White Rock Medical Center

All Charges

Charge

Type

Setting

Price

DRIVER NEEDLE XI MEGA

Facility

$10,487.40

Hospital Charge Code	992730
Hospital Revenue Code	270
Rate for Payer: Cash Price	$7,131.43

DRIVER STAR #15 CANNULATED DART-FIRE CAMPRESSION SCREW

Facility

$1,602.41

Service Code	HCPCS C1713
Hospital Charge Code	992373
Hospital Revenue Code	278
Min. Negotiated Rate	$400.60
Max. Negotiated Rate	$801.21
Rate for Payer: Cash Price	$1,089.64
Rate for Payer: Cigna Commercial	$400.60
Rate for Payer: Multiplan Auto	$801.21
Rate for Payer: Multiplan Commercial	$801.21
Rate for Payer: Multiplan Workers Comp	$801.21
Rate for Payer: Scott and White EPO/PPO	$801.21

DRIVER STAR #15 CANNULATED DART-FIRE CAMPRESSION SCREW

Facility

$1,602.41

Service Code	HCPCS C1713
Hospital Charge Code	992373
Hospital Revenue Code	278
Min. Negotiated Rate	$144.22
Max. Negotiated Rate	$1,153.74
Rate for Payer: Amerigroup CHIP/Medicaid	$144.22
Rate for Payer: BCBS of TX Blue Advantage	$480.72
Rate for Payer: BCBS of TX Blue Essentials	$576.87
Rate for Payer: BCBS of TX PPO	$640.96
Rate for Payer: Cash Price	$1,089.64
Rate for Payer: Cigna Medicaid	$1,153.74
Rate for Payer: Molina CHIP/Medicaid	$1,153.74
Rate for Payer: Multiplan Auto	$801.21
Rate for Payer: Multiplan Commercial	$801.21
Rate for Payer: Multiplan Workers Comp	$801.21
Rate for Payer: Parkland Medicaid	$1,153.74
Rate for Payer: Scott and White EPO/PPO	$801.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,153.74
Rate for Payer: Superior Health Plan EPO	$217.93

DRN CHST UWTR

Facility

$185.32

Hospital Charge Code	80320609
Hospital Revenue Code	270
Min. Negotiated Rate	$16.68
Max. Negotiated Rate	$133.43
Rate for Payer: Amerigroup CHIP/Medicaid	$16.68
Rate for Payer: BCBS of TX Blue Advantage	$55.60
Rate for Payer: BCBS of TX Blue Essentials	$66.72
Rate for Payer: BCBS of TX PPO	$74.13
Rate for Payer: Cash Price	$126.02
Rate for Payer: Cigna Medicaid	$133.43
Rate for Payer: Molina CHIP/Medicaid	$133.43
Rate for Payer: Multiplan Auto	$120.46
Rate for Payer: Multiplan Commercial	$120.46
Rate for Payer: Multiplan Workers Comp	$120.46
Rate for Payer: Parkland Medicaid	$133.43
Rate for Payer: Scott and White EPO/PPO	$92.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$133.43
Rate for Payer: Superior Health Plan EPO	$25.20

DRN CHST UWTR

Facility

$185.32

Hospital Charge Code	80320609
Hospital Revenue Code	270
Rate for Payer: Cash Price	$126.02

DRN SUMP SALEM -- DHF

Facility

$170.09

Hospital Charge Code	81821456
Hospital Revenue Code	272
Min. Negotiated Rate	$15.31
Max. Negotiated Rate	$122.46
Rate for Payer: Amerigroup CHIP/Medicaid	$15.31
Rate for Payer: BCBS of TX Blue Advantage	$51.03
Rate for Payer: BCBS of TX Blue Essentials	$61.23
Rate for Payer: BCBS of TX PPO	$68.04
Rate for Payer: Cash Price	$115.66
Rate for Payer: Cigna Medicaid	$122.46
Rate for Payer: Molina CHIP/Medicaid	$122.46
Rate for Payer: Multiplan Auto	$110.56
Rate for Payer: Multiplan Commercial	$110.56
Rate for Payer: Multiplan Workers Comp	$110.56
Rate for Payer: Parkland Medicaid	$122.46
Rate for Payer: Scott and White EPO/PPO	$85.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$122.46
Rate for Payer: Superior Health Plan EPO	$23.13

DRN SUMP SALEM -- DHF

Facility

$170.09

Hospital Charge Code	81821456
Hospital Revenue Code	272
Rate for Payer: Cash Price	$115.66

DRP ANGIO FEM -- DHF

Facility

$72.92

Hospital Charge Code	81620056
Hospital Revenue Code	272
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$52.50
Rate for Payer: Amerigroup CHIP/Medicaid	$6.56
Rate for Payer: BCBS of TX Blue Advantage	$21.88
Rate for Payer: BCBS of TX Blue Essentials	$26.25
Rate for Payer: BCBS of TX PPO	$29.17
Rate for Payer: Cash Price	$49.59
Rate for Payer: Cigna Medicaid	$52.50
Rate for Payer: Molina CHIP/Medicaid	$52.50
Rate for Payer: Multiplan Auto	$47.40
Rate for Payer: Multiplan Commercial	$47.40
Rate for Payer: Multiplan Workers Comp	$47.40
Rate for Payer: Parkland Medicaid	$52.50
Rate for Payer: Scott and White EPO/PPO	$36.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$52.50
Rate for Payer: Superior Health Plan EPO	$9.92

DRP ANGIO FEM -- DHF

Facility

$72.92

Hospital Charge Code	81620056
Hospital Revenue Code	272
Rate for Payer: Cash Price	$49.59

DRP SHEET SPLT -- DHF

Facility

$400.04

Hospital Charge Code	81623001
Hospital Revenue Code	272
Rate for Payer: Cash Price	$272.03

DRP SHEET SPLT -- DHF

Facility

$400.04

Hospital Charge Code	81623001
Hospital Revenue Code	272
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$288.03
Rate for Payer: Amerigroup CHIP/Medicaid	$36.00
Rate for Payer: BCBS of TX Blue Advantage	$120.01
Rate for Payer: BCBS of TX Blue Essentials	$144.01
Rate for Payer: BCBS of TX PPO	$160.02
Rate for Payer: Cash Price	$272.03
Rate for Payer: Cigna Medicaid	$288.03
Rate for Payer: Molina CHIP/Medicaid	$288.03
Rate for Payer: Multiplan Auto	$260.03
Rate for Payer: Multiplan Commercial	$260.03
Rate for Payer: Multiplan Workers Comp	$260.03
Rate for Payer: Parkland Medicaid	$288.03
Rate for Payer: Scott and White EPO/PPO	$200.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$288.03
Rate for Payer: Superior Health Plan EPO	$54.41

DRP STRI INCSM -- DHF

Facility

$211.71

Hospital Charge Code	81623753
Hospital Revenue Code	272
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$152.43
Rate for Payer: Amerigroup CHIP/Medicaid	$19.05
Rate for Payer: BCBS of TX Blue Advantage	$63.51
Rate for Payer: BCBS of TX Blue Essentials	$76.22
Rate for Payer: BCBS of TX PPO	$84.68
Rate for Payer: Cash Price	$143.96
Rate for Payer: Cigna Medicaid	$152.43
Rate for Payer: Molina CHIP/Medicaid	$152.43
Rate for Payer: Multiplan Auto	$137.61
Rate for Payer: Multiplan Commercial	$137.61
Rate for Payer: Multiplan Workers Comp	$137.61
Rate for Payer: Parkland Medicaid	$152.43
Rate for Payer: Scott and White EPO/PPO	$105.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$152.43
Rate for Payer: Superior Health Plan EPO	$28.79

DRP STRI INCSM -- DHF

Facility

$211.71

Hospital Charge Code	81623753
Hospital Revenue Code	272
Rate for Payer: Cash Price	$143.96

DRS ADHES WND -- DHF

Facility

$106.03

Hospital Charge Code	80243231
Hospital Revenue Code	270
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$76.34
Rate for Payer: Amerigroup CHIP/Medicaid	$9.54
Rate for Payer: BCBS of TX Blue Advantage	$31.81
Rate for Payer: BCBS of TX Blue Essentials	$38.17
Rate for Payer: BCBS of TX PPO	$42.41
Rate for Payer: Cash Price	$72.10
Rate for Payer: Cigna Medicaid	$76.34
Rate for Payer: Molina CHIP/Medicaid	$76.34
Rate for Payer: Multiplan Auto	$68.92
Rate for Payer: Multiplan Commercial	$68.92
Rate for Payer: Multiplan Workers Comp	$68.92
Rate for Payer: Parkland Medicaid	$76.34
Rate for Payer: Scott and White EPO/PPO	$53.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$76.34
Rate for Payer: Superior Health Plan EPO	$14.42

DRS ADHES WND -- DHF

Facility

$106.03

Hospital Charge Code	80243231
Hospital Revenue Code	270
Rate for Payer: Cash Price	$72.10

DRS ANTIMICROBIAL II -- DHF

Facility

$138.50

Hospital Charge Code	80243389
Hospital Revenue Code	272
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$99.72
Rate for Payer: Amerigroup CHIP/Medicaid	$12.46
Rate for Payer: BCBS of TX Blue Advantage	$41.55
Rate for Payer: BCBS of TX Blue Essentials	$49.86
Rate for Payer: BCBS of TX PPO	$55.40
Rate for Payer: Cash Price	$94.18
Rate for Payer: Cigna Medicaid	$99.72
Rate for Payer: Molina CHIP/Medicaid	$99.72
Rate for Payer: Multiplan Auto	$90.03
Rate for Payer: Multiplan Commercial	$90.03
Rate for Payer: Multiplan Workers Comp	$90.03
Rate for Payer: Parkland Medicaid	$99.72
Rate for Payer: Scott and White EPO/PPO	$69.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$99.72
Rate for Payer: Superior Health Plan EPO	$18.84

DRS ANTIMICROBIAL II -- DHF

Facility

$138.50

Hospital Charge Code	80243389
Hospital Revenue Code	272
Rate for Payer: Cash Price	$94.18

DRS BIND ELASTIC TUBLAR -- DHF

Facility

$136.73

Hospital Charge Code	80243678
Hospital Revenue Code	270
Min. Negotiated Rate	$12.31
Max. Negotiated Rate	$98.45
Rate for Payer: Amerigroup CHIP/Medicaid	$12.31
Rate for Payer: BCBS of TX Blue Advantage	$41.02
Rate for Payer: BCBS of TX Blue Essentials	$49.22
Rate for Payer: BCBS of TX PPO	$54.69
Rate for Payer: Cash Price	$92.98
Rate for Payer: Cigna Medicaid	$98.45
Rate for Payer: Molina CHIP/Medicaid	$98.45
Rate for Payer: Multiplan Auto	$88.87
Rate for Payer: Multiplan Commercial	$88.87
Rate for Payer: Multiplan Workers Comp	$88.87
Rate for Payer: Parkland Medicaid	$98.45
Rate for Payer: Scott and White EPO/PPO	$68.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$98.45
Rate for Payer: Superior Health Plan EPO	$18.60

DRS BIND ELASTIC TUBLAR -- DHF

Facility

$136.73

Hospital Charge Code	80243678
Hospital Revenue Code	270
Rate for Payer: Cash Price	$92.98

DRS COBAN 6IN -- DHF

Facility

$96.69

Hospital Charge Code	80243876
Hospital Revenue Code	272
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$69.62
Rate for Payer: Amerigroup CHIP/Medicaid	$8.70
Rate for Payer: BCBS of TX Blue Advantage	$29.01
Rate for Payer: BCBS of TX Blue Essentials	$34.81
Rate for Payer: BCBS of TX PPO	$38.68
Rate for Payer: Cash Price	$65.75
Rate for Payer: Cigna Medicaid	$69.62
Rate for Payer: Molina CHIP/Medicaid	$69.62
Rate for Payer: Multiplan Auto	$62.85
Rate for Payer: Multiplan Commercial	$62.85
Rate for Payer: Multiplan Workers Comp	$62.85
Rate for Payer: Parkland Medicaid	$69.62
Rate for Payer: Scott and White EPO/PPO	$48.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$69.62
Rate for Payer: Superior Health Plan EPO	$13.15

DRS COBAN 6IN -- DHF

Facility

$96.69

Hospital Charge Code	80243876
Hospital Revenue Code	272
Rate for Payer: Cash Price	$65.75

drs collagen gel 1 0z

Facility

$19.16

Hospital Charge Code	131596
Hospital Revenue Code	270
Rate for Payer: Cash Price	$13.03

drs collagen gel 1 0z

Facility

$19.16

Hospital Charge Code	131596
Hospital Revenue Code	270
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$13.80
Rate for Payer: Amerigroup CHIP/Medicaid	$1.72
Rate for Payer: BCBS of TX Blue Advantage	$5.75
Rate for Payer: BCBS of TX Blue Essentials	$6.90
Rate for Payer: BCBS of TX PPO	$7.66
Rate for Payer: Cash Price	$13.03
Rate for Payer: Cigna Medicaid	$13.80
Rate for Payer: Molina CHIP/Medicaid	$13.80
Rate for Payer: Multiplan Auto	$12.45
Rate for Payer: Multiplan Commercial	$12.45
Rate for Payer: Multiplan Workers Comp	$12.45
Rate for Payer: Parkland Medicaid	$13.80
Rate for Payer: Scott and White EPO/PPO	$9.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.80
Rate for Payer: Superior Health Plan EPO	$2.61

DRS DEBRID BURN -- DHF

Facility

$408.60

Hospital Charge Code	80243900
Hospital Revenue Code	270
Rate for Payer: Cash Price	$277.85

DRS DEBRID BURN -- DHF

Facility

$408.60

Hospital Charge Code	80243900
Hospital Revenue Code	270
Min. Negotiated Rate	$36.77
Max. Negotiated Rate	$294.19
Rate for Payer: Amerigroup CHIP/Medicaid	$36.77
Rate for Payer: BCBS of TX Blue Advantage	$122.58
Rate for Payer: BCBS of TX Blue Essentials	$147.10
Rate for Payer: BCBS of TX PPO	$163.44
Rate for Payer: Cash Price	$277.85
Rate for Payer: Cigna Medicaid	$294.19
Rate for Payer: Molina CHIP/Medicaid	$294.19
Rate for Payer: Multiplan Auto	$265.59
Rate for Payer: Multiplan Commercial	$265.59
Rate for Payer: Multiplan Workers Comp	$265.59
Rate for Payer: Parkland Medicaid	$294.19
Rate for Payer: Scott and White EPO/PPO	$204.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$294.19
Rate for Payer: Superior Health Plan EPO	$55.57

Know your out-of-pocket cost for care.

All Charges