White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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

SHELL, POWER, CONTROL, SIGNIA

Facility

$494.00

Hospital Charge Code	992780
Hospital Revenue Code	272
Rate for Payer: Cash Price	$335.92

SHELL, POWER, CONTROL, SIGNIA

Facility

$494.00

Hospital Charge Code	992780
Hospital Revenue Code	272
Min. Negotiated Rate	$44.46
Max. Negotiated Rate	$355.68
Rate for Payer: Amerigroup CHIP/Medicaid	$44.46
Rate for Payer: BCBS of TX Blue Advantage	$148.20
Rate for Payer: BCBS of TX Blue Essentials	$177.84
Rate for Payer: BCBS of TX PPO	$197.60
Rate for Payer: Cash Price	$335.92
Rate for Payer: Cigna Medicaid	$355.68
Rate for Payer: Molina CHIP/Medicaid	$355.68
Rate for Payer: Multiplan Auto	$321.10
Rate for Payer: Multiplan Commercial	$321.10
Rate for Payer: Multiplan Workers Comp	$321.10
Rate for Payer: Parkland Medicaid	$355.68
Rate for Payer: Scott and White EPO/PPO	$247.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$355.68
Rate for Payer: Superior Health Plan EPO	$67.18

SHFT REAMER MODULAR -- DHF

Facility

$1,574.76

Hospital Charge Code	80826829
Hospital Revenue Code	272
Min. Negotiated Rate	$141.73
Max. Negotiated Rate	$1,133.83
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	$1,070.84
Rate for Payer: Cigna Medicaid	$1,133.83
Rate for Payer: Molina CHIP/Medicaid	$1,133.83
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: Parkland Medicaid	$1,133.83
Rate for Payer: Scott and White EPO/PPO	$787.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,133.83
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	$1,070.84

SHIELD NPL 20MM SM

Facility

$18.48

Hospital Charge Code	111289
Hospital Revenue Code	270
Rate for Payer: Cash Price	$12.57

SHIELD NPL 20MM SM

Facility

$18.48

Hospital Charge Code	111289
Hospital Revenue Code	270
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$13.31
Rate for Payer: Amerigroup CHIP/Medicaid	$1.66
Rate for Payer: BCBS of TX Blue Advantage	$5.54
Rate for Payer: BCBS of TX Blue Essentials	$6.65
Rate for Payer: BCBS of TX PPO	$7.39
Rate for Payer: Cash Price	$12.57
Rate for Payer: Cigna Medicaid	$13.31
Rate for Payer: Molina CHIP/Medicaid	$13.31
Rate for Payer: Multiplan Auto	$12.01
Rate for Payer: Multiplan Commercial	$12.01
Rate for Payer: Multiplan Workers Comp	$12.01
Rate for Payer: Parkland Medicaid	$13.31
Rate for Payer: Scott and White EPO/PPO	$9.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.31
Rate for Payer: Superior Health Plan EPO	$2.51

Shiga Toxin I

Facility

$117.00

Service Code	HCPCS 87899 QW
Hospital Charge Code	4107908
Hospital Revenue Code	306
Rate for Payer: Cash Price	$79.56

Shiga Toxin I

Facility

$117.00

Service Code	HCPCS 87899 QW
Hospital Charge Code	4107908
Hospital Revenue Code	306
Min. Negotiated Rate	$6.27
Max. Negotiated Rate	$84.24
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	$35.10
Rate for Payer: BCBS of TX Blue Essentials	$42.12
Rate for Payer: BCBS of TX Medicare	$16.07
Rate for Payer: BCBS of TX PPO	$46.80
Rate for Payer: Cash Price	$79.56
Rate for Payer: Cash Price	$79.56
Rate for Payer: Cigna Medicaid	$84.24
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	$84.24
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	$84.24
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	$84.24
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 II

Facility

$117.00

Service Code	HCPCS 87899 QW
Hospital Charge Code	4107909
Hospital Revenue Code	306
Rate for Payer: Cash Price	$79.56

Shiga Toxin II

Facility

$117.00

Service Code	HCPCS 87899 QW
Hospital Charge Code	4107909
Hospital Revenue Code	306
Min. Negotiated Rate	$6.27
Max. Negotiated Rate	$84.24
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	$35.10
Rate for Payer: BCBS of TX Blue Essentials	$42.12
Rate for Payer: BCBS of TX Medicare	$16.07
Rate for Payer: BCBS of TX PPO	$46.80
Rate for Payer: Cash Price	$79.56
Rate for Payer: Cash Price	$79.56
Rate for Payer: Cigna Medicaid	$84.24
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	$84.24
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	$84.24
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	$84.24
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

SHOE CST WALKNG -- DHF

Facility

$181.91

Hospital Charge Code	81144156
Hospital Revenue Code	270
Rate for Payer: Cash Price	$123.70

SHOE CST WALKNG -- DHF

Facility

$181.91

Hospital Charge Code	81144156
Hospital Revenue Code	270
Min. Negotiated Rate	$16.37
Max. Negotiated Rate	$130.98
Rate for Payer: Amerigroup CHIP/Medicaid	$16.37
Rate for Payer: BCBS of TX Blue Advantage	$54.57
Rate for Payer: BCBS of TX Blue Essentials	$65.49
Rate for Payer: BCBS of TX PPO	$72.76
Rate for Payer: Cash Price	$123.70
Rate for Payer: Cigna Medicaid	$130.98
Rate for Payer: Molina CHIP/Medicaid	$130.98
Rate for Payer: Multiplan Auto	$118.24
Rate for Payer: Multiplan Commercial	$118.24
Rate for Payer: Multiplan Workers Comp	$118.24
Rate for Payer: Parkland Medicaid	$130.98
Rate for Payer: Scott and White EPO/PPO	$90.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$130.98
Rate for Payer: Superior Health Plan EPO	$24.74

SHOE ORTHOPEDIC -- DHF

Facility

$689.34

Hospital Charge Code	81144206
Hospital Revenue Code	271
Min. Negotiated Rate	$62.04
Max. Negotiated Rate	$496.32
Rate for Payer: Amerigroup CHIP/Medicaid	$62.04
Rate for Payer: BCBS of TX Blue Advantage	$206.80
Rate for Payer: BCBS of TX Blue Essentials	$248.16
Rate for Payer: BCBS of TX PPO	$275.74
Rate for Payer: Cash Price	$468.75
Rate for Payer: Cigna Medicaid	$496.32
Rate for Payer: Molina CHIP/Medicaid	$496.32
Rate for Payer: Multiplan Auto	$448.07
Rate for Payer: Multiplan Commercial	$448.07
Rate for Payer: Multiplan Workers Comp	$448.07
Rate for Payer: Parkland Medicaid	$496.32
Rate for Payer: Scott and White EPO/PPO	$344.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$496.32
Rate for Payer: Superior Health Plan EPO	$93.75

SHOE ORTHOPEDIC -- DHF

Facility

$689.34

Hospital Charge Code	81144206
Hospital Revenue Code	271
Rate for Payer: Cash Price	$468.75

SHOE POST-OP A/S -- DHF

Facility

$46.80

Hospital Charge Code	81144255
Hospital Revenue Code	271
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$33.70
Rate for Payer: Amerigroup CHIP/Medicaid	$4.21
Rate for Payer: BCBS of TX Blue Advantage	$14.04
Rate for Payer: BCBS of TX Blue Essentials	$16.85
Rate for Payer: BCBS of TX PPO	$18.72
Rate for Payer: Cash Price	$31.82
Rate for Payer: Cigna Medicaid	$33.70
Rate for Payer: Molina CHIP/Medicaid	$33.70
Rate for Payer: Multiplan Auto	$30.42
Rate for Payer: Multiplan Commercial	$30.42
Rate for Payer: Multiplan Workers Comp	$30.42
Rate for Payer: Parkland Medicaid	$33.70
Rate for Payer: Scott and White EPO/PPO	$23.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$33.70
Rate for Payer: Superior Health Plan EPO	$6.36

SHOE POST-OP A/S -- DHF

Facility

$46.80

Hospital Charge Code	81144255
Hospital Revenue Code	271
Rate for Payer: Cash Price	$31.82

SHOE, POST-OP, MALE, L, SIZE 11-13

Facility

$24.79

Hospital Charge Code	992955
Hospital Revenue Code	270
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$17.85
Rate for Payer: Amerigroup CHIP/Medicaid	$2.23
Rate for Payer: BCBS of TX Blue Advantage	$7.44
Rate for Payer: BCBS of TX Blue Essentials	$8.92
Rate for Payer: BCBS of TX PPO	$9.92
Rate for Payer: Cash Price	$16.86
Rate for Payer: Cigna Medicaid	$17.85
Rate for Payer: Molina CHIP/Medicaid	$17.85
Rate for Payer: Multiplan Auto	$16.11
Rate for Payer: Multiplan Commercial	$16.11
Rate for Payer: Multiplan Workers Comp	$16.11
Rate for Payer: Parkland Medicaid	$17.85
Rate for Payer: Scott and White EPO/PPO	$12.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.85
Rate for Payer: Superior Health Plan EPO	$3.37

SHOE, POST-OP, MALE, L, SIZE 11-13

Facility

$24.79

Hospital Charge Code	992955
Hospital Revenue Code	270
Rate for Payer: Cash Price	$16.86

SHOE, POST-OP, MALE, M, SIZE 9-11

Facility

$24.79

Hospital Charge Code	992956
Hospital Revenue Code	270
Rate for Payer: Cash Price	$16.86

SHOE, POST-OP, MALE, M, SIZE 9-11

Facility

$24.79

Hospital Charge Code	992956
Hospital Revenue Code	270
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$17.85
Rate for Payer: Amerigroup CHIP/Medicaid	$2.23
Rate for Payer: BCBS of TX Blue Advantage	$7.44
Rate for Payer: BCBS of TX Blue Essentials	$8.92
Rate for Payer: BCBS of TX PPO	$9.92
Rate for Payer: Cash Price	$16.86
Rate for Payer: Cigna Medicaid	$17.85
Rate for Payer: Molina CHIP/Medicaid	$17.85
Rate for Payer: Multiplan Auto	$16.11
Rate for Payer: Multiplan Commercial	$16.11
Rate for Payer: Multiplan Workers Comp	$16.11
Rate for Payer: Parkland Medicaid	$17.85
Rate for Payer: Scott and White EPO/PPO	$12.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.85
Rate for Payer: Superior Health Plan EPO	$3.37

SHOE, POST-OP, MALE, S, SIZE 7-9

Facility

$24.79

Hospital Charge Code	992957
Hospital Revenue Code	270
Rate for Payer: Cash Price	$16.86

SHOE, POST-OP, MALE, S, SIZE 7-9

Facility

$24.79

Hospital Charge Code	992957
Hospital Revenue Code	270
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$17.85
Rate for Payer: Amerigroup CHIP/Medicaid	$2.23
Rate for Payer: BCBS of TX Blue Advantage	$7.44
Rate for Payer: BCBS of TX Blue Essentials	$8.92
Rate for Payer: BCBS of TX PPO	$9.92
Rate for Payer: Cash Price	$16.86
Rate for Payer: Cigna Medicaid	$17.85
Rate for Payer: Molina CHIP/Medicaid	$17.85
Rate for Payer: Multiplan Auto	$16.11
Rate for Payer: Multiplan Commercial	$16.11
Rate for Payer: Multiplan Workers Comp	$16.11
Rate for Payer: Parkland Medicaid	$17.85
Rate for Payer: Scott and White EPO/PPO	$12.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.85
Rate for Payer: Superior Health Plan EPO	$3.37

SHOE, POST-OP, MALE, XL, SIZE 13 AND GREATER

Facility

$164.46

Hospital Charge Code	993096
Hospital Revenue Code	270
Rate for Payer: Cash Price	$111.83

SHOE, POST-OP, MALE, XL, SIZE 13 AND GREATER

Facility

$164.46

Hospital Charge Code	993096
Hospital Revenue Code	270
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$118.41
Rate for Payer: Amerigroup CHIP/Medicaid	$14.80
Rate for Payer: BCBS of TX Blue Advantage	$49.34
Rate for Payer: BCBS of TX Blue Essentials	$59.21
Rate for Payer: BCBS of TX PPO	$65.78
Rate for Payer: Cash Price	$111.83
Rate for Payer: Cigna Medicaid	$118.41
Rate for Payer: Molina CHIP/Medicaid	$118.41
Rate for Payer: Multiplan Auto	$106.90
Rate for Payer: Multiplan Commercial	$106.90
Rate for Payer: Multiplan Workers Comp	$106.90
Rate for Payer: Parkland Medicaid	$118.41
Rate for Payer: Scott and White EPO/PPO	$82.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$118.41
Rate for Payer: Superior Health Plan EPO	$22.37

Know your out-of-pocket cost for care.

All Charges