White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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
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, 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, 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, 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 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
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 RETRACTABLE BANANA

Facility

$2,805.72

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

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
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

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 SAGITTAL 25.0 X 1.27 X 100MM

Facility

$657.03

Hospital Charge Code	992748
Hospital Revenue Code	272
Min. Negotiated Rate	$59.13
Max. Negotiated Rate	$473.06
Rate for Payer: Amerigroup CHIP/Medicaid	$59.13
Rate for Payer: BCBS of TX Blue Advantage	$197.11
Rate for Payer: BCBS of TX Blue Essentials	$236.53
Rate for Payer: BCBS of TX PPO	$262.81
Rate for Payer: Cash Price	$446.78
Rate for Payer: Cigna Medicaid	$473.06
Rate for Payer: Molina CHIP/Medicaid	$473.06
Rate for Payer: Multiplan Auto	$427.07
Rate for Payer: Multiplan Commercial	$427.07
Rate for Payer: Multiplan Workers Comp	$427.07
Rate for Payer: Parkland Medicaid	$473.06
Rate for Payer: Scott and White EPO/PPO	$328.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$473.06
Rate for Payer: Superior Health Plan EPO	$89.36

BLADE SAGITTAL 25.0 X 1.27 X 100MM

Facility

$657.03

Hospital Charge Code	992748
Hospital Revenue Code	272
Rate for Payer: Cash Price	$446.78

BLADE SAGITTAL 25.0 X 1.27 X 90MM

Facility

$657.03

Hospital Charge Code	992749
Hospital Revenue Code	272
Min. Negotiated Rate	$59.13
Max. Negotiated Rate	$473.06
Rate for Payer: Amerigroup CHIP/Medicaid	$59.13
Rate for Payer: BCBS of TX Blue Advantage	$197.11
Rate for Payer: BCBS of TX Blue Essentials	$236.53
Rate for Payer: BCBS of TX PPO	$262.81
Rate for Payer: Cash Price	$446.78
Rate for Payer: Cigna Medicaid	$473.06
Rate for Payer: Molina CHIP/Medicaid	$473.06
Rate for Payer: Multiplan Auto	$427.07
Rate for Payer: Multiplan Commercial	$427.07
Rate for Payer: Multiplan Workers Comp	$427.07
Rate for Payer: Parkland Medicaid	$473.06
Rate for Payer: Scott and White EPO/PPO	$328.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$473.06
Rate for Payer: Superior Health Plan EPO	$89.36

BLADE SAGITTAL 25.0 X 1.27 X 90MM

Facility

$657.03

Hospital Charge Code	992749
Hospital Revenue Code	272
Rate for Payer: Cash Price	$446.78

BLADE,SAGITTAL & OSCILLATING

Facility

$1,515.91

Hospital Charge Code	993776
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,030.82

BLADE,SAGITTAL & OSCILLATING

Facility

$1,515.91

Hospital Charge Code	993776
Hospital Revenue Code	272
Min. Negotiated Rate	$136.43
Max. Negotiated Rate	$1,091.46
Rate for Payer: Amerigroup CHIP/Medicaid	$136.43
Rate for Payer: BCBS of TX Blue Advantage	$454.77
Rate for Payer: BCBS of TX Blue Essentials	$545.73
Rate for Payer: BCBS of TX PPO	$606.36
Rate for Payer: Cash Price	$1,030.82
Rate for Payer: Cigna Medicaid	$1,091.46
Rate for Payer: Molina CHIP/Medicaid	$1,091.46
Rate for Payer: Multiplan Auto	$985.34
Rate for Payer: Multiplan Commercial	$985.34
Rate for Payer: Multiplan Workers Comp	$985.34
Rate for Payer: Parkland Medicaid	$1,091.46
Rate for Payer: Scott and White EPO/PPO	$757.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,091.46
Rate for Payer: Superior Health Plan EPO	$206.16

Know your out-of-pocket cost for care.

All Charges