White Rock Medical Center

All Charges

Charge

Type

Setting

Price

BIT DRL 4.2X180MM AO T2 SS STRL DISP

Facility

$1,339.30

Hospital Charge Code	993283
Hospital Revenue Code	272
Rate for Payer: Cash Price	$910.72

BIT DRL 4.2X180MM AO T2 SS STRL DISP

Facility

$1,339.30

Hospital Charge Code	993283
Hospital Revenue Code	272
Min. Negotiated Rate	$120.54
Max. Negotiated Rate	$964.30
Rate for Payer: Amerigroup CHIP/Medicaid	$120.54
Rate for Payer: BCBS of TX Blue Advantage	$401.79
Rate for Payer: BCBS of TX Blue Essentials	$482.15
Rate for Payer: BCBS of TX PPO	$535.72
Rate for Payer: Cash Price	$910.72
Rate for Payer: Cigna Medicaid	$964.30
Rate for Payer: Molina CHIP/Medicaid	$964.30
Rate for Payer: Multiplan Auto	$870.54
Rate for Payer: Multiplan Commercial	$870.54
Rate for Payer: Multiplan Workers Comp	$870.54
Rate for Payer: Parkland Medicaid	$964.30
Rate for Payer: Scott and White EPO/PPO	$669.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$964.30
Rate for Payer: Superior Health Plan EPO	$182.14

BIT DRL 4.2X330MM 3 FLUT QC 100MM

Facility

$2,810.26

Hospital Charge Code	113852
Hospital Revenue Code	272
Min. Negotiated Rate	$252.92
Max. Negotiated Rate	$2,023.39
Rate for Payer: Amerigroup CHIP/Medicaid	$252.92
Rate for Payer: BCBS of TX Blue Advantage	$843.08
Rate for Payer: BCBS of TX Blue Essentials	$1,011.69
Rate for Payer: BCBS of TX PPO	$1,124.10
Rate for Payer: Cash Price	$1,910.98
Rate for Payer: Cigna Medicaid	$2,023.39
Rate for Payer: Molina CHIP/Medicaid	$2,023.39
Rate for Payer: Multiplan Auto	$1,826.67
Rate for Payer: Multiplan Commercial	$1,826.67
Rate for Payer: Multiplan Workers Comp	$1,826.67
Rate for Payer: Parkland Medicaid	$2,023.39
Rate for Payer: Scott and White EPO/PPO	$1,405.13
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,023.39
Rate for Payer: Superior Health Plan EPO	$382.20

BIT DRL 4.2X330MM 3 FLUT QC 100MM

Facility

$2,810.26

Hospital Charge Code	113852
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,910.98

BIT DRL LCK SHRT 4.3X216MM

Facility

$1,510.19

Hospital Charge Code	114051
Hospital Revenue Code	272
Min. Negotiated Rate	$135.92
Max. Negotiated Rate	$1,087.34
Rate for Payer: Amerigroup CHIP/Medicaid	$135.92
Rate for Payer: BCBS of TX Blue Advantage	$453.06
Rate for Payer: BCBS of TX Blue Essentials	$543.67
Rate for Payer: BCBS of TX PPO	$604.08
Rate for Payer: Cash Price	$1,026.93
Rate for Payer: Cigna Medicaid	$1,087.34
Rate for Payer: Molina CHIP/Medicaid	$1,087.34
Rate for Payer: Multiplan Auto	$981.62
Rate for Payer: Multiplan Commercial	$981.62
Rate for Payer: Multiplan Workers Comp	$981.62
Rate for Payer: Parkland Medicaid	$1,087.34
Rate for Payer: Scott and White EPO/PPO	$755.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,087.34
Rate for Payer: Superior Health Plan EPO	$205.39

BIT DRL LCK SHRT 4.3X216MM

Facility

$1,510.19

Hospital Charge Code	114051
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,026.93

BIT DRL NON-LCK SHRT 3.2X216MM

Facility

$1,510.19

Hospital Charge Code	114050
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,026.93

BIT DRL NON-LCK SHRT 3.2X216MM

Facility

$1,510.19

Hospital Charge Code	114050
Hospital Revenue Code	272
Min. Negotiated Rate	$135.92
Max. Negotiated Rate	$1,087.34
Rate for Payer: Amerigroup CHIP/Medicaid	$135.92
Rate for Payer: BCBS of TX Blue Advantage	$453.06
Rate for Payer: BCBS of TX Blue Essentials	$543.67
Rate for Payer: BCBS of TX PPO	$604.08
Rate for Payer: Cash Price	$1,026.93
Rate for Payer: Cigna Medicaid	$1,087.34
Rate for Payer: Molina CHIP/Medicaid	$1,087.34
Rate for Payer: Multiplan Auto	$981.62
Rate for Payer: Multiplan Commercial	$981.62
Rate for Payer: Multiplan Workers Comp	$981.62
Rate for Payer: Parkland Medicaid	$1,087.34
Rate for Payer: Scott and White EPO/PPO	$755.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,087.34
Rate for Payer: Superior Health Plan EPO	$205.39

BITE BLOCK, ENDOSCOPIC, ADULT, 60 FR

Facility

$4.81

Hospital Charge Code	993062
Hospital Revenue Code	270
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$3.46
Rate for Payer: Amerigroup CHIP/Medicaid	$0.43
Rate for Payer: BCBS of TX Blue Advantage	$1.44
Rate for Payer: BCBS of TX Blue Essentials	$1.73
Rate for Payer: BCBS of TX PPO	$1.92
Rate for Payer: Cash Price	$3.27
Rate for Payer: Cigna Medicaid	$3.46
Rate for Payer: Molina CHIP/Medicaid	$3.46
Rate for Payer: Multiplan Auto	$3.13
Rate for Payer: Multiplan Commercial	$3.13
Rate for Payer: Multiplan Workers Comp	$3.13
Rate for Payer: Parkland Medicaid	$3.46
Rate for Payer: Scott and White EPO/PPO	$2.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.46
Rate for Payer: Superior Health Plan EPO	$0.65

BITE BLOCK, ENDOSCOPIC, ADULT, 60 FR

Facility

$4.81

Hospital Charge Code	993062
Hospital Revenue Code	270
Rate for Payer: Cash Price	$3.27

BK Quant PCR (Plasma/Serum) SO

Facility

$647.00

Service Code	HCPCS 87799
Hospital Charge Code	1709963
Hospital Revenue Code	306
Rate for Payer: Cash Price	$439.96

BK Quant PCR (Plasma/Serum) SO

Facility

$647.00

Service Code	HCPCS 87799
Hospital Charge Code	1709963
Hospital Revenue Code	306
Min. Negotiated Rate	$16.71
Max. Negotiated Rate	$465.84
Rate for Payer: Amerigroup CHIP/Medicaid	$16.71
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$42.84
Rate for Payer: Amerigroup Medicare	$42.84
Rate for Payer: BCBS of TX Blue Advantage	$194.10
Rate for Payer: BCBS of TX Blue Essentials	$232.92
Rate for Payer: BCBS of TX Medicare	$42.84
Rate for Payer: BCBS of TX PPO	$258.80
Rate for Payer: Cash Price	$439.96
Rate for Payer: Cash Price	$439.96
Rate for Payer: Cigna Medicaid	$465.84
Rate for Payer: Cigna Medicare	$42.84
Rate for Payer: Employer Direct Commercial	$42.84
Rate for Payer: Humana Medicare/TRICARE	$42.84
Rate for Payer: Molina CHIP/Medicaid	$465.84
Rate for Payer: Molina Dual Medicare/Medicaid	$42.84
Rate for Payer: Molina Medicare	$42.84
Rate for Payer: Multiplan Auto	$420.55
Rate for Payer: Multiplan Commercial	$420.55
Rate for Payer: Multiplan Workers Comp	$420.55
Rate for Payer: Parkland Medicaid	$465.84
Rate for Payer: Scott and White EPO/PPO	$53.55
Rate for Payer: Scott and White Medicare	$42.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$465.84
Rate for Payer: Superior Health Plan EPO	$42.84
Rate for Payer: Superior Health Plan Medicare	$42.84
Rate for Payer: Universal American Dual Medicare/Medicaid	$42.84
Rate for Payer: Universal American Medicare	$42.84
Rate for Payer: Wellcare Medicare	$42.84
Rate for Payer: Wellmed Medicare	$42.84

BLADE ARTHROSCOPY BNS

Facility

$877.53

Hospital Charge Code	8414483
Hospital Revenue Code	272
Min. Negotiated Rate	$78.98
Max. Negotiated Rate	$631.82
Rate for Payer: Amerigroup CHIP/Medicaid	$78.98
Rate for Payer: BCBS of TX Blue Advantage	$263.26
Rate for Payer: BCBS of TX Blue Essentials	$315.91
Rate for Payer: BCBS of TX PPO	$351.01
Rate for Payer: Cash Price	$596.72
Rate for Payer: Cigna Medicaid	$631.82
Rate for Payer: Molina CHIP/Medicaid	$631.82
Rate for Payer: Multiplan Auto	$570.39
Rate for Payer: Multiplan Commercial	$570.39
Rate for Payer: Multiplan Workers Comp	$570.39
Rate for Payer: Parkland Medicaid	$631.82
Rate for Payer: Scott and White EPO/PPO	$438.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$631.82
Rate for Payer: Superior Health Plan EPO	$119.34

BLADE ARTHROSCOPY BNS

Facility

$877.53

Hospital Charge Code	8414483
Hospital Revenue Code	272
Rate for Payer: Cash Price	$596.72

BLADE,CLPPER,ASSMLBY,PPLE,9667L

Facility

$17.37

Hospital Charge Code	992882
Hospital Revenue Code	272
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$12.51
Rate for Payer: Amerigroup CHIP/Medicaid	$1.56
Rate for Payer: BCBS of TX Blue Advantage	$5.21
Rate for Payer: BCBS of TX Blue Essentials	$6.25
Rate for Payer: BCBS of TX PPO	$6.95
Rate for Payer: Cash Price	$11.81
Rate for Payer: Cigna Medicaid	$12.51
Rate for Payer: Molina CHIP/Medicaid	$12.51
Rate for Payer: Multiplan Auto	$11.29
Rate for Payer: Multiplan Commercial	$11.29
Rate for Payer: Multiplan Workers Comp	$11.29
Rate for Payer: Parkland Medicaid	$12.51
Rate for Payer: Scott and White EPO/PPO	$8.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.51
Rate for Payer: Superior Health Plan EPO	$2.36

BLADE,CLPPER,ASSMLBY,PPLE,9667L

Facility

$17.37

Hospital Charge Code	992882
Hospital Revenue Code	272
Rate for Payer: Cash Price	$11.81

BLADE ESURG 4MM SERFAS 90-S MAX

Facility

$780.56

Hospital Charge Code	993200
Hospital Revenue Code	272
Rate for Payer: Cash Price	$530.78

BLADE ESURG 4MM SERFAS 90-S MAX

Facility

$780.56

Hospital Charge Code	993200
Hospital Revenue Code	272
Min. Negotiated Rate	$70.25
Max. Negotiated Rate	$562.00
Rate for Payer: Amerigroup CHIP/Medicaid	$70.25
Rate for Payer: BCBS of TX Blue Advantage	$234.17
Rate for Payer: BCBS of TX Blue Essentials	$281.00
Rate for Payer: BCBS of TX PPO	$312.22
Rate for Payer: Cash Price	$530.78
Rate for Payer: Cigna Medicaid	$562.00
Rate for Payer: Molina CHIP/Medicaid	$562.00
Rate for Payer: Multiplan Auto	$507.36
Rate for Payer: Multiplan Commercial	$507.36
Rate for Payer: Multiplan Workers Comp	$507.36
Rate for Payer: Parkland Medicaid	$562.00
Rate for Payer: Scott and White EPO/PPO	$390.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$562.00
Rate for Payer: Superior Health Plan EPO	$106.16

blade great white shaver

Facility

$754.78

Hospital Charge Code	8688554
Hospital Revenue Code	272
Rate for Payer: Cash Price	$513.25

blade great white shaver

Facility

$754.78

Hospital Charge Code	8688554
Hospital Revenue Code	272
Min. Negotiated Rate	$67.93
Max. Negotiated Rate	$543.44
Rate for Payer: Amerigroup CHIP/Medicaid	$67.93
Rate for Payer: BCBS of TX Blue Advantage	$226.43
Rate for Payer: BCBS of TX Blue Essentials	$271.72
Rate for Payer: BCBS of TX PPO	$301.91
Rate for Payer: Cash Price	$513.25
Rate for Payer: Cigna Medicaid	$543.44
Rate for Payer: Molina CHIP/Medicaid	$543.44
Rate for Payer: Multiplan Auto	$490.61
Rate for Payer: Multiplan Commercial	$490.61
Rate for Payer: Multiplan Workers Comp	$490.61
Rate for Payer: Parkland Medicaid	$543.44
Rate for Payer: Scott and White EPO/PPO	$377.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$543.44
Rate for Payer: Superior Health Plan EPO	$102.65

BLADE HIP

Facility

$1,725.20

Hospital Charge Code	8528466
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,173.14

BLADE HIP

Facility

$1,725.20

Hospital Charge Code	8528466
Hospital Revenue Code	272
Min. Negotiated Rate	$155.27
Max. Negotiated Rate	$1,242.14
Rate for Payer: Amerigroup CHIP/Medicaid	$155.27
Rate for Payer: BCBS of TX Blue Advantage	$517.56
Rate for Payer: BCBS of TX Blue Essentials	$621.07
Rate for Payer: BCBS of TX PPO	$690.08
Rate for Payer: Cash Price	$1,173.14
Rate for Payer: Cigna Medicaid	$1,242.14
Rate for Payer: Molina CHIP/Medicaid	$1,242.14
Rate for Payer: Multiplan Auto	$1,121.38
Rate for Payer: Multiplan Commercial	$1,121.38
Rate for Payer: Multiplan Workers Comp	$1,121.38
Rate for Payer: Parkland Medicaid	$1,242.14
Rate for Payer: Scott and White EPO/PPO	$862.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,242.14
Rate for Payer: Superior Health Plan EPO	$234.63

BLADE HOOK RETRACTABLE, PARADIGM

Facility

$2,655.90

Hospital Charge Code	145897
Hospital Revenue Code	272
Min. Negotiated Rate	$239.03
Max. Negotiated Rate	$1,912.25
Rate for Payer: Amerigroup CHIP/Medicaid	$239.03
Rate for Payer: BCBS of TX Blue Advantage	$796.77
Rate for Payer: BCBS of TX Blue Essentials	$956.12
Rate for Payer: BCBS of TX PPO	$1,062.36
Rate for Payer: Cash Price	$1,806.01
Rate for Payer: Cigna Medicaid	$1,912.25
Rate for Payer: Molina CHIP/Medicaid	$1,912.25
Rate for Payer: Multiplan Auto	$1,726.34
Rate for Payer: Multiplan Commercial	$1,726.34
Rate for Payer: Multiplan Workers Comp	$1,726.34
Rate for Payer: Parkland Medicaid	$1,912.25
Rate for Payer: Scott and White EPO/PPO	$1,327.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,912.25
Rate for Payer: Superior Health Plan EPO	$361.20

BLADE HOOK RETRACTABLE, PARADIGM

Facility

$2,655.90

Hospital Charge Code	145897
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,806.01

BLADE, INCISOR PLUS 2.9 X 357MM DISPOSABLE -- DHF

Facility

$3,496.43

Hospital Charge Code	81723124
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,377.57

Know your out-of-pocket cost for care.

All Charges