White Rock Medical Center

All Charges

Charge

Type

Setting

Price

TAPE, SOFT, SURGICAL, 4 INX2YD, 10, 1CM

Facility

$10.45

Hospital Charge Code	993011
Hospital Revenue Code	270
Rate for Payer: Cash Price	$7.11

TAPE, SOFT, SURGICAL, 4 INX2YD, 10, 1CM

Facility

$10.45

Hospital Charge Code	993011
Hospital Revenue Code	270
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$7.52
Rate for Payer: Amerigroup CHIP/Medicaid	$0.94
Rate for Payer: BCBS of TX Blue Advantage	$3.13
Rate for Payer: BCBS of TX Blue Essentials	$3.76
Rate for Payer: BCBS of TX PPO	$4.18
Rate for Payer: Cash Price	$7.11
Rate for Payer: Cigna Medicaid	$7.52
Rate for Payer: Molina CHIP/Medicaid	$7.52
Rate for Payer: Multiplan Auto	$6.79
Rate for Payer: Multiplan Commercial	$6.79
Rate for Payer: Multiplan Workers Comp	$6.79
Rate for Payer: Parkland Medicaid	$7.52
Rate for Payer: Scott and White EPO/PPO	$5.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.52
Rate for Payer: Superior Health Plan EPO	$1.42

TAPE, SURGICAL, DURAPORE, 3'X10YD

Facility

$9.63

Hospital Charge Code	993580
Hospital Revenue Code	270
Rate for Payer: Cash Price	$6.55

TAPE, SURGICAL, DURAPORE, 3'X10YD

Facility

$9.63

Hospital Charge Code	993580
Hospital Revenue Code	270
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$6.93
Rate for Payer: Amerigroup CHIP/Medicaid	$0.87
Rate for Payer: BCBS of TX Blue Advantage	$2.89
Rate for Payer: BCBS of TX Blue Essentials	$3.47
Rate for Payer: BCBS of TX PPO	$3.85
Rate for Payer: Cash Price	$6.55
Rate for Payer: Cigna Medicaid	$6.93
Rate for Payer: Molina CHIP/Medicaid	$6.93
Rate for Payer: Multiplan Auto	$6.26
Rate for Payer: Multiplan Commercial	$6.26
Rate for Payer: Multiplan Workers Comp	$6.26
Rate for Payer: Parkland Medicaid	$6.93
Rate for Payer: Scott and White EPO/PPO	$4.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.93
Rate for Payer: Superior Health Plan EPO	$1.31

TAPE, SURGICAL, MICROFOAM, 4'X5.5YD

Facility

$24.43

Hospital Charge Code	993209
Hospital Revenue Code	270
Rate for Payer: Cash Price	$16.61

TAPE, SURGICAL, MICROFOAM, 4'X5.5YD

Facility

$24.43

Hospital Charge Code	993209
Hospital Revenue Code	270
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$17.59
Rate for Payer: Amerigroup CHIP/Medicaid	$2.20
Rate for Payer: BCBS of TX Blue Advantage	$7.33
Rate for Payer: BCBS of TX Blue Essentials	$8.79
Rate for Payer: BCBS of TX PPO	$9.77
Rate for Payer: Cash Price	$16.61
Rate for Payer: Cigna Medicaid	$17.59
Rate for Payer: Molina CHIP/Medicaid	$17.59
Rate for Payer: Multiplan Auto	$15.88
Rate for Payer: Multiplan Commercial	$15.88
Rate for Payer: Multiplan Workers Comp	$15.88
Rate for Payer: Parkland Medicaid	$17.59
Rate for Payer: Scott and White EPO/PPO	$12.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.59
Rate for Payer: Superior Health Plan EPO	$3.32

TAPE, SURGICAL. TRANSPORE, 1' X 10YD

Facility

$3.34

Hospital Charge Code	993074
Hospital Revenue Code	270
Rate for Payer: Cash Price	$2.27

TAPE, SURGICAL. TRANSPORE, 1' X 10YD

Facility

$3.34

Hospital Charge Code	993074
Hospital Revenue Code	270
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$2.40
Rate for Payer: Amerigroup CHIP/Medicaid	$0.30
Rate for Payer: BCBS of TX Blue Advantage	$1.00
Rate for Payer: BCBS of TX Blue Essentials	$1.20
Rate for Payer: BCBS of TX PPO	$1.34
Rate for Payer: Cash Price	$2.27
Rate for Payer: Cigna Medicaid	$2.40
Rate for Payer: Molina CHIP/Medicaid	$2.40
Rate for Payer: Multiplan Auto	$2.17
Rate for Payer: Multiplan Commercial	$2.17
Rate for Payer: Multiplan Workers Comp	$2.17
Rate for Payer: Parkland Medicaid	$2.40
Rate for Payer: Scott and White EPO/PPO	$1.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.40
Rate for Payer: Superior Health Plan EPO	$0.45

TAPE, SURGICAL, TRANSPORE, 1'X1.5YD

Facility

$0.92

Hospital Charge Code	993061
Hospital Revenue Code	270
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.66
Rate for Payer: Amerigroup CHIP/Medicaid	$0.08
Rate for Payer: BCBS of TX Blue Advantage	$0.28
Rate for Payer: BCBS of TX Blue Essentials	$0.33
Rate for Payer: BCBS of TX PPO	$0.37
Rate for Payer: Cash Price	$0.63
Rate for Payer: Cigna Medicaid	$0.66
Rate for Payer: Molina CHIP/Medicaid	$0.66
Rate for Payer: Multiplan Auto	$0.60
Rate for Payer: Multiplan Commercial	$0.60
Rate for Payer: Multiplan Workers Comp	$0.60
Rate for Payer: Parkland Medicaid	$0.66
Rate for Payer: Scott and White EPO/PPO	$0.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.66
Rate for Payer: Superior Health Plan EPO	$0.13

TAPE, SURGICAL, TRANSPORE, 1'X1.5YD

Facility

$0.92

Hospital Charge Code	993061
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.63

TB EMG ENDOTRACH -- DHF

Facility

$1,493.00

Hospital Charge Code	80346539
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,015.24

TB EMG ENDOTRACH -- DHF

Facility

$1,493.00

Hospital Charge Code	80346539
Hospital Revenue Code	272
Min. Negotiated Rate	$134.37
Max. Negotiated Rate	$1,074.96
Rate for Payer: Amerigroup CHIP/Medicaid	$134.37
Rate for Payer: BCBS of TX Blue Advantage	$447.90
Rate for Payer: BCBS of TX Blue Essentials	$537.48
Rate for Payer: BCBS of TX PPO	$597.20
Rate for Payer: Cash Price	$1,015.24
Rate for Payer: Cigna Medicaid	$1,074.96
Rate for Payer: Molina CHIP/Medicaid	$1,074.96
Rate for Payer: Multiplan Auto	$970.45
Rate for Payer: Multiplan Commercial	$970.45
Rate for Payer: Multiplan Workers Comp	$970.45
Rate for Payer: Parkland Medicaid	$1,074.96
Rate for Payer: Scott and White EPO/PPO	$746.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,074.96
Rate for Payer: Superior Health Plan EPO	$203.05

TB ENDO LZ -- DHF

Facility

$1,852.39

Hospital Charge Code	80932106
Hospital Revenue Code	270
Min. Negotiated Rate	$166.72
Max. Negotiated Rate	$1,333.72
Rate for Payer: Amerigroup CHIP/Medicaid	$166.72
Rate for Payer: BCBS of TX Blue Advantage	$555.72
Rate for Payer: BCBS of TX Blue Essentials	$666.86
Rate for Payer: BCBS of TX PPO	$740.96
Rate for Payer: Cash Price	$1,259.63
Rate for Payer: Cigna Medicaid	$1,333.72
Rate for Payer: Molina CHIP/Medicaid	$1,333.72
Rate for Payer: Multiplan Auto	$1,204.05
Rate for Payer: Multiplan Commercial	$1,204.05
Rate for Payer: Multiplan Workers Comp	$1,204.05
Rate for Payer: Parkland Medicaid	$1,333.72
Rate for Payer: Scott and White EPO/PPO	$926.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,333.72
Rate for Payer: Superior Health Plan EPO	$251.93

TB ENDO LZ -- DHF

Facility

$1,852.39

Hospital Charge Code	80932106
Hospital Revenue Code	270
Rate for Payer: Cash Price	$1,259.63

TB ENDOTRACH -- DHF

Facility

$174.75

Hospital Charge Code	82072653
Hospital Revenue Code	272
Rate for Payer: Cash Price	$118.83

TB ENDOTRACH -- DHF

Facility

$174.75

Hospital Charge Code	82072653
Hospital Revenue Code	272
Min. Negotiated Rate	$15.73
Max. Negotiated Rate	$125.82
Rate for Payer: Amerigroup CHIP/Medicaid	$15.73
Rate for Payer: BCBS of TX Blue Advantage	$52.42
Rate for Payer: BCBS of TX Blue Essentials	$62.91
Rate for Payer: BCBS of TX PPO	$69.90
Rate for Payer: Cash Price	$118.83
Rate for Payer: Cigna Medicaid	$125.82
Rate for Payer: Molina CHIP/Medicaid	$125.82
Rate for Payer: Multiplan Auto	$113.59
Rate for Payer: Multiplan Commercial	$113.59
Rate for Payer: Multiplan Workers Comp	$113.59
Rate for Payer: Parkland Medicaid	$125.82
Rate for Payer: Scott and White EPO/PPO	$87.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$125.82
Rate for Payer: Superior Health Plan EPO	$23.77

TB ENTRL FEED -- DHF

Facility

$78.23

Hospital Charge Code	80346554
Hospital Revenue Code	270
Rate for Payer: Cash Price	$53.20

TB ENTRL FEED -- DHF

Facility

$78.23

Hospital Charge Code	80346554
Hospital Revenue Code	270
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$56.33
Rate for Payer: Amerigroup CHIP/Medicaid	$7.04
Rate for Payer: BCBS of TX Blue Advantage	$23.47
Rate for Payer: BCBS of TX Blue Essentials	$28.16
Rate for Payer: BCBS of TX PPO	$31.29
Rate for Payer: Cash Price	$53.20
Rate for Payer: Cigna Medicaid	$56.33
Rate for Payer: Molina CHIP/Medicaid	$56.33
Rate for Payer: Multiplan Auto	$50.85
Rate for Payer: Multiplan Commercial	$50.85
Rate for Payer: Multiplan Workers Comp	$50.85
Rate for Payer: Parkland Medicaid	$56.33
Rate for Payer: Scott and White EPO/PPO	$39.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$56.33
Rate for Payer: Superior Health Plan EPO	$10.64

TB EPIDURAL PMP -- DHF

Facility

$52.01

Hospital Charge Code	80346588
Hospital Revenue Code	270
Rate for Payer: Cash Price	$35.37

TB EPIDURAL PMP -- DHF

Facility

$52.01

Hospital Charge Code	80346588
Hospital Revenue Code	270
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$37.45
Rate for Payer: Amerigroup CHIP/Medicaid	$4.68
Rate for Payer: BCBS of TX Blue Advantage	$15.60
Rate for Payer: BCBS of TX Blue Essentials	$18.72
Rate for Payer: BCBS of TX PPO	$20.80
Rate for Payer: Cash Price	$35.37
Rate for Payer: Cigna Medicaid	$37.45
Rate for Payer: Molina CHIP/Medicaid	$37.45
Rate for Payer: Multiplan Auto	$33.81
Rate for Payer: Multiplan Commercial	$33.81
Rate for Payer: Multiplan Workers Comp	$33.81
Rate for Payer: Parkland Medicaid	$37.45
Rate for Payer: Scott and White EPO/PPO	$26.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$37.45
Rate for Payer: Superior Health Plan EPO	$7.07

TB FD JEJUNAL -- DHF

Facility

$1,043.07

Hospital Charge Code	80346703
Hospital Revenue Code	272
Min. Negotiated Rate	$93.88
Max. Negotiated Rate	$751.01
Rate for Payer: Amerigroup CHIP/Medicaid	$93.88
Rate for Payer: BCBS of TX Blue Advantage	$312.92
Rate for Payer: BCBS of TX Blue Essentials	$375.51
Rate for Payer: BCBS of TX PPO	$417.23
Rate for Payer: Cash Price	$709.29
Rate for Payer: Cigna Medicaid	$751.01
Rate for Payer: Molina CHIP/Medicaid	$751.01
Rate for Payer: Multiplan Auto	$678.00
Rate for Payer: Multiplan Commercial	$678.00
Rate for Payer: Multiplan Workers Comp	$678.00
Rate for Payer: Parkland Medicaid	$751.01
Rate for Payer: Scott and White EPO/PPO	$521.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$751.01
Rate for Payer: Superior Health Plan EPO	$141.86

TB FD JEJUNAL -- DHF

Facility

$1,043.07

Hospital Charge Code	80346703
Hospital Revenue Code	272
Rate for Payer: Cash Price	$709.29

TB FEED -- DHF

Facility

$331.23

Hospital Charge Code	80346802
Hospital Revenue Code	270
Rate for Payer: Cash Price	$225.24

TB FEED -- DHF

Facility

$331.23

Hospital Charge Code	80346802
Hospital Revenue Code	270
Min. Negotiated Rate	$29.81
Max. Negotiated Rate	$238.49
Rate for Payer: Amerigroup CHIP/Medicaid	$29.81
Rate for Payer: BCBS of TX Blue Advantage	$99.37
Rate for Payer: BCBS of TX Blue Essentials	$119.24
Rate for Payer: BCBS of TX PPO	$132.49
Rate for Payer: Cash Price	$225.24
Rate for Payer: Cigna Medicaid	$238.49
Rate for Payer: Molina CHIP/Medicaid	$238.49
Rate for Payer: Multiplan Auto	$215.30
Rate for Payer: Multiplan Commercial	$215.30
Rate for Payer: Multiplan Workers Comp	$215.30
Rate for Payer: Parkland Medicaid	$238.49
Rate for Payer: Scott and White EPO/PPO	$165.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$238.49
Rate for Payer: Superior Health Plan EPO	$45.05

TB FEED INFANT -- DHF

Facility

$134.88

Hospital Charge Code	80346885
Hospital Revenue Code	272
Min. Negotiated Rate	$12.14
Max. Negotiated Rate	$97.11
Rate for Payer: Amerigroup CHIP/Medicaid	$12.14
Rate for Payer: BCBS of TX Blue Advantage	$40.46
Rate for Payer: BCBS of TX Blue Essentials	$48.56
Rate for Payer: BCBS of TX PPO	$53.95
Rate for Payer: Cash Price	$91.72
Rate for Payer: Cigna Medicaid	$97.11
Rate for Payer: Molina CHIP/Medicaid	$97.11
Rate for Payer: Multiplan Auto	$87.67
Rate for Payer: Multiplan Commercial	$87.67
Rate for Payer: Multiplan Workers Comp	$87.67
Rate for Payer: Parkland Medicaid	$97.11
Rate for Payer: Scott and White EPO/PPO	$67.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$97.11
Rate for Payer: Superior Health Plan EPO	$18.34

Know your out-of-pocket cost for care.

All Charges