White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SLING, ARM FASHION NAVY X-LARGE -- DHF

Facility

$96.69

Hospital Charge Code	81144453
Hospital Revenue Code	271
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$69.62
Rate for Payer: Amerigroup CHIP/Medicaid	$8.70
Rate for Payer: BCBS of TX Blue Advantage	$29.01
Rate for Payer: BCBS of TX Blue Essentials	$34.81
Rate for Payer: BCBS of TX PPO	$38.68
Rate for Payer: Cash Price	$65.75
Rate for Payer: Cigna Medicaid	$69.62
Rate for Payer: Molina CHIP/Medicaid	$69.62
Rate for Payer: Multiplan Auto	$62.85
Rate for Payer: Multiplan Commercial	$62.85
Rate for Payer: Multiplan Workers Comp	$62.85
Rate for Payer: Parkland Medicaid	$69.62
Rate for Payer: Scott and White EPO/PPO	$48.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$69.62
Rate for Payer: Superior Health Plan EPO	$13.15

SLING, ARM FASHION NAVY X-LARGE -- DHF

Facility

$96.69

Hospital Charge Code	81144453
Hospital Revenue Code	271
Rate for Payer: Cash Price	$65.75

SLING, ARM, UNIVERSAL, W/PADDED STRAP

Facility

$18.80

Hospital Charge Code	993368
Hospital Revenue Code	270
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$13.54
Rate for Payer: Amerigroup CHIP/Medicaid	$1.69
Rate for Payer: BCBS of TX Blue Advantage	$5.64
Rate for Payer: BCBS of TX Blue Essentials	$6.77
Rate for Payer: BCBS of TX PPO	$7.52
Rate for Payer: Cash Price	$12.78
Rate for Payer: Cigna Medicaid	$13.54
Rate for Payer: Molina CHIP/Medicaid	$13.54
Rate for Payer: Multiplan Auto	$12.22
Rate for Payer: Multiplan Commercial	$12.22
Rate for Payer: Multiplan Workers Comp	$12.22
Rate for Payer: Parkland Medicaid	$13.54
Rate for Payer: Scott and White EPO/PPO	$9.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.54
Rate for Payer: Superior Health Plan EPO	$2.56

SLING, ARM, UNIVERSAL, W/PADDED STRAP

Facility

$18.80

Hospital Charge Code	993368
Hospital Revenue Code	270
Rate for Payer: Cash Price	$12.78

SLING, URETHRAL DESARAFOR

Facility

$3,098.55

Service Code	HCPCS C1771
Hospital Charge Code	992637
Hospital Revenue Code	278
Min. Negotiated Rate	$774.64
Max. Negotiated Rate	$1,549.28
Rate for Payer: Cash Price	$2,107.01
Rate for Payer: Cigna Commercial	$774.64
Rate for Payer: Multiplan Auto	$1,549.28
Rate for Payer: Multiplan Commercial	$1,549.28
Rate for Payer: Multiplan Workers Comp	$1,549.28
Rate for Payer: Scott and White EPO/PPO	$1,549.28

SLING, URETHRAL DESARAFOR

Facility

$3,098.55

Service Code	HCPCS C1771
Hospital Charge Code	992637
Hospital Revenue Code	278
Min. Negotiated Rate	$278.87
Max. Negotiated Rate	$2,230.96
Rate for Payer: Amerigroup CHIP/Medicaid	$278.87
Rate for Payer: BCBS of TX Blue Advantage	$929.57
Rate for Payer: BCBS of TX Blue Essentials	$1,115.48
Rate for Payer: BCBS of TX PPO	$1,239.42
Rate for Payer: Cash Price	$2,107.01
Rate for Payer: Cigna Medicaid	$2,230.96
Rate for Payer: Molina CHIP/Medicaid	$2,230.96
Rate for Payer: Multiplan Auto	$1,549.28
Rate for Payer: Multiplan Commercial	$1,549.28
Rate for Payer: Multiplan Workers Comp	$1,549.28
Rate for Payer: Parkland Medicaid	$2,230.96
Rate for Payer: Scott and White EPO/PPO	$1,549.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,230.96
Rate for Payer: Superior Health Plan EPO	$421.40

SLIPPER, DBLE TRD, BARIATRIC, YELLOW

Facility

$4.55

Hospital Charge Code	993198
Hospital Revenue Code	270
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$3.28
Rate for Payer: Amerigroup CHIP/Medicaid	$0.41
Rate for Payer: BCBS of TX Blue Advantage	$1.36
Rate for Payer: BCBS of TX Blue Essentials	$1.64
Rate for Payer: BCBS of TX PPO	$1.82
Rate for Payer: Cash Price	$3.09
Rate for Payer: Cigna Medicaid	$3.28
Rate for Payer: Molina CHIP/Medicaid	$3.28
Rate for Payer: Multiplan Auto	$2.96
Rate for Payer: Multiplan Commercial	$2.96
Rate for Payer: Multiplan Workers Comp	$2.96
Rate for Payer: Parkland Medicaid	$3.28
Rate for Payer: Scott and White EPO/PPO	$2.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.28
Rate for Payer: Superior Health Plan EPO	$0.62

SLIPPER, DBLE TRD, BARIATRIC, YELLOW

Facility

$4.55

Hospital Charge Code	993198
Hospital Revenue Code	270
Rate for Payer: Cash Price	$3.09

SLIPPER, FALL PREV, YELLOW, LARGE

Facility

$2.94

Hospital Charge Code	993208
Hospital Revenue Code	270
Rate for Payer: Cash Price	$2.00

SLIPPER, FALL PREV, YELLOW, LARGE

Facility

$2.94

Hospital Charge Code	993208
Hospital Revenue Code	270
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$2.12
Rate for Payer: Amerigroup CHIP/Medicaid	$0.26
Rate for Payer: BCBS of TX Blue Advantage	$0.88
Rate for Payer: BCBS of TX Blue Essentials	$1.06
Rate for Payer: BCBS of TX PPO	$1.18
Rate for Payer: Cash Price	$2.00
Rate for Payer: Cigna Medicaid	$2.12
Rate for Payer: Molina CHIP/Medicaid	$2.12
Rate for Payer: Multiplan Auto	$1.91
Rate for Payer: Multiplan Commercial	$1.91
Rate for Payer: Multiplan Workers Comp	$1.91
Rate for Payer: Parkland Medicaid	$2.12
Rate for Payer: Scott and White EPO/PPO	$1.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.12
Rate for Payer: Superior Health Plan EPO	$0.40

SLIPPER, FALL PREV, YELLOW, XL

Facility

$4.10

Hospital Charge Code	993898
Hospital Revenue Code	270
Rate for Payer: Cash Price	$2.79

SLIPPER, FALL PREV, YELLOW, XL

Facility

$4.10

Hospital Charge Code	993898
Hospital Revenue Code	270
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$2.95
Rate for Payer: Amerigroup CHIP/Medicaid	$0.37
Rate for Payer: BCBS of TX Blue Advantage	$1.23
Rate for Payer: BCBS of TX Blue Essentials	$1.48
Rate for Payer: BCBS of TX PPO	$1.64
Rate for Payer: Cash Price	$2.79
Rate for Payer: Cigna Medicaid	$2.95
Rate for Payer: Molina CHIP/Medicaid	$2.95
Rate for Payer: Multiplan Auto	$2.67
Rate for Payer: Multiplan Commercial	$2.67
Rate for Payer: Multiplan Workers Comp	$2.67
Rate for Payer: Parkland Medicaid	$2.95
Rate for Payer: Scott and White EPO/PPO	$2.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.95
Rate for Payer: Superior Health Plan EPO	$0.56

SLITTER CATH -- DHF

Facility

$151.58

Hospital Charge Code	40049900
Hospital Revenue Code	272
Min. Negotiated Rate	$13.64
Max. Negotiated Rate	$109.14
Rate for Payer: Amerigroup CHIP/Medicaid	$13.64
Rate for Payer: BCBS of TX Blue Advantage	$45.47
Rate for Payer: BCBS of TX Blue Essentials	$54.57
Rate for Payer: BCBS of TX PPO	$60.63
Rate for Payer: Cash Price	$103.07
Rate for Payer: Cigna Medicaid	$109.14
Rate for Payer: Molina CHIP/Medicaid	$109.14
Rate for Payer: Multiplan Auto	$98.53
Rate for Payer: Multiplan Commercial	$98.53
Rate for Payer: Multiplan Workers Comp	$98.53
Rate for Payer: Parkland Medicaid	$109.14
Rate for Payer: Scott and White EPO/PPO	$75.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$109.14
Rate for Payer: Superior Health Plan EPO	$20.61

SLITTER CATH -- DHF

Facility

$151.58

Hospital Charge Code	40049900
Hospital Revenue Code	272
Rate for Payer: Cash Price	$103.07

Slotted Head Positioner 9 W X 8 D X 4 H Inch Foam Freestandi

Facility

$91.67

Hospital Charge Code	993037
Hospital Revenue Code	270
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$66.00
Rate for Payer: Amerigroup CHIP/Medicaid	$8.25
Rate for Payer: BCBS of TX Blue Advantage	$27.50
Rate for Payer: BCBS of TX Blue Essentials	$33.00
Rate for Payer: BCBS of TX PPO	$36.67
Rate for Payer: Cash Price	$62.34
Rate for Payer: Cigna Medicaid	$66.00
Rate for Payer: Molina CHIP/Medicaid	$66.00
Rate for Payer: Multiplan Auto	$59.59
Rate for Payer: Multiplan Commercial	$59.59
Rate for Payer: Multiplan Workers Comp	$59.59
Rate for Payer: Parkland Medicaid	$66.00
Rate for Payer: Scott and White EPO/PPO	$45.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$66.00
Rate for Payer: Superior Health Plan EPO	$12.47

Slotted Head Positioner 9 W X 8 D X 4 H Inch Foam Freestandi

Facility

$91.67

Hospital Charge Code	993037
Hospital Revenue Code	270
Rate for Payer: Cash Price	$62.34

SLOTTED PLATE

Facility

$879.52

Service Code	HCPCS C1734
Hospital Charge Code	992241
Hospital Revenue Code	278
Min. Negotiated Rate	$219.88
Max. Negotiated Rate	$439.76
Rate for Payer: Cash Price	$598.07
Rate for Payer: Cigna Commercial	$219.88
Rate for Payer: Multiplan Auto	$439.76
Rate for Payer: Multiplan Commercial	$439.76
Rate for Payer: Multiplan Workers Comp	$439.76
Rate for Payer: Scott and White EPO/PPO	$439.76

SLOTTED PLATE

Facility

$879.52

Service Code	HCPCS C1734
Hospital Charge Code	992241
Hospital Revenue Code	278
Min. Negotiated Rate	$79.16
Max. Negotiated Rate	$633.25
Rate for Payer: Amerigroup CHIP/Medicaid	$79.16
Rate for Payer: BCBS of TX Blue Advantage	$263.86
Rate for Payer: BCBS of TX Blue Essentials	$316.63
Rate for Payer: BCBS of TX PPO	$351.81
Rate for Payer: Cash Price	$598.07
Rate for Payer: Cigna Medicaid	$633.25
Rate for Payer: Molina CHIP/Medicaid	$633.25
Rate for Payer: Multiplan Auto	$439.76
Rate for Payer: Multiplan Commercial	$439.76
Rate for Payer: Multiplan Workers Comp	$439.76
Rate for Payer: Parkland Medicaid	$633.25
Rate for Payer: Scott and White EPO/PPO	$439.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$633.25
Rate for Payer: Superior Health Plan EPO	$119.61

SLP Assessment of Aphasia Units

Facility

$496.00

Service Code	HCPCS 96105
Hospital Charge Code	9114973
Hospital Revenue Code	444
Rate for Payer: Cash Price	$337.28

SLP Assessment of Aphasia Units

Facility

$496.00

Service Code	HCPCS 96105
Hospital Charge Code	9114973
Hospital Revenue Code	444
Min. Negotiated Rate	$67.46
Max. Negotiated Rate	$357.12
Rate for Payer: Amerigroup CHIP/Medicaid	$80.00
Rate for Payer: BCBS of TX Blue Advantage	$148.80
Rate for Payer: BCBS of TX Blue Essentials	$178.56
Rate for Payer: BCBS of TX PPO	$198.40
Rate for Payer: Cash Price	$337.28
Rate for Payer: Cash Price	$337.28
Rate for Payer: Cash Price	$337.28
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$357.12
Rate for Payer: Molina CHIP/Medicaid	$357.12
Rate for Payer: Multiplan Auto	$322.40
Rate for Payer: Multiplan Commercial	$322.40
Rate for Payer: Multiplan Workers Comp	$322.40
Rate for Payer: Parkland Medicaid	$357.12
Rate for Payer: Scott and White EPO/PPO	$118.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$357.12
Rate for Payer: Superior Health Plan EPO	$67.46

SLP Auditory Processing Tx Units

Facility

$326.00

Service Code	HCPCS 92507
Hospital Charge Code	4405445
Hospital Revenue Code	441
Min. Negotiated Rate	$44.34
Max. Negotiated Rate	$234.72
Rate for Payer: Amerigroup CHIP/Medicaid	$80.00
Rate for Payer: BCBS of TX Blue Advantage	$97.80
Rate for Payer: BCBS of TX Blue Essentials	$117.36
Rate for Payer: BCBS of TX PPO	$130.40
Rate for Payer: Cash Price	$221.68
Rate for Payer: Cash Price	$221.68
Rate for Payer: Cash Price	$221.68
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$234.72
Rate for Payer: Molina CHIP/Medicaid	$234.72
Rate for Payer: Multiplan Auto	$211.90
Rate for Payer: Multiplan Commercial	$211.90
Rate for Payer: Multiplan Workers Comp	$211.90
Rate for Payer: Parkland Medicaid	$234.72
Rate for Payer: Scott and White EPO/PPO	$94.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$234.72
Rate for Payer: Superior Health Plan EPO	$44.34

SLP Auditory Processing Tx Units

Facility

$326.00

Service Code	HCPCS 92507
Hospital Charge Code	4405445
Hospital Revenue Code	441
Rate for Payer: Cash Price	$221.68

SLP Eval Lang Comprehension,Express Unit

Facility

$396.00

Service Code	HCPCS 92523
Hospital Charge Code	4450055
Hospital Revenue Code	444
Min. Negotiated Rate	$53.86
Max. Negotiated Rate	$285.12
Rate for Payer: Amerigroup CHIP/Medicaid	$80.00
Rate for Payer: BCBS of TX Blue Advantage	$118.80
Rate for Payer: BCBS of TX Blue Essentials	$142.56
Rate for Payer: BCBS of TX PPO	$158.40
Rate for Payer: Cash Price	$269.28
Rate for Payer: Cash Price	$269.28
Rate for Payer: Cash Price	$269.28
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: Cigna Medicaid	$285.12
Rate for Payer: Molina CHIP/Medicaid	$285.12
Rate for Payer: Multiplan Auto	$257.40
Rate for Payer: Multiplan Commercial	$257.40
Rate for Payer: Multiplan Workers Comp	$257.40
Rate for Payer: Parkland Medicaid	$285.12
Rate for Payer: Scott and White EPO/PPO	$282.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$285.12
Rate for Payer: Superior Health Plan EPO	$53.86

SLP Eval Lang Comprehension,Express Unit

Facility

$396.00

Service Code	HCPCS 92523
Hospital Charge Code	4450055
Hospital Revenue Code	444
Rate for Payer: Cash Price	$269.28

SLP Eval of Speech Sound Prod Units

Facility

$364.00

Service Code	HCPCS 92522
Hospital Charge Code	9310565
Hospital Revenue Code	444
Rate for Payer: Cash Price	$247.52

Know your out-of-pocket cost for care.

All Charges