White Rock Medical Center

All Charges

Charge

Type

Setting

Price

STAPLER, INTERNAL LINEAR TITANIUM 90MM RELOADABLE -- DHF

Facility

$2,468.09

Hospital Charge Code	81910200
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,678.30

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	$1,777.02
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	$1,678.30
Rate for Payer: Cigna Medicaid	$1,777.02
Rate for Payer: Molina CHIP/Medicaid	$1,777.02
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: Parkland Medicaid	$1,777.02
Rate for Payer: Scott and White EPO/PPO	$1,234.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,777.02
Rate for Payer: Superior Health Plan EPO	$335.66

STAPLER, LINEAR, RELOAD, REG, BLUE, 30

Facility

$189.53

Hospital Charge Code	992333
Hospital Revenue Code	272
Min. Negotiated Rate	$17.06
Max. Negotiated Rate	$136.46
Rate for Payer: Amerigroup CHIP/Medicaid	$17.06
Rate for Payer: BCBS of TX Blue Advantage	$56.86
Rate for Payer: BCBS of TX Blue Essentials	$68.23
Rate for Payer: BCBS of TX PPO	$75.81
Rate for Payer: Cash Price	$128.88
Rate for Payer: Cigna Medicaid	$136.46
Rate for Payer: Molina CHIP/Medicaid	$136.46
Rate for Payer: Multiplan Auto	$123.19
Rate for Payer: Multiplan Commercial	$123.19
Rate for Payer: Multiplan Workers Comp	$123.19
Rate for Payer: Parkland Medicaid	$136.46
Rate for Payer: Scott and White EPO/PPO	$94.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$136.46
Rate for Payer: Superior Health Plan EPO	$25.78

STAPLER, LINEAR, RELOAD, REG, BLUE, 30

Facility

$189.53

Hospital Charge Code	992333
Hospital Revenue Code	272
Rate for Payer: Cash Price	$128.88

STAPLERS: Endo Gla articulating stapler device, medium staple, tan 60mm

Facility

$1,033.78

Hospital Charge Code	992799
Hospital Revenue Code	272
Min. Negotiated Rate	$93.04
Max. Negotiated Rate	$744.32
Rate for Payer: Amerigroup CHIP/Medicaid	$93.04
Rate for Payer: BCBS of TX Blue Advantage	$310.13
Rate for Payer: BCBS of TX Blue Essentials	$372.16
Rate for Payer: BCBS of TX PPO	$413.51
Rate for Payer: Cash Price	$702.97
Rate for Payer: Cigna Medicaid	$744.32
Rate for Payer: Molina CHIP/Medicaid	$744.32
Rate for Payer: Multiplan Auto	$671.96
Rate for Payer: Multiplan Commercial	$671.96
Rate for Payer: Multiplan Workers Comp	$671.96
Rate for Payer: Parkland Medicaid	$744.32
Rate for Payer: Scott and White EPO/PPO	$516.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$744.32
Rate for Payer: Superior Health Plan EPO	$140.59

STAPLERS: Endo Gla articulating stapler device, medium staple, tan 60mm

Facility

$1,033.78

Hospital Charge Code	992799
Hospital Revenue Code	272
Rate for Payer: Cash Price	$702.97

STAPLER SKIN INSORB STERILE

Facility

$272.36

Hospital Charge Code	144265
Hospital Revenue Code	272
Min. Negotiated Rate	$24.51
Max. Negotiated Rate	$196.10
Rate for Payer: Amerigroup CHIP/Medicaid	$24.51
Rate for Payer: BCBS of TX Blue Advantage	$81.71
Rate for Payer: BCBS of TX Blue Essentials	$98.05
Rate for Payer: BCBS of TX PPO	$108.94
Rate for Payer: Cash Price	$185.20
Rate for Payer: Cigna Medicaid	$196.10
Rate for Payer: Molina CHIP/Medicaid	$196.10
Rate for Payer: Multiplan Auto	$177.03
Rate for Payer: Multiplan Commercial	$177.03
Rate for Payer: Multiplan Workers Comp	$177.03
Rate for Payer: Parkland Medicaid	$196.10
Rate for Payer: Scott and White EPO/PPO	$136.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$196.10
Rate for Payer: Superior Health Plan EPO	$37.04

STAPLER SKIN INSORB STERILE

Facility

$272.36

Hospital Charge Code	144265
Hospital Revenue Code	272
Rate for Payer: Cash Price	$185.20

STAPLER TITAN

Facility

$3,178.00

Hospital Charge Code	146658
Hospital Revenue Code	272
Min. Negotiated Rate	$286.02
Max. Negotiated Rate	$2,288.16
Rate for Payer: Amerigroup CHIP/Medicaid	$286.02
Rate for Payer: BCBS of TX Blue Advantage	$953.40
Rate for Payer: BCBS of TX Blue Essentials	$1,144.08
Rate for Payer: BCBS of TX PPO	$1,271.20
Rate for Payer: Cash Price	$2,161.04
Rate for Payer: Cigna Medicaid	$2,288.16
Rate for Payer: Molina CHIP/Medicaid	$2,288.16
Rate for Payer: Multiplan Auto	$2,065.70
Rate for Payer: Multiplan Commercial	$2,065.70
Rate for Payer: Multiplan Workers Comp	$2,065.70
Rate for Payer: Parkland Medicaid	$2,288.16
Rate for Payer: Scott and White EPO/PPO	$1,589.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,288.16
Rate for Payer: Superior Health Plan EPO	$432.21

STAPLER TITAN

Facility

$3,178.00

Hospital Charge Code	146658
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,161.04

STAPLER UNIVERSAL EGIAUXL

Facility

$798.31

Hospital Charge Code	8720617
Hospital Revenue Code	272
Rate for Payer: Cash Price	$542.85

STAPLER UNIVERSAL EGIAUXL

Facility

$798.31

Hospital Charge Code	8720617
Hospital Revenue Code	272
Min. Negotiated Rate	$71.85
Max. Negotiated Rate	$574.78
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	$542.85
Rate for Payer: Cigna Medicaid	$574.78
Rate for Payer: Molina CHIP/Medicaid	$574.78
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: Parkland Medicaid	$574.78
Rate for Payer: Scott and White EPO/PPO	$399.15
Rate for Payer: Superior Health Plan CHIP/Medicaid	$574.78
Rate for Payer: Superior Health Plan EPO	$108.57

STAPLE SIZER FUSEFORCE

Facility

$1,222.89

Hospital Charge Code	992129
Hospital Revenue Code	272
Rate for Payer: Cash Price	$831.57

STAPLE SIZER FUSEFORCE

Facility

$1,222.89

Hospital Charge Code	992129
Hospital Revenue Code	272
Min. Negotiated Rate	$110.06
Max. Negotiated Rate	$880.48
Rate for Payer: Amerigroup CHIP/Medicaid	$110.06
Rate for Payer: BCBS of TX Blue Advantage	$366.87
Rate for Payer: BCBS of TX Blue Essentials	$440.24
Rate for Payer: BCBS of TX PPO	$489.16
Rate for Payer: Cash Price	$831.57
Rate for Payer: Cigna Medicaid	$880.48
Rate for Payer: Molina CHIP/Medicaid	$880.48
Rate for Payer: Multiplan Auto	$794.88
Rate for Payer: Multiplan Commercial	$794.88
Rate for Payer: Multiplan Workers Comp	$794.88
Rate for Payer: Parkland Medicaid	$880.48
Rate for Payer: Scott and White EPO/PPO	$611.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$880.48
Rate for Payer: Superior Health Plan EPO	$166.31

Start Kit

Facility

$3.48

Hospital Charge Code	993839
Hospital Revenue Code	270
Rate for Payer: Cash Price	$2.37

Start Kit

Facility

$3.48

Hospital Charge Code	993839
Hospital Revenue Code	270
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$2.51
Rate for Payer: Amerigroup CHIP/Medicaid	$0.31
Rate for Payer: BCBS of TX Blue Advantage	$1.04
Rate for Payer: BCBS of TX Blue Essentials	$1.25
Rate for Payer: BCBS of TX PPO	$1.39
Rate for Payer: Cash Price	$2.37
Rate for Payer: Cigna Medicaid	$2.51
Rate for Payer: Molina CHIP/Medicaid	$2.51
Rate for Payer: Multiplan Auto	$2.26
Rate for Payer: Multiplan Commercial	$2.26
Rate for Payer: Multiplan Workers Comp	$2.26
Rate for Payer: Parkland Medicaid	$2.51
Rate for Payer: Scott and White EPO/PPO	$1.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.51
Rate for Payer: Superior Health Plan EPO	$0.47

ST ART PUNCTURE -- DHF

Facility

$764.34

Hospital Charge Code	80826753
Hospital Revenue Code	272
Min. Negotiated Rate	$68.79
Max. Negotiated Rate	$550.32
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	$519.75
Rate for Payer: Cigna Medicaid	$550.32
Rate for Payer: Molina CHIP/Medicaid	$550.32
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: Parkland Medicaid	$550.32
Rate for Payer: Scott and White EPO/PPO	$382.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$550.32
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	$519.75

STATIC STRUT - EXTRA SHORT - LENGTH: 20 mm

Facility

$304.18

Hospital Charge Code	993423
Hospital Revenue Code	272
Rate for Payer: Cash Price	$206.84

STATIC STRUT - EXTRA SHORT - LENGTH: 20 mm

Facility

$304.18

Hospital Charge Code	993423
Hospital Revenue Code	272
Min. Negotiated Rate	$27.38
Max. Negotiated Rate	$219.01
Rate for Payer: Amerigroup CHIP/Medicaid	$27.38
Rate for Payer: BCBS of TX Blue Advantage	$91.25
Rate for Payer: BCBS of TX Blue Essentials	$109.50
Rate for Payer: BCBS of TX PPO	$121.67
Rate for Payer: Cash Price	$206.84
Rate for Payer: Cigna Medicaid	$219.01
Rate for Payer: Molina CHIP/Medicaid	$219.01
Rate for Payer: Multiplan Auto	$197.72
Rate for Payer: Multiplan Commercial	$197.72
Rate for Payer: Multiplan Workers Comp	$197.72
Rate for Payer: Parkland Medicaid	$219.01
Rate for Payer: Scott and White EPO/PPO	$152.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$219.01
Rate for Payer: Superior Health Plan EPO	$41.37

STATIC STRUT - LONG - LENGTH: 60 mm

Facility

$385.90

Hospital Charge Code	993424
Hospital Revenue Code	272
Rate for Payer: Cash Price	$262.41

STATIC STRUT - LONG - LENGTH: 60 mm

Facility

$385.90

Hospital Charge Code	993424
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

STATLOCK,SWIVEL TRICOT-ORDR QTY 25

Facility

$27.90

Hospital Charge Code	993088
Hospital Revenue Code	270
Rate for Payer: Cash Price	$18.97

STATLOCK,SWIVEL TRICOT-ORDR QTY 25

Facility

$27.90

Hospital Charge Code	993088
Hospital Revenue Code	270
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$20.09
Rate for Payer: Amerigroup CHIP/Medicaid	$2.51
Rate for Payer: BCBS of TX Blue Advantage	$8.37
Rate for Payer: BCBS of TX Blue Essentials	$10.04
Rate for Payer: BCBS of TX PPO	$11.16
Rate for Payer: Cash Price	$18.97
Rate for Payer: Cigna Medicaid	$20.09
Rate for Payer: Molina CHIP/Medicaid	$20.09
Rate for Payer: Multiplan Auto	$18.14
Rate for Payer: Multiplan Commercial	$18.14
Rate for Payer: Multiplan Workers Comp	$18.14
Rate for Payer: Parkland Medicaid	$20.09
Rate for Payer: Scott and White EPO/PPO	$13.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$20.09
Rate for Payer: Superior Health Plan EPO	$3.79

ST BLD FENWAL -- DHF

Facility

$379.76

Hospital Charge Code	54201116
Hospital Revenue Code	270
Rate for Payer: Cash Price	$258.24

Know your out-of-pocket cost for care.

All Charges