White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CATH EP FC SUPREME -- DHF

Facility

$856.43

Hospital Charge Code	82455742
Hospital Revenue Code	272
Rate for Payer: Cash Price	$582.37

CATH EP FC SUPREME -- DHF

Facility

$856.43

Hospital Charge Code	82455742
Hospital Revenue Code	272
Min. Negotiated Rate	$77.08
Max. Negotiated Rate	$616.63
Rate for Payer: Amerigroup CHIP/Medicaid	$77.08
Rate for Payer: BCBS of TX Blue Advantage	$256.93
Rate for Payer: BCBS of TX Blue Essentials	$308.31
Rate for Payer: BCBS of TX PPO	$342.57
Rate for Payer: Cash Price	$582.37
Rate for Payer: Cigna Medicaid	$616.63
Rate for Payer: Molina CHIP/Medicaid	$616.63
Rate for Payer: Multiplan Auto	$556.68
Rate for Payer: Multiplan Commercial	$556.68
Rate for Payer: Multiplan Workers Comp	$556.68
Rate for Payer: Parkland Medicaid	$616.63
Rate for Payer: Scott and White EPO/PPO	$428.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$616.63
Rate for Payer: Superior Health Plan EPO	$116.47

CATH EPIDURAL -- DHF

Facility

$705.67

Hospital Charge Code	80563430
Hospital Revenue Code	272
Min. Negotiated Rate	$63.51
Max. Negotiated Rate	$508.08
Rate for Payer: Amerigroup CHIP/Medicaid	$63.51
Rate for Payer: BCBS of TX Blue Advantage	$211.70
Rate for Payer: BCBS of TX Blue Essentials	$254.04
Rate for Payer: BCBS of TX PPO	$282.27
Rate for Payer: Cash Price	$479.86
Rate for Payer: Cigna Medicaid	$508.08
Rate for Payer: Molina CHIP/Medicaid	$508.08
Rate for Payer: Multiplan Auto	$458.69
Rate for Payer: Multiplan Commercial	$458.69
Rate for Payer: Multiplan Workers Comp	$458.69
Rate for Payer: Parkland Medicaid	$508.08
Rate for Payer: Scott and White EPO/PPO	$352.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$508.08
Rate for Payer: Superior Health Plan EPO	$95.97

CATH EPIDURAL -- DHF

Facility

$705.67

Hospital Charge Code	80563430
Hospital Revenue Code	272
Rate for Payer: Cash Price	$479.86

CATH EP LVWR STEERABLE -- DHF

Facility

$3,491.31

Hospital Charge Code	82408188
Hospital Revenue Code	272
Min. Negotiated Rate	$314.22
Max. Negotiated Rate	$2,513.74
Rate for Payer: Amerigroup CHIP/Medicaid	$314.22
Rate for Payer: BCBS of TX Blue Advantage	$1,047.39
Rate for Payer: BCBS of TX Blue Essentials	$1,256.87
Rate for Payer: BCBS of TX PPO	$1,396.52
Rate for Payer: Cash Price	$2,374.09
Rate for Payer: Cigna Medicaid	$2,513.74
Rate for Payer: Molina CHIP/Medicaid	$2,513.74
Rate for Payer: Multiplan Auto	$2,269.35
Rate for Payer: Multiplan Commercial	$2,269.35
Rate for Payer: Multiplan Workers Comp	$2,269.35
Rate for Payer: Parkland Medicaid	$2,513.74
Rate for Payer: Scott and White EPO/PPO	$1,745.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,513.74
Rate for Payer: Superior Health Plan EPO	$474.82

CATH EP LVWR STEERABLE -- DHF

Facility

$3,491.31

Hospital Charge Code	82408188
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,374.09

CATH EP STD 7FR BLAZER II

Facility

$5,335.00

Service Code	HCPCS C1730
Hospital Charge Code	109406
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.75
Max. Negotiated Rate	$2,667.50
Rate for Payer: Cash Price	$3,627.80
Rate for Payer: Cigna Commercial	$1,333.75
Rate for Payer: Multiplan Auto	$2,667.50
Rate for Payer: Multiplan Commercial	$2,667.50
Rate for Payer: Multiplan Workers Comp	$2,667.50
Rate for Payer: Scott and White EPO/PPO	$2,667.50

CATH EP STD 7FR BLAZER II

Facility

$5,335.00

Service Code	HCPCS C1730
Hospital Charge Code	109406
Hospital Revenue Code	278
Min. Negotiated Rate	$480.15
Max. Negotiated Rate	$3,841.20
Rate for Payer: Amerigroup CHIP/Medicaid	$480.15
Rate for Payer: BCBS of TX Blue Advantage	$1,600.50
Rate for Payer: BCBS of TX Blue Essentials	$1,920.60
Rate for Payer: BCBS of TX PPO	$2,134.00
Rate for Payer: Cash Price	$3,627.80
Rate for Payer: Cigna Medicaid	$3,841.20
Rate for Payer: Molina CHIP/Medicaid	$3,841.20
Rate for Payer: Multiplan Auto	$2,667.50
Rate for Payer: Multiplan Commercial	$2,667.50
Rate for Payer: Multiplan Workers Comp	$2,667.50
Rate for Payer: Parkland Medicaid	$3,841.20
Rate for Payer: Scott and White EPO/PPO	$2,667.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,841.20
Rate for Payer: Superior Health Plan EPO	$725.56

CATH EP SUPREME QUAD -- DHF

Facility

$1,804.65

Hospital Charge Code	40313553
Hospital Revenue Code	272
Min. Negotiated Rate	$162.42
Max. Negotiated Rate	$1,299.35
Rate for Payer: Amerigroup CHIP/Medicaid	$162.42
Rate for Payer: BCBS of TX Blue Advantage	$541.39
Rate for Payer: BCBS of TX Blue Essentials	$649.67
Rate for Payer: BCBS of TX PPO	$721.86
Rate for Payer: Cash Price	$1,227.16
Rate for Payer: Cigna Medicaid	$1,299.35
Rate for Payer: Molina CHIP/Medicaid	$1,299.35
Rate for Payer: Multiplan Auto	$1,173.02
Rate for Payer: Multiplan Commercial	$1,173.02
Rate for Payer: Multiplan Workers Comp	$1,173.02
Rate for Payer: Parkland Medicaid	$1,299.35
Rate for Payer: Scott and White EPO/PPO	$902.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,299.35
Rate for Payer: Superior Health Plan EPO	$245.43

CATH EP SUPREME QUAD -- DHF

Facility

$1,804.65

Hospital Charge Code	40313553
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,227.16

CATHETER, ALL-PUR. URETHRAL X-RAY RUB. 2-EYES 18FR -- DHF

Facility

$19.84

Hospital Charge Code	80412018
Hospital Revenue Code	272
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$14.28
Rate for Payer: Amerigroup CHIP/Medicaid	$1.79
Rate for Payer: BCBS of TX Blue Advantage	$5.95
Rate for Payer: BCBS of TX Blue Essentials	$7.14
Rate for Payer: BCBS of TX PPO	$7.94
Rate for Payer: Cash Price	$13.49
Rate for Payer: Cigna Medicaid	$14.28
Rate for Payer: Molina CHIP/Medicaid	$14.28
Rate for Payer: Multiplan Auto	$12.90
Rate for Payer: Multiplan Commercial	$12.90
Rate for Payer: Multiplan Workers Comp	$12.90
Rate for Payer: Parkland Medicaid	$14.28
Rate for Payer: Scott and White EPO/PPO	$9.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14.28
Rate for Payer: Superior Health Plan EPO	$2.70

CATHETER, ALL-PUR. URETHRAL X-RAY RUB. 2-EYES 18FR -- DHF

Facility

$19.84

Hospital Charge Code	80412018
Hospital Revenue Code	272
Rate for Payer: Cash Price	$13.49

catheter angio beacon tip- cook

Facility

$113.50

Hospital Charge Code	8688552
Hospital Revenue Code	272
Rate for Payer: Cash Price	$77.18

catheter angio beacon tip- cook

Facility

$113.50

Hospital Charge Code	8688552
Hospital Revenue Code	272
Min. Negotiated Rate	$10.21
Max. Negotiated Rate	$81.72
Rate for Payer: Amerigroup CHIP/Medicaid	$10.21
Rate for Payer: BCBS of TX Blue Advantage	$34.05
Rate for Payer: BCBS of TX Blue Essentials	$40.86
Rate for Payer: BCBS of TX PPO	$45.40
Rate for Payer: Cash Price	$77.18
Rate for Payer: Cigna Medicaid	$81.72
Rate for Payer: Molina CHIP/Medicaid	$81.72
Rate for Payer: Multiplan Auto	$73.78
Rate for Payer: Multiplan Commercial	$73.78
Rate for Payer: Multiplan Workers Comp	$73.78
Rate for Payer: Parkland Medicaid	$81.72
Rate for Payer: Scott and White EPO/PPO	$56.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$81.72
Rate for Payer: Superior Health Plan EPO	$15.44

CATHETER ANGIO OMNI FLSH 5FR 65CMX0.35IN

Facility

$119.86

Hospital Charge Code	106577
Hospital Revenue Code	272
Rate for Payer: Cash Price	$81.50

CATHETER ANGIO OMNI FLSH 5FR 65CMX0.35IN

Facility

$119.86

Hospital Charge Code	106577
Hospital Revenue Code	272
Min. Negotiated Rate	$10.79
Max. Negotiated Rate	$86.30
Rate for Payer: Amerigroup CHIP/Medicaid	$10.79
Rate for Payer: BCBS of TX Blue Advantage	$35.96
Rate for Payer: BCBS of TX Blue Essentials	$43.15
Rate for Payer: BCBS of TX PPO	$47.94
Rate for Payer: Cash Price	$81.50
Rate for Payer: Cigna Medicaid	$86.30
Rate for Payer: Molina CHIP/Medicaid	$86.30
Rate for Payer: Multiplan Auto	$77.91
Rate for Payer: Multiplan Commercial	$77.91
Rate for Payer: Multiplan Workers Comp	$77.91
Rate for Payer: Parkland Medicaid	$86.30
Rate for Payer: Scott and White EPO/PPO	$59.93
Rate for Payer: Superior Health Plan CHIP/Medicaid	$86.30
Rate for Payer: Superior Health Plan EPO	$16.30

CATHETER ANGIO OMNI FLUSH 6SH 5F .035 65CML

Facility

$167.98

Service Code	HCPCS C1725
Hospital Charge Code	992578
Hospital Revenue Code	272
Rate for Payer: Cash Price	$114.23

CATHETER ANGIO OMNI FLUSH 6SH 5F .035 65CML

Facility

$167.98

Service Code	HCPCS C1725
Hospital Charge Code	992578
Hospital Revenue Code	272
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$120.95
Rate for Payer: Amerigroup CHIP/Medicaid	$15.12
Rate for Payer: BCBS of TX Blue Advantage	$50.39
Rate for Payer: BCBS of TX Blue Essentials	$60.47
Rate for Payer: BCBS of TX PPO	$67.19
Rate for Payer: Cash Price	$114.23
Rate for Payer: Cigna Medicaid	$120.95
Rate for Payer: Molina CHIP/Medicaid	$120.95
Rate for Payer: Multiplan Auto	$109.19
Rate for Payer: Multiplan Commercial	$109.19
Rate for Payer: Multiplan Workers Comp	$109.19
Rate for Payer: Parkland Medicaid	$120.95
Rate for Payer: Scott and White EPO/PPO	$83.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$120.95
Rate for Payer: Superior Health Plan EPO	$22.85

CATHETER ANGIO RADL TGR 5FR 100CM

Facility

$212.47

Service Code	HCPCS C1725
Hospital Charge Code	993468
Hospital Revenue Code	272
Min. Negotiated Rate	$19.12
Max. Negotiated Rate	$152.98
Rate for Payer: Amerigroup CHIP/Medicaid	$19.12
Rate for Payer: BCBS of TX Blue Advantage	$63.74
Rate for Payer: BCBS of TX Blue Essentials	$76.49
Rate for Payer: BCBS of TX PPO	$84.99
Rate for Payer: Cash Price	$144.48
Rate for Payer: Cigna Medicaid	$152.98
Rate for Payer: Molina CHIP/Medicaid	$152.98
Rate for Payer: Multiplan Auto	$138.11
Rate for Payer: Multiplan Commercial	$138.11
Rate for Payer: Multiplan Workers Comp	$138.11
Rate for Payer: Parkland Medicaid	$152.98
Rate for Payer: Scott and White EPO/PPO	$106.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$152.98
Rate for Payer: Superior Health Plan EPO	$28.90

CATHETER ANGIO RADL TGR 5FR 100CM

Facility

$212.47

Service Code	HCPCS C1725
Hospital Charge Code	993468
Hospital Revenue Code	272
Rate for Payer: Cash Price	$144.48

CATHETER ANGIO RADL TGR 5FR OPTITORQUE

Facility

$212.47

Service Code	HCPCS C1725
Hospital Charge Code	993467
Hospital Revenue Code	272
Min. Negotiated Rate	$19.12
Max. Negotiated Rate	$152.98
Rate for Payer: Amerigroup CHIP/Medicaid	$19.12
Rate for Payer: BCBS of TX Blue Advantage	$63.74
Rate for Payer: BCBS of TX Blue Essentials	$76.49
Rate for Payer: BCBS of TX PPO	$84.99
Rate for Payer: Cash Price	$144.48
Rate for Payer: Cigna Medicaid	$152.98
Rate for Payer: Molina CHIP/Medicaid	$152.98
Rate for Payer: Multiplan Auto	$138.11
Rate for Payer: Multiplan Commercial	$138.11
Rate for Payer: Multiplan Workers Comp	$138.11
Rate for Payer: Parkland Medicaid	$152.98
Rate for Payer: Scott and White EPO/PPO	$106.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$152.98
Rate for Payer: Superior Health Plan EPO	$28.90

CATHETER ANGIO RADL TGR 5FR OPTITORQUE

Facility

$212.47

Service Code	HCPCS C1725
Hospital Charge Code	993467
Hospital Revenue Code	272
Rate for Payer: Cash Price	$144.48

CATHETER ARROW PKGD WEDGE 5 FRX 110CM

Facility

$612.90

Hospital Charge Code	145410
Hospital Revenue Code	272
Rate for Payer: Cash Price	$416.77

CATHETER ARROW PKGD WEDGE 5 FRX 110CM

Facility

$612.90

Hospital Charge Code	145410
Hospital Revenue Code	272
Min. Negotiated Rate	$55.16
Max. Negotiated Rate	$441.29
Rate for Payer: Amerigroup CHIP/Medicaid	$55.16
Rate for Payer: BCBS of TX Blue Advantage	$183.87
Rate for Payer: BCBS of TX Blue Essentials	$220.64
Rate for Payer: BCBS of TX PPO	$245.16
Rate for Payer: Cash Price	$416.77
Rate for Payer: Cigna Medicaid	$441.29
Rate for Payer: Molina CHIP/Medicaid	$441.29
Rate for Payer: Multiplan Auto	$398.38
Rate for Payer: Multiplan Commercial	$398.38
Rate for Payer: Multiplan Workers Comp	$398.38
Rate for Payer: Parkland Medicaid	$441.29
Rate for Payer: Scott and White EPO/PPO	$306.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$441.29
Rate for Payer: Superior Health Plan EPO	$83.35

CATHETER ART 7FR 110CM 4 LUM TD SG

Facility

$317.80

Hospital Charge Code	80567654
Hospital Revenue Code	272
Min. Negotiated Rate	$28.60
Max. Negotiated Rate	$228.82
Rate for Payer: Amerigroup CHIP/Medicaid	$28.60
Rate for Payer: BCBS of TX Blue Advantage	$95.34
Rate for Payer: BCBS of TX Blue Essentials	$114.41
Rate for Payer: BCBS of TX PPO	$127.12
Rate for Payer: Cash Price	$216.10
Rate for Payer: Cigna Medicaid	$228.82
Rate for Payer: Molina CHIP/Medicaid	$228.82
Rate for Payer: Multiplan Auto	$206.57
Rate for Payer: Multiplan Commercial	$206.57
Rate for Payer: Multiplan Workers Comp	$206.57
Rate for Payer: Parkland Medicaid	$228.82
Rate for Payer: Scott and White EPO/PPO	$158.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$228.82
Rate for Payer: Superior Health Plan EPO	$43.22

Know your out-of-pocket cost for care.

All Charges