White Rock Medical Center

All Charges

Charge

Type

Setting

Price

BLADE RETRACTABLE BANANA

Facility

$2,805.72

Hospital Charge Code	8428487
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,469.03

BLADE SAGITAL PERF SERIES 90X1.27

Facility

$236.99

Hospital Charge Code	114337
Hospital Revenue Code	272
Rate for Payer: Cash Price	$208.55

BLADE SAGITAL PERF SERIES 90X1.27

Facility

$236.99

Hospital Charge Code	114337
Hospital Revenue Code	272
Min. Negotiated Rate	$21.33
Max. Negotiated Rate	$154.04
Rate for Payer: Aetna Commercial	$130.34
Rate for Payer: Amerigroup CHIP/Medicaid	$21.33
Rate for Payer: BCBS of TX Blue Advantage	$71.10
Rate for Payer: BCBS of TX Blue Essentials	$85.32
Rate for Payer: BCBS of TX PPO	$94.80
Rate for Payer: Cash Price	$208.55
Rate for Payer: Multiplan Auto	$154.04
Rate for Payer: Multiplan Commercial	$154.04
Rate for Payer: Multiplan Workers Comp	$154.04
Rate for Payer: Scott and White EPO/PPO	$118.50
Rate for Payer: Superior Health Plan EPO	$32.23

BLADE SAW LAPIPLASTY 40MMX11MM

Facility

$227.00

Hospital Charge Code	145461
Hospital Revenue Code	272
Rate for Payer: Cash Price	$199.76

BLADE SAW LAPIPLASTY 40MMX11MM

Facility

$227.00

Hospital Charge Code	145461
Hospital Revenue Code	272
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$147.55
Rate for Payer: Aetna Commercial	$124.85
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	$199.76
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: Scott and White EPO/PPO	$113.50
Rate for Payer: Superior Health Plan EPO	$30.87

BLADE, SAW LONG NARROW 25 X 5.5MM -- DHF

Facility

$721.86

Hospital Charge Code	81723355
Hospital Revenue Code	272
Rate for Payer: Cash Price	$635.24

BLADE, SAW LONG NARROW 25 X 5.5MM -- DHF

Facility

$721.86

Hospital Charge Code	81723355
Hospital Revenue Code	272
Min. Negotiated Rate	$64.97
Max. Negotiated Rate	$469.21
Rate for Payer: Aetna Commercial	$397.02
Rate for Payer: Amerigroup CHIP/Medicaid	$64.97
Rate for Payer: BCBS of TX Blue Advantage	$216.56
Rate for Payer: BCBS of TX Blue Essentials	$259.87
Rate for Payer: BCBS of TX PPO	$288.74
Rate for Payer: Cash Price	$635.24
Rate for Payer: Multiplan Auto	$469.21
Rate for Payer: Multiplan Commercial	$469.21
Rate for Payer: Multiplan Workers Comp	$469.21
Rate for Payer: Scott and White EPO/PPO	$360.93
Rate for Payer: Superior Health Plan EPO	$98.17

BLADE, SAW MED AVERAGE .015''''TK 9.0MM W 25.0MM DPTH -- DHF

Facility

$83.46

Hospital Charge Code	81723504
Hospital Revenue Code	272
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$54.25
Rate for Payer: Aetna Commercial	$45.90
Rate for Payer: Amerigroup CHIP/Medicaid	$7.51
Rate for Payer: BCBS of TX Blue Advantage	$25.04
Rate for Payer: BCBS of TX Blue Essentials	$30.05
Rate for Payer: BCBS of TX PPO	$33.38
Rate for Payer: Cash Price	$73.44
Rate for Payer: Multiplan Auto	$54.25
Rate for Payer: Multiplan Commercial	$54.25
Rate for Payer: Multiplan Workers Comp	$54.25
Rate for Payer: Scott and White EPO/PPO	$41.73
Rate for Payer: Superior Health Plan EPO	$11.35

BLADE, SAW MED AVERAGE .015''''TK 9.0MM W 25.0MM DPTH -- DHF

Facility

$83.46

Hospital Charge Code	81723504
Hospital Revenue Code	272
Rate for Payer: Cash Price	$73.44

blade saw oxford cut

Facility

$2,029.38

Hospital Charge Code	144813
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,785.85

blade saw oxford cut

Facility

$2,029.38

Hospital Charge Code	144813
Hospital Revenue Code	272
Min. Negotiated Rate	$182.64
Max. Negotiated Rate	$1,319.10
Rate for Payer: Aetna Commercial	$1,116.16
Rate for Payer: Amerigroup CHIP/Medicaid	$182.64
Rate for Payer: BCBS of TX Blue Advantage	$608.81
Rate for Payer: BCBS of TX Blue Essentials	$730.58
Rate for Payer: BCBS of TX PPO	$811.75
Rate for Payer: Cash Price	$1,785.85
Rate for Payer: Multiplan Auto	$1,319.10
Rate for Payer: Multiplan Commercial	$1,319.10
Rate for Payer: Multiplan Workers Comp	$1,319.10
Rate for Payer: Scott and White EPO/PPO	$1,014.69
Rate for Payer: Superior Health Plan EPO	$276.00

BLADE, SAW SAGITAL 25MM X 100MM X 1.27MM -- DHF

Facility

$250.52

Hospital Charge Code	81722951
Hospital Revenue Code	272
Min. Negotiated Rate	$22.55
Max. Negotiated Rate	$162.84
Rate for Payer: Aetna Commercial	$137.79
Rate for Payer: Amerigroup CHIP/Medicaid	$22.55
Rate for Payer: BCBS of TX Blue Advantage	$75.16
Rate for Payer: BCBS of TX Blue Essentials	$90.19
Rate for Payer: BCBS of TX PPO	$100.21
Rate for Payer: Cash Price	$220.46
Rate for Payer: Multiplan Auto	$162.84
Rate for Payer: Multiplan Commercial	$162.84
Rate for Payer: Multiplan Workers Comp	$162.84
Rate for Payer: Scott and White EPO/PPO	$125.26
Rate for Payer: Superior Health Plan EPO	$34.07

BLADE, SAW SAGITTAL 5.5MM X 25.4MM -- DHF

Facility

$617.34

Hospital Charge Code	81722654
Hospital Revenue Code	272
Min. Negotiated Rate	$55.56
Max. Negotiated Rate	$401.27
Rate for Payer: Aetna Commercial	$339.54
Rate for Payer: Amerigroup CHIP/Medicaid	$55.56
Rate for Payer: BCBS of TX Blue Advantage	$185.20
Rate for Payer: BCBS of TX Blue Essentials	$222.24
Rate for Payer: BCBS of TX PPO	$246.94
Rate for Payer: Cash Price	$543.26
Rate for Payer: Multiplan Auto	$401.27
Rate for Payer: Multiplan Commercial	$401.27
Rate for Payer: Multiplan Workers Comp	$401.27
Rate for Payer: Scott and White EPO/PPO	$308.67
Rate for Payer: Superior Health Plan EPO	$83.96

BLADE, SAW SAGITTAL 9.5MM X 25.5MM 0.63MM THK -- DHF

Facility

$27.56

Hospital Charge Code	81723272
Hospital Revenue Code	272
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$17.91
Rate for Payer: Aetna Commercial	$15.16
Rate for Payer: Amerigroup CHIP/Medicaid	$2.48
Rate for Payer: BCBS of TX Blue Advantage	$8.27
Rate for Payer: BCBS of TX Blue Essentials	$9.92
Rate for Payer: BCBS of TX PPO	$11.02
Rate for Payer: Cash Price	$24.25
Rate for Payer: Multiplan Auto	$17.91
Rate for Payer: Multiplan Commercial	$17.91
Rate for Payer: Multiplan Workers Comp	$17.91
Rate for Payer: Scott and White EPO/PPO	$13.78
Rate for Payer: Superior Health Plan EPO	$3.75

BLADE, SAW SAGITTAL DUAL STR 18MM X 1.27MM X 100MM -- DHF

Facility

$250.52

Hospital Charge Code	81722951
Hospital Revenue Code	272
Rate for Payer: Cash Price	$220.46

BLADE, SAW SAGITTAL DUAL STR 18MM X 1.27MM X 100MM -- DHF

Facility

$250.52

Hospital Charge Code	81722951
Hospital Revenue Code	272
Min. Negotiated Rate	$22.55
Max. Negotiated Rate	$162.84
Rate for Payer: Aetna Commercial	$137.79
Rate for Payer: Amerigroup CHIP/Medicaid	$22.55
Rate for Payer: BCBS of TX Blue Advantage	$75.16
Rate for Payer: BCBS of TX Blue Essentials	$90.19
Rate for Payer: BCBS of TX PPO	$100.21
Rate for Payer: Cash Price	$220.46
Rate for Payer: Multiplan Auto	$162.84
Rate for Payer: Multiplan Commercial	$162.84
Rate for Payer: Multiplan Workers Comp	$162.84
Rate for Payer: Scott and White EPO/PPO	$125.26
Rate for Payer: Superior Health Plan EPO	$34.07

BLADE, SAW SAGITTAL S/S 21MM X 90MM X 1.9MM -- DHF

Facility

$354.16

Hospital Charge Code	81722902
Hospital Revenue Code	272
Min. Negotiated Rate	$31.87
Max. Negotiated Rate	$230.20
Rate for Payer: Aetna Commercial	$194.79
Rate for Payer: Amerigroup CHIP/Medicaid	$31.87
Rate for Payer: BCBS of TX Blue Advantage	$106.25
Rate for Payer: BCBS of TX Blue Essentials	$127.50
Rate for Payer: BCBS of TX PPO	$141.66
Rate for Payer: Cash Price	$311.66
Rate for Payer: Multiplan Auto	$230.20
Rate for Payer: Multiplan Commercial	$230.20
Rate for Payer: Multiplan Workers Comp	$230.20
Rate for Payer: Scott and White EPO/PPO	$177.08
Rate for Payer: Superior Health Plan EPO	$48.17

BLADE, SAW SAGITTAL S/S 21MM X 90MM X 1.9MM -- DHF

Facility

$354.16

Hospital Charge Code	81722902
Hospital Revenue Code	272
Rate for Payer: Cash Price	$311.66

BLADE, SAW SGTTL DEEP CUTTING 4.72CM 25.40MM .89MM -- DHF

Facility

$617.34

Hospital Charge Code	81722654
Hospital Revenue Code	272
Rate for Payer: Cash Price	$543.26

BLADE, SAW SGTTL DEEP CUTTING 4.72CM 25.40MM .89MM -- DHF

Facility

$617.34

Hospital Charge Code	81722654
Hospital Revenue Code	272
Min. Negotiated Rate	$55.56
Max. Negotiated Rate	$401.27
Rate for Payer: Aetna Commercial	$339.54
Rate for Payer: Amerigroup CHIP/Medicaid	$55.56
Rate for Payer: BCBS of TX Blue Advantage	$185.20
Rate for Payer: BCBS of TX Blue Essentials	$222.24
Rate for Payer: BCBS of TX PPO	$246.94
Rate for Payer: Cash Price	$543.26
Rate for Payer: Multiplan Auto	$401.27
Rate for Payer: Multiplan Commercial	$401.27
Rate for Payer: Multiplan Workers Comp	$401.27
Rate for Payer: Scott and White EPO/PPO	$308.67
Rate for Payer: Superior Health Plan EPO	$83.96

BLADE SHAVER LANZA

Facility

$544.80

Hospital Charge Code	8692540
Hospital Revenue Code	272
Min. Negotiated Rate	$49.03
Max. Negotiated Rate	$354.12
Rate for Payer: Aetna Commercial	$299.64
Rate for Payer: Amerigroup CHIP/Medicaid	$49.03
Rate for Payer: BCBS of TX Blue Advantage	$163.44
Rate for Payer: BCBS of TX Blue Essentials	$196.13
Rate for Payer: BCBS of TX PPO	$217.92
Rate for Payer: Cash Price	$479.42
Rate for Payer: Multiplan Auto	$354.12
Rate for Payer: Multiplan Commercial	$354.12
Rate for Payer: Multiplan Workers Comp	$354.12
Rate for Payer: Scott and White EPO/PPO	$272.40
Rate for Payer: Superior Health Plan EPO	$74.09

BLADE SHAVER LANZA

Facility

$544.80

Hospital Charge Code	8692540
Hospital Revenue Code	272
Rate for Payer: Cash Price	$479.42

BLADE, SURGICAL CLIPPER FOR MDL 4407 -- DHF

Facility

$198.05

Hospital Charge Code	81812307
Hospital Revenue Code	272
Rate for Payer: Cash Price	$174.28

BLADE, SURGICAL CLIPPER FOR MDL 4407 -- DHF

Facility

$198.05

Hospital Charge Code	81812307
Hospital Revenue Code	272
Min. Negotiated Rate	$17.82
Max. Negotiated Rate	$128.73
Rate for Payer: Aetna Commercial	$108.93
Rate for Payer: Amerigroup CHIP/Medicaid	$17.82
Rate for Payer: BCBS of TX Blue Advantage	$59.42
Rate for Payer: BCBS of TX Blue Essentials	$71.30
Rate for Payer: BCBS of TX PPO	$79.22
Rate for Payer: Cash Price	$174.28
Rate for Payer: Multiplan Auto	$128.73
Rate for Payer: Multiplan Commercial	$128.73
Rate for Payer: Multiplan Workers Comp	$128.73
Rate for Payer: Scott and White EPO/PPO	$99.02
Rate for Payer: Superior Health Plan EPO	$26.93

BLADE, SURGICAL S/S SIZE 15C FOR PLASTIC SURGERY -- DHF

Facility

$27.56

Hospital Charge Code	81723272
Hospital Revenue Code	272
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$17.91
Rate for Payer: Aetna Commercial	$15.16
Rate for Payer: Amerigroup CHIP/Medicaid	$2.48
Rate for Payer: BCBS of TX Blue Advantage	$8.27
Rate for Payer: BCBS of TX Blue Essentials	$9.92
Rate for Payer: BCBS of TX PPO	$11.02
Rate for Payer: Cash Price	$24.25
Rate for Payer: Multiplan Auto	$17.91
Rate for Payer: Multiplan Commercial	$17.91
Rate for Payer: Multiplan Workers Comp	$17.91
Rate for Payer: Scott and White EPO/PPO	$13.78
Rate for Payer: Superior Health Plan EPO	$3.75

Know your out-of-pocket cost for care.

All Charges