White Rock Medical Center

All Charges

Charge

Type

Setting

Price

TUBING MODEL 200230 ENDOGATOR FOR EGP-100

Facility

$17.49

Hospital Charge Code	993195
Hospital Revenue Code	270
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$12.59
Rate for Payer: Amerigroup CHIP/Medicaid	$1.57
Rate for Payer: BCBS of TX Blue Advantage	$5.25
Rate for Payer: BCBS of TX Blue Essentials	$6.30
Rate for Payer: BCBS of TX PPO	$7.00
Rate for Payer: Cash Price	$11.89
Rate for Payer: Cigna Medicaid	$12.59
Rate for Payer: Molina CHIP/Medicaid	$12.59
Rate for Payer: Multiplan Auto	$11.37
Rate for Payer: Multiplan Commercial	$11.37
Rate for Payer: Multiplan Workers Comp	$11.37
Rate for Payer: Parkland Medicaid	$12.59
Rate for Payer: Scott and White EPO/PPO	$8.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.59
Rate for Payer: Superior Health Plan EPO	$2.38

TUBING MODEL 200230 ENDOGATOR FOR EGP-100

Facility

$17.49

Hospital Charge Code	993195
Hospital Revenue Code	270
Rate for Payer: Cash Price	$11.89

TUBING, PUMP MAIN FOR AR-6400 ARTHROSCOPY PUMP -- DHF

Facility

$1,305.07

Hospital Charge Code	81776908
Hospital Revenue Code	272
Min. Negotiated Rate	$117.46
Max. Negotiated Rate	$939.65
Rate for Payer: Amerigroup CHIP/Medicaid	$117.46
Rate for Payer: BCBS of TX Blue Advantage	$391.52
Rate for Payer: BCBS of TX Blue Essentials	$469.83
Rate for Payer: BCBS of TX PPO	$522.03
Rate for Payer: Cash Price	$887.45
Rate for Payer: Cigna Medicaid	$939.65
Rate for Payer: Molina CHIP/Medicaid	$939.65
Rate for Payer: Multiplan Auto	$848.30
Rate for Payer: Multiplan Commercial	$848.30
Rate for Payer: Multiplan Workers Comp	$848.30
Rate for Payer: Parkland Medicaid	$939.65
Rate for Payer: Scott and White EPO/PPO	$652.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$939.65
Rate for Payer: Superior Health Plan EPO	$177.49

TUBING, PUMP MAIN FOR AR-6400 ARTHROSCOPY PUMP -- DHF

Facility

$1,305.07

Hospital Charge Code	81776908
Hospital Revenue Code	272
Rate for Payer: Cash Price	$887.45

TUBING SUCT/IRR ENDO W TIP LF DISP

Facility

$23.84

Hospital Charge Code	992683
Hospital Revenue Code	272
Rate for Payer: Cash Price	$16.21

TUBING SUCT/IRR ENDO W TIP LF DISP

Facility

$23.84

Hospital Charge Code	992683
Hospital Revenue Code	272
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$17.16
Rate for Payer: Amerigroup CHIP/Medicaid	$2.15
Rate for Payer: BCBS of TX Blue Advantage	$7.15
Rate for Payer: BCBS of TX Blue Essentials	$8.58
Rate for Payer: BCBS of TX PPO	$9.54
Rate for Payer: Cash Price	$16.21
Rate for Payer: Cigna Medicaid	$17.16
Rate for Payer: Molina CHIP/Medicaid	$17.16
Rate for Payer: Multiplan Auto	$15.50
Rate for Payer: Multiplan Commercial	$15.50
Rate for Payer: Multiplan Workers Comp	$15.50
Rate for Payer: Parkland Medicaid	$17.16
Rate for Payer: Scott and White EPO/PPO	$11.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.16
Rate for Payer: Superior Health Plan EPO	$3.24

TUBING, VAC-COLLECT MEDGYN

Facility

$43.08

Hospital Charge Code	8574470
Hospital Revenue Code	272
Rate for Payer: Cash Price	$29.29

TUBING, VAC-COLLECT MEDGYN

Facility

$43.08

Hospital Charge Code	8574470
Hospital Revenue Code	272
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$31.02
Rate for Payer: Amerigroup CHIP/Medicaid	$3.88
Rate for Payer: BCBS of TX Blue Advantage	$12.92
Rate for Payer: BCBS of TX Blue Essentials	$15.51
Rate for Payer: BCBS of TX PPO	$17.23
Rate for Payer: Cash Price	$29.29
Rate for Payer: Cigna Medicaid	$31.02
Rate for Payer: Molina CHIP/Medicaid	$31.02
Rate for Payer: Multiplan Auto	$28.00
Rate for Payer: Multiplan Commercial	$28.00
Rate for Payer: Multiplan Workers Comp	$28.00
Rate for Payer: Parkland Medicaid	$31.02
Rate for Payer: Scott and White EPO/PPO	$21.54
Rate for Payer: Superior Health Plan CHIP/Medicaid	$31.02
Rate for Payer: Superior Health Plan EPO	$5.86

TUNNELER, CATHETER AND SHEATH 17GX8' DISPOSABLE -- DHF

Facility

$813.30

Hospital Charge Code	81826406
Hospital Revenue Code	272
Rate for Payer: Cash Price	$553.04

TUNNELER, CATHETER AND SHEATH 17GX8' DISPOSABLE -- DHF

Facility

$813.30

Hospital Charge Code	81826406
Hospital Revenue Code	272
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$585.58
Rate for Payer: Amerigroup CHIP/Medicaid	$73.20
Rate for Payer: BCBS of TX Blue Advantage	$243.99
Rate for Payer: BCBS of TX Blue Essentials	$292.79
Rate for Payer: BCBS of TX PPO	$325.32
Rate for Payer: Cash Price	$553.04
Rate for Payer: Cigna Medicaid	$585.58
Rate for Payer: Molina CHIP/Medicaid	$585.58
Rate for Payer: Multiplan Auto	$528.64
Rate for Payer: Multiplan Commercial	$528.64
Rate for Payer: Multiplan Workers Comp	$528.64
Rate for Payer: Parkland Medicaid	$585.58
Rate for Payer: Scott and White EPO/PPO	$406.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$585.58
Rate for Payer: Superior Health Plan EPO	$110.61

TUNNELING TOOL

Facility

$340.50

Hospital Charge Code	13522724
Hospital Revenue Code	272
Min. Negotiated Rate	$30.64
Max. Negotiated Rate	$245.16
Rate for Payer: Amerigroup CHIP/Medicaid	$30.64
Rate for Payer: BCBS of TX Blue Advantage	$102.15
Rate for Payer: BCBS of TX Blue Essentials	$122.58
Rate for Payer: BCBS of TX PPO	$136.20
Rate for Payer: Cash Price	$231.54
Rate for Payer: Cigna Medicaid	$245.16
Rate for Payer: Molina CHIP/Medicaid	$245.16
Rate for Payer: Multiplan Auto	$221.32
Rate for Payer: Multiplan Commercial	$221.32
Rate for Payer: Multiplan Workers Comp	$221.32
Rate for Payer: Parkland Medicaid	$245.16
Rate for Payer: Scott and White EPO/PPO	$170.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$245.16
Rate for Payer: Superior Health Plan EPO	$46.31

TUNNELING TOOL

Facility

$340.50

Hospital Charge Code	13522724
Hospital Revenue Code	272
Rate for Payer: Cash Price	$231.54

TUNNELING TOOL 35CM

Facility

$4.54

Hospital Charge Code	993300
Hospital Revenue Code	272
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$3.27
Rate for Payer: Amerigroup CHIP/Medicaid	$0.41
Rate for Payer: BCBS of TX Blue Advantage	$1.36
Rate for Payer: BCBS of TX Blue Essentials	$1.63
Rate for Payer: BCBS of TX PPO	$1.82
Rate for Payer: Cash Price	$3.09
Rate for Payer: Cigna Medicaid	$3.27
Rate for Payer: Molina CHIP/Medicaid	$3.27
Rate for Payer: Multiplan Auto	$2.95
Rate for Payer: Multiplan Commercial	$2.95
Rate for Payer: Multiplan Workers Comp	$2.95
Rate for Payer: Parkland Medicaid	$3.27
Rate for Payer: Scott and White EPO/PPO	$2.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.27
Rate for Payer: Superior Health Plan EPO	$0.62

TUNNELING TOOL 35CM

Facility

$4.54

Hospital Charge Code	993300
Hospital Revenue Code	272
Rate for Payer: Cash Price	$3.09

TUNNELING TOOL KIT

Facility

$340.50

Hospital Charge Code	993876
Hospital Revenue Code	279
Min. Negotiated Rate	$30.64
Max. Negotiated Rate	$245.16
Rate for Payer: Amerigroup CHIP/Medicaid	$30.64
Rate for Payer: BCBS of TX Blue Advantage	$102.15
Rate for Payer: BCBS of TX Blue Essentials	$122.58
Rate for Payer: BCBS of TX PPO	$136.20
Rate for Payer: Cash Price	$231.54
Rate for Payer: Cigna Medicaid	$245.16
Rate for Payer: Molina CHIP/Medicaid	$245.16
Rate for Payer: Multiplan Auto	$221.32
Rate for Payer: Multiplan Commercial	$221.32
Rate for Payer: Multiplan Workers Comp	$221.32
Rate for Payer: Parkland Medicaid	$245.16
Rate for Payer: Scott and White EPO/PPO	$170.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$245.16
Rate for Payer: Superior Health Plan EPO	$46.31

TUNNELING TOOL KIT

Facility

$340.50

Hospital Charge Code	993876
Hospital Revenue Code	279
Rate for Payer: Cash Price	$231.54

Tx Prophylactic or Diag IVP Single or Initial Drug 96374

Facility

$360.00

Service Code	HCPCS 96374
Hospital Charge Code	1500388
Hospital Revenue Code	260
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$451.67
Rate for Payer: Amerigroup CHIP/Medicaid	$32.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$213.67
Rate for Payer: Amerigroup Medicare	$213.67
Rate for Payer: BCBS of TX Blue Advantage	$108.00
Rate for Payer: BCBS of TX Blue Essentials	$129.60
Rate for Payer: BCBS of TX Medicare	$213.67
Rate for Payer: BCBS of TX PPO	$144.00
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cigna Commercial	$451.67
Rate for Payer: Cigna Medicaid	$259.20
Rate for Payer: Cigna Medicare	$213.67
Rate for Payer: Employer Direct Commercial	$213.67
Rate for Payer: Humana Medicare/TRICARE	$213.67
Rate for Payer: Molina CHIP/Medicaid	$259.20
Rate for Payer: Molina Dual Medicare/Medicaid	$213.67
Rate for Payer: Molina Medicare	$213.67
Rate for Payer: Multiplan Auto	$234.00
Rate for Payer: Multiplan Commercial	$234.00
Rate for Payer: Multiplan Workers Comp	$234.00
Rate for Payer: Parkland Medicaid	$259.20
Rate for Payer: Scott and White EPO/PPO	$45.26
Rate for Payer: Scott and White Medicare	$213.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$259.20
Rate for Payer: Superior Health Plan EPO	$213.67
Rate for Payer: Superior Health Plan Medicare	$213.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$213.67
Rate for Payer: Universal American Medicare	$213.67
Rate for Payer: Wellcare Medicare	$213.67
Rate for Payer: Wellmed Medicare	$213.67

Tx Prophylactic or Diag IVP Single or Initial Drug 96374

Facility

$360.00

Service Code	HCPCS 96374
Hospital Charge Code	1500388
Hospital Revenue Code	260
Rate for Payer: Cash Price	$244.80

Tympanic membrane repair, with or without site preparation of perforation for closure, with or witho

Facility

$6,087.56

Service Code	HCPCS 69610
Hospital Charge Code	9900887
Hospital Revenue Code	360
Rate for Payer: Cash Price	$4,139.54

Tympanic membrane repair, with or without site preparation of perforation for closure, with or witho

Facility

$6,087.56

Service Code	HCPCS 69610
Hospital Charge Code	9900887
Hospital Revenue Code	360
Min. Negotiated Rate	$174.97
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$174.97
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,558.65
Rate for Payer: Amerigroup Medicare	$1,558.65
Rate for Payer: BCBS of TX Blue Advantage	$341.13
Rate for Payer: BCBS of TX Blue Essentials	$408.54
Rate for Payer: BCBS of TX Medicare	$1,558.65
Rate for Payer: BCBS of TX PPO	$514.76
Rate for Payer: Cash Price	$4,139.54
Rate for Payer: Cash Price	$4,139.54
Rate for Payer: Cash Price	$4,139.54
Rate for Payer: Cigna Commercial	$3,294.71
Rate for Payer: Cigna Medicaid	$4,383.04
Rate for Payer: Cigna Medicare	$1,558.65
Rate for Payer: Employer Direct Commercial	$1,558.65
Rate for Payer: Humana Medicare/TRICARE	$1,558.65
Rate for Payer: Molina CHIP/Medicaid	$4,383.04
Rate for Payer: Molina Dual Medicare/Medicaid	$1,558.65
Rate for Payer: Molina Medicare	$1,558.65
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$4,383.04
Rate for Payer: Scott and White EPO/PPO	$2,580.23
Rate for Payer: Scott and White Medicare	$1,558.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,383.04
Rate for Payer: Superior Health Plan EPO	$1,558.65
Rate for Payer: Superior Health Plan Medicare	$1,558.65
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,558.65
Rate for Payer: Universal American Medicare	$1,558.65
Rate for Payer: Wellcare Medicare	$1,558.65
Rate for Payer: Wellmed Medicare	$1,558.65

Tympanic membrane repair, with or without site preparation of perforation for closure, with or witho

Facility

$10,000.00

Service Code	CPT 69610
Hospital Charge Code	36069610
Hospital Revenue Code	360
Min. Negotiated Rate	$174.97
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$174.97
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,558.65
Rate for Payer: Amerigroup Medicare	$1,558.65
Rate for Payer: BCBS of TX Blue Advantage	$341.13
Rate for Payer: BCBS of TX Blue Essentials	$408.54
Rate for Payer: BCBS of TX Medicare	$1,558.65
Rate for Payer: BCBS of TX PPO	$514.76
Rate for Payer: Cigna Commercial	$3,294.71
Rate for Payer: Cigna Medicare	$1,558.65
Rate for Payer: Employer Direct Commercial	$1,558.65
Rate for Payer: Humana Medicare/TRICARE	$1,558.65
Rate for Payer: Molina Dual Medicare/Medicaid	$1,558.65
Rate for Payer: Molina Medicare	$1,558.65
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Scott and White EPO/PPO	$2,580.23
Rate for Payer: Scott and White Medicare	$1,558.65
Rate for Payer: Superior Health Plan EPO	$1,558.65
Rate for Payer: Superior Health Plan Medicare	$1,558.65
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,558.65
Rate for Payer: Universal American Medicare	$1,558.65
Rate for Payer: Wellcare Medicare	$1,558.65
Rate for Payer: Wellmed Medicare	$1,558.65

Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane

Facility

$15,258.15

Service Code	HCPCS 69644
Hospital Charge Code	9900891
Hospital Revenue Code	360
Min. Negotiated Rate	$1,954.22
Max. Negotiated Rate	$12,570.48
Rate for Payer: Amerigroup CHIP/Medicaid	$1,954.22
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Amerigroup Medicare	$5,946.81
Rate for Payer: BCBS of TX Blue Advantage	$8,100.39
Rate for Payer: BCBS of TX Blue Essentials	$9,701.06
Rate for Payer: BCBS of TX Medicare	$5,946.81
Rate for Payer: BCBS of TX PPO	$12,223.34
Rate for Payer: Cash Price	$10,375.54
Rate for Payer: Cash Price	$10,375.54
Rate for Payer: Cash Price	$10,375.54
Rate for Payer: Cigna Commercial	$12,570.48
Rate for Payer: Cigna Medicaid	$10,985.87
Rate for Payer: Cigna Medicare	$5,946.81
Rate for Payer: Employer Direct Commercial	$5,946.81
Rate for Payer: Humana Medicare/TRICARE	$5,946.81
Rate for Payer: Molina CHIP/Medicaid	$10,985.87
Rate for Payer: Molina Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Molina Medicare	$5,946.81
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$10,985.87
Rate for Payer: Scott and White EPO/PPO	$9,908.12
Rate for Payer: Scott and White Medicare	$5,946.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,985.87
Rate for Payer: Superior Health Plan EPO	$5,946.81
Rate for Payer: Superior Health Plan Medicare	$5,946.81
Rate for Payer: Universal American Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Universal American Medicare	$5,946.81
Rate for Payer: Wellcare Medicare	$5,946.81
Rate for Payer: Wellmed Medicare	$5,946.81

Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane

Facility

$12,570.48

Service Code	CPT 69646
Hospital Charge Code	36069646
Hospital Revenue Code	360
Min. Negotiated Rate	$1,954.22
Max. Negotiated Rate	$12,570.48
Rate for Payer: Amerigroup CHIP/Medicaid	$1,954.22
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Amerigroup Medicare	$5,946.81
Rate for Payer: BCBS of TX Blue Advantage	$8,100.39
Rate for Payer: BCBS of TX Blue Essentials	$9,701.06
Rate for Payer: BCBS of TX Medicare	$5,946.81
Rate for Payer: BCBS of TX PPO	$12,223.34
Rate for Payer: Cigna Commercial	$12,570.48
Rate for Payer: Cigna Medicare	$5,946.81
Rate for Payer: Employer Direct Commercial	$5,946.81
Rate for Payer: Humana Medicare/TRICARE	$5,946.81
Rate for Payer: Molina Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Molina Medicare	$5,946.81
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Scott and White EPO/PPO	$9,908.12
Rate for Payer: Scott and White Medicare	$5,946.81
Rate for Payer: Superior Health Plan EPO	$5,946.81
Rate for Payer: Superior Health Plan Medicare	$5,946.81
Rate for Payer: Universal American Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Universal American Medicare	$5,946.81
Rate for Payer: Wellcare Medicare	$5,946.81
Rate for Payer: Wellmed Medicare	$5,946.81

Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane

Facility

$15,258.15

Service Code	HCPCS 69646
Hospital Charge Code	9900892
Hospital Revenue Code	360
Rate for Payer: Cash Price	$10,375.54

Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane

Facility

$15,258.15

Service Code	HCPCS 69644
Hospital Charge Code	9900891
Hospital Revenue Code	360
Rate for Payer: Cash Price	$10,375.54

Know your out-of-pocket cost for care.

All Charges