White Rock Medical Center

All Charges

Charge

Type

Setting

Price

TUBE VACUETTE, URINE CCM, 13X75, 4ML

Facility

$0.90

Hospital Charge Code	993179
Hospital Revenue Code	270
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.65
Rate for Payer: Amerigroup CHIP/Medicaid	$0.08
Rate for Payer: BCBS of TX Blue Advantage	$0.27
Rate for Payer: BCBS of TX Blue Essentials	$0.32
Rate for Payer: BCBS of TX PPO	$0.36
Rate for Payer: Cash Price	$0.61
Rate for Payer: Cigna Medicaid	$0.65
Rate for Payer: Molina CHIP/Medicaid	$0.65
Rate for Payer: Multiplan Auto	$0.59
Rate for Payer: Multiplan Commercial	$0.59
Rate for Payer: Multiplan Workers Comp	$0.59
Rate for Payer: Parkland Medicaid	$0.65
Rate for Payer: Scott and White EPO/PPO	$0.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.65
Rate for Payer: Superior Health Plan EPO	$0.12

TUBE, VACUETTE, WHL BLD K2 LAV CAP 3ML

Facility

$0.34

Hospital Charge Code	993979
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.24
Rate for Payer: Amerigroup CHIP/Medicaid	$0.03
Rate for Payer: BCBS of TX Blue Advantage	$0.10
Rate for Payer: BCBS of TX Blue Essentials	$0.12
Rate for Payer: BCBS of TX PPO	$0.14
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna Medicaid	$0.24
Rate for Payer: Molina CHIP/Medicaid	$0.24
Rate for Payer: Multiplan Auto	$0.22
Rate for Payer: Multiplan Commercial	$0.22
Rate for Payer: Multiplan Workers Comp	$0.22
Rate for Payer: Parkland Medicaid	$0.24
Rate for Payer: Scott and White EPO/PPO	$0.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.24
Rate for Payer: Superior Health Plan EPO	$0.05

TUBE, VACUETTE, WHL BLD K2 LAV CAP 3ML

Facility

$0.34

Hospital Charge Code	993979
Hospital Revenue Code	272
Rate for Payer: Cash Price	$0.23

TUBE, Z URINE ROUND BASE, 9 ML, 16 X 1

Facility

$0.56

Hospital Charge Code	993078
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.38

TUBE, Z URINE ROUND BASE, 9 ML, 16 X 1

Facility

$0.56

Hospital Charge Code	993078
Hospital Revenue Code	270
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.40
Rate for Payer: Amerigroup CHIP/Medicaid	$0.05
Rate for Payer: BCBS of TX Blue Advantage	$0.17
Rate for Payer: BCBS of TX Blue Essentials	$0.20
Rate for Payer: BCBS of TX PPO	$0.22
Rate for Payer: Cash Price	$0.38
Rate for Payer: Cigna Medicaid	$0.40
Rate for Payer: Molina CHIP/Medicaid	$0.40
Rate for Payer: Multiplan Auto	$0.36
Rate for Payer: Multiplan Commercial	$0.36
Rate for Payer: Multiplan Workers Comp	$0.36
Rate for Payer: Parkland Medicaid	$0.40
Rate for Payer: Scott and White EPO/PPO	$0.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.40
Rate for Payer: Superior Health Plan EPO	$0.08

TUBING ARTERIAL PRESSURE MONITORING PVC F-M LL 2

Facility

$2.16

Hospital Charge Code	993296
Hospital Revenue Code	270
Rate for Payer: Cash Price	$1.47

TUBING ARTERIAL PRESSURE MONITORING PVC F-M LL 2

Facility

$2.16

Hospital Charge Code	993296
Hospital Revenue Code	270
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$1.56
Rate for Payer: Amerigroup CHIP/Medicaid	$0.19
Rate for Payer: BCBS of TX Blue Advantage	$0.65
Rate for Payer: BCBS of TX Blue Essentials	$0.78
Rate for Payer: BCBS of TX PPO	$0.86
Rate for Payer: Cash Price	$1.47
Rate for Payer: Cigna Medicaid	$1.56
Rate for Payer: Molina CHIP/Medicaid	$1.56
Rate for Payer: Multiplan Auto	$1.40
Rate for Payer: Multiplan Commercial	$1.40
Rate for Payer: Multiplan Workers Comp	$1.40
Rate for Payer: Parkland Medicaid	$1.56
Rate for Payer: Scott and White EPO/PPO	$1.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.56
Rate for Payer: Superior Health Plan EPO	$0.29

TUBING ARTHROSCOPY CASSETTE INFLOW

Facility

$335.12

Hospital Charge Code	993204
Hospital Revenue Code	272
Min. Negotiated Rate	$30.16
Max. Negotiated Rate	$241.29
Rate for Payer: Amerigroup CHIP/Medicaid	$30.16
Rate for Payer: BCBS of TX Blue Advantage	$100.54
Rate for Payer: BCBS of TX Blue Essentials	$120.64
Rate for Payer: BCBS of TX PPO	$134.05
Rate for Payer: Cash Price	$227.88
Rate for Payer: Cigna Medicaid	$241.29
Rate for Payer: Molina CHIP/Medicaid	$241.29
Rate for Payer: Multiplan Auto	$217.83
Rate for Payer: Multiplan Commercial	$217.83
Rate for Payer: Multiplan Workers Comp	$217.83
Rate for Payer: Parkland Medicaid	$241.29
Rate for Payer: Scott and White EPO/PPO	$167.56
Rate for Payer: Superior Health Plan CHIP/Medicaid	$241.29
Rate for Payer: Superior Health Plan EPO	$45.58

TUBING ARTHROSCOPY CASSETTE INFLOW

Facility

$335.12

Hospital Charge Code	993204
Hospital Revenue Code	272
Rate for Payer: Cash Price	$227.88

TUBING, ARTHROSCOPY CASSETTE INFLOW -- DHF

Facility

$276.94

Hospital Charge Code	81860082
Hospital Revenue Code	272
Rate for Payer: Cash Price	$188.32

TUBING, ARTHROSCOPY CASSETTE INFLOW -- DHF

Facility

$276.94

Hospital Charge Code	81860082
Hospital Revenue Code	272
Min. Negotiated Rate	$24.92
Max. Negotiated Rate	$199.40
Rate for Payer: Amerigroup CHIP/Medicaid	$24.92
Rate for Payer: BCBS of TX Blue Advantage	$83.08
Rate for Payer: BCBS of TX Blue Essentials	$99.70
Rate for Payer: BCBS of TX PPO	$110.78
Rate for Payer: Cash Price	$188.32
Rate for Payer: Cigna Medicaid	$199.40
Rate for Payer: Molina CHIP/Medicaid	$199.40
Rate for Payer: Multiplan Auto	$180.01
Rate for Payer: Multiplan Commercial	$180.01
Rate for Payer: Multiplan Workers Comp	$180.01
Rate for Payer: Parkland Medicaid	$199.40
Rate for Payer: Scott and White EPO/PPO	$138.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$199.40
Rate for Payer: Superior Health Plan EPO	$37.66

TUBING ARTHROSCOPY VERIFLOW

Facility

$227.00

Hospital Charge Code	144831
Hospital Revenue Code	272
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$163.44
Rate for Payer: Amerigroup CHIP/Medicaid	$20.43
Rate for Payer: BCBS of TX Blue Advantage	$68.10
Rate for Payer: BCBS of TX Blue Essentials	$81.72
Rate for Payer: BCBS of TX PPO	$90.80
Rate for Payer: Cash Price	$154.36
Rate for Payer: Cigna Medicaid	$163.44
Rate for Payer: Molina CHIP/Medicaid	$163.44
Rate for Payer: Multiplan Auto	$147.55
Rate for Payer: Multiplan Commercial	$147.55
Rate for Payer: Multiplan Workers Comp	$147.55
Rate for Payer: Parkland Medicaid	$163.44
Rate for Payer: Scott and White EPO/PPO	$113.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$163.44
Rate for Payer: Superior Health Plan EPO	$30.87

TUBING ARTHROSCOPY VERIFLOW

Facility

$227.00

Hospital Charge Code	144831
Hospital Revenue Code	272
Rate for Payer: Cash Price	$154.36

TUBING CONNECTOR VASOPRESS 60'

Facility

$9.73

Hospital Charge Code	993176
Hospital Revenue Code	272
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$7.01
Rate for Payer: Amerigroup CHIP/Medicaid	$0.88
Rate for Payer: BCBS of TX Blue Advantage	$2.92
Rate for Payer: BCBS of TX Blue Essentials	$3.50
Rate for Payer: BCBS of TX PPO	$3.89
Rate for Payer: Cash Price	$6.62
Rate for Payer: Cigna Medicaid	$7.01
Rate for Payer: Molina CHIP/Medicaid	$7.01
Rate for Payer: Multiplan Auto	$6.32
Rate for Payer: Multiplan Commercial	$6.32
Rate for Payer: Multiplan Workers Comp	$6.32
Rate for Payer: Parkland Medicaid	$7.01
Rate for Payer: Scott and White EPO/PPO	$4.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.01
Rate for Payer: Superior Health Plan EPO	$1.32

TUBING CONNECTOR VASOPRESS 60'

Facility

$9.73

Hospital Charge Code	993176
Hospital Revenue Code	272
Rate for Payer: Cash Price	$6.62

TUBING, GAS LINE HIGH PRESS SIDE-KICK MANIPULATOR

Facility

$246.25

Hospital Charge Code	80347206
Hospital Revenue Code	270
Rate for Payer: Cash Price	$167.45

TUBING, GAS LINE HIGH PRESS SIDE-KICK MANIPULATOR

Facility

$246.25

Hospital Charge Code	80347206
Hospital Revenue Code	270
Min. Negotiated Rate	$22.16
Max. Negotiated Rate	$177.30
Rate for Payer: Amerigroup CHIP/Medicaid	$22.16
Rate for Payer: BCBS of TX Blue Advantage	$73.88
Rate for Payer: BCBS of TX Blue Essentials	$88.65
Rate for Payer: BCBS of TX PPO	$98.50
Rate for Payer: Cash Price	$167.45
Rate for Payer: Cigna Medicaid	$177.30
Rate for Payer: Molina CHIP/Medicaid	$177.30
Rate for Payer: Multiplan Auto	$160.06
Rate for Payer: Multiplan Commercial	$160.06
Rate for Payer: Multiplan Workers Comp	$160.06
Rate for Payer: Parkland Medicaid	$177.30
Rate for Payer: Scott and White EPO/PPO	$123.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$177.30
Rate for Payer: Superior Health Plan EPO	$33.49

TUBING, INSUFLOW LAPAROSCOPIC FILTER HEATER 8'4' -- DHF

Facility

$1,930.01

Hospital Charge Code	80324957
Hospital Revenue Code	270
Rate for Payer: Cash Price	$1,312.41

TUBING, INSUFLOW LAPAROSCOPIC FILTER HEATER 8'4' -- DHF

Facility

$1,930.01

Hospital Charge Code	80324957
Hospital Revenue Code	270
Min. Negotiated Rate	$173.70
Max. Negotiated Rate	$1,389.61
Rate for Payer: Amerigroup CHIP/Medicaid	$173.70
Rate for Payer: BCBS of TX Blue Advantage	$579.00
Rate for Payer: BCBS of TX Blue Essentials	$694.80
Rate for Payer: BCBS of TX PPO	$772.00
Rate for Payer: Cash Price	$1,312.41
Rate for Payer: Cigna Medicaid	$1,389.61
Rate for Payer: Molina CHIP/Medicaid	$1,389.61
Rate for Payer: Multiplan Auto	$1,254.51
Rate for Payer: Multiplan Commercial	$1,254.51
Rate for Payer: Multiplan Workers Comp	$1,254.51
Rate for Payer: Parkland Medicaid	$1,389.61
Rate for Payer: Scott and White EPO/PPO	$965.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,389.61
Rate for Payer: Superior Health Plan EPO	$262.48

tubing irrigation 24hr erbe pump

Facility

$43.13

Hospital Charge Code	8626513
Hospital Revenue Code	272
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$31.05
Rate for Payer: Amerigroup CHIP/Medicaid	$3.88
Rate for Payer: BCBS of TX Blue Advantage	$12.94
Rate for Payer: BCBS of TX Blue Essentials	$15.53
Rate for Payer: BCBS of TX PPO	$17.25
Rate for Payer: Cash Price	$29.33
Rate for Payer: Cigna Medicaid	$31.05
Rate for Payer: Molina CHIP/Medicaid	$31.05
Rate for Payer: Multiplan Auto	$28.03
Rate for Payer: Multiplan Commercial	$28.03
Rate for Payer: Multiplan Workers Comp	$28.03
Rate for Payer: Parkland Medicaid	$31.05
Rate for Payer: Scott and White EPO/PPO	$21.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$31.05
Rate for Payer: Superior Health Plan EPO	$5.87

tubing irrigation 24hr erbe pump

Facility

$43.13

Hospital Charge Code	8626513
Hospital Revenue Code	272
Rate for Payer: Cash Price	$29.33

TUBING IRRIGATION LAPAROSCOPIC 4L/MIN FLOW RATE 10FTL PEDIAT

Facility

$30.16

Hospital Charge Code	993594
Hospital Revenue Code	272
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$21.72
Rate for Payer: Amerigroup CHIP/Medicaid	$2.71
Rate for Payer: BCBS of TX Blue Advantage	$9.05
Rate for Payer: BCBS of TX Blue Essentials	$10.86
Rate for Payer: BCBS of TX PPO	$12.06
Rate for Payer: Cash Price	$20.51
Rate for Payer: Cigna Medicaid	$21.72
Rate for Payer: Molina CHIP/Medicaid	$21.72
Rate for Payer: Multiplan Auto	$19.60
Rate for Payer: Multiplan Commercial	$19.60
Rate for Payer: Multiplan Workers Comp	$19.60
Rate for Payer: Parkland Medicaid	$21.72
Rate for Payer: Scott and White EPO/PPO	$15.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$21.72
Rate for Payer: Superior Health Plan EPO	$4.10

TUBING IRRIGATION LAPAROSCOPIC 4L/MIN FLOW RATE 10FTL PEDIAT

Facility

$30.16

Hospital Charge Code	993594
Hospital Revenue Code	272
Rate for Payer: Cash Price	$20.51

TUBING, KLEIN PUMP 13'

Facility

$92.53

Hospital Charge Code	133085
Hospital Revenue Code	272
Min. Negotiated Rate	$8.33
Max. Negotiated Rate	$66.62
Rate for Payer: Amerigroup CHIP/Medicaid	$8.33
Rate for Payer: BCBS of TX Blue Advantage	$27.76
Rate for Payer: BCBS of TX Blue Essentials	$33.31
Rate for Payer: BCBS of TX PPO	$37.01
Rate for Payer: Cash Price	$62.92
Rate for Payer: Cigna Medicaid	$66.62
Rate for Payer: Molina CHIP/Medicaid	$66.62
Rate for Payer: Multiplan Auto	$60.14
Rate for Payer: Multiplan Commercial	$60.14
Rate for Payer: Multiplan Workers Comp	$60.14
Rate for Payer: Parkland Medicaid	$66.62
Rate for Payer: Scott and White EPO/PPO	$46.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$66.62
Rate for Payer: Superior Health Plan EPO	$12.58

TUBING, KLEIN PUMP 13'

Facility

$92.53

Hospital Charge Code	133085
Hospital Revenue Code	272
Rate for Payer: Cash Price	$62.92

Know your out-of-pocket cost for care.

All Charges