White Rock Medical Center

All Charges

Charge

Type

Setting

Price

BIPOLAR DISORDERS

Facility

$2,244.65

Service Code	APR-DRG 7532
Min. Negotiated Rate	$2,116.34
Max. Negotiated Rate	$2,244.65
Rate for Payer: Amerigroup CHIP/Medicaid	$2,116.34
Rate for Payer: Cigna Medicaid	$2,116.34
Rate for Payer: Molina CHIP/Medicaid	$2,116.34
Rate for Payer: Parkland Medicaid	$2,116.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,244.65

Bipolar Forceps

Facility

$5,907.95

Hospital Charge Code	993206
Hospital Revenue Code	272
Rate for Payer: Cash Price	$4,017.41

Bipolar Forceps

Facility

$5,907.95

Hospital Charge Code	993206
Hospital Revenue Code	272
Min. Negotiated Rate	$531.72
Max. Negotiated Rate	$4,253.72
Rate for Payer: Amerigroup CHIP/Medicaid	$531.72
Rate for Payer: BCBS of TX Blue Advantage	$1,772.38
Rate for Payer: BCBS of TX Blue Essentials	$2,126.86
Rate for Payer: BCBS of TX PPO	$2,363.18
Rate for Payer: Cash Price	$4,017.41
Rate for Payer: Cigna Medicaid	$4,253.72
Rate for Payer: Molina CHIP/Medicaid	$4,253.72
Rate for Payer: Multiplan Auto	$3,840.17
Rate for Payer: Multiplan Commercial	$3,840.17
Rate for Payer: Multiplan Workers Comp	$3,840.17
Rate for Payer: Parkland Medicaid	$4,253.72
Rate for Payer: Scott and White EPO/PPO	$2,953.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,253.72
Rate for Payer: Superior Health Plan EPO	$803.48

BIPOLAR HIP

Facility

$15,060.24

Service Code	HCPCS C1734
Hospital Charge Code	992120
Hospital Revenue Code	278
Min. Negotiated Rate	$3,765.06
Max. Negotiated Rate	$7,530.12
Rate for Payer: Cash Price	$10,240.96
Rate for Payer: Cigna Commercial	$3,765.06
Rate for Payer: Multiplan Auto	$7,530.12
Rate for Payer: Multiplan Commercial	$7,530.12
Rate for Payer: Multiplan Workers Comp	$7,530.12
Rate for Payer: Scott and White EPO/PPO	$7,530.12

BIPOLAR HIP

Facility

$15,060.24

Service Code	HCPCS C1734
Hospital Charge Code	992120
Hospital Revenue Code	278
Min. Negotiated Rate	$1,355.42
Max. Negotiated Rate	$10,843.37
Rate for Payer: Amerigroup CHIP/Medicaid	$1,355.42
Rate for Payer: BCBS of TX Blue Advantage	$4,518.07
Rate for Payer: BCBS of TX Blue Essentials	$5,421.69
Rate for Payer: BCBS of TX PPO	$6,024.10
Rate for Payer: Cash Price	$10,240.96
Rate for Payer: Cigna Medicaid	$10,843.37
Rate for Payer: Molina CHIP/Medicaid	$10,843.37
Rate for Payer: Multiplan Auto	$7,530.12
Rate for Payer: Multiplan Commercial	$7,530.12
Rate for Payer: Multiplan Workers Comp	$7,530.12
Rate for Payer: Parkland Medicaid	$10,843.37
Rate for Payer: Scott and White EPO/PPO	$7,530.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,843.37
Rate for Payer: Superior Health Plan EPO	$2,048.19

bisacodyl 10 mg Rectal Supp

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77412297
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

bisacodyl 10 mg Rectal Supp

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77412297
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

bisacodyl 5 mg DR Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77412350
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

bisacodyl 5 mg DR Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77412350
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

BIT DRILL 2.0MM

Facility

$1,702.50

Hospital Charge Code	145137
Hospital Revenue Code	272
Min. Negotiated Rate	$153.22
Max. Negotiated Rate	$1,225.80
Rate for Payer: Amerigroup CHIP/Medicaid	$153.22
Rate for Payer: BCBS of TX Blue Advantage	$510.75
Rate for Payer: BCBS of TX Blue Essentials	$612.90
Rate for Payer: BCBS of TX PPO	$681.00
Rate for Payer: Cash Price	$1,157.70
Rate for Payer: Cigna Medicaid	$1,225.80
Rate for Payer: Molina CHIP/Medicaid	$1,225.80
Rate for Payer: Multiplan Auto	$1,106.62
Rate for Payer: Multiplan Commercial	$1,106.62
Rate for Payer: Multiplan Workers Comp	$1,106.62
Rate for Payer: Parkland Medicaid	$1,225.80
Rate for Payer: Scott and White EPO/PPO	$851.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,225.80
Rate for Payer: Superior Health Plan EPO	$231.54

BIT DRILL 2.0MM

Facility

$1,702.50

Hospital Charge Code	145137
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,157.70

BIT, DRILL 2.5MM X 110MM--DHF

Facility

$581.03

Hospital Charge Code	80911472
Hospital Revenue Code	272
Rate for Payer: Cash Price	$395.10

BIT, DRILL 2.5MM X 110MM--DHF

Facility

$581.03

Hospital Charge Code	80911472
Hospital Revenue Code	272
Min. Negotiated Rate	$52.29
Max. Negotiated Rate	$418.34
Rate for Payer: Amerigroup CHIP/Medicaid	$52.29
Rate for Payer: BCBS of TX Blue Advantage	$174.31
Rate for Payer: BCBS of TX Blue Essentials	$209.17
Rate for Payer: BCBS of TX PPO	$232.41
Rate for Payer: Cash Price	$395.10
Rate for Payer: Cigna Medicaid	$418.34
Rate for Payer: Molina CHIP/Medicaid	$418.34
Rate for Payer: Multiplan Auto	$377.67
Rate for Payer: Multiplan Commercial	$377.67
Rate for Payer: Multiplan Workers Comp	$377.67
Rate for Payer: Parkland Medicaid	$418.34
Rate for Payer: Scott and White EPO/PPO	$290.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$418.34
Rate for Payer: Superior Health Plan EPO	$79.02

BIT, DRILL ACET RINGLOCK PLUC 3.2MM X 30MM

Facility

$335.96

Hospital Charge Code	140617
Hospital Revenue Code	272
Rate for Payer: Cash Price	$228.45

BIT, DRILL ACET RINGLOCK PLUC 3.2MM X 30MM

Facility

$335.96

Hospital Charge Code	140617
Hospital Revenue Code	272
Min. Negotiated Rate	$30.24
Max. Negotiated Rate	$241.89
Rate for Payer: Amerigroup CHIP/Medicaid	$30.24
Rate for Payer: BCBS of TX Blue Advantage	$100.79
Rate for Payer: BCBS of TX Blue Essentials	$120.95
Rate for Payer: BCBS of TX PPO	$134.38
Rate for Payer: Cash Price	$228.45
Rate for Payer: Cigna Medicaid	$241.89
Rate for Payer: Molina CHIP/Medicaid	$241.89
Rate for Payer: Multiplan Auto	$218.37
Rate for Payer: Multiplan Commercial	$218.37
Rate for Payer: Multiplan Workers Comp	$218.37
Rate for Payer: Parkland Medicaid	$241.89
Rate for Payer: Scott and White EPO/PPO	$167.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$241.89
Rate for Payer: Superior Health Plan EPO	$45.69

BIT DRILL AO QUICK S/S 2.0MM DIA X 135MM L

Facility

$940.87

Hospital Charge Code	132428
Hospital Revenue Code	272
Rate for Payer: Cash Price	$639.79

BIT DRILL AO QUICK S/S 2.0MM DIA X 135MM L

Facility

$940.87

Hospital Charge Code	132428
Hospital Revenue Code	272
Min. Negotiated Rate	$84.68
Max. Negotiated Rate	$677.43
Rate for Payer: Amerigroup CHIP/Medicaid	$84.68
Rate for Payer: BCBS of TX Blue Advantage	$282.26
Rate for Payer: BCBS of TX Blue Essentials	$338.71
Rate for Payer: BCBS of TX PPO	$376.35
Rate for Payer: Cash Price	$639.79
Rate for Payer: Cigna Medicaid	$677.43
Rate for Payer: Molina CHIP/Medicaid	$677.43
Rate for Payer: Multiplan Auto	$611.57
Rate for Payer: Multiplan Commercial	$611.57
Rate for Payer: Multiplan Workers Comp	$611.57
Rate for Payer: Parkland Medicaid	$677.43
Rate for Payer: Scott and White EPO/PPO	$470.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$677.43
Rate for Payer: Superior Health Plan EPO	$127.96

BIT DRILL LONG 3.5 X 230MM AO STRL

Facility

$1,221.26

Hospital Charge Code	993286
Hospital Revenue Code	272
Rate for Payer: Cash Price	$830.46

BIT DRILL LONG 3.5 X 230MM AO STRL

Facility

$1,221.26

Hospital Charge Code	993286
Hospital Revenue Code	272
Min. Negotiated Rate	$109.91
Max. Negotiated Rate	$879.31
Rate for Payer: Amerigroup CHIP/Medicaid	$109.91
Rate for Payer: BCBS of TX Blue Advantage	$366.38
Rate for Payer: BCBS of TX Blue Essentials	$439.65
Rate for Payer: BCBS of TX PPO	$488.50
Rate for Payer: Cash Price	$830.46
Rate for Payer: Cigna Medicaid	$879.31
Rate for Payer: Molina CHIP/Medicaid	$879.31
Rate for Payer: Multiplan Auto	$793.82
Rate for Payer: Multiplan Commercial	$793.82
Rate for Payer: Multiplan Workers Comp	$793.82
Rate for Payer: Parkland Medicaid	$879.31
Rate for Payer: Scott and White EPO/PPO	$610.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$879.31
Rate for Payer: Superior Health Plan EPO	$166.09

BIT DRILL Y KNOT FLEX Y13D

Facility

$304.59

Hospital Charge Code	144848
Hospital Revenue Code	272
Min. Negotiated Rate	$27.41
Max. Negotiated Rate	$219.30
Rate for Payer: Amerigroup CHIP/Medicaid	$27.41
Rate for Payer: BCBS of TX Blue Advantage	$91.38
Rate for Payer: BCBS of TX Blue Essentials	$109.65
Rate for Payer: BCBS of TX PPO	$121.84
Rate for Payer: Cash Price	$207.12
Rate for Payer: Cigna Medicaid	$219.30
Rate for Payer: Molina CHIP/Medicaid	$219.30
Rate for Payer: Multiplan Auto	$197.98
Rate for Payer: Multiplan Commercial	$197.98
Rate for Payer: Multiplan Workers Comp	$197.98
Rate for Payer: Parkland Medicaid	$219.30
Rate for Payer: Scott and White EPO/PPO	$152.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$219.30
Rate for Payer: Superior Health Plan EPO	$41.42

BIT DRILL Y KNOT FLEX Y13D

Facility

$304.59

Hospital Charge Code	144848
Hospital Revenue Code	272
Rate for Payer: Cash Price	$207.12

BIT DRL 2X140MM QC D MRK NS

Facility

$1,236.24

Hospital Charge Code	113782
Hospital Revenue Code	272
Rate for Payer: Cash Price	$840.64

BIT DRL 2X140MM QC D MRK NS

Facility

$1,236.24

Hospital Charge Code	113782
Hospital Revenue Code	272
Min. Negotiated Rate	$111.26
Max. Negotiated Rate	$890.09
Rate for Payer: Amerigroup CHIP/Medicaid	$111.26
Rate for Payer: BCBS of TX Blue Advantage	$370.87
Rate for Payer: BCBS of TX Blue Essentials	$445.05
Rate for Payer: BCBS of TX PPO	$494.50
Rate for Payer: Cash Price	$840.64
Rate for Payer: Cigna Medicaid	$890.09
Rate for Payer: Molina CHIP/Medicaid	$890.09
Rate for Payer: Multiplan Auto	$803.56
Rate for Payer: Multiplan Commercial	$803.56
Rate for Payer: Multiplan Workers Comp	$803.56
Rate for Payer: Parkland Medicaid	$890.09
Rate for Payer: Scott and White EPO/PPO	$618.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$890.09
Rate for Payer: Superior Health Plan EPO	$168.13

BIT DRL 3.2X30MM RNGLC SS NS

Facility

$335.96

Hospital Charge Code	114118
Hospital Revenue Code	272
Min. Negotiated Rate	$30.24
Max. Negotiated Rate	$241.89
Rate for Payer: Amerigroup CHIP/Medicaid	$30.24
Rate for Payer: BCBS of TX Blue Advantage	$100.79
Rate for Payer: BCBS of TX Blue Essentials	$120.95
Rate for Payer: BCBS of TX PPO	$134.38
Rate for Payer: Cash Price	$228.45
Rate for Payer: Cigna Medicaid	$241.89
Rate for Payer: Molina CHIP/Medicaid	$241.89
Rate for Payer: Multiplan Auto	$218.37
Rate for Payer: Multiplan Commercial	$218.37
Rate for Payer: Multiplan Workers Comp	$218.37
Rate for Payer: Parkland Medicaid	$241.89
Rate for Payer: Scott and White EPO/PPO	$167.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$241.89
Rate for Payer: Superior Health Plan EPO	$45.69

BIT DRL 3.2X30MM RNGLC SS NS

Facility

$335.96

Hospital Charge Code	114118
Hospital Revenue Code	272
Rate for Payer: Cash Price	$228.45

Know your out-of-pocket cost for care.

All Charges