White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CATH BLN VENOGRAM -- DHF

Facility

$423.49

Hospital Charge Code	80561012
Hospital Revenue Code	272
Rate for Payer: Cash Price	$287.97

CATH BLN VENOGRAM -- DHF

Facility

$423.49

Hospital Charge Code	80561012
Hospital Revenue Code	272
Min. Negotiated Rate	$38.11
Max. Negotiated Rate	$304.91
Rate for Payer: Amerigroup CHIP/Medicaid	$38.11
Rate for Payer: BCBS of TX Blue Advantage	$127.05
Rate for Payer: BCBS of TX Blue Essentials	$152.46
Rate for Payer: BCBS of TX PPO	$169.40
Rate for Payer: Cash Price	$287.97
Rate for Payer: Cigna Medicaid	$304.91
Rate for Payer: Molina CHIP/Medicaid	$304.91
Rate for Payer: Multiplan Auto	$275.27
Rate for Payer: Multiplan Commercial	$275.27
Rate for Payer: Multiplan Workers Comp	$275.27
Rate for Payer: Parkland Medicaid	$304.91
Rate for Payer: Scott and White EPO/PPO	$211.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$304.91
Rate for Payer: Superior Health Plan EPO	$57.59

CATH CARD F-S B -- DHF

Facility

$813.75

Hospital Charge Code	80561657
Hospital Revenue Code	272
Rate for Payer: Cash Price	$553.35

CATH CARD F-S B -- DHF

Facility

$813.75

Hospital Charge Code	80561657
Hospital Revenue Code	272
Min. Negotiated Rate	$73.24
Max. Negotiated Rate	$585.90
Rate for Payer: Amerigroup CHIP/Medicaid	$73.24
Rate for Payer: BCBS of TX Blue Advantage	$244.12
Rate for Payer: BCBS of TX Blue Essentials	$292.95
Rate for Payer: BCBS of TX PPO	$325.50
Rate for Payer: Cash Price	$553.35
Rate for Payer: Cigna Medicaid	$585.90
Rate for Payer: Molina CHIP/Medicaid	$585.90
Rate for Payer: Multiplan Auto	$528.94
Rate for Payer: Multiplan Commercial	$528.94
Rate for Payer: Multiplan Workers Comp	$528.94
Rate for Payer: Parkland Medicaid	$585.90
Rate for Payer: Scott and White EPO/PPO	$406.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$585.90
Rate for Payer: Superior Health Plan EPO	$110.67

CATH CARD INFUSN -- DHF

Facility

$881.41

Hospital Charge Code	80561905
Hospital Revenue Code	272
Min. Negotiated Rate	$79.33
Max. Negotiated Rate	$634.62
Rate for Payer: Amerigroup CHIP/Medicaid	$79.33
Rate for Payer: BCBS of TX Blue Advantage	$264.42
Rate for Payer: BCBS of TX Blue Essentials	$317.31
Rate for Payer: BCBS of TX PPO	$352.56
Rate for Payer: Cash Price	$599.36
Rate for Payer: Cigna Medicaid	$634.62
Rate for Payer: Molina CHIP/Medicaid	$634.62
Rate for Payer: Multiplan Auto	$572.92
Rate for Payer: Multiplan Commercial	$572.92
Rate for Payer: Multiplan Workers Comp	$572.92
Rate for Payer: Parkland Medicaid	$634.62
Rate for Payer: Scott and White EPO/PPO	$440.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$634.62
Rate for Payer: Superior Health Plan EPO	$119.87

CATH CARD INFUSN -- DHF

Facility

$881.41

Hospital Charge Code	80561905
Hospital Revenue Code	272
Rate for Payer: Cash Price	$599.36

CATH CARD SON AB -- DHF

Facility

$8,381.62

Hospital Charge Code	80562705
Hospital Revenue Code	272
Min. Negotiated Rate	$754.35
Max. Negotiated Rate	$6,034.77
Rate for Payer: Amerigroup CHIP/Medicaid	$754.35
Rate for Payer: BCBS of TX Blue Advantage	$2,514.49
Rate for Payer: BCBS of TX Blue Essentials	$3,017.38
Rate for Payer: BCBS of TX PPO	$3,352.65
Rate for Payer: Cash Price	$5,699.50
Rate for Payer: Cigna Medicaid	$6,034.77
Rate for Payer: Molina CHIP/Medicaid	$6,034.77
Rate for Payer: Multiplan Auto	$5,448.05
Rate for Payer: Multiplan Commercial	$5,448.05
Rate for Payer: Multiplan Workers Comp	$5,448.05
Rate for Payer: Parkland Medicaid	$6,034.77
Rate for Payer: Scott and White EPO/PPO	$4,190.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,034.77
Rate for Payer: Superior Health Plan EPO	$1,139.90

CATH CARD SON AB -- DHF

Facility

$8,381.62

Hospital Charge Code	80562705
Hospital Revenue Code	272
Rate for Payer: Cash Price	$5,699.50

CATH CEREBRAL -- DHF

Facility

$72.64

Hospital Charge Code	80563216
Hospital Revenue Code	272
Rate for Payer: Cash Price	$49.40

CATH CEREBRAL -- DHF

Facility

$72.64

Hospital Charge Code	80563216
Hospital Revenue Code	272
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$52.30
Rate for Payer: Amerigroup CHIP/Medicaid	$6.54
Rate for Payer: BCBS of TX Blue Advantage	$21.79
Rate for Payer: BCBS of TX Blue Essentials	$26.15
Rate for Payer: BCBS of TX PPO	$29.06
Rate for Payer: Cash Price	$49.40
Rate for Payer: Cigna Medicaid	$52.30
Rate for Payer: Molina CHIP/Medicaid	$52.30
Rate for Payer: Multiplan Auto	$47.22
Rate for Payer: Multiplan Commercial	$47.22
Rate for Payer: Multiplan Workers Comp	$47.22
Rate for Payer: Parkland Medicaid	$52.30
Rate for Payer: Scott and White EPO/PPO	$36.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$52.30
Rate for Payer: Superior Health Plan EPO	$9.88

CATH CHOLANG A/S -- DHF

Facility

$117.99

Hospital Charge Code	80315906
Hospital Revenue Code	272
Rate for Payer: Cash Price	$80.23

CATH CHOLANG A/S -- DHF

Facility

$117.99

Hospital Charge Code	80315906
Hospital Revenue Code	272
Min. Negotiated Rate	$10.62
Max. Negotiated Rate	$84.95
Rate for Payer: Amerigroup CHIP/Medicaid	$10.62
Rate for Payer: BCBS of TX Blue Advantage	$35.40
Rate for Payer: BCBS of TX Blue Essentials	$42.48
Rate for Payer: BCBS of TX PPO	$47.20
Rate for Payer: Cash Price	$80.23
Rate for Payer: Cigna Medicaid	$84.95
Rate for Payer: Molina CHIP/Medicaid	$84.95
Rate for Payer: Multiplan Auto	$76.69
Rate for Payer: Multiplan Commercial	$76.69
Rate for Payer: Multiplan Workers Comp	$76.69
Rate for Payer: Parkland Medicaid	$84.95
Rate for Payer: Scott and White EPO/PPO	$58.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$84.95
Rate for Payer: Superior Health Plan EPO	$16.05

CATH CHOLNG -- DHF

Facility

$1,499.40

Hospital Charge Code	80563455
Hospital Revenue Code	272
Min. Negotiated Rate	$134.95
Max. Negotiated Rate	$1,079.57
Rate for Payer: Amerigroup CHIP/Medicaid	$134.95
Rate for Payer: BCBS of TX Blue Advantage	$449.82
Rate for Payer: BCBS of TX Blue Essentials	$539.78
Rate for Payer: BCBS of TX PPO	$599.76
Rate for Payer: Cash Price	$1,019.59
Rate for Payer: Cigna Medicaid	$1,079.57
Rate for Payer: Molina CHIP/Medicaid	$1,079.57
Rate for Payer: Multiplan Auto	$974.61
Rate for Payer: Multiplan Commercial	$974.61
Rate for Payer: Multiplan Workers Comp	$974.61
Rate for Payer: Parkland Medicaid	$1,079.57
Rate for Payer: Scott and White EPO/PPO	$749.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,079.57
Rate for Payer: Superior Health Plan EPO	$203.92

CATH CHOLNG -- DHF

Facility

$1,499.40

Hospital Charge Code	80563455
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,019.59

CATH COUDE ALL -- DHF

Facility

$546.91

Hospital Charge Code	80411002
Hospital Revenue Code	272
Min. Negotiated Rate	$49.22
Max. Negotiated Rate	$393.78
Rate for Payer: Amerigroup CHIP/Medicaid	$49.22
Rate for Payer: BCBS of TX Blue Advantage	$164.07
Rate for Payer: BCBS of TX Blue Essentials	$196.89
Rate for Payer: BCBS of TX PPO	$218.76
Rate for Payer: Cash Price	$371.90
Rate for Payer: Cigna Medicaid	$393.78
Rate for Payer: Molina CHIP/Medicaid	$393.78
Rate for Payer: Multiplan Auto	$355.49
Rate for Payer: Multiplan Commercial	$355.49
Rate for Payer: Multiplan Workers Comp	$355.49
Rate for Payer: Parkland Medicaid	$393.78
Rate for Payer: Scott and White EPO/PPO	$273.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$393.78
Rate for Payer: Superior Health Plan EPO	$74.38

CATH COUDE ALL -- DHF

Facility

$546.91

Hospital Charge Code	80411002
Hospital Revenue Code	272
Rate for Payer: Cash Price	$371.90

CATH DIAG ELECT TORQR -- DHF

Facility

$652.60

Hospital Charge Code	82407784
Hospital Revenue Code	272
Min. Negotiated Rate	$58.73
Max. Negotiated Rate	$469.87
Rate for Payer: Amerigroup CHIP/Medicaid	$58.73
Rate for Payer: BCBS of TX Blue Advantage	$195.78
Rate for Payer: BCBS of TX Blue Essentials	$234.94
Rate for Payer: BCBS of TX PPO	$261.04
Rate for Payer: Cash Price	$443.77
Rate for Payer: Cigna Medicaid	$469.87
Rate for Payer: Molina CHIP/Medicaid	$469.87
Rate for Payer: Multiplan Auto	$424.19
Rate for Payer: Multiplan Commercial	$424.19
Rate for Payer: Multiplan Workers Comp	$424.19
Rate for Payer: Parkland Medicaid	$469.87
Rate for Payer: Scott and White EPO/PPO	$326.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$469.87
Rate for Payer: Superior Health Plan EPO	$88.75

CATH DIAG ELECT TORQR -- DHF

Facility

$652.60

Hospital Charge Code	82407784
Hospital Revenue Code	272
Rate for Payer: Cash Price	$443.77

CATH DIALYS HEMO -- DHF

Facility

$2,210.51

Hospital Charge Code	80563901
Hospital Revenue Code	272
Min. Negotiated Rate	$198.95
Max. Negotiated Rate	$1,591.57
Rate for Payer: Amerigroup CHIP/Medicaid	$198.95
Rate for Payer: BCBS of TX Blue Advantage	$663.15
Rate for Payer: BCBS of TX Blue Essentials	$795.78
Rate for Payer: BCBS of TX PPO	$884.20
Rate for Payer: Cash Price	$1,503.15
Rate for Payer: Cigna Medicaid	$1,591.57
Rate for Payer: Molina CHIP/Medicaid	$1,591.57
Rate for Payer: Multiplan Auto	$1,436.83
Rate for Payer: Multiplan Commercial	$1,436.83
Rate for Payer: Multiplan Workers Comp	$1,436.83
Rate for Payer: Parkland Medicaid	$1,591.57
Rate for Payer: Scott and White EPO/PPO	$1,105.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,591.57
Rate for Payer: Superior Health Plan EPO	$300.63

CATH DIALYS HEMO -- DHF

Facility

$2,210.51

Hospital Charge Code	80563901
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,503.15

CATH DIAMOND BACK SYS-CLASSIC DBP-EX-150CLA145

Facility

$16,775.30

Hospital Charge Code	145241
Hospital Revenue Code	272
Min. Negotiated Rate	$1,509.78
Max. Negotiated Rate	$12,078.22
Rate for Payer: Amerigroup CHIP/Medicaid	$1,509.78
Rate for Payer: BCBS of TX Blue Advantage	$5,032.59
Rate for Payer: BCBS of TX Blue Essentials	$6,039.11
Rate for Payer: BCBS of TX PPO	$6,710.12
Rate for Payer: Cash Price	$11,407.20
Rate for Payer: Cigna Medicaid	$12,078.22
Rate for Payer: Molina CHIP/Medicaid	$12,078.22
Rate for Payer: Multiplan Auto	$10,903.94
Rate for Payer: Multiplan Commercial	$10,903.94
Rate for Payer: Multiplan Workers Comp	$10,903.94
Rate for Payer: Parkland Medicaid	$12,078.22
Rate for Payer: Scott and White EPO/PPO	$8,387.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,078.22
Rate for Payer: Superior Health Plan EPO	$2,281.44

CATH DIAMOND BACK SYS-CLASSIC DBP-EX-150CLA145

Facility

$16,775.30

Hospital Charge Code	145241
Hospital Revenue Code	272
Rate for Payer: Cash Price	$11,407.20

CATH DIAMOND BACK SYS-CLASSIC DBP-EX-200CLA145

Facility

$16,775.30

Hospital Charge Code	145242
Hospital Revenue Code	272
Rate for Payer: Cash Price	$11,407.20

CATH DIAMOND BACK SYS-CLASSIC DBP-EX-200CLA145

Facility

$16,775.30

Hospital Charge Code	145242
Hospital Revenue Code	272
Min. Negotiated Rate	$1,509.78
Max. Negotiated Rate	$12,078.22
Rate for Payer: Amerigroup CHIP/Medicaid	$1,509.78
Rate for Payer: BCBS of TX Blue Advantage	$5,032.59
Rate for Payer: BCBS of TX Blue Essentials	$6,039.11
Rate for Payer: BCBS of TX PPO	$6,710.12
Rate for Payer: Cash Price	$11,407.20
Rate for Payer: Cigna Medicaid	$12,078.22
Rate for Payer: Molina CHIP/Medicaid	$12,078.22
Rate for Payer: Multiplan Auto	$10,903.94
Rate for Payer: Multiplan Commercial	$10,903.94
Rate for Payer: Multiplan Workers Comp	$10,903.94
Rate for Payer: Parkland Medicaid	$12,078.22
Rate for Payer: Scott and White EPO/PPO	$8,387.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,078.22
Rate for Payer: Superior Health Plan EPO	$2,281.44

CATH DIAMONDBACK SYS-SOLID DBP-EX-125SOL145

Facility

$16,775.30

Hospital Charge Code	145243
Hospital Revenue Code	272
Min. Negotiated Rate	$1,509.78
Max. Negotiated Rate	$12,078.22
Rate for Payer: Amerigroup CHIP/Medicaid	$1,509.78
Rate for Payer: BCBS of TX Blue Advantage	$5,032.59
Rate for Payer: BCBS of TX Blue Essentials	$6,039.11
Rate for Payer: BCBS of TX PPO	$6,710.12
Rate for Payer: Cash Price	$11,407.20
Rate for Payer: Cigna Medicaid	$12,078.22
Rate for Payer: Molina CHIP/Medicaid	$12,078.22
Rate for Payer: Multiplan Auto	$10,903.94
Rate for Payer: Multiplan Commercial	$10,903.94
Rate for Payer: Multiplan Workers Comp	$10,903.94
Rate for Payer: Parkland Medicaid	$12,078.22
Rate for Payer: Scott and White EPO/PPO	$8,387.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,078.22
Rate for Payer: Superior Health Plan EPO	$2,281.44

Know your out-of-pocket cost for care.

All Charges