White Rock Medical Center

All Charges

Charge

Type

Setting

Price

TAPE, CLOTH SOFT SURGICAL 4'''' X 10 YARDS -- DHF

Facility

$36.69

Hospital Charge Code	80349004
Hospital Revenue Code	270
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$23.85
Rate for Payer: Aetna Commercial	$20.18
Rate for Payer: Amerigroup CHIP/Medicaid	$3.30
Rate for Payer: BCBS of TX Blue Advantage	$11.01
Rate for Payer: BCBS of TX Blue Essentials	$13.21
Rate for Payer: BCBS of TX PPO	$14.68
Rate for Payer: Cash Price	$32.29
Rate for Payer: Multiplan Auto	$23.85
Rate for Payer: Multiplan Commercial	$23.85
Rate for Payer: Multiplan Workers Comp	$23.85
Rate for Payer: Scott and White EPO/PPO	$18.34
Rate for Payer: Superior Health Plan EPO	$4.99

TAPE, CLOTH SOFT SURGICAL 4'''' X 10 YARDS -- DHF

Facility

$36.69

Hospital Charge Code	80349004
Hospital Revenue Code	270
Rate for Payer: Cash Price	$32.29

TAPE, COTTON UMBILICAL 1/8'' X 18'' -- DHF

Facility

$96.69

Hospital Charge Code	81950008
Hospital Revenue Code	272
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$62.85
Rate for Payer: Aetna Commercial	$53.18
Rate for Payer: Amerigroup CHIP/Medicaid	$8.70
Rate for Payer: BCBS of TX Blue Advantage	$29.01
Rate for Payer: BCBS of TX Blue Essentials	$34.81
Rate for Payer: BCBS of TX PPO	$38.68
Rate for Payer: Cash Price	$85.09
Rate for Payer: Multiplan Auto	$62.85
Rate for Payer: Multiplan Commercial	$62.85
Rate for Payer: Multiplan Workers Comp	$62.85
Rate for Payer: Scott and White EPO/PPO	$48.34
Rate for Payer: Superior Health Plan EPO	$13.15

TAPE, COTTON UMBILICAL 1/8'''' X 30'''' -- DHF

Facility

$96.69

Hospital Charge Code	81950008
Hospital Revenue Code	272
Rate for Payer: Cash Price	$85.09

TAPE, COTTON UMBILICAL 1/8'''' X 30'''' -- DHF

Facility

$96.69

Hospital Charge Code	81950008
Hospital Revenue Code	272
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$62.85
Rate for Payer: Aetna Commercial	$53.18
Rate for Payer: Amerigroup CHIP/Medicaid	$8.70
Rate for Payer: BCBS of TX Blue Advantage	$29.01
Rate for Payer: BCBS of TX Blue Essentials	$34.81
Rate for Payer: BCBS of TX PPO	$38.68
Rate for Payer: Cash Price	$85.09
Rate for Payer: Multiplan Auto	$62.85
Rate for Payer: Multiplan Commercial	$62.85
Rate for Payer: Multiplan Workers Comp	$62.85
Rate for Payer: Scott and White EPO/PPO	$48.34
Rate for Payer: Superior Health Plan EPO	$13.15

TB EMG ENDOTRACH -- DHF

Facility

$1,493.00

Hospital Charge Code	80346539
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,313.84

TB EMG ENDOTRACH -- DHF

Facility

$1,493.00

Hospital Charge Code	80346539
Hospital Revenue Code	272
Min. Negotiated Rate	$134.37
Max. Negotiated Rate	$970.45
Rate for Payer: Aetna Commercial	$821.15
Rate for Payer: Amerigroup CHIP/Medicaid	$134.37
Rate for Payer: BCBS of TX Blue Advantage	$447.90
Rate for Payer: BCBS of TX Blue Essentials	$537.48
Rate for Payer: BCBS of TX PPO	$597.20
Rate for Payer: Cash Price	$1,313.84
Rate for Payer: Multiplan Auto	$970.45
Rate for Payer: Multiplan Commercial	$970.45
Rate for Payer: Multiplan Workers Comp	$970.45
Rate for Payer: Scott and White EPO/PPO	$746.50
Rate for Payer: Superior Health Plan EPO	$203.05

TB ENDO LZ -- DHF

Facility

$1,852.39

Hospital Charge Code	80932106
Hospital Revenue Code	270
Min. Negotiated Rate	$166.72
Max. Negotiated Rate	$1,204.05
Rate for Payer: Aetna Commercial	$1,018.81
Rate for Payer: Amerigroup CHIP/Medicaid	$166.72
Rate for Payer: BCBS of TX Blue Advantage	$555.72
Rate for Payer: BCBS of TX Blue Essentials	$666.86
Rate for Payer: BCBS of TX PPO	$740.96
Rate for Payer: Cash Price	$1,630.10
Rate for Payer: Multiplan Auto	$1,204.05
Rate for Payer: Multiplan Commercial	$1,204.05
Rate for Payer: Multiplan Workers Comp	$1,204.05
Rate for Payer: Scott and White EPO/PPO	$926.20
Rate for Payer: Superior Health Plan EPO	$251.93

TB ENDO LZ -- DHF

Facility

$1,852.39

Hospital Charge Code	80932106
Hospital Revenue Code	270
Rate for Payer: Cash Price	$1,630.10

TB ENDOTRACH -- DHF

Facility

$174.75

Hospital Charge Code	82072653
Hospital Revenue Code	272
Min. Negotiated Rate	$15.73
Max. Negotiated Rate	$113.59
Rate for Payer: Aetna Commercial	$96.11
Rate for Payer: Amerigroup CHIP/Medicaid	$15.73
Rate for Payer: BCBS of TX Blue Advantage	$52.42
Rate for Payer: BCBS of TX Blue Essentials	$62.91
Rate for Payer: BCBS of TX PPO	$69.90
Rate for Payer: Cash Price	$153.78
Rate for Payer: Multiplan Auto	$113.59
Rate for Payer: Multiplan Commercial	$113.59
Rate for Payer: Multiplan Workers Comp	$113.59
Rate for Payer: Scott and White EPO/PPO	$87.38
Rate for Payer: Superior Health Plan EPO	$23.77

TB ENDOTRACH -- DHF

Facility

$174.75

Hospital Charge Code	82072653
Hospital Revenue Code	272
Rate for Payer: Cash Price	$153.78

TB ENTRL FEED -- DHF

Facility

$78.23

Hospital Charge Code	80346554
Hospital Revenue Code	270
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$50.85
Rate for Payer: Aetna Commercial	$43.03
Rate for Payer: Amerigroup CHIP/Medicaid	$7.04
Rate for Payer: BCBS of TX Blue Advantage	$23.47
Rate for Payer: BCBS of TX Blue Essentials	$28.16
Rate for Payer: BCBS of TX PPO	$31.29
Rate for Payer: Cash Price	$68.84
Rate for Payer: Multiplan Auto	$50.85
Rate for Payer: Multiplan Commercial	$50.85
Rate for Payer: Multiplan Workers Comp	$50.85
Rate for Payer: Scott and White EPO/PPO	$39.12
Rate for Payer: Superior Health Plan EPO	$10.64

TB ENTRL FEED -- DHF

Facility

$78.23

Hospital Charge Code	80346554
Hospital Revenue Code	270
Rate for Payer: Cash Price	$68.84

TB EPIDURAL PMP -- DHF

Facility

$52.01

Hospital Charge Code	80346588
Hospital Revenue Code	270
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$33.81
Rate for Payer: Aetna Commercial	$28.61
Rate for Payer: Amerigroup CHIP/Medicaid	$4.68
Rate for Payer: BCBS of TX Blue Advantage	$15.60
Rate for Payer: BCBS of TX Blue Essentials	$18.72
Rate for Payer: BCBS of TX PPO	$20.80
Rate for Payer: Cash Price	$45.77
Rate for Payer: Multiplan Auto	$33.81
Rate for Payer: Multiplan Commercial	$33.81
Rate for Payer: Multiplan Workers Comp	$33.81
Rate for Payer: Scott and White EPO/PPO	$26.00
Rate for Payer: Superior Health Plan EPO	$7.07

TB EPIDURAL PMP -- DHF

Facility

$52.01

Hospital Charge Code	80346588
Hospital Revenue Code	270
Rate for Payer: Cash Price	$45.77

TB FD JEJUNAL -- DHF

Facility

$1,043.07

Hospital Charge Code	80346703
Hospital Revenue Code	272
Min. Negotiated Rate	$93.88
Max. Negotiated Rate	$678.00
Rate for Payer: Aetna Commercial	$573.69
Rate for Payer: Amerigroup CHIP/Medicaid	$93.88
Rate for Payer: BCBS of TX Blue Advantage	$312.92
Rate for Payer: BCBS of TX Blue Essentials	$375.51
Rate for Payer: BCBS of TX PPO	$417.23
Rate for Payer: Cash Price	$917.90
Rate for Payer: Multiplan Auto	$678.00
Rate for Payer: Multiplan Commercial	$678.00
Rate for Payer: Multiplan Workers Comp	$678.00
Rate for Payer: Scott and White EPO/PPO	$521.54
Rate for Payer: Superior Health Plan EPO	$141.86

TB FD JEJUNAL -- DHF

Facility

$1,043.07

Hospital Charge Code	80346703
Hospital Revenue Code	272
Rate for Payer: Cash Price	$917.90

TB FEED 8 FR

Facility

$39.13

Hospital Charge Code	80346901
Hospital Revenue Code	270
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$25.43
Rate for Payer: Aetna Commercial	$21.52
Rate for Payer: Amerigroup CHIP/Medicaid	$3.52
Rate for Payer: BCBS of TX Blue Advantage	$11.74
Rate for Payer: BCBS of TX Blue Essentials	$14.09
Rate for Payer: BCBS of TX PPO	$15.65
Rate for Payer: Cash Price	$34.43
Rate for Payer: Multiplan Auto	$25.43
Rate for Payer: Multiplan Commercial	$25.43
Rate for Payer: Multiplan Workers Comp	$25.43
Rate for Payer: Scott and White EPO/PPO	$19.56
Rate for Payer: Superior Health Plan EPO	$5.32

TB FEED 8 FR

Facility

$39.13

Hospital Charge Code	80346901
Hospital Revenue Code	270
Rate for Payer: Cash Price	$34.43

TB FEED -- DHF

Facility

$331.23

Hospital Charge Code	80346802
Hospital Revenue Code	270
Rate for Payer: Cash Price	$291.48

TB FEED -- DHF

Facility

$331.23

Hospital Charge Code	80346802
Hospital Revenue Code	270
Min. Negotiated Rate	$29.81
Max. Negotiated Rate	$215.30
Rate for Payer: Aetna Commercial	$182.18
Rate for Payer: Amerigroup CHIP/Medicaid	$29.81
Rate for Payer: BCBS of TX Blue Advantage	$99.37
Rate for Payer: BCBS of TX Blue Essentials	$119.24
Rate for Payer: BCBS of TX PPO	$132.49
Rate for Payer: Cash Price	$291.48
Rate for Payer: Multiplan Auto	$215.30
Rate for Payer: Multiplan Commercial	$215.30
Rate for Payer: Multiplan Workers Comp	$215.30
Rate for Payer: Scott and White EPO/PPO	$165.62
Rate for Payer: Superior Health Plan EPO	$45.05

TB FEED INFANT -- DHF

Facility

$134.88

Hospital Charge Code	80346885
Hospital Revenue Code	272
Min. Negotiated Rate	$12.14
Max. Negotiated Rate	$87.67
Rate for Payer: Aetna Commercial	$74.18
Rate for Payer: Amerigroup CHIP/Medicaid	$12.14
Rate for Payer: BCBS of TX Blue Advantage	$40.46
Rate for Payer: BCBS of TX Blue Essentials	$48.56
Rate for Payer: BCBS of TX PPO	$53.95
Rate for Payer: Cash Price	$118.69
Rate for Payer: Multiplan Auto	$87.67
Rate for Payer: Multiplan Commercial	$87.67
Rate for Payer: Multiplan Workers Comp	$87.67
Rate for Payer: Scott and White EPO/PPO	$67.44
Rate for Payer: Superior Health Plan EPO	$18.34

TB FEED INFANT -- DHF

Facility

$134.88

Hospital Charge Code	80346885
Hospital Revenue Code	272
Rate for Payer: Cash Price	$118.69

TB FEED KANGAROO/ENFIT ALL SIZES

Facility

$70.46

Hospital Charge Code	144788
Hospital Revenue Code	272
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$45.80
Rate for Payer: Aetna Commercial	$38.75
Rate for Payer: Amerigroup CHIP/Medicaid	$6.34
Rate for Payer: BCBS of TX Blue Advantage	$21.14
Rate for Payer: BCBS of TX Blue Essentials	$25.37
Rate for Payer: BCBS of TX PPO	$28.18
Rate for Payer: Cash Price	$62.00
Rate for Payer: Multiplan Auto	$45.80
Rate for Payer: Multiplan Commercial	$45.80
Rate for Payer: Multiplan Workers Comp	$45.80
Rate for Payer: Scott and White EPO/PPO	$35.23
Rate for Payer: Superior Health Plan EPO	$9.58

TB FEED KANGAROO/ENFIT ALL SIZES

Facility

$70.46

Hospital Charge Code	144788
Hospital Revenue Code	272
Rate for Payer: Cash Price	$62.00

Know your out-of-pocket cost for care.

All Charges