White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CATHETER GD AL1 6FR 100CM COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992421
Hospital Revenue Code	272
Rate for Payer: Cash Price	$132.75

CATHETER GD AL2 SH 6FR 100CM COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992422
Hospital Revenue Code	272
Min. Negotiated Rate	$17.57
Max. Negotiated Rate	$140.56
Rate for Payer: Amerigroup CHIP/Medicaid	$17.57
Rate for Payer: BCBS of TX Blue Advantage	$58.57
Rate for Payer: BCBS of TX Blue Essentials	$70.28
Rate for Payer: BCBS of TX PPO	$78.09
Rate for Payer: Cash Price	$132.75
Rate for Payer: Cigna Medicaid	$140.56
Rate for Payer: Molina CHIP/Medicaid	$140.56
Rate for Payer: Multiplan Auto	$126.89
Rate for Payer: Multiplan Commercial	$126.89
Rate for Payer: Multiplan Workers Comp	$126.89
Rate for Payer: Parkland Medicaid	$140.56
Rate for Payer: Scott and White EPO/PPO	$97.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$140.56
Rate for Payer: Superior Health Plan EPO	$26.55

CATHETER GD AL2 SH 6FR 100CM COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992422
Hospital Revenue Code	272
Rate for Payer: Cash Price	$132.75

CATHETER GD AR1 6FR 100CM COR LNCHR

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	992423
Hospital Revenue Code	272
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$163.44
Rate for Payer: Amerigroup CHIP/Medicaid	$20.43
Rate for Payer: BCBS of TX Blue Advantage	$68.10
Rate for Payer: BCBS of TX Blue Essentials	$81.72
Rate for Payer: BCBS of TX PPO	$90.80
Rate for Payer: Cash Price	$154.36
Rate for Payer: Cigna Medicaid	$163.44
Rate for Payer: Molina CHIP/Medicaid	$163.44
Rate for Payer: Multiplan Auto	$147.55
Rate for Payer: Multiplan Commercial	$147.55
Rate for Payer: Multiplan Workers Comp	$147.55
Rate for Payer: Parkland Medicaid	$163.44
Rate for Payer: Scott and White EPO/PPO	$113.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$163.44
Rate for Payer: Superior Health Plan EPO	$30.87

CATHETER GD AR1 6FR 100CM COR LNCHR

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	992423
Hospital Revenue Code	272
Rate for Payer: Cash Price	$154.36

CATHETER GD EBU3.5 6FR 100CM COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992425
Hospital Revenue Code	272
Rate for Payer: Cash Price	$132.75

CATHETER GD EBU3.5 6FR 100CM COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992425
Hospital Revenue Code	272
Min. Negotiated Rate	$17.57
Max. Negotiated Rate	$140.56
Rate for Payer: Amerigroup CHIP/Medicaid	$17.57
Rate for Payer: BCBS of TX Blue Advantage	$58.57
Rate for Payer: BCBS of TX Blue Essentials	$70.28
Rate for Payer: BCBS of TX PPO	$78.09
Rate for Payer: Cash Price	$132.75
Rate for Payer: Cigna Medicaid	$140.56
Rate for Payer: Molina CHIP/Medicaid	$140.56
Rate for Payer: Multiplan Auto	$126.89
Rate for Payer: Multiplan Commercial	$126.89
Rate for Payer: Multiplan Workers Comp	$126.89
Rate for Payer: Parkland Medicaid	$140.56
Rate for Payer: Scott and White EPO/PPO	$97.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$140.56
Rate for Payer: Superior Health Plan EPO	$26.55

CATHETER GD EBU3.5 SH 6FR 100 COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992426
Hospital Revenue Code	272
Min. Negotiated Rate	$17.57
Max. Negotiated Rate	$140.56
Rate for Payer: Amerigroup CHIP/Medicaid	$17.57
Rate for Payer: BCBS of TX Blue Advantage	$58.57
Rate for Payer: BCBS of TX Blue Essentials	$70.28
Rate for Payer: BCBS of TX PPO	$78.09
Rate for Payer: Cash Price	$132.75
Rate for Payer: Cigna Medicaid	$140.56
Rate for Payer: Molina CHIP/Medicaid	$140.56
Rate for Payer: Multiplan Auto	$126.89
Rate for Payer: Multiplan Commercial	$126.89
Rate for Payer: Multiplan Workers Comp	$126.89
Rate for Payer: Parkland Medicaid	$140.56
Rate for Payer: Scott and White EPO/PPO	$97.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$140.56
Rate for Payer: Superior Health Plan EPO	$26.55

CATHETER GD EBU3.5 SH 6FR 100 COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992426
Hospital Revenue Code	272
Rate for Payer: Cash Price	$132.75

CATHETER GD EBU3 6FR 100CM COR LNCHR

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	992424
Hospital Revenue Code	272
Rate for Payer: Cash Price	$154.36

CATHETER GD EBU3 6FR 100CM COR LNCHR

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	992424
Hospital Revenue Code	272
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$163.44
Rate for Payer: Amerigroup CHIP/Medicaid	$20.43
Rate for Payer: BCBS of TX Blue Advantage	$68.10
Rate for Payer: BCBS of TX Blue Essentials	$81.72
Rate for Payer: BCBS of TX PPO	$90.80
Rate for Payer: Cash Price	$154.36
Rate for Payer: Cigna Medicaid	$163.44
Rate for Payer: Molina CHIP/Medicaid	$163.44
Rate for Payer: Multiplan Auto	$147.55
Rate for Payer: Multiplan Commercial	$147.55
Rate for Payer: Multiplan Workers Comp	$147.55
Rate for Payer: Parkland Medicaid	$163.44
Rate for Payer: Scott and White EPO/PPO	$113.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$163.44
Rate for Payer: Superior Health Plan EPO	$30.87

CATHETER GD EBU3.75 6FR 100CM COR LNCHR

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	992437
Hospital Revenue Code	272
Rate for Payer: Cash Price	$154.36

CATHETER GD EBU3.75 6FR 100CM COR LNCHR

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	992437
Hospital Revenue Code	272
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$163.44
Rate for Payer: Amerigroup CHIP/Medicaid	$20.43
Rate for Payer: BCBS of TX Blue Advantage	$68.10
Rate for Payer: BCBS of TX Blue Essentials	$81.72
Rate for Payer: BCBS of TX PPO	$90.80
Rate for Payer: Cash Price	$154.36
Rate for Payer: Cigna Medicaid	$163.44
Rate for Payer: Molina CHIP/Medicaid	$163.44
Rate for Payer: Multiplan Auto	$147.55
Rate for Payer: Multiplan Commercial	$147.55
Rate for Payer: Multiplan Workers Comp	$147.55
Rate for Payer: Parkland Medicaid	$163.44
Rate for Payer: Scott and White EPO/PPO	$113.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$163.44
Rate for Payer: Superior Health Plan EPO	$30.87

CATHETER GD EBU3.75 SH 6FR 100 COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992438
Hospital Revenue Code	272
Rate for Payer: Cash Price	$132.75

CATHETER GD EBU3.75 SH 6FR 100 COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992438
Hospital Revenue Code	272
Min. Negotiated Rate	$17.57
Max. Negotiated Rate	$140.56
Rate for Payer: Amerigroup CHIP/Medicaid	$17.57
Rate for Payer: BCBS of TX Blue Advantage	$58.57
Rate for Payer: BCBS of TX Blue Essentials	$70.28
Rate for Payer: BCBS of TX PPO	$78.09
Rate for Payer: Cash Price	$132.75
Rate for Payer: Cigna Medicaid	$140.56
Rate for Payer: Molina CHIP/Medicaid	$140.56
Rate for Payer: Multiplan Auto	$126.89
Rate for Payer: Multiplan Commercial	$126.89
Rate for Payer: Multiplan Workers Comp	$126.89
Rate for Payer: Parkland Medicaid	$140.56
Rate for Payer: Scott and White EPO/PPO	$97.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$140.56
Rate for Payer: Superior Health Plan EPO	$26.55

CATHETER GD EBU4.5 6FR 100CM COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992439
Hospital Revenue Code	272
Rate for Payer: Cash Price	$132.75

CATHETER GD EBU4.5 6FR 100CM COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992439
Hospital Revenue Code	272
Min. Negotiated Rate	$17.57
Max. Negotiated Rate	$140.56
Rate for Payer: Amerigroup CHIP/Medicaid	$17.57
Rate for Payer: BCBS of TX Blue Advantage	$58.57
Rate for Payer: BCBS of TX Blue Essentials	$70.28
Rate for Payer: BCBS of TX PPO	$78.09
Rate for Payer: Cash Price	$132.75
Rate for Payer: Cigna Medicaid	$140.56
Rate for Payer: Molina CHIP/Medicaid	$140.56
Rate for Payer: Multiplan Auto	$126.89
Rate for Payer: Multiplan Commercial	$126.89
Rate for Payer: Multiplan Workers Comp	$126.89
Rate for Payer: Parkland Medicaid	$140.56
Rate for Payer: Scott and White EPO/PPO	$97.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$140.56
Rate for Payer: Superior Health Plan EPO	$26.55

CATHETER GD EBU4.5 SH 6FR 100 COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992440
Hospital Revenue Code	272
Rate for Payer: Cash Price	$132.75

CATHETER GD EBU4.5 SH 6FR 100 COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992440
Hospital Revenue Code	272
Min. Negotiated Rate	$17.57
Max. Negotiated Rate	$140.56
Rate for Payer: Amerigroup CHIP/Medicaid	$17.57
Rate for Payer: BCBS of TX Blue Advantage	$58.57
Rate for Payer: BCBS of TX Blue Essentials	$70.28
Rate for Payer: BCBS of TX PPO	$78.09
Rate for Payer: Cash Price	$132.75
Rate for Payer: Cigna Medicaid	$140.56
Rate for Payer: Molina CHIP/Medicaid	$140.56
Rate for Payer: Multiplan Auto	$126.89
Rate for Payer: Multiplan Commercial	$126.89
Rate for Payer: Multiplan Workers Comp	$126.89
Rate for Payer: Parkland Medicaid	$140.56
Rate for Payer: Scott and White EPO/PPO	$97.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$140.56
Rate for Payer: Superior Health Plan EPO	$26.55

CATHETER GD EBU4 6FR 100CM COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992427
Hospital Revenue Code	272
Min. Negotiated Rate	$17.57
Max. Negotiated Rate	$140.56
Rate for Payer: Amerigroup CHIP/Medicaid	$17.57
Rate for Payer: BCBS of TX Blue Advantage	$58.57
Rate for Payer: BCBS of TX Blue Essentials	$70.28
Rate for Payer: BCBS of TX PPO	$78.09
Rate for Payer: Cash Price	$132.75
Rate for Payer: Cigna Medicaid	$140.56
Rate for Payer: Molina CHIP/Medicaid	$140.56
Rate for Payer: Multiplan Auto	$126.89
Rate for Payer: Multiplan Commercial	$126.89
Rate for Payer: Multiplan Workers Comp	$126.89
Rate for Payer: Parkland Medicaid	$140.56
Rate for Payer: Scott and White EPO/PPO	$97.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$140.56
Rate for Payer: Superior Health Plan EPO	$26.55

CATHETER GD EBU4 6FR 100CM COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992427
Hospital Revenue Code	272
Rate for Payer: Cash Price	$132.75

CATHETER GD EBU4 SH 6FR 100CM COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992428
Hospital Revenue Code	272
Rate for Payer: Cash Price	$132.75

CATHETER GD EBU4 SH 6FR 100CM COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992428
Hospital Revenue Code	272
Min. Negotiated Rate	$17.57
Max. Negotiated Rate	$140.56
Rate for Payer: Amerigroup CHIP/Medicaid	$17.57
Rate for Payer: BCBS of TX Blue Advantage	$58.57
Rate for Payer: BCBS of TX Blue Essentials	$70.28
Rate for Payer: BCBS of TX PPO	$78.09
Rate for Payer: Cash Price	$132.75
Rate for Payer: Cigna Medicaid	$140.56
Rate for Payer: Molina CHIP/Medicaid	$140.56
Rate for Payer: Multiplan Auto	$126.89
Rate for Payer: Multiplan Commercial	$126.89
Rate for Payer: Multiplan Workers Comp	$126.89
Rate for Payer: Parkland Medicaid	$140.56
Rate for Payer: Scott and White EPO/PPO	$97.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$140.56
Rate for Payer: Superior Health Plan EPO	$26.55

CATHETER GD JL3.5 6FR 100CM COR LNCHR

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	992429
Hospital Revenue Code	272
Rate for Payer: Cash Price	$154.36

CATHETER GD JL3.5 6FR 100CM COR LNCHR

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	992429
Hospital Revenue Code	272
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$163.44
Rate for Payer: Amerigroup CHIP/Medicaid	$20.43
Rate for Payer: BCBS of TX Blue Advantage	$68.10
Rate for Payer: BCBS of TX Blue Essentials	$81.72
Rate for Payer: BCBS of TX PPO	$90.80
Rate for Payer: Cash Price	$154.36
Rate for Payer: Cigna Medicaid	$163.44
Rate for Payer: Molina CHIP/Medicaid	$163.44
Rate for Payer: Multiplan Auto	$147.55
Rate for Payer: Multiplan Commercial	$147.55
Rate for Payer: Multiplan Workers Comp	$147.55
Rate for Payer: Parkland Medicaid	$163.44
Rate for Payer: Scott and White EPO/PPO	$113.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$163.44
Rate for Payer: Superior Health Plan EPO	$30.87

Know your out-of-pocket cost for care.

All Charges