White Rock Medical Center

All Charges

Charge

Type

Setting

Price

NEEDLE, SUTURE PASSER EXPRESSEW III -- DHF

Facility

$1,139.54

Hospital Charge Code	81754590
Hospital Revenue Code	272
Min. Negotiated Rate	$102.56
Max. Negotiated Rate	$820.47
Rate for Payer: Amerigroup CHIP/Medicaid	$102.56
Rate for Payer: BCBS of TX Blue Advantage	$341.86
Rate for Payer: BCBS of TX Blue Essentials	$410.23
Rate for Payer: BCBS of TX PPO	$455.82
Rate for Payer: Cash Price	$774.89
Rate for Payer: Cigna Medicaid	$820.47
Rate for Payer: Molina CHIP/Medicaid	$820.47
Rate for Payer: Multiplan Auto	$740.70
Rate for Payer: Multiplan Commercial	$740.70
Rate for Payer: Multiplan Workers Comp	$740.70
Rate for Payer: Parkland Medicaid	$820.47
Rate for Payer: Scott and White EPO/PPO	$569.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$820.47
Rate for Payer: Superior Health Plan EPO	$154.98

NEEDLE, SUTURE PASSER EXPRESSEW III -- DHF

Facility

$1,139.54

Hospital Charge Code	81754590
Hospital Revenue Code	272
Rate for Payer: Cash Price	$774.89

NEEDLE, TROCAR 1/2 CIRCLE CUT #5 DISP -- DHF

Facility

$29.68

Hospital Charge Code	80328347
Hospital Revenue Code	272
Rate for Payer: Cash Price	$20.18

NEEDLE, TROCAR 1/2 CIRCLE CUT #5 DISP -- DHF

Facility

$29.68

Hospital Charge Code	80328347
Hospital Revenue Code	272
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$21.37
Rate for Payer: Amerigroup CHIP/Medicaid	$2.67
Rate for Payer: BCBS of TX Blue Advantage	$8.90
Rate for Payer: BCBS of TX Blue Essentials	$10.68
Rate for Payer: BCBS of TX PPO	$11.87
Rate for Payer: Cash Price	$20.18
Rate for Payer: Cigna Medicaid	$21.37
Rate for Payer: Molina CHIP/Medicaid	$21.37
Rate for Payer: Multiplan Auto	$19.29
Rate for Payer: Multiplan Commercial	$19.29
Rate for Payer: Multiplan Workers Comp	$19.29
Rate for Payer: Parkland Medicaid	$21.37
Rate for Payer: Scott and White EPO/PPO	$14.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$21.37
Rate for Payer: Superior Health Plan EPO	$4.04

NEEDLE, VENTRICULAR HEPARIN FLUSHING 18G X 1 7/8'L

Facility

$90.80

Hospital Charge Code	992727
Hospital Revenue Code	272
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$65.38
Rate for Payer: Amerigroup CHIP/Medicaid	$8.17
Rate for Payer: BCBS of TX Blue Advantage	$27.24
Rate for Payer: BCBS of TX Blue Essentials	$32.69
Rate for Payer: BCBS of TX PPO	$36.32
Rate for Payer: Cash Price	$61.74
Rate for Payer: Cigna Medicaid	$65.38
Rate for Payer: Molina CHIP/Medicaid	$65.38
Rate for Payer: Multiplan Auto	$59.02
Rate for Payer: Multiplan Commercial	$59.02
Rate for Payer: Multiplan Workers Comp	$59.02
Rate for Payer: Parkland Medicaid	$65.38
Rate for Payer: Scott and White EPO/PPO	$45.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$65.38
Rate for Payer: Superior Health Plan EPO	$12.35

NEEDLE, VENTRICULAR HEPARIN FLUSHING 18G X 1 7/8'L

Facility

$90.80

Hospital Charge Code	992727
Hospital Revenue Code	272
Rate for Payer: Cash Price	$61.74

Neg Press Wound Tx Dme <=50 Sq cm

Facility

$794.80

Service Code	HCPCS 97605
Hospital Charge Code	7150618
Hospital Revenue Code	361
Rate for Payer: Cash Price	$540.46

Neg Press Wound Tx Dme <=50 Sq cm

Facility

$794.80

Service Code	HCPCS 97605
Hospital Charge Code	7150618
Hospital Revenue Code	361
Min. Negotiated Rate	$29.71
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$71.53
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$201.55
Rate for Payer: Amerigroup Medicare	$201.55
Rate for Payer: BCBS of TX Blue Advantage	$238.44
Rate for Payer: BCBS of TX Blue Essentials	$286.13
Rate for Payer: BCBS of TX Medicare	$201.55
Rate for Payer: BCBS of TX PPO	$317.92
Rate for Payer: Cash Price	$540.46
Rate for Payer: Cash Price	$540.46
Rate for Payer: Cash Price	$540.46
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$572.26
Rate for Payer: Cigna Medicare	$201.55
Rate for Payer: Employer Direct Commercial	$201.55
Rate for Payer: Humana Medicare/TRICARE	$201.55
Rate for Payer: Molina CHIP/Medicaid	$572.26
Rate for Payer: Molina Dual Medicare/Medicaid	$201.55
Rate for Payer: Molina Medicare	$201.55
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$572.26
Rate for Payer: Scott and White EPO/PPO	$29.71
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$572.26
Rate for Payer: Superior Health Plan EPO	$201.55
Rate for Payer: Superior Health Plan Medicare	$201.55
Rate for Payer: Universal American Dual Medicare/Medicaid	$201.55
Rate for Payer: Universal American Medicare	$201.55
Rate for Payer: Wellcare Medicare	$201.55
Rate for Payer: Wellmed Medicare	$201.55

Neg Press Wound Tx Nondme <=50 Sq cm

Facility

$688.00

Service Code	HCPCS 97607
Hospital Charge Code	7150921
Hospital Revenue Code	361
Min. Negotiated Rate	$25.71
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$61.92
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$408.37
Rate for Payer: Amerigroup Medicare	$408.37
Rate for Payer: BCBS of TX Blue Advantage	$206.40
Rate for Payer: BCBS of TX Blue Essentials	$247.68
Rate for Payer: BCBS of TX Medicare	$408.37
Rate for Payer: BCBS of TX PPO	$275.20
Rate for Payer: Cash Price	$467.84
Rate for Payer: Cash Price	$467.84
Rate for Payer: Cash Price	$467.84
Rate for Payer: Cigna Commercial	$863.21
Rate for Payer: Cigna Medicaid	$495.36
Rate for Payer: Cigna Medicare	$408.37
Rate for Payer: Employer Direct Commercial	$408.37
Rate for Payer: Humana Medicare/TRICARE	$408.37
Rate for Payer: Molina CHIP/Medicaid	$495.36
Rate for Payer: Molina Dual Medicare/Medicaid	$408.37
Rate for Payer: Molina Medicare	$408.37
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$495.36
Rate for Payer: Scott and White EPO/PPO	$25.71
Rate for Payer: Scott and White Medicare	$408.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$495.36
Rate for Payer: Superior Health Plan EPO	$408.37
Rate for Payer: Superior Health Plan Medicare	$408.37
Rate for Payer: Universal American Dual Medicare/Medicaid	$408.37
Rate for Payer: Universal American Medicare	$408.37
Rate for Payer: Wellcare Medicare	$408.37
Rate for Payer: Wellmed Medicare	$408.37

Neg Press Wound Tx Nondme <=50 Sq cm

Facility

$688.00

Service Code	HCPCS 97607
Hospital Charge Code	7150921
Hospital Revenue Code	361
Rate for Payer: Cash Price	$467.84

Neisseria gonorrhoeae Culture

Facility

$229.00

Service Code	HCPCS 87081
Hospital Charge Code	4107160
Hospital Revenue Code	306
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$164.88
Rate for Payer: Amerigroup CHIP/Medicaid	$2.59
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6.63
Rate for Payer: Amerigroup Medicare	$6.63
Rate for Payer: BCBS of TX Blue Advantage	$68.70
Rate for Payer: BCBS of TX Blue Essentials	$82.44
Rate for Payer: BCBS of TX Medicare	$6.63
Rate for Payer: BCBS of TX PPO	$91.60
Rate for Payer: Cash Price	$155.72
Rate for Payer: Cash Price	$155.72
Rate for Payer: Cigna Medicaid	$164.88
Rate for Payer: Cigna Medicare	$6.63
Rate for Payer: Employer Direct Commercial	$6.63
Rate for Payer: Humana Medicare/TRICARE	$6.63
Rate for Payer: Molina CHIP/Medicaid	$164.88
Rate for Payer: Molina Dual Medicare/Medicaid	$6.63
Rate for Payer: Molina Medicare	$6.63
Rate for Payer: Multiplan Auto	$148.85
Rate for Payer: Multiplan Commercial	$148.85
Rate for Payer: Multiplan Workers Comp	$148.85
Rate for Payer: Parkland Medicaid	$164.88
Rate for Payer: Scott and White EPO/PPO	$8.29
Rate for Payer: Scott and White Medicare	$6.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$164.88
Rate for Payer: Superior Health Plan EPO	$6.63
Rate for Payer: Superior Health Plan Medicare	$6.63
Rate for Payer: Universal American Dual Medicare/Medicaid	$6.63
Rate for Payer: Universal American Medicare	$6.63
Rate for Payer: Wellcare Medicare	$6.63
Rate for Payer: Wellmed Medicare	$6.63

Neisseria gonorrhoeae Culture

Facility

$229.00

Service Code	HCPCS 87081
Hospital Charge Code	4107160
Hospital Revenue Code	306
Rate for Payer: Cash Price	$155.72

neomycin-polymyxin B sulfate 40 mg-200,000 units/mL irrigation Soln 20 mL

Facility

$291.00

Service Code	HCPCS J3490
Hospital Charge Code	77723036
Hospital Revenue Code	250
Rate for Payer: Cash Price	$197.88

neomycin-polymyxin B sulfate 40 mg-200,000 units/mL irrigation Soln 20 mL

Facility

$291.00

Service Code	HCPCS J3490
Hospital Charge Code	77723036
Hospital Revenue Code	250
Min. Negotiated Rate	$26.19
Max. Negotiated Rate	$209.52
Rate for Payer: Amerigroup CHIP/Medicaid	$26.19
Rate for Payer: BCBS of TX Blue Advantage	$87.30
Rate for Payer: BCBS of TX Blue Essentials	$104.76
Rate for Payer: BCBS of TX PPO	$116.40
Rate for Payer: Cash Price	$197.88
Rate for Payer: Cigna Medicaid	$209.52
Rate for Payer: Molina CHIP/Medicaid	$209.52
Rate for Payer: Multiplan Auto	$189.15
Rate for Payer: Multiplan Commercial	$189.15
Rate for Payer: Multiplan Workers Comp	$189.15
Rate for Payer: Parkland Medicaid	$209.52
Rate for Payer: Scott and White EPO/PPO	$145.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$209.52
Rate for Payer: Superior Health Plan EPO	$39.58

NEONATAL AFTERCARE

Facility

$3,667.79

Service Code	APR-DRG 8631
Min. Negotiated Rate	$3,458.12
Max. Negotiated Rate	$3,667.79
Rate for Payer: Amerigroup CHIP/Medicaid	$3,458.12
Rate for Payer: Cigna Medicaid	$3,458.12
Rate for Payer: Molina CHIP/Medicaid	$3,458.12
Rate for Payer: Parkland Medicaid	$3,458.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,667.79

NEONATAL AFTERCARE

Facility

$64,210.02

Service Code	APR-DRG 8634
Min. Negotiated Rate	$60,539.45
Max. Negotiated Rate	$64,210.02
Rate for Payer: Amerigroup CHIP/Medicaid	$60,539.45
Rate for Payer: Cigna Medicaid	$60,539.45
Rate for Payer: Molina CHIP/Medicaid	$60,539.45
Rate for Payer: Parkland Medicaid	$60,539.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$64,210.02

NEONATAL AFTERCARE

Facility

$9,763.16

Service Code	APR-DRG 8632
Min. Negotiated Rate	$9,205.05
Max. Negotiated Rate	$9,763.16
Rate for Payer: Amerigroup CHIP/Medicaid	$9,205.05
Rate for Payer: Cigna Medicaid	$9,205.05
Rate for Payer: Molina CHIP/Medicaid	$9,205.05
Rate for Payer: Parkland Medicaid	$9,205.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,763.16

NEONATAL AFTERCARE

Facility

$14,895.95

Service Code	APR-DRG 8633
Min. Negotiated Rate	$14,044.42
Max. Negotiated Rate	$14,895.95
Rate for Payer: Amerigroup CHIP/Medicaid	$14,044.42
Rate for Payer: Cigna Medicaid	$14,044.42
Rate for Payer: Molina CHIP/Medicaid	$14,044.42
Rate for Payer: Parkland Medicaid	$14,044.42
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14,895.95

Neonatal Bilirubin Profile

Facility

$54.72

Service Code	HCPCS 88720
Hospital Charge Code	993994
Hospital Revenue Code	300
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$39.40
Rate for Payer: Amerigroup CHIP/Medicaid	$1.96
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.02
Rate for Payer: Amerigroup Medicare	$5.02
Rate for Payer: BCBS of TX Blue Advantage	$16.42
Rate for Payer: BCBS of TX Blue Essentials	$19.70
Rate for Payer: BCBS of TX Medicare	$5.02
Rate for Payer: BCBS of TX PPO	$21.89
Rate for Payer: Cash Price	$37.21
Rate for Payer: Cash Price	$37.21
Rate for Payer: Cigna Medicaid	$39.40
Rate for Payer: Cigna Medicare	$5.02
Rate for Payer: Employer Direct Commercial	$5.02
Rate for Payer: Humana Medicare/TRICARE	$5.02
Rate for Payer: Molina CHIP/Medicaid	$39.40
Rate for Payer: Molina Dual Medicare/Medicaid	$5.02
Rate for Payer: Molina Medicare	$5.02
Rate for Payer: Multiplan Auto	$35.57
Rate for Payer: Multiplan Commercial	$35.57
Rate for Payer: Multiplan Workers Comp	$35.57
Rate for Payer: Parkland Medicaid	$39.40
Rate for Payer: Scott and White EPO/PPO	$6.28
Rate for Payer: Scott and White Medicare	$5.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$39.40
Rate for Payer: Superior Health Plan EPO	$5.02
Rate for Payer: Superior Health Plan Medicare	$5.02
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.02
Rate for Payer: Universal American Medicare	$5.02
Rate for Payer: Wellcare Medicare	$5.02
Rate for Payer: Wellmed Medicare	$5.02

Neonatal Bilirubin Profile

Facility

$54.72

Service Code	HCPCS 88720
Hospital Charge Code	993994
Hospital Revenue Code	300
Rate for Payer: Cash Price	$37.21

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$24,085.78

Service Code	APR-DRG 6032
Min. Negotiated Rate	$22,708.92
Max. Negotiated Rate	$24,085.78
Rate for Payer: Amerigroup CHIP/Medicaid	$22,708.92
Rate for Payer: Cigna Medicaid	$22,708.92
Rate for Payer: Molina CHIP/Medicaid	$22,708.92
Rate for Payer: Parkland Medicaid	$22,708.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$24,085.78

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$12,695.43

Service Code	APR-DRG 6031
Min. Negotiated Rate	$11,969.69
Max. Negotiated Rate	$12,695.43
Rate for Payer: Amerigroup CHIP/Medicaid	$11,969.69
Rate for Payer: Cigna Medicaid	$11,969.69
Rate for Payer: Molina CHIP/Medicaid	$11,969.69
Rate for Payer: Parkland Medicaid	$11,969.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,695.43

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$78,848.34

Service Code	APR-DRG 6034
Min. Negotiated Rate	$74,340.98
Max. Negotiated Rate	$78,848.34
Rate for Payer: Amerigroup CHIP/Medicaid	$74,340.98
Rate for Payer: Cigna Medicaid	$74,340.98
Rate for Payer: Molina CHIP/Medicaid	$74,340.98
Rate for Payer: Parkland Medicaid	$74,340.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$78,848.34

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$30,069.13

Service Code	APR-DRG 6033
Min. Negotiated Rate	$28,350.23
Max. Negotiated Rate	$30,069.13
Rate for Payer: Amerigroup CHIP/Medicaid	$28,350.23
Rate for Payer: Cigna Medicaid	$28,350.23
Rate for Payer: Molina CHIP/Medicaid	$28,350.23
Rate for Payer: Parkland Medicaid	$28,350.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$30,069.13

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY

Facility

$45,323.03

Service Code	APR-DRG 6023
Min. Negotiated Rate	$42,732.14
Max. Negotiated Rate	$45,323.03
Rate for Payer: Amerigroup CHIP/Medicaid	$42,732.14
Rate for Payer: Cigna Medicaid	$42,732.14
Rate for Payer: Molina CHIP/Medicaid	$42,732.14
Rate for Payer: Parkland Medicaid	$42,732.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$45,323.03

Know your out-of-pocket cost for care.

All Charges