White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$250.52

Hospital Charge Code	81722951
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 SAGITTAL S/S 21MM X 90MM X 1.9MM -- DHF

Facility

$354.16

Hospital Charge Code	81722902
Hospital Revenue Code	272
Rate for Payer: Cash Price	$240.83

BLADE, SAW SAGITTAL S/S 21MM X 90MM X 1.9MM -- DHF

Facility

$354.16

Hospital Charge Code	81722902
Hospital Revenue Code	272
Min. Negotiated Rate	$31.87
Max. Negotiated Rate	$255.00
Rate for Payer: Amerigroup CHIP/Medicaid	$31.87
Rate for Payer: BCBS of TX Blue Advantage	$106.25
Rate for Payer: BCBS of TX Blue Essentials	$127.50
Rate for Payer: BCBS of TX PPO	$141.66
Rate for Payer: Cash Price	$240.83
Rate for Payer: Cigna Medicaid	$255.00
Rate for Payer: Molina CHIP/Medicaid	$255.00
Rate for Payer: Multiplan Auto	$230.20
Rate for Payer: Multiplan Commercial	$230.20
Rate for Payer: Multiplan Workers Comp	$230.20
Rate for Payer: Parkland Medicaid	$255.00
Rate for Payer: Scott and White EPO/PPO	$177.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$255.00
Rate for Payer: Superior Health Plan EPO	$48.17

BLADE, SAW SGTTL DEEP CUTTING 4.72CM 25.40MM .89MM -- DHF

Facility

$617.34

Hospital Charge Code	81722654
Hospital Revenue Code	272
Min. Negotiated Rate	$55.56
Max. Negotiated Rate	$444.48
Rate for Payer: Amerigroup CHIP/Medicaid	$55.56
Rate for Payer: BCBS of TX Blue Advantage	$185.20
Rate for Payer: BCBS of TX Blue Essentials	$222.24
Rate for Payer: BCBS of TX PPO	$246.94
Rate for Payer: Cash Price	$419.79
Rate for Payer: Cigna Medicaid	$444.48
Rate for Payer: Molina CHIP/Medicaid	$444.48
Rate for Payer: Multiplan Auto	$401.27
Rate for Payer: Multiplan Commercial	$401.27
Rate for Payer: Multiplan Workers Comp	$401.27
Rate for Payer: Parkland Medicaid	$444.48
Rate for Payer: Scott and White EPO/PPO	$308.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$444.48
Rate for Payer: Superior Health Plan EPO	$83.96

BLADE, SAW SGTTL DEEP CUTTING 4.72CM 25.40MM .89MM -- DHF

Facility

$617.34

Hospital Charge Code	81722654
Hospital Revenue Code	272
Rate for Payer: Cash Price	$419.79

BLADE SHAVER LANZA

Facility

$544.80

Hospital Charge Code	8692540
Hospital Revenue Code	272
Rate for Payer: Cash Price	$370.46

BLADE SHAVER LANZA

Facility

$544.80

Hospital Charge Code	8692540
Hospital Revenue Code	272
Min. Negotiated Rate	$49.03
Max. Negotiated Rate	$392.26
Rate for Payer: Amerigroup CHIP/Medicaid	$49.03
Rate for Payer: BCBS of TX Blue Advantage	$163.44
Rate for Payer: BCBS of TX Blue Essentials	$196.13
Rate for Payer: BCBS of TX PPO	$217.92
Rate for Payer: Cash Price	$370.46
Rate for Payer: Cigna Medicaid	$392.26
Rate for Payer: Molina CHIP/Medicaid	$392.26
Rate for Payer: Multiplan Auto	$354.12
Rate for Payer: Multiplan Commercial	$354.12
Rate for Payer: Multiplan Workers Comp	$354.12
Rate for Payer: Parkland Medicaid	$392.26
Rate for Payer: Scott and White EPO/PPO	$272.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$392.26
Rate for Payer: Superior Health Plan EPO	$74.09

BLADE, SURGICAL, CARBON-STEEL, 15

Facility

$1.47

Hospital Charge Code	992874
Hospital Revenue Code	272
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$1.06
Rate for Payer: Amerigroup CHIP/Medicaid	$0.13
Rate for Payer: BCBS of TX Blue Advantage	$0.44
Rate for Payer: BCBS of TX Blue Essentials	$0.53
Rate for Payer: BCBS of TX PPO	$0.59
Rate for Payer: Cash Price	$1.00
Rate for Payer: Cigna Medicaid	$1.06
Rate for Payer: Molina CHIP/Medicaid	$1.06
Rate for Payer: Multiplan Auto	$0.96
Rate for Payer: Multiplan Commercial	$0.96
Rate for Payer: Multiplan Workers Comp	$0.96
Rate for Payer: Parkland Medicaid	$1.06
Rate for Payer: Scott and White EPO/PPO	$0.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.06
Rate for Payer: Superior Health Plan EPO	$0.20

BLADE, SURGICAL, CARBON-STEEL, 15

Facility

$1.47

Hospital Charge Code	992874
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1.00

BLADE, SURGICAL CLIPPER FOR MDL 4407 -- DHF

Facility

$198.05

Hospital Charge Code	81812307
Hospital Revenue Code	272
Rate for Payer: Cash Price	$134.67

BLADE, SURGICAL CLIPPER FOR MDL 4407 -- DHF

Facility

$198.05

Hospital Charge Code	81812307
Hospital Revenue Code	272
Min. Negotiated Rate	$17.82
Max. Negotiated Rate	$142.60
Rate for Payer: Amerigroup CHIP/Medicaid	$17.82
Rate for Payer: BCBS of TX Blue Advantage	$59.41
Rate for Payer: BCBS of TX Blue Essentials	$71.30
Rate for Payer: BCBS of TX PPO	$79.22
Rate for Payer: Cash Price	$134.67
Rate for Payer: Cigna Medicaid	$142.60
Rate for Payer: Molina CHIP/Medicaid	$142.60
Rate for Payer: Multiplan Auto	$128.73
Rate for Payer: Multiplan Commercial	$128.73
Rate for Payer: Multiplan Workers Comp	$128.73
Rate for Payer: Parkland Medicaid	$142.60
Rate for Payer: Scott and White EPO/PPO	$99.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$142.60
Rate for Payer: Superior Health Plan EPO	$26.93

BLADE, SURGICAL, STAINLESS, 10, STERILE

Facility

$1.29

Hospital Charge Code	992854
Hospital Revenue Code	272
Rate for Payer: Cash Price	$0.88

BLADE, SURGICAL, STAINLESS, 10, STERILE

Facility

$1.29

Hospital Charge Code	992854
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.93
Rate for Payer: Amerigroup CHIP/Medicaid	$0.12
Rate for Payer: BCBS of TX Blue Advantage	$0.39
Rate for Payer: BCBS of TX Blue Essentials	$0.46
Rate for Payer: BCBS of TX PPO	$0.52
Rate for Payer: Cash Price	$0.88
Rate for Payer: Cigna Medicaid	$0.93
Rate for Payer: Molina CHIP/Medicaid	$0.93
Rate for Payer: Multiplan Auto	$0.84
Rate for Payer: Multiplan Commercial	$0.84
Rate for Payer: Multiplan Workers Comp	$0.84
Rate for Payer: Parkland Medicaid	$0.93
Rate for Payer: Scott and White EPO/PPO	$0.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.93
Rate for Payer: Superior Health Plan EPO	$0.18

BLADE, SURGICAL, STAINLESS, 11, STERILE

Facility

$1.29

Hospital Charge Code	992855
Hospital Revenue Code	272
Rate for Payer: Cash Price	$0.88

BLADE, SURGICAL, STAINLESS, 11, STERILE

Facility

$1.29

Hospital Charge Code	992855
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.93
Rate for Payer: Amerigroup CHIP/Medicaid	$0.12
Rate for Payer: BCBS of TX Blue Advantage	$0.39
Rate for Payer: BCBS of TX Blue Essentials	$0.46
Rate for Payer: BCBS of TX PPO	$0.52
Rate for Payer: Cash Price	$0.88
Rate for Payer: Cigna Medicaid	$0.93
Rate for Payer: Molina CHIP/Medicaid	$0.93
Rate for Payer: Multiplan Auto	$0.84
Rate for Payer: Multiplan Commercial	$0.84
Rate for Payer: Multiplan Workers Comp	$0.84
Rate for Payer: Parkland Medicaid	$0.93
Rate for Payer: Scott and White EPO/PPO	$0.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.93
Rate for Payer: Superior Health Plan EPO	$0.18

BLADE, SURGICAL, STAINLESS, 15, STERILE

Facility

$1.29

Hospital Charge Code	992856
Hospital Revenue Code	272
Rate for Payer: Cash Price	$0.88

BLADE, SURGICAL, STAINLESS, 15, STERILE

Facility

$1.29

Hospital Charge Code	992856
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.93
Rate for Payer: Amerigroup CHIP/Medicaid	$0.12
Rate for Payer: BCBS of TX Blue Advantage	$0.39
Rate for Payer: BCBS of TX Blue Essentials	$0.46
Rate for Payer: BCBS of TX PPO	$0.52
Rate for Payer: Cash Price	$0.88
Rate for Payer: Cigna Medicaid	$0.93
Rate for Payer: Molina CHIP/Medicaid	$0.93
Rate for Payer: Multiplan Auto	$0.84
Rate for Payer: Multiplan Commercial	$0.84
Rate for Payer: Multiplan Workers Comp	$0.84
Rate for Payer: Parkland Medicaid	$0.93
Rate for Payer: Scott and White EPO/PPO	$0.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.93
Rate for Payer: Superior Health Plan EPO	$0.18

BLADE, THIN, PRECISION, 9.0 X 0.38 X 25.0MM

Facility

$384.49

Hospital Charge Code	992750
Hospital Revenue Code	272
Rate for Payer: Cash Price	$261.45

BLADE, THIN, PRECISION, 9.0 X 0.38 X 25.0MM

Facility

$384.49

Hospital Charge Code	992750
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, TONGUE, 6', STERILE

Facility

$0.18

Hospital Charge Code	993232
Hospital Revenue Code	270
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.13
Rate for Payer: Amerigroup CHIP/Medicaid	$0.02
Rate for Payer: BCBS of TX Blue Advantage	$0.05
Rate for Payer: BCBS of TX Blue Essentials	$0.06
Rate for Payer: BCBS of TX PPO	$0.07
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna Medicaid	$0.13
Rate for Payer: Molina CHIP/Medicaid	$0.13
Rate for Payer: Multiplan Auto	$0.12
Rate for Payer: Multiplan Commercial	$0.12
Rate for Payer: Multiplan Workers Comp	$0.12
Rate for Payer: Parkland Medicaid	$0.13
Rate for Payer: Scott and White EPO/PPO	$0.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.13
Rate for Payer: Superior Health Plan EPO	$0.02

BLADE, TONGUE, 6', STERILE

Facility

$0.18

Hospital Charge Code	993232
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.12

BLANKET WARMING FULL BODY

Facility

$104.05

Hospital Charge Code	8538531
Hospital Revenue Code	272
Rate for Payer: Cash Price	$70.75

BLANKET WARMING FULL BODY

Facility

$104.05

Hospital Charge Code	8538531
Hospital Revenue Code	272
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$74.92
Rate for Payer: Amerigroup CHIP/Medicaid	$9.36
Rate for Payer: BCBS of TX Blue Advantage	$31.21
Rate for Payer: BCBS of TX Blue Essentials	$37.46
Rate for Payer: BCBS of TX PPO	$41.62
Rate for Payer: Cash Price	$70.75
Rate for Payer: Cigna Medicaid	$74.92
Rate for Payer: Molina CHIP/Medicaid	$74.92
Rate for Payer: Multiplan Auto	$67.63
Rate for Payer: Multiplan Commercial	$67.63
Rate for Payer: Multiplan Workers Comp	$67.63
Rate for Payer: Parkland Medicaid	$74.92
Rate for Payer: Scott and White EPO/PPO	$52.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$74.92
Rate for Payer: Superior Health Plan EPO	$14.15

BLANKET WARMING HALF BODY

Facility

$23.24

Hospital Charge Code	8538532
Hospital Revenue Code	272
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$16.73
Rate for Payer: Amerigroup CHIP/Medicaid	$2.09
Rate for Payer: BCBS of TX Blue Advantage	$6.97
Rate for Payer: BCBS of TX Blue Essentials	$8.37
Rate for Payer: BCBS of TX PPO	$9.30
Rate for Payer: Cash Price	$15.80
Rate for Payer: Cigna Medicaid	$16.73
Rate for Payer: Molina CHIP/Medicaid	$16.73
Rate for Payer: Multiplan Auto	$15.11
Rate for Payer: Multiplan Commercial	$15.11
Rate for Payer: Multiplan Workers Comp	$15.11
Rate for Payer: Parkland Medicaid	$16.73
Rate for Payer: Scott and White EPO/PPO	$11.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16.73
Rate for Payer: Superior Health Plan EPO	$3.16

BLANKET WARMING HALF BODY

Facility

$23.24

Hospital Charge Code	8538532
Hospital Revenue Code	272
Rate for Payer: Cash Price	$15.80

Know your out-of-pocket cost for care.

All Charges