White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SOFT TISSUE PROCEDURES WITHOUT CC/MCC

Facility

$26,115.50

Service Code	MSDRG 502
Min. Negotiated Rate	$11,103.46
Max. Negotiated Rate	$26,115.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14,624.22
Rate for Payer: Amerigroup Medicare	$14,624.22
Rate for Payer: BCBS of TX Medicare	$14,624.22
Rate for Payer: Cigna Commercial	$17,335.19
Rate for Payer: Cigna Medicare	$14,624.22
Rate for Payer: Employer Direct Commercial	$14,624.22
Rate for Payer: Humana Medicare/TRICARE	$14,624.22
Rate for Payer: Molina Dual Medicare/Medicaid	$14,624.22
Rate for Payer: Molina Medicare	$14,624.22
Rate for Payer: Multiplan Auto	$26,115.50
Rate for Payer: Multiplan Commercial	$26,115.50
Rate for Payer: Multiplan Workers Comp	$26,115.50
Rate for Payer: Scott and White EPO/PPO	$12,026.88
Rate for Payer: Scott and White Medicare	$14,624.22
Rate for Payer: Superior Health Plan EPO	$14,624.22
Rate for Payer: Superior Health Plan Medicare	$14,624.22
Rate for Payer: Universal American Dual Medicare/Medicaid	$14,624.22
Rate for Payer: Universal American Medicare	$14,624.22
Rate for Payer: Wellcare Medicare	$14,624.22
Rate for Payer: Wellmed Medicare	$14,624.22

SOFT TISSUE PROCEDURES W MCC

Facility

$60,885.50

Service Code	MSDRG 500
Min. Negotiated Rate	$26,384.80
Max. Negotiated Rate	$60,885.50
Rate for Payer: BCBS of TX Blue Advantage	$26,384.80
Rate for Payer: BCBS of TX Blue Essentials	$31,658.69
Rate for Payer: BCBS of TX PPO	$35,177.69

SOFT TISSUE PROCEDURES W/O CC/MCC

Facility

$26,115.50

Service Code	MSDRG 502
Min. Negotiated Rate	$11,103.46
Max. Negotiated Rate	$26,115.50
Rate for Payer: BCBS of TX Blue Advantage	$11,103.46
Rate for Payer: BCBS of TX Blue Essentials	$13,322.86
Rate for Payer: BCBS of TX PPO	$14,803.75

SOLENT PROXI CATHETER US

Facility

$227.00

Service Code	HCPCS C1757
Hospital Charge Code	992519
Hospital Revenue Code	272
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$163.44
Rate for Payer: Amerigroup CHIP/Medicaid	$20.43
Rate for Payer: BCBS of TX Blue Advantage	$68.10
Rate for Payer: BCBS of TX Blue Essentials	$81.72
Rate for Payer: BCBS of TX PPO	$90.80
Rate for Payer: Cash Price	$154.36
Rate for Payer: Cigna Medicaid	$163.44
Rate for Payer: Molina CHIP/Medicaid	$163.44
Rate for Payer: Multiplan Auto	$147.55
Rate for Payer: Multiplan Commercial	$147.55
Rate for Payer: Multiplan Workers Comp	$147.55
Rate for Payer: Parkland Medicaid	$163.44
Rate for Payer: Scott and White EPO/PPO	$113.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$163.44
Rate for Payer: Superior Health Plan EPO	$30.87

SOLENT PROXI CATHETER US

Facility

$227.00

Service Code	HCPCS C1757
Hospital Charge Code	992519
Hospital Revenue Code	272
Rate for Payer: Cash Price	$154.36

SOL, SOD CHL, 0.9 PERC, 1000ML, INJ, BAG

Facility

$8.71

Hospital Charge Code	993001
Hospital Revenue Code	270
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$6.27
Rate for Payer: Amerigroup CHIP/Medicaid	$0.78
Rate for Payer: BCBS of TX Blue Advantage	$2.61
Rate for Payer: BCBS of TX Blue Essentials	$3.14
Rate for Payer: BCBS of TX PPO	$3.48
Rate for Payer: Cash Price	$5.92
Rate for Payer: Cigna Medicaid	$6.27
Rate for Payer: Molina CHIP/Medicaid	$6.27
Rate for Payer: Multiplan Auto	$5.66
Rate for Payer: Multiplan Commercial	$5.66
Rate for Payer: Multiplan Workers Comp	$5.66
Rate for Payer: Parkland Medicaid	$6.27
Rate for Payer: Scott and White EPO/PPO	$4.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.27
Rate for Payer: Superior Health Plan EPO	$1.18

SOL, SOD CHL, 0.9 PERC, 1000ML, INJ, BAG

Facility

$8.71

Hospital Charge Code	993001
Hospital Revenue Code	270
Rate for Payer: Cash Price	$5.92

SOLU, NACL, 0.9% IRRG, BTL, 1000ML

Facility

$13.13

Hospital Charge Code	992947
Hospital Revenue Code	270
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$9.45
Rate for Payer: Amerigroup CHIP/Medicaid	$1.18
Rate for Payer: BCBS of TX Blue Advantage	$3.94
Rate for Payer: BCBS of TX Blue Essentials	$4.73
Rate for Payer: BCBS of TX PPO	$5.25
Rate for Payer: Cash Price	$8.93
Rate for Payer: Cigna Medicaid	$9.45
Rate for Payer: Molina CHIP/Medicaid	$9.45
Rate for Payer: Multiplan Auto	$8.53
Rate for Payer: Multiplan Commercial	$8.53
Rate for Payer: Multiplan Workers Comp	$8.53
Rate for Payer: Parkland Medicaid	$9.45
Rate for Payer: Scott and White EPO/PPO	$6.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.45
Rate for Payer: Superior Health Plan EPO	$1.79

SOLU, NACL, 0.9% IRRG, BTL, 1000ML

Facility

$13.13

Hospital Charge Code	992947
Hospital Revenue Code	270
Rate for Payer: Cash Price	$8.93

SOLU, SOD CHL, 9 PCNT, 250ML, INJ, USP, B

Facility

$9.25

Hospital Charge Code	992905
Hospital Revenue Code	270
Rate for Payer: Cash Price	$6.29

SOLU, SOD CHL, 9 PCNT, 250ML, INJ, USP, B

Facility

$9.25

Hospital Charge Code	992905
Hospital Revenue Code	270
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$6.66
Rate for Payer: Amerigroup CHIP/Medicaid	$0.83
Rate for Payer: BCBS of TX Blue Advantage	$2.77
Rate for Payer: BCBS of TX Blue Essentials	$3.33
Rate for Payer: BCBS of TX PPO	$3.70
Rate for Payer: Cash Price	$6.29
Rate for Payer: Cigna Medicaid	$6.66
Rate for Payer: Molina CHIP/Medicaid	$6.66
Rate for Payer: Multiplan Auto	$6.01
Rate for Payer: Multiplan Commercial	$6.01
Rate for Payer: Multiplan Workers Comp	$6.01
Rate for Payer: Parkland Medicaid	$6.66
Rate for Payer: Scott and White EPO/PPO	$4.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.66
Rate for Payer: Superior Health Plan EPO	$1.26

SOLUTION INHALATION STERILE WATER USP 1000ML BAG

Facility

$21.75

Hospital Charge Code	992745
Hospital Revenue Code	270
Rate for Payer: Cash Price	$14.79

SOLUTION INHALATION STERILE WATER USP 1000ML BAG

Facility

$21.75

Hospital Charge Code	992745
Hospital Revenue Code	270
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$15.66
Rate for Payer: Amerigroup CHIP/Medicaid	$1.96
Rate for Payer: BCBS of TX Blue Advantage	$6.53
Rate for Payer: BCBS of TX Blue Essentials	$7.83
Rate for Payer: BCBS of TX PPO	$8.70
Rate for Payer: Cash Price	$14.79
Rate for Payer: Cigna Medicaid	$15.66
Rate for Payer: Molina CHIP/Medicaid	$15.66
Rate for Payer: Multiplan Auto	$14.14
Rate for Payer: Multiplan Commercial	$14.14
Rate for Payer: Multiplan Workers Comp	$14.14
Rate for Payer: Parkland Medicaid	$15.66
Rate for Payer: Scott and White EPO/PPO	$10.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$15.66
Rate for Payer: Superior Health Plan EPO	$2.96

Solution Lactated ringers

Facility

$14.98

Hospital Charge Code	992699
Hospital Revenue Code	270
Rate for Payer: Cash Price	$10.19

Solution Lactated ringers

Facility

$14.98

Hospital Charge Code	992699
Hospital Revenue Code	270
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$10.79
Rate for Payer: Amerigroup CHIP/Medicaid	$1.35
Rate for Payer: BCBS of TX Blue Advantage	$4.49
Rate for Payer: BCBS of TX Blue Essentials	$5.39
Rate for Payer: BCBS of TX PPO	$5.99
Rate for Payer: Cash Price	$10.19
Rate for Payer: Cigna Medicaid	$10.79
Rate for Payer: Molina CHIP/Medicaid	$10.79
Rate for Payer: Multiplan Auto	$9.74
Rate for Payer: Multiplan Commercial	$9.74
Rate for Payer: Multiplan Workers Comp	$9.74
Rate for Payer: Parkland Medicaid	$10.79
Rate for Payer: Scott and White EPO/PPO	$7.49
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10.79
Rate for Payer: Superior Health Plan EPO	$2.04

SOLUTION, NACL, 0.9%, IRRG, BAG, 3000ML

Facility

$60.21

Hospital Charge Code	992961
Hospital Revenue Code	270
Rate for Payer: Cash Price	$40.94

SOLUTION, NACL, 0.9%, IRRG, BAG, 3000ML

Facility

$60.21

Hospital Charge Code	992961
Hospital Revenue Code	270
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$43.35
Rate for Payer: Amerigroup CHIP/Medicaid	$5.42
Rate for Payer: BCBS of TX Blue Advantage	$18.06
Rate for Payer: BCBS of TX Blue Essentials	$21.68
Rate for Payer: BCBS of TX PPO	$24.08
Rate for Payer: Cash Price	$40.94
Rate for Payer: Cigna Medicaid	$43.35
Rate for Payer: Molina CHIP/Medicaid	$43.35
Rate for Payer: Multiplan Auto	$39.14
Rate for Payer: Multiplan Commercial	$39.14
Rate for Payer: Multiplan Workers Comp	$39.14
Rate for Payer: Parkland Medicaid	$43.35
Rate for Payer: Scott and White EPO/PPO	$30.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$43.35
Rate for Payer: Superior Health Plan EPO	$8.19

SOLUTION, PREP, POVIDNE IODINE, 4OZ BTL

Facility

$7.52

Hospital Charge Code	993178
Hospital Revenue Code	270
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$5.41
Rate for Payer: Amerigroup CHIP/Medicaid	$0.68
Rate for Payer: BCBS of TX Blue Advantage	$2.26
Rate for Payer: BCBS of TX Blue Essentials	$2.71
Rate for Payer: BCBS of TX PPO	$3.01
Rate for Payer: Cash Price	$5.11
Rate for Payer: Cigna Medicaid	$5.41
Rate for Payer: Molina CHIP/Medicaid	$5.41
Rate for Payer: Multiplan Auto	$4.89
Rate for Payer: Multiplan Commercial	$4.89
Rate for Payer: Multiplan Workers Comp	$4.89
Rate for Payer: Parkland Medicaid	$5.41
Rate for Payer: Scott and White EPO/PPO	$3.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.41
Rate for Payer: Superior Health Plan EPO	$1.02

SOLUTION, PREP, POVIDNE IODINE, 4OZ BTL

Facility

$7.52

Hospital Charge Code	993178
Hospital Revenue Code	270
Rate for Payer: Cash Price	$5.11

SOLUTION, SODIUM CHL, 0.9, 500ML, INJECT

Facility

$10.88

Hospital Charge Code	992948
Hospital Revenue Code	270
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$7.83
Rate for Payer: Amerigroup CHIP/Medicaid	$0.98
Rate for Payer: BCBS of TX Blue Advantage	$3.26
Rate for Payer: BCBS of TX Blue Essentials	$3.92
Rate for Payer: BCBS of TX PPO	$4.35
Rate for Payer: Cash Price	$7.40
Rate for Payer: Cigna Medicaid	$7.83
Rate for Payer: Molina CHIP/Medicaid	$7.83
Rate for Payer: Multiplan Auto	$7.07
Rate for Payer: Multiplan Commercial	$7.07
Rate for Payer: Multiplan Workers Comp	$7.07
Rate for Payer: Parkland Medicaid	$7.83
Rate for Payer: Scott and White EPO/PPO	$5.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.83
Rate for Payer: Superior Health Plan EPO	$1.48

SOLUTION, SODIUM CHL, 0.9, 500ML, INJECT

Facility

$10.88

Hospital Charge Code	992948
Hospital Revenue Code	270
Rate for Payer: Cash Price	$7.40

SOLUTION SRGSCRB CHG 1 PCT AVG 500ML

Facility

$185.62

Hospital Charge Code	992920
Hospital Revenue Code	270
Rate for Payer: Cash Price	$126.22

SOLUTION SRGSCRB CHG 1 PCT AVG 500ML

Facility

$185.62

Hospital Charge Code	992920
Hospital Revenue Code	270
Min. Negotiated Rate	$16.71
Max. Negotiated Rate	$133.65
Rate for Payer: Amerigroup CHIP/Medicaid	$16.71
Rate for Payer: BCBS of TX Blue Advantage	$55.69
Rate for Payer: BCBS of TX Blue Essentials	$66.82
Rate for Payer: BCBS of TX PPO	$74.25
Rate for Payer: Cash Price	$126.22
Rate for Payer: Cigna Medicaid	$133.65
Rate for Payer: Molina CHIP/Medicaid	$133.65
Rate for Payer: Multiplan Auto	$120.65
Rate for Payer: Multiplan Commercial	$120.65
Rate for Payer: Multiplan Workers Comp	$120.65
Rate for Payer: Parkland Medicaid	$133.65
Rate for Payer: Scott and White EPO/PPO	$92.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$133.65
Rate for Payer: Superior Health Plan EPO	$25.24

SOLUTN,SOD CHL,.9 PCNT, 500ML, IRR, BTL

Facility

$11.22

Hospital Charge Code	992952
Hospital Revenue Code	270
Rate for Payer: Cash Price	$7.63

SOLUTN,SOD CHL,.9 PCNT, 500ML, IRR, BTL

Facility

$11.22

Hospital Charge Code	992952
Hospital Revenue Code	270
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$8.08
Rate for Payer: Amerigroup CHIP/Medicaid	$1.01
Rate for Payer: BCBS of TX Blue Advantage	$3.37
Rate for Payer: BCBS of TX Blue Essentials	$4.04
Rate for Payer: BCBS of TX PPO	$4.49
Rate for Payer: Cash Price	$7.63
Rate for Payer: Cigna Medicaid	$8.08
Rate for Payer: Molina CHIP/Medicaid	$8.08
Rate for Payer: Multiplan Auto	$7.29
Rate for Payer: Multiplan Commercial	$7.29
Rate for Payer: Multiplan Workers Comp	$7.29
Rate for Payer: Parkland Medicaid	$8.08
Rate for Payer: Scott and White EPO/PPO	$5.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.08
Rate for Payer: Superior Health Plan EPO	$1.53

Know your out-of-pocket cost for care.

All Charges