White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Saw blade stryker univ wide total ankle .500

Facility

$1,915.88

Hospital Charge Code	993322
Hospital Revenue Code	272
Min. Negotiated Rate	$172.43
Max. Negotiated Rate	$1,379.43
Rate for Payer: Amerigroup CHIP/Medicaid	$172.43
Rate for Payer: BCBS of TX Blue Advantage	$574.76
Rate for Payer: BCBS of TX Blue Essentials	$689.72
Rate for Payer: BCBS of TX PPO	$766.35
Rate for Payer: Cash Price	$1,302.80
Rate for Payer: Cigna Medicaid	$1,379.43
Rate for Payer: Molina CHIP/Medicaid	$1,379.43
Rate for Payer: Multiplan Auto	$1,245.32
Rate for Payer: Multiplan Commercial	$1,245.32
Rate for Payer: Multiplan Workers Comp	$1,245.32
Rate for Payer: Parkland Medicaid	$1,379.43
Rate for Payer: Scott and White EPO/PPO	$957.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,379.43
Rate for Payer: Superior Health Plan EPO	$260.56

Saw blade stryker univ wide total ankle .500

Facility

$1,915.88

Hospital Charge Code	993322
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,302.80

SC-4230SC-4276

Facility

$54.22

Service Code	HCPCS A9270
Hospital Charge Code	994127
Hospital Revenue Code	272
Rate for Payer: Cash Price	$36.87

SC-4230SC-4276

Facility

$54.22

Service Code	HCPCS A9270
Hospital Charge Code	77773906
Hospital Revenue Code	272
Rate for Payer: Cash Price	$36.87

SC-4230SC-4276

Facility

$54.22

Service Code	HCPCS A9270
Hospital Charge Code	77773906
Hospital Revenue Code	272
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$39.04
Rate for Payer: Amerigroup CHIP/Medicaid	$4.88
Rate for Payer: BCBS of TX Blue Advantage	$16.27
Rate for Payer: BCBS of TX Blue Essentials	$19.52
Rate for Payer: BCBS of TX PPO	$21.69
Rate for Payer: Cash Price	$36.87
Rate for Payer: Cigna Medicaid	$39.04
Rate for Payer: Molina CHIP/Medicaid	$39.04
Rate for Payer: Multiplan Auto	$35.24
Rate for Payer: Multiplan Commercial	$35.24
Rate for Payer: Multiplan Workers Comp	$35.24
Rate for Payer: Parkland Medicaid	$39.04
Rate for Payer: Scott and White EPO/PPO	$27.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$39.04
Rate for Payer: Superior Health Plan EPO	$7.37

SC-4230SC-4276

Facility

$54.22

Service Code	HCPCS A9270
Hospital Charge Code	994127
Hospital Revenue Code	272
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$39.04
Rate for Payer: Amerigroup CHIP/Medicaid	$4.88
Rate for Payer: BCBS of TX Blue Advantage	$16.27
Rate for Payer: BCBS of TX Blue Essentials	$19.52
Rate for Payer: BCBS of TX PPO	$21.69
Rate for Payer: Cash Price	$36.87
Rate for Payer: Cigna Medicaid	$39.04
Rate for Payer: Molina CHIP/Medicaid	$39.04
Rate for Payer: Multiplan Auto	$35.24
Rate for Payer: Multiplan Commercial	$35.24
Rate for Payer: Multiplan Workers Comp	$35.24
Rate for Payer: Parkland Medicaid	$39.04
Rate for Payer: Scott and White EPO/PPO	$27.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$39.04
Rate for Payer: Superior Health Plan EPO	$7.37

SC-4316

Facility

$1,204.82

Service Code	HCPCS C1713
Hospital Charge Code	994126
Hospital Revenue Code	278
Min. Negotiated Rate	$301.20
Max. Negotiated Rate	$602.41
Rate for Payer: Cash Price	$819.28
Rate for Payer: Cigna Commercial	$301.20
Rate for Payer: Multiplan Auto	$602.41
Rate for Payer: Multiplan Commercial	$602.41
Rate for Payer: Multiplan Workers Comp	$602.41
Rate for Payer: Scott and White EPO/PPO	$602.41

SC-4316

Facility

$1,204.82

Service Code	HCPCS C1713
Hospital Charge Code	994126
Hospital Revenue Code	278
Min. Negotiated Rate	$108.43
Max. Negotiated Rate	$867.47
Rate for Payer: Amerigroup CHIP/Medicaid	$108.43
Rate for Payer: BCBS of TX Blue Advantage	$361.45
Rate for Payer: BCBS of TX Blue Essentials	$433.74
Rate for Payer: BCBS of TX PPO	$481.93
Rate for Payer: Cash Price	$819.28
Rate for Payer: Cigna Medicaid	$867.47
Rate for Payer: Molina CHIP/Medicaid	$867.47
Rate for Payer: Multiplan Auto	$602.41
Rate for Payer: Multiplan Commercial	$602.41
Rate for Payer: Multiplan Workers Comp	$602.41
Rate for Payer: Parkland Medicaid	$867.47
Rate for Payer: Scott and White EPO/PPO	$602.41
Rate for Payer: Superior Health Plan CHIP/Medicaid	$867.47
Rate for Payer: Superior Health Plan EPO	$163.86

SC-8336-50SC-5572-1

Facility

$145,783.13

Service Code	HCPCS C1820
Hospital Charge Code	13522732
Hospital Revenue Code	278
Min. Negotiated Rate	$36,445.78
Max. Negotiated Rate	$72,891.57
Rate for Payer: Cash Price	$99,132.53
Rate for Payer: Cigna Commercial	$36,445.78
Rate for Payer: Multiplan Auto	$72,891.57
Rate for Payer: Multiplan Commercial	$72,891.57
Rate for Payer: Multiplan Workers Comp	$72,891.57
Rate for Payer: Scott and White EPO/PPO	$72,891.57

SC-8336-50SC-5572-1

Facility

$145,783.13

Service Code	HCPCS C1820
Hospital Charge Code	994125
Hospital Revenue Code	278
Min. Negotiated Rate	$13,120.48
Max. Negotiated Rate	$104,963.85
Rate for Payer: Amerigroup CHIP/Medicaid	$13,120.48
Rate for Payer: BCBS of TX Blue Advantage	$43,734.94
Rate for Payer: BCBS of TX Blue Essentials	$52,481.93
Rate for Payer: BCBS of TX PPO	$58,313.25
Rate for Payer: Cash Price	$99,132.53
Rate for Payer: Cigna Medicaid	$104,963.85
Rate for Payer: Molina CHIP/Medicaid	$104,963.85
Rate for Payer: Multiplan Auto	$72,891.57
Rate for Payer: Multiplan Commercial	$72,891.57
Rate for Payer: Multiplan Workers Comp	$72,891.57
Rate for Payer: Parkland Medicaid	$104,963.85
Rate for Payer: Scott and White EPO/PPO	$72,891.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$104,963.85
Rate for Payer: Superior Health Plan EPO	$19,826.51

SC-8336-50SC-5572-1

Facility

$145,783.13

Service Code	HCPCS C1820
Hospital Charge Code	994125
Hospital Revenue Code	278
Min. Negotiated Rate	$36,445.78
Max. Negotiated Rate	$72,891.57
Rate for Payer: Cash Price	$99,132.53
Rate for Payer: Cigna Commercial	$36,445.78
Rate for Payer: Multiplan Auto	$72,891.57
Rate for Payer: Multiplan Commercial	$72,891.57
Rate for Payer: Multiplan Workers Comp	$72,891.57
Rate for Payer: Scott and White EPO/PPO	$72,891.57

SC-8336-50SC-5572-1

Facility

$145,783.13

Service Code	HCPCS C1820
Hospital Charge Code	13522732
Hospital Revenue Code	278
Min. Negotiated Rate	$13,120.48
Max. Negotiated Rate	$104,963.85
Rate for Payer: Amerigroup CHIP/Medicaid	$13,120.48
Rate for Payer: BCBS of TX Blue Advantage	$43,734.94
Rate for Payer: BCBS of TX Blue Essentials	$52,481.93
Rate for Payer: BCBS of TX PPO	$58,313.25
Rate for Payer: Cash Price	$99,132.53
Rate for Payer: Cigna Medicaid	$104,963.85
Rate for Payer: Molina CHIP/Medicaid	$104,963.85
Rate for Payer: Multiplan Auto	$72,891.57
Rate for Payer: Multiplan Commercial	$72,891.57
Rate for Payer: Multiplan Workers Comp	$72,891.57
Rate for Payer: Parkland Medicaid	$104,963.85
Rate for Payer: Scott and White EPO/PPO	$72,891.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$104,963.85
Rate for Payer: Superior Health Plan EPO	$19,826.51

Scaled Drill Bit AO FIT DIA 2.6 X 220MM

Facility

$2,973.70

Hospital Charge Code	993380
Hospital Revenue Code	272
Min. Negotiated Rate	$267.63
Max. Negotiated Rate	$2,141.06
Rate for Payer: Amerigroup CHIP/Medicaid	$267.63
Rate for Payer: BCBS of TX Blue Advantage	$892.11
Rate for Payer: BCBS of TX Blue Essentials	$1,070.53
Rate for Payer: BCBS of TX PPO	$1,189.48
Rate for Payer: Cash Price	$2,022.12
Rate for Payer: Cigna Medicaid	$2,141.06
Rate for Payer: Molina CHIP/Medicaid	$2,141.06
Rate for Payer: Multiplan Auto	$1,932.90
Rate for Payer: Multiplan Commercial	$1,932.90
Rate for Payer: Multiplan Workers Comp	$1,932.90
Rate for Payer: Parkland Medicaid	$2,141.06
Rate for Payer: Scott and White EPO/PPO	$1,486.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,141.06
Rate for Payer: Superior Health Plan EPO	$404.42

Scaled Drill Bit AO FIT DIA 2.6 X 220MM

Facility

$2,973.70

Hospital Charge Code	993380
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,022.12

SCALPEL HARMONIC FOCUS HAR9F

Facility

$1,631.99

Hospital Charge Code	134451
Hospital Revenue Code	272
Min. Negotiated Rate	$146.88
Max. Negotiated Rate	$1,175.03
Rate for Payer: Amerigroup CHIP/Medicaid	$146.88
Rate for Payer: BCBS of TX Blue Advantage	$489.60
Rate for Payer: BCBS of TX Blue Essentials	$587.52
Rate for Payer: BCBS of TX PPO	$652.80
Rate for Payer: Cash Price	$1,109.75
Rate for Payer: Cigna Medicaid	$1,175.03
Rate for Payer: Molina CHIP/Medicaid	$1,175.03
Rate for Payer: Multiplan Auto	$1,060.79
Rate for Payer: Multiplan Commercial	$1,060.79
Rate for Payer: Multiplan Workers Comp	$1,060.79
Rate for Payer: Parkland Medicaid	$1,175.03
Rate for Payer: Scott and White EPO/PPO	$816.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,175.03
Rate for Payer: Superior Health Plan EPO	$221.95

SCALPEL HARMONIC FOCUS HAR9F

Facility

$1,631.99

Hospital Charge Code	134451
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,109.75

SCHIZOPHRENIA

Facility

$2,422.68

Service Code	APR-DRG 7502
Min. Negotiated Rate	$2,284.19
Max. Negotiated Rate	$2,422.68
Rate for Payer: Amerigroup CHIP/Medicaid	$2,284.19
Rate for Payer: Cigna Medicaid	$2,284.19
Rate for Payer: Molina CHIP/Medicaid	$2,284.19
Rate for Payer: Parkland Medicaid	$2,284.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,422.68

SCHIZOPHRENIA

Facility

$2,086.23

Service Code	APR-DRG 7501
Min. Negotiated Rate	$1,966.97
Max. Negotiated Rate	$2,086.23
Rate for Payer: Amerigroup CHIP/Medicaid	$1,966.97
Rate for Payer: Cigna Medicaid	$1,966.97
Rate for Payer: Molina CHIP/Medicaid	$1,966.97
Rate for Payer: Parkland Medicaid	$1,966.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,086.23

SCHIZOPHRENIA

Facility

$13,106.19

Service Code	APR-DRG 7504
Min. Negotiated Rate	$12,356.97
Max. Negotiated Rate	$13,106.19
Rate for Payer: Amerigroup CHIP/Medicaid	$12,356.97
Rate for Payer: Cigna Medicaid	$12,356.97
Rate for Payer: Molina CHIP/Medicaid	$12,356.97
Rate for Payer: Parkland Medicaid	$12,356.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13,106.19

SCHIZOPHRENIA

Facility

$3,710.03

Service Code	APR-DRG 7503
Min. Negotiated Rate	$3,497.95
Max. Negotiated Rate	$3,710.03
Rate for Payer: Amerigroup CHIP/Medicaid	$3,497.95
Rate for Payer: Cigna Medicaid	$3,497.95
Rate for Payer: Molina CHIP/Medicaid	$3,497.95
Rate for Payer: Parkland Medicaid	$3,497.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,710.03

SCISSOR DISP. LAP 45CM

Facility

$172.52

Hospital Charge Code	145301
Hospital Revenue Code	270
Rate for Payer: Cash Price	$117.31

SCISSOR DISP. LAP 45CM

Facility

$172.52

Hospital Charge Code	145301
Hospital Revenue Code	270
Min. Negotiated Rate	$15.53
Max. Negotiated Rate	$124.21
Rate for Payer: Amerigroup CHIP/Medicaid	$15.53
Rate for Payer: BCBS of TX Blue Advantage	$51.76
Rate for Payer: BCBS of TX Blue Essentials	$62.11
Rate for Payer: BCBS of TX PPO	$69.01
Rate for Payer: Cash Price	$117.31
Rate for Payer: Cigna Medicaid	$124.21
Rate for Payer: Molina CHIP/Medicaid	$124.21
Rate for Payer: Multiplan Auto	$112.14
Rate for Payer: Multiplan Commercial	$112.14
Rate for Payer: Multiplan Workers Comp	$112.14
Rate for Payer: Parkland Medicaid	$124.21
Rate for Payer: Scott and White EPO/PPO	$86.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$124.21
Rate for Payer: Superior Health Plan EPO	$23.46

SCISSOR FULL DISPOSIBLE 5MM/35CM

Facility

$136.14

Hospital Charge Code	993669
Hospital Revenue Code	272
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$98.02
Rate for Payer: Amerigroup CHIP/Medicaid	$12.25
Rate for Payer: BCBS of TX Blue Advantage	$40.84
Rate for Payer: BCBS of TX Blue Essentials	$49.01
Rate for Payer: BCBS of TX PPO	$54.46
Rate for Payer: Cash Price	$92.58
Rate for Payer: Cigna Medicaid	$98.02
Rate for Payer: Molina CHIP/Medicaid	$98.02
Rate for Payer: Multiplan Auto	$88.49
Rate for Payer: Multiplan Commercial	$88.49
Rate for Payer: Multiplan Workers Comp	$88.49
Rate for Payer: Parkland Medicaid	$98.02
Rate for Payer: Scott and White EPO/PPO	$68.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$98.02
Rate for Payer: Superior Health Plan EPO	$18.52

SCISSOR FULL DISPOSIBLE 5MM/35CM

Facility

$136.14

Hospital Charge Code	993669
Hospital Revenue Code	272
Rate for Payer: Cash Price	$92.58

SCISSOR MINI FULL DISPOSIBLE 5MM/35CM

Facility

$136.14

Hospital Charge Code	993668
Hospital Revenue Code	272
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$98.02
Rate for Payer: Amerigroup CHIP/Medicaid	$12.25
Rate for Payer: BCBS of TX Blue Advantage	$40.84
Rate for Payer: BCBS of TX Blue Essentials	$49.01
Rate for Payer: BCBS of TX PPO	$54.46
Rate for Payer: Cash Price	$92.58
Rate for Payer: Cigna Medicaid	$98.02
Rate for Payer: Molina CHIP/Medicaid	$98.02
Rate for Payer: Multiplan Auto	$88.49
Rate for Payer: Multiplan Commercial	$88.49
Rate for Payer: Multiplan Workers Comp	$88.49
Rate for Payer: Parkland Medicaid	$98.02
Rate for Payer: Scott and White EPO/PPO	$68.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$98.02
Rate for Payer: Superior Health Plan EPO	$18.52

Know your out-of-pocket cost for care.

All Charges