White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SHEALTH SYSTEM FORTRESS 6FR 90CM

Facility

$385.90

Hospital Charge Code	145375
Hospital Revenue Code	272
Min. Negotiated Rate	$34.73
Max. Negotiated Rate	$250.84
Rate for Payer: Aetna Commercial	$212.24
Rate for Payer: Amerigroup CHIP/Medicaid	$34.73
Rate for Payer: BCBS of TX Blue Advantage	$115.77
Rate for Payer: BCBS of TX Blue Essentials	$138.92
Rate for Payer: BCBS of TX PPO	$154.36
Rate for Payer: Cash Price	$339.59
Rate for Payer: Multiplan Auto	$250.84
Rate for Payer: Multiplan Commercial	$250.84
Rate for Payer: Multiplan Workers Comp	$250.84
Rate for Payer: Scott and White EPO/PPO	$192.95
Rate for Payer: Superior Health Plan EPO	$52.48

SHEARS, HARMONIC CRVD W/ERGNMC HANDLE 5.5MM X 23CM -- DHF

Facility

$2,457.37

Hospital Charge Code	80811300
Hospital Revenue Code	272
Min. Negotiated Rate	$221.16
Max. Negotiated Rate	$1,597.29
Rate for Payer: Aetna Commercial	$1,351.55
Rate for Payer: Amerigroup CHIP/Medicaid	$221.16
Rate for Payer: BCBS of TX Blue Advantage	$737.21
Rate for Payer: BCBS of TX Blue Essentials	$884.65
Rate for Payer: BCBS of TX PPO	$982.95
Rate for Payer: Cash Price	$2,162.49
Rate for Payer: Multiplan Auto	$1,597.29
Rate for Payer: Multiplan Commercial	$1,597.29
Rate for Payer: Multiplan Workers Comp	$1,597.29
Rate for Payer: Scott and White EPO/PPO	$1,228.68
Rate for Payer: Superior Health Plan EPO	$334.20

SHEARS, HARMONIC CRVD W/ERGNMC HANDLE 5MM X 36CM -- DHF

Facility

$2,457.37

Hospital Charge Code	80811300
Hospital Revenue Code	272
Min. Negotiated Rate	$221.16
Max. Negotiated Rate	$1,597.29
Rate for Payer: Aetna Commercial	$1,351.55
Rate for Payer: Amerigroup CHIP/Medicaid	$221.16
Rate for Payer: BCBS of TX Blue Advantage	$737.21
Rate for Payer: BCBS of TX Blue Essentials	$884.65
Rate for Payer: BCBS of TX PPO	$982.95
Rate for Payer: Cash Price	$2,162.49
Rate for Payer: Multiplan Auto	$1,597.29
Rate for Payer: Multiplan Commercial	$1,597.29
Rate for Payer: Multiplan Workers Comp	$1,597.29
Rate for Payer: Scott and White EPO/PPO	$1,228.68
Rate for Payer: Superior Health Plan EPO	$334.20

SHEARS, LAPAROSONIC ADAPTIVE TISSUE 5MM X 36CM -- DHF

Facility

$2,457.37

Hospital Charge Code	80811300
Hospital Revenue Code	272
Min. Negotiated Rate	$221.16
Max. Negotiated Rate	$1,597.29
Rate for Payer: Aetna Commercial	$1,351.55
Rate for Payer: Amerigroup CHIP/Medicaid	$221.16
Rate for Payer: BCBS of TX Blue Advantage	$737.21
Rate for Payer: BCBS of TX Blue Essentials	$884.65
Rate for Payer: BCBS of TX PPO	$982.95
Rate for Payer: Cash Price	$2,162.49
Rate for Payer: Multiplan Auto	$1,597.29
Rate for Payer: Multiplan Commercial	$1,597.29
Rate for Payer: Multiplan Workers Comp	$1,597.29
Rate for Payer: Scott and White EPO/PPO	$1,228.68
Rate for Payer: Superior Health Plan EPO	$334.20

SHEARS, LAPAROSONIC ADAPTIVE TISSUE 5MM X 36CM -- DHF

Facility

$2,457.37

Hospital Charge Code	80811300
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,162.49

SHEATH DRYSEAL FLEX 12X33

Facility

$2,342.64

Hospital Charge Code	8528497
Hospital Revenue Code	272
Min. Negotiated Rate	$210.84
Max. Negotiated Rate	$1,522.72
Rate for Payer: Aetna Commercial	$1,288.45
Rate for Payer: Amerigroup CHIP/Medicaid	$210.84
Rate for Payer: BCBS of TX Blue Advantage	$702.79
Rate for Payer: BCBS of TX Blue Essentials	$843.35
Rate for Payer: BCBS of TX PPO	$937.06
Rate for Payer: Cash Price	$2,061.52
Rate for Payer: Multiplan Auto	$1,522.72
Rate for Payer: Multiplan Commercial	$1,522.72
Rate for Payer: Multiplan Workers Comp	$1,522.72
Rate for Payer: Scott and White EPO/PPO	$1,171.32
Rate for Payer: Superior Health Plan EPO	$318.60

SHEATH DRYSEAL FLEX 12X33

Facility

$2,342.64

Hospital Charge Code	8528497
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,061.52

SHEATH DRYSEAL FLEX 16X33

Facility

$2,342.64

Hospital Charge Code	107545
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,061.52

SHEATH DRYSEAL FLEX 16X33

Facility

$2,342.64

Hospital Charge Code	107545
Hospital Revenue Code	272
Min. Negotiated Rate	$210.84
Max. Negotiated Rate	$1,522.72
Rate for Payer: Aetna Commercial	$1,288.45
Rate for Payer: Amerigroup CHIP/Medicaid	$210.84
Rate for Payer: BCBS of TX Blue Advantage	$702.79
Rate for Payer: BCBS of TX Blue Essentials	$843.35
Rate for Payer: BCBS of TX PPO	$937.06
Rate for Payer: Cash Price	$2,061.52
Rate for Payer: Multiplan Auto	$1,522.72
Rate for Payer: Multiplan Commercial	$1,522.72
Rate for Payer: Multiplan Workers Comp	$1,522.72
Rate for Payer: Scott and White EPO/PPO	$1,171.32
Rate for Payer: Superior Health Plan EPO	$318.60

SHEATH DRYSEAL FLEX 18X33

Facility

$3,010.02

Hospital Charge Code	8528499
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,648.82

SHEATH DRYSEAL FLEX 18X33

Facility

$3,010.02

Hospital Charge Code	8528499
Hospital Revenue Code	272
Min. Negotiated Rate	$270.90
Max. Negotiated Rate	$1,956.51
Rate for Payer: Aetna Commercial	$1,655.51
Rate for Payer: Amerigroup CHIP/Medicaid	$270.90
Rate for Payer: BCBS of TX Blue Advantage	$903.01
Rate for Payer: BCBS of TX Blue Essentials	$1,083.61
Rate for Payer: BCBS of TX PPO	$1,204.01
Rate for Payer: Cash Price	$2,648.82
Rate for Payer: Multiplan Auto	$1,956.51
Rate for Payer: Multiplan Commercial	$1,956.51
Rate for Payer: Multiplan Workers Comp	$1,956.51
Rate for Payer: Scott and White EPO/PPO	$1,505.01
Rate for Payer: Superior Health Plan EPO	$409.36

SHEET AIR LACTERAL COMFT GLIDE

Facility

$271.26

Hospital Charge Code	8514467
Hospital Revenue Code	272
Min. Negotiated Rate	$24.41
Max. Negotiated Rate	$176.32
Rate for Payer: Aetna Commercial	$149.19
Rate for Payer: Amerigroup CHIP/Medicaid	$24.41
Rate for Payer: BCBS of TX Blue Advantage	$81.38
Rate for Payer: BCBS of TX Blue Essentials	$97.65
Rate for Payer: BCBS of TX PPO	$108.50
Rate for Payer: Cash Price	$238.71
Rate for Payer: Multiplan Auto	$176.32
Rate for Payer: Multiplan Commercial	$176.32
Rate for Payer: Multiplan Workers Comp	$176.32
Rate for Payer: Scott and White EPO/PPO	$135.63
Rate for Payer: Superior Health Plan EPO	$36.89

SHEET AIR LACTERAL COMFT GLIDE

Facility

$271.26

Hospital Charge Code	8514467
Hospital Revenue Code	272
Rate for Payer: Cash Price	$238.71

SHEET GLIDE TURN & POSIT -- DHF

Facility

$250.99

Hospital Charge Code	80386808
Hospital Revenue Code	272
Rate for Payer: Cash Price	$220.87

SHEET GLIDE TURN & POSIT -- DHF

Facility

$250.99

Hospital Charge Code	80386808
Hospital Revenue Code	272
Min. Negotiated Rate	$22.59
Max. Negotiated Rate	$163.14
Rate for Payer: Aetna Commercial	$138.04
Rate for Payer: Amerigroup CHIP/Medicaid	$22.59
Rate for Payer: BCBS of TX Blue Advantage	$75.30
Rate for Payer: BCBS of TX Blue Essentials	$90.36
Rate for Payer: BCBS of TX PPO	$100.40
Rate for Payer: Cash Price	$220.87
Rate for Payer: Multiplan Auto	$163.14
Rate for Payer: Multiplan Commercial	$163.14
Rate for Payer: Multiplan Workers Comp	$163.14
Rate for Payer: Scott and White EPO/PPO	$125.50
Rate for Payer: Superior Health Plan EPO	$34.13

SHEET, LAPAROTOMY TRANSVERSE -- DHF

Facility

$445.91

Hospital Charge Code	81623050
Hospital Revenue Code	272
Rate for Payer: Cash Price	$392.40

SHEET, LAPAROTOMY TRANSVERSE -- DHF

Facility

$445.91

Hospital Charge Code	81623050
Hospital Revenue Code	272
Min. Negotiated Rate	$40.13
Max. Negotiated Rate	$289.84
Rate for Payer: Aetna Commercial	$245.25
Rate for Payer: Amerigroup CHIP/Medicaid	$40.13
Rate for Payer: BCBS of TX Blue Advantage	$133.77
Rate for Payer: BCBS of TX Blue Essentials	$160.53
Rate for Payer: BCBS of TX PPO	$178.36
Rate for Payer: Cash Price	$392.40
Rate for Payer: Multiplan Auto	$289.84
Rate for Payer: Multiplan Commercial	$289.84
Rate for Payer: Multiplan Workers Comp	$289.84
Rate for Payer: Scott and White EPO/PPO	$222.96
Rate for Payer: Superior Health Plan EPO	$60.64

SHEET, THYROID W/ARMBOARD COVERS -- DHF

Facility

$372.24

Hospital Charge Code	81624652
Hospital Revenue Code	272
Min. Negotiated Rate	$33.50
Max. Negotiated Rate	$241.96
Rate for Payer: Aetna Commercial	$204.73
Rate for Payer: Amerigroup CHIP/Medicaid	$33.50
Rate for Payer: BCBS of TX Blue Advantage	$111.67
Rate for Payer: BCBS of TX Blue Essentials	$134.01
Rate for Payer: BCBS of TX PPO	$148.90
Rate for Payer: Cash Price	$327.57
Rate for Payer: Multiplan Auto	$241.96
Rate for Payer: Multiplan Commercial	$241.96
Rate for Payer: Multiplan Workers Comp	$241.96
Rate for Payer: Scott and White EPO/PPO	$186.12
Rate for Payer: Superior Health Plan EPO	$50.62

SHEET, THYROID W/ARMBOARD COVERS -- DHF

Facility

$372.24

Hospital Charge Code	81624652
Hospital Revenue Code	272
Rate for Payer: Cash Price	$327.57

SHELL, DISPOSABLE ENDOSCOPIC SIGNIA STAPLER -- DHF

Facility

$2,407.34

Hospital Charge Code	80899024
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,118.46

SHELL, DISPOSABLE ENDOSCOPIC SIGNIA STAPLER -- DHF

Facility

$2,407.34

Hospital Charge Code	80899024
Hospital Revenue Code	272
Min. Negotiated Rate	$216.66
Max. Negotiated Rate	$1,564.77
Rate for Payer: Aetna Commercial	$1,324.04
Rate for Payer: Amerigroup CHIP/Medicaid	$216.66
Rate for Payer: BCBS of TX Blue Advantage	$722.20
Rate for Payer: BCBS of TX Blue Essentials	$866.64
Rate for Payer: BCBS of TX PPO	$962.94
Rate for Payer: Cash Price	$2,118.46
Rate for Payer: Multiplan Auto	$1,564.77
Rate for Payer: Multiplan Commercial	$1,564.77
Rate for Payer: Multiplan Workers Comp	$1,564.77
Rate for Payer: Scott and White EPO/PPO	$1,203.67
Rate for Payer: Superior Health Plan EPO	$327.40

SHFT REAMER MODULAR -- DHF

Facility

$1,574.76

Hospital Charge Code	80826829
Hospital Revenue Code	272
Min. Negotiated Rate	$141.73
Max. Negotiated Rate	$1,023.59
Rate for Payer: Aetna Commercial	$866.12
Rate for Payer: Amerigroup CHIP/Medicaid	$141.73
Rate for Payer: BCBS of TX Blue Advantage	$472.43
Rate for Payer: BCBS of TX Blue Essentials	$566.91
Rate for Payer: BCBS of TX PPO	$629.90
Rate for Payer: Cash Price	$1,385.79
Rate for Payer: Multiplan Auto	$1,023.59
Rate for Payer: Multiplan Commercial	$1,023.59
Rate for Payer: Multiplan Workers Comp	$1,023.59
Rate for Payer: Scott and White EPO/PPO	$787.38
Rate for Payer: Superior Health Plan EPO	$214.17

SHFT REAMER MODULAR -- DHF

Facility

$1,574.76

Hospital Charge Code	80826829
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,385.79

Shiga Toxin I

Facility

$117.00

Service Code	CPT 87899
Hospital Charge Code	4107908
Hospital Revenue Code	306
Min. Negotiated Rate	$6.27
Max. Negotiated Rate	$76.05
Rate for Payer: Aetna Commercial	$16.87
Rate for Payer: Aetna Medicare	$24.10
Rate for Payer: Amerigroup CHIP/Medicaid	$6.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16.07
Rate for Payer: Amerigroup Medicare	$16.07
Rate for Payer: BCBS of TX Blue Advantage	$26.52
Rate for Payer: BCBS of TX Blue Essentials	$31.82
Rate for Payer: BCBS of TX Medicare	$16.07
Rate for Payer: BCBS of TX PPO	$35.51
Rate for Payer: Cash Price	$102.96
Rate for Payer: Cash Price	$102.96
Rate for Payer: Cigna Medicaid	$16.07
Rate for Payer: Cigna Medicare	$16.07
Rate for Payer: Employer Direct Commercial	$16.07
Rate for Payer: Humana Medicare/TRICARE	$16.07
Rate for Payer: Molina CHIP/Medicaid	$16.07
Rate for Payer: Molina Dual Medicare/Medicaid	$16.07
Rate for Payer: Molina Medicare	$16.07
Rate for Payer: Multiplan Auto	$76.05
Rate for Payer: Multiplan Commercial	$76.05
Rate for Payer: Multiplan Workers Comp	$76.05
Rate for Payer: Parkland Medicaid	$16.07
Rate for Payer: Scott and White EPO/PPO	$20.09
Rate for Payer: Scott and White Medicare	$16.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16.07
Rate for Payer: Superior Health Plan EPO	$16.07
Rate for Payer: Superior Health Plan Medicare	$16.07
Rate for Payer: Universal American Dual Medicare/Medicaid	$16.07
Rate for Payer: Universal American Medicare	$16.07
Rate for Payer: Wellcare Medicare	$16.07
Rate for Payer: Wellmed Medicare	$16.07

Shiga Toxin I

Facility

$117.00

Service Code	CPT 87899
Hospital Charge Code	4107908
Hospital Revenue Code	306
Rate for Payer: Cash Price	$102.96

Know your out-of-pocket cost for care.

All Charges