White Rock Medical Center

All Charges

Charge

Type

Setting

Price

DRILL FLEXIBLE CANNULATED 16MM

Facility

$9,570.32

Hospital Charge Code	146581
Hospital Revenue Code	272
Min. Negotiated Rate	$861.33
Max. Negotiated Rate	$6,890.63
Rate for Payer: Amerigroup CHIP/Medicaid	$861.33
Rate for Payer: BCBS of TX Blue Advantage	$2,871.10
Rate for Payer: BCBS of TX Blue Essentials	$3,445.32
Rate for Payer: BCBS of TX PPO	$3,828.13
Rate for Payer: Cash Price	$6,507.82
Rate for Payer: Cigna Medicaid	$6,890.63
Rate for Payer: Molina CHIP/Medicaid	$6,890.63
Rate for Payer: Multiplan Auto	$6,220.71
Rate for Payer: Multiplan Commercial	$6,220.71
Rate for Payer: Multiplan Workers Comp	$6,220.71
Rate for Payer: Parkland Medicaid	$6,890.63
Rate for Payer: Scott and White EPO/PPO	$4,785.16
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,890.63
Rate for Payer: Superior Health Plan EPO	$1,301.56

DRILL FLEXIBLE CANNULATED 16MM

Facility

$9,570.32

Hospital Charge Code	146581
Hospital Revenue Code	272
Rate for Payer: Cash Price	$6,507.82

DRILL LAG SCREW

Facility

$681.00

Hospital Charge Code	145227
Hospital Revenue Code	272
Min. Negotiated Rate	$61.29
Max. Negotiated Rate	$490.32
Rate for Payer: Amerigroup CHIP/Medicaid	$61.29
Rate for Payer: BCBS of TX Blue Advantage	$204.30
Rate for Payer: BCBS of TX Blue Essentials	$245.16
Rate for Payer: BCBS of TX PPO	$272.40
Rate for Payer: Cash Price	$463.08
Rate for Payer: Cigna Medicaid	$490.32
Rate for Payer: Molina CHIP/Medicaid	$490.32
Rate for Payer: Multiplan Auto	$442.65
Rate for Payer: Multiplan Commercial	$442.65
Rate for Payer: Multiplan Workers Comp	$442.65
Rate for Payer: Parkland Medicaid	$490.32
Rate for Payer: Scott and White EPO/PPO	$340.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$490.32
Rate for Payer: Superior Health Plan EPO	$92.62

DRILL LAG SCREW

Facility

$681.00

Hospital Charge Code	145227
Hospital Revenue Code	272
Rate for Payer: Cash Price	$463.08

DRILL LAG SCRW

Facility

$681.00

Hospital Charge Code	145481
Hospital Revenue Code	272
Min. Negotiated Rate	$61.29
Max. Negotiated Rate	$490.32
Rate for Payer: Amerigroup CHIP/Medicaid	$61.29
Rate for Payer: BCBS of TX Blue Advantage	$204.30
Rate for Payer: BCBS of TX Blue Essentials	$245.16
Rate for Payer: BCBS of TX PPO	$272.40
Rate for Payer: Cash Price	$463.08
Rate for Payer: Cigna Medicaid	$490.32
Rate for Payer: Molina CHIP/Medicaid	$490.32
Rate for Payer: Multiplan Auto	$442.65
Rate for Payer: Multiplan Commercial	$442.65
Rate for Payer: Multiplan Workers Comp	$442.65
Rate for Payer: Parkland Medicaid	$490.32
Rate for Payer: Scott and White EPO/PPO	$340.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$490.32
Rate for Payer: Superior Health Plan EPO	$92.62

DRILL LAG SCRW

Facility

$681.00

Hospital Charge Code	145481
Hospital Revenue Code	272
Rate for Payer: Cash Price	$463.08

drill lag stepped gamma3 15.5x495mm

Facility

$10,058.91

Hospital Charge Code	8660702
Hospital Revenue Code	272
Rate for Payer: Cash Price	$6,840.06

drill lag stepped gamma3 15.5x495mm

Facility

$10,058.91

Hospital Charge Code	8660702
Hospital Revenue Code	272
Min. Negotiated Rate	$905.30
Max. Negotiated Rate	$7,242.42
Rate for Payer: Amerigroup CHIP/Medicaid	$905.30
Rate for Payer: BCBS of TX Blue Advantage	$3,017.67
Rate for Payer: BCBS of TX Blue Essentials	$3,621.21
Rate for Payer: BCBS of TX PPO	$4,023.56
Rate for Payer: Cash Price	$6,840.06
Rate for Payer: Cigna Medicaid	$7,242.42
Rate for Payer: Molina CHIP/Medicaid	$7,242.42
Rate for Payer: Multiplan Auto	$6,538.29
Rate for Payer: Multiplan Commercial	$6,538.29
Rate for Payer: Multiplan Workers Comp	$6,538.29
Rate for Payer: Parkland Medicaid	$7,242.42
Rate for Payer: Scott and White EPO/PPO	$5,029.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,242.42
Rate for Payer: Superior Health Plan EPO	$1,368.01

DRILL LONG DISP -- DHF

Facility

$7,003.40

Hospital Charge Code	81315673
Hospital Revenue Code	272
Rate for Payer: Cash Price	$4,762.31

DRILL LONG DISP -- DHF

Facility

$7,003.40

Hospital Charge Code	81315673
Hospital Revenue Code	272
Min. Negotiated Rate	$630.31
Max. Negotiated Rate	$5,042.45
Rate for Payer: Amerigroup CHIP/Medicaid	$630.31
Rate for Payer: BCBS of TX Blue Advantage	$2,101.02
Rate for Payer: BCBS of TX Blue Essentials	$2,521.22
Rate for Payer: BCBS of TX PPO	$2,801.36
Rate for Payer: Cash Price	$4,762.31
Rate for Payer: Cigna Medicaid	$5,042.45
Rate for Payer: Molina CHIP/Medicaid	$5,042.45
Rate for Payer: Multiplan Auto	$4,552.21
Rate for Payer: Multiplan Commercial	$4,552.21
Rate for Payer: Multiplan Workers Comp	$4,552.21
Rate for Payer: Parkland Medicaid	$5,042.45
Rate for Payer: Scott and White EPO/PPO	$3,501.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,042.45
Rate for Payer: Superior Health Plan EPO	$952.46

DRILL QUICK RELEASE 1/8 STERILE 2PK

Facility

$352.76

Hospital Charge Code	144893
Hospital Revenue Code	272
Min. Negotiated Rate	$31.75
Max. Negotiated Rate	$253.99
Rate for Payer: Amerigroup CHIP/Medicaid	$31.75
Rate for Payer: BCBS of TX Blue Advantage	$105.83
Rate for Payer: BCBS of TX Blue Essentials	$126.99
Rate for Payer: BCBS of TX PPO	$141.10
Rate for Payer: Cash Price	$239.88
Rate for Payer: Cigna Medicaid	$253.99
Rate for Payer: Molina CHIP/Medicaid	$253.99
Rate for Payer: Multiplan Auto	$229.29
Rate for Payer: Multiplan Commercial	$229.29
Rate for Payer: Multiplan Workers Comp	$229.29
Rate for Payer: Parkland Medicaid	$253.99
Rate for Payer: Scott and White EPO/PPO	$176.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$253.99
Rate for Payer: Superior Health Plan EPO	$47.98

DRILL QUICK RELEASE 1/8 STERILE 2PK

Facility

$352.76

Hospital Charge Code	144893
Hospital Revenue Code	272
Rate for Payer: Cash Price	$239.88

DRILL R3CON 2.4 X 140

Facility

$844.44

Hospital Charge Code	146419
Hospital Revenue Code	272
Rate for Payer: Cash Price	$574.22

DRILL R3CON 2.4 X 140

Facility

$844.44

Hospital Charge Code	146419
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 TIP -- DHF

Facility

$3,364.30

Hospital Charge Code	80810955
Hospital Revenue Code	272
Min. Negotiated Rate	$302.79
Max. Negotiated Rate	$2,422.30
Rate for Payer: Amerigroup CHIP/Medicaid	$302.79
Rate for Payer: BCBS of TX Blue Advantage	$1,009.29
Rate for Payer: BCBS of TX Blue Essentials	$1,211.15
Rate for Payer: BCBS of TX PPO	$1,345.72
Rate for Payer: Cash Price	$2,287.72
Rate for Payer: Cigna Medicaid	$2,422.30
Rate for Payer: Molina CHIP/Medicaid	$2,422.30
Rate for Payer: Multiplan Auto	$2,186.80
Rate for Payer: Multiplan Commercial	$2,186.80
Rate for Payer: Multiplan Workers Comp	$2,186.80
Rate for Payer: Parkland Medicaid	$2,422.30
Rate for Payer: Scott and White EPO/PPO	$1,682.15
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,422.30
Rate for Payer: Superior Health Plan EPO	$457.54

DRILL TIP -- DHF

Facility

$3,364.30

Hospital Charge Code	80810955
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,287.72

DRILL TWIST -- DHF

Facility

$62.04

Hospital Charge Code	80911423
Hospital Revenue Code	272
Min. Negotiated Rate	$5.58
Max. Negotiated Rate	$44.67
Rate for Payer: Amerigroup CHIP/Medicaid	$5.58
Rate for Payer: BCBS of TX Blue Advantage	$18.61
Rate for Payer: BCBS of TX Blue Essentials	$22.33
Rate for Payer: BCBS of TX PPO	$24.82
Rate for Payer: Cash Price	$42.19
Rate for Payer: Cigna Medicaid	$44.67
Rate for Payer: Molina CHIP/Medicaid	$44.67
Rate for Payer: Multiplan Auto	$40.33
Rate for Payer: Multiplan Commercial	$40.33
Rate for Payer: Multiplan Workers Comp	$40.33
Rate for Payer: Parkland Medicaid	$44.67
Rate for Payer: Scott and White EPO/PPO	$31.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$44.67
Rate for Payer: Superior Health Plan EPO	$8.44

DRILL TWIST -- DHF

Facility

$62.04

Hospital Charge Code	80911423
Hospital Revenue Code	272
Rate for Payer: Cash Price	$42.19

DRIVER CANNULATED

Facility

$2,156.50

Hospital Charge Code	145138
Hospital Revenue Code	272
Min. Negotiated Rate	$194.09
Max. Negotiated Rate	$1,552.68
Rate for Payer: Amerigroup CHIP/Medicaid	$194.09
Rate for Payer: BCBS of TX Blue Advantage	$646.95
Rate for Payer: BCBS of TX Blue Essentials	$776.34
Rate for Payer: BCBS of TX PPO	$862.60
Rate for Payer: Cash Price	$1,466.42
Rate for Payer: Cigna Medicaid	$1,552.68
Rate for Payer: Molina CHIP/Medicaid	$1,552.68
Rate for Payer: Multiplan Auto	$1,401.72
Rate for Payer: Multiplan Commercial	$1,401.72
Rate for Payer: Multiplan Workers Comp	$1,401.72
Rate for Payer: Parkland Medicaid	$1,552.68
Rate for Payer: Scott and White EPO/PPO	$1,078.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,552.68
Rate for Payer: Superior Health Plan EPO	$293.28

DRIVER CANNULATED

Facility

$2,156.50

Hospital Charge Code	145138
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,466.42

DRIVER DISP SCREW -- DHF

Facility

$608.36

Hospital Charge Code	81740698
Hospital Revenue Code	272
Rate for Payer: Cash Price	$413.68

DRIVER DISP SCREW -- DHF

Facility

$608.36

Hospital Charge Code	81740698
Hospital Revenue Code	272
Min. Negotiated Rate	$54.75
Max. Negotiated Rate	$438.02
Rate for Payer: Amerigroup CHIP/Medicaid	$54.75
Rate for Payer: BCBS of TX Blue Advantage	$182.51
Rate for Payer: BCBS of TX Blue Essentials	$219.01
Rate for Payer: BCBS of TX PPO	$243.34
Rate for Payer: Cash Price	$413.68
Rate for Payer: Cigna Medicaid	$438.02
Rate for Payer: Molina CHIP/Medicaid	$438.02
Rate for Payer: Multiplan Auto	$395.43
Rate for Payer: Multiplan Commercial	$395.43
Rate for Payer: Multiplan Workers Comp	$395.43
Rate for Payer: Parkland Medicaid	$438.02
Rate for Payer: Scott and White EPO/PPO	$304.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$438.02
Rate for Payer: Superior Health Plan EPO	$82.74

Driver hex 2.5mm sterile mica screw system

Facility

$1,030.58

Service Code	HCPCS C1713
Hospital Charge Code	993402
Hospital Revenue Code	278
Min. Negotiated Rate	$257.64
Max. Negotiated Rate	$515.29
Rate for Payer: Cash Price	$700.79
Rate for Payer: Cigna Commercial	$257.64
Rate for Payer: Multiplan Auto	$515.29
Rate for Payer: Multiplan Commercial	$515.29
Rate for Payer: Multiplan Workers Comp	$515.29
Rate for Payer: Scott and White EPO/PPO	$515.29

Driver hex 2.5mm sterile mica screw system

Facility

$1,030.58

Service Code	HCPCS C1713
Hospital Charge Code	993402
Hospital Revenue Code	278
Min. Negotiated Rate	$92.75
Max. Negotiated Rate	$742.02
Rate for Payer: Amerigroup CHIP/Medicaid	$92.75
Rate for Payer: BCBS of TX Blue Advantage	$309.17
Rate for Payer: BCBS of TX Blue Essentials	$371.01
Rate for Payer: BCBS of TX PPO	$412.23
Rate for Payer: Cash Price	$700.79
Rate for Payer: Cigna Medicaid	$742.02
Rate for Payer: Molina CHIP/Medicaid	$742.02
Rate for Payer: Multiplan Auto	$515.29
Rate for Payer: Multiplan Commercial	$515.29
Rate for Payer: Multiplan Workers Comp	$515.29
Rate for Payer: Parkland Medicaid	$742.02
Rate for Payer: Scott and White EPO/PPO	$515.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$742.02
Rate for Payer: Superior Health Plan EPO	$140.16

DRIVER NEEDLE XI MEGA

Facility

$10,487.40

Hospital Charge Code	992730
Hospital Revenue Code	270
Min. Negotiated Rate	$943.87
Max. Negotiated Rate	$7,550.93
Rate for Payer: Amerigroup CHIP/Medicaid	$943.87
Rate for Payer: BCBS of TX Blue Advantage	$3,146.22
Rate for Payer: BCBS of TX Blue Essentials	$3,775.46
Rate for Payer: BCBS of TX PPO	$4,194.96
Rate for Payer: Cash Price	$7,131.43
Rate for Payer: Cigna Medicaid	$7,550.93
Rate for Payer: Molina CHIP/Medicaid	$7,550.93
Rate for Payer: Multiplan Auto	$6,816.81
Rate for Payer: Multiplan Commercial	$6,816.81
Rate for Payer: Multiplan Workers Comp	$6,816.81
Rate for Payer: Parkland Medicaid	$7,550.93
Rate for Payer: Scott and White EPO/PPO	$5,243.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,550.93
Rate for Payer: Superior Health Plan EPO	$1,426.29

Know your out-of-pocket cost for care.

All Charges