White Rock Medical Center

All Charges

Charge

Type

Setting

Price

trocar versaone optical

Facility

$92.03

Hospital Charge Code	8688549
Hospital Revenue Code	272
Min. Negotiated Rate	$8.28
Max. Negotiated Rate	$59.82
Rate for Payer: Aetna Commercial	$50.62
Rate for Payer: Amerigroup CHIP/Medicaid	$8.28
Rate for Payer: BCBS of TX Blue Advantage	$27.61
Rate for Payer: BCBS of TX Blue Essentials	$33.13
Rate for Payer: BCBS of TX PPO	$36.81
Rate for Payer: Cash Price	$80.99
Rate for Payer: Multiplan Auto	$59.82
Rate for Payer: Multiplan Commercial	$59.82
Rate for Payer: Multiplan Workers Comp	$59.82
Rate for Payer: Scott and White EPO/PPO	$46.02
Rate for Payer: Superior Health Plan EPO	$12.52

trocar versaone univ fixation cannula

Facility

$41.72

Hospital Charge Code	8688550
Hospital Revenue Code	272
Rate for Payer: Cash Price	$36.71

trocar versaone univ fixation cannula

Facility

$41.72

Hospital Charge Code	8688550
Hospital Revenue Code	272
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$27.12
Rate for Payer: Aetna Commercial	$22.95
Rate for Payer: Amerigroup CHIP/Medicaid	$3.75
Rate for Payer: BCBS of TX Blue Advantage	$12.52
Rate for Payer: BCBS of TX Blue Essentials	$15.02
Rate for Payer: BCBS of TX PPO	$16.69
Rate for Payer: Cash Price	$36.71
Rate for Payer: Multiplan Auto	$27.12
Rate for Payer: Multiplan Commercial	$27.12
Rate for Payer: Multiplan Workers Comp	$27.12
Rate for Payer: Scott and White EPO/PPO	$20.86
Rate for Payer: Superior Health Plan EPO	$5.67

Troponin-I

Facility

$442.00

Service Code	CPT 84484
Hospital Charge Code	1603208
Hospital Revenue Code	301
Rate for Payer: Cash Price	$388.96

Troponin-I

Facility

$442.00

Service Code	CPT 84484
Hospital Charge Code	1603208
Hospital Revenue Code	301
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$287.30
Rate for Payer: Aetna Commercial	$13.09
Rate for Payer: Aetna Medicare	$18.70
Rate for Payer: Amerigroup CHIP/Medicaid	$4.86
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12.47
Rate for Payer: Amerigroup Medicare	$12.47
Rate for Payer: BCBS of TX Blue Advantage	$20.58
Rate for Payer: BCBS of TX Blue Essentials	$24.69
Rate for Payer: BCBS of TX Medicare	$12.47
Rate for Payer: BCBS of TX PPO	$27.56
Rate for Payer: Cash Price	$388.96
Rate for Payer: Cash Price	$388.96
Rate for Payer: Cigna Medicaid	$12.47
Rate for Payer: Cigna Medicare	$12.47
Rate for Payer: Employer Direct Commercial	$12.47
Rate for Payer: Humana Medicare/TRICARE	$12.47
Rate for Payer: Molina CHIP/Medicaid	$12.47
Rate for Payer: Molina Dual Medicare/Medicaid	$12.47
Rate for Payer: Molina Medicare	$12.47
Rate for Payer: Multiplan Auto	$287.30
Rate for Payer: Multiplan Commercial	$287.30
Rate for Payer: Multiplan Workers Comp	$287.30
Rate for Payer: Parkland Medicaid	$12.47
Rate for Payer: Scott and White EPO/PPO	$15.59
Rate for Payer: Scott and White Medicare	$12.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.47
Rate for Payer: Superior Health Plan EPO	$12.47
Rate for Payer: Superior Health Plan Medicare	$12.47
Rate for Payer: Universal American Dual Medicare/Medicaid	$12.47
Rate for Payer: Universal American Medicare	$12.47
Rate for Payer: Wellcare Medicare	$12.47
Rate for Payer: Wellmed Medicare	$12.47

TRU CLEAR MINI DENSE TISSUE

Facility

$1,058.53

Hospital Charge Code	136710
Hospital Revenue Code	272
Min. Negotiated Rate	$95.27
Max. Negotiated Rate	$688.04
Rate for Payer: Aetna Commercial	$582.19
Rate for Payer: Amerigroup CHIP/Medicaid	$95.27
Rate for Payer: BCBS of TX Blue Advantage	$317.56
Rate for Payer: BCBS of TX Blue Essentials	$381.07
Rate for Payer: BCBS of TX PPO	$423.41
Rate for Payer: Cash Price	$931.51
Rate for Payer: Multiplan Auto	$688.04
Rate for Payer: Multiplan Commercial	$688.04
Rate for Payer: Multiplan Workers Comp	$688.04
Rate for Payer: Scott and White EPO/PPO	$529.26
Rate for Payer: Superior Health Plan EPO	$143.96

TRU CLEAR MINI DENSE TISSUE

Facility

$1,058.53

Hospital Charge Code	136710
Hospital Revenue Code	272
Rate for Payer: Cash Price	$931.51

Truclear mini shaver

Facility

$2,488.69

Hospital Charge Code	8602531
Hospital Revenue Code	272
Min. Negotiated Rate	$223.98
Max. Negotiated Rate	$1,617.65
Rate for Payer: Aetna Commercial	$1,368.78
Rate for Payer: Amerigroup CHIP/Medicaid	$223.98
Rate for Payer: BCBS of TX Blue Advantage	$746.61
Rate for Payer: BCBS of TX Blue Essentials	$895.93
Rate for Payer: BCBS of TX PPO	$995.48
Rate for Payer: Cash Price	$2,190.05
Rate for Payer: Multiplan Auto	$1,617.65
Rate for Payer: Multiplan Commercial	$1,617.65
Rate for Payer: Multiplan Workers Comp	$1,617.65
Rate for Payer: Scott and White EPO/PPO	$1,244.34
Rate for Payer: Superior Health Plan EPO	$338.46

Truclear mini shaver

Facility

$2,488.69

Hospital Charge Code	8602531
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,190.05

TRY ANES EPIDURAL -BBRAUN

Facility

$150.68

Hospital Charge Code	131551
Hospital Revenue Code	272
Rate for Payer: Cash Price	$132.60

TRY ANES EPIDURAL -BBRAUN

Facility

$150.68

Hospital Charge Code	131551
Hospital Revenue Code	272
Min. Negotiated Rate	$13.56
Max. Negotiated Rate	$97.94
Rate for Payer: Aetna Commercial	$82.87
Rate for Payer: Amerigroup CHIP/Medicaid	$13.56
Rate for Payer: BCBS of TX Blue Advantage	$45.20
Rate for Payer: BCBS of TX Blue Essentials	$54.24
Rate for Payer: BCBS of TX PPO	$60.27
Rate for Payer: Cash Price	$132.60
Rate for Payer: Multiplan Auto	$97.94
Rate for Payer: Multiplan Commercial	$97.94
Rate for Payer: Multiplan Workers Comp	$97.94
Rate for Payer: Scott and White EPO/PPO	$75.34
Rate for Payer: Superior Health Plan EPO	$20.49

TRY ANS EPIDRL -TELEFLEX

Facility

$171.29

Hospital Charge Code	80828700
Hospital Revenue Code	272
Min. Negotiated Rate	$15.42
Max. Negotiated Rate	$111.34
Rate for Payer: Aetna Commercial	$94.21
Rate for Payer: Amerigroup CHIP/Medicaid	$15.42
Rate for Payer: BCBS of TX Blue Advantage	$51.39
Rate for Payer: BCBS of TX Blue Essentials	$61.66
Rate for Payer: BCBS of TX PPO	$68.52
Rate for Payer: Cash Price	$150.74
Rate for Payer: Multiplan Auto	$111.34
Rate for Payer: Multiplan Commercial	$111.34
Rate for Payer: Multiplan Workers Comp	$111.34
Rate for Payer: Scott and White EPO/PPO	$85.64
Rate for Payer: Superior Health Plan EPO	$23.30

TRY ANS EPIDRL -TELEFLEX

Facility

$171.29

Hospital Charge Code	80828700
Hospital Revenue Code	272
Rate for Payer: Cash Price	$150.74

TRY ANS SPINAL -- DHF

Facility

$109.10

Hospital Charge Code	80829153
Hospital Revenue Code	272
Rate for Payer: Cash Price	$96.01

TRY ANS SPINAL -- DHF

Facility

$109.10

Hospital Charge Code	80829153
Hospital Revenue Code	272
Min. Negotiated Rate	$9.82
Max. Negotiated Rate	$70.92
Rate for Payer: Aetna Commercial	$60.00
Rate for Payer: Amerigroup CHIP/Medicaid	$9.82
Rate for Payer: BCBS of TX Blue Advantage	$32.73
Rate for Payer: BCBS of TX Blue Essentials	$39.28
Rate for Payer: BCBS of TX PPO	$43.64
Rate for Payer: Cash Price	$96.01
Rate for Payer: Multiplan Auto	$70.92
Rate for Payer: Multiplan Commercial	$70.92
Rate for Payer: Multiplan Workers Comp	$70.92
Rate for Payer: Scott and White EPO/PPO	$54.55
Rate for Payer: Superior Health Plan EPO	$14.84

TRY ARTRL LIN -- DHF

Facility

$789.03

Hospital Charge Code	80829757
Hospital Revenue Code	272
Rate for Payer: Cash Price	$694.35

TRY ARTRL LIN -- DHF

Facility

$789.03

Hospital Charge Code	80829757
Hospital Revenue Code	272
Min. Negotiated Rate	$71.01
Max. Negotiated Rate	$512.87
Rate for Payer: Aetna Commercial	$433.97
Rate for Payer: Amerigroup CHIP/Medicaid	$71.01
Rate for Payer: BCBS of TX Blue Advantage	$236.71
Rate for Payer: BCBS of TX Blue Essentials	$284.05
Rate for Payer: BCBS of TX PPO	$315.61
Rate for Payer: Cash Price	$694.35
Rate for Payer: Multiplan Auto	$512.87
Rate for Payer: Multiplan Commercial	$512.87
Rate for Payer: Multiplan Workers Comp	$512.87
Rate for Payer: Scott and White EPO/PPO	$394.52
Rate for Payer: Superior Health Plan EPO	$107.31

TRY BN MARROW -- DHF

Facility

$137.10

Hospital Charge Code	80830052
Hospital Revenue Code	272
Rate for Payer: Cash Price	$120.65

TRY BN MARROW -- DHF

Facility

$137.10

Hospital Charge Code	80830052
Hospital Revenue Code	272
Min. Negotiated Rate	$12.34
Max. Negotiated Rate	$89.12
Rate for Payer: Aetna Commercial	$75.40
Rate for Payer: Amerigroup CHIP/Medicaid	$12.34
Rate for Payer: BCBS of TX Blue Advantage	$41.13
Rate for Payer: BCBS of TX Blue Essentials	$49.36
Rate for Payer: BCBS of TX PPO	$54.84
Rate for Payer: Cash Price	$120.65
Rate for Payer: Multiplan Auto	$89.12
Rate for Payer: Multiplan Commercial	$89.12
Rate for Payer: Multiplan Workers Comp	$89.12
Rate for Payer: Scott and White EPO/PPO	$68.55
Rate for Payer: Superior Health Plan EPO	$18.65

TRY BX BASIC -- DHF

Facility

$123.54

Hospital Charge Code	80830409
Hospital Revenue Code	272
Min. Negotiated Rate	$11.12
Max. Negotiated Rate	$80.30
Rate for Payer: Aetna Commercial	$67.95
Rate for Payer: Amerigroup CHIP/Medicaid	$11.12
Rate for Payer: BCBS of TX Blue Advantage	$37.06
Rate for Payer: BCBS of TX Blue Essentials	$44.47
Rate for Payer: BCBS of TX PPO	$49.42
Rate for Payer: Cash Price	$108.72
Rate for Payer: Multiplan Auto	$80.30
Rate for Payer: Multiplan Commercial	$80.30
Rate for Payer: Multiplan Workers Comp	$80.30
Rate for Payer: Scott and White EPO/PPO	$61.77
Rate for Payer: Superior Health Plan EPO	$16.80

TRY BX BASIC -- DHF

Facility

$123.54

Hospital Charge Code	80830409
Hospital Revenue Code	272
Rate for Payer: Cash Price	$108.72

TRY CATH PICC DL MAXBAR -- DHF

Facility

$977.91

Service Code	HCPCS C1751
Hospital Charge Code	80570278
Hospital Revenue Code	278
Min. Negotiated Rate	$88.01
Max. Negotiated Rate	$488.96
Rate for Payer: Aetna Commercial	$293.37
Rate for Payer: Amerigroup CHIP/Medicaid	$88.01
Rate for Payer: BCBS of TX Blue Advantage	$293.37
Rate for Payer: BCBS of TX Blue Essentials	$352.05
Rate for Payer: BCBS of TX PPO	$391.16
Rate for Payer: Cash Price	$860.56
Rate for Payer: Multiplan Auto	$488.96
Rate for Payer: Multiplan Commercial	$488.96
Rate for Payer: Multiplan Workers Comp	$488.96
Rate for Payer: Scott and White EPO/PPO	$488.96
Rate for Payer: Superior Health Plan EPO	$133.00

TRY CATH PICC DL MAXBAR -- DHF

Facility

$977.91

Service Code	HCPCS C1751
Hospital Charge Code	80570278
Hospital Revenue Code	278
Min. Negotiated Rate	$244.48
Max. Negotiated Rate	$488.96
Rate for Payer: Aetna Commercial	$293.37
Rate for Payer: Cash Price	$860.56
Rate for Payer: Cigna Commercial	$244.48
Rate for Payer: Multiplan Auto	$488.96
Rate for Payer: Multiplan Commercial	$488.96
Rate for Payer: Multiplan Workers Comp	$488.96
Rate for Payer: Scott and White EPO/PPO	$488.96

TRY CATH ST -- DHF

Facility

$254.05

Hospital Charge Code	80831753
Hospital Revenue Code	272
Rate for Payer: Cash Price	$223.56

TRY CATH ST -- DHF

Facility

$254.05

Hospital Charge Code	80831753
Hospital Revenue Code	272
Min. Negotiated Rate	$22.86
Max. Negotiated Rate	$165.13
Rate for Payer: Aetna Commercial	$139.73
Rate for Payer: Amerigroup CHIP/Medicaid	$22.86
Rate for Payer: BCBS of TX Blue Advantage	$76.22
Rate for Payer: BCBS of TX Blue Essentials	$91.46
Rate for Payer: BCBS of TX PPO	$101.62
Rate for Payer: Cash Price	$223.56
Rate for Payer: Multiplan Auto	$165.13
Rate for Payer: Multiplan Commercial	$165.13
Rate for Payer: Multiplan Workers Comp	$165.13
Rate for Payer: Scott and White EPO/PPO	$127.02
Rate for Payer: Superior Health Plan EPO	$34.55

Know your out-of-pocket cost for care.

All Charges