White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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
Rate for Payer: Cash Price	$243.89

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 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 2.5MM X 60MM

Facility

$1,057.82

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

DRILL BIT, 2.7MM

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

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
Rate for Payer: Cash Price	$830.46

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 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 4.2X130mm 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 4.2 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
Rate for Payer: Cash Price	$852.07

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 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
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 FLEX Y-KNOT Y18D

Facility

$304.59

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

Know your out-of-pocket cost for care.

All Charges