White Rock Medical Center

All Charges

Charge

Type

Setting

Price

BLADE, SAGITTAL, WIDE, MEDIUM, LONG

Facility

$535.36

Hospital Charge Code	993739
Hospital Revenue Code	272
Min. Negotiated Rate	$48.18
Max. Negotiated Rate	$385.46
Rate for Payer: Amerigroup CHIP/Medicaid	$48.18
Rate for Payer: BCBS of TX Blue Advantage	$160.61
Rate for Payer: BCBS of TX Blue Essentials	$192.73
Rate for Payer: BCBS of TX PPO	$214.14
Rate for Payer: Cash Price	$364.04
Rate for Payer: Cigna Medicaid	$385.46
Rate for Payer: Molina CHIP/Medicaid	$385.46
Rate for Payer: Multiplan Auto	$347.98
Rate for Payer: Multiplan Commercial	$347.98
Rate for Payer: Multiplan Workers Comp	$347.98
Rate for Payer: Parkland Medicaid	$385.46
Rate for Payer: Scott and White EPO/PPO	$267.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$385.46
Rate for Payer: Superior Health Plan EPO	$72.81

BLADE, SAGITTAL, WIDE, MEDIUM, LONG

Facility

$535.36

Hospital Charge Code	993739
Hospital Revenue Code	272
Rate for Payer: Cash Price	$364.04

BLADE SAW 0.6X12.5MM RECIP SS

Facility

$136.20

Hospital Charge Code	993570
Hospital Revenue Code	272
Rate for Payer: Cash Price	$92.62

BLADE SAW 0.6X12.5MM RECIP SS

Facility

$136.20

Hospital Charge Code	993570
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 SAW 100X25X1.27MM DL CUT SGTL S6

Facility

$250.52

Hospital Charge Code	993571
Hospital Revenue Code	272
Rate for Payer: Cash Price	$170.35

BLADE SAW 100X25X1.27MM DL CUT SGTL S6

Facility

$250.52

Hospital Charge Code	993571
Hospital Revenue Code	272
Min. Negotiated Rate	$22.55
Max. Negotiated Rate	$180.37
Rate for Payer: Amerigroup CHIP/Medicaid	$22.55
Rate for Payer: BCBS of TX Blue Advantage	$75.16
Rate for Payer: BCBS of TX Blue Essentials	$90.19
Rate for Payer: BCBS of TX PPO	$100.21
Rate for Payer: Cash Price	$170.35
Rate for Payer: Cigna Medicaid	$180.37
Rate for Payer: Molina CHIP/Medicaid	$180.37
Rate for Payer: Multiplan Auto	$162.84
Rate for Payer: Multiplan Commercial	$162.84
Rate for Payer: Multiplan Workers Comp	$162.84
Rate for Payer: Parkland Medicaid	$180.37
Rate for Payer: Scott and White EPO/PPO	$125.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$180.37
Rate for Payer: Superior Health Plan EPO	$34.07

BLADE SAW 31X9X0.38MM PRCSN MED LNG THN OSC/SAG STRL

Facility

$147.55

Hospital Charge Code	114231
Hospital Revenue Code	272
Min. Negotiated Rate	$13.28
Max. Negotiated Rate	$106.24
Rate for Payer: Amerigroup CHIP/Medicaid	$13.28
Rate for Payer: BCBS of TX Blue Advantage	$44.27
Rate for Payer: BCBS of TX Blue Essentials	$53.12
Rate for Payer: BCBS of TX PPO	$59.02
Rate for Payer: Cash Price	$100.33
Rate for Payer: Cigna Medicaid	$106.24
Rate for Payer: Molina CHIP/Medicaid	$106.24
Rate for Payer: Multiplan Auto	$95.91
Rate for Payer: Multiplan Commercial	$95.91
Rate for Payer: Multiplan Workers Comp	$95.91
Rate for Payer: Parkland Medicaid	$106.24
Rate for Payer: Scott and White EPO/PPO	$73.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$106.24
Rate for Payer: Superior Health Plan EPO	$20.07

BLADE SAW 31X9X0.38MM PRCSN MED LNG THN OSC/SAG STRL

Facility

$147.55

Hospital Charge Code	114231
Hospital Revenue Code	272
Rate for Payer: Cash Price	$100.33

BLADE SAW 4X13MM

Facility

$1,638.94

Hospital Charge Code	992668
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,114.48

BLADE SAW 4X13MM

Facility

$1,638.94

Hospital Charge Code	992668
Hospital Revenue Code	272
Min. Negotiated Rate	$147.50
Max. Negotiated Rate	$1,180.04
Rate for Payer: Amerigroup CHIP/Medicaid	$147.50
Rate for Payer: BCBS of TX Blue Advantage	$491.68
Rate for Payer: BCBS of TX Blue Essentials	$590.02
Rate for Payer: BCBS of TX PPO	$655.58
Rate for Payer: Cash Price	$1,114.48
Rate for Payer: Cigna Medicaid	$1,180.04
Rate for Payer: Molina CHIP/Medicaid	$1,180.04
Rate for Payer: Multiplan Auto	$1,065.31
Rate for Payer: Multiplan Commercial	$1,065.31
Rate for Payer: Multiplan Workers Comp	$1,065.31
Rate for Payer: Parkland Medicaid	$1,180.04
Rate for Payer: Scott and White EPO/PPO	$819.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,180.04
Rate for Payer: Superior Health Plan EPO	$222.90

BLADE SAW 90X21X1.19MM SGTL

Facility

$266.18

Hospital Charge Code	993572
Hospital Revenue Code	272
Min. Negotiated Rate	$23.96
Max. Negotiated Rate	$191.65
Rate for Payer: Amerigroup CHIP/Medicaid	$23.96
Rate for Payer: BCBS of TX Blue Advantage	$79.85
Rate for Payer: BCBS of TX Blue Essentials	$95.82
Rate for Payer: BCBS of TX PPO	$106.47
Rate for Payer: Cash Price	$181.00
Rate for Payer: Cigna Medicaid	$191.65
Rate for Payer: Molina CHIP/Medicaid	$191.65
Rate for Payer: Multiplan Auto	$173.02
Rate for Payer: Multiplan Commercial	$173.02
Rate for Payer: Multiplan Workers Comp	$173.02
Rate for Payer: Parkland Medicaid	$191.65
Rate for Payer: Scott and White EPO/PPO	$133.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$191.65
Rate for Payer: Superior Health Plan EPO	$36.20

BLADE SAW 90X21X1.19MM SGTL

Facility

$266.18

Hospital Charge Code	993572
Hospital Revenue Code	272
Rate for Payer: Cash Price	$181.00

BLADE SAW LAPIPLASTY 40MMX11MM

Facility

$227.00

Hospital Charge Code	145461
Hospital Revenue Code	272
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$163.44
Rate for Payer: Amerigroup CHIP/Medicaid	$20.43
Rate for Payer: BCBS of TX Blue Advantage	$68.10
Rate for Payer: BCBS of TX Blue Essentials	$81.72
Rate for Payer: BCBS of TX PPO	$90.80
Rate for Payer: Cash Price	$154.36
Rate for Payer: Cigna Medicaid	$163.44
Rate for Payer: Molina CHIP/Medicaid	$163.44
Rate for Payer: Multiplan Auto	$147.55
Rate for Payer: Multiplan Commercial	$147.55
Rate for Payer: Multiplan Workers Comp	$147.55
Rate for Payer: Parkland Medicaid	$163.44
Rate for Payer: Scott and White EPO/PPO	$113.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$163.44
Rate for Payer: Superior Health Plan EPO	$30.87

BLADE SAW LAPIPLASTY 40MMX11MM

Facility

$227.00

Hospital Charge Code	145461
Hospital Revenue Code	272
Rate for Payer: Cash Price	$154.36

BLADE, SAW LONG NARROW 25 X 5.5MM -- DHF

Facility

$721.86

Hospital Charge Code	81723355
Hospital Revenue Code	272
Rate for Payer: Cash Price	$490.86

BLADE, SAW LONG NARROW 25 X 5.5MM -- DHF

Facility

$721.86

Hospital Charge Code	81723355
Hospital Revenue Code	272
Min. Negotiated Rate	$64.97
Max. Negotiated Rate	$519.74
Rate for Payer: Amerigroup CHIP/Medicaid	$64.97
Rate for Payer: BCBS of TX Blue Advantage	$216.56
Rate for Payer: BCBS of TX Blue Essentials	$259.87
Rate for Payer: BCBS of TX PPO	$288.74
Rate for Payer: Cash Price	$490.86
Rate for Payer: Cigna Medicaid	$519.74
Rate for Payer: Molina CHIP/Medicaid	$519.74
Rate for Payer: Multiplan Auto	$469.21
Rate for Payer: Multiplan Commercial	$469.21
Rate for Payer: Multiplan Workers Comp	$469.21
Rate for Payer: Parkland Medicaid	$519.74
Rate for Payer: Scott and White EPO/PPO	$360.93
Rate for Payer: Superior Health Plan CHIP/Medicaid	$519.74
Rate for Payer: Superior Health Plan EPO	$98.17

BLADE, SAW MED AVERAGE .0

Facility

$96.75

Hospital Charge Code	993568
Hospital Revenue Code	272
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$69.66
Rate for Payer: Amerigroup CHIP/Medicaid	$8.71
Rate for Payer: BCBS of TX Blue Advantage	$29.02
Rate for Payer: BCBS of TX Blue Essentials	$34.83
Rate for Payer: BCBS of TX PPO	$38.70
Rate for Payer: Cash Price	$65.79
Rate for Payer: Cigna Medicaid	$69.66
Rate for Payer: Molina CHIP/Medicaid	$69.66
Rate for Payer: Multiplan Auto	$62.89
Rate for Payer: Multiplan Commercial	$62.89
Rate for Payer: Multiplan Workers Comp	$62.89
Rate for Payer: Parkland Medicaid	$69.66
Rate for Payer: Scott and White EPO/PPO	$48.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$69.66
Rate for Payer: Superior Health Plan EPO	$13.16

BLADE, SAW MED AVERAGE .0

Facility

$96.75

Hospital Charge Code	993568
Hospital Revenue Code	272
Rate for Payer: Cash Price	$65.79

BLADE, SAW MED AVERAGE .015'TK 9.0MM W 25.0MM DPTH -- DHF

Facility

$83.46

Hospital Charge Code	81723504
Hospital Revenue Code	272
Rate for Payer: Cash Price	$56.75

BLADE, SAW MED AVERAGE .015'TK 9.0MM W 25.0MM DPTH -- DHF

Facility

$83.46

Hospital Charge Code	81723504
Hospital Revenue Code	272
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$60.09
Rate for Payer: Amerigroup CHIP/Medicaid	$7.51
Rate for Payer: BCBS of TX Blue Advantage	$25.04
Rate for Payer: BCBS of TX Blue Essentials	$30.05
Rate for Payer: BCBS of TX PPO	$33.38
Rate for Payer: Cash Price	$56.75
Rate for Payer: Cigna Medicaid	$60.09
Rate for Payer: Molina CHIP/Medicaid	$60.09
Rate for Payer: Multiplan Auto	$54.25
Rate for Payer: Multiplan Commercial	$54.25
Rate for Payer: Multiplan Workers Comp	$54.25
Rate for Payer: Parkland Medicaid	$60.09
Rate for Payer: Scott and White EPO/PPO	$41.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$60.09
Rate for Payer: Superior Health Plan EPO	$11.35

BLADE, SAW MEDIUM NARROW

Facility

$147.55

Hospital Charge Code	133016
Hospital Revenue Code	272
Min. Negotiated Rate	$13.28
Max. Negotiated Rate	$106.24
Rate for Payer: Amerigroup CHIP/Medicaid	$13.28
Rate for Payer: BCBS of TX Blue Advantage	$44.27
Rate for Payer: BCBS of TX Blue Essentials	$53.12
Rate for Payer: BCBS of TX PPO	$59.02
Rate for Payer: Cash Price	$100.33
Rate for Payer: Cigna Medicaid	$106.24
Rate for Payer: Molina CHIP/Medicaid	$106.24
Rate for Payer: Multiplan Auto	$95.91
Rate for Payer: Multiplan Commercial	$95.91
Rate for Payer: Multiplan Workers Comp	$95.91
Rate for Payer: Parkland Medicaid	$106.24
Rate for Payer: Scott and White EPO/PPO	$73.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$106.24
Rate for Payer: Superior Health Plan EPO	$20.07

BLADE, SAW MEDIUM NARROW

Facility

$147.55

Hospital Charge Code	133016
Hospital Revenue Code	272
Rate for Payer: Cash Price	$100.33

blade saw oxford cut

Facility

$2,029.38

Hospital Charge Code	144813
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,379.98

blade saw oxford cut

Facility

$2,029.38

Hospital Charge Code	144813
Hospital Revenue Code	272
Min. Negotiated Rate	$182.64
Max. Negotiated Rate	$1,461.15
Rate for Payer: Amerigroup CHIP/Medicaid	$182.64
Rate for Payer: BCBS of TX Blue Advantage	$608.81
Rate for Payer: BCBS of TX Blue Essentials	$730.58
Rate for Payer: BCBS of TX PPO	$811.75
Rate for Payer: Cash Price	$1,379.98
Rate for Payer: Cigna Medicaid	$1,461.15
Rate for Payer: Molina CHIP/Medicaid	$1,461.15
Rate for Payer: Multiplan Auto	$1,319.10
Rate for Payer: Multiplan Commercial	$1,319.10
Rate for Payer: Multiplan Workers Comp	$1,319.10
Rate for Payer: Parkland Medicaid	$1,461.15
Rate for Payer: Scott and White EPO/PPO	$1,014.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,461.15
Rate for Payer: Superior Health Plan EPO	$276.00

BLADE, SAW SAGITTAL DUAL STR 18MM X 1.27MM X 100MM -- DHF

Facility

$250.52

Hospital Charge Code	81722951
Hospital Revenue Code	272
Rate for Payer: Cash Price	$170.35

Know your out-of-pocket cost for care.

All Charges