White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CATHETER BLN PASSEO-18 3X200X130

Facility

$499.40

Hospital Charge Code	145695
Hospital Revenue Code	272
Min. Negotiated Rate	$44.95
Max. Negotiated Rate	$359.57
Rate for Payer: Amerigroup CHIP/Medicaid	$44.95
Rate for Payer: BCBS of TX Blue Advantage	$149.82
Rate for Payer: BCBS of TX Blue Essentials	$179.78
Rate for Payer: BCBS of TX PPO	$199.76
Rate for Payer: Cash Price	$339.59
Rate for Payer: Cigna Medicaid	$359.57
Rate for Payer: Molina CHIP/Medicaid	$359.57
Rate for Payer: Multiplan Auto	$324.61
Rate for Payer: Multiplan Commercial	$324.61
Rate for Payer: Multiplan Workers Comp	$324.61
Rate for Payer: Parkland Medicaid	$359.57
Rate for Payer: Scott and White EPO/PPO	$249.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$359.57
Rate for Payer: Superior Health Plan EPO	$67.92

CATHETER BLN PASSEO-18 3X80X130

Facility

$499.40

Hospital Charge Code	145697
Hospital Revenue Code	272
Rate for Payer: Cash Price	$339.59

CATHETER BLN PASSEO-18 3X80X130

Facility

$499.40

Hospital Charge Code	145697
Hospital Revenue Code	272
Min. Negotiated Rate	$44.95
Max. Negotiated Rate	$359.57
Rate for Payer: Amerigroup CHIP/Medicaid	$44.95
Rate for Payer: BCBS of TX Blue Advantage	$149.82
Rate for Payer: BCBS of TX Blue Essentials	$179.78
Rate for Payer: BCBS of TX PPO	$199.76
Rate for Payer: Cash Price	$339.59
Rate for Payer: Cigna Medicaid	$359.57
Rate for Payer: Molina CHIP/Medicaid	$359.57
Rate for Payer: Multiplan Auto	$324.61
Rate for Payer: Multiplan Commercial	$324.61
Rate for Payer: Multiplan Workers Comp	$324.61
Rate for Payer: Parkland Medicaid	$359.57
Rate for Payer: Scott and White EPO/PPO	$249.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$359.57
Rate for Payer: Superior Health Plan EPO	$67.92

CATHETER BLN PASSEO-18 4X120X130

Facility

$499.40

Hospital Charge Code	145698
Hospital Revenue Code	272
Rate for Payer: Cash Price	$339.59

CATHETER BLN PASSEO-18 4X120X130

Facility

$499.40

Hospital Charge Code	145698
Hospital Revenue Code	272
Min. Negotiated Rate	$44.95
Max. Negotiated Rate	$359.57
Rate for Payer: Amerigroup CHIP/Medicaid	$44.95
Rate for Payer: BCBS of TX Blue Advantage	$149.82
Rate for Payer: BCBS of TX Blue Essentials	$179.78
Rate for Payer: BCBS of TX PPO	$199.76
Rate for Payer: Cash Price	$339.59
Rate for Payer: Cigna Medicaid	$359.57
Rate for Payer: Molina CHIP/Medicaid	$359.57
Rate for Payer: Multiplan Auto	$324.61
Rate for Payer: Multiplan Commercial	$324.61
Rate for Payer: Multiplan Workers Comp	$324.61
Rate for Payer: Parkland Medicaid	$359.57
Rate for Payer: Scott and White EPO/PPO	$249.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$359.57
Rate for Payer: Superior Health Plan EPO	$67.92

CATHETER BLN PASSEO-18 4X150X130

Facility

$499.40

Hospital Charge Code	145699
Hospital Revenue Code	272
Min. Negotiated Rate	$44.95
Max. Negotiated Rate	$359.57
Rate for Payer: Amerigroup CHIP/Medicaid	$44.95
Rate for Payer: BCBS of TX Blue Advantage	$149.82
Rate for Payer: BCBS of TX Blue Essentials	$179.78
Rate for Payer: BCBS of TX PPO	$199.76
Rate for Payer: Cash Price	$339.59
Rate for Payer: Cigna Medicaid	$359.57
Rate for Payer: Molina CHIP/Medicaid	$359.57
Rate for Payer: Multiplan Auto	$324.61
Rate for Payer: Multiplan Commercial	$324.61
Rate for Payer: Multiplan Workers Comp	$324.61
Rate for Payer: Parkland Medicaid	$359.57
Rate for Payer: Scott and White EPO/PPO	$249.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$359.57
Rate for Payer: Superior Health Plan EPO	$67.92

CATHETER BLN PASSEO-18 4X150X130

Facility

$499.40

Hospital Charge Code	145699
Hospital Revenue Code	272
Rate for Payer: Cash Price	$339.59

CATHETER BLN PASSEO-18 4X170X130

Facility

$499.40

Hospital Charge Code	145700
Hospital Revenue Code	272
Min. Negotiated Rate	$44.95
Max. Negotiated Rate	$359.57
Rate for Payer: Amerigroup CHIP/Medicaid	$44.95
Rate for Payer: BCBS of TX Blue Advantage	$149.82
Rate for Payer: BCBS of TX Blue Essentials	$179.78
Rate for Payer: BCBS of TX PPO	$199.76
Rate for Payer: Cash Price	$339.59
Rate for Payer: Cigna Medicaid	$359.57
Rate for Payer: Molina CHIP/Medicaid	$359.57
Rate for Payer: Multiplan Auto	$324.61
Rate for Payer: Multiplan Commercial	$324.61
Rate for Payer: Multiplan Workers Comp	$324.61
Rate for Payer: Parkland Medicaid	$359.57
Rate for Payer: Scott and White EPO/PPO	$249.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$359.57
Rate for Payer: Superior Health Plan EPO	$67.92

CATHETER BLN PASSEO-18 4X170X130

Facility

$499.40

Hospital Charge Code	145700
Hospital Revenue Code	272
Rate for Payer: Cash Price	$339.59

CATHETER BLN PASSEO-18 4X200X130

Facility

$499.40

Hospital Charge Code	145701
Hospital Revenue Code	272
Min. Negotiated Rate	$44.95
Max. Negotiated Rate	$359.57
Rate for Payer: Amerigroup CHIP/Medicaid	$44.95
Rate for Payer: BCBS of TX Blue Advantage	$149.82
Rate for Payer: BCBS of TX Blue Essentials	$179.78
Rate for Payer: BCBS of TX PPO	$199.76
Rate for Payer: Cash Price	$339.59
Rate for Payer: Cigna Medicaid	$359.57
Rate for Payer: Molina CHIP/Medicaid	$359.57
Rate for Payer: Multiplan Auto	$324.61
Rate for Payer: Multiplan Commercial	$324.61
Rate for Payer: Multiplan Workers Comp	$324.61
Rate for Payer: Parkland Medicaid	$359.57
Rate for Payer: Scott and White EPO/PPO	$249.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$359.57
Rate for Payer: Superior Health Plan EPO	$67.92

CATHETER BLN PASSEO-18 4X200X130

Facility

$499.40

Hospital Charge Code	145701
Hospital Revenue Code	272
Rate for Payer: Cash Price	$339.59

CATHETER BLN PASSEO-18 PTA- OTW

Facility

$499.40

Hospital Charge Code	145599
Hospital Revenue Code	272
Min. Negotiated Rate	$44.95
Max. Negotiated Rate	$359.57
Rate for Payer: Amerigroup CHIP/Medicaid	$44.95
Rate for Payer: BCBS of TX Blue Advantage	$149.82
Rate for Payer: BCBS of TX Blue Essentials	$179.78
Rate for Payer: BCBS of TX PPO	$199.76
Rate for Payer: Cash Price	$339.59
Rate for Payer: Cigna Medicaid	$359.57
Rate for Payer: Molina CHIP/Medicaid	$359.57
Rate for Payer: Multiplan Auto	$324.61
Rate for Payer: Multiplan Commercial	$324.61
Rate for Payer: Multiplan Workers Comp	$324.61
Rate for Payer: Parkland Medicaid	$359.57
Rate for Payer: Scott and White EPO/PPO	$249.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$359.57
Rate for Payer: Superior Health Plan EPO	$67.92

CATHETER BLN PASSEO-18 PTA- OTW

Facility

$499.40

Hospital Charge Code	145599
Hospital Revenue Code	272
Rate for Payer: Cash Price	$339.59

CATHETER BLN PASSEO-35 5X120X130

Facility

$499.40

Hospital Charge Code	145468
Hospital Revenue Code	272
Min. Negotiated Rate	$44.95
Max. Negotiated Rate	$359.57
Rate for Payer: Amerigroup CHIP/Medicaid	$44.95
Rate for Payer: BCBS of TX Blue Advantage	$149.82
Rate for Payer: BCBS of TX Blue Essentials	$179.78
Rate for Payer: BCBS of TX PPO	$199.76
Rate for Payer: Cash Price	$339.59
Rate for Payer: Cigna Medicaid	$359.57
Rate for Payer: Molina CHIP/Medicaid	$359.57
Rate for Payer: Multiplan Auto	$324.61
Rate for Payer: Multiplan Commercial	$324.61
Rate for Payer: Multiplan Workers Comp	$324.61
Rate for Payer: Parkland Medicaid	$359.57
Rate for Payer: Scott and White EPO/PPO	$249.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$359.57
Rate for Payer: Superior Health Plan EPO	$67.92

CATHETER BLN PASSEO-35 5X120X130

Facility

$499.40

Hospital Charge Code	145468
Hospital Revenue Code	272
Rate for Payer: Cash Price	$339.59

CATHETER BLN PASSEO 35 8X100X30

Facility

$431.30

Hospital Charge Code	145425
Hospital Revenue Code	272
Rate for Payer: Cash Price	$293.28

CATHETER BLN PASSEO 35 8X100X30

Facility

$431.30

Hospital Charge Code	145425
Hospital Revenue Code	272
Min. Negotiated Rate	$38.82
Max. Negotiated Rate	$310.54
Rate for Payer: Amerigroup CHIP/Medicaid	$38.82
Rate for Payer: BCBS of TX Blue Advantage	$129.39
Rate for Payer: BCBS of TX Blue Essentials	$155.27
Rate for Payer: BCBS of TX PPO	$172.52
Rate for Payer: Cash Price	$293.28
Rate for Payer: Cigna Medicaid	$310.54
Rate for Payer: Molina CHIP/Medicaid	$310.54
Rate for Payer: Multiplan Auto	$280.35
Rate for Payer: Multiplan Commercial	$280.35
Rate for Payer: Multiplan Workers Comp	$280.35
Rate for Payer: Parkland Medicaid	$310.54
Rate for Payer: Scott and White EPO/PPO	$215.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$310.54
Rate for Payer: Superior Health Plan EPO	$58.66

CATHETER BLN PASSO-35 6X200X35

Facility

$431.00

Service Code	HCPCS C1726
Hospital Charge Code	145465
Hospital Revenue Code	278
Min. Negotiated Rate	$38.79
Max. Negotiated Rate	$310.32
Rate for Payer: Amerigroup CHIP/Medicaid	$38.79
Rate for Payer: BCBS of TX Blue Advantage	$129.30
Rate for Payer: BCBS of TX Blue Essentials	$155.16
Rate for Payer: BCBS of TX PPO	$172.40
Rate for Payer: Cash Price	$293.08
Rate for Payer: Cigna Medicaid	$310.32
Rate for Payer: Molina CHIP/Medicaid	$310.32
Rate for Payer: Multiplan Auto	$215.50
Rate for Payer: Multiplan Commercial	$215.50
Rate for Payer: Multiplan Workers Comp	$215.50
Rate for Payer: Parkland Medicaid	$310.32
Rate for Payer: Scott and White EPO/PPO	$215.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$310.32
Rate for Payer: Superior Health Plan EPO	$58.62

CATHETER BLN PASSO-35 6X200X35

Facility

$431.00

Service Code	HCPCS C1726
Hospital Charge Code	145465
Hospital Revenue Code	278
Min. Negotiated Rate	$107.75
Max. Negotiated Rate	$215.50
Rate for Payer: Cash Price	$293.08
Rate for Payer: Cigna Commercial	$107.75
Rate for Payer: Multiplan Auto	$215.50
Rate for Payer: Multiplan Commercial	$215.50
Rate for Payer: Multiplan Workers Comp	$215.50
Rate for Payer: Scott and White EPO/PPO	$215.50

CATHETER, CHOLANGIOGRAPHY

Facility

$81.67

Hospital Charge Code	993958
Hospital Revenue Code	279
Rate for Payer: Cash Price	$55.54

CATHETER, CHOLANGIOGRAPHY

Facility

$81.67

Hospital Charge Code	993958
Hospital Revenue Code	279
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$58.80
Rate for Payer: Amerigroup CHIP/Medicaid	$7.35
Rate for Payer: BCBS of TX Blue Advantage	$24.50
Rate for Payer: BCBS of TX Blue Essentials	$29.40
Rate for Payer: BCBS of TX PPO	$32.67
Rate for Payer: Cash Price	$55.54
Rate for Payer: Cigna Medicaid	$58.80
Rate for Payer: Molina CHIP/Medicaid	$58.80
Rate for Payer: Multiplan Auto	$53.09
Rate for Payer: Multiplan Commercial	$53.09
Rate for Payer: Multiplan Workers Comp	$53.09
Rate for Payer: Parkland Medicaid	$58.80
Rate for Payer: Scott and White EPO/PPO	$40.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$58.80
Rate for Payer: Superior Health Plan EPO	$11.11

CATHETER, CORONARY DILATION SAPPHIRE II 2.5X15MM

Facility

$663.00

Service Code	HCPCS C1726
Hospital Charge Code	80599038
Hospital Revenue Code	278
Min. Negotiated Rate	$59.67
Max. Negotiated Rate	$477.36
Rate for Payer: Amerigroup CHIP/Medicaid	$59.67
Rate for Payer: BCBS of TX Blue Advantage	$198.90
Rate for Payer: BCBS of TX Blue Essentials	$238.68
Rate for Payer: BCBS of TX PPO	$265.20
Rate for Payer: Cash Price	$450.84
Rate for Payer: Cigna Medicaid	$477.36
Rate for Payer: Molina CHIP/Medicaid	$477.36
Rate for Payer: Multiplan Auto	$331.50
Rate for Payer: Multiplan Commercial	$331.50
Rate for Payer: Multiplan Workers Comp	$331.50
Rate for Payer: Parkland Medicaid	$477.36
Rate for Payer: Scott and White EPO/PPO	$331.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$477.36
Rate for Payer: Superior Health Plan EPO	$90.17

CATHETER, CORONARY DILATION SAPPHIRE II 2.5X15MM

Facility

$663.00

Service Code	HCPCS C1726
Hospital Charge Code	80599038
Hospital Revenue Code	278
Min. Negotiated Rate	$165.75
Max. Negotiated Rate	$331.50
Rate for Payer: Cash Price	$450.84
Rate for Payer: Cigna Commercial	$165.75
Rate for Payer: Multiplan Auto	$331.50
Rate for Payer: Multiplan Commercial	$331.50
Rate for Payer: Multiplan Workers Comp	$331.50
Rate for Payer: Scott and White EPO/PPO	$331.50

CATHETER CORONARY DIL SAPPHIRE -- DHF

Facility

$663.00

Service Code	HCPCS C1726
Hospital Charge Code	80599020
Hospital Revenue Code	278
Min. Negotiated Rate	$165.75
Max. Negotiated Rate	$331.50
Rate for Payer: Cash Price	$450.84
Rate for Payer: Cigna Commercial	$165.75
Rate for Payer: Multiplan Auto	$331.50
Rate for Payer: Multiplan Commercial	$331.50
Rate for Payer: Multiplan Workers Comp	$331.50
Rate for Payer: Scott and White EPO/PPO	$331.50

CATHETER CORONARY DIL SAPPHIRE -- DHF

Facility

$663.00

Service Code	HCPCS C1726
Hospital Charge Code	80599020
Hospital Revenue Code	278
Min. Negotiated Rate	$59.67
Max. Negotiated Rate	$477.36
Rate for Payer: Amerigroup CHIP/Medicaid	$59.67
Rate for Payer: BCBS of TX Blue Advantage	$198.90
Rate for Payer: BCBS of TX Blue Essentials	$238.68
Rate for Payer: BCBS of TX PPO	$265.20
Rate for Payer: Cash Price	$450.84
Rate for Payer: Cigna Medicaid	$477.36
Rate for Payer: Molina CHIP/Medicaid	$477.36
Rate for Payer: Multiplan Auto	$331.50
Rate for Payer: Multiplan Commercial	$331.50
Rate for Payer: Multiplan Workers Comp	$331.50
Rate for Payer: Parkland Medicaid	$477.36
Rate for Payer: Scott and White EPO/PPO	$331.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$477.36
Rate for Payer: Superior Health Plan EPO	$90.17

Know your out-of-pocket cost for care.

All Charges