White Rock Medical Center

All Charges

Charge

Type

Setting

Price

TUBE, CAPILLARY 175 UL PLASTIC HEPARIN COATED

Facility

$11.30

Hospital Charge Code	993975
Hospital Revenue Code	272
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$8.14
Rate for Payer: Amerigroup CHIP/Medicaid	$1.02
Rate for Payer: BCBS of TX Blue Advantage	$3.39
Rate for Payer: BCBS of TX Blue Essentials	$4.07
Rate for Payer: BCBS of TX PPO	$4.52
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cigna Medicaid	$8.14
Rate for Payer: Molina CHIP/Medicaid	$8.14
Rate for Payer: Multiplan Auto	$7.34
Rate for Payer: Multiplan Commercial	$7.34
Rate for Payer: Multiplan Workers Comp	$7.34
Rate for Payer: Parkland Medicaid	$8.14
Rate for Payer: Scott and White EPO/PPO	$5.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.14
Rate for Payer: Superior Health Plan EPO	$1.54

TUBE, CONNECTING 9/32 I.D, 240' LGTH -- DHF

Facility

$87.80

Hospital Charge Code	81855850
Hospital Revenue Code	272
Rate for Payer: Cash Price	$59.70

TUBE, CONNECTING 9/32 I.D, 240' LGTH -- DHF

Facility

$87.80

Hospital Charge Code	81855850
Hospital Revenue Code	272
Min. Negotiated Rate	$7.90
Max. Negotiated Rate	$63.22
Rate for Payer: Amerigroup CHIP/Medicaid	$7.90
Rate for Payer: BCBS of TX Blue Advantage	$26.34
Rate for Payer: BCBS of TX Blue Essentials	$31.61
Rate for Payer: BCBS of TX PPO	$35.12
Rate for Payer: Cash Price	$59.70
Rate for Payer: Cigna Medicaid	$63.22
Rate for Payer: Molina CHIP/Medicaid	$63.22
Rate for Payer: Multiplan Auto	$57.07
Rate for Payer: Multiplan Commercial	$57.07
Rate for Payer: Multiplan Workers Comp	$57.07
Rate for Payer: Parkland Medicaid	$63.22
Rate for Payer: Scott and White EPO/PPO	$43.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$63.22
Rate for Payer: Superior Health Plan EPO	$11.94

TUBE, CONNECTING NON-COND

Facility

$9.35

Hospital Charge Code	992898
Hospital Revenue Code	270
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$6.73
Rate for Payer: Amerigroup CHIP/Medicaid	$0.84
Rate for Payer: BCBS of TX Blue Advantage	$2.81
Rate for Payer: BCBS of TX Blue Essentials	$3.37
Rate for Payer: BCBS of TX PPO	$3.74
Rate for Payer: Cash Price	$6.36
Rate for Payer: Cigna Medicaid	$6.73
Rate for Payer: Molina CHIP/Medicaid	$6.73
Rate for Payer: Multiplan Auto	$6.08
Rate for Payer: Multiplan Commercial	$6.08
Rate for Payer: Multiplan Workers Comp	$6.08
Rate for Payer: Parkland Medicaid	$6.73
Rate for Payer: Scott and White EPO/PPO	$4.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.73
Rate for Payer: Superior Health Plan EPO	$1.27

TUBE, CONNECTING NON-COND

Facility

$9.35

Hospital Charge Code	992898
Hospital Revenue Code	270
Rate for Payer: Cash Price	$6.36

TUBE, ENDOTRACH, HI-LO, MURPHY, 7.0MM

Facility

$6.23

Hospital Charge Code	992765
Hospital Revenue Code	270
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$4.49
Rate for Payer: Amerigroup CHIP/Medicaid	$0.56
Rate for Payer: BCBS of TX Blue Advantage	$1.87
Rate for Payer: BCBS of TX Blue Essentials	$2.24
Rate for Payer: BCBS of TX PPO	$2.49
Rate for Payer: Cash Price	$4.24
Rate for Payer: Cigna Medicaid	$4.49
Rate for Payer: Molina CHIP/Medicaid	$4.49
Rate for Payer: Multiplan Auto	$4.05
Rate for Payer: Multiplan Commercial	$4.05
Rate for Payer: Multiplan Workers Comp	$4.05
Rate for Payer: Parkland Medicaid	$4.49
Rate for Payer: Scott and White EPO/PPO	$3.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.49
Rate for Payer: Superior Health Plan EPO	$0.85

TUBE, ENDOTRACH, HI-LO, MURPHY, 7.0MM

Facility

$6.23

Hospital Charge Code	992765
Hospital Revenue Code	270
Rate for Payer: Cash Price	$4.24

TUBE, ENDOTRACH, HI-LO, MURPHY, 7.5MM

Facility

$6.23

Hospital Charge Code	992839
Hospital Revenue Code	272
Rate for Payer: Cash Price	$4.24

TUBE, ENDOTRACH, HI-LO, MURPHY, 7.5MM

Facility

$6.23

Hospital Charge Code	992839
Hospital Revenue Code	272
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$4.49
Rate for Payer: Amerigroup CHIP/Medicaid	$0.56
Rate for Payer: BCBS of TX Blue Advantage	$1.87
Rate for Payer: BCBS of TX Blue Essentials	$2.24
Rate for Payer: BCBS of TX PPO	$2.49
Rate for Payer: Cash Price	$4.24
Rate for Payer: Cigna Medicaid	$4.49
Rate for Payer: Molina CHIP/Medicaid	$4.49
Rate for Payer: Multiplan Auto	$4.05
Rate for Payer: Multiplan Commercial	$4.05
Rate for Payer: Multiplan Workers Comp	$4.05
Rate for Payer: Parkland Medicaid	$4.49
Rate for Payer: Scott and White EPO/PPO	$3.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.49
Rate for Payer: Superior Health Plan EPO	$0.85

TUBE, ENDOTRACH, HI-LO, MURPHY, 8.0MM

Facility

$6.23

Hospital Charge Code	992840
Hospital Revenue Code	272
Rate for Payer: Cash Price	$4.24

TUBE, ENDOTRACH, HI-LO, MURPHY, 8.0MM

Facility

$6.23

Hospital Charge Code	992840
Hospital Revenue Code	272
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$4.49
Rate for Payer: Amerigroup CHIP/Medicaid	$0.56
Rate for Payer: BCBS of TX Blue Advantage	$1.87
Rate for Payer: BCBS of TX Blue Essentials	$2.24
Rate for Payer: BCBS of TX PPO	$2.49
Rate for Payer: Cash Price	$4.24
Rate for Payer: Cigna Medicaid	$4.49
Rate for Payer: Molina CHIP/Medicaid	$4.49
Rate for Payer: Multiplan Auto	$4.05
Rate for Payer: Multiplan Commercial	$4.05
Rate for Payer: Multiplan Workers Comp	$4.05
Rate for Payer: Parkland Medicaid	$4.49
Rate for Payer: Scott and White EPO/PPO	$3.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.49
Rate for Payer: Superior Health Plan EPO	$0.85

TUBE, ENDO UNCUFF BLUE LI

Facility

$184.51

Hospital Charge Code	134147
Hospital Revenue Code	272
Rate for Payer: Cash Price	$125.47

TUBE, ENDO UNCUFF BLUE LI

Facility

$184.51

Hospital Charge Code	134147
Hospital Revenue Code	272
Min. Negotiated Rate	$16.61
Max. Negotiated Rate	$132.85
Rate for Payer: Amerigroup CHIP/Medicaid	$16.61
Rate for Payer: BCBS of TX Blue Advantage	$55.35
Rate for Payer: BCBS of TX Blue Essentials	$66.42
Rate for Payer: BCBS of TX PPO	$73.80
Rate for Payer: Cash Price	$125.47
Rate for Payer: Cigna Medicaid	$132.85
Rate for Payer: Molina CHIP/Medicaid	$132.85
Rate for Payer: Multiplan Auto	$119.93
Rate for Payer: Multiplan Commercial	$119.93
Rate for Payer: Multiplan Workers Comp	$119.93
Rate for Payer: Parkland Medicaid	$132.85
Rate for Payer: Scott and White EPO/PPO	$92.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$132.85
Rate for Payer: Superior Health Plan EPO	$25.09

TUBE, EXTENSION EXTENDABLE

Facility

$3.77

Hospital Charge Code	992914
Hospital Revenue Code	270
Rate for Payer: Cash Price	$2.56

TUBE, EXTENSION EXTENDABLE

Facility

$3.77

Hospital Charge Code	992914
Hospital Revenue Code	270
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$2.71
Rate for Payer: Amerigroup CHIP/Medicaid	$0.34
Rate for Payer: BCBS of TX Blue Advantage	$1.13
Rate for Payer: BCBS of TX Blue Essentials	$1.36
Rate for Payer: BCBS of TX PPO	$1.51
Rate for Payer: Cash Price	$2.56
Rate for Payer: Cigna Medicaid	$2.71
Rate for Payer: Molina CHIP/Medicaid	$2.71
Rate for Payer: Multiplan Auto	$2.45
Rate for Payer: Multiplan Commercial	$2.45
Rate for Payer: Multiplan Workers Comp	$2.45
Rate for Payer: Parkland Medicaid	$2.71
Rate for Payer: Scott and White EPO/PPO	$1.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.71
Rate for Payer: Superior Health Plan EPO	$0.51

TUBE FEED KANGAROO GSTRO Y PORT 14FR

Facility

$70.46

Hospital Charge Code	144788
Hospital Revenue Code	272
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$50.73
Rate for Payer: Amerigroup CHIP/Medicaid	$6.34
Rate for Payer: BCBS of TX Blue Advantage	$21.14
Rate for Payer: BCBS of TX Blue Essentials	$25.37
Rate for Payer: BCBS of TX PPO	$28.18
Rate for Payer: Cash Price	$47.91
Rate for Payer: Cigna Medicaid	$50.73
Rate for Payer: Molina CHIP/Medicaid	$50.73
Rate for Payer: Multiplan Auto	$45.80
Rate for Payer: Multiplan Commercial	$45.80
Rate for Payer: Multiplan Workers Comp	$45.80
Rate for Payer: Parkland Medicaid	$50.73
Rate for Payer: Scott and White EPO/PPO	$35.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$50.73
Rate for Payer: Superior Health Plan EPO	$9.58

TUBE FEED KANGAROO GSTRO Y PORT 14FR

Facility

$70.46

Hospital Charge Code	144788
Hospital Revenue Code	272
Rate for Payer: Cash Price	$47.91

TUBE INJECTOR TRANSFER -- DHF

Facility

$321.67

Hospital Charge Code	81799017
Hospital Revenue Code	272
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$231.60
Rate for Payer: Amerigroup CHIP/Medicaid	$28.95
Rate for Payer: BCBS of TX Blue Advantage	$96.50
Rate for Payer: BCBS of TX Blue Essentials	$115.80
Rate for Payer: BCBS of TX PPO	$128.67
Rate for Payer: Cash Price	$218.74
Rate for Payer: Cigna Medicaid	$231.60
Rate for Payer: Molina CHIP/Medicaid	$231.60
Rate for Payer: Multiplan Auto	$209.09
Rate for Payer: Multiplan Commercial	$209.09
Rate for Payer: Multiplan Workers Comp	$209.09
Rate for Payer: Parkland Medicaid	$231.60
Rate for Payer: Scott and White EPO/PPO	$160.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$231.60
Rate for Payer: Superior Health Plan EPO	$43.75

TUBE INJECTOR TRANSFER -- DHF

Facility

$321.67

Hospital Charge Code	81799017
Hospital Revenue Code	272
Rate for Payer: Cash Price	$218.74

TUBE, LITHIUM HEPARIN GEL 13X100, 5ML

Facility

$0.60

Hospital Charge Code	993267
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.41

TUBE, LITHIUM HEPARIN GEL 13X100, 5ML

Facility

$0.60

Hospital Charge Code	993267
Hospital Revenue Code	270
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.43
Rate for Payer: Amerigroup CHIP/Medicaid	$0.05
Rate for Payer: BCBS of TX Blue Advantage	$0.18
Rate for Payer: BCBS of TX Blue Essentials	$0.22
Rate for Payer: BCBS of TX PPO	$0.24
Rate for Payer: Cash Price	$0.41
Rate for Payer: Cigna Medicaid	$0.43
Rate for Payer: Molina CHIP/Medicaid	$0.43
Rate for Payer: Multiplan Auto	$0.39
Rate for Payer: Multiplan Commercial	$0.39
Rate for Payer: Multiplan Workers Comp	$0.39
Rate for Payer: Parkland Medicaid	$0.43
Rate for Payer: Scott and White EPO/PPO	$0.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.43
Rate for Payer: Superior Health Plan EPO	$0.08

TUBE, NASOGASTRIC, STANDARD, 18FR X 48'

Facility

$11.01

Hospital Charge Code	992951
Hospital Revenue Code	270
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$7.93
Rate for Payer: Amerigroup CHIP/Medicaid	$0.99
Rate for Payer: BCBS of TX Blue Advantage	$3.30
Rate for Payer: BCBS of TX Blue Essentials	$3.96
Rate for Payer: BCBS of TX PPO	$4.40
Rate for Payer: Cash Price	$7.49
Rate for Payer: Cigna Medicaid	$7.93
Rate for Payer: Molina CHIP/Medicaid	$7.93
Rate for Payer: Multiplan Auto	$7.16
Rate for Payer: Multiplan Commercial	$7.16
Rate for Payer: Multiplan Workers Comp	$7.16
Rate for Payer: Parkland Medicaid	$7.93
Rate for Payer: Scott and White EPO/PPO	$5.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.93
Rate for Payer: Superior Health Plan EPO	$1.50

TUBE, NASOGASTRIC, STANDARD, 18FR X 48'

Facility

$11.01

Hospital Charge Code	992951
Hospital Revenue Code	270
Rate for Payer: Cash Price	$7.49

TUBE NG 8FR STYL RGD OUTLT ENTFLX 43IN

Facility

$39.13

Hospital Charge Code	80346901
Hospital Revenue Code	270
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$28.17
Rate for Payer: Amerigroup CHIP/Medicaid	$3.52
Rate for Payer: BCBS of TX Blue Advantage	$11.74
Rate for Payer: BCBS of TX Blue Essentials	$14.09
Rate for Payer: BCBS of TX PPO	$15.65
Rate for Payer: Cash Price	$26.61
Rate for Payer: Cigna Medicaid	$28.17
Rate for Payer: Molina CHIP/Medicaid	$28.17
Rate for Payer: Multiplan Auto	$25.43
Rate for Payer: Multiplan Commercial	$25.43
Rate for Payer: Multiplan Workers Comp	$25.43
Rate for Payer: Parkland Medicaid	$28.17
Rate for Payer: Scott and White EPO/PPO	$19.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$28.17
Rate for Payer: Superior Health Plan EPO	$5.32

TUBE NG 8FR STYL RGD OUTLT ENTFLX 43IN

Facility

$39.13

Hospital Charge Code	80346901
Hospital Revenue Code	270
Rate for Payer: Cash Price	$26.61

Know your out-of-pocket cost for care.

All Charges