White Rock Medical Center

All Charges

Charge

Type

Setting

Price

NEEDLE, 25GX5/8', ECLIPSE, USE LUER LOK

Facility

$0.65

Hospital Charge Code	993013
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.44

NEEDLE, 25GX5/8', ECLIPSE, USE LUER LOK

Facility

$0.65

Hospital Charge Code	993013
Hospital Revenue Code	270
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.47
Rate for Payer: Amerigroup CHIP/Medicaid	$0.06
Rate for Payer: BCBS of TX Blue Advantage	$0.20
Rate for Payer: BCBS of TX Blue Essentials	$0.23
Rate for Payer: BCBS of TX PPO	$0.26
Rate for Payer: Cash Price	$0.44
Rate for Payer: Cigna Medicaid	$0.47
Rate for Payer: Molina CHIP/Medicaid	$0.47
Rate for Payer: Multiplan Auto	$0.42
Rate for Payer: Multiplan Commercial	$0.42
Rate for Payer: Multiplan Workers Comp	$0.42
Rate for Payer: Parkland Medicaid	$0.47
Rate for Payer: Scott and White EPO/PPO	$0.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.47
Rate for Payer: Superior Health Plan EPO	$0.09

NEEDLE, BIOPSY JAMSHIDI 8 X 6 CONTOUR HANDLE DISP -- DHF

Facility

$138.28

Hospital Charge Code	80327406
Hospital Revenue Code	272
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$99.56
Rate for Payer: Amerigroup CHIP/Medicaid	$12.45
Rate for Payer: BCBS of TX Blue Advantage	$41.48
Rate for Payer: BCBS of TX Blue Essentials	$49.78
Rate for Payer: BCBS of TX PPO	$55.31
Rate for Payer: Cash Price	$94.03
Rate for Payer: Cigna Medicaid	$99.56
Rate for Payer: Molina CHIP/Medicaid	$99.56
Rate for Payer: Multiplan Auto	$89.88
Rate for Payer: Multiplan Commercial	$89.88
Rate for Payer: Multiplan Workers Comp	$89.88
Rate for Payer: Parkland Medicaid	$99.56
Rate for Payer: Scott and White EPO/PPO	$69.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$99.56
Rate for Payer: Superior Health Plan EPO	$18.81

NEEDLE, BIOPSY JAMSHIDI 8 X 6 CONTOUR HANDLE DISP -- DHF

Facility

$138.28

Hospital Charge Code	80327406
Hospital Revenue Code	272
Rate for Payer: Cash Price	$94.03

NEEDLE, BLOCK REGIONAL 22G X 1 1/2' -- DHF

Facility

$75.03

Hospital Charge Code	80328743
Hospital Revenue Code	272
Rate for Payer: Cash Price	$51.02

NEEDLE, BLOCK REGIONAL 22G X 1 1/2' -- DHF

Facility

$75.03

Hospital Charge Code	80328743
Hospital Revenue Code	272
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$54.02
Rate for Payer: Amerigroup CHIP/Medicaid	$6.75
Rate for Payer: BCBS of TX Blue Advantage	$22.51
Rate for Payer: BCBS of TX Blue Essentials	$27.01
Rate for Payer: BCBS of TX PPO	$30.01
Rate for Payer: Cash Price	$51.02
Rate for Payer: Cigna Medicaid	$54.02
Rate for Payer: Molina CHIP/Medicaid	$54.02
Rate for Payer: Multiplan Auto	$48.77
Rate for Payer: Multiplan Commercial	$48.77
Rate for Payer: Multiplan Workers Comp	$48.77
Rate for Payer: Parkland Medicaid	$54.02
Rate for Payer: Scott and White EPO/PPO	$37.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$54.02
Rate for Payer: Superior Health Plan EPO	$10.20

NEEDLE, BLUNT, 18GX1.5'

Facility

$0.33

Hospital Charge Code	993738
Hospital Revenue Code	272
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	$0.13
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna Medicaid	$0.24
Rate for Payer: Molina CHIP/Medicaid	$0.24
Rate for Payer: Multiplan Auto	$0.21
Rate for Payer: Multiplan Commercial	$0.21
Rate for Payer: Multiplan Workers Comp	$0.21
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	$0.04

NEEDLE, BLUNT, 18GX1.5'

Facility

$0.33

Hospital Charge Code	993738
Hospital Revenue Code	272
Rate for Payer: Cash Price	$0.22

NEEDLE, BLUNT, FILL 18GX 1/2'

Facility

$0.30

Hospital Charge Code	992827
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.22
Rate for Payer: Amerigroup CHIP/Medicaid	$0.03
Rate for Payer: BCBS of TX Blue Advantage	$0.09
Rate for Payer: BCBS of TX Blue Essentials	$0.11
Rate for Payer: BCBS of TX PPO	$0.12
Rate for Payer: Cash Price	$0.20
Rate for Payer: Cigna Medicaid	$0.22
Rate for Payer: Molina CHIP/Medicaid	$0.22
Rate for Payer: Multiplan Auto	$0.20
Rate for Payer: Multiplan Commercial	$0.20
Rate for Payer: Multiplan Workers Comp	$0.20
Rate for Payer: Parkland Medicaid	$0.22
Rate for Payer: Scott and White EPO/PPO	$0.15
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.22
Rate for Payer: Superior Health Plan EPO	$0.04

NEEDLE, BLUNT, FILL 18GX 1/2'

Facility

$0.30

Hospital Charge Code	992827
Hospital Revenue Code	272
Rate for Payer: Cash Price	$0.20

NEEDLE, BONE BIOPSY KYPHON SZ2

Facility

$407.69

Hospital Charge Code	8568492
Hospital Revenue Code	272
Min. Negotiated Rate	$36.69
Max. Negotiated Rate	$293.54
Rate for Payer: Amerigroup CHIP/Medicaid	$36.69
Rate for Payer: BCBS of TX Blue Advantage	$122.31
Rate for Payer: BCBS of TX Blue Essentials	$146.77
Rate for Payer: BCBS of TX PPO	$163.08
Rate for Payer: Cash Price	$277.23
Rate for Payer: Cigna Medicaid	$293.54
Rate for Payer: Molina CHIP/Medicaid	$293.54
Rate for Payer: Multiplan Auto	$265.00
Rate for Payer: Multiplan Commercial	$265.00
Rate for Payer: Multiplan Workers Comp	$265.00
Rate for Payer: Parkland Medicaid	$293.54
Rate for Payer: Scott and White EPO/PPO	$203.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$293.54
Rate for Payer: Superior Health Plan EPO	$55.45

NEEDLE, BONE BIOPSY KYPHON SZ2

Facility

$407.69

Hospital Charge Code	8568492
Hospital Revenue Code	272
Rate for Payer: Cash Price	$277.23

NEEDLE EXPRESSEW II

Facility

$1,120.47

Hospital Charge Code	992667
Hospital Revenue Code	272
Rate for Payer: Cash Price	$761.92

NEEDLE EXPRESSEW II

Facility

$1,120.47

Hospital Charge Code	992667
Hospital Revenue Code	272
Min. Negotiated Rate	$100.84
Max. Negotiated Rate	$806.74
Rate for Payer: Amerigroup CHIP/Medicaid	$100.84
Rate for Payer: BCBS of TX Blue Advantage	$336.14
Rate for Payer: BCBS of TX Blue Essentials	$403.37
Rate for Payer: BCBS of TX PPO	$448.19
Rate for Payer: Cash Price	$761.92
Rate for Payer: Cigna Medicaid	$806.74
Rate for Payer: Molina CHIP/Medicaid	$806.74
Rate for Payer: Multiplan Auto	$728.31
Rate for Payer: Multiplan Commercial	$728.31
Rate for Payer: Multiplan Workers Comp	$728.31
Rate for Payer: Parkland Medicaid	$806.74
Rate for Payer: Scott and White EPO/PPO	$560.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$806.74
Rate for Payer: Superior Health Plan EPO	$152.38

NEEDLE, HUBER, 20GX1, Y-INJECT SITE, SET

Facility

$58.69

Hospital Charge Code	992837
Hospital Revenue Code	272
Rate for Payer: Cash Price	$39.91

NEEDLE, HUBER, 20GX1, Y-INJECT SITE, SET

Facility

$58.69

Hospital Charge Code	992837
Hospital Revenue Code	272
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$42.26
Rate for Payer: Amerigroup CHIP/Medicaid	$5.28
Rate for Payer: BCBS of TX Blue Advantage	$17.61
Rate for Payer: BCBS of TX Blue Essentials	$21.13
Rate for Payer: BCBS of TX PPO	$23.48
Rate for Payer: Cash Price	$39.91
Rate for Payer: Cigna Medicaid	$42.26
Rate for Payer: Molina CHIP/Medicaid	$42.26
Rate for Payer: Multiplan Auto	$38.15
Rate for Payer: Multiplan Commercial	$38.15
Rate for Payer: Multiplan Workers Comp	$38.15
Rate for Payer: Parkland Medicaid	$42.26
Rate for Payer: Scott and White EPO/PPO	$29.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$42.26
Rate for Payer: Superior Health Plan EPO	$7.98

NEEDLE HYPO 22GAX1.5IN MNJCT MGLN SFTY

Facility

$12.20

Hospital Charge Code	993413
Hospital Revenue Code	272
Rate for Payer: Cash Price	$8.30

NEEDLE HYPO 22GAX1.5IN MNJCT MGLN SFTY

Facility

$12.20

Hospital Charge Code	993413
Hospital Revenue Code	272
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$8.78
Rate for Payer: Amerigroup CHIP/Medicaid	$1.10
Rate for Payer: BCBS of TX Blue Advantage	$3.66
Rate for Payer: BCBS of TX Blue Essentials	$4.39
Rate for Payer: BCBS of TX PPO	$4.88
Rate for Payer: Cash Price	$8.30
Rate for Payer: Cigna Medicaid	$8.78
Rate for Payer: Molina CHIP/Medicaid	$8.78
Rate for Payer: Multiplan Auto	$7.93
Rate for Payer: Multiplan Commercial	$7.93
Rate for Payer: Multiplan Workers Comp	$7.93
Rate for Payer: Parkland Medicaid	$8.78
Rate for Payer: Scott and White EPO/PPO	$6.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.78
Rate for Payer: Superior Health Plan EPO	$1.66

NEEDLE HYPO 25GAX1.5IN REG BVL WL

Facility

$0.01

Hospital Charge Code	993442
Hospital Revenue Code	272
Rate for Payer: Cash Price	$0.01

NEEDLE HYPO 25GAX1.5IN REG BVL WL

Facility

$0.01

Hospital Charge Code	993442
Hospital Revenue Code	272
Max. Negotiated Rate	$0.01
Rate for Payer: Amerigroup CHIP/Medicaid	$0.00
Rate for Payer: BCBS of TX Blue Advantage	$0.00
Rate for Payer: BCBS of TX Blue Essentials	$0.00
Rate for Payer: BCBS of TX PPO	$0.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna Medicaid	$0.01
Rate for Payer: Molina CHIP/Medicaid	$0.01
Rate for Payer: Multiplan Auto	$0.01
Rate for Payer: Multiplan Commercial	$0.01
Rate for Payer: Multiplan Workers Comp	$0.01
Rate for Payer: Parkland Medicaid	$0.01
Rate for Payer: Scott and White EPO/PPO	$0.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.01
Rate for Payer: Superior Health Plan EPO	$0.00

NEEDLE INJ CRLK

Facility

$286.02

Hospital Charge Code	116162
Hospital Revenue Code	272
Rate for Payer: Cash Price	$194.49

NEEDLE INJ CRLK

Facility

$286.02

Hospital Charge Code	116162
Hospital Revenue Code	272
Min. Negotiated Rate	$25.74
Max. Negotiated Rate	$205.93
Rate for Payer: Amerigroup CHIP/Medicaid	$25.74
Rate for Payer: BCBS of TX Blue Advantage	$85.81
Rate for Payer: BCBS of TX Blue Essentials	$102.97
Rate for Payer: BCBS of TX PPO	$114.41
Rate for Payer: Cash Price	$194.49
Rate for Payer: Cigna Medicaid	$205.93
Rate for Payer: Molina CHIP/Medicaid	$205.93
Rate for Payer: Multiplan Auto	$185.91
Rate for Payer: Multiplan Commercial	$185.91
Rate for Payer: Multiplan Workers Comp	$185.91
Rate for Payer: Parkland Medicaid	$205.93
Rate for Payer: Scott and White EPO/PPO	$143.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$205.93
Rate for Payer: Superior Health Plan EPO	$38.90

Needle insertion(s) without injection(s); 1 or 2 muscle(s)

Facility

$94.79

Service Code	HCPCS 20560
Hospital Charge Code	9393000
Hospital Revenue Code	420
Min. Negotiated Rate	$8.53
Max. Negotiated Rate	$200.00
Rate for Payer: Amerigroup CHIP/Medicaid	$8.53
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$29.06
Rate for Payer: Amerigroup Medicare	$29.06
Rate for Payer: BCBS of TX Blue Advantage	$28.44
Rate for Payer: BCBS of TX Blue Essentials	$34.12
Rate for Payer: BCBS of TX Medicare	$29.06
Rate for Payer: BCBS of TX PPO	$37.92
Rate for Payer: Cash Price	$64.46
Rate for Payer: Cash Price	$64.46
Rate for Payer: Cash Price	$64.46
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$68.25
Rate for Payer: Cigna Medicare	$29.06
Rate for Payer: Employer Direct Commercial	$29.06
Rate for Payer: Humana Medicare/TRICARE	$29.06
Rate for Payer: Molina CHIP/Medicaid	$68.25
Rate for Payer: Molina Dual Medicare/Medicaid	$29.06
Rate for Payer: Molina Medicare	$29.06
Rate for Payer: Multiplan Auto	$61.61
Rate for Payer: Multiplan Commercial	$61.61
Rate for Payer: Multiplan Workers Comp	$61.61
Rate for Payer: Parkland Medicaid	$68.25
Rate for Payer: Scott and White EPO/PPO	$18.14
Rate for Payer: Scott and White Medicare	$29.06
Rate for Payer: Superior Health Plan CHIP/Medicaid	$68.25
Rate for Payer: Superior Health Plan EPO	$29.06
Rate for Payer: Superior Health Plan Medicare	$29.06
Rate for Payer: Universal American Dual Medicare/Medicaid	$29.06
Rate for Payer: Universal American Medicare	$29.06
Rate for Payer: Wellcare Medicare	$29.06
Rate for Payer: Wellmed Medicare	$29.06

Needle insertion(s) without injection(s); 1 or 2 muscle(s)

Facility

$94.79

Service Code	HCPCS 20560
Hospital Charge Code	9393000
Hospital Revenue Code	420
Rate for Payer: Cash Price	$64.46

NEEDLE, INSUFFLATION, 14GX15CM MENDOPATH

Facility

$57.79

Hospital Charge Code	992824
Hospital Revenue Code	272
Rate for Payer: Cash Price	$39.30

Know your out-of-pocket cost for care.

All Charges