White Rock Medical Center

All Charges

Charge

Type

Setting

Price

REAMER GRAFTMAX SENTINEL 5.5MM

Facility

$1,248.50

Hospital Charge Code	146149
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 8.0MM

Facility

$1,248.50

Hospital Charge Code	146147
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 8.0MM

Facility

$1,248.50

Hospital Charge Code	146147
Hospital Revenue Code	272
Rate for Payer: Cash Price	$848.98

REAMER GRAFTMAX SENTINEL 8.5MM

Facility

$1,248.50

Hospital Charge Code	146148
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 8.5MM

Facility

$1,248.50

Hospital Charge Code	146148
Hospital Revenue Code	272
Rate for Payer: Cash Price	$848.98

REAMER HEADED 8MM

Facility

$976.10

Hospital Charge Code	117535
Hospital Revenue Code	272
Min. Negotiated Rate	$87.85
Max. Negotiated Rate	$702.79
Rate for Payer: Amerigroup CHIP/Medicaid	$87.85
Rate for Payer: BCBS of TX Blue Advantage	$292.83
Rate for Payer: BCBS of TX Blue Essentials	$351.40
Rate for Payer: BCBS of TX PPO	$390.44
Rate for Payer: Cash Price	$663.75
Rate for Payer: Cigna Medicaid	$702.79
Rate for Payer: Molina CHIP/Medicaid	$702.79
Rate for Payer: Multiplan Auto	$634.47
Rate for Payer: Multiplan Commercial	$634.47
Rate for Payer: Multiplan Workers Comp	$634.47
Rate for Payer: Parkland Medicaid	$702.79
Rate for Payer: Scott and White EPO/PPO	$488.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$702.79
Rate for Payer: Superior Health Plan EPO	$132.75

REAMER HEADED 8MM

Facility

$976.10

Hospital Charge Code	117535
Hospital Revenue Code	272
Rate for Payer: Cash Price	$663.75

REAMER INFINITY RETRO 7MM

Facility

$1,407.40

Hospital Charge Code	8428503
Hospital Revenue Code	272
Min. Negotiated Rate	$126.67
Max. Negotiated Rate	$1,013.33
Rate for Payer: Amerigroup CHIP/Medicaid	$126.67
Rate for Payer: BCBS of TX Blue Advantage	$422.22
Rate for Payer: BCBS of TX Blue Essentials	$506.66
Rate for Payer: BCBS of TX PPO	$562.96
Rate for Payer: Cash Price	$957.03
Rate for Payer: Cigna Medicaid	$1,013.33
Rate for Payer: Molina CHIP/Medicaid	$1,013.33
Rate for Payer: Multiplan Auto	$914.81
Rate for Payer: Multiplan Commercial	$914.81
Rate for Payer: Multiplan Workers Comp	$914.81
Rate for Payer: Parkland Medicaid	$1,013.33
Rate for Payer: Scott and White EPO/PPO	$703.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,013.33
Rate for Payer: Superior Health Plan EPO	$191.41

REAMER INFINITY RETRO 7MM

Facility

$1,407.40

Hospital Charge Code	8428503
Hospital Revenue Code	272
Rate for Payer: Cash Price	$957.03

REAMER LOW PROFILE

Facility

$2,179.20

Hospital Charge Code	145093
Hospital Revenue Code	272
Min. Negotiated Rate	$196.13
Max. Negotiated Rate	$1,569.02
Rate for Payer: Amerigroup CHIP/Medicaid	$196.13
Rate for Payer: BCBS of TX Blue Advantage	$653.76
Rate for Payer: BCBS of TX Blue Essentials	$784.51
Rate for Payer: BCBS of TX PPO	$871.68
Rate for Payer: Cash Price	$1,481.86
Rate for Payer: Cigna Medicaid	$1,569.02
Rate for Payer: Molina CHIP/Medicaid	$1,569.02
Rate for Payer: Multiplan Auto	$1,416.48
Rate for Payer: Multiplan Commercial	$1,416.48
Rate for Payer: Multiplan Workers Comp	$1,416.48
Rate for Payer: Parkland Medicaid	$1,569.02
Rate for Payer: Scott and White EPO/PPO	$1,089.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,569.02
Rate for Payer: Superior Health Plan EPO	$296.37

REAMER LOW PROFILE

Facility

$2,179.20

Hospital Charge Code	145093
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,481.86

REAMER LOW PROFILE 9.5MM

Facility

$1,475.50

Hospital Charge Code	117539
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,003.34

REAMER LOW PROFILE 9.5MM

Facility

$1,475.50

Hospital Charge Code	117539
Hospital Revenue Code	272
Min. Negotiated Rate	$132.79
Max. Negotiated Rate	$1,062.36
Rate for Payer: Amerigroup CHIP/Medicaid	$132.79
Rate for Payer: BCBS of TX Blue Advantage	$442.65
Rate for Payer: BCBS of TX Blue Essentials	$531.18
Rate for Payer: BCBS of TX PPO	$590.20
Rate for Payer: Cash Price	$1,003.34
Rate for Payer: Cigna Medicaid	$1,062.36
Rate for Payer: Molina CHIP/Medicaid	$1,062.36
Rate for Payer: Multiplan Auto	$959.08
Rate for Payer: Multiplan Commercial	$959.08
Rate for Payer: Multiplan Workers Comp	$959.08
Rate for Payer: Parkland Medicaid	$1,062.36
Rate for Payer: Scott and White EPO/PPO	$737.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,062.36
Rate for Payer: Superior Health Plan EPO	$200.67

REAMER LOW PROFILE 9MM

Facility

$1,292.58

Hospital Charge Code	144816
Hospital Revenue Code	272
Rate for Payer: Cash Price	$878.95

REAMER LOW PROFILE 9MM

Facility

$1,292.58

Hospital Charge Code	144816
Hospital Revenue Code	272
Min. Negotiated Rate	$116.33
Max. Negotiated Rate	$930.66
Rate for Payer: Amerigroup CHIP/Medicaid	$116.33
Rate for Payer: BCBS of TX Blue Advantage	$387.77
Rate for Payer: BCBS of TX Blue Essentials	$465.33
Rate for Payer: BCBS of TX PPO	$517.03
Rate for Payer: Cash Price	$878.95
Rate for Payer: Cigna Medicaid	$930.66
Rate for Payer: Molina CHIP/Medicaid	$930.66
Rate for Payer: Multiplan Auto	$840.18
Rate for Payer: Multiplan Commercial	$840.18
Rate for Payer: Multiplan Workers Comp	$840.18
Rate for Payer: Parkland Medicaid	$930.66
Rate for Payer: Scott and White EPO/PPO	$646.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$930.66
Rate for Payer: Superior Health Plan EPO	$175.79

REAMER OPENING CONICAL ONE STEP GAMMA NAIL

Facility

$3,823.41

Hospital Charge Code	146177
Hospital Revenue Code	272
Min. Negotiated Rate	$344.11
Max. Negotiated Rate	$2,752.86
Rate for Payer: Amerigroup CHIP/Medicaid	$344.11
Rate for Payer: BCBS of TX Blue Advantage	$1,147.02
Rate for Payer: BCBS of TX Blue Essentials	$1,376.43
Rate for Payer: BCBS of TX PPO	$1,529.36
Rate for Payer: Cash Price	$2,599.92
Rate for Payer: Cigna Medicaid	$2,752.86
Rate for Payer: Molina CHIP/Medicaid	$2,752.86
Rate for Payer: Multiplan Auto	$2,485.22
Rate for Payer: Multiplan Commercial	$2,485.22
Rate for Payer: Multiplan Workers Comp	$2,485.22
Rate for Payer: Parkland Medicaid	$2,752.86
Rate for Payer: Scott and White EPO/PPO	$1,911.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,752.86
Rate for Payer: Superior Health Plan EPO	$519.98

REAMER OPENING CONICAL ONE STEP GAMMA NAIL

Facility

$3,823.41

Hospital Charge Code	146177
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,599.92

REAMER SHAFT 470MM

Facility

$4,140.48

Hospital Charge Code	146688
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,815.53

REAMER SHAFT 470MM

Facility

$4,140.48

Hospital Charge Code	146688
Hospital Revenue Code	272
Min. Negotiated Rate	$372.64
Max. Negotiated Rate	$2,981.15
Rate for Payer: Amerigroup CHIP/Medicaid	$372.64
Rate for Payer: BCBS of TX Blue Advantage	$1,242.14
Rate for Payer: BCBS of TX Blue Essentials	$1,490.57
Rate for Payer: BCBS of TX PPO	$1,656.19
Rate for Payer: Cash Price	$2,815.53
Rate for Payer: Cigna Medicaid	$2,981.15
Rate for Payer: Molina CHIP/Medicaid	$2,981.15
Rate for Payer: Multiplan Auto	$2,691.31
Rate for Payer: Multiplan Commercial	$2,691.31
Rate for Payer: Multiplan Workers Comp	$2,691.31
Rate for Payer: Parkland Medicaid	$2,981.15
Rate for Payer: Scott and White EPO/PPO	$2,070.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,981.15
Rate for Payer: Superior Health Plan EPO	$563.11

REAMER SHAFT MODIFIED TRINKLE 8 X 510 MM

Facility

$4,246.99

Hospital Charge Code	993140
Hospital Revenue Code	270
Min. Negotiated Rate	$382.23
Max. Negotiated Rate	$3,057.83
Rate for Payer: Amerigroup CHIP/Medicaid	$382.23
Rate for Payer: BCBS of TX Blue Advantage	$1,274.10
Rate for Payer: BCBS of TX Blue Essentials	$1,528.92
Rate for Payer: BCBS of TX PPO	$1,698.80
Rate for Payer: Cash Price	$2,887.95
Rate for Payer: Cigna Medicaid	$3,057.83
Rate for Payer: Molina CHIP/Medicaid	$3,057.83
Rate for Payer: Multiplan Auto	$2,760.54
Rate for Payer: Multiplan Commercial	$2,760.54
Rate for Payer: Multiplan Workers Comp	$2,760.54
Rate for Payer: Parkland Medicaid	$3,057.83
Rate for Payer: Scott and White EPO/PPO	$2,123.49
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,057.83
Rate for Payer: Superior Health Plan EPO	$577.59

REAMER SHAFT MODIFIED TRINKLE 8 X 510 MM

Facility

$4,246.99

Hospital Charge Code	993140
Hospital Revenue Code	270
Rate for Payer: Cash Price	$2,887.95

Reamer Shaft Modified Trinkle 8x510mm

Facility

$3,685.66

Hospital Charge Code	117570
Hospital Revenue Code	272
Min. Negotiated Rate	$331.71
Max. Negotiated Rate	$2,653.68
Rate for Payer: Amerigroup CHIP/Medicaid	$331.71
Rate for Payer: BCBS of TX Blue Advantage	$1,105.70
Rate for Payer: BCBS of TX Blue Essentials	$1,326.84
Rate for Payer: BCBS of TX PPO	$1,474.26
Rate for Payer: Cash Price	$2,506.25
Rate for Payer: Cigna Medicaid	$2,653.68
Rate for Payer: Molina CHIP/Medicaid	$2,653.68
Rate for Payer: Multiplan Auto	$2,395.68
Rate for Payer: Multiplan Commercial	$2,395.68
Rate for Payer: Multiplan Workers Comp	$2,395.68
Rate for Payer: Parkland Medicaid	$2,653.68
Rate for Payer: Scott and White EPO/PPO	$1,842.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,653.68
Rate for Payer: Superior Health Plan EPO	$501.25

Reamer Shaft Modified Trinkle 8x510mm

Facility

$3,685.66

Hospital Charge Code	117570
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,506.25

REAMER STEPPED 8/12MM

Facility

$5,184.57

Hospital Charge Code	132357
Hospital Revenue Code	272
Rate for Payer: Cash Price	$3,525.51

REAMER STEPPED 8/12MM

Facility

$5,184.57

Hospital Charge Code	132357
Hospital Revenue Code	272
Min. Negotiated Rate	$466.61
Max. Negotiated Rate	$3,732.89
Rate for Payer: Amerigroup CHIP/Medicaid	$466.61
Rate for Payer: BCBS of TX Blue Advantage	$1,555.37
Rate for Payer: BCBS of TX Blue Essentials	$1,866.45
Rate for Payer: BCBS of TX PPO	$2,073.83
Rate for Payer: Cash Price	$3,525.51
Rate for Payer: Cigna Medicaid	$3,732.89
Rate for Payer: Molina CHIP/Medicaid	$3,732.89
Rate for Payer: Multiplan Auto	$3,369.97
Rate for Payer: Multiplan Commercial	$3,369.97
Rate for Payer: Multiplan Workers Comp	$3,369.97
Rate for Payer: Parkland Medicaid	$3,732.89
Rate for Payer: Scott and White EPO/PPO	$2,592.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,732.89
Rate for Payer: Superior Health Plan EPO	$705.10

Know your out-of-pocket cost for care.

All Charges