White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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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

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Facility

$1,129.64

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

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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

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Facility

$3,519.41

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

DRILL BIT LONG

Facility

$567.50

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

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

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Facility

$2,310.86

Hospital Charge Code	8692518
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,571.38

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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

DRILL BITS 1 -- DHF

Facility

$1,075.98

Hospital Charge Code	80911464
Hospital Revenue Code	272
Min. Negotiated Rate	$96.84
Max. Negotiated Rate	$774.71
Rate for Payer: Amerigroup CHIP/Medicaid	$96.84
Rate for Payer: BCBS of TX Blue Advantage	$322.79
Rate for Payer: BCBS of TX Blue Essentials	$387.35
Rate for Payer: BCBS of TX PPO	$430.39
Rate for Payer: Cash Price	$731.67
Rate for Payer: Cigna Medicaid	$774.71
Rate for Payer: Molina CHIP/Medicaid	$774.71
Rate for Payer: Multiplan Auto	$699.39
Rate for Payer: Multiplan Commercial	$699.39
Rate for Payer: Multiplan Workers Comp	$699.39
Rate for Payer: Parkland Medicaid	$774.71
Rate for Payer: Scott and White EPO/PPO	$537.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$774.71
Rate for Payer: Superior Health Plan EPO	$146.33

DRILL BITS 1 -- DHF

Facility

$1,075.98

Hospital Charge Code	80911464
Hospital Revenue Code	272
Rate for Payer: Cash Price	$731.67

DRILL BITS 2

Facility

$928.88

Hospital Charge Code	8394478
Hospital Revenue Code	272
Rate for Payer: Cash Price	$631.64

DRILL BITS 2

Facility

$928.88

Hospital Charge Code	8394478
Hospital Revenue Code	272
Min. Negotiated Rate	$83.60
Max. Negotiated Rate	$668.79
Rate for Payer: Amerigroup CHIP/Medicaid	$83.60
Rate for Payer: BCBS of TX Blue Advantage	$278.66
Rate for Payer: BCBS of TX Blue Essentials	$334.40
Rate for Payer: BCBS of TX PPO	$371.55
Rate for Payer: Cash Price	$631.64
Rate for Payer: Cigna Medicaid	$668.79
Rate for Payer: Molina CHIP/Medicaid	$668.79
Rate for Payer: Multiplan Auto	$603.77
Rate for Payer: Multiplan Commercial	$603.77
Rate for Payer: Multiplan Workers Comp	$603.77
Rate for Payer: Parkland Medicaid	$668.79
Rate for Payer: Scott and White EPO/PPO	$464.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$668.79
Rate for Payer: Superior Health Plan EPO	$126.33

DRILL BITS 3 -- DHF

Facility

$724.75

Hospital Charge Code	80911480
Hospital Revenue Code	272
Rate for Payer: Cash Price	$492.83

DRILL BITS 3 -- DHF

Facility

$724.75

Hospital Charge Code	80911480
Hospital Revenue Code	272
Min. Negotiated Rate	$65.23
Max. Negotiated Rate	$521.82
Rate for Payer: Amerigroup CHIP/Medicaid	$65.23
Rate for Payer: BCBS of TX Blue Advantage	$217.43
Rate for Payer: BCBS of TX Blue Essentials	$260.91
Rate for Payer: BCBS of TX PPO	$289.90
Rate for Payer: Cash Price	$492.83
Rate for Payer: Cigna Medicaid	$521.82
Rate for Payer: Molina CHIP/Medicaid	$521.82
Rate for Payer: Multiplan Auto	$471.09
Rate for Payer: Multiplan Commercial	$471.09
Rate for Payer: Multiplan Workers Comp	$471.09
Rate for Payer: Parkland Medicaid	$521.82
Rate for Payer: Scott and White EPO/PPO	$362.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$521.82
Rate for Payer: Superior Health Plan EPO	$98.57

DRILL BITS 4

Facility

$908.00

Hospital Charge Code	8420454
Hospital Revenue Code	272
Rate for Payer: Cash Price	$617.44

DRILL BITS 4

Facility

$908.00

Hospital Charge Code	8420454
Hospital Revenue Code	272
Min. Negotiated Rate	$81.72
Max. Negotiated Rate	$653.76
Rate for Payer: Amerigroup CHIP/Medicaid	$81.72
Rate for Payer: BCBS of TX Blue Advantage	$272.40
Rate for Payer: BCBS of TX Blue Essentials	$326.88
Rate for Payer: BCBS of TX PPO	$363.20
Rate for Payer: Cash Price	$617.44
Rate for Payer: Cigna Medicaid	$653.76
Rate for Payer: Molina CHIP/Medicaid	$653.76
Rate for Payer: Multiplan Auto	$590.20
Rate for Payer: Multiplan Commercial	$590.20
Rate for Payer: Multiplan Workers Comp	$590.20
Rate for Payer: Parkland Medicaid	$653.76
Rate for Payer: Scott and White EPO/PPO	$454.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$653.76
Rate for Payer: Superior Health Plan EPO	$123.49

DRILL BITS #5

Facility

$227.00

Hospital Charge Code	8492481
Hospital Revenue Code	272
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$163.44
Rate for Payer: Amerigroup CHIP/Medicaid	$20.43
Rate for Payer: BCBS of TX Blue Advantage	$68.10
Rate for Payer: BCBS of TX Blue Essentials	$81.72
Rate for Payer: BCBS of TX PPO	$90.80
Rate for Payer: Cash Price	$154.36
Rate for Payer: Cigna Medicaid	$163.44
Rate for Payer: Molina CHIP/Medicaid	$163.44
Rate for Payer: Multiplan Auto	$147.55
Rate for Payer: Multiplan Commercial	$147.55
Rate for Payer: Multiplan Workers Comp	$147.55
Rate for Payer: Parkland Medicaid	$163.44
Rate for Payer: Scott and White EPO/PPO	$113.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$163.44
Rate for Payer: Superior Health Plan EPO	$30.87

DRILL BITS #5

Facility

$227.00

Hospital Charge Code	8492481
Hospital Revenue Code	272
Rate for Payer: Cash Price	$154.36

DRILL CALIBRATED 4.2 X 330MM

Facility

$1,793.30

Hospital Charge Code	146685
Hospital Revenue Code	272
Min. Negotiated Rate	$161.40
Max. Negotiated Rate	$1,291.18
Rate for Payer: Amerigroup CHIP/Medicaid	$161.40
Rate for Payer: BCBS of TX Blue Advantage	$537.99
Rate for Payer: BCBS of TX Blue Essentials	$645.59
Rate for Payer: BCBS of TX PPO	$717.32
Rate for Payer: Cash Price	$1,219.44
Rate for Payer: Cigna Medicaid	$1,291.18
Rate for Payer: Molina CHIP/Medicaid	$1,291.18
Rate for Payer: Multiplan Auto	$1,165.64
Rate for Payer: Multiplan Commercial	$1,165.64
Rate for Payer: Multiplan Workers Comp	$1,165.64
Rate for Payer: Parkland Medicaid	$1,291.18
Rate for Payer: Scott and White EPO/PPO	$896.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,291.18
Rate for Payer: Superior Health Plan EPO	$243.89

DRILL CALIBRATED 4.2 X 330MM

Facility

$1,793.30

Hospital Charge Code	146685
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,219.44

DRILL CANNULATED 2.6 X 130 R3CON

Facility

$844.44

Hospital Charge Code	146423
Hospital Revenue Code	272
Rate for Payer: Cash Price	$574.22

DRILL CANNULATED 2.6 X 130 R3CON

Facility

$844.44

Hospital Charge Code	146423
Hospital Revenue Code	272
Min. Negotiated Rate	$76.00
Max. Negotiated Rate	$608.00
Rate for Payer: Amerigroup CHIP/Medicaid	$76.00
Rate for Payer: BCBS of TX Blue Advantage	$253.33
Rate for Payer: BCBS of TX Blue Essentials	$304.00
Rate for Payer: BCBS of TX PPO	$337.78
Rate for Payer: Cash Price	$574.22
Rate for Payer: Cigna Medicaid	$608.00
Rate for Payer: Molina CHIP/Medicaid	$608.00
Rate for Payer: Multiplan Auto	$548.89
Rate for Payer: Multiplan Commercial	$548.89
Rate for Payer: Multiplan Workers Comp	$548.89
Rate for Payer: Parkland Medicaid	$608.00
Rate for Payer: Scott and White EPO/PPO	$422.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$608.00
Rate for Payer: Superior Health Plan EPO	$114.84

DRILL CANNULATED OPENING 11.2MM

Facility

$1,475.00

Hospital Charge Code	146684
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,003.00

DRILL CANNULATED OPENING 11.2MM

Facility

$1,475.00

Hospital Charge Code	146684
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 CANNULATED STEP 6MM/9MM

Facility

$6,419.56

Hospital Charge Code	146585
Hospital Revenue Code	272
Min. Negotiated Rate	$577.76
Max. Negotiated Rate	$4,622.08
Rate for Payer: Amerigroup CHIP/Medicaid	$577.76
Rate for Payer: BCBS of TX Blue Advantage	$1,925.87
Rate for Payer: BCBS of TX Blue Essentials	$2,311.04
Rate for Payer: BCBS of TX PPO	$2,567.82
Rate for Payer: Cash Price	$4,365.30
Rate for Payer: Cigna Medicaid	$4,622.08
Rate for Payer: Molina CHIP/Medicaid	$4,622.08
Rate for Payer: Multiplan Auto	$4,172.71
Rate for Payer: Multiplan Commercial	$4,172.71
Rate for Payer: Multiplan Workers Comp	$4,172.71
Rate for Payer: Parkland Medicaid	$4,622.08
Rate for Payer: Scott and White EPO/PPO	$3,209.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,622.08
Rate for Payer: Superior Health Plan EPO	$873.06

Know your out-of-pocket cost for care.

All Charges