White Rock Medical Center

All Charges

Charge

Type

Setting

Price

trocar versaone optical

Facility

$92.03

Hospital Charge Code	8688549
Hospital Revenue Code	272
Min. Negotiated Rate	$8.28
Max. Negotiated Rate	$66.26
Rate for Payer: Amerigroup CHIP/Medicaid	$8.28
Rate for Payer: BCBS of TX Blue Advantage	$27.61
Rate for Payer: BCBS of TX Blue Essentials	$33.13
Rate for Payer: BCBS of TX PPO	$36.81
Rate for Payer: Cash Price	$62.58
Rate for Payer: Cigna Medicaid	$66.26
Rate for Payer: Molina CHIP/Medicaid	$66.26
Rate for Payer: Multiplan Auto	$59.82
Rate for Payer: Multiplan Commercial	$59.82
Rate for Payer: Multiplan Workers Comp	$59.82
Rate for Payer: Parkland Medicaid	$66.26
Rate for Payer: Scott and White EPO/PPO	$46.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$66.26
Rate for Payer: Superior Health Plan EPO	$12.52

trocar versaone univ fixation cannula

Facility

$41.72

Hospital Charge Code	8688550
Hospital Revenue Code	272
Rate for Payer: Cash Price	$28.37

trocar versaone univ fixation cannula

Facility

$41.72

Hospital Charge Code	8688550
Hospital Revenue Code	272
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$30.04
Rate for Payer: Amerigroup CHIP/Medicaid	$3.75
Rate for Payer: BCBS of TX Blue Advantage	$12.52
Rate for Payer: BCBS of TX Blue Essentials	$15.02
Rate for Payer: BCBS of TX PPO	$16.69
Rate for Payer: Cash Price	$28.37
Rate for Payer: Cigna Medicaid	$30.04
Rate for Payer: Molina CHIP/Medicaid	$30.04
Rate for Payer: Multiplan Auto	$27.12
Rate for Payer: Multiplan Commercial	$27.12
Rate for Payer: Multiplan Workers Comp	$27.12
Rate for Payer: Parkland Medicaid	$30.04
Rate for Payer: Scott and White EPO/PPO	$20.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$30.04
Rate for Payer: Superior Health Plan EPO	$5.67

TROCAR, XCL W OPTVEW, BLADELESS, 5/100MM

Facility

$105.00

Hospital Charge Code	992826
Hospital Revenue Code	272
Rate for Payer: Cash Price	$71.40

TROCAR, XCL W OPTVEW, BLADELESS, 5/100MM

Facility

$105.00

Hospital Charge Code	992826
Hospital Revenue Code	272
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$75.60
Rate for Payer: Amerigroup CHIP/Medicaid	$9.45
Rate for Payer: BCBS of TX Blue Advantage	$31.50
Rate for Payer: BCBS of TX Blue Essentials	$37.80
Rate for Payer: BCBS of TX PPO	$42.00
Rate for Payer: Cash Price	$71.40
Rate for Payer: Cigna Medicaid	$75.60
Rate for Payer: Molina CHIP/Medicaid	$75.60
Rate for Payer: Multiplan Auto	$68.25
Rate for Payer: Multiplan Commercial	$68.25
Rate for Payer: Multiplan Workers Comp	$68.25
Rate for Payer: Parkland Medicaid	$75.60
Rate for Payer: Scott and White EPO/PPO	$52.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$75.60
Rate for Payer: Superior Health Plan EPO	$14.28

TROCH NAIL

Facility

$13,132.53

Service Code	HCPCS C1776
Hospital Charge Code	992208
Hospital Revenue Code	278
Min. Negotiated Rate	$1,181.93
Max. Negotiated Rate	$9,455.42
Rate for Payer: Amerigroup CHIP/Medicaid	$1,181.93
Rate for Payer: BCBS of TX Blue Advantage	$3,939.76
Rate for Payer: BCBS of TX Blue Essentials	$4,727.71
Rate for Payer: BCBS of TX PPO	$5,253.01
Rate for Payer: Cash Price	$8,930.12
Rate for Payer: Cigna Medicaid	$9,455.42
Rate for Payer: Molina CHIP/Medicaid	$9,455.42
Rate for Payer: Multiplan Auto	$6,566.27
Rate for Payer: Multiplan Commercial	$6,566.27
Rate for Payer: Multiplan Workers Comp	$6,566.27
Rate for Payer: Parkland Medicaid	$9,455.42
Rate for Payer: Scott and White EPO/PPO	$6,566.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,455.42
Rate for Payer: Superior Health Plan EPO	$1,786.02

TROCH NAIL

Facility

$13,132.53

Service Code	HCPCS C1776
Hospital Charge Code	992208
Hospital Revenue Code	278
Min. Negotiated Rate	$3,283.13
Max. Negotiated Rate	$6,566.27
Rate for Payer: Cash Price	$8,930.12
Rate for Payer: Cigna Commercial	$3,283.13
Rate for Payer: Multiplan Auto	$6,566.27
Rate for Payer: Multiplan Commercial	$6,566.27
Rate for Payer: Multiplan Workers Comp	$6,566.27
Rate for Payer: Scott and White EPO/PPO	$6,566.27

Troponin-I

Facility

$442.00

Service Code	HCPCS 84484
Hospital Charge Code	1603208
Hospital Revenue Code	301
Rate for Payer: Cash Price	$300.56

Troponin-I

Facility

$442.00

Service Code	HCPCS 84484
Hospital Charge Code	1603208
Hospital Revenue Code	301
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$318.24
Rate for Payer: Amerigroup CHIP/Medicaid	$4.86
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12.47
Rate for Payer: Amerigroup Medicare	$12.47
Rate for Payer: BCBS of TX Blue Advantage	$132.60
Rate for Payer: BCBS of TX Blue Essentials	$159.12
Rate for Payer: BCBS of TX Medicare	$12.47
Rate for Payer: BCBS of TX PPO	$176.80
Rate for Payer: Cash Price	$300.56
Rate for Payer: Cash Price	$300.56
Rate for Payer: Cigna Medicaid	$318.24
Rate for Payer: Cigna Medicare	$12.47
Rate for Payer: Employer Direct Commercial	$12.47
Rate for Payer: Humana Medicare/TRICARE	$12.47
Rate for Payer: Molina CHIP/Medicaid	$318.24
Rate for Payer: Molina Dual Medicare/Medicaid	$12.47
Rate for Payer: Molina Medicare	$12.47
Rate for Payer: Multiplan Auto	$287.30
Rate for Payer: Multiplan Commercial	$287.30
Rate for Payer: Multiplan Workers Comp	$287.30
Rate for Payer: Parkland Medicaid	$318.24
Rate for Payer: Scott and White EPO/PPO	$15.59
Rate for Payer: Scott and White Medicare	$12.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$318.24
Rate for Payer: Superior Health Plan EPO	$12.47
Rate for Payer: Superior Health Plan Medicare	$12.47
Rate for Payer: Universal American Dual Medicare/Medicaid	$12.47
Rate for Payer: Universal American Medicare	$12.47
Rate for Payer: Wellcare Medicare	$12.47
Rate for Payer: Wellmed Medicare	$12.47

Truclear mini shaver

Facility

$2,488.69

Hospital Charge Code	8602531
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,692.31

Truclear mini shaver

Facility

$2,488.69

Hospital Charge Code	8602531
Hospital Revenue Code	272
Min. Negotiated Rate	$223.98
Max. Negotiated Rate	$1,791.86
Rate for Payer: Amerigroup CHIP/Medicaid	$223.98
Rate for Payer: BCBS of TX Blue Advantage	$746.61
Rate for Payer: BCBS of TX Blue Essentials	$895.93
Rate for Payer: BCBS of TX PPO	$995.48
Rate for Payer: Cash Price	$1,692.31
Rate for Payer: Cigna Medicaid	$1,791.86
Rate for Payer: Molina CHIP/Medicaid	$1,791.86
Rate for Payer: Multiplan Auto	$1,617.65
Rate for Payer: Multiplan Commercial	$1,617.65
Rate for Payer: Multiplan Workers Comp	$1,617.65
Rate for Payer: Parkland Medicaid	$1,791.86
Rate for Payer: Scott and White EPO/PPO	$1,244.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,791.86
Rate for Payer: Superior Health Plan EPO	$338.46

TRY ARTRL LIN -- DHF

Facility

$789.03

Hospital Charge Code	80829757
Hospital Revenue Code	272
Min. Negotiated Rate	$71.01
Max. Negotiated Rate	$568.10
Rate for Payer: Amerigroup CHIP/Medicaid	$71.01
Rate for Payer: BCBS of TX Blue Advantage	$236.71
Rate for Payer: BCBS of TX Blue Essentials	$284.05
Rate for Payer: BCBS of TX PPO	$315.61
Rate for Payer: Cash Price	$536.54
Rate for Payer: Cigna Medicaid	$568.10
Rate for Payer: Molina CHIP/Medicaid	$568.10
Rate for Payer: Multiplan Auto	$512.87
Rate for Payer: Multiplan Commercial	$512.87
Rate for Payer: Multiplan Workers Comp	$512.87
Rate for Payer: Parkland Medicaid	$568.10
Rate for Payer: Scott and White EPO/PPO	$394.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$568.10
Rate for Payer: Superior Health Plan EPO	$107.31

TRY ARTRL LIN -- DHF

Facility

$789.03

Hospital Charge Code	80829757
Hospital Revenue Code	272
Rate for Payer: Cash Price	$536.54

TRY BN MARROW -- DHF

Facility

$137.10

Hospital Charge Code	80830052
Hospital Revenue Code	272
Rate for Payer: Cash Price	$93.23

TRY BN MARROW -- DHF

Facility

$137.10

Hospital Charge Code	80830052
Hospital Revenue Code	272
Min. Negotiated Rate	$12.34
Max. Negotiated Rate	$98.71
Rate for Payer: Amerigroup CHIP/Medicaid	$12.34
Rate for Payer: BCBS of TX Blue Advantage	$41.13
Rate for Payer: BCBS of TX Blue Essentials	$49.36
Rate for Payer: BCBS of TX PPO	$54.84
Rate for Payer: Cash Price	$93.23
Rate for Payer: Cigna Medicaid	$98.71
Rate for Payer: Molina CHIP/Medicaid	$98.71
Rate for Payer: Multiplan Auto	$89.11
Rate for Payer: Multiplan Commercial	$89.11
Rate for Payer: Multiplan Workers Comp	$89.11
Rate for Payer: Parkland Medicaid	$98.71
Rate for Payer: Scott and White EPO/PPO	$68.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$98.71
Rate for Payer: Superior Health Plan EPO	$18.65

TRY BX BASIC -- DHF

Facility

$123.54

Hospital Charge Code	80830409
Hospital Revenue Code	272
Rate for Payer: Cash Price	$84.01

TRY BX BASIC -- DHF

Facility

$123.54

Hospital Charge Code	80830409
Hospital Revenue Code	272
Min. Negotiated Rate	$11.12
Max. Negotiated Rate	$88.95
Rate for Payer: Amerigroup CHIP/Medicaid	$11.12
Rate for Payer: BCBS of TX Blue Advantage	$37.06
Rate for Payer: BCBS of TX Blue Essentials	$44.47
Rate for Payer: BCBS of TX PPO	$49.42
Rate for Payer: Cash Price	$84.01
Rate for Payer: Cigna Medicaid	$88.95
Rate for Payer: Molina CHIP/Medicaid	$88.95
Rate for Payer: Multiplan Auto	$80.30
Rate for Payer: Multiplan Commercial	$80.30
Rate for Payer: Multiplan Workers Comp	$80.30
Rate for Payer: Parkland Medicaid	$88.95
Rate for Payer: Scott and White EPO/PPO	$61.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$88.95
Rate for Payer: Superior Health Plan EPO	$16.80

TRY CATH -- DHF

Facility

$977.91

Service Code	HCPCS A4649
Hospital Charge Code	80570278
Hospital Revenue Code	272
Rate for Payer: Cash Price	$664.98

TRY CATH -- DHF

Facility

$977.91

Service Code	HCPCS A4649
Hospital Charge Code	80570278
Hospital Revenue Code	272
Min. Negotiated Rate	$88.01
Max. Negotiated Rate	$704.10
Rate for Payer: Amerigroup CHIP/Medicaid	$88.01
Rate for Payer: BCBS of TX Blue Advantage	$293.37
Rate for Payer: BCBS of TX Blue Essentials	$352.05
Rate for Payer: BCBS of TX PPO	$391.16
Rate for Payer: Cash Price	$664.98
Rate for Payer: Cigna Medicaid	$704.10
Rate for Payer: Molina CHIP/Medicaid	$704.10
Rate for Payer: Multiplan Auto	$635.64
Rate for Payer: Multiplan Commercial	$635.64
Rate for Payer: Multiplan Workers Comp	$635.64
Rate for Payer: Parkland Medicaid	$704.10
Rate for Payer: Scott and White EPO/PPO	$488.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$704.10
Rate for Payer: Superior Health Plan EPO	$133.00

TRY CATH ST -- DHF

Facility

$254.05

Hospital Charge Code	80831753
Hospital Revenue Code	272
Rate for Payer: Cash Price	$172.75

TRY CATH ST -- DHF

Facility

$254.05

Hospital Charge Code	80831753
Hospital Revenue Code	272
Min. Negotiated Rate	$22.86
Max. Negotiated Rate	$182.92
Rate for Payer: Amerigroup CHIP/Medicaid	$22.86
Rate for Payer: BCBS of TX Blue Advantage	$76.22
Rate for Payer: BCBS of TX Blue Essentials	$91.46
Rate for Payer: BCBS of TX PPO	$101.62
Rate for Payer: Cash Price	$172.75
Rate for Payer: Cigna Medicaid	$182.92
Rate for Payer: Molina CHIP/Medicaid	$182.92
Rate for Payer: Multiplan Auto	$165.13
Rate for Payer: Multiplan Commercial	$165.13
Rate for Payer: Multiplan Workers Comp	$165.13
Rate for Payer: Parkland Medicaid	$182.92
Rate for Payer: Scott and White EPO/PPO	$127.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$182.92
Rate for Payer: Superior Health Plan EPO	$34.55

TRY CIRCUM DISP -- DHF

Facility

$48.01

Hospital Charge Code	80832306
Hospital Revenue Code	272
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$34.57
Rate for Payer: Amerigroup CHIP/Medicaid	$4.32
Rate for Payer: BCBS of TX Blue Advantage	$14.40
Rate for Payer: BCBS of TX Blue Essentials	$17.28
Rate for Payer: BCBS of TX PPO	$19.20
Rate for Payer: Cash Price	$32.65
Rate for Payer: Cigna Medicaid	$34.57
Rate for Payer: Molina CHIP/Medicaid	$34.57
Rate for Payer: Multiplan Auto	$31.21
Rate for Payer: Multiplan Commercial	$31.21
Rate for Payer: Multiplan Workers Comp	$31.21
Rate for Payer: Parkland Medicaid	$34.57
Rate for Payer: Scott and White EPO/PPO	$24.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$34.57
Rate for Payer: Superior Health Plan EPO	$6.53

TRY CIRCUM DISP -- DHF

Facility

$48.01

Hospital Charge Code	80832306
Hospital Revenue Code	272
Rate for Payer: Cash Price	$32.65

TRY FEM INST -- DHF

Facility

$278.74

Hospital Charge Code	80835374
Hospital Revenue Code	270
Rate for Payer: Cash Price	$189.54

TRY FEM INST -- DHF

Facility

$278.74

Hospital Charge Code	80835374
Hospital Revenue Code	270
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$200.69
Rate for Payer: Amerigroup CHIP/Medicaid	$25.09
Rate for Payer: BCBS of TX Blue Advantage	$83.62
Rate for Payer: BCBS of TX Blue Essentials	$100.35
Rate for Payer: BCBS of TX PPO	$111.50
Rate for Payer: Cash Price	$189.54
Rate for Payer: Cigna Medicaid	$200.69
Rate for Payer: Molina CHIP/Medicaid	$200.69
Rate for Payer: Multiplan Auto	$181.18
Rate for Payer: Multiplan Commercial	$181.18
Rate for Payer: Multiplan Workers Comp	$181.18
Rate for Payer: Parkland Medicaid	$200.69
Rate for Payer: Scott and White EPO/PPO	$139.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$200.69
Rate for Payer: Superior Health Plan EPO	$37.91

Know your out-of-pocket cost for care.

All Charges