White Rock Medical Center

All Charges

Charge

Type

Setting

Price

TUBE SET HI-FLOW PNEUMOCLEAR W/SMK EVAC

Facility

$144.41

Hospital Charge Code	8556476
Hospital Revenue Code	272
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$103.98
Rate for Payer: Amerigroup CHIP/Medicaid	$13.00
Rate for Payer: BCBS of TX Blue Advantage	$43.32
Rate for Payer: BCBS of TX Blue Essentials	$51.99
Rate for Payer: BCBS of TX PPO	$57.76
Rate for Payer: Cash Price	$98.20
Rate for Payer: Cigna Medicaid	$103.98
Rate for Payer: Molina CHIP/Medicaid	$103.98
Rate for Payer: Multiplan Auto	$93.87
Rate for Payer: Multiplan Commercial	$93.87
Rate for Payer: Multiplan Workers Comp	$93.87
Rate for Payer: Parkland Medicaid	$103.98
Rate for Payer: Scott and White EPO/PPO	$72.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$103.98
Rate for Payer: Superior Health Plan EPO	$19.64

TUBE SET HI-FLOW PNEUMOCLEAR W/SMK EVAC

Facility

$144.41

Hospital Charge Code	8556476
Hospital Revenue Code	272
Rate for Payer: Cash Price	$98.20

TUBE SET HIGH FLOW PNEUMOCLEAR

Facility

$43.31

Hospital Charge Code	8556475
Hospital Revenue Code	272
Rate for Payer: Cash Price	$29.45

TUBE SET HIGH FLOW PNEUMOCLEAR

Facility

$43.31

Hospital Charge Code	8556475
Hospital Revenue Code	272
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$31.18
Rate for Payer: Amerigroup CHIP/Medicaid	$3.90
Rate for Payer: BCBS of TX Blue Advantage	$12.99
Rate for Payer: BCBS of TX Blue Essentials	$15.59
Rate for Payer: BCBS of TX PPO	$17.32
Rate for Payer: Cash Price	$29.45
Rate for Payer: Cigna Medicaid	$31.18
Rate for Payer: Molina CHIP/Medicaid	$31.18
Rate for Payer: Multiplan Auto	$28.15
Rate for Payer: Multiplan Commercial	$28.15
Rate for Payer: Multiplan Workers Comp	$28.15
Rate for Payer: Parkland Medicaid	$31.18
Rate for Payer: Scott and White EPO/PPO	$21.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$31.18
Rate for Payer: Superior Health Plan EPO	$5.89

TUBE TRACHEOSTOMY FLEX D.I.C. CUFF GRN 7MMX70MML

Facility

$121.08

Hospital Charge Code	132344
Hospital Revenue Code	272
Min. Negotiated Rate	$10.90
Max. Negotiated Rate	$87.18
Rate for Payer: Amerigroup CHIP/Medicaid	$10.90
Rate for Payer: BCBS of TX Blue Advantage	$36.32
Rate for Payer: BCBS of TX Blue Essentials	$43.59
Rate for Payer: BCBS of TX PPO	$48.43
Rate for Payer: Cash Price	$82.33
Rate for Payer: Cigna Medicaid	$87.18
Rate for Payer: Molina CHIP/Medicaid	$87.18
Rate for Payer: Multiplan Auto	$78.70
Rate for Payer: Multiplan Commercial	$78.70
Rate for Payer: Multiplan Workers Comp	$78.70
Rate for Payer: Parkland Medicaid	$87.18
Rate for Payer: Scott and White EPO/PPO	$60.54
Rate for Payer: Superior Health Plan CHIP/Medicaid	$87.18
Rate for Payer: Superior Health Plan EPO	$16.47

TUBE TRACHEOSTOMY FLEX D.I.C. CUFF GRN 7MMX70MML

Facility

$121.08

Hospital Charge Code	132344
Hospital Revenue Code	272
Rate for Payer: Cash Price	$82.33

TUBE TRCH 6.4MM CUF FEN

Facility

$199.44

Hospital Charge Code	82073107
Hospital Revenue Code	272
Rate for Payer: Cash Price	$135.62

TUBE TRCH 6.4MM CUF FEN

Facility

$199.44

Hospital Charge Code	82073107
Hospital Revenue Code	272
Min. Negotiated Rate	$17.95
Max. Negotiated Rate	$143.60
Rate for Payer: Amerigroup CHIP/Medicaid	$17.95
Rate for Payer: BCBS of TX Blue Advantage	$59.83
Rate for Payer: BCBS of TX Blue Essentials	$71.80
Rate for Payer: BCBS of TX PPO	$79.78
Rate for Payer: Cash Price	$135.62
Rate for Payer: Cigna Medicaid	$143.60
Rate for Payer: Molina CHIP/Medicaid	$143.60
Rate for Payer: Multiplan Auto	$129.64
Rate for Payer: Multiplan Commercial	$129.64
Rate for Payer: Multiplan Workers Comp	$129.64
Rate for Payer: Parkland Medicaid	$143.60
Rate for Payer: Scott and White EPO/PPO	$99.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$143.60
Rate for Payer: Superior Health Plan EPO	$27.12

TUBE TRCH 6.4MM UNCUF NFEN SHLY

Facility

$276.30

Hospital Charge Code	112383
Hospital Revenue Code	272
Min. Negotiated Rate	$24.87
Max. Negotiated Rate	$198.94
Rate for Payer: Amerigroup CHIP/Medicaid	$24.87
Rate for Payer: BCBS of TX Blue Advantage	$82.89
Rate for Payer: BCBS of TX Blue Essentials	$99.47
Rate for Payer: BCBS of TX PPO	$110.52
Rate for Payer: Cash Price	$187.88
Rate for Payer: Cigna Medicaid	$198.94
Rate for Payer: Molina CHIP/Medicaid	$198.94
Rate for Payer: Multiplan Auto	$179.59
Rate for Payer: Multiplan Commercial	$179.59
Rate for Payer: Multiplan Workers Comp	$179.59
Rate for Payer: Parkland Medicaid	$198.94
Rate for Payer: Scott and White EPO/PPO	$138.15
Rate for Payer: Superior Health Plan CHIP/Medicaid	$198.94
Rate for Payer: Superior Health Plan EPO	$37.58

TUBE TRCH 6.4MM UNCUF NFEN SHLY

Facility

$276.30

Hospital Charge Code	112383
Hospital Revenue Code	272
Rate for Payer: Cash Price	$187.88

TUBE TRCH 7.6MM CUF LP SHLY

Facility

$409.37

Hospital Charge Code	112381
Hospital Revenue Code	272
Min. Negotiated Rate	$36.84
Max. Negotiated Rate	$294.75
Rate for Payer: Amerigroup CHIP/Medicaid	$36.84
Rate for Payer: BCBS of TX Blue Advantage	$122.81
Rate for Payer: BCBS of TX Blue Essentials	$147.37
Rate for Payer: BCBS of TX PPO	$163.75
Rate for Payer: Cash Price	$278.37
Rate for Payer: Cigna Medicaid	$294.75
Rate for Payer: Molina CHIP/Medicaid	$294.75
Rate for Payer: Multiplan Auto	$266.09
Rate for Payer: Multiplan Commercial	$266.09
Rate for Payer: Multiplan Workers Comp	$266.09
Rate for Payer: Parkland Medicaid	$294.75
Rate for Payer: Scott and White EPO/PPO	$204.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$294.75
Rate for Payer: Superior Health Plan EPO	$55.67

TUBE TRCH 7.6MM CUF LP SHLY

Facility

$409.37

Hospital Charge Code	112381
Hospital Revenue Code	272
Rate for Payer: Cash Price	$278.37

TUBE TRCH 7MM CUF DIST XTN

Facility

$274.76

Hospital Charge Code	112395
Hospital Revenue Code	272
Rate for Payer: Cash Price	$186.84

TUBE TRCH 7MM CUF DIST XTN

Facility

$274.76

Hospital Charge Code	112395
Hospital Revenue Code	272
Min. Negotiated Rate	$24.73
Max. Negotiated Rate	$197.83
Rate for Payer: Amerigroup CHIP/Medicaid	$24.73
Rate for Payer: BCBS of TX Blue Advantage	$82.43
Rate for Payer: BCBS of TX Blue Essentials	$98.91
Rate for Payer: BCBS of TX PPO	$109.90
Rate for Payer: Cash Price	$186.84
Rate for Payer: Cigna Medicaid	$197.83
Rate for Payer: Molina CHIP/Medicaid	$197.83
Rate for Payer: Multiplan Auto	$178.59
Rate for Payer: Multiplan Commercial	$178.59
Rate for Payer: Multiplan Workers Comp	$178.59
Rate for Payer: Parkland Medicaid	$197.83
Rate for Payer: Scott and White EPO/PPO	$137.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$197.83
Rate for Payer: Superior Health Plan EPO	$37.37

TUBE TRCH BVN HYFL 7MM ADLT ADJ NK FLNG

Facility

$832.36

Hospital Charge Code	82073255
Hospital Revenue Code	272
Min. Negotiated Rate	$74.91
Max. Negotiated Rate	$599.30
Rate for Payer: Amerigroup CHIP/Medicaid	$74.91
Rate for Payer: BCBS of TX Blue Advantage	$249.71
Rate for Payer: BCBS of TX Blue Essentials	$299.65
Rate for Payer: BCBS of TX PPO	$332.94
Rate for Payer: Cash Price	$566.00
Rate for Payer: Cigna Medicaid	$599.30
Rate for Payer: Molina CHIP/Medicaid	$599.30
Rate for Payer: Multiplan Auto	$541.03
Rate for Payer: Multiplan Commercial	$541.03
Rate for Payer: Multiplan Workers Comp	$541.03
Rate for Payer: Parkland Medicaid	$599.30
Rate for Payer: Scott and White EPO/PPO	$416.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$599.30
Rate for Payer: Superior Health Plan EPO	$113.20

TUBE TRCH BVN HYFL 7MM ADLT ADJ NK FLNG

Facility

$832.36

Hospital Charge Code	82073255
Hospital Revenue Code	272
Rate for Payer: Cash Price	$566.00

TUBE TRCH BVN TTS 7X10X80MM ADLT

Facility

$350.85

Hospital Charge Code	112445
Hospital Revenue Code	272
Min. Negotiated Rate	$31.58
Max. Negotiated Rate	$252.61
Rate for Payer: Amerigroup CHIP/Medicaid	$31.58
Rate for Payer: BCBS of TX Blue Advantage	$105.25
Rate for Payer: BCBS of TX Blue Essentials	$126.31
Rate for Payer: BCBS of TX PPO	$140.34
Rate for Payer: Cash Price	$238.58
Rate for Payer: Cigna Medicaid	$252.61
Rate for Payer: Molina CHIP/Medicaid	$252.61
Rate for Payer: Multiplan Auto	$228.05
Rate for Payer: Multiplan Commercial	$228.05
Rate for Payer: Multiplan Workers Comp	$228.05
Rate for Payer: Parkland Medicaid	$252.61
Rate for Payer: Scott and White EPO/PPO	$175.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$252.61
Rate for Payer: Superior Health Plan EPO	$47.72

TUBE TRCH BVN TTS 7X10X80MM ADLT

Facility

$350.85

Hospital Charge Code	112445
Hospital Revenue Code	272
Rate for Payer: Cash Price	$238.58

TUBE TRCH HPFLX 6MM UNCUF XLN

Facility

$502.03

Hospital Charge Code	112441
Hospital Revenue Code	272
Rate for Payer: Cash Price	$341.38

TUBE TRCH HPFLX 6MM UNCUF XLN

Facility

$502.03

Hospital Charge Code	112441
Hospital Revenue Code	272
Min. Negotiated Rate	$45.18
Max. Negotiated Rate	$361.46
Rate for Payer: Amerigroup CHIP/Medicaid	$45.18
Rate for Payer: BCBS of TX Blue Advantage	$150.61
Rate for Payer: BCBS of TX Blue Essentials	$180.73
Rate for Payer: BCBS of TX PPO	$200.81
Rate for Payer: Cash Price	$341.38
Rate for Payer: Cigna Medicaid	$361.46
Rate for Payer: Molina CHIP/Medicaid	$361.46
Rate for Payer: Multiplan Auto	$326.32
Rate for Payer: Multiplan Commercial	$326.32
Rate for Payer: Multiplan Workers Comp	$326.32
Rate for Payer: Parkland Medicaid	$361.46
Rate for Payer: Scott and White EPO/PPO	$251.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$361.46
Rate for Payer: Superior Health Plan EPO	$68.28

TUBE URINE COLL. YELLOW VAC. 9.5ML

Facility

$3.37

Hospital Charge Code	993262
Hospital Revenue Code	270
Rate for Payer: Cash Price	$2.29

TUBE URINE COLL. YELLOW VAC. 9.5ML

Facility

$3.37

Hospital Charge Code	993262
Hospital Revenue Code	270
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$2.43
Rate for Payer: Amerigroup CHIP/Medicaid	$0.30
Rate for Payer: BCBS of TX Blue Advantage	$1.01
Rate for Payer: BCBS of TX Blue Essentials	$1.21
Rate for Payer: BCBS of TX PPO	$1.35
Rate for Payer: Cash Price	$2.29
Rate for Payer: Cigna Medicaid	$2.43
Rate for Payer: Molina CHIP/Medicaid	$2.43
Rate for Payer: Multiplan Auto	$2.19
Rate for Payer: Multiplan Commercial	$2.19
Rate for Payer: Multiplan Workers Comp	$2.19
Rate for Payer: Parkland Medicaid	$2.43
Rate for Payer: Scott and White EPO/PPO	$1.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.43
Rate for Payer: Superior Health Plan EPO	$0.46

TUBE, VACUETTE, GLUCOSE GRAY CAP 2ML

Facility

$0.45

Hospital Charge Code	993978
Hospital Revenue Code	272
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.32
Rate for Payer: Amerigroup CHIP/Medicaid	$0.04
Rate for Payer: BCBS of TX Blue Advantage	$0.14
Rate for Payer: BCBS of TX Blue Essentials	$0.16
Rate for Payer: BCBS of TX PPO	$0.18
Rate for Payer: Cash Price	$0.31
Rate for Payer: Cigna Medicaid	$0.32
Rate for Payer: Molina CHIP/Medicaid	$0.32
Rate for Payer: Multiplan Auto	$0.29
Rate for Payer: Multiplan Commercial	$0.29
Rate for Payer: Multiplan Workers Comp	$0.29
Rate for Payer: Parkland Medicaid	$0.32
Rate for Payer: Scott and White EPO/PPO	$0.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.32
Rate for Payer: Superior Health Plan EPO	$0.06

TUBE, VACUETTE, GLUCOSE GRAY CAP 2ML

Facility

$0.45

Hospital Charge Code	993978
Hospital Revenue Code	272
Rate for Payer: Cash Price	$0.31

TUBE VACUETTE, URINE CCM, 13X75, 4ML

Facility

$0.90

Hospital Charge Code	993179
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.61

Know your out-of-pocket cost for care.

All Charges