White Rock Medical Center

All Charges

Charge

Type

Setting

Price

drill lag stepped gamma3 15.5x495mm

Facility

$10,058.91

Hospital Charge Code	8660702
Hospital Revenue Code	272
Rate for Payer: Cash Price	$8,851.84

drill lag stepped gamma3 15.5x495mm

Facility

$10,058.91

Hospital Charge Code	8660702
Hospital Revenue Code	272
Min. Negotiated Rate	$905.30
Max. Negotiated Rate	$6,538.29
Rate for Payer: Aetna Commercial	$5,532.40
Rate for Payer: Amerigroup CHIP/Medicaid	$905.30
Rate for Payer: BCBS of TX Blue Advantage	$3,017.67
Rate for Payer: BCBS of TX Blue Essentials	$3,621.21
Rate for Payer: BCBS of TX PPO	$4,023.56
Rate for Payer: Cash Price	$8,851.84
Rate for Payer: Multiplan Auto	$6,538.29
Rate for Payer: Multiplan Commercial	$6,538.29
Rate for Payer: Multiplan Workers Comp	$6,538.29
Rate for Payer: Scott and White EPO/PPO	$5,029.46
Rate for Payer: Superior Health Plan EPO	$1,368.01

DRILL LONG DISP -- DHF

Facility

$7,003.40

Hospital Charge Code	81315673
Hospital Revenue Code	272
Min. Negotiated Rate	$630.31
Max. Negotiated Rate	$4,552.21
Rate for Payer: Aetna Commercial	$3,851.87
Rate for Payer: Amerigroup CHIP/Medicaid	$630.31
Rate for Payer: BCBS of TX Blue Advantage	$2,101.02
Rate for Payer: BCBS of TX Blue Essentials	$2,521.22
Rate for Payer: BCBS of TX PPO	$2,801.36
Rate for Payer: Cash Price	$6,162.99
Rate for Payer: Multiplan Auto	$4,552.21
Rate for Payer: Multiplan Commercial	$4,552.21
Rate for Payer: Multiplan Workers Comp	$4,552.21
Rate for Payer: Scott and White EPO/PPO	$3,501.70
Rate for Payer: Superior Health Plan EPO	$952.46

DRILL LONG DISP -- DHF

Facility

$7,003.40

Hospital Charge Code	81315673
Hospital Revenue Code	272
Rate for Payer: Cash Price	$6,162.99

DRILL TIP -- DHF

Facility

$3,364.30

Hospital Charge Code	80810955
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,960.58

DRILL TIP -- DHF

Facility

$3,364.30

Hospital Charge Code	80810955
Hospital Revenue Code	272
Min. Negotiated Rate	$302.79
Max. Negotiated Rate	$2,186.80
Rate for Payer: Aetna Commercial	$1,850.36
Rate for Payer: Amerigroup CHIP/Medicaid	$302.79
Rate for Payer: BCBS of TX Blue Advantage	$1,009.29
Rate for Payer: BCBS of TX Blue Essentials	$1,211.15
Rate for Payer: BCBS of TX PPO	$1,345.72
Rate for Payer: Cash Price	$2,960.58
Rate for Payer: Multiplan Auto	$2,186.80
Rate for Payer: Multiplan Commercial	$2,186.80
Rate for Payer: Multiplan Workers Comp	$2,186.80
Rate for Payer: Scott and White EPO/PPO	$1,682.15
Rate for Payer: Superior Health Plan EPO	$457.54

DRILL TWIST -- DHF

Facility

$62.04

Hospital Charge Code	80911423
Hospital Revenue Code	272
Rate for Payer: Cash Price	$54.60

DRILL TWIST -- DHF

Facility

$62.04

Hospital Charge Code	80911423
Hospital Revenue Code	272
Min. Negotiated Rate	$5.58
Max. Negotiated Rate	$40.33
Rate for Payer: Aetna Commercial	$34.12
Rate for Payer: Amerigroup CHIP/Medicaid	$5.58
Rate for Payer: BCBS of TX Blue Advantage	$18.61
Rate for Payer: BCBS of TX Blue Essentials	$22.33
Rate for Payer: BCBS of TX PPO	$24.82
Rate for Payer: Cash Price	$54.60
Rate for Payer: Multiplan Auto	$40.33
Rate for Payer: Multiplan Commercial	$40.33
Rate for Payer: Multiplan Workers Comp	$40.33
Rate for Payer: Scott and White EPO/PPO	$31.02
Rate for Payer: Superior Health Plan EPO	$8.44

DRIVER DISP SCREW -- DHF

Facility

$608.36

Hospital Charge Code	81740698
Hospital Revenue Code	272
Min. Negotiated Rate	$54.75
Max. Negotiated Rate	$395.43
Rate for Payer: Aetna Commercial	$334.60
Rate for Payer: Amerigroup CHIP/Medicaid	$54.75
Rate for Payer: BCBS of TX Blue Advantage	$182.51
Rate for Payer: BCBS of TX Blue Essentials	$219.01
Rate for Payer: BCBS of TX PPO	$243.34
Rate for Payer: Cash Price	$535.36
Rate for Payer: Multiplan Auto	$395.43
Rate for Payer: Multiplan Commercial	$395.43
Rate for Payer: Multiplan Workers Comp	$395.43
Rate for Payer: Scott and White EPO/PPO	$304.18
Rate for Payer: Superior Health Plan EPO	$82.74

DRIVER DISP SCREW -- DHF

Facility

$608.36

Hospital Charge Code	81740698
Hospital Revenue Code	272
Rate for Payer: Cash Price	$535.36

DRN CHST UWTR

Facility

$185.32

Hospital Charge Code	80320609
Hospital Revenue Code	270
Rate for Payer: Cash Price	$163.08

DRN CHST UWTR

Facility

$185.32

Hospital Charge Code	80320609
Hospital Revenue Code	270
Min. Negotiated Rate	$16.68
Max. Negotiated Rate	$120.46
Rate for Payer: Aetna Commercial	$101.93
Rate for Payer: Amerigroup CHIP/Medicaid	$16.68
Rate for Payer: BCBS of TX Blue Advantage	$55.60
Rate for Payer: BCBS of TX Blue Essentials	$66.72
Rate for Payer: BCBS of TX PPO	$74.13
Rate for Payer: Cash Price	$163.08
Rate for Payer: Multiplan Auto	$120.46
Rate for Payer: Multiplan Commercial	$120.46
Rate for Payer: Multiplan Workers Comp	$120.46
Rate for Payer: Scott and White EPO/PPO	$92.66
Rate for Payer: Superior Health Plan EPO	$25.20

DRN SUMP SALEM -- DHF

Facility

$170.09

Hospital Charge Code	81821456
Hospital Revenue Code	272
Min. Negotiated Rate	$15.31
Max. Negotiated Rate	$110.56
Rate for Payer: Aetna Commercial	$93.55
Rate for Payer: Amerigroup CHIP/Medicaid	$15.31
Rate for Payer: BCBS of TX Blue Advantage	$51.03
Rate for Payer: BCBS of TX Blue Essentials	$61.23
Rate for Payer: BCBS of TX PPO	$68.04
Rate for Payer: Cash Price	$149.68
Rate for Payer: Multiplan Auto	$110.56
Rate for Payer: Multiplan Commercial	$110.56
Rate for Payer: Multiplan Workers Comp	$110.56
Rate for Payer: Scott and White EPO/PPO	$85.04
Rate for Payer: Superior Health Plan EPO	$23.13

DRN SUMP SALEM -- DHF

Facility

$170.09

Hospital Charge Code	81821456
Hospital Revenue Code	272
Rate for Payer: Cash Price	$149.68

DRP ANGIO FEM -- DHF

Facility

$72.92

Hospital Charge Code	81620056
Hospital Revenue Code	272
Rate for Payer: Cash Price	$64.17

DRP ANGIO FEM -- DHF

Facility

$72.92

Hospital Charge Code	81620056
Hospital Revenue Code	272
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$47.40
Rate for Payer: Aetna Commercial	$40.11
Rate for Payer: Amerigroup CHIP/Medicaid	$6.56
Rate for Payer: BCBS of TX Blue Advantage	$21.88
Rate for Payer: BCBS of TX Blue Essentials	$26.25
Rate for Payer: BCBS of TX PPO	$29.17
Rate for Payer: Cash Price	$64.17
Rate for Payer: Multiplan Auto	$47.40
Rate for Payer: Multiplan Commercial	$47.40
Rate for Payer: Multiplan Workers Comp	$47.40
Rate for Payer: Scott and White EPO/PPO	$36.46
Rate for Payer: Superior Health Plan EPO	$9.92

DRP SHEET SPLT -- DHF

Facility

$400.04

Hospital Charge Code	81623001
Hospital Revenue Code	272
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$260.03
Rate for Payer: Aetna Commercial	$220.02
Rate for Payer: Amerigroup CHIP/Medicaid	$36.00
Rate for Payer: BCBS of TX Blue Advantage	$120.01
Rate for Payer: BCBS of TX Blue Essentials	$144.01
Rate for Payer: BCBS of TX PPO	$160.02
Rate for Payer: Cash Price	$352.04
Rate for Payer: Multiplan Auto	$260.03
Rate for Payer: Multiplan Commercial	$260.03
Rate for Payer: Multiplan Workers Comp	$260.03
Rate for Payer: Scott and White EPO/PPO	$200.02
Rate for Payer: Superior Health Plan EPO	$54.41

DRP SHEET SPLT -- DHF

Facility

$400.04

Hospital Charge Code	81623001
Hospital Revenue Code	272
Rate for Payer: Cash Price	$352.04

DRP STRI INCSM -- DHF

Facility

$211.71

Hospital Charge Code	81623753
Hospital Revenue Code	272
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$137.61
Rate for Payer: Aetna Commercial	$116.44
Rate for Payer: Amerigroup CHIP/Medicaid	$19.05
Rate for Payer: BCBS of TX Blue Advantage	$63.51
Rate for Payer: BCBS of TX Blue Essentials	$76.22
Rate for Payer: BCBS of TX PPO	$84.68
Rate for Payer: Cash Price	$186.30
Rate for Payer: Multiplan Auto	$137.61
Rate for Payer: Multiplan Commercial	$137.61
Rate for Payer: Multiplan Workers Comp	$137.61
Rate for Payer: Scott and White EPO/PPO	$105.86
Rate for Payer: Superior Health Plan EPO	$28.79

DRP STRI INCSM -- DHF

Facility

$211.71

Hospital Charge Code	81623753
Hospital Revenue Code	272
Rate for Payer: Cash Price	$186.30

DRS ADHES WND -- DHF

Facility

$106.03

Hospital Charge Code	80243231
Hospital Revenue Code	270
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$68.92
Rate for Payer: Aetna Commercial	$58.32
Rate for Payer: Amerigroup CHIP/Medicaid	$9.54
Rate for Payer: BCBS of TX Blue Advantage	$31.81
Rate for Payer: BCBS of TX Blue Essentials	$38.17
Rate for Payer: BCBS of TX PPO	$42.41
Rate for Payer: Cash Price	$93.31
Rate for Payer: Multiplan Auto	$68.92
Rate for Payer: Multiplan Commercial	$68.92
Rate for Payer: Multiplan Workers Comp	$68.92
Rate for Payer: Scott and White EPO/PPO	$53.02
Rate for Payer: Superior Health Plan EPO	$14.42

DRS ADHES WND -- DHF

Facility

$106.03

Hospital Charge Code	80243231
Hospital Revenue Code	270
Rate for Payer: Cash Price	$93.31

DRS ANTIMICROBIAL II -- DHF

Facility

$138.50

Hospital Charge Code	80243389
Hospital Revenue Code	272
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$90.02
Rate for Payer: Aetna Commercial	$76.18
Rate for Payer: Amerigroup CHIP/Medicaid	$12.46
Rate for Payer: BCBS of TX Blue Advantage	$41.55
Rate for Payer: BCBS of TX Blue Essentials	$49.86
Rate for Payer: BCBS of TX PPO	$55.40
Rate for Payer: Cash Price	$121.88
Rate for Payer: Multiplan Auto	$90.02
Rate for Payer: Multiplan Commercial	$90.02
Rate for Payer: Multiplan Workers Comp	$90.02
Rate for Payer: Scott and White EPO/PPO	$69.25
Rate for Payer: Superior Health Plan EPO	$18.84

DRS ANTIMICROBIAL II -- DHF

Facility

$138.50

Hospital Charge Code	80243389
Hospital Revenue Code	272
Rate for Payer: Cash Price	$121.88

DRS BIND ELASTIC TUBLAR -- DHF

Facility

$136.73

Hospital Charge Code	80243678
Hospital Revenue Code	270
Rate for Payer: Cash Price	$120.32

Know your out-of-pocket cost for care.

All Charges