White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CATHETER GD JL3.5 SH 6FR 100CM COR LNCHR

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	992430
Hospital Revenue Code	272
Rate for Payer: Cash Price	$154.36

CATHETER GD JL3.5 SH 6FR 100CM COR LNCHR

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	992430
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 JL3 6FR 100CM COR LNCHR

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	992441
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 JL3 6FR 100CM COR LNCHR

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	992441
Hospital Revenue Code	272
Rate for Payer: Cash Price	$154.36

CATHETER GD JL4.5 6FR 100CM COR LNCHR

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	992442
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 JL4.5 6FR 100CM COR LNCHR

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	992442
Hospital Revenue Code	272
Rate for Payer: Cash Price	$154.36

CATHETER GD JL4.5 SH 6FR COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992443
Hospital Revenue Code	272
Rate for Payer: Cash Price	$132.75

CATHETER GD JL4.5 SH 6FR COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992443
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 JL4 6FR 100CM COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992431
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 JL4 6FR 100CM COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992431
Hospital Revenue Code	272
Rate for Payer: Cash Price	$132.75

CATHETER GD JL4 SH 6FR 100CM COR LNCHR

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	992432
Hospital Revenue Code	272
Rate for Payer: Cash Price	$154.36

CATHETER GD JL4 SH 6FR 100CM COR LNCHR

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	992432
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 JR3.5 SH 6FR 100CM COR LNCHR

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	992433
Hospital Revenue Code	272
Rate for Payer: Cash Price	$154.36

CATHETER GD JR3.5 SH 6FR 100CM COR LNCHR

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	992433
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 JR4 6FR COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992434
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 JR4 6FR COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992434
Hospital Revenue Code	272
Rate for Payer: Cash Price	$132.75

CATHETER GD JR4 SH 6FR COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992435
Hospital Revenue Code	272
Rate for Payer: Cash Price	$132.75

CATHETER GD JR4 SH 6FR COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992435
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 JR5 SH 6FR 100CM COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992436
Hospital Revenue Code	272
Rate for Payer: Cash Price	$132.75

CATHETER GD JR5 SH 6FR 100CM COR LNCHR

Facility

$195.22

Service Code	HCPCS C1887
Hospital Charge Code	992436
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 WORHORSE 6FRX100CM LA6NOTO

Facility

$227.00

Hospital Charge Code	145608
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 WORHORSE 6FRX100CM LA6NOTO

Facility

$227.00

Hospital Charge Code	145608
Hospital Revenue Code	272
Rate for Payer: Cash Price	$154.36

Catheter, guiding (may include infusion/perfusion capability)

Facility

$1,609.64

Service Code	HCPCS C1887
Hospital Charge Code	991057
Hospital Revenue Code	275
Min. Negotiated Rate	$402.41
Max. Negotiated Rate	$804.82
Rate for Payer: Cash Price	$1,094.56
Rate for Payer: Cigna Commercial	$402.41
Rate for Payer: Multiplan Auto	$804.82
Rate for Payer: Multiplan Commercial	$804.82
Rate for Payer: Multiplan Workers Comp	$804.82
Rate for Payer: Scott and White EPO/PPO	$804.82

Catheter, guiding (may include infusion/perfusion capability)

Facility

$1,609.64

Service Code	HCPCS C1887
Hospital Charge Code	991057
Hospital Revenue Code	275
Min. Negotiated Rate	$144.87
Max. Negotiated Rate	$1,158.94
Rate for Payer: Amerigroup CHIP/Medicaid	$144.87
Rate for Payer: BCBS of TX Blue Advantage	$482.89
Rate for Payer: BCBS of TX Blue Essentials	$579.47
Rate for Payer: BCBS of TX PPO	$643.86
Rate for Payer: Cash Price	$1,094.56
Rate for Payer: Cigna Medicaid	$1,158.94
Rate for Payer: Molina CHIP/Medicaid	$1,158.94
Rate for Payer: Multiplan Auto	$804.82
Rate for Payer: Multiplan Commercial	$804.82
Rate for Payer: Multiplan Workers Comp	$804.82
Rate for Payer: Parkland Medicaid	$1,158.94
Rate for Payer: Scott and White EPO/PPO	$804.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,158.94
Rate for Payer: Superior Health Plan EPO	$218.91

CATHETER IMG COR EE PLTN 5FR STD TIP

Facility

$6,583.00

Hospital Charge Code	80565468
Hospital Revenue Code	272
Min. Negotiated Rate	$592.47
Max. Negotiated Rate	$4,739.76
Rate for Payer: Amerigroup CHIP/Medicaid	$592.47
Rate for Payer: BCBS of TX Blue Advantage	$1,974.90
Rate for Payer: BCBS of TX Blue Essentials	$2,369.88
Rate for Payer: BCBS of TX PPO	$2,633.20
Rate for Payer: Cash Price	$4,476.44
Rate for Payer: Cigna Medicaid	$4,739.76
Rate for Payer: Molina CHIP/Medicaid	$4,739.76
Rate for Payer: Multiplan Auto	$4,278.95
Rate for Payer: Multiplan Commercial	$4,278.95
Rate for Payer: Multiplan Workers Comp	$4,278.95
Rate for Payer: Parkland Medicaid	$4,739.76
Rate for Payer: Scott and White EPO/PPO	$3,291.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,739.76
Rate for Payer: Superior Health Plan EPO	$895.29

Know your out-of-pocket cost for care.

All Charges