White Rock Medical Center

All Charges

Charge

Type

Setting

Price

blade great white shaver

Facility

$754.78

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

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
Rate for Payer: Cash Price	$1,806.01

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, INCISOR PLUS 2.9 X 357MM DISPOSABLE -- DHF

Facility

$3,496.43

Hospital Charge Code	81723124
Hospital Revenue Code	272
Min. Negotiated Rate	$314.68
Max. Negotiated Rate	$2,517.43
Rate for Payer: Amerigroup CHIP/Medicaid	$314.68
Rate for Payer: BCBS of TX Blue Advantage	$1,048.93
Rate for Payer: BCBS of TX Blue Essentials	$1,258.71
Rate for Payer: BCBS of TX PPO	$1,398.57
Rate for Payer: Cash Price	$2,377.57
Rate for Payer: Cigna Medicaid	$2,517.43
Rate for Payer: Molina CHIP/Medicaid	$2,517.43
Rate for Payer: Multiplan Auto	$2,272.68
Rate for Payer: Multiplan Commercial	$2,272.68
Rate for Payer: Multiplan Workers Comp	$2,272.68
Rate for Payer: Parkland Medicaid	$2,517.43
Rate for Payer: Scott and White EPO/PPO	$1,748.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,517.43
Rate for Payer: Superior Health Plan EPO	$475.51

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

BLADE, LARYN, 2, MILLER, DISP, STRL

Facility

$26.30

Hospital Charge Code	993000
Hospital Revenue Code	270
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$18.94
Rate for Payer: Amerigroup CHIP/Medicaid	$2.37
Rate for Payer: BCBS of TX Blue Advantage	$7.89
Rate for Payer: BCBS of TX Blue Essentials	$9.47
Rate for Payer: BCBS of TX PPO	$10.52
Rate for Payer: Cash Price	$17.88
Rate for Payer: Cigna Medicaid	$18.94
Rate for Payer: Molina CHIP/Medicaid	$18.94
Rate for Payer: Multiplan Auto	$17.09
Rate for Payer: Multiplan Commercial	$17.09
Rate for Payer: Multiplan Workers Comp	$17.09
Rate for Payer: Parkland Medicaid	$18.94
Rate for Payer: Scott and White EPO/PPO	$13.15
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18.94
Rate for Payer: Superior Health Plan EPO	$3.58

BLADE, LARYN, 2, MILLER, DISP, STRL

Facility

$26.30

Hospital Charge Code	993000
Hospital Revenue Code	270
Rate for Payer: Cash Price	$17.88

BLADE, LARYN, 3, MAC, DISP, STRL

Facility

$26.30

Hospital Charge Code	993729
Hospital Revenue Code	272
Rate for Payer: Cash Price	$17.88

BLADE, LARYN, 3, MAC, DISP, STRL

Facility

$26.30

Hospital Charge Code	993729
Hospital Revenue Code	272
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$18.94
Rate for Payer: Amerigroup CHIP/Medicaid	$2.37
Rate for Payer: BCBS of TX Blue Advantage	$7.89
Rate for Payer: BCBS of TX Blue Essentials	$9.47
Rate for Payer: BCBS of TX PPO	$10.52
Rate for Payer: Cash Price	$17.88
Rate for Payer: Cigna Medicaid	$18.94
Rate for Payer: Molina CHIP/Medicaid	$18.94
Rate for Payer: Multiplan Auto	$17.09
Rate for Payer: Multiplan Commercial	$17.09
Rate for Payer: Multiplan Workers Comp	$17.09
Rate for Payer: Parkland Medicaid	$18.94
Rate for Payer: Scott and White EPO/PPO	$13.15
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18.94
Rate for Payer: Superior Health Plan EPO	$3.58

BLADE, LARYN, 3, MILLER, DISP

Facility

$52.59

Hospital Charge Code	993845
Hospital Revenue Code	272
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$37.86
Rate for Payer: Amerigroup CHIP/Medicaid	$4.73
Rate for Payer: BCBS of TX Blue Advantage	$15.78
Rate for Payer: BCBS of TX Blue Essentials	$18.93
Rate for Payer: BCBS of TX PPO	$21.04
Rate for Payer: Cash Price	$35.76
Rate for Payer: Cigna Medicaid	$37.86
Rate for Payer: Molina CHIP/Medicaid	$37.86
Rate for Payer: Multiplan Auto	$34.18
Rate for Payer: Multiplan Commercial	$34.18
Rate for Payer: Multiplan Workers Comp	$34.18
Rate for Payer: Parkland Medicaid	$37.86
Rate for Payer: Scott and White EPO/PPO	$26.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$37.86
Rate for Payer: Superior Health Plan EPO	$7.15

BLADE, LARYN, 3, MILLER, DISP

Facility

$52.59

Hospital Charge Code	993845
Hospital Revenue Code	272
Rate for Payer: Cash Price	$35.76

BLADE, MINIATURE EDGED STAINLESS STEEL #69 -- DHF

Facility

$30.81

Hospital Charge Code	81722407
Hospital Revenue Code	272
Rate for Payer: Cash Price	$20.95

BLADE, MINIATURE EDGED STAINLESS STEEL #69 -- DHF

Facility

$30.81

Hospital Charge Code	81722407
Hospital Revenue Code	272
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$22.18
Rate for Payer: Amerigroup CHIP/Medicaid	$2.77
Rate for Payer: BCBS of TX Blue Advantage	$9.24
Rate for Payer: BCBS of TX Blue Essentials	$11.09
Rate for Payer: BCBS of TX PPO	$12.32
Rate for Payer: Cash Price	$20.95
Rate for Payer: Cigna Medicaid	$22.18
Rate for Payer: Molina CHIP/Medicaid	$22.18
Rate for Payer: Multiplan Auto	$20.03
Rate for Payer: Multiplan Commercial	$20.03
Rate for Payer: Multiplan Workers Comp	$20.03
Rate for Payer: Parkland Medicaid	$22.18
Rate for Payer: Scott and White EPO/PPO	$15.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$22.18
Rate for Payer: Superior Health Plan EPO	$4.19

BLADE, PLASMA EXT SHAFT S

Facility

$2,601.42

Hospital Charge Code	81812349
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,768.97

BLADE, PLASMA EXT SHAFT S

Facility

$2,601.42

Hospital Charge Code	81812349
Hospital Revenue Code	272
Min. Negotiated Rate	$234.13
Max. Negotiated Rate	$1,873.02
Rate for Payer: Amerigroup CHIP/Medicaid	$234.13
Rate for Payer: BCBS of TX Blue Advantage	$780.43
Rate for Payer: BCBS of TX Blue Essentials	$936.51
Rate for Payer: BCBS of TX PPO	$1,040.57
Rate for Payer: Cash Price	$1,768.97
Rate for Payer: Cigna Medicaid	$1,873.02
Rate for Payer: Molina CHIP/Medicaid	$1,873.02
Rate for Payer: Multiplan Auto	$1,690.92
Rate for Payer: Multiplan Commercial	$1,690.92
Rate for Payer: Multiplan Workers Comp	$1,690.92
Rate for Payer: Parkland Medicaid	$1,873.02
Rate for Payer: Scott and White EPO/PPO	$1,300.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,873.02
Rate for Payer: Superior Health Plan EPO	$353.79

blade reciproc dbl side 0277096275

Facility

$136.20

Hospital Charge Code	8610562
Hospital Revenue Code	272
Rate for Payer: Cash Price	$92.62

blade reciproc dbl side 0277096275

Facility

$136.20

Hospital Charge Code	8610562
Hospital Revenue Code	272
Min. Negotiated Rate	$12.26
Max. Negotiated Rate	$98.06
Rate for Payer: Amerigroup CHIP/Medicaid	$12.26
Rate for Payer: BCBS of TX Blue Advantage	$40.86
Rate for Payer: BCBS of TX Blue Essentials	$49.03
Rate for Payer: BCBS of TX PPO	$54.48
Rate for Payer: Cash Price	$92.62
Rate for Payer: Cigna Medicaid	$98.06
Rate for Payer: Molina CHIP/Medicaid	$98.06
Rate for Payer: Multiplan Auto	$88.53
Rate for Payer: Multiplan Commercial	$88.53
Rate for Payer: Multiplan Workers Comp	$88.53
Rate for Payer: Parkland Medicaid	$98.06
Rate for Payer: Scott and White EPO/PPO	$68.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$98.06
Rate for Payer: Superior Health Plan EPO	$18.52

BLADE RETRACTABLE BANANA

Facility

$2,805.72

Hospital Charge Code	8428487
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,907.89

BLADE RETRACTABLE BANANA

Facility

$2,805.72

Hospital Charge Code	8428487
Hospital Revenue Code	272
Min. Negotiated Rate	$252.51
Max. Negotiated Rate	$2,020.12
Rate for Payer: Amerigroup CHIP/Medicaid	$252.51
Rate for Payer: BCBS of TX Blue Advantage	$841.72
Rate for Payer: BCBS of TX Blue Essentials	$1,010.06
Rate for Payer: BCBS of TX PPO	$1,122.29
Rate for Payer: Cash Price	$1,907.89
Rate for Payer: Cigna Medicaid	$2,020.12
Rate for Payer: Molina CHIP/Medicaid	$2,020.12
Rate for Payer: Multiplan Auto	$1,823.72
Rate for Payer: Multiplan Commercial	$1,823.72
Rate for Payer: Multiplan Workers Comp	$1,823.72
Rate for Payer: Parkland Medicaid	$2,020.12
Rate for Payer: Scott and White EPO/PPO	$1,402.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,020.12
Rate for Payer: Superior Health Plan EPO	$381.58

BLADE SAGITAL LONG NARROW 31MM X 9

Facility

$384.49

Hospital Charge Code	993736
Hospital Revenue Code	272
Rate for Payer: Cash Price	$261.45

BLADE SAGITAL LONG NARROW 31MM X 9

Facility

$384.49

Hospital Charge Code	993736
Hospital Revenue Code	272
Min. Negotiated Rate	$34.60
Max. Negotiated Rate	$276.83
Rate for Payer: Amerigroup CHIP/Medicaid	$34.60
Rate for Payer: BCBS of TX Blue Advantage	$115.35
Rate for Payer: BCBS of TX Blue Essentials	$138.42
Rate for Payer: BCBS of TX PPO	$153.80
Rate for Payer: Cash Price	$261.45
Rate for Payer: Cigna Medicaid	$276.83
Rate for Payer: Molina CHIP/Medicaid	$276.83
Rate for Payer: Multiplan Auto	$249.92
Rate for Payer: Multiplan Commercial	$249.92
Rate for Payer: Multiplan Workers Comp	$249.92
Rate for Payer: Parkland Medicaid	$276.83
Rate for Payer: Scott and White EPO/PPO	$192.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$276.83
Rate for Payer: Superior Health Plan EPO	$52.29

BLADE SAGITAL PERF SERIES 90X1.27

Facility

$236.99

Hospital Charge Code	114337
Hospital Revenue Code	272
Rate for Payer: Cash Price	$161.15

BLADE SAGITAL PERF SERIES 90X1.27

Facility

$236.99

Hospital Charge Code	114337
Hospital Revenue Code	272
Min. Negotiated Rate	$21.33
Max. Negotiated Rate	$170.63
Rate for Payer: Amerigroup CHIP/Medicaid	$21.33
Rate for Payer: BCBS of TX Blue Advantage	$71.10
Rate for Payer: BCBS of TX Blue Essentials	$85.32
Rate for Payer: BCBS of TX PPO	$94.80
Rate for Payer: Cash Price	$161.15
Rate for Payer: Cigna Medicaid	$170.63
Rate for Payer: Molina CHIP/Medicaid	$170.63
Rate for Payer: Multiplan Auto	$154.04
Rate for Payer: Multiplan Commercial	$154.04
Rate for Payer: Multiplan Workers Comp	$154.04
Rate for Payer: Parkland Medicaid	$170.63
Rate for Payer: Scott and White EPO/PPO	$118.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$170.63
Rate for Payer: Superior Health Plan EPO	$32.23

Know your out-of-pocket cost for care.

All Charges