White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Endo Gla articulating stapler device, medium to thick staple, purple, 60mm

Facility

$1,079.68

Hospital Charge Code	992798
Hospital Revenue Code	272
Min. Negotiated Rate	$97.17
Max. Negotiated Rate	$777.37
Rate for Payer: Amerigroup CHIP/Medicaid	$97.17
Rate for Payer: BCBS of TX Blue Advantage	$323.90
Rate for Payer: BCBS of TX Blue Essentials	$388.68
Rate for Payer: BCBS of TX PPO	$431.87
Rate for Payer: Cash Price	$734.18
Rate for Payer: Cigna Medicaid	$777.37
Rate for Payer: Molina CHIP/Medicaid	$777.37
Rate for Payer: Multiplan Auto	$701.79
Rate for Payer: Multiplan Commercial	$701.79
Rate for Payer: Multiplan Workers Comp	$701.79
Rate for Payer: Parkland Medicaid	$777.37
Rate for Payer: Scott and White EPO/PPO	$539.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$777.37
Rate for Payer: Superior Health Plan EPO	$146.84

ENDOJAWAGTR LC W/NDL 2.8MM 230CM 20/BX

Facility

$889.98

Hospital Charge Code	993909
Hospital Revenue Code	272
Rate for Payer: Cash Price	$605.19

ENDOJAWAGTR LC W/NDL 2.8MM 230CM 20/BX

Facility

$889.98

Hospital Charge Code	993909
Hospital Revenue Code	272
Min. Negotiated Rate	$80.10
Max. Negotiated Rate	$640.79
Rate for Payer: Amerigroup CHIP/Medicaid	$80.10
Rate for Payer: BCBS of TX Blue Advantage	$266.99
Rate for Payer: BCBS of TX Blue Essentials	$320.39
Rate for Payer: BCBS of TX PPO	$355.99
Rate for Payer: Cash Price	$605.19
Rate for Payer: Cigna Medicaid	$640.79
Rate for Payer: Molina CHIP/Medicaid	$640.79
Rate for Payer: Multiplan Auto	$578.49
Rate for Payer: Multiplan Commercial	$578.49
Rate for Payer: Multiplan Workers Comp	$578.49
Rate for Payer: Parkland Medicaid	$640.79
Rate for Payer: Scott and White EPO/PPO	$444.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$640.79
Rate for Payer: Superior Health Plan EPO	$121.04

ENDOPATH ECHELON RELOAD 60MM

Facility

$548.19

Hospital Charge Code	992366
Hospital Revenue Code	272
Rate for Payer: Cash Price	$372.77

ENDOPATH ECHELON RELOAD 60MM

Facility

$548.19

Hospital Charge Code	992366
Hospital Revenue Code	272
Min. Negotiated Rate	$49.34
Max. Negotiated Rate	$394.70
Rate for Payer: Amerigroup CHIP/Medicaid	$49.34
Rate for Payer: BCBS of TX Blue Advantage	$164.46
Rate for Payer: BCBS of TX Blue Essentials	$197.35
Rate for Payer: BCBS of TX PPO	$219.28
Rate for Payer: Cash Price	$372.77
Rate for Payer: Cigna Medicaid	$394.70
Rate for Payer: Molina CHIP/Medicaid	$394.70
Rate for Payer: Multiplan Auto	$356.32
Rate for Payer: Multiplan Commercial	$356.32
Rate for Payer: Multiplan Workers Comp	$356.32
Rate for Payer: Parkland Medicaid	$394.70
Rate for Payer: Scott and White EPO/PPO	$274.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$394.70
Rate for Payer: Superior Health Plan EPO	$74.55

ENDOQUICK DETERGENT 3 BTLS/CASE

Facility

$509.43

Hospital Charge Code	993940
Hospital Revenue Code	271
Rate for Payer: Cash Price	$346.41

ENDOQUICK DETERGENT 3 BTLS/CASE

Facility

$509.43

Hospital Charge Code	993940
Hospital Revenue Code	271
Min. Negotiated Rate	$45.85
Max. Negotiated Rate	$366.79
Rate for Payer: Amerigroup CHIP/Medicaid	$45.85
Rate for Payer: BCBS of TX Blue Advantage	$152.83
Rate for Payer: BCBS of TX Blue Essentials	$183.39
Rate for Payer: BCBS of TX PPO	$203.77
Rate for Payer: Cash Price	$346.41
Rate for Payer: Cigna Medicaid	$366.79
Rate for Payer: Molina CHIP/Medicaid	$366.79
Rate for Payer: Multiplan Auto	$331.13
Rate for Payer: Multiplan Commercial	$331.13
Rate for Payer: Multiplan Workers Comp	$331.13
Rate for Payer: Parkland Medicaid	$366.79
Rate for Payer: Scott and White EPO/PPO	$254.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$366.79
Rate for Payer: Superior Health Plan EPO	$69.28

Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, f

Facility

$15,408.22

Service Code	CPT 62380
Hospital Charge Code	36062380
Hospital Revenue Code	360
Min. Negotiated Rate	$2,398.52
Max. Negotiated Rate	$15,408.22
Rate for Payer: Amerigroup CHIP/Medicaid	$2,398.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Amerigroup Medicare	$7,289.28
Rate for Payer: BCBS of TX Blue Advantage	$9,989.86
Rate for Payer: BCBS of TX Blue Essentials	$11,963.90
Rate for Payer: BCBS of TX Medicare	$7,289.28
Rate for Payer: BCBS of TX PPO	$15,074.51
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicare	$7,289.28
Rate for Payer: Employer Direct Commercial	$7,289.28
Rate for Payer: Humana Medicare/TRICARE	$7,289.28
Rate for Payer: Molina Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Molina Medicare	$7,289.28
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	$13,485.17
Rate for Payer: Scott and White Medicare	$7,289.28
Rate for Payer: Superior Health Plan EPO	$7,289.28
Rate for Payer: Superior Health Plan Medicare	$7,289.28
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Universal American Medicare	$7,289.28
Rate for Payer: Wellcare Medicare	$7,289.28
Rate for Payer: Wellmed Medicare	$7,289.28

Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, f

Facility

$83,065.62

Service Code	HCPCS 62380
Hospital Charge Code	9900759
Hospital Revenue Code	360
Rate for Payer: Cash Price	$56,484.62

Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, f

Facility

$83,065.62

Service Code	HCPCS 62380
Hospital Charge Code	9900759
Hospital Revenue Code	360
Min. Negotiated Rate	$2,398.52
Max. Negotiated Rate	$59,807.25
Rate for Payer: Amerigroup CHIP/Medicaid	$2,398.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Amerigroup Medicare	$7,289.28
Rate for Payer: BCBS of TX Blue Advantage	$9,989.86
Rate for Payer: BCBS of TX Blue Essentials	$11,963.90
Rate for Payer: BCBS of TX Medicare	$7,289.28
Rate for Payer: BCBS of TX PPO	$15,074.51
Rate for Payer: Cash Price	$56,484.62
Rate for Payer: Cash Price	$56,484.62
Rate for Payer: Cash Price	$56,484.62
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicaid	$59,807.25
Rate for Payer: Cigna Medicare	$7,289.28
Rate for Payer: Employer Direct Commercial	$7,289.28
Rate for Payer: Humana Medicare/TRICARE	$7,289.28
Rate for Payer: Molina CHIP/Medicaid	$59,807.25
Rate for Payer: Molina Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Molina Medicare	$7,289.28
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	$59,807.25
Rate for Payer: Scott and White EPO/PPO	$13,485.17
Rate for Payer: Scott and White Medicare	$7,289.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$59,807.25
Rate for Payer: Superior Health Plan EPO	$7,289.28
Rate for Payer: Superior Health Plan Medicare	$7,289.28
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Universal American Medicare	$7,289.28
Rate for Payer: Wellcare Medicare	$7,289.28
Rate for Payer: Wellmed Medicare	$7,289.28

Endoscopic plantar fasciotomy

Facility

$8,640.00

Service Code	HCPCS 29893
Hospital Charge Code	9900582
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,875.20

Endoscopic plantar fasciotomy

Facility

$8,640.00

Service Code	HCPCS 29893
Hospital Charge Code	9900582
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: Cash Price	$5,875.20
Rate for Payer: Cash Price	$5,875.20
Rate for Payer: Cash Price	$5,875.20
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicaid	$6,220.80
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	$6,220.80
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	$6,220.80
Rate for Payer: Scott and White EPO/PPO	$6,080.78
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,220.80
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

Endoscopic plantar fasciotomy

Facility

$10,000.00

Service Code	CPT 29893
Hospital Charge Code	36029893
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	$6,080.78
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

Endoscopy, wrist, surgical, with release of transverse carpal ligament

Facility

$11,138.80

Service Code	HCPCS 29848
Hospital Charge Code	9900560
Hospital Revenue Code	360
Min. Negotiated Rate	$593.04
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$593.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Amerigroup Medicare	$1,615.32
Rate for Payer: BCBS of TX Blue Advantage	$2,263.50
Rate for Payer: BCBS of TX Blue Essentials	$2,710.78
Rate for Payer: BCBS of TX Medicare	$1,615.32
Rate for Payer: BCBS of TX PPO	$3,415.58
Rate for Payer: Cash Price	$7,574.38
Rate for Payer: Cash Price	$7,574.38
Rate for Payer: Cash Price	$7,574.38
Rate for Payer: Cigna Commercial	$3,414.49
Rate for Payer: Cigna Medicaid	$8,019.94
Rate for Payer: Cigna Medicare	$1,615.32
Rate for Payer: Employer Direct Commercial	$1,615.32
Rate for Payer: Humana Medicare/TRICARE	$1,615.32
Rate for Payer: Molina CHIP/Medicaid	$8,019.94
Rate for Payer: Molina Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Molina Medicare	$1,615.32
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	$8,019.94
Rate for Payer: Scott and White EPO/PPO	$2,988.34
Rate for Payer: Scott and White Medicare	$1,615.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,019.94
Rate for Payer: Superior Health Plan EPO	$1,615.32
Rate for Payer: Superior Health Plan Medicare	$1,615.32
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Universal American Medicare	$1,615.32
Rate for Payer: Wellcare Medicare	$1,615.32
Rate for Payer: Wellmed Medicare	$1,615.32

Endoscopy, wrist, surgical, with release of transverse carpal ligament

Facility

$11,138.80

Service Code	HCPCS 29848
Hospital Charge Code	9900560
Hospital Revenue Code	360
Rate for Payer: Cash Price	$7,574.38

Endoscopy, wrist, surgical, with release of transverse carpal ligament

Facility

$10,000.00

Service Code	CPT 29848
Hospital Charge Code	36029848
Hospital Revenue Code	360
Min. Negotiated Rate	$593.04
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$593.04
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Amerigroup Medicare	$1,615.32
Rate for Payer: BCBS of TX Blue Advantage	$2,263.50
Rate for Payer: BCBS of TX Blue Essentials	$2,710.78
Rate for Payer: BCBS of TX Medicare	$1,615.32
Rate for Payer: BCBS of TX PPO	$3,415.58
Rate for Payer: Cigna Commercial	$3,414.49
Rate for Payer: Cigna Medicare	$1,615.32
Rate for Payer: Employer Direct Commercial	$1,615.32
Rate for Payer: Humana Medicare/TRICARE	$1,615.32
Rate for Payer: Molina Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Molina Medicare	$1,615.32
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	$2,988.34
Rate for Payer: Scott and White Medicare	$1,615.32
Rate for Payer: Superior Health Plan EPO	$1,615.32
Rate for Payer: Superior Health Plan Medicare	$1,615.32
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,615.32
Rate for Payer: Universal American Medicare	$1,615.32
Rate for Payer: Wellcare Medicare	$1,615.32
Rate for Payer: Wellmed Medicare	$1,615.32

ENDOSTITCH

Facility

$1,084.52

Hospital Charge Code	992679
Hospital Revenue Code	272
Rate for Payer: Cash Price	$737.47

ENDOSTITCH

Facility

$1,084.52

Hospital Charge Code	992679
Hospital Revenue Code	272
Min. Negotiated Rate	$97.61
Max. Negotiated Rate	$780.85
Rate for Payer: Amerigroup CHIP/Medicaid	$97.61
Rate for Payer: BCBS of TX Blue Advantage	$325.36
Rate for Payer: BCBS of TX Blue Essentials	$390.43
Rate for Payer: BCBS of TX PPO	$433.81
Rate for Payer: Cash Price	$737.47
Rate for Payer: Cigna Medicaid	$780.85
Rate for Payer: Molina CHIP/Medicaid	$780.85
Rate for Payer: Multiplan Auto	$704.94
Rate for Payer: Multiplan Commercial	$704.94
Rate for Payer: Multiplan Workers Comp	$704.94
Rate for Payer: Parkland Medicaid	$780.85
Rate for Payer: Scott and White EPO/PPO	$542.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$780.85
Rate for Payer: Superior Health Plan EPO	$147.49

ENDOSTITCH POLYSORB 3-0 170071

Facility

$98.43

Hospital Charge Code	116428
Hospital Revenue Code	272
Rate for Payer: Cash Price	$66.93

ENDOSTITCH POLYSORB 3-0 170071

Facility

$98.43

Hospital Charge Code	116428
Hospital Revenue Code	272
Min. Negotiated Rate	$8.86
Max. Negotiated Rate	$70.87
Rate for Payer: Amerigroup CHIP/Medicaid	$8.86
Rate for Payer: BCBS of TX Blue Advantage	$29.53
Rate for Payer: BCBS of TX Blue Essentials	$35.43
Rate for Payer: BCBS of TX PPO	$39.37
Rate for Payer: Cash Price	$66.93
Rate for Payer: Cigna Medicaid	$70.87
Rate for Payer: Molina CHIP/Medicaid	$70.87
Rate for Payer: Multiplan Auto	$63.98
Rate for Payer: Multiplan Commercial	$63.98
Rate for Payer: Multiplan Workers Comp	$63.98
Rate for Payer: Parkland Medicaid	$70.87
Rate for Payer: Scott and White EPO/PPO	$49.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$70.87
Rate for Payer: Superior Health Plan EPO	$13.39

ENDOSTITCH POLYSORB O 170052

Facility

$96.43

Hospital Charge Code	116426
Hospital Revenue Code	272
Rate for Payer: Cash Price	$65.57

ENDOSTITCH POLYSORB O 170052

Facility

$96.43

Hospital Charge Code	116426
Hospital Revenue Code	272
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$69.43
Rate for Payer: Amerigroup CHIP/Medicaid	$8.68
Rate for Payer: BCBS of TX Blue Advantage	$28.93
Rate for Payer: BCBS of TX Blue Essentials	$34.71
Rate for Payer: BCBS of TX PPO	$38.57
Rate for Payer: Cash Price	$65.57
Rate for Payer: Cigna Medicaid	$69.43
Rate for Payer: Molina CHIP/Medicaid	$69.43
Rate for Payer: Multiplan Auto	$62.68
Rate for Payer: Multiplan Commercial	$62.68
Rate for Payer: Multiplan Workers Comp	$62.68
Rate for Payer: Parkland Medicaid	$69.43
Rate for Payer: Scott and White EPO/PPO	$48.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$69.43
Rate for Payer: Superior Health Plan EPO	$13.11

ENDOSTITCH SOFSILK 2-0 170004

Facility

$271.54

Hospital Charge Code	116425
Hospital Revenue Code	272
Rate for Payer: Cash Price	$184.65

ENDOSTITCH SOFSILK 2-0 170004

Facility

$271.54

Hospital Charge Code	116425
Hospital Revenue Code	272
Min. Negotiated Rate	$24.44
Max. Negotiated Rate	$195.51
Rate for Payer: Amerigroup CHIP/Medicaid	$24.44
Rate for Payer: BCBS of TX Blue Advantage	$81.46
Rate for Payer: BCBS of TX Blue Essentials	$97.75
Rate for Payer: BCBS of TX PPO	$108.62
Rate for Payer: Cash Price	$184.65
Rate for Payer: Cigna Medicaid	$195.51
Rate for Payer: Molina CHIP/Medicaid	$195.51
Rate for Payer: Multiplan Auto	$176.50
Rate for Payer: Multiplan Commercial	$176.50
Rate for Payer: Multiplan Workers Comp	$176.50
Rate for Payer: Parkland Medicaid	$195.51
Rate for Payer: Scott and White EPO/PPO	$135.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$195.51
Rate for Payer: Superior Health Plan EPO	$36.93

ENDOSTITCH SUTURE DEVICE

Facility

$1,955.55

Hospital Charge Code	8538527
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,329.77

Know your out-of-pocket cost for care.

All Charges