White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Drill bit 3.0mm X 60mm sterile mica cannulated

Facility

$1,411.94

Hospital Charge Code	993401
Hospital Revenue Code	272
Min. Negotiated Rate	$127.07
Max. Negotiated Rate	$1,016.60
Rate for Payer: Amerigroup CHIP/Medicaid	$127.07
Rate for Payer: BCBS of TX Blue Advantage	$423.58
Rate for Payer: BCBS of TX Blue Essentials	$508.30
Rate for Payer: BCBS of TX PPO	$564.78
Rate for Payer: Cash Price	$960.12
Rate for Payer: Cigna Medicaid	$1,016.60
Rate for Payer: Molina CHIP/Medicaid	$1,016.60
Rate for Payer: Multiplan Auto	$917.76
Rate for Payer: Multiplan Commercial	$917.76
Rate for Payer: Multiplan Workers Comp	$917.76
Rate for Payer: Parkland Medicaid	$1,016.60
Rate for Payer: Scott and White EPO/PPO	$705.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,016.60
Rate for Payer: Superior Health Plan EPO	$192.02

Drill bit 3.0mm X 60mm sterile mica cannulated

Facility

$1,411.94

Hospital Charge Code	993401
Hospital Revenue Code	272
Rate for Payer: Cash Price	$960.12

DRILL BIT 3.5MM X 60MM

Facility

$1,403.61

Hospital Charge Code	993155
Hospital Revenue Code	270
Rate for Payer: Cash Price	$954.45

DRILL BIT 3.5MM X 60MM

Facility

$1,403.61

Hospital Charge Code	993155
Hospital Revenue Code	270
Min. Negotiated Rate	$126.32
Max. Negotiated Rate	$1,010.60
Rate for Payer: Amerigroup CHIP/Medicaid	$126.32
Rate for Payer: BCBS of TX Blue Advantage	$421.08
Rate for Payer: BCBS of TX Blue Essentials	$505.30
Rate for Payer: BCBS of TX PPO	$561.44
Rate for Payer: Cash Price	$954.45
Rate for Payer: Cigna Medicaid	$1,010.60
Rate for Payer: Molina CHIP/Medicaid	$1,010.60
Rate for Payer: Multiplan Auto	$912.35
Rate for Payer: Multiplan Commercial	$912.35
Rate for Payer: Multiplan Workers Comp	$912.35
Rate for Payer: Parkland Medicaid	$1,010.60
Rate for Payer: Scott and White EPO/PPO	$701.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,010.60
Rate for Payer: Superior Health Plan EPO	$190.89

Drill bit 3.5X130mm AO sterile

Facility

$1,221.26

Hospital Charge Code	993306
Hospital Revenue Code	272
Min. Negotiated Rate	$109.91
Max. Negotiated Rate	$879.31
Rate for Payer: Amerigroup CHIP/Medicaid	$109.91
Rate for Payer: BCBS of TX Blue Advantage	$366.38
Rate for Payer: BCBS of TX Blue Essentials	$439.65
Rate for Payer: BCBS of TX PPO	$488.50
Rate for Payer: Cash Price	$830.46
Rate for Payer: Cigna Medicaid	$879.31
Rate for Payer: Molina CHIP/Medicaid	$879.31
Rate for Payer: Multiplan Auto	$793.82
Rate for Payer: Multiplan Commercial	$793.82
Rate for Payer: Multiplan Workers Comp	$793.82
Rate for Payer: Parkland Medicaid	$879.31
Rate for Payer: Scott and White EPO/PPO	$610.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$879.31
Rate for Payer: Superior Health Plan EPO	$166.09

Drill bit 3.5X130mm AO sterile

Facility

$1,221.26

Hospital Charge Code	993306
Hospital Revenue Code	272
Rate for Payer: Cash Price	$830.46

DRILL BIT 4.2X130mm AO STERILE

Facility

$1,253.04

Hospital Charge Code	993355
Hospital Revenue Code	272
Min. Negotiated Rate	$112.77
Max. Negotiated Rate	$902.19
Rate for Payer: Amerigroup CHIP/Medicaid	$112.77
Rate for Payer: BCBS of TX Blue Advantage	$375.91
Rate for Payer: BCBS of TX Blue Essentials	$451.09
Rate for Payer: BCBS of TX PPO	$501.22
Rate for Payer: Cash Price	$852.07
Rate for Payer: Cigna Medicaid	$902.19
Rate for Payer: Molina CHIP/Medicaid	$902.19
Rate for Payer: Multiplan Auto	$814.48
Rate for Payer: Multiplan Commercial	$814.48
Rate for Payer: Multiplan Workers Comp	$814.48
Rate for Payer: Parkland Medicaid	$902.19
Rate for Payer: Scott and White EPO/PPO	$626.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$902.19
Rate for Payer: Superior Health Plan EPO	$170.41

DRILL BIT 4.2X130mm AO STERILE

Facility

$1,253.04

Hospital Charge Code	993355
Hospital Revenue Code	272
Rate for Payer: Cash Price	$852.07

DRILL BIT 4.2 X 180

Facility

$1,579.92

Hospital Charge Code	145367
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 4.2 X 180

Facility

$1,579.92

Hospital Charge Code	145367
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,074.35

DRILL BIT 4.2X340mm AO STERILE

Facility

$1,253.04

Hospital Charge Code	993419
Hospital Revenue Code	272
Min. Negotiated Rate	$112.77
Max. Negotiated Rate	$902.19
Rate for Payer: Amerigroup CHIP/Medicaid	$112.77
Rate for Payer: BCBS of TX Blue Advantage	$375.91
Rate for Payer: BCBS of TX Blue Essentials	$451.09
Rate for Payer: BCBS of TX PPO	$501.22
Rate for Payer: Cash Price	$852.07
Rate for Payer: Cigna Medicaid	$902.19
Rate for Payer: Molina CHIP/Medicaid	$902.19
Rate for Payer: Multiplan Auto	$814.48
Rate for Payer: Multiplan Commercial	$814.48
Rate for Payer: Multiplan Workers Comp	$814.48
Rate for Payer: Parkland Medicaid	$902.19
Rate for Payer: Scott and White EPO/PPO	$626.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$902.19
Rate for Payer: Superior Health Plan EPO	$170.41

DRILL BIT 4.2X340mm AO STERILE

Facility

$1,253.04

Hospital Charge Code	993419
Hospital Revenue Code	272
Rate for Payer: Cash Price	$852.07

drill bit 5.2x300mm

Facility

$1,579.92

Hospital Charge Code	8720615
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 5.2x300mm

Facility

$1,579.92

Hospital Charge Code	8720615
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,074.35

DRILL BIT CANNL -- DHF

Facility

$2,653.56

Hospital Charge Code	81740508
Hospital Revenue Code	272
Min. Negotiated Rate	$238.82
Max. Negotiated Rate	$1,910.56
Rate for Payer: Amerigroup CHIP/Medicaid	$238.82
Rate for Payer: BCBS of TX Blue Advantage	$796.07
Rate for Payer: BCBS of TX Blue Essentials	$955.28
Rate for Payer: BCBS of TX PPO	$1,061.42
Rate for Payer: Cash Price	$1,804.42
Rate for Payer: Cigna Medicaid	$1,910.56
Rate for Payer: Molina CHIP/Medicaid	$1,910.56
Rate for Payer: Multiplan Auto	$1,724.81
Rate for Payer: Multiplan Commercial	$1,724.81
Rate for Payer: Multiplan Workers Comp	$1,724.81
Rate for Payer: Parkland Medicaid	$1,910.56
Rate for Payer: Scott and White EPO/PPO	$1,326.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,910.56
Rate for Payer: Superior Health Plan EPO	$360.88

DRILL BIT CANNL -- DHF

Facility

$2,653.56

Hospital Charge Code	81740508
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,804.42

DRILL BIT FLEX Y-KNOT Y18D

Facility

$304.59

Hospital Charge Code	145090
Hospital Revenue Code	272
Rate for Payer: Cash Price	$207.12

DRILL BIT FLEX Y-KNOT Y18D

Facility

$304.59

Hospital Charge Code	145090
Hospital Revenue Code	272
Min. Negotiated Rate	$27.41
Max. Negotiated Rate	$219.30
Rate for Payer: Amerigroup CHIP/Medicaid	$27.41
Rate for Payer: BCBS of TX Blue Advantage	$91.38
Rate for Payer: BCBS of TX Blue Essentials	$109.65
Rate for Payer: BCBS of TX PPO	$121.84
Rate for Payer: Cash Price	$207.12
Rate for Payer: Cigna Medicaid	$219.30
Rate for Payer: Molina CHIP/Medicaid	$219.30
Rate for Payer: Multiplan Auto	$197.98
Rate for Payer: Multiplan Commercial	$197.98
Rate for Payer: Multiplan Workers Comp	$197.98
Rate for Payer: Parkland Medicaid	$219.30
Rate for Payer: Scott and White EPO/PPO	$152.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$219.30
Rate for Payer: Superior Health Plan EPO	$41.42

drill bit gamma 4.2x300mm ao small

Facility

$1,129.64

Hospital Charge Code	8660703
Hospital Revenue Code	272
Min. Negotiated Rate	$101.67
Max. Negotiated Rate	$813.34
Rate for Payer: Amerigroup CHIP/Medicaid	$101.67
Rate for Payer: BCBS of TX Blue Advantage	$338.89
Rate for Payer: BCBS of TX Blue Essentials	$406.67
Rate for Payer: BCBS of TX PPO	$451.86
Rate for Payer: Cash Price	$768.16
Rate for Payer: Cigna Medicaid	$813.34
Rate for Payer: Molina CHIP/Medicaid	$813.34
Rate for Payer: Multiplan Auto	$734.27
Rate for Payer: Multiplan Commercial	$734.27
Rate for Payer: Multiplan Workers Comp	$734.27
Rate for Payer: Parkland Medicaid	$813.34
Rate for Payer: Scott and White EPO/PPO	$564.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$813.34
Rate for Payer: Superior Health Plan EPO	$153.63

drill bit gamma 4.2x300mm ao small

Facility

$1,129.64

Hospital Charge Code	8660703
Hospital Revenue Code	272
Rate for Payer: Cash Price	$768.16

drill bit lag screw stopper

Facility

$3,519.41

Hospital Charge Code	8720616
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,393.20

drill bit lag screw stopper

Facility

$3,519.41

Hospital Charge Code	8720616
Hospital Revenue Code	272
Min. Negotiated Rate	$316.75
Max. Negotiated Rate	$2,533.98
Rate for Payer: Amerigroup CHIP/Medicaid	$316.75
Rate for Payer: BCBS of TX Blue Advantage	$1,055.82
Rate for Payer: BCBS of TX Blue Essentials	$1,266.99
Rate for Payer: BCBS of TX PPO	$1,407.76
Rate for Payer: Cash Price	$2,393.20
Rate for Payer: Cigna Medicaid	$2,533.98
Rate for Payer: Molina CHIP/Medicaid	$2,533.98
Rate for Payer: Multiplan Auto	$2,287.62
Rate for Payer: Multiplan Commercial	$2,287.62
Rate for Payer: Multiplan Workers Comp	$2,287.62
Rate for Payer: Parkland Medicaid	$2,533.98
Rate for Payer: Scott and White EPO/PPO	$1,759.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,533.98
Rate for Payer: Superior Health Plan EPO	$478.64

DRILL BIT LONG

Facility

$567.50

Hospital Charge Code	145471
Hospital Revenue Code	272
Min. Negotiated Rate	$51.08
Max. Negotiated Rate	$408.60
Rate for Payer: Amerigroup CHIP/Medicaid	$51.08
Rate for Payer: BCBS of TX Blue Advantage	$170.25
Rate for Payer: BCBS of TX Blue Essentials	$204.30
Rate for Payer: BCBS of TX PPO	$227.00
Rate for Payer: Cash Price	$385.90
Rate for Payer: Cigna Medicaid	$408.60
Rate for Payer: Molina CHIP/Medicaid	$408.60
Rate for Payer: Multiplan Auto	$368.88
Rate for Payer: Multiplan Commercial	$368.88
Rate for Payer: Multiplan Workers Comp	$368.88
Rate for Payer: Parkland Medicaid	$408.60
Rate for Payer: Scott and White EPO/PPO	$283.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$408.60
Rate for Payer: Superior Health Plan EPO	$77.18

DRILL BIT LONG

Facility

$567.50

Hospital Charge Code	145471
Hospital Revenue Code	272
Rate for Payer: Cash Price	$385.90

drill bit press fit

Facility

$2,310.86

Hospital Charge Code	8692518
Hospital Revenue Code	272
Min. Negotiated Rate	$207.98
Max. Negotiated Rate	$1,663.82
Rate for Payer: Amerigroup CHIP/Medicaid	$207.98
Rate for Payer: BCBS of TX Blue Advantage	$693.26
Rate for Payer: BCBS of TX Blue Essentials	$831.91
Rate for Payer: BCBS of TX PPO	$924.34
Rate for Payer: Cash Price	$1,571.38
Rate for Payer: Cigna Medicaid	$1,663.82
Rate for Payer: Molina CHIP/Medicaid	$1,663.82
Rate for Payer: Multiplan Auto	$1,502.06
Rate for Payer: Multiplan Commercial	$1,502.06
Rate for Payer: Multiplan Workers Comp	$1,502.06
Rate for Payer: Parkland Medicaid	$1,663.82
Rate for Payer: Scott and White EPO/PPO	$1,155.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,663.82
Rate for Payer: Superior Health Plan EPO	$314.28

Know your out-of-pocket cost for care.

All Charges