White Rock Medical Center

All Charges

Charge

Type

Setting

Price

DRILL 7.5MM CANNULATED

Facility

$1,475.00

Hospital Charge Code	146503
Hospital Revenue Code	272
Min. Negotiated Rate	$132.75
Max. Negotiated Rate	$1,062.00
Rate for Payer: Amerigroup CHIP/Medicaid	$132.75
Rate for Payer: BCBS of TX Blue Advantage	$442.50
Rate for Payer: BCBS of TX Blue Essentials	$531.00
Rate for Payer: BCBS of TX PPO	$590.00
Rate for Payer: Cash Price	$1,003.00
Rate for Payer: Cigna Medicaid	$1,062.00
Rate for Payer: Molina CHIP/Medicaid	$1,062.00
Rate for Payer: Multiplan Auto	$958.75
Rate for Payer: Multiplan Commercial	$958.75
Rate for Payer: Multiplan Workers Comp	$958.75
Rate for Payer: Parkland Medicaid	$1,062.00
Rate for Payer: Scott and White EPO/PPO	$737.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,062.00
Rate for Payer: Superior Health Plan EPO	$200.60

DRILL ARTHROSCOPIC 2.9MM F/SUPER QUICKANCHOR/RC GLS

Facility

$1,629.86

Hospital Charge Code	116438
Hospital Revenue Code	270
Min. Negotiated Rate	$146.69
Max. Negotiated Rate	$1,173.50
Rate for Payer: Amerigroup CHIP/Medicaid	$146.69
Rate for Payer: BCBS of TX Blue Advantage	$488.96
Rate for Payer: BCBS of TX Blue Essentials	$586.75
Rate for Payer: BCBS of TX PPO	$651.94
Rate for Payer: Cash Price	$1,108.30
Rate for Payer: Cigna Medicaid	$1,173.50
Rate for Payer: Molina CHIP/Medicaid	$1,173.50
Rate for Payer: Multiplan Auto	$1,059.41
Rate for Payer: Multiplan Commercial	$1,059.41
Rate for Payer: Multiplan Workers Comp	$1,059.41
Rate for Payer: Parkland Medicaid	$1,173.50
Rate for Payer: Scott and White EPO/PPO	$814.93
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,173.50
Rate for Payer: Superior Health Plan EPO	$221.66

DRILL ARTHROSCOPIC 2.9MM F/SUPER QUICKANCHOR/RC GLS

Facility

$1,629.86

Hospital Charge Code	116438
Hospital Revenue Code	270
Rate for Payer: Cash Price	$1,108.30

DRILL BADGER CANNULATED 8.0

Facility

$580.35

Hospital Charge Code	146152
Hospital Revenue Code	272
Rate for Payer: Cash Price	$394.64

DRILL BADGER CANNULATED 8.0

Facility

$580.35

Hospital Charge Code	146152
Hospital Revenue Code	272
Min. Negotiated Rate	$52.23
Max. Negotiated Rate	$417.85
Rate for Payer: Amerigroup CHIP/Medicaid	$52.23
Rate for Payer: BCBS of TX Blue Advantage	$174.10
Rate for Payer: BCBS of TX Blue Essentials	$208.93
Rate for Payer: BCBS of TX PPO	$232.14
Rate for Payer: Cash Price	$394.64
Rate for Payer: Cigna Medicaid	$417.85
Rate for Payer: Molina CHIP/Medicaid	$417.85
Rate for Payer: Multiplan Auto	$377.23
Rate for Payer: Multiplan Commercial	$377.23
Rate for Payer: Multiplan Workers Comp	$377.23
Rate for Payer: Parkland Medicaid	$417.85
Rate for Payer: Scott and White EPO/PPO	$290.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$417.85
Rate for Payer: Superior Health Plan EPO	$78.93

DRILL BIT

Facility

$1,035.12

Hospital Charge Code	993089
Hospital Revenue Code	272
Min. Negotiated Rate	$93.16
Max. Negotiated Rate	$745.29
Rate for Payer: Amerigroup CHIP/Medicaid	$93.16
Rate for Payer: BCBS of TX Blue Advantage	$310.54
Rate for Payer: BCBS of TX Blue Essentials	$372.64
Rate for Payer: BCBS of TX PPO	$414.05
Rate for Payer: Cash Price	$703.88
Rate for Payer: Cigna Medicaid	$745.29
Rate for Payer: Molina CHIP/Medicaid	$745.29
Rate for Payer: Multiplan Auto	$672.83
Rate for Payer: Multiplan Commercial	$672.83
Rate for Payer: Multiplan Workers Comp	$672.83
Rate for Payer: Parkland Medicaid	$745.29
Rate for Payer: Scott and White EPO/PPO	$517.56
Rate for Payer: Superior Health Plan CHIP/Medicaid	$745.29
Rate for Payer: Superior Health Plan EPO	$140.78

DRILL BIT

Facility

$1,035.12

Hospital Charge Code	993089
Hospital Revenue Code	272
Rate for Payer: Cash Price	$703.88

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	$1,351.97
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	$1,276.86
Rate for Payer: Cigna Medicaid	$1,351.97
Rate for Payer: Molina CHIP/Medicaid	$1,351.97
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: Parkland Medicaid	$1,351.97
Rate for Payer: Scott and White EPO/PPO	$938.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,351.97
Rate for Payer: Superior Health Plan EPO	$255.37

DRILL BIT 013.0 X 300MM

Facility

$1,877.74

Hospital Charge Code	145343
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,276.86

drill bit 017x300mm

Facility

$4,717.97

Hospital Charge Code	8720594
Hospital Revenue Code	272
Rate for Payer: Cash Price	$3,208.22

drill bit 017x300mm

Facility

$4,717.97

Hospital Charge Code	8720594
Hospital Revenue Code	272
Min. Negotiated Rate	$424.62
Max. Negotiated Rate	$3,396.94
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	$3,208.22
Rate for Payer: Cigna Medicaid	$3,396.94
Rate for Payer: Molina CHIP/Medicaid	$3,396.94
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: Parkland Medicaid	$3,396.94
Rate for Payer: Scott and White EPO/PPO	$2,358.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,396.94
Rate for Payer: Superior Health Plan EPO	$641.64

DRILL BIT 04.2 X 300MM

Facility

$1,579.92

Hospital Charge Code	145342
Hospital Revenue Code	272
Min. Negotiated Rate	$142.19
Max. Negotiated Rate	$1,137.54
Rate for Payer: Amerigroup CHIP/Medicaid	$142.19
Rate for Payer: BCBS of TX Blue Advantage	$473.98
Rate for Payer: BCBS of TX Blue Essentials	$568.77
Rate for Payer: BCBS of TX PPO	$631.97
Rate for Payer: Cash Price	$1,074.35
Rate for Payer: Cigna Medicaid	$1,137.54
Rate for Payer: Molina CHIP/Medicaid	$1,137.54
Rate for Payer: Multiplan Auto	$1,026.95
Rate for Payer: Multiplan Commercial	$1,026.95
Rate for Payer: Multiplan Workers Comp	$1,026.95
Rate for Payer: Parkland Medicaid	$1,137.54
Rate for Payer: Scott and White EPO/PPO	$789.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,137.54
Rate for Payer: Superior Health Plan EPO	$214.87

DRILL BIT 04.2 X 300MM

Facility

$1,579.92

Hospital Charge Code	145342
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,074.35

Drill bit 2.0mm cannulated dart-fire compression screw

Facility

$1,157.70

Service Code	HCPCS C1713
Hospital Charge Code	993406
Hospital Revenue Code	278
Min. Negotiated Rate	$289.43
Max. Negotiated Rate	$578.85
Rate for Payer: Cash Price	$787.24
Rate for Payer: Cigna Commercial	$289.43
Rate for Payer: Multiplan Auto	$578.85
Rate for Payer: Multiplan Commercial	$578.85
Rate for Payer: Multiplan Workers Comp	$578.85
Rate for Payer: Scott and White EPO/PPO	$578.85

Drill bit 2.0mm cannulated dart-fire compression screw

Facility

$1,157.70

Service Code	HCPCS C1713
Hospital Charge Code	993406
Hospital Revenue Code	278
Min. Negotiated Rate	$104.19
Max. Negotiated Rate	$833.54
Rate for Payer: Amerigroup CHIP/Medicaid	$104.19
Rate for Payer: BCBS of TX Blue Advantage	$347.31
Rate for Payer: BCBS of TX Blue Essentials	$416.77
Rate for Payer: BCBS of TX PPO	$463.08
Rate for Payer: Cash Price	$787.24
Rate for Payer: Cigna Medicaid	$833.54
Rate for Payer: Molina CHIP/Medicaid	$833.54
Rate for Payer: Multiplan Auto	$578.85
Rate for Payer: Multiplan Commercial	$578.85
Rate for Payer: Multiplan Workers Comp	$578.85
Rate for Payer: Parkland Medicaid	$833.54
Rate for Payer: Scott and White EPO/PPO	$578.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$833.54
Rate for Payer: Superior Health Plan EPO	$157.45

DRILL BIT 2.2MM CANNULATED DART-FIRE COMPRESSION

Facility

$1,157.70

Hospital Charge Code	993557
Hospital Revenue Code	272
Min. Negotiated Rate	$104.19
Max. Negotiated Rate	$833.54
Rate for Payer: Amerigroup CHIP/Medicaid	$104.19
Rate for Payer: BCBS of TX Blue Advantage	$347.31
Rate for Payer: BCBS of TX Blue Essentials	$416.77
Rate for Payer: BCBS of TX PPO	$463.08
Rate for Payer: Cash Price	$787.24
Rate for Payer: Cigna Medicaid	$833.54
Rate for Payer: Molina CHIP/Medicaid	$833.54
Rate for Payer: Multiplan Auto	$752.50
Rate for Payer: Multiplan Commercial	$752.50
Rate for Payer: Multiplan Workers Comp	$752.50
Rate for Payer: Parkland Medicaid	$833.54
Rate for Payer: Scott and White EPO/PPO	$578.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$833.54
Rate for Payer: Superior Health Plan EPO	$157.45

DRILL BIT 2.2MM CANNULATED DART-FIRE COMPRESSION

Facility

$1,157.70

Hospital Charge Code	993557
Hospital Revenue Code	272
Rate for Payer: Cash Price	$787.24

DRILL BIT 2.2MM NS

Facility

$486.23

Hospital Charge Code	993090
Hospital Revenue Code	272
Min. Negotiated Rate	$43.76
Max. Negotiated Rate	$350.09
Rate for Payer: Amerigroup CHIP/Medicaid	$43.76
Rate for Payer: BCBS of TX Blue Advantage	$145.87
Rate for Payer: BCBS of TX Blue Essentials	$175.04
Rate for Payer: BCBS of TX PPO	$194.49
Rate for Payer: Cash Price	$330.64
Rate for Payer: Cigna Medicaid	$350.09
Rate for Payer: Molina CHIP/Medicaid	$350.09
Rate for Payer: Multiplan Auto	$316.05
Rate for Payer: Multiplan Commercial	$316.05
Rate for Payer: Multiplan Workers Comp	$316.05
Rate for Payer: Parkland Medicaid	$350.09
Rate for Payer: Scott and White EPO/PPO	$243.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$350.09
Rate for Payer: Superior Health Plan EPO	$66.13

DRILL BIT 2.2MM NS

Facility

$486.23

Hospital Charge Code	993090
Hospital Revenue Code	272
Rate for Payer: Cash Price	$330.64

DRILL BIT 2.5MM

Facility

$358.66

Hospital Charge Code	145272
Hospital Revenue Code	272
Min. Negotiated Rate	$32.28
Max. Negotiated Rate	$258.24
Rate for Payer: Amerigroup CHIP/Medicaid	$32.28
Rate for Payer: BCBS of TX Blue Advantage	$107.60
Rate for Payer: BCBS of TX Blue Essentials	$129.12
Rate for Payer: BCBS of TX PPO	$143.46
Rate for Payer: Cash Price	$243.89
Rate for Payer: Cigna Medicaid	$258.24
Rate for Payer: Molina CHIP/Medicaid	$258.24
Rate for Payer: Multiplan Auto	$233.13
Rate for Payer: Multiplan Commercial	$233.13
Rate for Payer: Multiplan Workers Comp	$233.13
Rate for Payer: Parkland Medicaid	$258.24
Rate for Payer: Scott and White EPO/PPO	$179.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$258.24
Rate for Payer: Superior Health Plan EPO	$48.78

DRILL BIT 2.5MM

Facility

$358.66

Hospital Charge Code	145272
Hospital Revenue Code	272
Rate for Payer: Cash Price	$243.89

DRILL BIT 2.5MM X 60MM

Facility

$1,057.82

Hospital Charge Code	993446
Hospital Revenue Code	272
Rate for Payer: Cash Price	$719.32

DRILL BIT 2.5MM X 60MM

Facility

$1,057.82

Hospital Charge Code	993446
Hospital Revenue Code	272
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$761.63
Rate for Payer: Amerigroup CHIP/Medicaid	$95.20
Rate for Payer: BCBS of TX Blue Advantage	$317.35
Rate for Payer: BCBS of TX Blue Essentials	$380.82
Rate for Payer: BCBS of TX PPO	$423.13
Rate for Payer: Cash Price	$719.32
Rate for Payer: Cigna Medicaid	$761.63
Rate for Payer: Molina CHIP/Medicaid	$761.63
Rate for Payer: Multiplan Auto	$687.58
Rate for Payer: Multiplan Commercial	$687.58
Rate for Payer: Multiplan Workers Comp	$687.58
Rate for Payer: Parkland Medicaid	$761.63
Rate for Payer: Scott and White EPO/PPO	$528.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$761.63
Rate for Payer: Superior Health Plan EPO	$143.86

DRILL BIT, 2.7MM

Facility

$385.90

Hospital Charge Code	992604
Hospital Revenue Code	272
Min. Negotiated Rate	$34.73
Max. Negotiated Rate	$277.85
Rate for Payer: Amerigroup CHIP/Medicaid	$34.73
Rate for Payer: BCBS of TX Blue Advantage	$115.77
Rate for Payer: BCBS of TX Blue Essentials	$138.92
Rate for Payer: BCBS of TX PPO	$154.36
Rate for Payer: Cash Price	$262.41
Rate for Payer: Cigna Medicaid	$277.85
Rate for Payer: Molina CHIP/Medicaid	$277.85
Rate for Payer: Multiplan Auto	$250.84
Rate for Payer: Multiplan Commercial	$250.84
Rate for Payer: Multiplan Workers Comp	$250.84
Rate for Payer: Parkland Medicaid	$277.85
Rate for Payer: Scott and White EPO/PPO	$192.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$277.85
Rate for Payer: Superior Health Plan EPO	$52.48

DRILL BIT, 2.7MM

Facility

$385.90

Hospital Charge Code	992604
Hospital Revenue Code	272
Rate for Payer: Cash Price	$262.41

Know your out-of-pocket cost for care.

All Charges