White Rock Medical Center

All Charges

Charge

Type

Setting

Price

TRY GASTRC LAV -- DHF

Facility

$436.21

Hospital Charge Code	80835655
Hospital Revenue Code	270
Rate for Payer: Cash Price	$296.62

TRY GASTRC LAV -- DHF

Facility

$436.21

Hospital Charge Code	80835655
Hospital Revenue Code	270
Min. Negotiated Rate	$39.26
Max. Negotiated Rate	$314.07
Rate for Payer: Amerigroup CHIP/Medicaid	$39.26
Rate for Payer: BCBS of TX Blue Advantage	$130.86
Rate for Payer: BCBS of TX Blue Essentials	$157.04
Rate for Payer: BCBS of TX PPO	$174.48
Rate for Payer: Cash Price	$296.62
Rate for Payer: Cigna Medicaid	$314.07
Rate for Payer: Molina CHIP/Medicaid	$314.07
Rate for Payer: Multiplan Auto	$283.54
Rate for Payer: Multiplan Commercial	$283.54
Rate for Payer: Multiplan Workers Comp	$283.54
Rate for Payer: Parkland Medicaid	$314.07
Rate for Payer: Scott and White EPO/PPO	$218.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$314.07
Rate for Payer: Superior Health Plan EPO	$59.32

TRY HYPERAL -- DHF

Facility

$362.11

Hospital Charge Code	80836208
Hospital Revenue Code	270
Rate for Payer: Cash Price	$246.23

TRY HYPERAL -- DHF

Facility

$362.11

Hospital Charge Code	80836208
Hospital Revenue Code	270
Min. Negotiated Rate	$32.59
Max. Negotiated Rate	$260.72
Rate for Payer: Amerigroup CHIP/Medicaid	$32.59
Rate for Payer: BCBS of TX Blue Advantage	$108.63
Rate for Payer: BCBS of TX Blue Essentials	$130.36
Rate for Payer: BCBS of TX PPO	$144.84
Rate for Payer: Cash Price	$246.23
Rate for Payer: Cigna Medicaid	$260.72
Rate for Payer: Molina CHIP/Medicaid	$260.72
Rate for Payer: Multiplan Auto	$235.37
Rate for Payer: Multiplan Commercial	$235.37
Rate for Payer: Multiplan Workers Comp	$235.37
Rate for Payer: Parkland Medicaid	$260.72
Rate for Payer: Scott and White EPO/PPO	$181.06
Rate for Payer: Superior Health Plan CHIP/Medicaid	$260.72
Rate for Payer: Superior Health Plan EPO	$49.25

TRY LUMB PUNCT -- DHF

Facility

$47.23

Hospital Charge Code	80838055
Hospital Revenue Code	272
Rate for Payer: Cash Price	$32.12

TRY LUMB PUNCT -- DHF

Facility

$47.23

Hospital Charge Code	80838055
Hospital Revenue Code	272
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$34.01
Rate for Payer: Amerigroup CHIP/Medicaid	$4.25
Rate for Payer: BCBS of TX Blue Advantage	$14.17
Rate for Payer: BCBS of TX Blue Essentials	$17.00
Rate for Payer: BCBS of TX PPO	$18.89
Rate for Payer: Cash Price	$32.12
Rate for Payer: Cigna Medicaid	$34.01
Rate for Payer: Molina CHIP/Medicaid	$34.01
Rate for Payer: Multiplan Auto	$30.70
Rate for Payer: Multiplan Commercial	$30.70
Rate for Payer: Multiplan Workers Comp	$30.70
Rate for Payer: Parkland Medicaid	$34.01
Rate for Payer: Scott and White EPO/PPO	$23.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$34.01
Rate for Payer: Superior Health Plan EPO	$6.42

TRY MAJ ORTHO -- DHF

Facility

$1,891.20

Hospital Charge Code	80838402
Hospital Revenue Code	272
Min. Negotiated Rate	$170.21
Max. Negotiated Rate	$1,361.66
Rate for Payer: Amerigroup CHIP/Medicaid	$170.21
Rate for Payer: BCBS of TX Blue Advantage	$567.36
Rate for Payer: BCBS of TX Blue Essentials	$680.83
Rate for Payer: BCBS of TX PPO	$756.48
Rate for Payer: Cash Price	$1,286.02
Rate for Payer: Cigna Medicaid	$1,361.66
Rate for Payer: Molina CHIP/Medicaid	$1,361.66
Rate for Payer: Multiplan Auto	$1,229.28
Rate for Payer: Multiplan Commercial	$1,229.28
Rate for Payer: Multiplan Workers Comp	$1,229.28
Rate for Payer: Parkland Medicaid	$1,361.66
Rate for Payer: Scott and White EPO/PPO	$945.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,361.66
Rate for Payer: Superior Health Plan EPO	$257.20

TRY MAJ ORTHO -- DHF

Facility

$1,891.20

Hospital Charge Code	80838402
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,286.02

TRY MYELOGRAM -- DHF

Facility

$575.58

Hospital Charge Code	80839004
Hospital Revenue Code	272
Rate for Payer: Cash Price	$391.39

TRY MYELOGRAM -- DHF

Facility

$575.58

Hospital Charge Code	80839004
Hospital Revenue Code	272
Min. Negotiated Rate	$51.80
Max. Negotiated Rate	$414.42
Rate for Payer: Amerigroup CHIP/Medicaid	$51.80
Rate for Payer: BCBS of TX Blue Advantage	$172.67
Rate for Payer: BCBS of TX Blue Essentials	$207.21
Rate for Payer: BCBS of TX PPO	$230.23
Rate for Payer: Cash Price	$391.39
Rate for Payer: Cigna Medicaid	$414.42
Rate for Payer: Molina CHIP/Medicaid	$414.42
Rate for Payer: Multiplan Auto	$374.13
Rate for Payer: Multiplan Commercial	$374.13
Rate for Payer: Multiplan Workers Comp	$374.13
Rate for Payer: Parkland Medicaid	$414.42
Rate for Payer: Scott and White EPO/PPO	$287.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$414.42
Rate for Payer: Superior Health Plan EPO	$78.28

TRY REMV SUT -- DHF

Facility

$98.82

Hospital Charge Code	80841307
Hospital Revenue Code	272
Rate for Payer: Cash Price	$67.20

TRY REMV SUT -- DHF

Facility

$98.82

Hospital Charge Code	80841307
Hospital Revenue Code	272
Min. Negotiated Rate	$8.89
Max. Negotiated Rate	$71.15
Rate for Payer: Amerigroup CHIP/Medicaid	$8.89
Rate for Payer: BCBS of TX Blue Advantage	$29.65
Rate for Payer: BCBS of TX Blue Essentials	$35.58
Rate for Payer: BCBS of TX PPO	$39.53
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cigna Medicaid	$71.15
Rate for Payer: Molina CHIP/Medicaid	$71.15
Rate for Payer: Multiplan Auto	$64.23
Rate for Payer: Multiplan Commercial	$64.23
Rate for Payer: Multiplan Workers Comp	$64.23
Rate for Payer: Parkland Medicaid	$71.15
Rate for Payer: Scott and White EPO/PPO	$49.41
Rate for Payer: Superior Health Plan CHIP/Medicaid	$71.15
Rate for Payer: Superior Health Plan EPO	$13.44

TRY THORACENTES -- DHF

Facility

$755.53

Hospital Charge Code	80843105
Hospital Revenue Code	272
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$543.98
Rate for Payer: Amerigroup CHIP/Medicaid	$68.00
Rate for Payer: BCBS of TX Blue Advantage	$226.66
Rate for Payer: BCBS of TX Blue Essentials	$271.99
Rate for Payer: BCBS of TX PPO	$302.21
Rate for Payer: Cash Price	$513.76
Rate for Payer: Cigna Medicaid	$543.98
Rate for Payer: Molina CHIP/Medicaid	$543.98
Rate for Payer: Multiplan Auto	$491.09
Rate for Payer: Multiplan Commercial	$491.09
Rate for Payer: Multiplan Workers Comp	$491.09
Rate for Payer: Parkland Medicaid	$543.98
Rate for Payer: Scott and White EPO/PPO	$377.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$543.98
Rate for Payer: Superior Health Plan EPO	$102.75

TRY THORACENTES -- DHF

Facility

$755.53

Hospital Charge Code	80843105
Hospital Revenue Code	272
Rate for Payer: Cash Price	$513.76

TRY TRACH CLEAN -- DHF

Facility

$202.44

Hospital Charge Code	80843501
Hospital Revenue Code	270
Rate for Payer: Cash Price	$137.66

TRY TRACH CLEAN -- DHF

Facility

$202.44

Hospital Charge Code	80843501
Hospital Revenue Code	270
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$145.76
Rate for Payer: Amerigroup CHIP/Medicaid	$18.22
Rate for Payer: BCBS of TX Blue Advantage	$60.73
Rate for Payer: BCBS of TX Blue Essentials	$72.88
Rate for Payer: BCBS of TX PPO	$80.98
Rate for Payer: Cash Price	$137.66
Rate for Payer: Cigna Medicaid	$145.76
Rate for Payer: Molina CHIP/Medicaid	$145.76
Rate for Payer: Multiplan Auto	$131.59
Rate for Payer: Multiplan Commercial	$131.59
Rate for Payer: Multiplan Workers Comp	$131.59
Rate for Payer: Parkland Medicaid	$145.76
Rate for Payer: Scott and White EPO/PPO	$101.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$145.76
Rate for Payer: Superior Health Plan EPO	$27.53

TRY UMBL ART CTH -- DHF

Facility

$292.41

Hospital Charge Code	80843956
Hospital Revenue Code	272
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$210.54
Rate for Payer: Amerigroup CHIP/Medicaid	$26.32
Rate for Payer: BCBS of TX Blue Advantage	$87.72
Rate for Payer: BCBS of TX Blue Essentials	$105.27
Rate for Payer: BCBS of TX PPO	$116.96
Rate for Payer: Cash Price	$198.84
Rate for Payer: Cigna Medicaid	$210.54
Rate for Payer: Molina CHIP/Medicaid	$210.54
Rate for Payer: Multiplan Auto	$190.07
Rate for Payer: Multiplan Commercial	$190.07
Rate for Payer: Multiplan Workers Comp	$190.07
Rate for Payer: Parkland Medicaid	$210.54
Rate for Payer: Scott and White EPO/PPO	$146.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$210.54
Rate for Payer: Superior Health Plan EPO	$39.77

TRY UMBL ART CTH -- DHF

Facility

$292.41

Hospital Charge Code	80843956
Hospital Revenue Code	272
Rate for Payer: Cash Price	$198.84

TTE w or w/o fol w.con,stress BCE

Facility

$3,465.84

Hospital Charge Code	9100978
Hospital Revenue Code	483
Min. Negotiated Rate	$311.93
Max. Negotiated Rate	$2,495.40
Rate for Payer: Amerigroup CHIP/Medicaid	$311.93
Rate for Payer: BCBS of TX Blue Advantage	$1,039.75
Rate for Payer: BCBS of TX Blue Essentials	$1,247.70
Rate for Payer: BCBS of TX PPO	$1,386.34
Rate for Payer: Cash Price	$2,356.77
Rate for Payer: Cigna Medicaid	$2,495.40
Rate for Payer: Molina CHIP/Medicaid	$2,495.40
Rate for Payer: Multiplan Auto	$2,252.80
Rate for Payer: Multiplan Commercial	$2,252.80
Rate for Payer: Multiplan Workers Comp	$2,252.80
Rate for Payer: Parkland Medicaid	$2,495.40
Rate for Payer: Scott and White EPO/PPO	$1,732.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,495.40
Rate for Payer: Superior Health Plan EPO	$471.35

TTE w or w/o fol w.con,stress BCE

Facility

$3,465.84

Hospital Charge Code	9100978
Hospital Revenue Code	483
Rate for Payer: Cash Price	$2,356.77

TUBE, BLOOD COLLECT K2 EDTA 6ML PINK CAP

Facility

$0.38

Hospital Charge Code	993588
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.26

TUBE, BLOOD COLLECT K2 EDTA 6ML PINK CAP

Facility

$0.38

Hospital Charge Code	993588
Hospital Revenue Code	270
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.27
Rate for Payer: Amerigroup CHIP/Medicaid	$0.03
Rate for Payer: BCBS of TX Blue Advantage	$0.11
Rate for Payer: BCBS of TX Blue Essentials	$0.14
Rate for Payer: BCBS of TX PPO	$0.15
Rate for Payer: Cash Price	$0.26
Rate for Payer: Cigna Medicaid	$0.27
Rate for Payer: Molina CHIP/Medicaid	$0.27
Rate for Payer: Multiplan Auto	$0.25
Rate for Payer: Multiplan Commercial	$0.25
Rate for Payer: Multiplan Workers Comp	$0.25
Rate for Payer: Parkland Medicaid	$0.27
Rate for Payer: Scott and White EPO/PPO	$0.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.27
Rate for Payer: Superior Health Plan EPO	$0.05

TUBE, CALIBRATION SINGLE FOR LAP-BAND -- DHF

Facility

$631.63

Hospital Charge Code	81775165
Hospital Revenue Code	272
Rate for Payer: Cash Price	$429.51

TUBE, CALIBRATION SINGLE FOR LAP-BAND -- DHF

Facility

$631.63

Hospital Charge Code	81775165
Hospital Revenue Code	272
Min. Negotiated Rate	$56.85
Max. Negotiated Rate	$454.77
Rate for Payer: Amerigroup CHIP/Medicaid	$56.85
Rate for Payer: BCBS of TX Blue Advantage	$189.49
Rate for Payer: BCBS of TX Blue Essentials	$227.39
Rate for Payer: BCBS of TX PPO	$252.65
Rate for Payer: Cash Price	$429.51
Rate for Payer: Cigna Medicaid	$454.77
Rate for Payer: Molina CHIP/Medicaid	$454.77
Rate for Payer: Multiplan Auto	$410.56
Rate for Payer: Multiplan Commercial	$410.56
Rate for Payer: Multiplan Workers Comp	$410.56
Rate for Payer: Parkland Medicaid	$454.77
Rate for Payer: Scott and White EPO/PPO	$315.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$454.77
Rate for Payer: Superior Health Plan EPO	$85.90

TUBE, CAPILLARY 175 UL PLASTIC HEPARIN COATED

Facility

$11.30

Hospital Charge Code	993975
Hospital Revenue Code	272
Rate for Payer: Cash Price	$7.68

Know your out-of-pocket cost for care.

All Charges