White Rock Medical Center

All Charges

Charge

Type

Setting

Price

NEEDLE, INSUFFLATION, 14GX15CM MENDOPATH

Facility

$57.79

Hospital Charge Code	992824
Hospital Revenue Code	272
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$41.61
Rate for Payer: Amerigroup CHIP/Medicaid	$5.20
Rate for Payer: BCBS of TX Blue Advantage	$17.34
Rate for Payer: BCBS of TX Blue Essentials	$20.80
Rate for Payer: BCBS of TX PPO	$23.12
Rate for Payer: Cash Price	$39.30
Rate for Payer: Cigna Medicaid	$41.61
Rate for Payer: Molina CHIP/Medicaid	$41.61
Rate for Payer: Multiplan Auto	$37.56
Rate for Payer: Multiplan Commercial	$37.56
Rate for Payer: Multiplan Workers Comp	$37.56
Rate for Payer: Parkland Medicaid	$41.61
Rate for Payer: Scott and White EPO/PPO	$28.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$41.61
Rate for Payer: Superior Health Plan EPO	$7.86

NEEDLE IO BRSL MOD PNK RED

Facility

$249.70

Hospital Charge Code	993492
Hospital Revenue Code	270
Rate for Payer: Cash Price	$169.80

NEEDLE IO BRSL MOD PNK RED

Facility

$249.70

Hospital Charge Code	993492
Hospital Revenue Code	270
Min. Negotiated Rate	$22.47
Max. Negotiated Rate	$179.78
Rate for Payer: Amerigroup CHIP/Medicaid	$22.47
Rate for Payer: BCBS of TX Blue Advantage	$74.91
Rate for Payer: BCBS of TX Blue Essentials	$89.89
Rate for Payer: BCBS of TX PPO	$99.88
Rate for Payer: Cash Price	$169.80
Rate for Payer: Cigna Medicaid	$179.78
Rate for Payer: Molina CHIP/Medicaid	$179.78
Rate for Payer: Multiplan Auto	$162.31
Rate for Payer: Multiplan Commercial	$162.31
Rate for Payer: Multiplan Workers Comp	$162.31
Rate for Payer: Parkland Medicaid	$179.78
Rate for Payer: Scott and White EPO/PPO	$124.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$179.78
Rate for Payer: Superior Health Plan EPO	$33.96

NEEDLE IO BRSL MOD PUR

Facility

$249.70

Hospital Charge Code	993500
Hospital Revenue Code	270
Rate for Payer: Cash Price	$169.80

NEEDLE IO BRSL MOD PUR

Facility

$249.70

Hospital Charge Code	993500
Hospital Revenue Code	270
Min. Negotiated Rate	$22.47
Max. Negotiated Rate	$179.78
Rate for Payer: Amerigroup CHIP/Medicaid	$22.47
Rate for Payer: BCBS of TX Blue Advantage	$74.91
Rate for Payer: BCBS of TX Blue Essentials	$89.89
Rate for Payer: BCBS of TX PPO	$99.88
Rate for Payer: Cash Price	$169.80
Rate for Payer: Cigna Medicaid	$179.78
Rate for Payer: Molina CHIP/Medicaid	$179.78
Rate for Payer: Multiplan Auto	$162.31
Rate for Payer: Multiplan Commercial	$162.31
Rate for Payer: Multiplan Workers Comp	$162.31
Rate for Payer: Parkland Medicaid	$179.78
Rate for Payer: Scott and White EPO/PPO	$124.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$179.78
Rate for Payer: Superior Health Plan EPO	$33.96

NEEDLE, MICRO DISSECTION INSULATED 3CM STERILE -- DHF

Facility

$899.29

Hospital Charge Code	80822554
Hospital Revenue Code	270
Min. Negotiated Rate	$80.94
Max. Negotiated Rate	$647.49
Rate for Payer: Amerigroup CHIP/Medicaid	$80.94
Rate for Payer: BCBS of TX Blue Advantage	$269.79
Rate for Payer: BCBS of TX Blue Essentials	$323.74
Rate for Payer: BCBS of TX PPO	$359.72
Rate for Payer: Cash Price	$611.52
Rate for Payer: Cigna Medicaid	$647.49
Rate for Payer: Molina CHIP/Medicaid	$647.49
Rate for Payer: Multiplan Auto	$584.54
Rate for Payer: Multiplan Commercial	$584.54
Rate for Payer: Multiplan Workers Comp	$584.54
Rate for Payer: Parkland Medicaid	$647.49
Rate for Payer: Scott and White EPO/PPO	$449.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$647.49
Rate for Payer: Superior Health Plan EPO	$122.30

NEEDLE, MICRO DISSECTION INSULATED 3CM STERILE -- DHF

Facility

$899.29

Hospital Charge Code	80822554
Hospital Revenue Code	270
Rate for Payer: Cash Price	$611.52

NEEDLE, NERVE STIMULATOR INSULATD W/EXT SET 21GX4' -- DHF

Facility

$73.38

Hospital Charge Code	80329154
Hospital Revenue Code	272
Rate for Payer: Cash Price	$49.90

NEEDLE, NERVE STIMULATOR INSULATD W/EXT SET 21GX4' -- DHF

Facility

$73.38

Hospital Charge Code	80329154
Hospital Revenue Code	272
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$52.83
Rate for Payer: Amerigroup CHIP/Medicaid	$6.60
Rate for Payer: BCBS of TX Blue Advantage	$22.01
Rate for Payer: BCBS of TX Blue Essentials	$26.42
Rate for Payer: BCBS of TX PPO	$29.35
Rate for Payer: Cash Price	$49.90
Rate for Payer: Cigna Medicaid	$52.83
Rate for Payer: Molina CHIP/Medicaid	$52.83
Rate for Payer: Multiplan Auto	$47.70
Rate for Payer: Multiplan Commercial	$47.70
Rate for Payer: Multiplan Workers Comp	$47.70
Rate for Payer: Parkland Medicaid	$52.83
Rate for Payer: Scott and White EPO/PPO	$36.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$52.83
Rate for Payer: Superior Health Plan EPO	$9.98

NEEDLE, SAFETY, 21G X 1, MAGELLAN

Facility

$1.22

Hospital Charge Code	993026
Hospital Revenue Code	272
Rate for Payer: Cash Price	$0.83

NEEDLE, SAFETY, 21G X 1, MAGELLAN

Facility

$1.22

Hospital Charge Code	993026
Hospital Revenue Code	272
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.88
Rate for Payer: Amerigroup CHIP/Medicaid	$0.11
Rate for Payer: BCBS of TX Blue Advantage	$0.37
Rate for Payer: BCBS of TX Blue Essentials	$0.44
Rate for Payer: BCBS of TX PPO	$0.49
Rate for Payer: Cash Price	$0.83
Rate for Payer: Cigna Medicaid	$0.88
Rate for Payer: Molina CHIP/Medicaid	$0.88
Rate for Payer: Multiplan Auto	$0.79
Rate for Payer: Multiplan Commercial	$0.79
Rate for Payer: Multiplan Workers Comp	$0.79
Rate for Payer: Parkland Medicaid	$0.88
Rate for Payer: Scott and White EPO/PPO	$0.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.88
Rate for Payer: Superior Health Plan EPO	$0.17

NEEDLE, SAFETY, 25G X 1, MAGELLAN

Facility

$1.22

Hospital Charge Code	993056
Hospital Revenue Code	272
Rate for Payer: Cash Price	$0.83

NEEDLE, SAFETY, 25G X 1, MAGELLAN

Facility

$1.22

Hospital Charge Code	993056
Hospital Revenue Code	272
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.88
Rate for Payer: Amerigroup CHIP/Medicaid	$0.11
Rate for Payer: BCBS of TX Blue Advantage	$0.37
Rate for Payer: BCBS of TX Blue Essentials	$0.44
Rate for Payer: BCBS of TX PPO	$0.49
Rate for Payer: Cash Price	$0.83
Rate for Payer: Cigna Medicaid	$0.88
Rate for Payer: Molina CHIP/Medicaid	$0.88
Rate for Payer: Multiplan Auto	$0.79
Rate for Payer: Multiplan Commercial	$0.79
Rate for Payer: Multiplan Workers Comp	$0.79
Rate for Payer: Parkland Medicaid	$0.88
Rate for Payer: Scott and White EPO/PPO	$0.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.88
Rate for Payer: Superior Health Plan EPO	$0.17

NEEDLE SCORPION AR13995N

Facility

$1,103.22

Hospital Charge Code	8524477
Hospital Revenue Code	272
Rate for Payer: Cash Price	$750.19

NEEDLE SCORPION AR13995N

Facility

$1,103.22

Hospital Charge Code	8524477
Hospital Revenue Code	272
Min. Negotiated Rate	$99.29
Max. Negotiated Rate	$794.32
Rate for Payer: Amerigroup CHIP/Medicaid	$99.29
Rate for Payer: BCBS of TX Blue Advantage	$330.97
Rate for Payer: BCBS of TX Blue Essentials	$397.16
Rate for Payer: BCBS of TX PPO	$441.29
Rate for Payer: Cash Price	$750.19
Rate for Payer: Cigna Medicaid	$794.32
Rate for Payer: Molina CHIP/Medicaid	$794.32
Rate for Payer: Multiplan Auto	$717.09
Rate for Payer: Multiplan Commercial	$717.09
Rate for Payer: Multiplan Workers Comp	$717.09
Rate for Payer: Parkland Medicaid	$794.32
Rate for Payer: Scott and White EPO/PPO	$551.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$794.32
Rate for Payer: Superior Health Plan EPO	$150.04

NEEDLE SET INTRAOSSEOUS 15MM

Facility

$620.16

Hospital Charge Code	8612538
Hospital Revenue Code	272
Min. Negotiated Rate	$55.81
Max. Negotiated Rate	$446.52
Rate for Payer: Amerigroup CHIP/Medicaid	$55.81
Rate for Payer: BCBS of TX Blue Advantage	$186.05
Rate for Payer: BCBS of TX Blue Essentials	$223.26
Rate for Payer: BCBS of TX PPO	$248.06
Rate for Payer: Cash Price	$421.71
Rate for Payer: Cigna Medicaid	$446.52
Rate for Payer: Molina CHIP/Medicaid	$446.52
Rate for Payer: Multiplan Auto	$403.10
Rate for Payer: Multiplan Commercial	$403.10
Rate for Payer: Multiplan Workers Comp	$403.10
Rate for Payer: Parkland Medicaid	$446.52
Rate for Payer: Scott and White EPO/PPO	$310.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$446.52
Rate for Payer: Superior Health Plan EPO	$84.34

NEEDLE SET INTRAOSSEOUS 15MM

Facility

$620.16

Hospital Charge Code	8612538
Hospital Revenue Code	272
Rate for Payer: Cash Price	$421.71

NEEDLE SET INTRAOSSEOUS 25MM

Facility

$627.43

Hospital Charge Code	8612532
Hospital Revenue Code	272
Min. Negotiated Rate	$56.47
Max. Negotiated Rate	$451.75
Rate for Payer: Amerigroup CHIP/Medicaid	$56.47
Rate for Payer: BCBS of TX Blue Advantage	$188.23
Rate for Payer: BCBS of TX Blue Essentials	$225.87
Rate for Payer: BCBS of TX PPO	$250.97
Rate for Payer: Cash Price	$426.65
Rate for Payer: Cigna Medicaid	$451.75
Rate for Payer: Molina CHIP/Medicaid	$451.75
Rate for Payer: Multiplan Auto	$407.83
Rate for Payer: Multiplan Commercial	$407.83
Rate for Payer: Multiplan Workers Comp	$407.83
Rate for Payer: Parkland Medicaid	$451.75
Rate for Payer: Scott and White EPO/PPO	$313.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$451.75
Rate for Payer: Superior Health Plan EPO	$85.33

NEEDLE SET INTRAOSSEOUS 25MM

Facility

$627.43

Hospital Charge Code	8612532
Hospital Revenue Code	272
Rate for Payer: Cash Price	$426.65

NEEDLE SET INTRAOSSEOUS 45MM

Facility

$627.43

Hospital Charge Code	8612537
Hospital Revenue Code	272
Min. Negotiated Rate	$56.47
Max. Negotiated Rate	$451.75
Rate for Payer: Amerigroup CHIP/Medicaid	$56.47
Rate for Payer: BCBS of TX Blue Advantage	$188.23
Rate for Payer: BCBS of TX Blue Essentials	$225.87
Rate for Payer: BCBS of TX PPO	$250.97
Rate for Payer: Cash Price	$426.65
Rate for Payer: Cigna Medicaid	$451.75
Rate for Payer: Molina CHIP/Medicaid	$451.75
Rate for Payer: Multiplan Auto	$407.83
Rate for Payer: Multiplan Commercial	$407.83
Rate for Payer: Multiplan Workers Comp	$407.83
Rate for Payer: Parkland Medicaid	$451.75
Rate for Payer: Scott and White EPO/PPO	$313.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$451.75
Rate for Payer: Superior Health Plan EPO	$85.33

NEEDLE SET INTRAOSSEOUS 45MM

Facility

$627.43

Hospital Charge Code	8612537
Hospital Revenue Code	272
Rate for Payer: Cash Price	$426.65

needle spectrum autopass

Facility

$776.06

Hospital Charge Code	8646515
Hospital Revenue Code	272
Min. Negotiated Rate	$69.85
Max. Negotiated Rate	$558.76
Rate for Payer: Amerigroup CHIP/Medicaid	$69.85
Rate for Payer: BCBS of TX Blue Advantage	$232.82
Rate for Payer: BCBS of TX Blue Essentials	$279.38
Rate for Payer: BCBS of TX PPO	$310.42
Rate for Payer: Cash Price	$527.72
Rate for Payer: Cigna Medicaid	$558.76
Rate for Payer: Molina CHIP/Medicaid	$558.76
Rate for Payer: Multiplan Auto	$504.44
Rate for Payer: Multiplan Commercial	$504.44
Rate for Payer: Multiplan Workers Comp	$504.44
Rate for Payer: Parkland Medicaid	$558.76
Rate for Payer: Scott and White EPO/PPO	$388.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$558.76
Rate for Payer: Superior Health Plan EPO	$105.54

needle spectrum autopass

Facility

$776.06

Hospital Charge Code	8646515
Hospital Revenue Code	272
Rate for Payer: Cash Price	$527.72

NEEDLE, SPINAL YALE 18GA X 3 1/2' PINK -- DHF

Facility

$78.04

Hospital Charge Code	80328750
Hospital Revenue Code	272
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$56.19
Rate for Payer: Amerigroup CHIP/Medicaid	$7.02
Rate for Payer: BCBS of TX Blue Advantage	$23.41
Rate for Payer: BCBS of TX Blue Essentials	$28.09
Rate for Payer: BCBS of TX PPO	$31.22
Rate for Payer: Cash Price	$53.07
Rate for Payer: Cigna Medicaid	$56.19
Rate for Payer: Molina CHIP/Medicaid	$56.19
Rate for Payer: Multiplan Auto	$50.73
Rate for Payer: Multiplan Commercial	$50.73
Rate for Payer: Multiplan Workers Comp	$50.73
Rate for Payer: Parkland Medicaid	$56.19
Rate for Payer: Scott and White EPO/PPO	$39.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$56.19
Rate for Payer: Superior Health Plan EPO	$10.61

NEEDLE, SPINAL YALE 18GA X 3 1/2' PINK -- DHF

Facility

$78.04

Hospital Charge Code	80328750
Hospital Revenue Code	272
Rate for Payer: Cash Price	$53.07

Know your out-of-pocket cost for care.

All Charges