White Rock Medical Center

All Charges

Charge

Type

Setting

Price

WAND ARTHRO BIPLR DISP2

Facility

$3,364.14

Hospital Charge Code	81779621
Hospital Revenue Code	272
Min. Negotiated Rate	$302.77
Max. Negotiated Rate	$2,422.18
Rate for Payer: Amerigroup CHIP/Medicaid	$302.77
Rate for Payer: BCBS of TX Blue Advantage	$1,009.24
Rate for Payer: BCBS of TX Blue Essentials	$1,211.09
Rate for Payer: BCBS of TX PPO	$1,345.66
Rate for Payer: Cash Price	$2,287.62
Rate for Payer: Cigna Medicaid	$2,422.18
Rate for Payer: Molina CHIP/Medicaid	$2,422.18
Rate for Payer: Multiplan Auto	$2,186.69
Rate for Payer: Multiplan Commercial	$2,186.69
Rate for Payer: Multiplan Workers Comp	$2,186.69
Rate for Payer: Parkland Medicaid	$2,422.18
Rate for Payer: Scott and White EPO/PPO	$1,682.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,422.18
Rate for Payer: Superior Health Plan EPO	$457.52

warfarin 1 mg Tab

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77880316
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.44

warfarin 1 mg Tab

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77880316
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$5.76
Rate for Payer: Amerigroup CHIP/Medicaid	$0.72
Rate for Payer: BCBS of TX Blue Advantage	$2.40
Rate for Payer: BCBS of TX Blue Essentials	$2.88
Rate for Payer: BCBS of TX PPO	$3.20
Rate for Payer: Cash Price	$5.44
Rate for Payer: Cigna Medicaid	$5.76
Rate for Payer: Molina CHIP/Medicaid	$5.76
Rate for Payer: Multiplan Auto	$5.20
Rate for Payer: Multiplan Commercial	$5.20
Rate for Payer: Multiplan Workers Comp	$5.20
Rate for Payer: Parkland Medicaid	$5.76
Rate for Payer: Scott and White EPO/PPO	$4.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.76
Rate for Payer: Superior Health Plan EPO	$1.09

warfarin 2 mg Tab

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77880418
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.44

warfarin 2 mg Tab

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77880418
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$5.76
Rate for Payer: Amerigroup CHIP/Medicaid	$0.72
Rate for Payer: BCBS of TX Blue Advantage	$2.40
Rate for Payer: BCBS of TX Blue Essentials	$2.88
Rate for Payer: BCBS of TX PPO	$3.20
Rate for Payer: Cash Price	$5.44
Rate for Payer: Cigna Medicaid	$5.76
Rate for Payer: Molina CHIP/Medicaid	$5.76
Rate for Payer: Multiplan Auto	$5.20
Rate for Payer: Multiplan Commercial	$5.20
Rate for Payer: Multiplan Workers Comp	$5.20
Rate for Payer: Parkland Medicaid	$5.76
Rate for Payer: Scott and White EPO/PPO	$4.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.76
Rate for Payer: Superior Health Plan EPO	$1.09

warfarin 5 mg Tab

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77880622
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.44

warfarin 5 mg Tab

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77880622
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$5.76
Rate for Payer: Amerigroup CHIP/Medicaid	$0.72
Rate for Payer: BCBS of TX Blue Advantage	$2.40
Rate for Payer: BCBS of TX Blue Essentials	$2.88
Rate for Payer: BCBS of TX PPO	$3.20
Rate for Payer: Cash Price	$5.44
Rate for Payer: Cigna Medicaid	$5.76
Rate for Payer: Molina CHIP/Medicaid	$5.76
Rate for Payer: Multiplan Auto	$5.20
Rate for Payer: Multiplan Commercial	$5.20
Rate for Payer: Multiplan Workers Comp	$5.20
Rate for Payer: Parkland Medicaid	$5.76
Rate for Payer: Scott and White EPO/PPO	$4.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.76
Rate for Payer: Superior Health Plan EPO	$1.09

warming pad w/rack

Facility

$353.62

Hospital Charge Code	993047
Hospital Revenue Code	270
Min. Negotiated Rate	$31.83
Max. Negotiated Rate	$254.61
Rate for Payer: Amerigroup CHIP/Medicaid	$31.83
Rate for Payer: BCBS of TX Blue Advantage	$106.09
Rate for Payer: BCBS of TX Blue Essentials	$127.30
Rate for Payer: BCBS of TX PPO	$141.45
Rate for Payer: Cash Price	$240.46
Rate for Payer: Cigna Medicaid	$254.61
Rate for Payer: Molina CHIP/Medicaid	$254.61
Rate for Payer: Multiplan Auto	$229.85
Rate for Payer: Multiplan Commercial	$229.85
Rate for Payer: Multiplan Workers Comp	$229.85
Rate for Payer: Parkland Medicaid	$254.61
Rate for Payer: Scott and White EPO/PPO	$176.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$254.61
Rate for Payer: Superior Health Plan EPO	$48.09

warming pad w/rack

Facility

$353.62

Hospital Charge Code	993047
Hospital Revenue Code	270
Rate for Payer: Cash Price	$240.46

WASHBASIN, RECTANGULAR, GRAPHITE, 7.5 QT

Facility

$3.45

Hospital Charge Code	993228
Hospital Revenue Code	270
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$2.48
Rate for Payer: Amerigroup CHIP/Medicaid	$0.31
Rate for Payer: BCBS of TX Blue Advantage	$1.03
Rate for Payer: BCBS of TX Blue Essentials	$1.24
Rate for Payer: BCBS of TX PPO	$1.38
Rate for Payer: Cash Price	$2.35
Rate for Payer: Cigna Medicaid	$2.48
Rate for Payer: Molina CHIP/Medicaid	$2.48
Rate for Payer: Multiplan Auto	$2.24
Rate for Payer: Multiplan Commercial	$2.24
Rate for Payer: Multiplan Workers Comp	$2.24
Rate for Payer: Parkland Medicaid	$2.48
Rate for Payer: Scott and White EPO/PPO	$1.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.48
Rate for Payer: Superior Health Plan EPO	$0.47

WASHBASIN, RECTANGULAR, GRAPHITE, 7.5 QT

Facility

$3.45

Hospital Charge Code	993228
Hospital Revenue Code	270
Rate for Payer: Cash Price	$2.35

WASHCLOTH, DISPOSABLE, WHITE, 10X13'. 50/BG

Facility

$0.39

Hospital Charge Code	993696
Hospital Revenue Code	272
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.28
Rate for Payer: Amerigroup CHIP/Medicaid	$0.04
Rate for Payer: BCBS of TX Blue Advantage	$0.12
Rate for Payer: BCBS of TX Blue Essentials	$0.14
Rate for Payer: BCBS of TX PPO	$0.16
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna Medicaid	$0.28
Rate for Payer: Molina CHIP/Medicaid	$0.28
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	$0.28
Rate for Payer: Scott and White EPO/PPO	$0.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.28
Rate for Payer: Superior Health Plan EPO	$0.05

WASHCLOTH, DISPOSABLE, WHITE, 10X13'. 50/BG

Facility

$0.39

Hospital Charge Code	993696
Hospital Revenue Code	272
Rate for Payer: Cash Price	$0.27

WASHER

Facility

$3,820.86

Hospital Charge Code	993987
Hospital Revenue Code	270
Rate for Payer: Cash Price	$2,598.18

WASHER

Facility

$3,820.86

Hospital Charge Code	993987
Hospital Revenue Code	270
Min. Negotiated Rate	$343.88
Max. Negotiated Rate	$2,751.02
Rate for Payer: Amerigroup CHIP/Medicaid	$343.88
Rate for Payer: BCBS of TX Blue Advantage	$1,146.26
Rate for Payer: BCBS of TX Blue Essentials	$1,375.51
Rate for Payer: BCBS of TX PPO	$1,528.34
Rate for Payer: Cash Price	$2,598.18
Rate for Payer: Cigna Medicaid	$2,751.02
Rate for Payer: Molina CHIP/Medicaid	$2,751.02
Rate for Payer: Multiplan Auto	$2,483.56
Rate for Payer: Multiplan Commercial	$2,483.56
Rate for Payer: Multiplan Workers Comp	$2,483.56
Rate for Payer: Parkland Medicaid	$2,751.02
Rate for Payer: Scott and White EPO/PPO	$1,910.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,751.02
Rate for Payer: Superior Health Plan EPO	$519.64

WASHER FOR 6.5/8.0 SCREWS

Facility

$267.00

Service Code	HCPCS C1713
Hospital Charge Code	126364
Hospital Revenue Code	278
Min. Negotiated Rate	$66.75
Max. Negotiated Rate	$133.50
Rate for Payer: Cash Price	$181.56
Rate for Payer: Cigna Commercial	$66.75
Rate for Payer: Multiplan Auto	$133.50
Rate for Payer: Multiplan Commercial	$133.50
Rate for Payer: Multiplan Workers Comp	$133.50
Rate for Payer: Scott and White EPO/PPO	$133.50

WASHER FOR 6.5/8.0 SCREWS

Facility

$267.00

Service Code	HCPCS C1713
Hospital Charge Code	126364
Hospital Revenue Code	278
Min. Negotiated Rate	$24.03
Max. Negotiated Rate	$192.24
Rate for Payer: Amerigroup CHIP/Medicaid	$24.03
Rate for Payer: BCBS of TX Blue Advantage	$80.10
Rate for Payer: BCBS of TX Blue Essentials	$96.12
Rate for Payer: BCBS of TX PPO	$106.80
Rate for Payer: Cash Price	$181.56
Rate for Payer: Cigna Medicaid	$192.24
Rate for Payer: Molina CHIP/Medicaid	$192.24
Rate for Payer: Multiplan Auto	$133.50
Rate for Payer: Multiplan Commercial	$133.50
Rate for Payer: Multiplan Workers Comp	$133.50
Rate for Payer: Parkland Medicaid	$192.24
Rate for Payer: Scott and White EPO/PPO	$133.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$192.24
Rate for Payer: Superior Health Plan EPO	$36.31

Waste Management Manifold

Facility

$94.23

Hospital Charge Code	993731
Hospital Revenue Code	270
Min. Negotiated Rate	$8.48
Max. Negotiated Rate	$67.85
Rate for Payer: Amerigroup CHIP/Medicaid	$8.48
Rate for Payer: BCBS of TX Blue Advantage	$28.27
Rate for Payer: BCBS of TX Blue Essentials	$33.92
Rate for Payer: BCBS of TX PPO	$37.69
Rate for Payer: Cash Price	$64.08
Rate for Payer: Cigna Medicaid	$67.85
Rate for Payer: Molina CHIP/Medicaid	$67.85
Rate for Payer: Multiplan Auto	$61.25
Rate for Payer: Multiplan Commercial	$61.25
Rate for Payer: Multiplan Workers Comp	$61.25
Rate for Payer: Parkland Medicaid	$67.85
Rate for Payer: Scott and White EPO/PPO	$47.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$67.85
Rate for Payer: Superior Health Plan EPO	$12.82

Waste Management Manifold

Facility

$94.23

Hospital Charge Code	993731
Hospital Revenue Code	270
Rate for Payer: Cash Price	$64.08

WATER, STERILE, 500ML, IRRIGATION, BTL

Facility

$10.67

Hospital Charge Code	992950
Hospital Revenue Code	270
Rate for Payer: Cash Price	$7.26

WATER, STERILE, 500ML, IRRIGATION, BTL

Facility

$10.67

Hospital Charge Code	992950
Hospital Revenue Code	270
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$7.68
Rate for Payer: Amerigroup CHIP/Medicaid	$0.96
Rate for Payer: BCBS of TX Blue Advantage	$3.20
Rate for Payer: BCBS of TX Blue Essentials	$3.84
Rate for Payer: BCBS of TX PPO	$4.27
Rate for Payer: Cash Price	$7.26
Rate for Payer: Cigna Medicaid	$7.68
Rate for Payer: Molina CHIP/Medicaid	$7.68
Rate for Payer: Multiplan Auto	$6.94
Rate for Payer: Multiplan Commercial	$6.94
Rate for Payer: Multiplan Workers Comp	$6.94
Rate for Payer: Parkland Medicaid	$7.68
Rate for Payer: Scott and White EPO/PPO	$5.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.68
Rate for Payer: Superior Health Plan EPO	$1.45

WATER, STERILE FOR INHALATION, USP

Facility

$24.41

Hospital Charge Code	993060
Hospital Revenue Code	270
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$17.58
Rate for Payer: Amerigroup CHIP/Medicaid	$2.20
Rate for Payer: BCBS of TX Blue Advantage	$7.32
Rate for Payer: BCBS of TX Blue Essentials	$8.79
Rate for Payer: BCBS of TX PPO	$9.76
Rate for Payer: Cash Price	$16.60
Rate for Payer: Cigna Medicaid	$17.58
Rate for Payer: Molina CHIP/Medicaid	$17.58
Rate for Payer: Multiplan Auto	$15.87
Rate for Payer: Multiplan Commercial	$15.87
Rate for Payer: Multiplan Workers Comp	$15.87
Rate for Payer: Parkland Medicaid	$17.58
Rate for Payer: Scott and White EPO/PPO	$12.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.58
Rate for Payer: Superior Health Plan EPO	$3.32

WATER, STERILE FOR INHALATION, USP

Facility

$24.41

Hospital Charge Code	993060
Hospital Revenue Code	270
Rate for Payer: Cash Price	$16.60

WATER, STERILE, IRRG, BTL, 1000ML

Facility

$12.04

Hospital Charge Code	992942
Hospital Revenue Code	270
Rate for Payer: Cash Price	$8.19

WATER, STERILE, IRRG, BTL, 1000ML

Facility

$12.04

Hospital Charge Code	992942
Hospital Revenue Code	270
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$8.67
Rate for Payer: Amerigroup CHIP/Medicaid	$1.08
Rate for Payer: BCBS of TX Blue Advantage	$3.61
Rate for Payer: BCBS of TX Blue Essentials	$4.33
Rate for Payer: BCBS of TX PPO	$4.82
Rate for Payer: Cash Price	$8.19
Rate for Payer: Cigna Medicaid	$8.67
Rate for Payer: Molina CHIP/Medicaid	$8.67
Rate for Payer: Multiplan Auto	$7.83
Rate for Payer: Multiplan Commercial	$7.83
Rate for Payer: Multiplan Workers Comp	$7.83
Rate for Payer: Parkland Medicaid	$8.67
Rate for Payer: Scott and White EPO/PPO	$6.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.67
Rate for Payer: Superior Health Plan EPO	$1.64

Know your out-of-pocket cost for care.

All Charges