White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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
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

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	992495
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

SHEATH INTRODUCER RADIOPQ MRKER 6F 4CM .038

Facility

$632.20

Service Code	HCPCS C1766
Hospital Charge Code	992495
Hospital Revenue Code	272
Rate for Payer: Cash Price	$429.90

SHEET AIR LACTERAL COMFT GLIDE

Facility

$271.26

Hospital Charge Code	8514467
Hospital Revenue Code	272
Rate for Payer: Cash Price	$184.46

SHEET AIR LACTERAL COMFT GLIDE

Facility

$271.26

Hospital Charge Code	8514467
Hospital Revenue Code	272
Min. Negotiated Rate	$24.41
Max. Negotiated Rate	$195.31
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	$184.46
Rate for Payer: Cigna Medicaid	$195.31
Rate for Payer: Molina CHIP/Medicaid	$195.31
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: Parkland Medicaid	$195.31
Rate for Payer: Scott and White EPO/PPO	$135.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$195.31
Rate for Payer: Superior Health Plan EPO	$36.89

SHEET GLIDE TURN & POSIT

Facility

$250.99

Hospital Charge Code	80386808
Hospital Revenue Code	272
Min. Negotiated Rate	$22.59
Max. Negotiated Rate	$180.71
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	$170.67
Rate for Payer: Cigna Medicaid	$180.71
Rate for Payer: Molina CHIP/Medicaid	$180.71
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: Parkland Medicaid	$180.71
Rate for Payer: Scott and White EPO/PPO	$125.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$180.71
Rate for Payer: Superior Health Plan EPO	$34.13

SHEET GLIDE TURN & POSIT

Facility

$250.99

Hospital Charge Code	80386808
Hospital Revenue Code	272
Rate for Payer: Cash Price	$170.67

SHEET, LAPAROTOMY TRANSVERSE -- DHF

Facility

$445.91

Hospital Charge Code	81623050
Hospital Revenue Code	272
Min. Negotiated Rate	$40.13
Max. Negotiated Rate	$321.06
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	$303.22
Rate for Payer: Cigna Medicaid	$321.06
Rate for Payer: Molina CHIP/Medicaid	$321.06
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: Parkland Medicaid	$321.06
Rate for Payer: Scott and White EPO/PPO	$222.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$321.06
Rate for Payer: Superior Health Plan EPO	$60.64

SHEET, LAPAROTOMY TRANSVERSE -- DHF

Facility

$445.91

Hospital Charge Code	81623050
Hospital Revenue Code	272
Rate for Payer: Cash Price	$303.22

SHEET REPOSITION COMFORT GLIDE REPROCESSED 40X80

Facility

$263.54

Hospital Charge Code	993043
Hospital Revenue Code	270
Rate for Payer: Cash Price	$179.21

SHEET REPOSITION COMFORT GLIDE REPROCESSED 40X80

Facility

$263.54

Hospital Charge Code	993043
Hospital Revenue Code	270
Min. Negotiated Rate	$23.72
Max. Negotiated Rate	$189.75
Rate for Payer: Amerigroup CHIP/Medicaid	$23.72
Rate for Payer: BCBS of TX Blue Advantage	$79.06
Rate for Payer: BCBS of TX Blue Essentials	$94.87
Rate for Payer: BCBS of TX PPO	$105.42
Rate for Payer: Cash Price	$179.21
Rate for Payer: Cigna Medicaid	$189.75
Rate for Payer: Molina CHIP/Medicaid	$189.75
Rate for Payer: Multiplan Auto	$171.30
Rate for Payer: Multiplan Commercial	$171.30
Rate for Payer: Multiplan Workers Comp	$171.30
Rate for Payer: Parkland Medicaid	$189.75
Rate for Payer: Scott and White EPO/PPO	$131.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$189.75
Rate for Payer: Superior Health Plan EPO	$35.84

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	$268.01
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	$253.12
Rate for Payer: Cigna Medicaid	$268.01
Rate for Payer: Molina CHIP/Medicaid	$268.01
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: Parkland Medicaid	$268.01
Rate for Payer: Scott and White EPO/PPO	$186.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$268.01
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	$253.12

SHEET, T, THYROID, ST, 12/CS

Facility

$24.36

Hospital Charge Code	992852
Hospital Revenue Code	272
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$17.54
Rate for Payer: Amerigroup CHIP/Medicaid	$2.19
Rate for Payer: BCBS of TX Blue Advantage	$7.31
Rate for Payer: BCBS of TX Blue Essentials	$8.77
Rate for Payer: BCBS of TX PPO	$9.74
Rate for Payer: Cash Price	$16.56
Rate for Payer: Cigna Medicaid	$17.54
Rate for Payer: Molina CHIP/Medicaid	$17.54
Rate for Payer: Multiplan Auto	$15.83
Rate for Payer: Multiplan Commercial	$15.83
Rate for Payer: Multiplan Workers Comp	$15.83
Rate for Payer: Parkland Medicaid	$17.54
Rate for Payer: Scott and White EPO/PPO	$12.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.54
Rate for Payer: Superior Health Plan EPO	$3.31

SHEET, T, THYROID, ST, 12/CS

Facility

$24.36

Hospital Charge Code	992852
Hospital Revenue Code	272
Rate for Payer: Cash Price	$16.56

SHELL, DISPOSABLE ENDOSCOPIC SIGNIA STAPLER -- DHF

Facility

$2,407.34

Hospital Charge Code	80899024
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,636.99

Know your out-of-pocket cost for care.

All Charges