White Rock Medical Center

All Charges

Charge

Type

Setting

Price

WAX BONE 2.5GMS -- DHF

Facility

$211.71

Hospital Charge Code	81952509
Hospital Revenue Code	272
Rate for Payer: Cash Price	$143.96

WAX BONE 2.5GMS -- DHF

Facility

$211.71

Hospital Charge Code	81952509
Hospital Revenue Code	272
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$152.43
Rate for Payer: Amerigroup CHIP/Medicaid	$19.05
Rate for Payer: BCBS of TX Blue Advantage	$63.51
Rate for Payer: BCBS of TX Blue Essentials	$76.22
Rate for Payer: BCBS of TX PPO	$84.68
Rate for Payer: Cash Price	$143.96
Rate for Payer: Cigna Medicaid	$152.43
Rate for Payer: Molina CHIP/Medicaid	$152.43
Rate for Payer: Multiplan Auto	$137.61
Rate for Payer: Multiplan Commercial	$137.61
Rate for Payer: Multiplan Workers Comp	$137.61
Rate for Payer: Parkland Medicaid	$152.43
Rate for Payer: Scott and White EPO/PPO	$105.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$152.43
Rate for Payer: Superior Health Plan EPO	$28.79

Weak D

Facility

$129.00

Service Code	HCPCS 86885
Hospital Charge Code	2402915
Hospital Revenue Code	300
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$361.78
Rate for Payer: Amerigroup CHIP/Medicaid	$2.23
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.72
Rate for Payer: Amerigroup Medicare	$5.72
Rate for Payer: BCBS of TX Blue Advantage	$38.70
Rate for Payer: BCBS of TX Blue Essentials	$46.44
Rate for Payer: BCBS of TX Medicare	$5.72
Rate for Payer: BCBS of TX PPO	$51.60
Rate for Payer: Cash Price	$87.72
Rate for Payer: Cash Price	$87.72
Rate for Payer: Cash Price	$87.72
Rate for Payer: Cigna Commercial	$361.78
Rate for Payer: Cigna Medicaid	$92.88
Rate for Payer: Cigna Medicare	$5.72
Rate for Payer: Employer Direct Commercial	$5.72
Rate for Payer: Humana Medicare/TRICARE	$5.72
Rate for Payer: Molina CHIP/Medicaid	$92.88
Rate for Payer: Molina Dual Medicare/Medicaid	$5.72
Rate for Payer: Molina Medicare	$5.72
Rate for Payer: Multiplan Auto	$83.85
Rate for Payer: Multiplan Commercial	$83.85
Rate for Payer: Multiplan Workers Comp	$83.85
Rate for Payer: Parkland Medicaid	$92.88
Rate for Payer: Scott and White EPO/PPO	$7.15
Rate for Payer: Scott and White Medicare	$5.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$92.88
Rate for Payer: Superior Health Plan EPO	$5.72
Rate for Payer: Superior Health Plan Medicare	$5.72
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.72
Rate for Payer: Universal American Medicare	$5.72
Rate for Payer: Wellcare Medicare	$5.72
Rate for Payer: Wellmed Medicare	$5.72

Weak D

Facility

$129.00

Service Code	HCPCS 86885
Hospital Charge Code	2402915
Hospital Revenue Code	300
Rate for Payer: Cash Price	$87.72

WEDGE COMFORT GLIDE -- DHF

Facility

$144.71

Hospital Charge Code	80399017
Hospital Revenue Code	270
Min. Negotiated Rate	$13.02
Max. Negotiated Rate	$104.19
Rate for Payer: Amerigroup CHIP/Medicaid	$13.02
Rate for Payer: BCBS of TX Blue Advantage	$43.41
Rate for Payer: BCBS of TX Blue Essentials	$52.10
Rate for Payer: BCBS of TX PPO	$57.88
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cigna Medicaid	$104.19
Rate for Payer: Molina CHIP/Medicaid	$104.19
Rate for Payer: Multiplan Auto	$94.06
Rate for Payer: Multiplan Commercial	$94.06
Rate for Payer: Multiplan Workers Comp	$94.06
Rate for Payer: Parkland Medicaid	$104.19
Rate for Payer: Scott and White EPO/PPO	$72.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$104.19
Rate for Payer: Superior Health Plan EPO	$19.68

WEDGE COMFORT GLIDE -- DHF

Facility

$144.71

Hospital Charge Code	80399017
Hospital Revenue Code	270
Rate for Payer: Cash Price	$98.40

Wedge excision of skin of nail fold (eg, for ingrown toenail)

Facility

$6,002.00

Service Code	HCPCS 11765
Hospital Charge Code	8914638
Hospital Revenue Code	360
Rate for Payer: Cash Price	$4,081.36

Wedge excision of skin of nail fold (eg, for ingrown toenail)

Facility

$6,002.00

Service Code	HCPCS 11765
Hospital Charge Code	9900103
Hospital Revenue Code	360
Rate for Payer: Cash Price	$4,081.36

Wedge excision of skin of nail fold (eg, for ingrown toenail)

Facility

$10,000.00

Service Code	CPT 11765
Hospital Charge Code	36011765
Hospital Revenue Code	360
Min. Negotiated Rate	$408.37
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$408.37
Rate for Payer: Amerigroup Medicare	$408.37
Rate for Payer: BCBS of TX Blue Advantage	$533.58
Rate for Payer: BCBS of TX Blue Essentials	$639.02
Rate for Payer: BCBS of TX Medicare	$408.37
Rate for Payer: BCBS of TX PPO	$805.17
Rate for Payer: Cigna Commercial	$863.21
Rate for Payer: Cigna Medicare	$408.37
Rate for Payer: Employer Direct Commercial	$408.37
Rate for Payer: Humana Medicare/TRICARE	$408.37
Rate for Payer: Molina Dual Medicare/Medicaid	$408.37
Rate for Payer: Molina Medicare	$408.37
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	$674.64
Rate for Payer: Scott and White Medicare	$408.37
Rate for Payer: Superior Health Plan EPO	$408.37
Rate for Payer: Superior Health Plan Medicare	$408.37
Rate for Payer: Universal American Dual Medicare/Medicaid	$408.37
Rate for Payer: Universal American Medicare	$408.37
Rate for Payer: Wellcare Medicare	$408.37
Rate for Payer: Wellmed Medicare	$408.37

Wedge excision of skin of nail fold (eg, for ingrown toenail)

Facility

$6,002.00

Service Code	HCPCS 11765
Hospital Charge Code	8914638
Hospital Revenue Code	360
Min. Negotiated Rate	$408.37
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$540.18
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$408.37
Rate for Payer: Amerigroup Medicare	$408.37
Rate for Payer: BCBS of TX Blue Advantage	$533.58
Rate for Payer: BCBS of TX Blue Essentials	$639.02
Rate for Payer: BCBS of TX Medicare	$408.37
Rate for Payer: BCBS of TX PPO	$805.17
Rate for Payer: Cash Price	$4,081.36
Rate for Payer: Cash Price	$4,081.36
Rate for Payer: Cash Price	$4,081.36
Rate for Payer: Cigna Commercial	$863.21
Rate for Payer: Cigna Medicaid	$4,321.44
Rate for Payer: Cigna Medicare	$408.37
Rate for Payer: Employer Direct Commercial	$408.37
Rate for Payer: Humana Medicare/TRICARE	$408.37
Rate for Payer: Molina CHIP/Medicaid	$4,321.44
Rate for Payer: Molina Dual Medicare/Medicaid	$408.37
Rate for Payer: Molina Medicare	$408.37
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	$4,321.44
Rate for Payer: Scott and White EPO/PPO	$674.64
Rate for Payer: Scott and White Medicare	$408.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,321.44
Rate for Payer: Superior Health Plan EPO	$408.37
Rate for Payer: Superior Health Plan Medicare	$408.37
Rate for Payer: Universal American Dual Medicare/Medicaid	$408.37
Rate for Payer: Universal American Medicare	$408.37
Rate for Payer: Wellcare Medicare	$408.37
Rate for Payer: Wellmed Medicare	$408.37

Wedge excision of skin of nail fold (eg, for ingrown toenail)

Facility

$6,002.00

Service Code	HCPCS 11765
Hospital Charge Code	9900103
Hospital Revenue Code	360
Min. Negotiated Rate	$408.37
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$540.18
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$408.37
Rate for Payer: Amerigroup Medicare	$408.37
Rate for Payer: BCBS of TX Blue Advantage	$533.58
Rate for Payer: BCBS of TX Blue Essentials	$639.02
Rate for Payer: BCBS of TX Medicare	$408.37
Rate for Payer: BCBS of TX PPO	$805.17
Rate for Payer: Cash Price	$4,081.36
Rate for Payer: Cash Price	$4,081.36
Rate for Payer: Cash Price	$4,081.36
Rate for Payer: Cigna Commercial	$863.21
Rate for Payer: Cigna Medicaid	$4,321.44
Rate for Payer: Cigna Medicare	$408.37
Rate for Payer: Employer Direct Commercial	$408.37
Rate for Payer: Humana Medicare/TRICARE	$408.37
Rate for Payer: Molina CHIP/Medicaid	$4,321.44
Rate for Payer: Molina Dual Medicare/Medicaid	$408.37
Rate for Payer: Molina Medicare	$408.37
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	$4,321.44
Rate for Payer: Scott and White EPO/PPO	$674.64
Rate for Payer: Scott and White Medicare	$408.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,321.44
Rate for Payer: Superior Health Plan EPO	$408.37
Rate for Payer: Superior Health Plan Medicare	$408.37
Rate for Payer: Universal American Dual Medicare/Medicaid	$408.37
Rate for Payer: Universal American Medicare	$408.37
Rate for Payer: Wellcare Medicare	$408.37
Rate for Payer: Wellmed Medicare	$408.37

WEDGE POSITIONING UNIVERSAL 24X11X8.5

Facility

$58.54

Hospital Charge Code	145202
Hospital Revenue Code	270
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$42.15
Rate for Payer: Amerigroup CHIP/Medicaid	$5.27
Rate for Payer: BCBS of TX Blue Advantage	$17.56
Rate for Payer: BCBS of TX Blue Essentials	$21.07
Rate for Payer: BCBS of TX PPO	$23.42
Rate for Payer: Cash Price	$39.81
Rate for Payer: Cigna Medicaid	$42.15
Rate for Payer: Molina CHIP/Medicaid	$42.15
Rate for Payer: Multiplan Auto	$38.05
Rate for Payer: Multiplan Commercial	$38.05
Rate for Payer: Multiplan Workers Comp	$38.05
Rate for Payer: Parkland Medicaid	$42.15
Rate for Payer: Scott and White EPO/PPO	$29.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$42.15
Rate for Payer: Superior Health Plan EPO	$7.96

WEDGE POSITIONING UNIVERSAL 24X11X8.5

Facility

$58.54

Hospital Charge Code	145202
Hospital Revenue Code	270
Rate for Payer: Cash Price	$39.81

Wet Prep

Facility

$98.00

Service Code	HCPCS 87210
Hospital Charge Code	4107210
Hospital Revenue Code	306
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$70.56
Rate for Payer: Amerigroup CHIP/Medicaid	$2.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.82
Rate for Payer: Amerigroup Medicare	$5.82
Rate for Payer: BCBS of TX Blue Advantage	$29.40
Rate for Payer: BCBS of TX Blue Essentials	$35.28
Rate for Payer: BCBS of TX Medicare	$5.82
Rate for Payer: BCBS of TX PPO	$39.20
Rate for Payer: Cash Price	$66.64
Rate for Payer: Cash Price	$66.64
Rate for Payer: Cigna Medicaid	$70.56
Rate for Payer: Cigna Medicare	$5.82
Rate for Payer: Employer Direct Commercial	$5.82
Rate for Payer: Humana Medicare/TRICARE	$5.82
Rate for Payer: Molina CHIP/Medicaid	$70.56
Rate for Payer: Molina Dual Medicare/Medicaid	$5.82
Rate for Payer: Molina Medicare	$5.82
Rate for Payer: Multiplan Auto	$63.70
Rate for Payer: Multiplan Commercial	$63.70
Rate for Payer: Multiplan Workers Comp	$63.70
Rate for Payer: Parkland Medicaid	$70.56
Rate for Payer: Scott and White EPO/PPO	$7.28
Rate for Payer: Scott and White Medicare	$5.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$70.56
Rate for Payer: Superior Health Plan EPO	$5.82
Rate for Payer: Superior Health Plan Medicare	$5.82
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.82
Rate for Payer: Universal American Medicare	$5.82
Rate for Payer: Wellcare Medicare	$5.82
Rate for Payer: Wellmed Medicare	$5.82

Wet Prep

Facility

$98.00

Service Code	HCPCS 87210
Hospital Charge Code	4107210
Hospital Revenue Code	306
Rate for Payer: Cash Price	$66.64

WIPE CLN LG 6.75X6IN S SNCLTH

Facility

$28.41

Hospital Charge Code	993059
Hospital Revenue Code	270
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$20.46
Rate for Payer: Amerigroup CHIP/Medicaid	$2.56
Rate for Payer: BCBS of TX Blue Advantage	$8.52
Rate for Payer: BCBS of TX Blue Essentials	$10.23
Rate for Payer: BCBS of TX PPO	$11.36
Rate for Payer: Cash Price	$19.32
Rate for Payer: Cigna Medicaid	$20.46
Rate for Payer: Molina CHIP/Medicaid	$20.46
Rate for Payer: Multiplan Auto	$18.47
Rate for Payer: Multiplan Commercial	$18.47
Rate for Payer: Multiplan Workers Comp	$18.47
Rate for Payer: Parkland Medicaid	$20.46
Rate for Payer: Scott and White EPO/PPO	$14.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$20.46
Rate for Payer: Superior Health Plan EPO	$3.86

WIPE CLN LG 6.75X6IN S SNCLTH

Facility

$28.41

Hospital Charge Code	993059
Hospital Revenue Code	270
Rate for Payer: Cash Price	$19.32

WIPE, GERMCDE, SPR, SNI-CLTH, XLG CANSTR

Facility

$297.82

Hospital Charge Code	993793
Hospital Revenue Code	279
Min. Negotiated Rate	$26.80
Max. Negotiated Rate	$214.43
Rate for Payer: Amerigroup CHIP/Medicaid	$26.80
Rate for Payer: BCBS of TX Blue Advantage	$89.35
Rate for Payer: BCBS of TX Blue Essentials	$107.22
Rate for Payer: BCBS of TX PPO	$119.13
Rate for Payer: Cash Price	$202.52
Rate for Payer: Cigna Medicaid	$214.43
Rate for Payer: Molina CHIP/Medicaid	$214.43
Rate for Payer: Multiplan Auto	$193.58
Rate for Payer: Multiplan Commercial	$193.58
Rate for Payer: Multiplan Workers Comp	$193.58
Rate for Payer: Parkland Medicaid	$214.43
Rate for Payer: Scott and White EPO/PPO	$148.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$214.43
Rate for Payer: Superior Health Plan EPO	$40.50

WIPE, GERMCDE, SPR, SNI-CLTH, XLG CANSTR

Facility

$297.82

Hospital Charge Code	993793
Hospital Revenue Code	279
Rate for Payer: Cash Price	$202.52

WIPES SONO ULTRASOUND WOPES,7X10 50/PK

Facility

$75.34

Hospital Charge Code	993110
Hospital Revenue Code	270
Min. Negotiated Rate	$6.78
Max. Negotiated Rate	$54.24
Rate for Payer: Amerigroup CHIP/Medicaid	$6.78
Rate for Payer: BCBS of TX Blue Advantage	$22.60
Rate for Payer: BCBS of TX Blue Essentials	$27.12
Rate for Payer: BCBS of TX PPO	$30.14
Rate for Payer: Cash Price	$51.23
Rate for Payer: Cigna Medicaid	$54.24
Rate for Payer: Molina CHIP/Medicaid	$54.24
Rate for Payer: Multiplan Auto	$48.97
Rate for Payer: Multiplan Commercial	$48.97
Rate for Payer: Multiplan Workers Comp	$48.97
Rate for Payer: Parkland Medicaid	$54.24
Rate for Payer: Scott and White EPO/PPO	$37.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$54.24
Rate for Payer: Superior Health Plan EPO	$10.25

WIPES SONO ULTRASOUND WOPES,7X10 50/PK

Facility

$75.34

Hospital Charge Code	993110
Hospital Revenue Code	270
Rate for Payer: Cash Price	$51.23

WIPE SUPR SNCL XL 14X8IN

Facility

$29.78

Hospital Charge Code	992904
Hospital Revenue Code	270
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$21.44
Rate for Payer: Amerigroup CHIP/Medicaid	$2.68
Rate for Payer: BCBS of TX Blue Advantage	$8.93
Rate for Payer: BCBS of TX Blue Essentials	$10.72
Rate for Payer: BCBS of TX PPO	$11.91
Rate for Payer: Cash Price	$20.25
Rate for Payer: Cigna Medicaid	$21.44
Rate for Payer: Molina CHIP/Medicaid	$21.44
Rate for Payer: Multiplan Auto	$19.36
Rate for Payer: Multiplan Commercial	$19.36
Rate for Payer: Multiplan Workers Comp	$19.36
Rate for Payer: Parkland Medicaid	$21.44
Rate for Payer: Scott and White EPO/PPO	$14.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$21.44
Rate for Payer: Superior Health Plan EPO	$4.05

WIPE SUPR SNCL XL 14X8IN

Facility

$29.78

Hospital Charge Code	992904
Hospital Revenue Code	270
Rate for Payer: Cash Price	$20.25

Wire bayonet 1.8 mm X 400 mm

Facility

$1,316.60

Hospital Charge Code	993387
Hospital Revenue Code	272
Rate for Payer: Cash Price	$895.29

Wire bayonet 1.8 mm X 400 mm

Facility

$1,316.60

Hospital Charge Code	993387
Hospital Revenue Code	272
Min. Negotiated Rate	$118.49
Max. Negotiated Rate	$947.95
Rate for Payer: Amerigroup CHIP/Medicaid	$118.49
Rate for Payer: BCBS of TX Blue Advantage	$394.98
Rate for Payer: BCBS of TX Blue Essentials	$473.98
Rate for Payer: BCBS of TX PPO	$526.64
Rate for Payer: Cash Price	$895.29
Rate for Payer: Cigna Medicaid	$947.95
Rate for Payer: Molina CHIP/Medicaid	$947.95
Rate for Payer: Multiplan Auto	$855.79
Rate for Payer: Multiplan Commercial	$855.79
Rate for Payer: Multiplan Workers Comp	$855.79
Rate for Payer: Parkland Medicaid	$947.95
Rate for Payer: Scott and White EPO/PPO	$658.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$947.95
Rate for Payer: Superior Health Plan EPO	$179.06

Know your out-of-pocket cost for care.

All Charges