White Rock Medical Center

All Charges

Charge

Type

Setting

Price

STAPLER, INTERNAL CURVE ORVIL EEA-21MM XL TIT 35CM -- DHF

Facility

$1,383.59

Hospital Charge Code	81911158
Hospital Revenue Code	272
Min. Negotiated Rate	$124.52
Max. Negotiated Rate	$899.33
Rate for Payer: Aetna Commercial	$760.97
Rate for Payer: Amerigroup CHIP/Medicaid	$124.52
Rate for Payer: BCBS of TX Blue Advantage	$415.08
Rate for Payer: BCBS of TX Blue Essentials	$498.09
Rate for Payer: BCBS of TX PPO	$553.44
Rate for Payer: Cash Price	$1,217.56
Rate for Payer: Multiplan Auto	$899.33
Rate for Payer: Multiplan Commercial	$899.33
Rate for Payer: Multiplan Workers Comp	$899.33
Rate for Payer: Scott and White EPO/PPO	$691.80
Rate for Payer: Superior Health Plan EPO	$188.17

STAPLER, INTERNAL ENDOSCOPIC CRVD INTRALUMINL 21MM -- DHF

Facility

$957.89

Hospital Charge Code	81911554
Hospital Revenue Code	272
Min. Negotiated Rate	$86.21
Max. Negotiated Rate	$622.63
Rate for Payer: Aetna Commercial	$526.84
Rate for Payer: Amerigroup CHIP/Medicaid	$86.21
Rate for Payer: BCBS of TX Blue Advantage	$287.37
Rate for Payer: BCBS of TX Blue Essentials	$344.84
Rate for Payer: BCBS of TX PPO	$383.16
Rate for Payer: Cash Price	$842.94
Rate for Payer: Multiplan Auto	$622.63
Rate for Payer: Multiplan Commercial	$622.63
Rate for Payer: Multiplan Workers Comp	$622.63
Rate for Payer: Scott and White EPO/PPO	$478.94
Rate for Payer: Superior Health Plan EPO	$130.27

STAPLER, INTERNAL ENDOSCOPIC CRVD INTRALUMINL 21MM -- DHF

Facility

$957.89

Hospital Charge Code	81911554
Hospital Revenue Code	272
Rate for Payer: Cash Price	$842.94

STAPLER INTERNAL ENDOSCOPIC CRVD INTRALUMINL 25MM

Facility

$978.82

Hospital Charge Code	8538528
Hospital Revenue Code	272
Min. Negotiated Rate	$88.09
Max. Negotiated Rate	$636.23
Rate for Payer: Aetna Commercial	$538.35
Rate for Payer: Amerigroup CHIP/Medicaid	$88.09
Rate for Payer: BCBS of TX Blue Advantage	$293.65
Rate for Payer: BCBS of TX Blue Essentials	$352.38
Rate for Payer: BCBS of TX PPO	$391.53
Rate for Payer: Cash Price	$861.36
Rate for Payer: Multiplan Auto	$636.23
Rate for Payer: Multiplan Commercial	$636.23
Rate for Payer: Multiplan Workers Comp	$636.23
Rate for Payer: Scott and White EPO/PPO	$489.41
Rate for Payer: Superior Health Plan EPO	$133.12

STAPLER INTERNAL ENDOSCOPIC CRVD INTRALUMINL 25MM

Facility

$978.82

Hospital Charge Code	8538528
Hospital Revenue Code	272
Rate for Payer: Cash Price	$861.36

STAPLER INTERNAL ENDOSCOPIC CRVD INTRALUMINL 29MM

Facility

$978.82

Hospital Charge Code	8538534
Hospital Revenue Code	272
Min. Negotiated Rate	$88.09
Max. Negotiated Rate	$636.23
Rate for Payer: Aetna Commercial	$538.35
Rate for Payer: Amerigroup CHIP/Medicaid	$88.09
Rate for Payer: BCBS of TX Blue Advantage	$293.65
Rate for Payer: BCBS of TX Blue Essentials	$352.38
Rate for Payer: BCBS of TX PPO	$391.53
Rate for Payer: Cash Price	$861.36
Rate for Payer: Multiplan Auto	$636.23
Rate for Payer: Multiplan Commercial	$636.23
Rate for Payer: Multiplan Workers Comp	$636.23
Rate for Payer: Scott and White EPO/PPO	$489.41
Rate for Payer: Superior Health Plan EPO	$133.12

STAPLER INTERNAL ENDOSCOPIC CRVD INTRALUMINL 29MM

Facility

$978.82

Hospital Charge Code	8538534
Hospital Revenue Code	272
Rate for Payer: Cash Price	$861.36

STAPLER INTERNAL ENDOSCOPIC CRVD INTRALUMINL 33MM

Facility

$972.82

Hospital Charge Code	8538533
Hospital Revenue Code	272
Rate for Payer: Cash Price	$856.08

STAPLER INTERNAL ENDOSCOPIC CRVD INTRALUMINL 33MM

Facility

$972.82

Hospital Charge Code	8538533
Hospital Revenue Code	272
Min. Negotiated Rate	$87.55
Max. Negotiated Rate	$632.33
Rate for Payer: Aetna Commercial	$535.05
Rate for Payer: Amerigroup CHIP/Medicaid	$87.55
Rate for Payer: BCBS of TX Blue Advantage	$291.85
Rate for Payer: BCBS of TX Blue Essentials	$350.22
Rate for Payer: BCBS of TX PPO	$389.13
Rate for Payer: Cash Price	$856.08
Rate for Payer: Multiplan Auto	$632.33
Rate for Payer: Multiplan Commercial	$632.33
Rate for Payer: Multiplan Workers Comp	$632.33
Rate for Payer: Scott and White EPO/PPO	$486.41
Rate for Payer: Superior Health Plan EPO	$132.30

STAPLER INTERNAL LINEAR 100MM TLC10

Facility

$1,541.38

Hospital Charge Code	8528470
Hospital Revenue Code	272
Min. Negotiated Rate	$138.72
Max. Negotiated Rate	$1,001.90
Rate for Payer: Aetna Commercial	$847.76
Rate for Payer: Amerigroup CHIP/Medicaid	$138.72
Rate for Payer: BCBS of TX Blue Advantage	$462.41
Rate for Payer: BCBS of TX Blue Essentials	$554.90
Rate for Payer: BCBS of TX PPO	$616.55
Rate for Payer: Cash Price	$1,356.41
Rate for Payer: Multiplan Auto	$1,001.90
Rate for Payer: Multiplan Commercial	$1,001.90
Rate for Payer: Multiplan Workers Comp	$1,001.90
Rate for Payer: Scott and White EPO/PPO	$770.69
Rate for Payer: Superior Health Plan EPO	$209.63

STAPLER INTERNAL LINEAR 100MM TLC10

Facility

$1,541.38

Hospital Charge Code	8528470
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,356.41

STAPLER, INTERNAL LINEAR CUTTER 75MM 52/EA TITANUM -- DHF

Facility

$1,009.15

Hospital Charge Code	81911802
Hospital Revenue Code	272
Min. Negotiated Rate	$90.82
Max. Negotiated Rate	$655.95
Rate for Payer: Aetna Commercial	$555.03
Rate for Payer: Amerigroup CHIP/Medicaid	$90.82
Rate for Payer: BCBS of TX Blue Advantage	$302.74
Rate for Payer: BCBS of TX Blue Essentials	$363.29
Rate for Payer: BCBS of TX PPO	$403.66
Rate for Payer: Cash Price	$888.05
Rate for Payer: Multiplan Auto	$655.95
Rate for Payer: Multiplan Commercial	$655.95
Rate for Payer: Multiplan Workers Comp	$655.95
Rate for Payer: Scott and White EPO/PPO	$504.58
Rate for Payer: Superior Health Plan EPO	$137.24

STAPLER, INTERNAL LINEAR CUTTER 75MM 52/EA TITANUM -- DHF

Facility

$1,009.15

Hospital Charge Code	81911802
Hospital Revenue Code	272
Rate for Payer: Cash Price	$888.05

STAPLER, INTERNAL LINEAR TITANIUM 90MM RELOADABLE -- DHF

Facility

$2,468.09

Hospital Charge Code	81910200
Hospital Revenue Code	272
Min. Negotiated Rate	$222.13
Max. Negotiated Rate	$1,604.26
Rate for Payer: Aetna Commercial	$1,357.45
Rate for Payer: Amerigroup CHIP/Medicaid	$222.13
Rate for Payer: BCBS of TX Blue Advantage	$740.43
Rate for Payer: BCBS of TX Blue Essentials	$888.51
Rate for Payer: BCBS of TX PPO	$987.24
Rate for Payer: Cash Price	$2,171.92
Rate for Payer: Multiplan Auto	$1,604.26
Rate for Payer: Multiplan Commercial	$1,604.26
Rate for Payer: Multiplan Workers Comp	$1,604.26
Rate for Payer: Scott and White EPO/PPO	$1,234.04
Rate for Payer: Superior Health Plan EPO	$335.66

STAPLER, INTERNAL LINEAR TITANIUM 90MM RELOADABLE -- DHF

Facility

$2,468.09

Hospital Charge Code	81910200
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,171.92

STAPLER, SKIN ROTATING HEAD II WIDE 35/EA DISP -- DHF

Facility

$615.69

Hospital Charge Code	81911703
Hospital Revenue Code	272
Rate for Payer: Cash Price	$541.81

STAPLER, SKIN ROTATING HEAD II WIDE 35/EA DISP -- DHF

Facility

$615.69

Hospital Charge Code	81911703
Hospital Revenue Code	272
Min. Negotiated Rate	$55.41
Max. Negotiated Rate	$400.20
Rate for Payer: Aetna Commercial	$338.63
Rate for Payer: Amerigroup CHIP/Medicaid	$55.41
Rate for Payer: BCBS of TX Blue Advantage	$184.71
Rate for Payer: BCBS of TX Blue Essentials	$221.65
Rate for Payer: BCBS of TX PPO	$246.28
Rate for Payer: Cash Price	$541.81
Rate for Payer: Multiplan Auto	$400.20
Rate for Payer: Multiplan Commercial	$400.20
Rate for Payer: Multiplan Workers Comp	$400.20
Rate for Payer: Scott and White EPO/PPO	$307.84
Rate for Payer: Superior Health Plan EPO	$83.73

STAPLER UNIVERSAL EGIAUXL

Facility

$798.31

Hospital Charge Code	8720617
Hospital Revenue Code	272
Rate for Payer: Cash Price	$702.51

STAPLER UNIVERSAL EGIAUXL

Facility

$798.31

Hospital Charge Code	8720617
Hospital Revenue Code	272
Min. Negotiated Rate	$71.85
Max. Negotiated Rate	$518.90
Rate for Payer: Aetna Commercial	$439.07
Rate for Payer: Amerigroup CHIP/Medicaid	$71.85
Rate for Payer: BCBS of TX Blue Advantage	$239.49
Rate for Payer: BCBS of TX Blue Essentials	$287.39
Rate for Payer: BCBS of TX PPO	$319.32
Rate for Payer: Cash Price	$702.51
Rate for Payer: Multiplan Auto	$518.90
Rate for Payer: Multiplan Commercial	$518.90
Rate for Payer: Multiplan Workers Comp	$518.90
Rate for Payer: Scott and White EPO/PPO	$399.16
Rate for Payer: Superior Health Plan EPO	$108.57

ST ART PUNCTURE -- DHF

Facility

$764.34

Hospital Charge Code	80826753
Hospital Revenue Code	272
Min. Negotiated Rate	$68.79
Max. Negotiated Rate	$496.82
Rate for Payer: Aetna Commercial	$420.39
Rate for Payer: Amerigroup CHIP/Medicaid	$68.79
Rate for Payer: BCBS of TX Blue Advantage	$229.30
Rate for Payer: BCBS of TX Blue Essentials	$275.16
Rate for Payer: BCBS of TX PPO	$305.74
Rate for Payer: Cash Price	$672.62
Rate for Payer: Multiplan Auto	$496.82
Rate for Payer: Multiplan Commercial	$496.82
Rate for Payer: Multiplan Workers Comp	$496.82
Rate for Payer: Scott and White EPO/PPO	$382.17
Rate for Payer: Superior Health Plan EPO	$103.95

ST ART PUNCTURE -- DHF

Facility

$764.34

Hospital Charge Code	80826753
Hospital Revenue Code	272
Rate for Payer: Cash Price	$672.62

ST BLD FENWAL -- DHF

Facility

$379.76

Hospital Charge Code	54201116
Hospital Revenue Code	270
Rate for Payer: Cash Price	$334.19

ST BLD FENWAL -- DHF

Facility

$379.76

Hospital Charge Code	54201116
Hospital Revenue Code	270
Min. Negotiated Rate	$34.18
Max. Negotiated Rate	$246.84
Rate for Payer: Aetna Commercial	$208.87
Rate for Payer: Amerigroup CHIP/Medicaid	$34.18
Rate for Payer: BCBS of TX Blue Advantage	$113.93
Rate for Payer: BCBS of TX Blue Essentials	$136.71
Rate for Payer: BCBS of TX PPO	$151.90
Rate for Payer: Cash Price	$334.19
Rate for Payer: Multiplan Auto	$246.84
Rate for Payer: Multiplan Commercial	$246.84
Rate for Payer: Multiplan Workers Comp	$246.84
Rate for Payer: Scott and White EPO/PPO	$189.88
Rate for Payer: Superior Health Plan EPO	$51.65

STENT ABSOLUTE PRO 6X100X135

Facility

$5,903.61

Service Code	HCPCS C1876
Hospital Charge Code	131686
Hospital Revenue Code	278
Min. Negotiated Rate	$1,475.90
Max. Negotiated Rate	$2,951.80
Rate for Payer: Aetna Commercial	$1,771.08
Rate for Payer: Cash Price	$5,195.18
Rate for Payer: Cigna Commercial	$1,475.90
Rate for Payer: Multiplan Auto	$2,951.80
Rate for Payer: Multiplan Commercial	$2,951.80
Rate for Payer: Multiplan Workers Comp	$2,951.80
Rate for Payer: Scott and White EPO/PPO	$2,951.80

STENT ABSOLUTE PRO 6X100X135

Facility

$5,903.61

Service Code	HCPCS C1876
Hospital Charge Code	131686
Hospital Revenue Code	278
Min. Negotiated Rate	$531.32
Max. Negotiated Rate	$2,951.80
Rate for Payer: Aetna Commercial	$1,771.08
Rate for Payer: Amerigroup CHIP/Medicaid	$531.32
Rate for Payer: BCBS of TX Blue Advantage	$1,771.08
Rate for Payer: BCBS of TX Blue Essentials	$2,125.30
Rate for Payer: BCBS of TX PPO	$2,361.44
Rate for Payer: Cash Price	$5,195.18
Rate for Payer: Multiplan Auto	$2,951.80
Rate for Payer: Multiplan Commercial	$2,951.80
Rate for Payer: Multiplan Workers Comp	$2,951.80
Rate for Payer: Scott and White EPO/PPO	$2,951.80
Rate for Payer: Superior Health Plan EPO	$802.89

Know your out-of-pocket cost for care.

All Charges