White Rock Medical Center

All Charges

Charge

Type

Setting

Price

RELOAD, ENDOSCOPIC LINEAR RELOADABLE GREEN 60MM -- DHF

Facility

$1,558.66

Hospital Charge Code	81945859
Hospital Revenue Code	272
Min. Negotiated Rate	$140.28
Max. Negotiated Rate	$1,013.13
Rate for Payer: Aetna Commercial	$857.26
Rate for Payer: Amerigroup CHIP/Medicaid	$140.28
Rate for Payer: BCBS of TX Blue Advantage	$467.60
Rate for Payer: BCBS of TX Blue Essentials	$561.12
Rate for Payer: BCBS of TX PPO	$623.46
Rate for Payer: Cash Price	$1,371.62
Rate for Payer: Multiplan Auto	$1,013.13
Rate for Payer: Multiplan Commercial	$1,013.13
Rate for Payer: Multiplan Workers Comp	$1,013.13
Rate for Payer: Scott and White EPO/PPO	$779.33
Rate for Payer: Superior Health Plan EPO	$211.98

RELOAD, ENDOSCOPIC LINEAR RELOADABLE WHITE 60MM -- DHF

Facility

$1,558.66

Hospital Charge Code	81945859
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,371.62

RELOAD, ENDOSCOPIC LINEAR RELOADABLE WHITE 60MM -- DHF

Facility

$1,558.66

Hospital Charge Code	81945859
Hospital Revenue Code	272
Min. Negotiated Rate	$140.28
Max. Negotiated Rate	$1,013.13
Rate for Payer: Aetna Commercial	$857.26
Rate for Payer: Amerigroup CHIP/Medicaid	$140.28
Rate for Payer: BCBS of TX Blue Advantage	$467.60
Rate for Payer: BCBS of TX Blue Essentials	$561.12
Rate for Payer: BCBS of TX PPO	$623.46
Rate for Payer: Cash Price	$1,371.62
Rate for Payer: Multiplan Auto	$1,013.13
Rate for Payer: Multiplan Commercial	$1,013.13
Rate for Payer: Multiplan Workers Comp	$1,013.13
Rate for Payer: Scott and White EPO/PPO	$779.33
Rate for Payer: Superior Health Plan EPO	$211.98

RELOAD LINEAR CUTTER 100MM TCR10

Facility

$374.36

Hospital Charge Code	8528467
Hospital Revenue Code	272
Min. Negotiated Rate	$33.69
Max. Negotiated Rate	$243.33
Rate for Payer: Aetna Commercial	$205.90
Rate for Payer: Amerigroup CHIP/Medicaid	$33.69
Rate for Payer: BCBS of TX Blue Advantage	$112.31
Rate for Payer: BCBS of TX Blue Essentials	$134.77
Rate for Payer: BCBS of TX PPO	$149.74
Rate for Payer: Cash Price	$329.44
Rate for Payer: Multiplan Auto	$243.33
Rate for Payer: Multiplan Commercial	$243.33
Rate for Payer: Multiplan Workers Comp	$243.33
Rate for Payer: Scott and White EPO/PPO	$187.18
Rate for Payer: Superior Health Plan EPO	$50.91

RELOAD LINEAR CUTTER 100MM TCR10

Facility

$374.36

Hospital Charge Code	8528467
Hospital Revenue Code	272
Rate for Payer: Cash Price	$329.44

RELOAD, LINEAR CUTTER BLUE 45MM 6 ROW DISP -- DHF

Facility

$517.02

Hospital Charge Code	81366627
Hospital Revenue Code	272
Min. Negotiated Rate	$46.53
Max. Negotiated Rate	$336.06
Rate for Payer: Aetna Commercial	$284.36
Rate for Payer: Amerigroup CHIP/Medicaid	$46.53
Rate for Payer: BCBS of TX Blue Advantage	$155.11
Rate for Payer: BCBS of TX Blue Essentials	$186.13
Rate for Payer: BCBS of TX PPO	$206.81
Rate for Payer: Cash Price	$454.98
Rate for Payer: Multiplan Auto	$336.06
Rate for Payer: Multiplan Commercial	$336.06
Rate for Payer: Multiplan Workers Comp	$336.06
Rate for Payer: Scott and White EPO/PPO	$258.51
Rate for Payer: Superior Health Plan EPO	$70.31

RELOAD, LINEAR CUTTER BLUE 45MM 6 ROW DISP -- DHF

Facility

$517.02

Hospital Charge Code	81366627
Hospital Revenue Code	272
Rate for Payer: Cash Price	$454.98

RELOAD, STAPLE REINFORCED W/TRI 60MM -- DHF

Facility

$3,152.59

Hospital Charge Code	81911406
Hospital Revenue Code	272
Min. Negotiated Rate	$283.73
Max. Negotiated Rate	$2,049.18
Rate for Payer: Aetna Commercial	$1,733.92
Rate for Payer: Amerigroup CHIP/Medicaid	$283.73
Rate for Payer: BCBS of TX Blue Advantage	$945.78
Rate for Payer: BCBS of TX Blue Essentials	$1,134.93
Rate for Payer: BCBS of TX PPO	$1,261.04
Rate for Payer: Cash Price	$2,774.28
Rate for Payer: Multiplan Auto	$2,049.18
Rate for Payer: Multiplan Commercial	$2,049.18
Rate for Payer: Multiplan Workers Comp	$2,049.18
Rate for Payer: Scott and White EPO/PPO	$1,576.30
Rate for Payer: Superior Health Plan EPO	$428.75

RELOAD, STAPLE REINFORCED W/TRI 60MM -- DHF

Facility

$3,152.59

Hospital Charge Code	81911406
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,774.28

reload stapler sureform 60 black

Facility

$1,044.20

Hospital Charge Code	8690515
Hospital Revenue Code	272
Min. Negotiated Rate	$93.98
Max. Negotiated Rate	$678.73
Rate for Payer: Aetna Commercial	$574.31
Rate for Payer: Amerigroup CHIP/Medicaid	$93.98
Rate for Payer: BCBS of TX Blue Advantage	$313.26
Rate for Payer: BCBS of TX Blue Essentials	$375.91
Rate for Payer: BCBS of TX PPO	$417.68
Rate for Payer: Cash Price	$918.90
Rate for Payer: Multiplan Auto	$678.73
Rate for Payer: Multiplan Commercial	$678.73
Rate for Payer: Multiplan Workers Comp	$678.73
Rate for Payer: Scott and White EPO/PPO	$522.10
Rate for Payer: Superior Health Plan EPO	$142.01

reload stapler sureform 60 black

Facility

$1,044.20

Hospital Charge Code	8690515
Hospital Revenue Code	272
Rate for Payer: Cash Price	$918.90

reload stapler sureform 60 blue

Facility

$1,044.20

Hospital Charge Code	8690518
Hospital Revenue Code	272
Min. Negotiated Rate	$93.98
Max. Negotiated Rate	$678.73
Rate for Payer: Aetna Commercial	$574.31
Rate for Payer: Amerigroup CHIP/Medicaid	$93.98
Rate for Payer: BCBS of TX Blue Advantage	$313.26
Rate for Payer: BCBS of TX Blue Essentials	$375.91
Rate for Payer: BCBS of TX PPO	$417.68
Rate for Payer: Cash Price	$918.90
Rate for Payer: Multiplan Auto	$678.73
Rate for Payer: Multiplan Commercial	$678.73
Rate for Payer: Multiplan Workers Comp	$678.73
Rate for Payer: Scott and White EPO/PPO	$522.10
Rate for Payer: Superior Health Plan EPO	$142.01

reload stapler sureform 60 blue

Facility

$1,044.20

Hospital Charge Code	8690518
Hospital Revenue Code	272
Rate for Payer: Cash Price	$918.90

reload stapler sureform 60 green

Facility

$1,044.20

Hospital Charge Code	8690519
Hospital Revenue Code	272
Min. Negotiated Rate	$93.98
Max. Negotiated Rate	$678.73
Rate for Payer: Aetna Commercial	$574.31
Rate for Payer: Amerigroup CHIP/Medicaid	$93.98
Rate for Payer: BCBS of TX Blue Advantage	$313.26
Rate for Payer: BCBS of TX Blue Essentials	$375.91
Rate for Payer: BCBS of TX PPO	$417.68
Rate for Payer: Cash Price	$918.90
Rate for Payer: Multiplan Auto	$678.73
Rate for Payer: Multiplan Commercial	$678.73
Rate for Payer: Multiplan Workers Comp	$678.73
Rate for Payer: Scott and White EPO/PPO	$522.10
Rate for Payer: Superior Health Plan EPO	$142.01

reload stapler sureform 60 green

Facility

$1,044.20

Hospital Charge Code	8690519
Hospital Revenue Code	272
Rate for Payer: Cash Price	$918.90

reload stapler sureform 60 white

Facility

$1,044.20

Hospital Charge Code	8690517
Hospital Revenue Code	272
Rate for Payer: Cash Price	$918.90

reload stapler sureform 60 white

Facility

$1,044.20

Hospital Charge Code	8690517
Hospital Revenue Code	272
Min. Negotiated Rate	$93.98
Max. Negotiated Rate	$678.73
Rate for Payer: Aetna Commercial	$574.31
Rate for Payer: Amerigroup CHIP/Medicaid	$93.98
Rate for Payer: BCBS of TX Blue Advantage	$313.26
Rate for Payer: BCBS of TX Blue Essentials	$375.91
Rate for Payer: BCBS of TX PPO	$417.68
Rate for Payer: Cash Price	$918.90
Rate for Payer: Multiplan Auto	$678.73
Rate for Payer: Multiplan Commercial	$678.73
Rate for Payer: Multiplan Workers Comp	$678.73
Rate for Payer: Scott and White EPO/PPO	$522.10
Rate for Payer: Superior Health Plan EPO	$142.01

reload tri staple 60black sig60axt

Facility

$1,358.23

Hospital Charge Code	8634513
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,195.24

reload tri staple 60black sig60axt

Facility

$1,358.23

Hospital Charge Code	8634513
Hospital Revenue Code	272
Min. Negotiated Rate	$122.24
Max. Negotiated Rate	$882.85
Rate for Payer: Aetna Commercial	$747.03
Rate for Payer: Amerigroup CHIP/Medicaid	$122.24
Rate for Payer: BCBS of TX Blue Advantage	$407.47
Rate for Payer: BCBS of TX Blue Essentials	$488.96
Rate for Payer: BCBS of TX PPO	$543.29
Rate for Payer: Cash Price	$1,195.24
Rate for Payer: Multiplan Auto	$882.85
Rate for Payer: Multiplan Commercial	$882.85
Rate for Payer: Multiplan Workers Comp	$882.85
Rate for Payer: Scott and White EPO/PPO	$679.12
Rate for Payer: Superior Health Plan EPO	$184.72

RELOAD TRI-STAPLE 60 BLACK SIGTRSB60AXT

Facility

$2,159.18

Hospital Charge Code	132066
Hospital Revenue Code	272
Min. Negotiated Rate	$194.33
Max. Negotiated Rate	$1,403.47
Rate for Payer: Aetna Commercial	$1,187.55
Rate for Payer: Amerigroup CHIP/Medicaid	$194.33
Rate for Payer: BCBS of TX Blue Advantage	$647.75
Rate for Payer: BCBS of TX Blue Essentials	$777.30
Rate for Payer: BCBS of TX PPO	$863.67
Rate for Payer: Cash Price	$1,900.08
Rate for Payer: Multiplan Auto	$1,403.47
Rate for Payer: Multiplan Commercial	$1,403.47
Rate for Payer: Multiplan Workers Comp	$1,403.47
Rate for Payer: Scott and White EPO/PPO	$1,079.59
Rate for Payer: Superior Health Plan EPO	$293.65

RELOAD TRI-STAPLE 60 BLACK SIGTRSB60AXT

Facility

$2,159.18

Hospital Charge Code	132066
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,900.08

RELOAD TRI STPL 45PURPLE EGIA45AMT

Facility

$2,526.83

Hospital Charge Code	8612534
Hospital Revenue Code	272
Min. Negotiated Rate	$227.41
Max. Negotiated Rate	$1,642.44
Rate for Payer: Aetna Commercial	$1,389.76
Rate for Payer: Amerigroup CHIP/Medicaid	$227.41
Rate for Payer: BCBS of TX Blue Advantage	$758.05
Rate for Payer: BCBS of TX Blue Essentials	$909.66
Rate for Payer: BCBS of TX PPO	$1,010.73
Rate for Payer: Cash Price	$2,223.61
Rate for Payer: Multiplan Auto	$1,642.44
Rate for Payer: Multiplan Commercial	$1,642.44
Rate for Payer: Multiplan Workers Comp	$1,642.44
Rate for Payer: Scott and White EPO/PPO	$1,263.42
Rate for Payer: Superior Health Plan EPO	$343.65

RELOAD TRI STPL 45PURPLE EGIA45AMT

Facility

$2,526.83

Hospital Charge Code	8612534
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,223.61

RELOAD TRI STPL 60PURPLE EGIA60AMT

Facility

$2,751.42

Hospital Charge Code	8612535
Hospital Revenue Code	272
Min. Negotiated Rate	$247.63
Max. Negotiated Rate	$1,788.42
Rate for Payer: Aetna Commercial	$1,513.28
Rate for Payer: Amerigroup CHIP/Medicaid	$247.63
Rate for Payer: BCBS of TX Blue Advantage	$825.43
Rate for Payer: BCBS of TX Blue Essentials	$990.51
Rate for Payer: BCBS of TX PPO	$1,100.57
Rate for Payer: Cash Price	$2,421.25
Rate for Payer: Multiplan Auto	$1,788.42
Rate for Payer: Multiplan Commercial	$1,788.42
Rate for Payer: Multiplan Workers Comp	$1,788.42
Rate for Payer: Scott and White EPO/PPO	$1,375.71
Rate for Payer: Superior Health Plan EPO	$374.19

RELOAD TRI STPL 60PURPLE EGIA60AMT

Facility

$2,751.42

Hospital Charge Code	8612535
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,421.25

Know your out-of-pocket cost for care.

All Charges