White Rock Medical Center

All Charges

Charge

Type

Setting

Price

LINE BOOT DERMAPROX

Facility

$1,235.61

Hospital Charge Code	145900
Hospital Revenue Code	272
Min. Negotiated Rate	$111.20
Max. Negotiated Rate	$889.64
Rate for Payer: Amerigroup CHIP/Medicaid	$111.20
Rate for Payer: BCBS of TX Blue Advantage	$370.68
Rate for Payer: BCBS of TX Blue Essentials	$444.82
Rate for Payer: BCBS of TX PPO	$494.24
Rate for Payer: Cash Price	$840.21
Rate for Payer: Cigna Medicaid	$889.64
Rate for Payer: Molina CHIP/Medicaid	$889.64
Rate for Payer: Multiplan Auto	$803.15
Rate for Payer: Multiplan Commercial	$803.15
Rate for Payer: Multiplan Workers Comp	$803.15
Rate for Payer: Parkland Medicaid	$889.64
Rate for Payer: Scott and White EPO/PPO	$617.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$889.64
Rate for Payer: Superior Health Plan EPO	$168.04

Line Draw Arterial Blood Sampling Kit, Luer Slip

Facility

$1.73

Hospital Charge Code	993361
Hospital Revenue Code	270
Rate for Payer: Cash Price	$1.18

Line Draw Arterial Blood Sampling Kit, Luer Slip

Facility

$1.73

Hospital Charge Code	993361
Hospital Revenue Code	270
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$1.25
Rate for Payer: Amerigroup CHIP/Medicaid	$0.16
Rate for Payer: BCBS of TX Blue Advantage	$0.52
Rate for Payer: BCBS of TX Blue Essentials	$0.62
Rate for Payer: BCBS of TX PPO	$0.69
Rate for Payer: Cash Price	$1.18
Rate for Payer: Cigna Medicaid	$1.25
Rate for Payer: Molina CHIP/Medicaid	$1.25
Rate for Payer: Multiplan Auto	$1.12
Rate for Payer: Multiplan Commercial	$1.12
Rate for Payer: Multiplan Workers Comp	$1.12
Rate for Payer: Parkland Medicaid	$1.25
Rate for Payer: Scott and White EPO/PPO	$0.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.25
Rate for Payer: Superior Health Plan EPO	$0.24

LINER BOOT REVOLUTION PARADIGM

Facility

$3,414.94

Hospital Charge Code	146729
Hospital Revenue Code	270
Min. Negotiated Rate	$307.34
Max. Negotiated Rate	$2,458.76
Rate for Payer: Amerigroup CHIP/Medicaid	$307.34
Rate for Payer: BCBS of TX Blue Advantage	$1,024.48
Rate for Payer: BCBS of TX Blue Essentials	$1,229.38
Rate for Payer: BCBS of TX PPO	$1,365.98
Rate for Payer: Cash Price	$2,322.16
Rate for Payer: Cigna Medicaid	$2,458.76
Rate for Payer: Molina CHIP/Medicaid	$2,458.76
Rate for Payer: Multiplan Auto	$2,219.71
Rate for Payer: Multiplan Commercial	$2,219.71
Rate for Payer: Multiplan Workers Comp	$2,219.71
Rate for Payer: Parkland Medicaid	$2,458.76
Rate for Payer: Scott and White EPO/PPO	$1,707.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,458.76
Rate for Payer: Superior Health Plan EPO	$464.43

LINER BOOT REVOLUTION PARADIGM

Facility

$3,414.94

Hospital Charge Code	146729
Hospital Revenue Code	270
Rate for Payer: Cash Price	$2,322.16

LINER, FOR PITCHER, LIGHTWEIGHT, PLA

Facility

$0.38

Hospital Charge Code	993224
Hospital Revenue Code	270
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.27
Rate for Payer: Amerigroup CHIP/Medicaid	$0.03
Rate for Payer: BCBS of TX Blue Advantage	$0.11
Rate for Payer: BCBS of TX Blue Essentials	$0.14
Rate for Payer: BCBS of TX PPO	$0.15
Rate for Payer: Cash Price	$0.26
Rate for Payer: Cigna Medicaid	$0.27
Rate for Payer: Molina CHIP/Medicaid	$0.27
Rate for Payer: Multiplan Auto	$0.25
Rate for Payer: Multiplan Commercial	$0.25
Rate for Payer: Multiplan Workers Comp	$0.25
Rate for Payer: Parkland Medicaid	$0.27
Rate for Payer: Scott and White EPO/PPO	$0.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.27
Rate for Payer: Superior Health Plan EPO	$0.05

LINER, FOR PITCHER, LIGHTWEIGHT, PLA

Facility

$0.38

Hospital Charge Code	993224
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.26

LINER G7 OSSEOTI 4 HOLE SHELL 58MM G

Facility

$13,640.96

Service Code	HCPCS C1734
Hospital Charge Code	992131
Hospital Revenue Code	278
Min. Negotiated Rate	$3,410.24
Max. Negotiated Rate	$6,820.48
Rate for Payer: Cash Price	$9,275.85
Rate for Payer: Cigna Commercial	$3,410.24
Rate for Payer: Multiplan Auto	$6,820.48
Rate for Payer: Multiplan Commercial	$6,820.48
Rate for Payer: Multiplan Workers Comp	$6,820.48
Rate for Payer: Scott and White EPO/PPO	$6,820.48

LINER G7 OSSEOTI 4 HOLE SHELL 58MM G

Facility

$13,640.96

Service Code	HCPCS C1734
Hospital Charge Code	992131
Hospital Revenue Code	278
Min. Negotiated Rate	$1,227.69
Max. Negotiated Rate	$9,821.49
Rate for Payer: Amerigroup CHIP/Medicaid	$1,227.69
Rate for Payer: BCBS of TX Blue Advantage	$4,092.29
Rate for Payer: BCBS of TX Blue Essentials	$4,910.75
Rate for Payer: BCBS of TX PPO	$5,456.38
Rate for Payer: Cash Price	$9,275.85
Rate for Payer: Cigna Medicaid	$9,821.49
Rate for Payer: Molina CHIP/Medicaid	$9,821.49
Rate for Payer: Multiplan Auto	$6,820.48
Rate for Payer: Multiplan Commercial	$6,820.48
Rate for Payer: Multiplan Workers Comp	$6,820.48
Rate for Payer: Parkland Medicaid	$9,821.49
Rate for Payer: Scott and White EPO/PPO	$6,820.48
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,821.49
Rate for Payer: Superior Health Plan EPO	$1,855.17

LINER, LLD, WHITE, 40X46, 40-45 GAL, 90MIL

Facility

$0.75

Hospital Charge Code	993886
Hospital Revenue Code	270
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.54
Rate for Payer: Amerigroup CHIP/Medicaid	$0.07
Rate for Payer: BCBS of TX Blue Advantage	$0.23
Rate for Payer: BCBS of TX Blue Essentials	$0.27
Rate for Payer: BCBS of TX PPO	$0.30
Rate for Payer: Cash Price	$0.51
Rate for Payer: Cigna Medicaid	$0.54
Rate for Payer: Molina CHIP/Medicaid	$0.54
Rate for Payer: Multiplan Auto	$0.49
Rate for Payer: Multiplan Commercial	$0.49
Rate for Payer: Multiplan Workers Comp	$0.49
Rate for Payer: Parkland Medicaid	$0.54
Rate for Payer: Scott and White EPO/PPO	$0.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.54
Rate for Payer: Superior Health Plan EPO	$0.10

LINER, LLD, WHITE, 40X46, 40-45 GAL, 90MIL

Facility

$0.75

Hospital Charge Code	993886
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.51

LINER, NATURAL, 30X37, LIGHT, ROLL

Facility

$0.21

Hospital Charge Code	993290
Hospital Revenue Code	270
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.15
Rate for Payer: Amerigroup CHIP/Medicaid	$0.02
Rate for Payer: BCBS of TX Blue Advantage	$0.06
Rate for Payer: BCBS of TX Blue Essentials	$0.08
Rate for Payer: BCBS of TX PPO	$0.08
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cigna Medicaid	$0.15
Rate for Payer: Molina CHIP/Medicaid	$0.15
Rate for Payer: Multiplan Auto	$0.14
Rate for Payer: Multiplan Commercial	$0.14
Rate for Payer: Multiplan Workers Comp	$0.14
Rate for Payer: Parkland Medicaid	$0.15
Rate for Payer: Scott and White EPO/PPO	$0.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.15
Rate for Payer: Superior Health Plan EPO	$0.03

LINER, NATURAL, 30X37, LIGHT, ROLL

Facility

$0.21

Hospital Charge Code	993290
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.14

LINER, NATURAL, 40X48, LIGHT, ROLL

Facility

$0.34

Hospital Charge Code	993276
Hospital Revenue Code	270
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.24
Rate for Payer: Amerigroup CHIP/Medicaid	$0.03
Rate for Payer: BCBS of TX Blue Advantage	$0.10
Rate for Payer: BCBS of TX Blue Essentials	$0.12
Rate for Payer: BCBS of TX PPO	$0.14
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna Medicaid	$0.24
Rate for Payer: Molina CHIP/Medicaid	$0.24
Rate for Payer: Multiplan Auto	$0.22
Rate for Payer: Multiplan Commercial	$0.22
Rate for Payer: Multiplan Workers Comp	$0.22
Rate for Payer: Parkland Medicaid	$0.24
Rate for Payer: Scott and White EPO/PPO	$0.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.24
Rate for Payer: Superior Health Plan EPO	$0.05

LINER, NATURAL, 40X48, LIGHT, ROLL

Facility

$0.34

Hospital Charge Code	993276
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.23

LINER, TRAY, ABSORBANT, 20X25

Facility

$1.05

Hospital Charge Code	993022
Hospital Revenue Code	272
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.76
Rate for Payer: Amerigroup CHIP/Medicaid	$0.09
Rate for Payer: BCBS of TX Blue Advantage	$0.32
Rate for Payer: BCBS of TX Blue Essentials	$0.38
Rate for Payer: BCBS of TX PPO	$0.42
Rate for Payer: Cash Price	$0.71
Rate for Payer: Cigna Medicaid	$0.76
Rate for Payer: Molina CHIP/Medicaid	$0.76
Rate for Payer: Multiplan Auto	$0.68
Rate for Payer: Multiplan Commercial	$0.68
Rate for Payer: Multiplan Workers Comp	$0.68
Rate for Payer: Parkland Medicaid	$0.76
Rate for Payer: Scott and White EPO/PPO	$0.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.76
Rate for Payer: Superior Health Plan EPO	$0.14

LINER, TRAY, ABSORBANT, 20X25

Facility

$1.05

Hospital Charge Code	993022
Hospital Revenue Code	272
Rate for Payer: Cash Price	$0.71

LINE, SAMPLE GAS FOR ANESTHESIA

Facility

$4.03

Hospital Charge Code	993040
Hospital Revenue Code	270
Rate for Payer: Cash Price	$2.74

LINE, SAMPLE GAS FOR ANESTHESIA

Facility

$4.03

Hospital Charge Code	993040
Hospital Revenue Code	270
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$2.90
Rate for Payer: Amerigroup CHIP/Medicaid	$0.36
Rate for Payer: BCBS of TX Blue Advantage	$1.21
Rate for Payer: BCBS of TX Blue Essentials	$1.45
Rate for Payer: BCBS of TX PPO	$1.61
Rate for Payer: Cash Price	$2.74
Rate for Payer: Cigna Medicaid	$2.90
Rate for Payer: Molina CHIP/Medicaid	$2.90
Rate for Payer: Multiplan Auto	$2.62
Rate for Payer: Multiplan Commercial	$2.62
Rate for Payer: Multiplan Workers Comp	$2.62
Rate for Payer: Parkland Medicaid	$2.90
Rate for Payer: Scott and White EPO/PPO	$2.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.90
Rate for Payer: Superior Health Plan EPO	$0.55

LINE SAMPLING ADULTO2 SMART CAPNOLINE H PLUS

Facility

$20.59

Hospital Charge Code	993609
Hospital Revenue Code	270
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$14.82
Rate for Payer: Amerigroup CHIP/Medicaid	$1.85
Rate for Payer: BCBS of TX Blue Advantage	$6.18
Rate for Payer: BCBS of TX Blue Essentials	$7.41
Rate for Payer: BCBS of TX PPO	$8.24
Rate for Payer: Cash Price	$14.00
Rate for Payer: Cigna Medicaid	$14.82
Rate for Payer: Molina CHIP/Medicaid	$14.82
Rate for Payer: Multiplan Auto	$13.38
Rate for Payer: Multiplan Commercial	$13.38
Rate for Payer: Multiplan Workers Comp	$13.38
Rate for Payer: Parkland Medicaid	$14.82
Rate for Payer: Scott and White EPO/PPO	$10.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14.82
Rate for Payer: Superior Health Plan EPO	$2.80

LINE SAMPLING ADULTO2 SMART CAPNOLINE H PLUS

Facility

$20.59

Hospital Charge Code	993609
Hospital Revenue Code	270
Rate for Payer: Cash Price	$14.00

linezolid 2 mg/mL IV Soln 300 mL

Facility

$253.70

Service Code	HCPCS J2020
Hospital Charge Code	78438885
Hospital Revenue Code	636
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$182.66
Rate for Payer: Amerigroup CHIP/Medicaid	$22.83
Rate for Payer: BCBS of TX Blue Advantage	$20.88
Rate for Payer: BCBS of TX Blue Essentials	$25.06
Rate for Payer: BCBS of TX PPO	$27.79
Rate for Payer: Cash Price	$172.52
Rate for Payer: Cash Price	$172.52
Rate for Payer: Cigna Medicaid	$182.66
Rate for Payer: Molina CHIP/Medicaid	$182.66
Rate for Payer: Multiplan Auto	$164.91
Rate for Payer: Multiplan Commercial	$164.91
Rate for Payer: Multiplan Workers Comp	$164.91
Rate for Payer: Parkland Medicaid	$182.66
Rate for Payer: Scott and White EPO/PPO	$126.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$182.66
Rate for Payer: Superior Health Plan EPO	$34.50

linezolid 2 mg/mL IV Soln 300 mL

Facility

$253.70

Service Code	HCPCS J2020
Hospital Charge Code	78438885
Hospital Revenue Code	636
Min. Negotiated Rate	$63.42
Max. Negotiated Rate	$126.85
Rate for Payer: Cash Price	$172.52
Rate for Payer: Cigna Commercial	$63.42
Rate for Payer: Scott and White EPO/PPO	$126.85

linezolid 600 mg Tab

Facility

$314.00

Service Code	HCPCS J3490
Hospital Charge Code	78430404
Hospital Revenue Code	250
Rate for Payer: Cash Price	$213.52

linezolid 600 mg Tab

Facility

$314.00

Service Code	HCPCS J3490
Hospital Charge Code	78430404
Hospital Revenue Code	250
Min. Negotiated Rate	$28.26
Max. Negotiated Rate	$226.08
Rate for Payer: Amerigroup CHIP/Medicaid	$28.26
Rate for Payer: BCBS of TX Blue Advantage	$94.20
Rate for Payer: BCBS of TX Blue Essentials	$113.04
Rate for Payer: BCBS of TX PPO	$125.60
Rate for Payer: Cash Price	$213.52
Rate for Payer: Cigna Medicaid	$226.08
Rate for Payer: Molina CHIP/Medicaid	$226.08
Rate for Payer: Multiplan Auto	$204.10
Rate for Payer: Multiplan Commercial	$204.10
Rate for Payer: Multiplan Workers Comp	$204.10
Rate for Payer: Parkland Medicaid	$226.08
Rate for Payer: Scott and White EPO/PPO	$157.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$226.08
Rate for Payer: Superior Health Plan EPO	$42.70

Know your out-of-pocket cost for care.

All Charges