White Rock Medical Center

All Charges

Charge

Type

Setting

Price

RELOAD, ENDOPATH, W/GST, 45MM

Facility

$636.65

Hospital Charge Code	993817
Hospital Revenue Code	279
Rate for Payer: Cash Price	$432.92

RELOAD, ENDOPATH, W/GST, 45MM

Facility

$636.65

Hospital Charge Code	993817
Hospital Revenue Code	279
Min. Negotiated Rate	$57.30
Max. Negotiated Rate	$458.39
Rate for Payer: Amerigroup CHIP/Medicaid	$57.30
Rate for Payer: BCBS of TX Blue Advantage	$191.00
Rate for Payer: BCBS of TX Blue Essentials	$229.19
Rate for Payer: BCBS of TX PPO	$254.66
Rate for Payer: Cash Price	$432.92
Rate for Payer: Cigna Medicaid	$458.39
Rate for Payer: Molina CHIP/Medicaid	$458.39
Rate for Payer: Multiplan Auto	$413.82
Rate for Payer: Multiplan Commercial	$413.82
Rate for Payer: Multiplan Workers Comp	$413.82
Rate for Payer: Parkland Medicaid	$458.39
Rate for Payer: Scott and White EPO/PPO	$318.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$458.39
Rate for Payer: Superior Health Plan EPO	$86.58

RELOAD, ENDOSCOPIC LINEAR CUTTER ETS45 WHITE 45MM -- DHF

Facility

$615.69

Hospital Charge Code	81911703
Hospital Revenue Code	272
Rate for Payer: Cash Price	$418.67

RELOAD, ENDOSCOPIC LINEAR CUTTER ETS45 WHITE 45MM -- DHF

Facility

$615.69

Hospital Charge Code	81911703
Hospital Revenue Code	272
Min. Negotiated Rate	$55.41
Max. Negotiated Rate	$443.30
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	$418.67
Rate for Payer: Cigna Medicaid	$443.30
Rate for Payer: Molina CHIP/Medicaid	$443.30
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: Parkland Medicaid	$443.30
Rate for Payer: Scott and White EPO/PPO	$307.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$443.30
Rate for Payer: Superior Health Plan EPO	$83.73

RELOAD, ENDOSCOPIC LINEAR RELOADABLE GREEN 60MM -- DHF

Facility

$1,558.66

Hospital Charge Code	81945859
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,059.89

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	$1,122.24
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	$1,059.89
Rate for Payer: Cigna Medicaid	$1,122.24
Rate for Payer: Molina CHIP/Medicaid	$1,122.24
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: Parkland Medicaid	$1,122.24
Rate for Payer: Scott and White EPO/PPO	$779.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,122.24
Rate for Payer: Superior Health Plan EPO	$211.98

RELOAD ENDOSTITCH,SURGDAC,GRN.2-0,48

Facility

$104.35

Hospital Charge Code	993856
Hospital Revenue Code	279
Min. Negotiated Rate	$9.39
Max. Negotiated Rate	$75.13
Rate for Payer: Amerigroup CHIP/Medicaid	$9.39
Rate for Payer: BCBS of TX Blue Advantage	$31.30
Rate for Payer: BCBS of TX Blue Essentials	$37.57
Rate for Payer: BCBS of TX PPO	$41.74
Rate for Payer: Cash Price	$70.96
Rate for Payer: Cigna Medicaid	$75.13
Rate for Payer: Molina CHIP/Medicaid	$75.13
Rate for Payer: Multiplan Auto	$67.83
Rate for Payer: Multiplan Commercial	$67.83
Rate for Payer: Multiplan Workers Comp	$67.83
Rate for Payer: Parkland Medicaid	$75.13
Rate for Payer: Scott and White EPO/PPO	$52.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$75.13
Rate for Payer: Superior Health Plan EPO	$14.19

RELOAD ENDOSTITCH,SURGDAC,GRN.2-0,48

Facility

$104.35

Hospital Charge Code	993856
Hospital Revenue Code	279
Rate for Payer: Cash Price	$70.96

RELOAD, GST, BLACK, 60MM, 6ROW

Facility

$936.81

Hospital Charge Code	992299
Hospital Revenue Code	272
Min. Negotiated Rate	$84.31
Max. Negotiated Rate	$674.50
Rate for Payer: Amerigroup CHIP/Medicaid	$84.31
Rate for Payer: BCBS of TX Blue Advantage	$281.04
Rate for Payer: BCBS of TX Blue Essentials	$337.25
Rate for Payer: BCBS of TX PPO	$374.72
Rate for Payer: Cash Price	$637.03
Rate for Payer: Cigna Medicaid	$674.50
Rate for Payer: Molina CHIP/Medicaid	$674.50
Rate for Payer: Multiplan Auto	$608.93
Rate for Payer: Multiplan Commercial	$608.93
Rate for Payer: Multiplan Workers Comp	$608.93
Rate for Payer: Parkland Medicaid	$674.50
Rate for Payer: Scott and White EPO/PPO	$468.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$674.50
Rate for Payer: Superior Health Plan EPO	$127.41

RELOAD, GST, BLACK, 60MM, 6ROW

Facility

$936.81

Hospital Charge Code	992299
Hospital Revenue Code	272
Rate for Payer: Cash Price	$637.03

RELOAD, GST, BLUE, 60MM, 6ROW

Facility

$936.81

Hospital Charge Code	992300
Hospital Revenue Code	272
Min. Negotiated Rate	$84.31
Max. Negotiated Rate	$674.50
Rate for Payer: Amerigroup CHIP/Medicaid	$84.31
Rate for Payer: BCBS of TX Blue Advantage	$281.04
Rate for Payer: BCBS of TX Blue Essentials	$337.25
Rate for Payer: BCBS of TX PPO	$374.72
Rate for Payer: Cash Price	$637.03
Rate for Payer: Cigna Medicaid	$674.50
Rate for Payer: Molina CHIP/Medicaid	$674.50
Rate for Payer: Multiplan Auto	$608.93
Rate for Payer: Multiplan Commercial	$608.93
Rate for Payer: Multiplan Workers Comp	$608.93
Rate for Payer: Parkland Medicaid	$674.50
Rate for Payer: Scott and White EPO/PPO	$468.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$674.50
Rate for Payer: Superior Health Plan EPO	$127.41

RELOAD, GST, BLUE, 60MM, 6ROW

Facility

$936.81

Hospital Charge Code	992300
Hospital Revenue Code	272
Rate for Payer: Cash Price	$637.03

RELOAD, GST, GOLD, 60MM, 6ROW

Facility

$936.81

Hospital Charge Code	992305
Hospital Revenue Code	272
Rate for Payer: Cash Price	$637.03

RELOAD, GST, GOLD, 60MM, 6ROW

Facility

$936.81

Hospital Charge Code	992305
Hospital Revenue Code	272
Min. Negotiated Rate	$84.31
Max. Negotiated Rate	$674.50
Rate for Payer: Amerigroup CHIP/Medicaid	$84.31
Rate for Payer: BCBS of TX Blue Advantage	$281.04
Rate for Payer: BCBS of TX Blue Essentials	$337.25
Rate for Payer: BCBS of TX PPO	$374.72
Rate for Payer: Cash Price	$637.03
Rate for Payer: Cigna Medicaid	$674.50
Rate for Payer: Molina CHIP/Medicaid	$674.50
Rate for Payer: Multiplan Auto	$608.93
Rate for Payer: Multiplan Commercial	$608.93
Rate for Payer: Multiplan Workers Comp	$608.93
Rate for Payer: Parkland Medicaid	$674.50
Rate for Payer: Scott and White EPO/PPO	$468.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$674.50
Rate for Payer: Superior Health Plan EPO	$127.41

RELOAD, GST, GREEN, 60MM, 6ROW

Facility

$913.45

Hospital Charge Code	992335
Hospital Revenue Code	272
Rate for Payer: Cash Price	$621.15

RELOAD, GST, GREEN, 60MM, 6ROW

Facility

$913.45

Hospital Charge Code	992335
Hospital Revenue Code	272
Min. Negotiated Rate	$82.21
Max. Negotiated Rate	$657.68
Rate for Payer: Amerigroup CHIP/Medicaid	$82.21
Rate for Payer: BCBS of TX Blue Advantage	$274.04
Rate for Payer: BCBS of TX Blue Essentials	$328.84
Rate for Payer: BCBS of TX PPO	$365.38
Rate for Payer: Cash Price	$621.15
Rate for Payer: Cigna Medicaid	$657.68
Rate for Payer: Molina CHIP/Medicaid	$657.68
Rate for Payer: Multiplan Auto	$593.74
Rate for Payer: Multiplan Commercial	$593.74
Rate for Payer: Multiplan Workers Comp	$593.74
Rate for Payer: Parkland Medicaid	$657.68
Rate for Payer: Scott and White EPO/PPO	$456.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$657.68
Rate for Payer: Superior Health Plan EPO	$124.23

RELOAD LINEAR CUTTER 100MM TCR10

Facility

$374.36

Hospital Charge Code	8528467
Hospital Revenue Code	272
Min. Negotiated Rate	$33.69
Max. Negotiated Rate	$269.54
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	$254.56
Rate for Payer: Cigna Medicaid	$269.54
Rate for Payer: Molina CHIP/Medicaid	$269.54
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: Parkland Medicaid	$269.54
Rate for Payer: Scott and White EPO/PPO	$187.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$269.54
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	$254.56

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	$351.57

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	$372.25
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	$351.57
Rate for Payer: Cigna Medicaid	$372.25
Rate for Payer: Molina CHIP/Medicaid	$372.25
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: Parkland Medicaid	$372.25
Rate for Payer: Scott and White EPO/PPO	$258.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$372.25
Rate for Payer: Superior Health Plan EPO	$70.31

RELOAD, SIGNIA, TRISTAPLEBUTTRESSE, XL

Facility

$2,342.02

Hospital Charge Code	992306
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,592.57

RELOAD, SIGNIA, TRISTAPLEBUTTRESSE, XL

Facility

$2,342.02

Hospital Charge Code	992306
Hospital Revenue Code	272
Min. Negotiated Rate	$210.78
Max. Negotiated Rate	$1,686.25
Rate for Payer: Amerigroup CHIP/Medicaid	$210.78
Rate for Payer: BCBS of TX Blue Advantage	$702.61
Rate for Payer: BCBS of TX Blue Essentials	$843.13
Rate for Payer: BCBS of TX PPO	$936.81
Rate for Payer: Cash Price	$1,592.57
Rate for Payer: Cigna Medicaid	$1,686.25
Rate for Payer: Molina CHIP/Medicaid	$1,686.25
Rate for Payer: Multiplan Auto	$1,522.31
Rate for Payer: Multiplan Commercial	$1,522.31
Rate for Payer: Multiplan Workers Comp	$1,522.31
Rate for Payer: Parkland Medicaid	$1,686.25
Rate for Payer: Scott and White EPO/PPO	$1,171.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,686.25
Rate for Payer: Superior Health Plan EPO	$318.51

RELOAD STAPLE ARTICULATING REINFORCED TRI 60MM

Facility

$2,159.18

Hospital Charge Code	132066
Hospital Revenue Code	272
Min. Negotiated Rate	$194.33
Max. Negotiated Rate	$1,554.61
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	$1,468.24
Rate for Payer: Cigna Medicaid	$1,554.61
Rate for Payer: Molina CHIP/Medicaid	$1,554.61
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: Parkland Medicaid	$1,554.61
Rate for Payer: Scott and White EPO/PPO	$1,079.59
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,554.61
Rate for Payer: Superior Health Plan EPO	$293.65

RELOAD STAPLE ARTICULATING REINFORCED TRI 60MM

Facility

$2,159.18

Hospital Charge Code	132066
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,468.24

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

Facility

$1,880.65

Hospital Charge Code	81911406
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,278.84

Know your out-of-pocket cost for care.

All Charges