White Rock Medical Center

All Charges

Charge

Type

Setting

Price

REAGENT THRMB 10X5ML COAG

Facility

$217.49

Hospital Charge Code	993461
Hospital Revenue Code	270
Rate for Payer: Cash Price	$147.89

REAGENT, URINALSIS, UF-II SHEATH, 489TS

Facility

$1.40

Hospital Charge Code	993353
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.95

REAGENT, URINALSIS, UF-II SHEATH, 489TS

Facility

$1.40

Hospital Charge Code	993353
Hospital Revenue Code	270
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$1.01
Rate for Payer: Amerigroup CHIP/Medicaid	$0.13
Rate for Payer: BCBS of TX Blue Advantage	$0.42
Rate for Payer: BCBS of TX Blue Essentials	$0.50
Rate for Payer: BCBS of TX PPO	$0.56
Rate for Payer: Cash Price	$0.95
Rate for Payer: Cigna Medicaid	$1.01
Rate for Payer: Molina CHIP/Medicaid	$1.01
Rate for Payer: Multiplan Auto	$0.91
Rate for Payer: Multiplan Commercial	$0.91
Rate for Payer: Multiplan Workers Comp	$0.91
Rate for Payer: Parkland Medicaid	$1.01
Rate for Payer: Scott and White EPO/PPO	$0.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.01
Rate for Payer: Superior Health Plan EPO	$0.19

Realignment of extensor tendon, hand, each tendon

Facility

$10,000.00

Service Code	CPT 26437
Hospital Charge Code	36026437
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
Rate for Payer: BCBS of TX Blue Advantage	$4,571.54
Rate for Payer: BCBS of TX Blue Essentials	$5,474.90
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Scott and White EPO/PPO	$5,476.44
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Realignment of extensor tendon, hand, each tendon

Facility

$17,353.68

Service Code	HCPCS 26437
Hospital Charge Code	9900340
Hospital Revenue Code	360
Rate for Payer: Cash Price	$11,800.50

Realignment of extensor tendon, hand, each tendon

Facility

$17,353.68

Service Code	HCPCS 26437
Hospital Charge Code	9900340
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$12,494.65
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
Rate for Payer: BCBS of TX Blue Advantage	$4,571.54
Rate for Payer: BCBS of TX Blue Essentials	$5,474.90
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cash Price	$11,800.50
Rate for Payer: Cash Price	$11,800.50
Rate for Payer: Cash Price	$11,800.50
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicaid	$12,494.65
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina CHIP/Medicaid	$12,494.65
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$12,494.65
Rate for Payer: Scott and White EPO/PPO	$5,476.44
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,494.65
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

reamer acorn

Facility

$2,256.38

Hospital Charge Code	8612543
Hospital Revenue Code	272
Min. Negotiated Rate	$203.07
Max. Negotiated Rate	$1,624.59
Rate for Payer: Amerigroup CHIP/Medicaid	$203.07
Rate for Payer: BCBS of TX Blue Advantage	$676.91
Rate for Payer: BCBS of TX Blue Essentials	$812.30
Rate for Payer: BCBS of TX PPO	$902.55
Rate for Payer: Cash Price	$1,534.34
Rate for Payer: Cigna Medicaid	$1,624.59
Rate for Payer: Molina CHIP/Medicaid	$1,624.59
Rate for Payer: Multiplan Auto	$1,466.65
Rate for Payer: Multiplan Commercial	$1,466.65
Rate for Payer: Multiplan Workers Comp	$1,466.65
Rate for Payer: Parkland Medicaid	$1,624.59
Rate for Payer: Scott and White EPO/PPO	$1,128.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,624.59
Rate for Payer: Superior Health Plan EPO	$306.87

reamer acorn

Facility

$2,256.38

Hospital Charge Code	8612543
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,534.34

REAMER. ACORN STERILE 9.0MM

Facility

$2,628.66

Hospital Charge Code	139395
Hospital Revenue Code	272
Min. Negotiated Rate	$236.58
Max. Negotiated Rate	$1,892.64
Rate for Payer: Amerigroup CHIP/Medicaid	$236.58
Rate for Payer: BCBS of TX Blue Advantage	$788.60
Rate for Payer: BCBS of TX Blue Essentials	$946.32
Rate for Payer: BCBS of TX PPO	$1,051.46
Rate for Payer: Cash Price	$1,787.49
Rate for Payer: Cigna Medicaid	$1,892.64
Rate for Payer: Molina CHIP/Medicaid	$1,892.64
Rate for Payer: Multiplan Auto	$1,708.63
Rate for Payer: Multiplan Commercial	$1,708.63
Rate for Payer: Multiplan Workers Comp	$1,708.63
Rate for Payer: Parkland Medicaid	$1,892.64
Rate for Payer: Scott and White EPO/PPO	$1,314.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,892.64
Rate for Payer: Superior Health Plan EPO	$357.50

REAMER. ACORN STERILE 9.0MM

Facility

$2,628.66

Hospital Charge Code	139395
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,787.49

REAMER CANULATE -- DHF

Facility

$1,362.00

Hospital Charge Code	80826506
Hospital Revenue Code	272
Rate for Payer: Cash Price	$926.16

REAMER CANULATE -- DHF

Facility

$1,362.00

Hospital Charge Code	80826506
Hospital Revenue Code	272
Min. Negotiated Rate	$122.58
Max. Negotiated Rate	$980.64
Rate for Payer: Amerigroup CHIP/Medicaid	$122.58
Rate for Payer: BCBS of TX Blue Advantage	$408.60
Rate for Payer: BCBS of TX Blue Essentials	$490.32
Rate for Payer: BCBS of TX PPO	$544.80
Rate for Payer: Cash Price	$926.16
Rate for Payer: Cigna Medicaid	$980.64
Rate for Payer: Molina CHIP/Medicaid	$980.64
Rate for Payer: Multiplan Auto	$885.30
Rate for Payer: Multiplan Commercial	$885.30
Rate for Payer: Multiplan Workers Comp	$885.30
Rate for Payer: Parkland Medicaid	$980.64
Rate for Payer: Scott and White EPO/PPO	$681.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$980.64
Rate for Payer: Superior Health Plan EPO	$185.23

reamer constant 5.5

Facility

$1,623.05

Hospital Charge Code	8646514
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,103.67

reamer constant 5.5

Facility

$1,623.05

Hospital Charge Code	8646514
Hospital Revenue Code	272
Min. Negotiated Rate	$146.07
Max. Negotiated Rate	$1,168.60
Rate for Payer: Amerigroup CHIP/Medicaid	$146.07
Rate for Payer: BCBS of TX Blue Advantage	$486.92
Rate for Payer: BCBS of TX Blue Essentials	$584.30
Rate for Payer: BCBS of TX PPO	$649.22
Rate for Payer: Cash Price	$1,103.67
Rate for Payer: Cigna Medicaid	$1,168.60
Rate for Payer: Molina CHIP/Medicaid	$1,168.60
Rate for Payer: Multiplan Auto	$1,054.98
Rate for Payer: Multiplan Commercial	$1,054.98
Rate for Payer: Multiplan Workers Comp	$1,054.98
Rate for Payer: Parkland Medicaid	$1,168.60
Rate for Payer: Scott and White EPO/PPO	$811.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,168.60
Rate for Payer: Superior Health Plan EPO	$220.73

REAMER DHS HEAD STANDARD

Facility

$14,319.16

Hospital Charge Code	113932
Hospital Revenue Code	272
Min. Negotiated Rate	$1,288.72
Max. Negotiated Rate	$10,309.80
Rate for Payer: Amerigroup CHIP/Medicaid	$1,288.72
Rate for Payer: BCBS of TX Blue Advantage	$4,295.75
Rate for Payer: BCBS of TX Blue Essentials	$5,154.90
Rate for Payer: BCBS of TX PPO	$5,727.66
Rate for Payer: Cash Price	$9,737.03
Rate for Payer: Cigna Medicaid	$10,309.80
Rate for Payer: Molina CHIP/Medicaid	$10,309.80
Rate for Payer: Multiplan Auto	$9,307.45
Rate for Payer: Multiplan Commercial	$9,307.45
Rate for Payer: Multiplan Workers Comp	$9,307.45
Rate for Payer: Parkland Medicaid	$10,309.80
Rate for Payer: Scott and White EPO/PPO	$7,159.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,309.80
Rate for Payer: Superior Health Plan EPO	$1,947.41

REAMER DHS HEAD STANDARD

Facility

$14,319.16

Hospital Charge Code	113932
Hospital Revenue Code	272
Rate for Payer: Cash Price	$9,737.03

REAMER, FLEX SENTINEL 10.0 MM

Facility

$1,514.14

Hospital Charge Code	141510
Hospital Revenue Code	272
Min. Negotiated Rate	$136.27
Max. Negotiated Rate	$1,090.18
Rate for Payer: Amerigroup CHIP/Medicaid	$136.27
Rate for Payer: BCBS of TX Blue Advantage	$454.24
Rate for Payer: BCBS of TX Blue Essentials	$545.09
Rate for Payer: BCBS of TX PPO	$605.66
Rate for Payer: Cash Price	$1,029.62
Rate for Payer: Cigna Medicaid	$1,090.18
Rate for Payer: Molina CHIP/Medicaid	$1,090.18
Rate for Payer: Multiplan Auto	$984.19
Rate for Payer: Multiplan Commercial	$984.19
Rate for Payer: Multiplan Workers Comp	$984.19
Rate for Payer: Parkland Medicaid	$1,090.18
Rate for Payer: Scott and White EPO/PPO	$757.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,090.18
Rate for Payer: Superior Health Plan EPO	$205.92

REAMER, FLEX SENTINEL 10.0 MM

Facility

$1,514.14

Hospital Charge Code	141510
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,029.62

REAMER, FULLY FLUTED

Facility

$2,628.66

Hospital Charge Code	139396
Hospital Revenue Code	272
Min. Negotiated Rate	$236.58
Max. Negotiated Rate	$1,892.64
Rate for Payer: Amerigroup CHIP/Medicaid	$236.58
Rate for Payer: BCBS of TX Blue Advantage	$788.60
Rate for Payer: BCBS of TX Blue Essentials	$946.32
Rate for Payer: BCBS of TX PPO	$1,051.46
Rate for Payer: Cash Price	$1,787.49
Rate for Payer: Cigna Medicaid	$1,892.64
Rate for Payer: Molina CHIP/Medicaid	$1,892.64
Rate for Payer: Multiplan Auto	$1,708.63
Rate for Payer: Multiplan Commercial	$1,708.63
Rate for Payer: Multiplan Workers Comp	$1,708.63
Rate for Payer: Parkland Medicaid	$1,892.64
Rate for Payer: Scott and White EPO/PPO	$1,314.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,892.64
Rate for Payer: Superior Health Plan EPO	$357.50

REAMER, FULLY FLUTED

Facility

$2,628.66

Hospital Charge Code	139396
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,787.49

REAMER GRAFTMAX CHANNEL 4.5MM

Facility

$1,248.50

Hospital Charge Code	146150
Hospital Revenue Code	272
Rate for Payer: Cash Price	$848.98

REAMER GRAFTMAX CHANNEL 4.5MM

Facility

$1,248.50

Hospital Charge Code	146150
Hospital Revenue Code	272
Min. Negotiated Rate	$112.36
Max. Negotiated Rate	$898.92
Rate for Payer: Amerigroup CHIP/Medicaid	$112.36
Rate for Payer: BCBS of TX Blue Advantage	$374.55
Rate for Payer: BCBS of TX Blue Essentials	$449.46
Rate for Payer: BCBS of TX PPO	$499.40
Rate for Payer: Cash Price	$848.98
Rate for Payer: Cigna Medicaid	$898.92
Rate for Payer: Molina CHIP/Medicaid	$898.92
Rate for Payer: Multiplan Auto	$811.52
Rate for Payer: Multiplan Commercial	$811.52
Rate for Payer: Multiplan Workers Comp	$811.52
Rate for Payer: Parkland Medicaid	$898.92
Rate for Payer: Scott and White EPO/PPO	$624.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$898.92
Rate for Payer: Superior Health Plan EPO	$169.80

REAMER GRAFTMAX CHANNEL 5.0MM

Facility

$1,248.50

Hospital Charge Code	141483
Hospital Revenue Code	272
Rate for Payer: Cash Price	$848.98

REAMER GRAFTMAX CHANNEL 5.0MM

Facility

$1,248.50

Hospital Charge Code	141483
Hospital Revenue Code	272
Min. Negotiated Rate	$112.36
Max. Negotiated Rate	$898.92
Rate for Payer: Amerigroup CHIP/Medicaid	$112.36
Rate for Payer: BCBS of TX Blue Advantage	$374.55
Rate for Payer: BCBS of TX Blue Essentials	$449.46
Rate for Payer: BCBS of TX PPO	$499.40
Rate for Payer: Cash Price	$848.98
Rate for Payer: Cigna Medicaid	$898.92
Rate for Payer: Molina CHIP/Medicaid	$898.92
Rate for Payer: Multiplan Auto	$811.52
Rate for Payer: Multiplan Commercial	$811.52
Rate for Payer: Multiplan Workers Comp	$811.52
Rate for Payer: Parkland Medicaid	$898.92
Rate for Payer: Scott and White EPO/PPO	$624.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$898.92
Rate for Payer: Superior Health Plan EPO	$169.80

REAMER GRAFTMAX SENTINEL 5.5MM

Facility

$1,248.50

Hospital Charge Code	146149
Hospital Revenue Code	272
Rate for Payer: Cash Price	$848.98

Know your out-of-pocket cost for care.

All Charges