White Rock Medical Center

All Charges

Charge

Type

Setting

Price

DRESSING, NON-ADHERENT ISLAND MELOLIN 6'''' X 3-1/8'''' -- DHF

Facility

$96.69

Hospital Charge Code	80243306
Hospital Revenue Code	272
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$62.85
Rate for Payer: Aetna Commercial	$53.18
Rate for Payer: Amerigroup CHIP/Medicaid	$8.70
Rate for Payer: BCBS of TX Blue Advantage	$29.01
Rate for Payer: BCBS of TX Blue Essentials	$34.81
Rate for Payer: BCBS of TX PPO	$38.68
Rate for Payer: Cash Price	$85.09
Rate for Payer: Multiplan Auto	$62.85
Rate for Payer: Multiplan Commercial	$62.85
Rate for Payer: Multiplan Workers Comp	$62.85
Rate for Payer: Scott and White EPO/PPO	$48.34
Rate for Payer: Superior Health Plan EPO	$13.15

DRESSING, NON-ADHERENT ISLAND MELOLIN 8 X 4'''' -- DHF

Facility

$96.69

Hospital Charge Code	80243306
Hospital Revenue Code	272
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$62.85
Rate for Payer: Aetna Commercial	$53.18
Rate for Payer: Amerigroup CHIP/Medicaid	$8.70
Rate for Payer: BCBS of TX Blue Advantage	$29.01
Rate for Payer: BCBS of TX Blue Essentials	$34.81
Rate for Payer: BCBS of TX PPO	$38.68
Rate for Payer: Cash Price	$85.09
Rate for Payer: Multiplan Auto	$62.85
Rate for Payer: Multiplan Commercial	$62.85
Rate for Payer: Multiplan Workers Comp	$62.85
Rate for Payer: Scott and White EPO/PPO	$48.34
Rate for Payer: Superior Health Plan EPO	$13.15

DRESSING, NON-ADHERENT ISLAND MELOLIN 8 X 4'''' -- DHF

Facility

$96.69

Hospital Charge Code	80243306
Hospital Revenue Code	272
Rate for Payer: Cash Price	$85.09

DRESSING, PAD NON-ADHERENT 3'''' X 4'''' STERILE -- DHF

Facility

$4.69

Hospital Charge Code	80249261
Hospital Revenue Code	270
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$3.05
Rate for Payer: Aetna Commercial	$2.58
Rate for Payer: Amerigroup CHIP/Medicaid	$0.42
Rate for Payer: BCBS of TX Blue Advantage	$1.41
Rate for Payer: BCBS of TX Blue Essentials	$1.69
Rate for Payer: BCBS of TX PPO	$1.88
Rate for Payer: Cash Price	$4.13
Rate for Payer: Multiplan Auto	$3.05
Rate for Payer: Multiplan Commercial	$3.05
Rate for Payer: Multiplan Workers Comp	$3.05
Rate for Payer: Scott and White EPO/PPO	$2.34
Rate for Payer: Superior Health Plan EPO	$0.64

DRESSING, TRANSPARENT TEGADERM REGULAR 4''''X4-3/4'''' -- DHF

Facility

$6.57

Hospital Charge Code	80249295
Hospital Revenue Code	270
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$4.27
Rate for Payer: Aetna Commercial	$3.61
Rate for Payer: Amerigroup CHIP/Medicaid	$0.59
Rate for Payer: BCBS of TX Blue Advantage	$1.97
Rate for Payer: BCBS of TX Blue Essentials	$2.37
Rate for Payer: BCBS of TX PPO	$2.63
Rate for Payer: Cash Price	$5.78
Rate for Payer: Multiplan Auto	$4.27
Rate for Payer: Multiplan Commercial	$4.27
Rate for Payer: Multiplan Workers Comp	$4.27
Rate for Payer: Scott and White EPO/PPO	$3.28
Rate for Payer: Superior Health Plan EPO	$0.89

DRESSING, TRANSPARENT WOUND W/CLR WINDOW 10CMX12CM -- DHF

Facility

$73.38

Hospital Charge Code	80248859
Hospital Revenue Code	270
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna Commercial	$40.36
Rate for Payer: Amerigroup CHIP/Medicaid	$6.60
Rate for Payer: BCBS of TX Blue Advantage	$22.01
Rate for Payer: BCBS of TX Blue Essentials	$26.42
Rate for Payer: BCBS of TX PPO	$29.35
Rate for Payer: Cash Price	$64.57
Rate for Payer: Multiplan Auto	$47.70
Rate for Payer: Multiplan Commercial	$47.70
Rate for Payer: Multiplan Workers Comp	$47.70
Rate for Payer: Scott and White EPO/PPO	$36.69
Rate for Payer: Superior Health Plan EPO	$9.98

DRESSING, TRANSPARENT WOUND W/CLR WINDOW 10CMX12CM -- DHF

Facility

$73.38

Hospital Charge Code	80248859
Hospital Revenue Code	270
Rate for Payer: Cash Price	$64.57

DRESSING WOUND EXUFIBER 17.5 X 8

Facility

$33.87

Hospital Charge Code	8598510
Hospital Revenue Code	272
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$22.02
Rate for Payer: Aetna Commercial	$18.63
Rate for Payer: Amerigroup CHIP/Medicaid	$3.05
Rate for Payer: BCBS of TX Blue Advantage	$10.16
Rate for Payer: BCBS of TX Blue Essentials	$12.19
Rate for Payer: BCBS of TX PPO	$13.55
Rate for Payer: Cash Price	$29.81
Rate for Payer: Multiplan Auto	$22.02
Rate for Payer: Multiplan Commercial	$22.02
Rate for Payer: Multiplan Workers Comp	$22.02
Rate for Payer: Scott and White EPO/PPO	$16.94
Rate for Payer: Superior Health Plan EPO	$4.61

DRESSING WOUND EXUFIBER 17.5 X 8

Facility

$33.87

Hospital Charge Code	8598510
Hospital Revenue Code	272
Rate for Payer: Cash Price	$29.81

DRESSING WOUND EXUFIBER 4X5

Facility

$28.28

Hospital Charge Code	8568965
Hospital Revenue Code	272
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$18.38
Rate for Payer: Aetna Commercial	$15.55
Rate for Payer: Amerigroup CHIP/Medicaid	$2.55
Rate for Payer: BCBS of TX Blue Advantage	$8.48
Rate for Payer: BCBS of TX Blue Essentials	$10.18
Rate for Payer: BCBS of TX PPO	$11.31
Rate for Payer: Cash Price	$24.89
Rate for Payer: Multiplan Auto	$18.38
Rate for Payer: Multiplan Commercial	$18.38
Rate for Payer: Multiplan Workers Comp	$18.38
Rate for Payer: Scott and White EPO/PPO	$14.14
Rate for Payer: Superior Health Plan EPO	$3.85

DRESSING WOUND EXUFIBER 4X5

Facility

$28.28

Hospital Charge Code	8568965
Hospital Revenue Code	272
Rate for Payer: Cash Price	$24.89

DRESSING, XEROFORM 1 X 8'''' OVERWRAP PK STERILE -- DHF

Facility

$4.69

Hospital Charge Code	80249261
Hospital Revenue Code	270
Rate for Payer: Cash Price	$4.13

DRESSING, XEROFORM 1 X 8'''' OVERWRAP PK STERILE -- DHF

Facility

$4.69

Hospital Charge Code	80249261
Hospital Revenue Code	270
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$3.05
Rate for Payer: Aetna Commercial	$2.58
Rate for Payer: Amerigroup CHIP/Medicaid	$0.42
Rate for Payer: BCBS of TX Blue Advantage	$1.41
Rate for Payer: BCBS of TX Blue Essentials	$1.69
Rate for Payer: BCBS of TX PPO	$1.88
Rate for Payer: Cash Price	$4.13
Rate for Payer: Multiplan Auto	$3.05
Rate for Payer: Multiplan Commercial	$3.05
Rate for Payer: Multiplan Workers Comp	$3.05
Rate for Payer: Scott and White EPO/PPO	$2.34
Rate for Payer: Superior Health Plan EPO	$0.64

DRESSING, XEROFORM 5 X 9'''' STERILE -- DHF

Facility

$6.57

Hospital Charge Code	80249295
Hospital Revenue Code	270
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$4.27
Rate for Payer: Aetna Commercial	$3.61
Rate for Payer: Amerigroup CHIP/Medicaid	$0.59
Rate for Payer: BCBS of TX Blue Advantage	$1.97
Rate for Payer: BCBS of TX Blue Essentials	$2.37
Rate for Payer: BCBS of TX PPO	$2.63
Rate for Payer: Cash Price	$5.78
Rate for Payer: Multiplan Auto	$4.27
Rate for Payer: Multiplan Commercial	$4.27
Rate for Payer: Multiplan Workers Comp	$4.27
Rate for Payer: Scott and White EPO/PPO	$3.28
Rate for Payer: Superior Health Plan EPO	$0.89

DRESSING, XEROFORM 5 X 9'''' STERILE -- DHF

Facility

$6.57

Hospital Charge Code	80249295
Hospital Revenue Code	270
Rate for Payer: Cash Price	$5.78

DRILL 2.0

Facility

$940.87

Hospital Charge Code	132428
Hospital Revenue Code	272
Rate for Payer: Cash Price	$827.97

DRILL 2.0

Facility

$940.87

Hospital Charge Code	132428
Hospital Revenue Code	272
Min. Negotiated Rate	$84.68
Max. Negotiated Rate	$611.57
Rate for Payer: Aetna Commercial	$517.48
Rate for Payer: Amerigroup CHIP/Medicaid	$84.68
Rate for Payer: BCBS of TX Blue Advantage	$282.26
Rate for Payer: BCBS of TX Blue Essentials	$338.71
Rate for Payer: BCBS of TX PPO	$376.35
Rate for Payer: Cash Price	$827.97
Rate for Payer: Multiplan Auto	$611.57
Rate for Payer: Multiplan Commercial	$611.57
Rate for Payer: Multiplan Workers Comp	$611.57
Rate for Payer: Scott and White EPO/PPO	$470.44
Rate for Payer: Superior Health Plan EPO	$127.96

drill 6.5 twist 702601

Facility

$2,699.76

Hospital Charge Code	80911415
Hospital Revenue Code	272
Min. Negotiated Rate	$242.98
Max. Negotiated Rate	$1,754.84
Rate for Payer: Aetna Commercial	$1,484.87
Rate for Payer: Amerigroup CHIP/Medicaid	$242.98
Rate for Payer: BCBS of TX Blue Advantage	$809.93
Rate for Payer: BCBS of TX Blue Essentials	$971.91
Rate for Payer: BCBS of TX PPO	$1,079.90
Rate for Payer: Cash Price	$2,375.79
Rate for Payer: Multiplan Auto	$1,754.84
Rate for Payer: Multiplan Commercial	$1,754.84
Rate for Payer: Multiplan Workers Comp	$1,754.84
Rate for Payer: Scott and White EPO/PPO	$1,349.88
Rate for Payer: Superior Health Plan EPO	$367.17

drill 6.5 twist 702601

Facility

$2,699.76

Hospital Charge Code	80911415
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,375.79

DRILL, 6.5 TWIST 702601

Facility

$1,523.62

Hospital Charge Code	8570488
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,340.79

DRILL, 6.5 TWIST 702601

Facility

$1,523.62

Hospital Charge Code	8570488
Hospital Revenue Code	272
Min. Negotiated Rate	$137.13
Max. Negotiated Rate	$990.35
Rate for Payer: Aetna Commercial	$837.99
Rate for Payer: Amerigroup CHIP/Medicaid	$137.13
Rate for Payer: BCBS of TX Blue Advantage	$457.09
Rate for Payer: BCBS of TX Blue Essentials	$548.50
Rate for Payer: BCBS of TX PPO	$609.45
Rate for Payer: Cash Price	$1,340.79
Rate for Payer: Multiplan Auto	$990.35
Rate for Payer: Multiplan Commercial	$990.35
Rate for Payer: Multiplan Workers Comp	$990.35
Rate for Payer: Scott and White EPO/PPO	$761.81
Rate for Payer: Superior Health Plan EPO	$207.21

DRILL BIT 013.0 X 300MM

Facility

$1,877.74

Hospital Charge Code	145343
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,652.41

DRILL BIT 013.0 X 300MM

Facility

$1,877.74

Hospital Charge Code	145343
Hospital Revenue Code	272
Min. Negotiated Rate	$169.00
Max. Negotiated Rate	$1,220.53
Rate for Payer: Aetna Commercial	$1,032.76
Rate for Payer: Amerigroup CHIP/Medicaid	$169.00
Rate for Payer: BCBS of TX Blue Advantage	$563.32
Rate for Payer: BCBS of TX Blue Essentials	$675.99
Rate for Payer: BCBS of TX PPO	$751.10
Rate for Payer: Cash Price	$1,652.41
Rate for Payer: Multiplan Auto	$1,220.53
Rate for Payer: Multiplan Commercial	$1,220.53
Rate for Payer: Multiplan Workers Comp	$1,220.53
Rate for Payer: Scott and White EPO/PPO	$938.87
Rate for Payer: Superior Health Plan EPO	$255.37

drill bit 017x300mm

Facility

$4,717.97

Hospital Charge Code	8720594
Hospital Revenue Code	272
Min. Negotiated Rate	$424.62
Max. Negotiated Rate	$3,066.68
Rate for Payer: Aetna Commercial	$2,594.88
Rate for Payer: Amerigroup CHIP/Medicaid	$424.62
Rate for Payer: BCBS of TX Blue Advantage	$1,415.39
Rate for Payer: BCBS of TX Blue Essentials	$1,698.47
Rate for Payer: BCBS of TX PPO	$1,887.19
Rate for Payer: Cash Price	$4,151.81
Rate for Payer: Multiplan Auto	$3,066.68
Rate for Payer: Multiplan Commercial	$3,066.68
Rate for Payer: Multiplan Workers Comp	$3,066.68
Rate for Payer: Scott and White EPO/PPO	$2,358.98
Rate for Payer: Superior Health Plan EPO	$641.64

drill bit 017x300mm

Facility

$4,717.97

Hospital Charge Code	8720594
Hospital Revenue Code	272
Rate for Payer: Cash Price	$4,151.81

Know your out-of-pocket cost for care.

All Charges