White Rock Medical Center

All Charges

Charge

Type

Setting

Price

PAPER, ECG, MORTARA EL250

Facility

$64.10

Hospital Charge Code	992978
Hospital Revenue Code	270
Rate for Payer: Cash Price	$43.59

PAPER, ECG, MORTARA EL250

Facility

$64.10

Hospital Charge Code	992978
Hospital Revenue Code	270
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$46.15
Rate for Payer: Amerigroup CHIP/Medicaid	$5.77
Rate for Payer: BCBS of TX Blue Advantage	$19.23
Rate for Payer: BCBS of TX Blue Essentials	$23.08
Rate for Payer: BCBS of TX PPO	$25.64
Rate for Payer: Cash Price	$43.59
Rate for Payer: Cigna Medicaid	$46.15
Rate for Payer: Molina CHIP/Medicaid	$46.15
Rate for Payer: Multiplan Auto	$41.66
Rate for Payer: Multiplan Commercial	$41.66
Rate for Payer: Multiplan Workers Comp	$41.66
Rate for Payer: Parkland Medicaid	$46.15
Rate for Payer: Scott and White EPO/PPO	$32.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$46.15
Rate for Payer: Superior Health Plan EPO	$8.72

PAPER, LINER, TRAP, 20' X 25

Facility

$1.04

Hospital Charge Code	992946
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.71

PAPER, LINER, TRAP, 20' X 25

Facility

$1.04

Hospital Charge Code	992946
Hospital Revenue Code	270
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.75
Rate for Payer: Amerigroup CHIP/Medicaid	$0.09
Rate for Payer: BCBS of TX Blue Advantage	$0.31
Rate for Payer: BCBS of TX Blue Essentials	$0.37
Rate for Payer: BCBS of TX PPO	$0.42
Rate for Payer: Cash Price	$0.71
Rate for Payer: Cigna Medicaid	$0.75
Rate for Payer: Molina CHIP/Medicaid	$0.75
Rate for Payer: Multiplan Auto	$0.68
Rate for Payer: Multiplan Commercial	$0.68
Rate for Payer: Multiplan Workers Comp	$0.68
Rate for Payer: Parkland Medicaid	$0.75
Rate for Payer: Scott and White EPO/PPO	$0.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.75
Rate for Payer: Superior Health Plan EPO	$0.14

PAPER PRINTER FOR GEM PREMIER

Facility

$9.48

Hospital Charge Code	993534
Hospital Revenue Code	270
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$6.83
Rate for Payer: Amerigroup CHIP/Medicaid	$0.85
Rate for Payer: BCBS of TX Blue Advantage	$2.84
Rate for Payer: BCBS of TX Blue Essentials	$3.41
Rate for Payer: BCBS of TX PPO	$3.79
Rate for Payer: Cash Price	$6.45
Rate for Payer: Cigna Medicaid	$6.83
Rate for Payer: Molina CHIP/Medicaid	$6.83
Rate for Payer: Multiplan Auto	$6.16
Rate for Payer: Multiplan Commercial	$6.16
Rate for Payer: Multiplan Workers Comp	$6.16
Rate for Payer: Parkland Medicaid	$6.83
Rate for Payer: Scott and White EPO/PPO	$4.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.83
Rate for Payer: Superior Health Plan EPO	$1.29

PAPER PRINTER FOR GEM PREMIER

Facility

$9.48

Hospital Charge Code	993534
Hospital Revenue Code	270
Rate for Payer: Cash Price	$6.45

PAPER, TOILET ST CVR, 1/2FO, REFILL, 5000CS

Facility

$0.04

Hospital Charge Code	993970
Hospital Revenue Code	270
Max. Negotiated Rate	$0.03
Rate for Payer: Amerigroup CHIP/Medicaid	$0.00
Rate for Payer: BCBS of TX Blue Advantage	$0.01
Rate for Payer: BCBS of TX Blue Essentials	$0.01
Rate for Payer: BCBS of TX PPO	$0.02
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna Medicaid	$0.03
Rate for Payer: Molina CHIP/Medicaid	$0.03
Rate for Payer: Multiplan Auto	$0.03
Rate for Payer: Multiplan Commercial	$0.03
Rate for Payer: Multiplan Workers Comp	$0.03
Rate for Payer: Parkland Medicaid	$0.03
Rate for Payer: Scott and White EPO/PPO	$0.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.03
Rate for Payer: Superior Health Plan EPO	$0.01

PAPER, TOILET ST CVR, 1/2FO, REFILL, 5000CS

Facility

$0.04

Hospital Charge Code	993970
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.03

paper towels

Facility

$27.33

Hospital Charge Code	993344
Hospital Revenue Code	270
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$19.68
Rate for Payer: Amerigroup CHIP/Medicaid	$2.46
Rate for Payer: BCBS of TX Blue Advantage	$8.20
Rate for Payer: BCBS of TX Blue Essentials	$9.84
Rate for Payer: BCBS of TX PPO	$10.93
Rate for Payer: Cash Price	$18.58
Rate for Payer: Cigna Medicaid	$19.68
Rate for Payer: Molina CHIP/Medicaid	$19.68
Rate for Payer: Multiplan Auto	$17.76
Rate for Payer: Multiplan Commercial	$17.76
Rate for Payer: Multiplan Workers Comp	$17.76
Rate for Payer: Parkland Medicaid	$19.68
Rate for Payer: Scott and White EPO/PPO	$13.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$19.68
Rate for Payer: Superior Health Plan EPO	$3.72

paper towels

Facility

$27.33

Hospital Charge Code	993344
Hospital Revenue Code	270
Rate for Payer: Cash Price	$18.58

Pap IG (Image Guided) SO

Facility

$169.00

Service Code	HCPCS 88175
Hospital Charge Code	8662511
Hospital Revenue Code	311
Rate for Payer: Cash Price	$114.92

Pap IG (Image Guided) SO

Facility

$169.00

Service Code	HCPCS 88175
Hospital Charge Code	8662511
Hospital Revenue Code	311
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$121.68
Rate for Payer: Amerigroup CHIP/Medicaid	$10.38
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$26.61
Rate for Payer: Amerigroup Medicare	$26.61
Rate for Payer: BCBS of TX Blue Advantage	$50.70
Rate for Payer: BCBS of TX Blue Essentials	$60.84
Rate for Payer: BCBS of TX Medicare	$26.61
Rate for Payer: BCBS of TX PPO	$67.60
Rate for Payer: Cash Price	$114.92
Rate for Payer: Cash Price	$114.92
Rate for Payer: Cigna Medicaid	$121.68
Rate for Payer: Cigna Medicare	$26.61
Rate for Payer: Employer Direct Commercial	$26.61
Rate for Payer: Humana Medicare/TRICARE	$26.61
Rate for Payer: Molina CHIP/Medicaid	$121.68
Rate for Payer: Molina Dual Medicare/Medicaid	$26.61
Rate for Payer: Molina Medicare	$26.61
Rate for Payer: Multiplan Auto	$109.85
Rate for Payer: Multiplan Commercial	$109.85
Rate for Payer: Multiplan Workers Comp	$109.85
Rate for Payer: Parkland Medicaid	$121.68
Rate for Payer: Scott and White EPO/PPO	$33.26
Rate for Payer: Scott and White Medicare	$26.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$121.68
Rate for Payer: Superior Health Plan EPO	$26.61
Rate for Payer: Superior Health Plan Medicare	$26.61
Rate for Payer: Universal American Dual Medicare/Medicaid	$26.61
Rate for Payer: Universal American Medicare	$26.61
Rate for Payer: Wellcare Medicare	$26.61
Rate for Payer: Wellmed Medicare	$26.61

Parathyroid Hormone Intact Intraoperative/Post Operative

Facility

$302.00

Service Code	HCPCS 83970
Hospital Charge Code	1707926
Hospital Revenue Code	301
Rate for Payer: Cash Price	$205.36

Parathyroid Hormone Intact Intraoperative/Post Operative

Facility

$302.00

Service Code	HCPCS 83970
Hospital Charge Code	1707926
Hospital Revenue Code	301
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$217.44
Rate for Payer: Amerigroup CHIP/Medicaid	$16.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$41.28
Rate for Payer: Amerigroup Medicare	$41.28
Rate for Payer: BCBS of TX Blue Advantage	$90.60
Rate for Payer: BCBS of TX Blue Essentials	$108.72
Rate for Payer: BCBS of TX Medicare	$41.28
Rate for Payer: BCBS of TX PPO	$120.80
Rate for Payer: Cash Price	$205.36
Rate for Payer: Cash Price	$205.36
Rate for Payer: Cigna Medicaid	$217.44
Rate for Payer: Cigna Medicare	$41.28
Rate for Payer: Employer Direct Commercial	$41.28
Rate for Payer: Humana Medicare/TRICARE	$41.28
Rate for Payer: Molina CHIP/Medicaid	$217.44
Rate for Payer: Molina Dual Medicare/Medicaid	$41.28
Rate for Payer: Molina Medicare	$41.28
Rate for Payer: Multiplan Auto	$196.30
Rate for Payer: Multiplan Commercial	$196.30
Rate for Payer: Multiplan Workers Comp	$196.30
Rate for Payer: Parkland Medicaid	$217.44
Rate for Payer: Scott and White EPO/PPO	$51.60
Rate for Payer: Scott and White Medicare	$41.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$217.44
Rate for Payer: Superior Health Plan EPO	$41.28
Rate for Payer: Superior Health Plan Medicare	$41.28
Rate for Payer: Universal American Dual Medicare/Medicaid	$41.28
Rate for Payer: Universal American Medicare	$41.28
Rate for Payer: Wellcare Medicare	$41.28
Rate for Payer: Wellmed Medicare	$41.28

Paravertebral block (PVB) (paraspinous block), thoracic; second and any additional injection site(s)

Facility

$1,297.04

Service Code	HCPCS 64462
Hospital Charge Code	9900793
Hospital Revenue Code	360
Rate for Payer: Cash Price	$881.99

Paravertebral block (PVB) (paraspinous block), thoracic; second and any additional injection site(s)

Facility

$1,297.04

Service Code	HCPCS 64462
Hospital Charge Code	9900793
Hospital Revenue Code	360
Min. Negotiated Rate	$116.73
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$116.73
Rate for Payer: BCBS of TX Blue Advantage	$389.11
Rate for Payer: BCBS of TX Blue Essentials	$466.93
Rate for Payer: BCBS of TX PPO	$518.82
Rate for Payer: Cash Price	$881.99
Rate for Payer: Cash Price	$881.99
Rate for Payer: Cigna Medicaid	$933.87
Rate for Payer: Molina CHIP/Medicaid	$933.87
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	$933.87
Rate for Payer: Scott and White EPO/PPO	$648.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$933.87
Rate for Payer: Superior Health Plan EPO	$176.40

Paravertebral block (PVB) (paraspinous block), thoracic; second and any additional injection site(s)

Facility

$10,000.00

Service Code	CPT 64462
Hospital Charge Code	36064462
Hospital Revenue Code	360
Min. Negotiated Rate	$58.64
Max. Negotiated Rate	$10,000.00
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: Scott and White EPO/PPO	$58.64

Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging gui

Facility

$1,297.04

Service Code	HCPCS 64461
Hospital Charge Code	9900792
Hospital Revenue Code	360
Min. Negotiated Rate	$262.86
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$262.86
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$709.10
Rate for Payer: Amerigroup Medicare	$709.10
Rate for Payer: BCBS of TX Blue Advantage	$1,043.83
Rate for Payer: BCBS of TX Blue Essentials	$1,250.10
Rate for Payer: BCBS of TX Medicare	$709.10
Rate for Payer: BCBS of TX PPO	$1,575.13
Rate for Payer: Cash Price	$881.99
Rate for Payer: Cash Price	$881.99
Rate for Payer: Cash Price	$881.99
Rate for Payer: Cigna Commercial	$1,498.91
Rate for Payer: Cigna Medicaid	$933.87
Rate for Payer: Cigna Medicare	$709.10
Rate for Payer: Employer Direct Commercial	$709.10
Rate for Payer: Humana Medicare/TRICARE	$709.10
Rate for Payer: Molina CHIP/Medicaid	$933.87
Rate for Payer: Molina Dual Medicare/Medicaid	$709.10
Rate for Payer: Molina Medicare	$709.10
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	$933.87
Rate for Payer: Scott and White EPO/PPO	$1,170.03
Rate for Payer: Scott and White Medicare	$709.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$933.87
Rate for Payer: Superior Health Plan EPO	$709.10
Rate for Payer: Superior Health Plan Medicare	$709.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$709.10
Rate for Payer: Universal American Medicare	$709.10
Rate for Payer: Wellcare Medicare	$709.10
Rate for Payer: Wellmed Medicare	$709.10

Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging gui

Facility

$10,000.00

Service Code	CPT 64461
Hospital Charge Code	36064461
Hospital Revenue Code	360
Min. Negotiated Rate	$262.86
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$262.86
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$709.10
Rate for Payer: Amerigroup Medicare	$709.10
Rate for Payer: BCBS of TX Blue Advantage	$1,043.83
Rate for Payer: BCBS of TX Blue Essentials	$1,250.10
Rate for Payer: BCBS of TX Medicare	$709.10
Rate for Payer: BCBS of TX PPO	$1,575.13
Rate for Payer: Cigna Commercial	$1,498.91
Rate for Payer: Cigna Medicare	$709.10
Rate for Payer: Employer Direct Commercial	$709.10
Rate for Payer: Humana Medicare/TRICARE	$709.10
Rate for Payer: Molina Dual Medicare/Medicaid	$709.10
Rate for Payer: Molina Medicare	$709.10
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: Scott and White EPO/PPO	$1,170.03
Rate for Payer: Scott and White Medicare	$709.10
Rate for Payer: Superior Health Plan EPO	$709.10
Rate for Payer: Superior Health Plan Medicare	$709.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$709.10
Rate for Payer: Universal American Medicare	$709.10
Rate for Payer: Wellcare Medicare	$709.10
Rate for Payer: Wellmed Medicare	$709.10

Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging gui

Facility

$1,297.04

Service Code	HCPCS 64461
Hospital Charge Code	9900792
Hospital Revenue Code	360
Rate for Payer: Cash Price	$881.99

Paring/Cutting Benign Lesion 2-4

Facility

$403.00

Service Code	HCPCS 11056
Hospital Charge Code	7150779
Hospital Revenue Code	361
Min. Negotiated Rate	$36.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$36.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$201.55
Rate for Payer: Amerigroup Medicare	$201.55
Rate for Payer: BCBS of TX Blue Advantage	$291.80
Rate for Payer: BCBS of TX Blue Essentials	$349.46
Rate for Payer: BCBS of TX Medicare	$201.55
Rate for Payer: BCBS of TX PPO	$440.32
Rate for Payer: Cash Price	$274.04
Rate for Payer: Cash Price	$274.04
Rate for Payer: Cash Price	$274.04
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$290.16
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	$290.16
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	$290.16
Rate for Payer: Scott and White EPO/PPO	$338.72
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$290.16
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

Paring/Cutting Benign Lesion 2-4

Facility

$403.00

Service Code	HCPCS 11056
Hospital Charge Code	7150779
Hospital Revenue Code	361
Rate for Payer: Cash Price	$274.04

Paring/Cutting Benign Lesion Over 4

Facility

$521.00

Service Code	HCPCS 11057
Hospital Charge Code	7150780
Hospital Revenue Code	361
Rate for Payer: Cash Price	$354.28

Paring/Cutting Benign Lesion Over 4

Facility

$521.00

Service Code	HCPCS 11057
Hospital Charge Code	7150780
Hospital Revenue Code	361
Min. Negotiated Rate	$55.65
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$55.65
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$201.55
Rate for Payer: Amerigroup Medicare	$201.55
Rate for Payer: BCBS of TX Blue Advantage	$97.03
Rate for Payer: BCBS of TX Blue Essentials	$116.20
Rate for Payer: BCBS of TX Medicare	$201.55
Rate for Payer: BCBS of TX PPO	$146.41
Rate for Payer: Cash Price	$354.28
Rate for Payer: Cash Price	$354.28
Rate for Payer: Cash Price	$354.28
Rate for Payer: Cigna Commercial	$426.04
Rate for Payer: Cigna Medicaid	$375.12
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	$375.12
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	$375.12
Rate for Payer: Scott and White EPO/PPO	$338.72
Rate for Payer: Scott and White Medicare	$201.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$375.12
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

PARoxetine 10 mg Tab

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77748317
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.44

Know your out-of-pocket cost for care.

All Charges