White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SHAVER BLADE 3-IN-1 4.2MM

Facility

$1,203.10

Hospital Charge Code	144828
Hospital Revenue Code	272
Rate for Payer: Cash Price	$818.11

SHAVER BLADE STND 3.4MM

Facility

$181.60

Hospital Charge Code	144829
Hospital Revenue Code	272
Min. Negotiated Rate	$16.34
Max. Negotiated Rate	$130.75
Rate for Payer: Amerigroup CHIP/Medicaid	$16.34
Rate for Payer: BCBS of TX Blue Advantage	$54.48
Rate for Payer: BCBS of TX Blue Essentials	$65.38
Rate for Payer: BCBS of TX PPO	$72.64
Rate for Payer: Cash Price	$123.49
Rate for Payer: Cigna Medicaid	$130.75
Rate for Payer: Molina CHIP/Medicaid	$130.75
Rate for Payer: Multiplan Auto	$118.04
Rate for Payer: Multiplan Commercial	$118.04
Rate for Payer: Multiplan Workers Comp	$118.04
Rate for Payer: Parkland Medicaid	$130.75
Rate for Payer: Scott and White EPO/PPO	$90.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$130.75
Rate for Payer: Superior Health Plan EPO	$24.70

SHAVER BLADE STND 3.4MM

Facility

$181.60

Hospital Charge Code	144829
Hospital Revenue Code	272
Rate for Payer: Cash Price	$123.49

SHAVER BURR MIMIX CUDA 3.5 X 8CM 35 DEGREE STEALTH

Facility

$830.14

Hospital Charge Code	146207
Hospital Revenue Code	272
Rate for Payer: Cash Price	$564.50

SHAVER BURR MIMIX CUDA 3.5 X 8CM 35 DEGREE STEALTH

Facility

$830.14

Hospital Charge Code	146207
Hospital Revenue Code	272
Min. Negotiated Rate	$74.71
Max. Negotiated Rate	$597.70
Rate for Payer: Amerigroup CHIP/Medicaid	$74.71
Rate for Payer: BCBS of TX Blue Advantage	$249.04
Rate for Payer: BCBS of TX Blue Essentials	$298.85
Rate for Payer: BCBS of TX PPO	$332.06
Rate for Payer: Cash Price	$564.50
Rate for Payer: Cigna Medicaid	$597.70
Rate for Payer: Molina CHIP/Medicaid	$597.70
Rate for Payer: Multiplan Auto	$539.59
Rate for Payer: Multiplan Commercial	$539.59
Rate for Payer: Multiplan Workers Comp	$539.59
Rate for Payer: Parkland Medicaid	$597.70
Rate for Payer: Scott and White EPO/PPO	$415.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$597.70
Rate for Payer: Superior Health Plan EPO	$112.90

SHAVER RESECTOR MIMIX FULL RADIUS 2.9 X 8CM 35 DEGREE STEALTH

Facility

$830.14

Hospital Charge Code	146205
Hospital Revenue Code	272
Rate for Payer: Cash Price	$564.50

SHAVER RESECTOR MIMIX FULL RADIUS 2.9 X 8CM 35 DEGREE STEALTH

Facility

$830.14

Hospital Charge Code	146205
Hospital Revenue Code	272
Min. Negotiated Rate	$74.71
Max. Negotiated Rate	$597.70
Rate for Payer: Amerigroup CHIP/Medicaid	$74.71
Rate for Payer: BCBS of TX Blue Advantage	$249.04
Rate for Payer: BCBS of TX Blue Essentials	$298.85
Rate for Payer: BCBS of TX PPO	$332.06
Rate for Payer: Cash Price	$564.50
Rate for Payer: Cigna Medicaid	$597.70
Rate for Payer: Molina CHIP/Medicaid	$597.70
Rate for Payer: Multiplan Auto	$539.59
Rate for Payer: Multiplan Commercial	$539.59
Rate for Payer: Multiplan Workers Comp	$539.59
Rate for Payer: Parkland Medicaid	$597.70
Rate for Payer: Scott and White EPO/PPO	$415.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$597.70
Rate for Payer: Superior Health Plan EPO	$112.90

SHAVER TOMCAT HC CROSSBLADE 4.0MM 'FORMULA

Facility

$415.11

Hospital Charge Code	8172360
Hospital Revenue Code	272
Min. Negotiated Rate	$37.36
Max. Negotiated Rate	$298.88
Rate for Payer: Amerigroup CHIP/Medicaid	$37.36
Rate for Payer: BCBS of TX Blue Advantage	$124.53
Rate for Payer: BCBS of TX Blue Essentials	$149.44
Rate for Payer: BCBS of TX PPO	$166.04
Rate for Payer: Cash Price	$282.27
Rate for Payer: Cigna Medicaid	$298.88
Rate for Payer: Molina CHIP/Medicaid	$298.88
Rate for Payer: Multiplan Auto	$269.82
Rate for Payer: Multiplan Commercial	$269.82
Rate for Payer: Multiplan Workers Comp	$269.82
Rate for Payer: Parkland Medicaid	$298.88
Rate for Payer: Scott and White EPO/PPO	$207.56
Rate for Payer: Superior Health Plan CHIP/Medicaid	$298.88
Rate for Payer: Superior Health Plan EPO	$56.45

SHAVER TOMCAT HC CROSSBLADE 4.0MM 'FORMULA

Facility

$415.11

Hospital Charge Code	8172360
Hospital Revenue Code	272
Rate for Payer: Cash Price	$282.27

SHEALTH SYSTEM FORTRESS 6FR 90CM

Facility

$385.90

Hospital Charge Code	145375
Hospital Revenue Code	272
Rate for Payer: Cash Price	$262.41

SHEALTH SYSTEM FORTRESS 6FR 90CM

Facility

$385.90

Hospital Charge Code	145375
Hospital Revenue Code	272
Min. Negotiated Rate	$34.73
Max. Negotiated Rate	$277.85
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	$262.41
Rate for Payer: Cigna Medicaid	$277.85
Rate for Payer: Molina CHIP/Medicaid	$277.85
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: Parkland Medicaid	$277.85
Rate for Payer: Scott and White EPO/PPO	$192.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$277.85
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	$1,769.31
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	$1,671.01
Rate for Payer: Cigna Medicaid	$1,769.31
Rate for Payer: Molina CHIP/Medicaid	$1,769.31
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: Parkland Medicaid	$1,769.31
Rate for Payer: Scott and White EPO/PPO	$1,228.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,769.31
Rate for Payer: Superior Health Plan EPO	$334.20

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

Facility

$2,457.37

Hospital Charge Code	80811300
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,671.01

SHEARS HARMONIC CRVD W/ERGNMC HANDLE 5MM X 23CM

Facility

$1,194.93

Hospital Charge Code	993685
Hospital Revenue Code	270
Min. Negotiated Rate	$107.54
Max. Negotiated Rate	$860.35
Rate for Payer: Amerigroup CHIP/Medicaid	$107.54
Rate for Payer: BCBS of TX Blue Advantage	$358.48
Rate for Payer: BCBS of TX Blue Essentials	$430.17
Rate for Payer: BCBS of TX PPO	$477.97
Rate for Payer: Cash Price	$812.55
Rate for Payer: Cigna Medicaid	$860.35
Rate for Payer: Molina CHIP/Medicaid	$860.35
Rate for Payer: Multiplan Auto	$776.70
Rate for Payer: Multiplan Commercial	$776.70
Rate for Payer: Multiplan Workers Comp	$776.70
Rate for Payer: Parkland Medicaid	$860.35
Rate for Payer: Scott and White EPO/PPO	$597.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$860.35
Rate for Payer: Superior Health Plan EPO	$162.51

SHEARS HARMONIC CRVD W/ERGNMC HANDLE 5MM X 23CM

Facility

$1,194.93

Hospital Charge Code	993685
Hospital Revenue Code	270
Rate for Payer: Cash Price	$812.55

SHEATH DRYSEAL FLEX 12X33

Facility

$2,342.64

Hospital Charge Code	8528497
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,593.00

SHEATH DRYSEAL FLEX 12X33

Facility

$2,342.64

Hospital Charge Code	8528497
Hospital Revenue Code	272
Min. Negotiated Rate	$210.84
Max. Negotiated Rate	$1,686.70
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	$1,593.00
Rate for Payer: Cigna Medicaid	$1,686.70
Rate for Payer: Molina CHIP/Medicaid	$1,686.70
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: Parkland Medicaid	$1,686.70
Rate for Payer: Scott and White EPO/PPO	$1,171.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,686.70
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
Min. Negotiated Rate	$270.90
Max. Negotiated Rate	$2,167.21
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	$2,046.81
Rate for Payer: Cigna Medicaid	$2,167.21
Rate for Payer: Molina CHIP/Medicaid	$2,167.21
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: Parkland Medicaid	$2,167.21
Rate for Payer: Scott and White EPO/PPO	$1,505.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,167.21
Rate for Payer: Superior Health Plan EPO	$409.36

SHEATH DRYSEAL FLEX 18X33

Facility

$3,010.02

Hospital Charge Code	8528499
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,046.81

SHEATH DRYSEAL FLEXSHEATH 16FR 33CM

Facility

$2,342.64

Hospital Charge Code	107545
Hospital Revenue Code	272
Min. Negotiated Rate	$210.84
Max. Negotiated Rate	$1,686.70
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	$1,593.00
Rate for Payer: Cigna Medicaid	$1,686.70
Rate for Payer: Molina CHIP/Medicaid	$1,686.70
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: Parkland Medicaid	$1,686.70
Rate for Payer: Scott and White EPO/PPO	$1,171.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,686.70
Rate for Payer: Superior Health Plan EPO	$318.60

SHEATH DRYSEAL FLEXSHEATH 16FR 33CM

Facility

$2,342.64

Hospital Charge Code	107545
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,593.00

SHEATH INTRODUCER 10CM 6FR 21G

Facility

$684.63

Service Code	HCPCS C1766
Hospital Charge Code	992502
Hospital Revenue Code	272
Min. Negotiated Rate	$61.62
Max. Negotiated Rate	$492.93
Rate for Payer: Amerigroup CHIP/Medicaid	$61.62
Rate for Payer: BCBS of TX Blue Advantage	$205.39
Rate for Payer: BCBS of TX Blue Essentials	$246.47
Rate for Payer: BCBS of TX PPO	$273.85
Rate for Payer: Cash Price	$465.55
Rate for Payer: Cigna Medicaid	$492.93
Rate for Payer: Molina CHIP/Medicaid	$492.93
Rate for Payer: Multiplan Auto	$445.01
Rate for Payer: Multiplan Commercial	$445.01
Rate for Payer: Multiplan Workers Comp	$445.01
Rate for Payer: Parkland Medicaid	$492.93
Rate for Payer: Scott and White EPO/PPO	$342.31
Rate for Payer: Superior Health Plan CHIP/Medicaid	$492.93
Rate for Payer: Superior Health Plan EPO	$93.11

SHEATH INTRODUCER 10CM 6FR 21G

Facility

$684.63

Service Code	HCPCS C1766
Hospital Charge Code	992502
Hospital Revenue Code	272
Rate for Payer: Cash Price	$465.55

SHEATH INTRODUCER RADIOPQ MRKER 6F 4CM .038

Facility

$632.20

Service Code	HCPCS C1766
Hospital Charge Code	992503
Hospital Revenue Code	272
Rate for Payer: Cash Price	$429.90

SHEATH INTRODUCER RADIOPQ MRKER 6F 4CM .038

Facility

$632.20

Service Code	HCPCS C1766
Hospital Charge Code	992503
Hospital Revenue Code	272
Min. Negotiated Rate	$56.90
Max. Negotiated Rate	$455.18
Rate for Payer: Amerigroup CHIP/Medicaid	$56.90
Rate for Payer: BCBS of TX Blue Advantage	$189.66
Rate for Payer: BCBS of TX Blue Essentials	$227.59
Rate for Payer: BCBS of TX PPO	$252.88
Rate for Payer: Cash Price	$429.90
Rate for Payer: Cigna Medicaid	$455.18
Rate for Payer: Molina CHIP/Medicaid	$455.18
Rate for Payer: Multiplan Auto	$410.93
Rate for Payer: Multiplan Commercial	$410.93
Rate for Payer: Multiplan Workers Comp	$410.93
Rate for Payer: Parkland Medicaid	$455.18
Rate for Payer: Scott and White EPO/PPO	$316.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$455.18
Rate for Payer: Superior Health Plan EPO	$85.98

Know your out-of-pocket cost for care.

All Charges