White Rock Medical Center

All Charges

Charge

Type

Setting

Price

MBO-SET, IRRIGATION, TWO-BAG, 94

Facility

$39.56

Hospital Charge Code	992969
Hospital Revenue Code	270
Rate for Payer: Cash Price	$26.90

MBO-SOLUTION, RINGERS, LACTATED, 1000ML, INJ

Facility

$9.79

Hospital Charge Code	992981
Hospital Revenue Code	270
Rate for Payer: Cash Price	$6.66

MBO-SOLUTION, RINGERS, LACTATED, 1000ML, INJ

Facility

$9.79

Hospital Charge Code	992981
Hospital Revenue Code	270
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$7.05
Rate for Payer: Amerigroup CHIP/Medicaid	$0.88
Rate for Payer: BCBS of TX Blue Advantage	$2.94
Rate for Payer: BCBS of TX Blue Essentials	$3.52
Rate for Payer: BCBS of TX PPO	$3.92
Rate for Payer: Cash Price	$6.66
Rate for Payer: Cigna Medicaid	$7.05
Rate for Payer: Molina CHIP/Medicaid	$7.05
Rate for Payer: Multiplan Auto	$6.36
Rate for Payer: Multiplan Commercial	$6.36
Rate for Payer: Multiplan Workers Comp	$6.36
Rate for Payer: Parkland Medicaid	$7.05
Rate for Payer: Scott and White EPO/PPO	$4.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.05
Rate for Payer: Superior Health Plan EPO	$1.33

MBO-SPLINT, FIBERGLASS, ORTHO-GLASS, 3X15

Facility

$308.49

Hospital Charge Code	993734
Hospital Revenue Code	270
Min. Negotiated Rate	$27.76
Max. Negotiated Rate	$222.11
Rate for Payer: Amerigroup CHIP/Medicaid	$27.76
Rate for Payer: BCBS of TX Blue Advantage	$92.55
Rate for Payer: BCBS of TX Blue Essentials	$111.06
Rate for Payer: BCBS of TX PPO	$123.40
Rate for Payer: Cash Price	$209.77
Rate for Payer: Cigna Medicaid	$222.11
Rate for Payer: Molina CHIP/Medicaid	$222.11
Rate for Payer: Multiplan Auto	$200.52
Rate for Payer: Multiplan Commercial	$200.52
Rate for Payer: Multiplan Workers Comp	$200.52
Rate for Payer: Parkland Medicaid	$222.11
Rate for Payer: Scott and White EPO/PPO	$154.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$222.11
Rate for Payer: Superior Health Plan EPO	$41.95

MBO-SPLINT, FIBERGLASS, ORTHO-GLASS, 3X15

Facility

$308.49

Hospital Charge Code	993734
Hospital Revenue Code	270
Rate for Payer: Cash Price	$209.77

MBO-SPLINT, FIBERGLASS, ORTHO-GLASS, 4X15

Facility

$370.15

Hospital Charge Code	992779
Hospital Revenue Code	270
Min. Negotiated Rate	$33.31
Max. Negotiated Rate	$266.51
Rate for Payer: Amerigroup CHIP/Medicaid	$33.31
Rate for Payer: BCBS of TX Blue Advantage	$111.05
Rate for Payer: BCBS of TX Blue Essentials	$133.25
Rate for Payer: BCBS of TX PPO	$148.06
Rate for Payer: Cash Price	$251.70
Rate for Payer: Cigna Medicaid	$266.51
Rate for Payer: Molina CHIP/Medicaid	$266.51
Rate for Payer: Multiplan Auto	$240.60
Rate for Payer: Multiplan Commercial	$240.60
Rate for Payer: Multiplan Workers Comp	$240.60
Rate for Payer: Parkland Medicaid	$266.51
Rate for Payer: Scott and White EPO/PPO	$185.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$266.51
Rate for Payer: Superior Health Plan EPO	$50.34

MBO-SPLINT, FIBERGLASS, ORTHO-GLASS, 4X15

Facility

$370.15

Hospital Charge Code	992779
Hospital Revenue Code	270
Rate for Payer: Cash Price	$251.70

MBO-STAPLER, SKIN, ROTATING HEAD, 35 WIDE

Facility

$79.89

Hospital Charge Code	992913
Hospital Revenue Code	270
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$57.52
Rate for Payer: Amerigroup CHIP/Medicaid	$7.19
Rate for Payer: BCBS of TX Blue Advantage	$23.97
Rate for Payer: BCBS of TX Blue Essentials	$28.76
Rate for Payer: BCBS of TX PPO	$31.96
Rate for Payer: Cash Price	$54.33
Rate for Payer: Cigna Medicaid	$57.52
Rate for Payer: Molina CHIP/Medicaid	$57.52
Rate for Payer: Multiplan Auto	$51.93
Rate for Payer: Multiplan Commercial	$51.93
Rate for Payer: Multiplan Workers Comp	$51.93
Rate for Payer: Parkland Medicaid	$57.52
Rate for Payer: Scott and White EPO/PPO	$39.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$57.52
Rate for Payer: Superior Health Plan EPO	$10.87

MBO-STAPLER, SKIN, ROTATING HEAD, 35 WIDE

Facility

$79.89

Hospital Charge Code	992913
Hospital Revenue Code	270
Rate for Payer: Cash Price	$54.33

MBO-SUTURE, MONOCRYL, 3-0, PS-2, 27, UNDYED

Facility

$19.22

Hospital Charge Code	992757
Hospital Revenue Code	272
Rate for Payer: Cash Price	$13.07

MBO-SUTURE, MONOCRYL, 3-0, PS-2, 27, UNDYED

Facility

$19.22

Hospital Charge Code	992757
Hospital Revenue Code	272
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$13.84
Rate for Payer: Amerigroup CHIP/Medicaid	$1.73
Rate for Payer: BCBS of TX Blue Advantage	$5.77
Rate for Payer: BCBS of TX Blue Essentials	$6.92
Rate for Payer: BCBS of TX PPO	$7.69
Rate for Payer: Cash Price	$13.07
Rate for Payer: Cigna Medicaid	$13.84
Rate for Payer: Molina CHIP/Medicaid	$13.84
Rate for Payer: Multiplan Auto	$12.49
Rate for Payer: Multiplan Commercial	$12.49
Rate for Payer: Multiplan Workers Comp	$12.49
Rate for Payer: Parkland Medicaid	$13.84
Rate for Payer: Scott and White EPO/PPO	$9.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.84
Rate for Payer: Superior Health Plan EPO	$2.61

MBO-TUBE, BLOOD COLLECTION, CITRATE

Facility

$0.42

Hospital Charge Code	993343
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.29

MBO-TUBE, BLOOD COLLECTION, CITRATE

Facility

$0.42

Hospital Charge Code	993343
Hospital Revenue Code	270
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.30
Rate for Payer: Amerigroup CHIP/Medicaid	$0.04
Rate for Payer: BCBS of TX Blue Advantage	$0.13
Rate for Payer: BCBS of TX Blue Essentials	$0.15
Rate for Payer: BCBS of TX PPO	$0.17
Rate for Payer: Cash Price	$0.29
Rate for Payer: Cigna Medicaid	$0.30
Rate for Payer: Molina CHIP/Medicaid	$0.30
Rate for Payer: Multiplan Auto	$0.27
Rate for Payer: Multiplan Commercial	$0.27
Rate for Payer: Multiplan Workers Comp	$0.27
Rate for Payer: Parkland Medicaid	$0.30
Rate for Payer: Scott and White EPO/PPO	$0.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.30
Rate for Payer: Superior Health Plan EPO	$0.06

MBO-TUBE, VCUETTE, RED, YLW RING, 5ML, 13X100

Facility

$0.57

Hospital Charge Code	993954
Hospital Revenue Code	272
Rate for Payer: Cash Price	$0.39

MBO-TUBE, VCUETTE, RED, YLW RING, 5ML, 13X100

Facility

$0.57

Hospital Charge Code	993954
Hospital Revenue Code	272
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.41
Rate for Payer: Amerigroup CHIP/Medicaid	$0.05
Rate for Payer: BCBS of TX Blue Advantage	$0.17
Rate for Payer: BCBS of TX Blue Essentials	$0.21
Rate for Payer: BCBS of TX PPO	$0.23
Rate for Payer: Cash Price	$0.39
Rate for Payer: Cigna Medicaid	$0.41
Rate for Payer: Molina CHIP/Medicaid	$0.41
Rate for Payer: Multiplan Auto	$0.37
Rate for Payer: Multiplan Commercial	$0.37
Rate for Payer: Multiplan Workers Comp	$0.37
Rate for Payer: Parkland Medicaid	$0.41
Rate for Payer: Scott and White EPO/PPO	$0.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.41
Rate for Payer: Superior Health Plan EPO	$0.08

MBO-TUBING, NONCONDUCTIVE, 3/16'X6', STRL

Facility

$15.53

Hospital Charge Code	993095
Hospital Revenue Code	270
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$11.18
Rate for Payer: Amerigroup CHIP/Medicaid	$1.40
Rate for Payer: BCBS of TX Blue Advantage	$4.66
Rate for Payer: BCBS of TX Blue Essentials	$5.59
Rate for Payer: BCBS of TX PPO	$6.21
Rate for Payer: Cash Price	$10.56
Rate for Payer: Cigna Medicaid	$11.18
Rate for Payer: Molina CHIP/Medicaid	$11.18
Rate for Payer: Multiplan Auto	$10.09
Rate for Payer: Multiplan Commercial	$10.09
Rate for Payer: Multiplan Workers Comp	$10.09
Rate for Payer: Parkland Medicaid	$11.18
Rate for Payer: Scott and White EPO/PPO	$7.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11.18
Rate for Payer: Superior Health Plan EPO	$2.11

MBO-TUBING, NONCONDUCTIVE, 3/16'X6', STRL

Facility

$15.53

Hospital Charge Code	993095
Hospital Revenue Code	270
Rate for Payer: Cash Price	$10.56

Mbo-wrap, STERILIZATION, QC, H500, 36X36

Facility

$7.77

Hospital Charge Code	992931
Hospital Revenue Code	270
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$5.59
Rate for Payer: Amerigroup CHIP/Medicaid	$0.70
Rate for Payer: BCBS of TX Blue Advantage	$2.33
Rate for Payer: BCBS of TX Blue Essentials	$2.80
Rate for Payer: BCBS of TX PPO	$3.11
Rate for Payer: Cash Price	$5.28
Rate for Payer: Cigna Medicaid	$5.59
Rate for Payer: Molina CHIP/Medicaid	$5.59
Rate for Payer: Multiplan Auto	$5.05
Rate for Payer: Multiplan Commercial	$5.05
Rate for Payer: Multiplan Workers Comp	$5.05
Rate for Payer: Parkland Medicaid	$5.59
Rate for Payer: Scott and White EPO/PPO	$3.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.59
Rate for Payer: Superior Health Plan EPO	$1.06

Mbo-wrap, STERILIZATION, QC, H500, 36X36

Facility

$7.77

Hospital Charge Code	992931
Hospital Revenue Code	270
Rate for Payer: Cash Price	$5.28

MD SCREW 2.7MM X 16MM

Facility

$1,100.60

Service Code	HCPCS C1713
Hospital Charge Code	992321
Hospital Revenue Code	278
Min. Negotiated Rate	$99.05
Max. Negotiated Rate	$792.43
Rate for Payer: Amerigroup CHIP/Medicaid	$99.05
Rate for Payer: BCBS of TX Blue Advantage	$330.18
Rate for Payer: BCBS of TX Blue Essentials	$396.22
Rate for Payer: BCBS of TX PPO	$440.24
Rate for Payer: Cash Price	$748.41
Rate for Payer: Cigna Medicaid	$792.43
Rate for Payer: Molina CHIP/Medicaid	$792.43
Rate for Payer: Multiplan Auto	$550.30
Rate for Payer: Multiplan Commercial	$550.30
Rate for Payer: Multiplan Workers Comp	$550.30
Rate for Payer: Parkland Medicaid	$792.43
Rate for Payer: Scott and White EPO/PPO	$550.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$792.43
Rate for Payer: Superior Health Plan EPO	$149.68

MD SCREW 2.7MM X 16MM

Facility

$1,100.60

Service Code	HCPCS C1713
Hospital Charge Code	992321
Hospital Revenue Code	278
Min. Negotiated Rate	$275.15
Max. Negotiated Rate	$550.30
Rate for Payer: Cash Price	$748.41
Rate for Payer: Cigna Commercial	$275.15
Rate for Payer: Multiplan Auto	$550.30
Rate for Payer: Multiplan Commercial	$550.30
Rate for Payer: Multiplan Workers Comp	$550.30
Rate for Payer: Scott and White EPO/PPO	$550.30

Measles Antibodies, IgM SO

Facility

$148.00

Service Code	HCPCS 86765
Hospital Charge Code	1706704
Hospital Revenue Code	302
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$106.56
Rate for Payer: Amerigroup CHIP/Medicaid	$5.02
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12.88
Rate for Payer: Amerigroup Medicare	$12.88
Rate for Payer: BCBS of TX Blue Advantage	$44.40
Rate for Payer: BCBS of TX Blue Essentials	$53.28
Rate for Payer: BCBS of TX Medicare	$12.88
Rate for Payer: BCBS of TX PPO	$59.20
Rate for Payer: Cash Price	$100.64
Rate for Payer: Cash Price	$100.64
Rate for Payer: Cigna Medicaid	$106.56
Rate for Payer: Cigna Medicare	$12.88
Rate for Payer: Employer Direct Commercial	$12.88
Rate for Payer: Humana Medicare/TRICARE	$12.88
Rate for Payer: Molina CHIP/Medicaid	$106.56
Rate for Payer: Molina Dual Medicare/Medicaid	$12.88
Rate for Payer: Molina Medicare	$12.88
Rate for Payer: Multiplan Auto	$96.20
Rate for Payer: Multiplan Commercial	$96.20
Rate for Payer: Multiplan Workers Comp	$96.20
Rate for Payer: Parkland Medicaid	$106.56
Rate for Payer: Scott and White EPO/PPO	$16.10
Rate for Payer: Scott and White Medicare	$12.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$106.56
Rate for Payer: Superior Health Plan EPO	$12.88
Rate for Payer: Superior Health Plan Medicare	$12.88
Rate for Payer: Universal American Dual Medicare/Medicaid	$12.88
Rate for Payer: Universal American Medicare	$12.88
Rate for Payer: Wellcare Medicare	$12.88
Rate for Payer: Wellmed Medicare	$12.88

Measles Antibodies, IgM SO

Facility

$148.00

Service Code	HCPCS 86765
Hospital Charge Code	1706704
Hospital Revenue Code	302
Rate for Payer: Cash Price	$100.64

Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging

Facility

$237.60

Service Code	HCPCS 51798
Hospital Charge Code	991168
Hospital Revenue Code	402
Rate for Payer: Cash Price	$161.57

Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging

Facility

$237.60

Service Code	HCPCS 51798
Hospital Charge Code	991168
Hospital Revenue Code	402
Min. Negotiated Rate	$13.96
Max. Negotiated Rate	$171.07
Rate for Payer: Amerigroup CHIP/Medicaid	$21.38
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$59.26
Rate for Payer: Amerigroup Medicare	$59.26
Rate for Payer: BCBS of TX Blue Advantage	$91.87
Rate for Payer: BCBS of TX Blue Essentials	$110.02
Rate for Payer: BCBS of TX Medicare	$59.26
Rate for Payer: BCBS of TX PPO	$138.63
Rate for Payer: Cash Price	$161.57
Rate for Payer: Cash Price	$161.57
Rate for Payer: Cash Price	$161.57
Rate for Payer: Cigna Commercial	$125.27
Rate for Payer: Cigna Medicaid	$171.07
Rate for Payer: Cigna Medicare	$59.26
Rate for Payer: Employer Direct Commercial	$59.26
Rate for Payer: Humana Medicare/TRICARE	$59.26
Rate for Payer: Molina CHIP/Medicaid	$171.07
Rate for Payer: Molina Dual Medicare/Medicaid	$59.26
Rate for Payer: Molina Medicare	$59.26
Rate for Payer: Multiplan Auto	$154.44
Rate for Payer: Multiplan Commercial	$154.44
Rate for Payer: Multiplan Workers Comp	$154.44
Rate for Payer: Parkland Medicaid	$171.07
Rate for Payer: Scott and White EPO/PPO	$13.96
Rate for Payer: Scott and White Medicare	$59.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$171.07
Rate for Payer: Superior Health Plan EPO	$59.26
Rate for Payer: Superior Health Plan Medicare	$59.26
Rate for Payer: Universal American Dual Medicare/Medicaid	$59.26
Rate for Payer: Universal American Medicare	$59.26
Rate for Payer: Wellcare Medicare	$59.26
Rate for Payer: Wellmed Medicare	$59.26

Know your out-of-pocket cost for care.

All Charges