White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Y-KNOT FLEX DISP. PERC PK

Facility

$545.89

Hospital Charge Code	146673
Hospital Revenue Code	272
Min. Negotiated Rate	$49.13
Max. Negotiated Rate	$393.04
Rate for Payer: Amerigroup CHIP/Medicaid	$49.13
Rate for Payer: BCBS of TX Blue Advantage	$163.77
Rate for Payer: BCBS of TX Blue Essentials	$196.52
Rate for Payer: BCBS of TX PPO	$218.36
Rate for Payer: Cash Price	$371.21
Rate for Payer: Cigna Medicaid	$393.04
Rate for Payer: Molina CHIP/Medicaid	$393.04
Rate for Payer: Multiplan Auto	$354.83
Rate for Payer: Multiplan Commercial	$354.83
Rate for Payer: Multiplan Workers Comp	$354.83
Rate for Payer: Parkland Medicaid	$393.04
Rate for Payer: Scott and White EPO/PPO	$272.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$393.04
Rate for Payer: Superior Health Plan EPO	$74.24

YST TEST KIT VTK2 20 CARDS

Facility

$493.59

Hospital Charge Code	992625
Hospital Revenue Code	270
Rate for Payer: Cash Price	$335.64

YST TEST KIT VTK2 20 CARDS

Facility

$493.59

Hospital Charge Code	992625
Hospital Revenue Code	270
Min. Negotiated Rate	$44.42
Max. Negotiated Rate	$355.38
Rate for Payer: Amerigroup CHIP/Medicaid	$44.42
Rate for Payer: BCBS of TX Blue Advantage	$148.08
Rate for Payer: BCBS of TX Blue Essentials	$177.69
Rate for Payer: BCBS of TX PPO	$197.44
Rate for Payer: Cash Price	$335.64
Rate for Payer: Cigna Medicaid	$355.38
Rate for Payer: Molina CHIP/Medicaid	$355.38
Rate for Payer: Multiplan Auto	$320.83
Rate for Payer: Multiplan Commercial	$320.83
Rate for Payer: Multiplan Workers Comp	$320.83
Rate for Payer: Parkland Medicaid	$355.38
Rate for Payer: Scott and White EPO/PPO	$246.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$355.38
Rate for Payer: Superior Health Plan EPO	$67.13

Zavation 2.5cc DBM Putty

Facility

$4,111.45

Service Code	HCPCS C9359
Hospital Charge Code	992217
Hospital Revenue Code	278
Min. Negotiated Rate	$370.03
Max. Negotiated Rate	$2,960.24
Rate for Payer: Amerigroup CHIP/Medicaid	$370.03
Rate for Payer: BCBS of TX Blue Advantage	$1,233.43
Rate for Payer: BCBS of TX Blue Essentials	$1,480.12
Rate for Payer: BCBS of TX PPO	$1,644.58
Rate for Payer: Cash Price	$2,795.79
Rate for Payer: Cigna Medicaid	$2,960.24
Rate for Payer: Molina CHIP/Medicaid	$2,960.24
Rate for Payer: Multiplan Auto	$2,055.72
Rate for Payer: Multiplan Commercial	$2,055.72
Rate for Payer: Multiplan Workers Comp	$2,055.72
Rate for Payer: Parkland Medicaid	$2,960.24
Rate for Payer: Scott and White EPO/PPO	$2,055.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,960.24
Rate for Payer: Superior Health Plan EPO	$559.16

Zavation 2.5cc DBM Putty

Facility

$4,111.45

Service Code	HCPCS C9359
Hospital Charge Code	992217
Hospital Revenue Code	278
Min. Negotiated Rate	$1,027.86
Max. Negotiated Rate	$2,055.72
Rate for Payer: Cash Price	$2,795.79
Rate for Payer: Cigna Commercial	$1,027.86
Rate for Payer: Multiplan Auto	$2,055.72
Rate for Payer: Multiplan Commercial	$2,055.72
Rate for Payer: Multiplan Workers Comp	$2,055.72
Rate for Payer: Scott and White EPO/PPO	$2,055.72

ZIMMER: 60707010400ATS Disposable Tourniquet Cuff, 24 L x 4

Facility

$11.35

Hospital Charge Code	993691
Hospital Revenue Code	270
Rate for Payer: Cash Price	$7.72

ZIMMER: 60707010400ATS Disposable Tourniquet Cuff, 24 L x 4

Facility

$11.35

Hospital Charge Code	993691
Hospital Revenue Code	270
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$8.17
Rate for Payer: Amerigroup CHIP/Medicaid	$1.02
Rate for Payer: BCBS of TX Blue Advantage	$3.40
Rate for Payer: BCBS of TX Blue Essentials	$4.09
Rate for Payer: BCBS of TX PPO	$4.54
Rate for Payer: Cash Price	$7.72
Rate for Payer: Cigna Medicaid	$8.17
Rate for Payer: Molina CHIP/Medicaid	$8.17
Rate for Payer: Multiplan Auto	$7.38
Rate for Payer: Multiplan Commercial	$7.38
Rate for Payer: Multiplan Workers Comp	$7.38
Rate for Payer: Parkland Medicaid	$8.17
Rate for Payer: Scott and White EPO/PPO	$5.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.17
Rate for Payer: Superior Health Plan EPO	$1.54

ZIMM STAPIER

Facility

$708.24

Hospital Charge Code	993635
Hospital Revenue Code	272
Rate for Payer: Cash Price	$481.60

ZIMM STAPIER

Facility

$708.24

Hospital Charge Code	993635
Hospital Revenue Code	272
Min. Negotiated Rate	$63.74
Max. Negotiated Rate	$509.93
Rate for Payer: Amerigroup CHIP/Medicaid	$63.74
Rate for Payer: BCBS of TX Blue Advantage	$212.47
Rate for Payer: BCBS of TX Blue Essentials	$254.97
Rate for Payer: BCBS of TX PPO	$283.30
Rate for Payer: Cash Price	$481.60
Rate for Payer: Cigna Medicaid	$509.93
Rate for Payer: Molina CHIP/Medicaid	$509.93
Rate for Payer: Multiplan Auto	$460.36
Rate for Payer: Multiplan Commercial	$460.36
Rate for Payer: Multiplan Workers Comp	$460.36
Rate for Payer: Parkland Medicaid	$509.93
Rate for Payer: Scott and White EPO/PPO	$354.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$509.93
Rate for Payer: Superior Health Plan EPO	$96.32

ZINC, MENTHOL, REMEDY SPECIALIZED, 4OZ

Facility

$23.12

Hospital Charge Code	993219
Hospital Revenue Code	270
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$16.65
Rate for Payer: Amerigroup CHIP/Medicaid	$2.08
Rate for Payer: BCBS of TX Blue Advantage	$6.94
Rate for Payer: BCBS of TX Blue Essentials	$8.32
Rate for Payer: BCBS of TX PPO	$9.25
Rate for Payer: Cash Price	$15.72
Rate for Payer: Cigna Medicaid	$16.65
Rate for Payer: Molina CHIP/Medicaid	$16.65
Rate for Payer: Multiplan Auto	$15.03
Rate for Payer: Multiplan Commercial	$15.03
Rate for Payer: Multiplan Workers Comp	$15.03
Rate for Payer: Parkland Medicaid	$16.65
Rate for Payer: Scott and White EPO/PPO	$11.56
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16.65
Rate for Payer: Superior Health Plan EPO	$3.14

ZINC, MENTHOL, REMEDY SPECIALIZED, 4OZ

Facility

$23.12

Hospital Charge Code	993219
Hospital Revenue Code	270
Rate for Payer: Cash Price	$15.72

Zinc, Plasma or Serum SO

Facility

$97.00

Service Code	HCPCS 84630
Hospital Charge Code	1700434
Hospital Revenue Code	301
Rate for Payer: Cash Price	$65.96

Zinc, Plasma or Serum SO

Facility

$97.00

Service Code	HCPCS 84630
Hospital Charge Code	1700434
Hospital Revenue Code	301
Min. Negotiated Rate	$4.44
Max. Negotiated Rate	$69.84
Rate for Payer: Amerigroup CHIP/Medicaid	$4.44
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11.39
Rate for Payer: Amerigroup Medicare	$11.39
Rate for Payer: BCBS of TX Blue Advantage	$29.10
Rate for Payer: BCBS of TX Blue Essentials	$34.92
Rate for Payer: BCBS of TX Medicare	$11.39
Rate for Payer: BCBS of TX PPO	$38.80
Rate for Payer: Cash Price	$65.96
Rate for Payer: Cash Price	$65.96
Rate for Payer: Cigna Medicaid	$69.84
Rate for Payer: Cigna Medicare	$11.39
Rate for Payer: Employer Direct Commercial	$11.39
Rate for Payer: Humana Medicare/TRICARE	$11.39
Rate for Payer: Molina CHIP/Medicaid	$69.84
Rate for Payer: Molina Dual Medicare/Medicaid	$11.39
Rate for Payer: Molina Medicare	$11.39
Rate for Payer: Multiplan Auto	$63.05
Rate for Payer: Multiplan Commercial	$63.05
Rate for Payer: Multiplan Workers Comp	$63.05
Rate for Payer: Parkland Medicaid	$69.84
Rate for Payer: Scott and White EPO/PPO	$14.24
Rate for Payer: Scott and White Medicare	$11.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$69.84
Rate for Payer: Superior Health Plan EPO	$11.39
Rate for Payer: Superior Health Plan Medicare	$11.39
Rate for Payer: Universal American Dual Medicare/Medicaid	$11.39
Rate for Payer: Universal American Medicare	$11.39
Rate for Payer: Wellcare Medicare	$11.39
Rate for Payer: Wellmed Medicare	$11.39

zinc sulfate 220 mg Cap

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77885668
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$5.51
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.29
Rate for Payer: BCBS of TX Blue Essentials	$2.75
Rate for Payer: BCBS of TX PPO	$3.06
Rate for Payer: Cash Price	$5.20
Rate for Payer: Cigna Medicaid	$5.51
Rate for Payer: Molina CHIP/Medicaid	$5.51
Rate for Payer: Multiplan Auto	$4.97
Rate for Payer: Multiplan Commercial	$4.97
Rate for Payer: Multiplan Workers Comp	$4.97
Rate for Payer: Parkland Medicaid	$5.51
Rate for Payer: Scott and White EPO/PPO	$3.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.51
Rate for Payer: Superior Health Plan EPO	$1.04

zinc sulfate 220 mg Cap

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77885668
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

ziprasidone 20 mg Cap

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77885878
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

ziprasidone 20 mg Cap

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77885878
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.44

ziprasidone 20 mg IM Inj

Facility

$672.85

Service Code	HCPCS J3486
Hospital Charge Code	77885933
Hospital Revenue Code	636
Min. Negotiated Rate	$36.02
Max. Negotiated Rate	$484.45
Rate for Payer: Amerigroup CHIP/Medicaid	$60.56
Rate for Payer: BCBS of TX Blue Advantage	$36.02
Rate for Payer: BCBS of TX Blue Essentials	$43.22
Rate for Payer: BCBS of TX PPO	$47.94
Rate for Payer: Cash Price	$457.54
Rate for Payer: Cash Price	$457.54
Rate for Payer: Cigna Medicaid	$484.45
Rate for Payer: Molina CHIP/Medicaid	$484.45
Rate for Payer: Multiplan Auto	$437.35
Rate for Payer: Multiplan Commercial	$437.35
Rate for Payer: Multiplan Workers Comp	$437.35
Rate for Payer: Parkland Medicaid	$484.45
Rate for Payer: Scott and White EPO/PPO	$336.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$484.45
Rate for Payer: Superior Health Plan EPO	$91.51

ziprasidone 20 mg IM Inj

Facility

$672.85

Service Code	HCPCS J3486
Hospital Charge Code	77885933
Hospital Revenue Code	636
Min. Negotiated Rate	$168.21
Max. Negotiated Rate	$336.43
Rate for Payer: Cash Price	$457.54
Rate for Payer: Cigna Commercial	$168.21
Rate for Payer: Scott and White EPO/PPO	$336.43

zolpidem 5 mg Tab

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77887089
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.44

zolpidem 5 mg Tab

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77887089
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

Zonisamide (Zonegran), Serum SO

Facility

$152.98

Service Code	HCPCS 80203
Hospital Charge Code	9145017
Hospital Revenue Code	301
Rate for Payer: Cash Price	$104.03

Zonisamide (Zonegran), Serum SO

Facility

$152.98

Service Code	HCPCS 80203
Hospital Charge Code	9145017
Hospital Revenue Code	301
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$110.15
Rate for Payer: Amerigroup CHIP/Medicaid	$5.17
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13.25
Rate for Payer: Amerigroup Medicare	$13.25
Rate for Payer: BCBS of TX Blue Advantage	$45.89
Rate for Payer: BCBS of TX Blue Essentials	$55.07
Rate for Payer: BCBS of TX Medicare	$13.25
Rate for Payer: BCBS of TX PPO	$61.19
Rate for Payer: Cash Price	$104.03
Rate for Payer: Cash Price	$104.03
Rate for Payer: Cigna Medicaid	$110.15
Rate for Payer: Cigna Medicare	$13.25
Rate for Payer: Employer Direct Commercial	$13.25
Rate for Payer: Humana Medicare/TRICARE	$13.25
Rate for Payer: Molina CHIP/Medicaid	$110.15
Rate for Payer: Molina Dual Medicare/Medicaid	$13.25
Rate for Payer: Molina Medicare	$13.25
Rate for Payer: Multiplan Auto	$99.44
Rate for Payer: Multiplan Commercial	$99.44
Rate for Payer: Multiplan Workers Comp	$99.44
Rate for Payer: Parkland Medicaid	$110.15
Rate for Payer: Scott and White EPO/PPO	$16.56
Rate for Payer: Scott and White Medicare	$13.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$110.15
Rate for Payer: Superior Health Plan EPO	$13.25
Rate for Payer: Superior Health Plan Medicare	$13.25
Rate for Payer: Universal American Dual Medicare/Medicaid	$13.25
Rate for Payer: Universal American Medicare	$13.25
Rate for Payer: Wellcare Medicare	$13.25
Rate for Payer: Wellmed Medicare	$13.25

Know your out-of-pocket cost for care.

All Charges