White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CURAD Xeroform gauze dressing sterile 1x8

Facility

$2.61

Hospital Charge Code	992945
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1.77

curved cutter stapler

Facility

$1,044.20

Hospital Charge Code	993971
Hospital Revenue Code	272
Rate for Payer: Cash Price	$710.06

curved cutter stapler

Facility

$1,044.20

Hospital Charge Code	993971
Hospital Revenue Code	272
Min. Negotiated Rate	$93.98
Max. Negotiated Rate	$751.82
Rate for Payer: Amerigroup CHIP/Medicaid	$93.98
Rate for Payer: BCBS of TX Blue Advantage	$313.26
Rate for Payer: BCBS of TX Blue Essentials	$375.91
Rate for Payer: BCBS of TX PPO	$417.68
Rate for Payer: Cash Price	$710.06
Rate for Payer: Cigna Medicaid	$751.82
Rate for Payer: Molina CHIP/Medicaid	$751.82
Rate for Payer: Multiplan Auto	$678.73
Rate for Payer: Multiplan Commercial	$678.73
Rate for Payer: Multiplan Workers Comp	$678.73
Rate for Payer: Parkland Medicaid	$751.82
Rate for Payer: Scott and White EPO/PPO	$522.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$751.82
Rate for Payer: Superior Health Plan EPO	$142.01

Custom PSI MTP Fusion Cage

Facility

$84,307.23

Service Code	HCPCS C1831
Hospital Charge Code	8504492
Hospital Revenue Code	278
Min. Negotiated Rate	$7,587.65
Max. Negotiated Rate	$60,701.21
Rate for Payer: Amerigroup CHIP/Medicaid	$7,587.65
Rate for Payer: Cash Price	$57,328.92
Rate for Payer: Cigna Medicaid	$60,701.21
Rate for Payer: Molina CHIP/Medicaid	$60,701.21
Rate for Payer: Multiplan Auto	$42,153.61
Rate for Payer: Multiplan Commercial	$42,153.61
Rate for Payer: Multiplan Workers Comp	$42,153.61
Rate for Payer: Parkland Medicaid	$60,701.21
Rate for Payer: Scott and White EPO/PPO	$42,153.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$60,701.21
Rate for Payer: Superior Health Plan EPO	$11,465.78

Custom PSI MTP Fusion Cage

Facility

$84,307.23

Service Code	HCPCS C1831
Hospital Charge Code	993129
Hospital Revenue Code	278
Min. Negotiated Rate	$7,587.65
Max. Negotiated Rate	$60,701.21
Rate for Payer: Amerigroup CHIP/Medicaid	$7,587.65
Rate for Payer: Cash Price	$57,328.92
Rate for Payer: Cigna Medicaid	$60,701.21
Rate for Payer: Molina CHIP/Medicaid	$60,701.21
Rate for Payer: Multiplan Auto	$42,153.61
Rate for Payer: Multiplan Commercial	$42,153.61
Rate for Payer: Multiplan Workers Comp	$42,153.61
Rate for Payer: Parkland Medicaid	$60,701.21
Rate for Payer: Scott and White EPO/PPO	$42,153.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$60,701.21
Rate for Payer: Superior Health Plan EPO	$11,465.78

Custom PSI MTP Fusion Cage

Facility

$84,307.23

Service Code	HCPCS C1831
Hospital Charge Code	8504492
Hospital Revenue Code	278
Min. Negotiated Rate	$21,076.81
Max. Negotiated Rate	$42,153.61
Rate for Payer: Cash Price	$57,328.92
Rate for Payer: Cigna Commercial	$21,076.81
Rate for Payer: Multiplan Auto	$42,153.61
Rate for Payer: Multiplan Commercial	$42,153.61
Rate for Payer: Multiplan Workers Comp	$42,153.61
Rate for Payer: Scott and White EPO/PPO	$42,153.61

Custom PSI MTP Fusion Cage

Facility

$84,307.23

Service Code	HCPCS C1831
Hospital Charge Code	993129
Hospital Revenue Code	278
Min. Negotiated Rate	$21,076.81
Max. Negotiated Rate	$42,153.61
Rate for Payer: Cash Price	$57,328.92
Rate for Payer: Cigna Commercial	$21,076.81
Rate for Payer: Multiplan Auto	$42,153.61
Rate for Payer: Multiplan Commercial	$42,153.61
Rate for Payer: Multiplan Workers Comp	$42,153.61
Rate for Payer: Scott and White EPO/PPO	$42,153.61

CUTTER/CRUSHER, PILL, BLUE

Facility

$34.62

Hospital Charge Code	993220
Hospital Revenue Code	270
Rate for Payer: Cash Price	$23.54

CUTTER/CRUSHER, PILL, BLUE

Facility

$34.62

Hospital Charge Code	993220
Hospital Revenue Code	270
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$24.93
Rate for Payer: Amerigroup CHIP/Medicaid	$3.12
Rate for Payer: BCBS of TX Blue Advantage	$10.39
Rate for Payer: BCBS of TX Blue Essentials	$12.46
Rate for Payer: BCBS of TX PPO	$13.85
Rate for Payer: Cash Price	$23.54
Rate for Payer: Cigna Medicaid	$24.93
Rate for Payer: Molina CHIP/Medicaid	$24.93
Rate for Payer: Multiplan Auto	$22.50
Rate for Payer: Multiplan Commercial	$22.50
Rate for Payer: Multiplan Workers Comp	$22.50
Rate for Payer: Parkland Medicaid	$24.93
Rate for Payer: Scott and White EPO/PPO	$17.31
Rate for Payer: Superior Health Plan CHIP/Medicaid	$24.93
Rate for Payer: Superior Health Plan EPO	$4.71

CUTTER, ECHELON, CONTOUR, BLUE

Facility

$3,051.83

Hospital Charge Code	992331
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,075.24

CUTTER, ECHELON, CONTOUR, BLUE

Facility

$3,051.83

Hospital Charge Code	992331
Hospital Revenue Code	272
Min. Negotiated Rate	$274.66
Max. Negotiated Rate	$2,197.32
Rate for Payer: Amerigroup CHIP/Medicaid	$274.66
Rate for Payer: BCBS of TX Blue Advantage	$915.55
Rate for Payer: BCBS of TX Blue Essentials	$1,098.66
Rate for Payer: BCBS of TX PPO	$1,220.73
Rate for Payer: Cash Price	$2,075.24
Rate for Payer: Cigna Medicaid	$2,197.32
Rate for Payer: Molina CHIP/Medicaid	$2,197.32
Rate for Payer: Multiplan Auto	$1,983.69
Rate for Payer: Multiplan Commercial	$1,983.69
Rate for Payer: Multiplan Workers Comp	$1,983.69
Rate for Payer: Parkland Medicaid	$2,197.32
Rate for Payer: Scott and White EPO/PPO	$1,525.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,197.32
Rate for Payer: Superior Health Plan EPO	$415.05

CUTTER, ECHELON, CONTOUR, GREEN BX

Facility

$3,051.83

Hospital Charge Code	992332
Hospital Revenue Code	272
Min. Negotiated Rate	$274.66
Max. Negotiated Rate	$2,197.32
Rate for Payer: Amerigroup CHIP/Medicaid	$274.66
Rate for Payer: BCBS of TX Blue Advantage	$915.55
Rate for Payer: BCBS of TX Blue Essentials	$1,098.66
Rate for Payer: BCBS of TX PPO	$1,220.73
Rate for Payer: Cash Price	$2,075.24
Rate for Payer: Cigna Medicaid	$2,197.32
Rate for Payer: Molina CHIP/Medicaid	$2,197.32
Rate for Payer: Multiplan Auto	$1,983.69
Rate for Payer: Multiplan Commercial	$1,983.69
Rate for Payer: Multiplan Workers Comp	$1,983.69
Rate for Payer: Parkland Medicaid	$2,197.32
Rate for Payer: Scott and White EPO/PPO	$1,525.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,197.32
Rate for Payer: Superior Health Plan EPO	$415.05

CUTTER, ECHELON, CONTOUR, GREEN BX

Facility

$3,051.83

Hospital Charge Code	992332
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,075.24

CUTTER, ENDOSCOPIC LINEAR ARTICULAT 45MM NO RELOAD -- DHF

Facility

$1,581.16

Hospital Charge Code	81911851
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,075.19

CUTTER, ENDOSCOPIC LINEAR ARTICULAT 45MM NO RELOAD -- DHF

Facility

$1,581.16

Hospital Charge Code	81911851
Hospital Revenue Code	272
Min. Negotiated Rate	$142.30
Max. Negotiated Rate	$1,138.44
Rate for Payer: Amerigroup CHIP/Medicaid	$142.30
Rate for Payer: BCBS of TX Blue Advantage	$474.35
Rate for Payer: BCBS of TX Blue Essentials	$569.22
Rate for Payer: BCBS of TX PPO	$632.46
Rate for Payer: Cash Price	$1,075.19
Rate for Payer: Cigna Medicaid	$1,138.44
Rate for Payer: Molina CHIP/Medicaid	$1,138.44
Rate for Payer: Multiplan Auto	$1,027.75
Rate for Payer: Multiplan Commercial	$1,027.75
Rate for Payer: Multiplan Workers Comp	$1,027.75
Rate for Payer: Parkland Medicaid	$1,138.44
Rate for Payer: Scott and White EPO/PPO	$790.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,138.44
Rate for Payer: Superior Health Plan EPO	$215.04

CUTTER, LINEAR, 75MM, SAFETY LOCKOUT

Facility

$460.30

Hospital Charge Code	993820
Hospital Revenue Code	279
Rate for Payer: Cash Price	$313.00

CUTTER, LINEAR, 75MM, SAFETY LOCKOUT

Facility

$460.30

Hospital Charge Code	993820
Hospital Revenue Code	279
Min. Negotiated Rate	$41.43
Max. Negotiated Rate	$331.42
Rate for Payer: Amerigroup CHIP/Medicaid	$41.43
Rate for Payer: BCBS of TX Blue Advantage	$138.09
Rate for Payer: BCBS of TX Blue Essentials	$165.71
Rate for Payer: BCBS of TX PPO	$184.12
Rate for Payer: Cash Price	$313.00
Rate for Payer: Cigna Medicaid	$331.42
Rate for Payer: Molina CHIP/Medicaid	$331.42
Rate for Payer: Multiplan Auto	$299.19
Rate for Payer: Multiplan Commercial	$299.19
Rate for Payer: Multiplan Workers Comp	$299.19
Rate for Payer: Parkland Medicaid	$331.42
Rate for Payer: Scott and White EPO/PPO	$230.15
Rate for Payer: Superior Health Plan CHIP/Medicaid	$331.42
Rate for Payer: Superior Health Plan EPO	$62.60

CUTTER, LINEAR ARTICULATING LONG FLEX 60MM 440MM -- DHF

Facility

$3,181.54

Hospital Charge Code	81945750
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,163.45

CUTTER, LINEAR ARTICULATING LONG FLEX 60MM 440MM -- DHF

Facility

$3,181.54

Hospital Charge Code	81945750
Hospital Revenue Code	272
Min. Negotiated Rate	$286.34
Max. Negotiated Rate	$2,290.71
Rate for Payer: Amerigroup CHIP/Medicaid	$286.34
Rate for Payer: BCBS of TX Blue Advantage	$954.46
Rate for Payer: BCBS of TX Blue Essentials	$1,145.35
Rate for Payer: BCBS of TX PPO	$1,272.62
Rate for Payer: Cash Price	$2,163.45
Rate for Payer: Cigna Medicaid	$2,290.71
Rate for Payer: Molina CHIP/Medicaid	$2,290.71
Rate for Payer: Multiplan Auto	$2,068.00
Rate for Payer: Multiplan Commercial	$2,068.00
Rate for Payer: Multiplan Workers Comp	$2,068.00
Rate for Payer: Parkland Medicaid	$2,290.71
Rate for Payer: Scott and White EPO/PPO	$1,590.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,290.71
Rate for Payer: Superior Health Plan EPO	$432.69

CUTTER SUT/KNOT PUSHER -- DHF

Facility

$726.40

Hospital Charge Code	81739716
Hospital Revenue Code	272
Rate for Payer: Cash Price	$493.95

CUTTER SUT/KNOT PUSHER -- DHF

Facility

$726.40

Hospital Charge Code	81739716
Hospital Revenue Code	272
Min. Negotiated Rate	$65.38
Max. Negotiated Rate	$523.01
Rate for Payer: Amerigroup CHIP/Medicaid	$65.38
Rate for Payer: BCBS of TX Blue Advantage	$217.92
Rate for Payer: BCBS of TX Blue Essentials	$261.50
Rate for Payer: BCBS of TX PPO	$290.56
Rate for Payer: Cash Price	$493.95
Rate for Payer: Cigna Medicaid	$523.01
Rate for Payer: Molina CHIP/Medicaid	$523.01
Rate for Payer: Multiplan Auto	$472.16
Rate for Payer: Multiplan Commercial	$472.16
Rate for Payer: Multiplan Workers Comp	$472.16
Rate for Payer: Parkland Medicaid	$523.01
Rate for Payer: Scott and White EPO/PPO	$363.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$523.01
Rate for Payer: Superior Health Plan EPO	$98.79

CUTTER TOMCAT HC CROSSBLADE 4.0MM

Facility

$518.89

Hospital Charge Code	993202
Hospital Revenue Code	272
Rate for Payer: Cash Price	$352.85

CUTTER TOMCAT HC CROSSBLADE 4.0MM

Facility

$518.89

Hospital Charge Code	993202
Hospital Revenue Code	272
Min. Negotiated Rate	$46.70
Max. Negotiated Rate	$373.60
Rate for Payer: Amerigroup CHIP/Medicaid	$46.70
Rate for Payer: BCBS of TX Blue Advantage	$155.67
Rate for Payer: BCBS of TX Blue Essentials	$186.80
Rate for Payer: BCBS of TX PPO	$207.56
Rate for Payer: Cash Price	$352.85
Rate for Payer: Cigna Medicaid	$373.60
Rate for Payer: Molina CHIP/Medicaid	$373.60
Rate for Payer: Multiplan Auto	$337.28
Rate for Payer: Multiplan Commercial	$337.28
Rate for Payer: Multiplan Workers Comp	$337.28
Rate for Payer: Parkland Medicaid	$373.60
Rate for Payer: Scott and White EPO/PPO	$259.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$373.60
Rate for Payer: Superior Health Plan EPO	$70.57

CUVETTE FOR CS-2500 ANALYZER

Facility

$10.49

Hospital Charge Code	993526
Hospital Revenue Code	270
Rate for Payer: Cash Price	$7.13

CUVETTE FOR CS-2500 ANALYZER

Facility

$10.49

Hospital Charge Code	993526
Hospital Revenue Code	270
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$7.55
Rate for Payer: Amerigroup CHIP/Medicaid	$0.94
Rate for Payer: BCBS of TX Blue Advantage	$3.15
Rate for Payer: BCBS of TX Blue Essentials	$3.78
Rate for Payer: BCBS of TX PPO	$4.20
Rate for Payer: Cash Price	$7.13
Rate for Payer: Cigna Medicaid	$7.55
Rate for Payer: Molina CHIP/Medicaid	$7.55
Rate for Payer: Multiplan Auto	$6.82
Rate for Payer: Multiplan Commercial	$6.82
Rate for Payer: Multiplan Workers Comp	$6.82
Rate for Payer: Parkland Medicaid	$7.55
Rate for Payer: Scott and White EPO/PPO	$5.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.55
Rate for Payer: Superior Health Plan EPO	$1.43

Know your out-of-pocket cost for care.

All Charges