$43.98
Rate for Payer: BCBS of TX PPO	$48.87
Rate for Payer: Cash Price	$83.08
Rate for Payer: Cigna Medicaid	$87.96
Rate for Payer: Molina CHIP/Medicaid	$87.96
Rate for Payer: Multiplan Auto	$79.41
Rate for Payer: Multiplan Commercial	$79.41
Rate for Payer: Multiplan Workers Comp	$79.41
Rate for Payer: Parkland Medicaid	$87.96
Rate for Payer: Scott and White EPO/PPO	$61.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$87.96
Rate for Payer: Superior Health Plan EPO	$16.62

KIT NDL GD 21GA

Facility

$122.17

Hospital Charge Code	80822539
Hospital Revenue Code	272
Rate for Payer: Cash Price	$83.08

KIT, NEBULIZER PREFILLED FOR INHALATION 1000ML

Facility

$14.33

Hospital Charge Code	993305
Hospital Revenue Code	270
Rate for Payer: Cash Price	$9.74

KIT, NEBULIZER PREFILLED FOR INHALATION 1000ML

Facility

$14.33

Hospital Charge Code	993305
Hospital Revenue Code	270
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$10.32
Rate for Payer: Amerigroup CHIP/Medicaid	$1.29
Rate for Payer: BCBS of TX Blue Advantage	$4.30
Rate for Payer: BCBS of TX Blue Essentials	$5.16
Rate for Payer: BCBS of TX PPO	$5.73
Rate for Payer: Cash Price	$9.74
Rate for Payer: Cigna Medicaid	$10.32
Rate for Payer: Molina CHIP/Medicaid	$10.32
Rate for Payer: Multiplan Auto	$9.31
Rate for Payer: Multiplan Commercial	$9.31
Rate for Payer: Multiplan Workers Comp	$9.31
Rate for Payer: Parkland Medicaid	$10.32
Rate for Payer: Scott and White EPO/PPO	$7.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10.32
Rate for Payer: Superior Health Plan EPO	$1.95

KIT NEBULIZER SM VOL MED W/ONE-WAY VLVS MTHPC 7FT O2 TBING T

Facility

$10.04

Hospital Charge Code	993612
Hospital Revenue Code	270
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$7.23
Rate for Payer: Amerigroup CHIP/Medicaid	$0.90
Rate for Payer: BCBS of TX Blue Advantage	$3.01
Rate for Payer: BCBS of TX Blue Essentials	$3.61
Rate for Payer: BCBS of TX PPO	$4.02
Rate for Payer: Cash Price	$6.83
Rate for Payer: Cigna Medicaid	$7.23
Rate for Payer: Molina CHIP/Medicaid	$7.23
Rate for Payer: Multiplan Auto	$6.53
Rate for Payer: Multiplan Commercial	$6.53
Rate for Payer: Multiplan Workers Comp	$6.53
Rate for Payer: Parkland Medicaid	$7.23
Rate for Payer: Scott and White EPO/PPO	$5.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.23
Rate for Payer: Superior Health Plan EPO	$1.37

KIT NEBULIZER SM VOL MED W/ONE-WAY VLVS MTHPC 7FT O2 TBING T

Facility

$10.04

Hospital Charge Code	993612
Hospital Revenue Code	270
Rate for Payer: Cash Price	$6.83

KIT ORAL CARE #6962

Facility

$167.03

Hospital Charge Code	145421
Hospital Revenue Code	272
Rate for Payer: Cash Price	$113.58

KIT ORAL CARE #6962

Facility

$167.03

Hospital Charge Code	145421
Hospital Revenue Code	272
Min. Negotiated Rate	$15.03
Max. Negotiated Rate	$120.26
Rate for Payer: Amerigroup CHIP/Medicaid	$15.03
Rate for Payer: BCBS of TX Blue Advantage	$50.11
Rate for Payer: BCBS of TX Blue Essentials	$60.13
Rate for Payer: BCBS of TX PPO	$66.81
Rate for Payer: Cash Price	$113.58
Rate for Payer: Cigna Medicaid	$120.26
Rate for Payer: Molina CHIP/Medicaid	$120.26
Rate for Payer: Multiplan Auto	$108.57
Rate for Payer: Multiplan Commercial	$108.57
Rate for Payer: Multiplan Workers Comp	$108.57
Rate for Payer: Parkland Medicaid	$120.26
Rate for Payer: Scott and White EPO/PPO	$83.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$120.26
Rate for Payer: Superior Health Plan EPO	$22.72

KIT ORTHOLOCK 2 JOINT PREP

Facility

$2,120.18

Hospital Charge Code	145483
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,441.72

KIT ORTHOLOCK 2 JOINT PREP

Facility

$2,120.18

Hospital Charge Code	145483
Hospital Revenue Code	272
Min. Negotiated Rate	$190.82
Max. Negotiated Rate	$1,526.53
Rate for Payer: Amerigroup CHIP/Medicaid	$190.82
Rate for Payer: BCBS of TX Blue Advantage	$636.05
Rate for Payer: BCBS of TX Blue Essentials	$763.26
Rate for Payer: BCBS of TX PPO	$848.07
Rate for Payer: Cash Price	$1,441.72
Rate for Payer: Cigna Medicaid	$1,526.53
Rate for Payer: Molina CHIP/Medicaid	$1,526.53
Rate for Payer: Multiplan Auto	$1,378.12
Rate for Payer: Multiplan Commercial	$1,378.12
Rate for Payer: Multiplan Workers Comp	$1,378.12
Rate for Payer: Parkland Medicaid	$1,526.53
Rate for Payer: Scott and White EPO/PPO	$1,060.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,526.53
Rate for Payer: Superior Health Plan EPO	$288.34

KIT OSTEOSET RESORBABLE BEAD 5CC

Facility

$4,505.24

Hospital Charge Code	133606
Hospital Revenue Code	272
Min. Negotiated Rate	$405.47
Max. Negotiated Rate	$3,243.77
Rate for Payer: Amerigroup CHIP/Medicaid	$405.47
Rate for Payer: BCBS of TX Blue Advantage	$1,351.57
Rate for Payer: BCBS of TX Blue Essentials	$1,621.89
Rate for Payer: BCBS of TX PPO	$1,802.10
Rate for Payer: Cash Price	$3,063.56
Rate for Payer: Cigna Medicaid	$3,243.77
Rate for Payer: Molina CHIP/Medicaid	$3,243.77
Rate for Payer: Multiplan Auto	$2,928.41
Rate for Payer: Multiplan Commercial	$2,928.41
Rate for Payer: Multiplan Workers Comp	$2,928.41
Rate for Payer: Parkland Medicaid	$3,243.77
Rate for Payer: Scott and White EPO/PPO	$2,252.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,243.77
Rate for Payer: Superior Health Plan EPO	$612.71

KIT OSTEOSET RESORBABLE BEAD 5CC

Facility

$4,505.24

Hospital Charge Code	133606
Hospital Revenue Code	272
Rate for Payer: Cash Price	$3,063.56

KIT PARADIGMACCESS EZ SWITCH

Facility

$8,172.00

Hospital Charge Code	144851
Hospital Revenue Code	272
Rate for Payer: Cash Price	$5,556.96

KIT PARADIGMACCESS EZ SWITCH

Facility

$8,172.00

Hospital Charge Code	144851
Hospital Revenue Code	272
Min. Negotiated Rate	$735.48
Max. Negotiated Rate	$5,883.84
Rate for Payer: Amerigroup CHIP/Medicaid	$735.48
Rate for Payer: BCBS of TX Blue Advantage	$2,451.60
Rate for Payer: BCBS of TX Blue Essentials	$2,941.92
Rate for Payer: BCBS of TX PPO	$3,268.80
Rate for Payer: Cash Price	$5,556.96
Rate for Payer: Cigna Medicaid	$5,883.84
Rate for Payer: Molina CHIP/Medicaid	$5,883.84
Rate for Payer: Multiplan Auto	$5,311.80
Rate for Payer: Multiplan Commercial	$5,311.80
Rate for Payer: Multiplan Workers Comp	$5,311.80
Rate for Payer: Parkland Medicaid	$5,883.84
Rate for Payer: Scott and White EPO/PPO	$4,086.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,883.84
Rate for Payer: Superior Health Plan EPO	$1,111.39

KIT PEG FLOW 20 PUSH

Facility

$431.30

Hospital Charge Code	8568963
Hospital Revenue Code	272
Rate for Payer: Cash Price	$293.28

KIT PEG FLOW 20 PUSH

Facility

$431.30

Hospital Charge Code	8568963
Hospital Revenue Code	272
Min. Negotiated Rate	$38.82
Max. Negotiated Rate	$310.54
Rate for Payer: Amerigroup CHIP/Medicaid	$38.82
Rate for Payer: BCBS of TX Blue Advantage	$129.39
Rate for Payer: BCBS of TX Blue Essentials	$155.27
Rate for Payer: BCBS of TX PPO	$172.52
Rate for Payer: Cash Price	$293.28
Rate for Payer: Cigna Medicaid	$310.54
Rate for Payer: Molina CHIP/Medicaid	$310.54
Rate for Payer: Multiplan Auto	$280.35
Rate for Payer: Multiplan Commercial	$280.35
Rate for Payer: Multiplan Workers Comp	$280.35
Rate for Payer: Parkland Medicaid	$310.54
Rate for Payer: Scott and White EPO/PPO	$215.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$310.54
Rate for Payer: Superior Health Plan EPO	$58.66

KIT, PERICARDIOCENTESIS W

Facility

$452.87

Hospital Charge Code	133128
Hospital Revenue Code	272
Min. Negotiated Rate	$40.76
Max. Negotiated Rate	$326.07
Rate for Payer: Amerigroup CHIP/Medicaid	$40.76
Rate for Payer: BCBS of TX Blue Advantage	$135.86
Rate for Payer: BCBS of TX Blue Essentials	$163.03
Rate for Payer: BCBS of TX PPO	$181.15
Rate for Payer: Cash Price	$307.95
Rate for Payer: Cigna Medicaid	$326.07
Rate for Payer: Molina CHIP/Medicaid	$326.07
Rate for Payer: Multiplan Auto	$294.37
Rate for Payer: Multiplan Commercial	$294.37
Rate for Payer: Multiplan Workers Comp	$294.37
Rate for Payer: Parkland Medicaid	$326.07
Rate for Payer: Scott and White EPO/PPO	$226.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$326.07
Rate for Payer: Superior Health Plan EPO	$61.59

KIT, PERICARDIOCENTESIS W

Facility

$452.87

Hospital Charge Code	133128
Hospital Revenue Code	272
Rate for Payer: Cash Price	$307.95

KIT, PICO 14, 10X40CM

Facility

$1,869.32

Hospital Charge Code	993098
Hospital Revenue Code	270
Rate for Payer: Cash Price	$1,271.14

Know your out-of-pocket cost for care.

All Charges