White Rock Medical Center

All Charges

Charge

Type

Setting

Price

NDL,18GX1.5(1.2MMX40MM) BLUNT,FILL

Facility

$1.73

Hospital Charge Code	993108
Hospital Revenue Code	270
Rate for Payer: Cash Price	$1.18

NDL, 22GX5', BLACK, LONG, STRL, SNGLE USE

Facility

$30.74

Hospital Charge Code	993005
Hospital Revenue Code	270
Rate for Payer: Cash Price	$20.90

NDL, 22GX5', BLACK, LONG, STRL, SNGLE USE

Facility

$30.74

Hospital Charge Code	993005
Hospital Revenue Code	270
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$22.13
Rate for Payer: Amerigroup CHIP/Medicaid	$2.77
Rate for Payer: BCBS of TX Blue Advantage	$9.22
Rate for Payer: BCBS of TX Blue Essentials	$11.07
Rate for Payer: BCBS of TX PPO	$12.30
Rate for Payer: Cash Price	$20.90
Rate for Payer: Cigna Medicaid	$22.13
Rate for Payer: Molina CHIP/Medicaid	$22.13
Rate for Payer: Multiplan Auto	$19.98
Rate for Payer: Multiplan Commercial	$19.98
Rate for Payer: Multiplan Workers Comp	$19.98
Rate for Payer: Parkland Medicaid	$22.13
Rate for Payer: Scott and White EPO/PPO	$15.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$22.13
Rate for Payer: Superior Health Plan EPO	$4.18

NDL BX -- DHF

Facility

$67.90

Hospital Charge Code	80327802
Hospital Revenue Code	272
Rate for Payer: Cash Price	$46.17

NDL BX -- DHF

Facility

$67.90

Hospital Charge Code	80327802
Hospital Revenue Code	272
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$48.89
Rate for Payer: Amerigroup CHIP/Medicaid	$6.11
Rate for Payer: BCBS of TX Blue Advantage	$20.37
Rate for Payer: BCBS of TX Blue Essentials	$24.44
Rate for Payer: BCBS of TX PPO	$27.16
Rate for Payer: Cash Price	$46.17
Rate for Payer: Cigna Medicaid	$48.89
Rate for Payer: Molina CHIP/Medicaid	$48.89
Rate for Payer: Multiplan Auto	$44.13
Rate for Payer: Multiplan Commercial	$44.13
Rate for Payer: Multiplan Workers Comp	$44.13
Rate for Payer: Parkland Medicaid	$48.89
Rate for Payer: Scott and White EPO/PPO	$33.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$48.89
Rate for Payer: Superior Health Plan EPO	$9.23

NDL BX GRN -- DHF

Facility

$643.48

Hospital Charge Code	80327901
Hospital Revenue Code	272
Min. Negotiated Rate	$57.91
Max. Negotiated Rate	$463.31
Rate for Payer: Amerigroup CHIP/Medicaid	$57.91
Rate for Payer: BCBS of TX Blue Advantage	$193.04
Rate for Payer: BCBS of TX Blue Essentials	$231.65
Rate for Payer: BCBS of TX PPO	$257.39
Rate for Payer: Cash Price	$437.57
Rate for Payer: Cigna Medicaid	$463.31
Rate for Payer: Molina CHIP/Medicaid	$463.31
Rate for Payer: Multiplan Auto	$418.26
Rate for Payer: Multiplan Commercial	$418.26
Rate for Payer: Multiplan Workers Comp	$418.26
Rate for Payer: Parkland Medicaid	$463.31
Rate for Payer: Scott and White EPO/PPO	$321.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$463.31
Rate for Payer: Superior Health Plan EPO	$87.51

NDL BX GRN -- DHF

Facility

$643.48

Hospital Charge Code	80327901
Hospital Revenue Code	272
Rate for Payer: Cash Price	$437.57

NDL CENTESIS YUEH -- DHF

Facility

$134.49

Hospital Charge Code	81781718
Hospital Revenue Code	272
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$96.83
Rate for Payer: Amerigroup CHIP/Medicaid	$12.10
Rate for Payer: BCBS of TX Blue Advantage	$40.35
Rate for Payer: BCBS of TX Blue Essentials	$48.42
Rate for Payer: BCBS of TX PPO	$53.80
Rate for Payer: Cash Price	$91.45
Rate for Payer: Cigna Medicaid	$96.83
Rate for Payer: Molina CHIP/Medicaid	$96.83
Rate for Payer: Multiplan Auto	$87.42
Rate for Payer: Multiplan Commercial	$87.42
Rate for Payer: Multiplan Workers Comp	$87.42
Rate for Payer: Parkland Medicaid	$96.83
Rate for Payer: Scott and White EPO/PPO	$67.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$96.83
Rate for Payer: Superior Health Plan EPO	$18.29

NDL CENTESIS YUEH -- DHF

Facility

$134.49

Hospital Charge Code	81781718
Hospital Revenue Code	272
Rate for Payer: Cash Price	$91.45

NDL ELECTRD INSULATED -- DHF

Facility

$64.94

Hospital Charge Code	80328073
Hospital Revenue Code	272
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$46.76
Rate for Payer: Amerigroup CHIP/Medicaid	$5.84
Rate for Payer: BCBS of TX Blue Advantage	$19.48
Rate for Payer: BCBS of TX Blue Essentials	$23.38
Rate for Payer: BCBS of TX PPO	$25.98
Rate for Payer: Cash Price	$44.16
Rate for Payer: Cigna Medicaid	$46.76
Rate for Payer: Molina CHIP/Medicaid	$46.76
Rate for Payer: Multiplan Auto	$42.21
Rate for Payer: Multiplan Commercial	$42.21
Rate for Payer: Multiplan Workers Comp	$42.21
Rate for Payer: Parkland Medicaid	$46.76
Rate for Payer: Scott and White EPO/PPO	$32.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$46.76
Rate for Payer: Superior Health Plan EPO	$8.83

NDL ELECTRD INSULATED -- DHF

Facility

$64.94

Hospital Charge Code	80328073
Hospital Revenue Code	272
Rate for Payer: Cash Price	$44.16

NDL EPIDURAL -- DHF

Facility

$30.36

Hospital Charge Code	80328081
Hospital Revenue Code	272
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$21.86
Rate for Payer: Amerigroup CHIP/Medicaid	$2.73
Rate for Payer: BCBS of TX Blue Advantage	$9.11
Rate for Payer: BCBS of TX Blue Essentials	$10.93
Rate for Payer: BCBS of TX PPO	$12.14
Rate for Payer: Cash Price	$20.64
Rate for Payer: Cigna Medicaid	$21.86
Rate for Payer: Molina CHIP/Medicaid	$21.86
Rate for Payer: Multiplan Auto	$19.73
Rate for Payer: Multiplan Commercial	$19.73
Rate for Payer: Multiplan Workers Comp	$19.73
Rate for Payer: Parkland Medicaid	$21.86
Rate for Payer: Scott and White EPO/PPO	$15.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$21.86
Rate for Payer: Superior Health Plan EPO	$4.13

NDL EPIDURAL -- DHF

Facility

$30.36

Hospital Charge Code	80328081
Hospital Revenue Code	272
Rate for Payer: Cash Price	$20.64

NDL HUBER -- DHF

Facility

$28.85

Hospital Charge Code	80328206
Hospital Revenue Code	272
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$20.77
Rate for Payer: Amerigroup CHIP/Medicaid	$2.60
Rate for Payer: BCBS of TX Blue Advantage	$8.65
Rate for Payer: BCBS of TX Blue Essentials	$10.39
Rate for Payer: BCBS of TX PPO	$11.54
Rate for Payer: Cash Price	$19.62
Rate for Payer: Cigna Medicaid	$20.77
Rate for Payer: Molina CHIP/Medicaid	$20.77
Rate for Payer: Multiplan Auto	$18.75
Rate for Payer: Multiplan Commercial	$18.75
Rate for Payer: Multiplan Workers Comp	$18.75
Rate for Payer: Parkland Medicaid	$20.77
Rate for Payer: Scott and White EPO/PPO	$14.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$20.77
Rate for Payer: Superior Health Plan EPO	$3.92

NDL HUBER -- DHF

Facility

$28.85

Hospital Charge Code	80328206
Hospital Revenue Code	272
Rate for Payer: Cash Price	$19.62

NDL SCLERO -- DHF

Facility

$1,185.97

Hospital Charge Code	80328701
Hospital Revenue Code	272
Min. Negotiated Rate	$106.74
Max. Negotiated Rate	$853.90
Rate for Payer: Amerigroup CHIP/Medicaid	$106.74
Rate for Payer: BCBS of TX Blue Advantage	$355.79
Rate for Payer: BCBS of TX Blue Essentials	$426.95
Rate for Payer: BCBS of TX PPO	$474.39
Rate for Payer: Cash Price	$806.46
Rate for Payer: Cigna Medicaid	$853.90
Rate for Payer: Molina CHIP/Medicaid	$853.90
Rate for Payer: Multiplan Auto	$770.88
Rate for Payer: Multiplan Commercial	$770.88
Rate for Payer: Multiplan Workers Comp	$770.88
Rate for Payer: Parkland Medicaid	$853.90
Rate for Payer: Scott and White EPO/PPO	$592.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$853.90
Rate for Payer: Superior Health Plan EPO	$161.29

NDL SCLERO -- DHF

Facility

$1,185.97

Hospital Charge Code	80328701
Hospital Revenue Code	272
Rate for Payer: Cash Price	$806.46

NDL SPINAL EPIDURAL

Facility

$95.00

Service Code	HCPCS C1713
Hospital Charge Code	8452480
Hospital Revenue Code	278
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$68.40
Rate for Payer: Amerigroup CHIP/Medicaid	$8.55
Rate for Payer: BCBS of TX Blue Advantage	$28.50
Rate for Payer: BCBS of TX Blue Essentials	$34.20
Rate for Payer: BCBS of TX PPO	$38.00
Rate for Payer: Cash Price	$64.60
Rate for Payer: Cigna Medicaid	$68.40
Rate for Payer: Molina CHIP/Medicaid	$68.40
Rate for Payer: Multiplan Auto	$47.50
Rate for Payer: Multiplan Commercial	$47.50
Rate for Payer: Multiplan Workers Comp	$47.50
Rate for Payer: Parkland Medicaid	$68.40
Rate for Payer: Scott and White EPO/PPO	$47.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$68.40
Rate for Payer: Superior Health Plan EPO	$12.92

NDL SPINAL EPIDURAL

Facility

$95.00

Service Code	HCPCS C1713
Hospital Charge Code	8452480
Hospital Revenue Code	278
Min. Negotiated Rate	$23.75
Max. Negotiated Rate	$47.50
Rate for Payer: Cash Price	$64.60
Rate for Payer: Cigna Commercial	$23.75
Rate for Payer: Multiplan Auto	$47.50
Rate for Payer: Multiplan Commercial	$47.50
Rate for Payer: Multiplan Workers Comp	$47.50
Rate for Payer: Scott and White EPO/PPO	$47.50

NEBLIZER, MISTY, O2 TBG, T ADAPT, MOUTH

Facility

$13.77

Hospital Charge Code	993654
Hospital Revenue Code	270
Rate for Payer: Cash Price	$9.36

NEBLIZER, MISTY, O2 TBG, T ADAPT, MOUTH

Facility

$13.77

Hospital Charge Code	993654
Hospital Revenue Code	270
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$9.91
Rate for Payer: Amerigroup CHIP/Medicaid	$1.24
Rate for Payer: BCBS of TX Blue Advantage	$4.13
Rate for Payer: BCBS of TX Blue Essentials	$4.96
Rate for Payer: BCBS of TX PPO	$5.51
Rate for Payer: Cash Price	$9.36
Rate for Payer: Cigna Medicaid	$9.91
Rate for Payer: Molina CHIP/Medicaid	$9.91
Rate for Payer: Multiplan Auto	$8.95
Rate for Payer: Multiplan Commercial	$8.95
Rate for Payer: Multiplan Workers Comp	$8.95
Rate for Payer: Parkland Medicaid	$9.91
Rate for Payer: Scott and White EPO/PPO	$6.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.91
Rate for Payer: Superior Health Plan EPO	$1.87

NEB PREFIL 150CC -- DHF

Facility

$68.92

Hospital Charge Code	82060054
Hospital Revenue Code	270
Rate for Payer: Cash Price	$46.87

NEB PREFIL 150CC -- DHF

Facility

$68.92

Hospital Charge Code	82060054
Hospital Revenue Code	270
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$49.62
Rate for Payer: Amerigroup CHIP/Medicaid	$6.20
Rate for Payer: BCBS of TX Blue Advantage	$20.68
Rate for Payer: BCBS of TX Blue Essentials	$24.81
Rate for Payer: BCBS of TX PPO	$27.57
Rate for Payer: Cash Price	$46.87
Rate for Payer: Cigna Medicaid	$49.62
Rate for Payer: Molina CHIP/Medicaid	$49.62
Rate for Payer: Multiplan Auto	$44.80
Rate for Payer: Multiplan Commercial	$44.80
Rate for Payer: Multiplan Workers Comp	$44.80
Rate for Payer: Parkland Medicaid	$49.62
Rate for Payer: Scott and White EPO/PPO	$34.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$49.62
Rate for Payer: Superior Health Plan EPO	$9.37

NECKSCREW ASSEMBLY

Facility

$4,518.00

Service Code	HCPCS C1713
Hospital Charge Code	145472
Hospital Revenue Code	278
Min. Negotiated Rate	$406.62
Max. Negotiated Rate	$3,252.96
Rate for Payer: Amerigroup CHIP/Medicaid	$406.62
Rate for Payer: BCBS of TX Blue Advantage	$1,355.40
Rate for Payer: BCBS of TX Blue Essentials	$1,626.48
Rate for Payer: BCBS of TX PPO	$1,807.20
Rate for Payer: Cash Price	$3,072.24
Rate for Payer: Cigna Medicaid	$3,252.96
Rate for Payer: Molina CHIP/Medicaid	$3,252.96
Rate for Payer: Multiplan Auto	$2,259.00
Rate for Payer: Multiplan Commercial	$2,259.00
Rate for Payer: Multiplan Workers Comp	$2,259.00
Rate for Payer: Parkland Medicaid	$3,252.96
Rate for Payer: Scott and White EPO/PPO	$2,259.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,252.96
Rate for Payer: Superior Health Plan EPO	$614.45

NECKSCREW ASSEMBLY

Facility

$4,518.00

Service Code	HCPCS C1713
Hospital Charge Code	145472
Hospital Revenue Code	278
Min. Negotiated Rate	$1,129.50
Max. Negotiated Rate	$2,259.00
Rate for Payer: Cash Price	$3,072.24
Rate for Payer: Cigna Commercial	$1,129.50
Rate for Payer: Multiplan Auto	$2,259.00
Rate for Payer: Multiplan Commercial	$2,259.00
Rate for Payer: Multiplan Workers Comp	$2,259.00
Rate for Payer: Scott and White EPO/PPO	$2,259.00

Know your out-of-pocket cost for care.

All Charges