White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Catheter nerve block kit

Facility

$2,007.91

Hospital Charge Code	992613
Hospital Revenue Code	272
Min. Negotiated Rate	$180.71
Max. Negotiated Rate	$1,445.70
Rate for Payer: Amerigroup CHIP/Medicaid	$180.71
Rate for Payer: BCBS of TX Blue Advantage	$602.37
Rate for Payer: BCBS of TX Blue Essentials	$722.85
Rate for Payer: BCBS of TX PPO	$803.16
Rate for Payer: Cash Price	$1,365.38
Rate for Payer: Cigna Medicaid	$1,445.70
Rate for Payer: Molina CHIP/Medicaid	$1,445.70
Rate for Payer: Multiplan Auto	$1,305.14
Rate for Payer: Multiplan Commercial	$1,305.14
Rate for Payer: Multiplan Workers Comp	$1,305.14
Rate for Payer: Parkland Medicaid	$1,445.70
Rate for Payer: Scott and White EPO/PPO	$1,003.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,445.70
Rate for Payer: Superior Health Plan EPO	$273.08

Catheter nerve block kit

Facility

$2,007.91

Hospital Charge Code	992613
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,365.38

CATHETER, PALINDROME DUAL LUMEN 14.5X19

Facility

$1,387.33

Hospital Charge Code	8568496
Hospital Revenue Code	272
Rate for Payer: Cash Price	$943.38

CATHETER, PALINDROME DUAL LUMEN 14.5X19

Facility

$1,387.33

Hospital Charge Code	8568496
Hospital Revenue Code	272
Min. Negotiated Rate	$124.86
Max. Negotiated Rate	$998.88
Rate for Payer: Amerigroup CHIP/Medicaid	$124.86
Rate for Payer: BCBS of TX Blue Advantage	$416.20
Rate for Payer: BCBS of TX Blue Essentials	$499.44
Rate for Payer: BCBS of TX PPO	$554.93
Rate for Payer: Cash Price	$943.38
Rate for Payer: Cigna Medicaid	$998.88
Rate for Payer: Molina CHIP/Medicaid	$998.88
Rate for Payer: Multiplan Auto	$901.76
Rate for Payer: Multiplan Commercial	$901.76
Rate for Payer: Multiplan Workers Comp	$901.76
Rate for Payer: Parkland Medicaid	$998.88
Rate for Payer: Scott and White EPO/PPO	$693.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$998.88
Rate for Payer: Superior Health Plan EPO	$188.68

CATHETER, PALINDROME DUAL LUMEN 14.5 X 23

Facility

$1,387.33

Hospital Charge Code	8576477
Hospital Revenue Code	272
Rate for Payer: Cash Price	$943.38

CATHETER, PALINDROME DUAL LUMEN 14.5 X 23

Facility

$1,387.33

Hospital Charge Code	8576477
Hospital Revenue Code	272
Min. Negotiated Rate	$124.86
Max. Negotiated Rate	$998.88
Rate for Payer: Amerigroup CHIP/Medicaid	$124.86
Rate for Payer: BCBS of TX Blue Advantage	$416.20
Rate for Payer: BCBS of TX Blue Essentials	$499.44
Rate for Payer: BCBS of TX PPO	$554.93
Rate for Payer: Cash Price	$943.38
Rate for Payer: Cigna Medicaid	$998.88
Rate for Payer: Molina CHIP/Medicaid	$998.88
Rate for Payer: Multiplan Auto	$901.76
Rate for Payer: Multiplan Commercial	$901.76
Rate for Payer: Multiplan Workers Comp	$901.76
Rate for Payer: Parkland Medicaid	$998.88
Rate for Payer: Scott and White EPO/PPO	$693.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$998.88
Rate for Payer: Superior Health Plan EPO	$188.68

CATHETER, PALINDROME DUAL LUMEN 14.5 X 28

Facility

$1,387.33

Hospital Charge Code	8576474
Hospital Revenue Code	272
Min. Negotiated Rate	$124.86
Max. Negotiated Rate	$998.88
Rate for Payer: Amerigroup CHIP/Medicaid	$124.86
Rate for Payer: BCBS of TX Blue Advantage	$416.20
Rate for Payer: BCBS of TX Blue Essentials	$499.44
Rate for Payer: BCBS of TX PPO	$554.93
Rate for Payer: Cash Price	$943.38
Rate for Payer: Cigna Medicaid	$998.88
Rate for Payer: Molina CHIP/Medicaid	$998.88
Rate for Payer: Multiplan Auto	$901.76
Rate for Payer: Multiplan Commercial	$901.76
Rate for Payer: Multiplan Workers Comp	$901.76
Rate for Payer: Parkland Medicaid	$998.88
Rate for Payer: Scott and White EPO/PPO	$693.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$998.88
Rate for Payer: Superior Health Plan EPO	$188.68

CATHETER, PALINDROME DUAL LUMEN 14.5 X 28

Facility

$1,387.33

Hospital Charge Code	8576474
Hospital Revenue Code	272
Rate for Payer: Cash Price	$943.38

CATHETER, PALINDROME DUAL LUMEN 14.5 X 33

Facility

$1,387.33

Hospital Charge Code	8576476
Hospital Revenue Code	272
Min. Negotiated Rate	$124.86
Max. Negotiated Rate	$998.88
Rate for Payer: Amerigroup CHIP/Medicaid	$124.86
Rate for Payer: BCBS of TX Blue Advantage	$416.20
Rate for Payer: BCBS of TX Blue Essentials	$499.44
Rate for Payer: BCBS of TX PPO	$554.93
Rate for Payer: Cash Price	$943.38
Rate for Payer: Cigna Medicaid	$998.88
Rate for Payer: Molina CHIP/Medicaid	$998.88
Rate for Payer: Multiplan Auto	$901.76
Rate for Payer: Multiplan Commercial	$901.76
Rate for Payer: Multiplan Workers Comp	$901.76
Rate for Payer: Parkland Medicaid	$998.88
Rate for Payer: Scott and White EPO/PPO	$693.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$998.88
Rate for Payer: Superior Health Plan EPO	$188.68

CATHETER, PALINDROME DUAL LUMEN 14.5 X 33

Facility

$1,387.33

Hospital Charge Code	8576476
Hospital Revenue Code	272
Rate for Payer: Cash Price	$943.38

CATHETER PALINDROME W/2 SLOTS 23CM X 40CM

Facility

$2,146.81

Service Code	HCPCS C1750
Hospital Charge Code	992362
Hospital Revenue Code	272
Min. Negotiated Rate	$193.21
Max. Negotiated Rate	$1,545.70
Rate for Payer: Amerigroup CHIP/Medicaid	$193.21
Rate for Payer: BCBS of TX Blue Advantage	$644.04
Rate for Payer: BCBS of TX Blue Essentials	$772.85
Rate for Payer: BCBS of TX PPO	$858.72
Rate for Payer: Cash Price	$1,459.83
Rate for Payer: Cigna Medicaid	$1,545.70
Rate for Payer: Molina CHIP/Medicaid	$1,545.70
Rate for Payer: Multiplan Auto	$1,395.43
Rate for Payer: Multiplan Commercial	$1,395.43
Rate for Payer: Multiplan Workers Comp	$1,395.43
Rate for Payer: Parkland Medicaid	$1,545.70
Rate for Payer: Scott and White EPO/PPO	$1,073.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,545.70
Rate for Payer: Superior Health Plan EPO	$291.97

CATHETER PALINDROME W/2 SLOTS 23CM X 40CM

Facility

$2,146.81

Service Code	HCPCS C1750
Hospital Charge Code	992362
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,459.83

CATHETER PALINDROME W/2 SLOTS 28CM X 45CM

Facility

$2,146.81

Service Code	HCPCS C1750
Hospital Charge Code	992361
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,459.83

CATHETER PALINDROME W/2 SLOTS 28CM X 45CM

Facility

$2,146.81

Service Code	HCPCS C1750
Hospital Charge Code	992361
Hospital Revenue Code	272
Min. Negotiated Rate	$193.21
Max. Negotiated Rate	$1,545.70
Rate for Payer: Amerigroup CHIP/Medicaid	$193.21
Rate for Payer: BCBS of TX Blue Advantage	$644.04
Rate for Payer: BCBS of TX Blue Essentials	$772.85
Rate for Payer: BCBS of TX PPO	$858.72
Rate for Payer: Cash Price	$1,459.83
Rate for Payer: Cigna Medicaid	$1,545.70
Rate for Payer: Molina CHIP/Medicaid	$1,545.70
Rate for Payer: Multiplan Auto	$1,395.43
Rate for Payer: Multiplan Commercial	$1,395.43
Rate for Payer: Multiplan Workers Comp	$1,395.43
Rate for Payer: Parkland Medicaid	$1,545.70
Rate for Payer: Scott and White EPO/PPO	$1,073.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,545.70
Rate for Payer: Superior Health Plan EPO	$291.97

catheter perifix poly epidural 19gx36

Facility

$47.49

Hospital Charge Code	8634511
Hospital Revenue Code	272
Rate for Payer: Cash Price	$32.29

catheter perifix poly epidural 19gx36

Facility

$47.49

Hospital Charge Code	8634511
Hospital Revenue Code	272
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$34.19
Rate for Payer: Amerigroup CHIP/Medicaid	$4.27
Rate for Payer: BCBS of TX Blue Advantage	$14.25
Rate for Payer: BCBS of TX Blue Essentials	$17.10
Rate for Payer: BCBS of TX PPO	$19.00
Rate for Payer: Cash Price	$32.29
Rate for Payer: Cigna Medicaid	$34.19
Rate for Payer: Molina CHIP/Medicaid	$34.19
Rate for Payer: Multiplan Auto	$30.87
Rate for Payer: Multiplan Commercial	$30.87
Rate for Payer: Multiplan Workers Comp	$30.87
Rate for Payer: Parkland Medicaid	$34.19
Rate for Payer: Scott and White EPO/PPO	$23.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$34.19
Rate for Payer: Superior Health Plan EPO	$6.46

CATHETER PERIPH THROMBECTOMY 6FR 3X15MMX90CM

Facility

$9,353.58

Service Code	HCPCS C1757
Hospital Charge Code	992634
Hospital Revenue Code	272
Min. Negotiated Rate	$841.82
Max. Negotiated Rate	$6,734.58
Rate for Payer: Amerigroup CHIP/Medicaid	$841.82
Rate for Payer: BCBS of TX Blue Advantage	$2,806.07
Rate for Payer: BCBS of TX Blue Essentials	$3,367.29
Rate for Payer: BCBS of TX PPO	$3,741.43
Rate for Payer: Cash Price	$6,360.43
Rate for Payer: Cigna Medicaid	$6,734.58
Rate for Payer: Molina CHIP/Medicaid	$6,734.58
Rate for Payer: Multiplan Auto	$6,079.83
Rate for Payer: Multiplan Commercial	$6,079.83
Rate for Payer: Multiplan Workers Comp	$6,079.83
Rate for Payer: Parkland Medicaid	$6,734.58
Rate for Payer: Scott and White EPO/PPO	$4,676.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,734.58
Rate for Payer: Superior Health Plan EPO	$1,272.09

CATHETER PERIPH THROMBECTOMY 6FR 3X15MMX90CM

Facility

$9,353.58

Service Code	HCPCS C1757
Hospital Charge Code	992634
Hospital Revenue Code	272
Rate for Payer: Cash Price	$6,360.43

CATHETER PERITONEAL PD

Facility

$485.78

Hospital Charge Code	8484506
Hospital Revenue Code	272
Rate for Payer: Cash Price	$330.33

CATHETER PERITONEAL PD

Facility

$485.78

Hospital Charge Code	8484506
Hospital Revenue Code	272
Min. Negotiated Rate	$43.72
Max. Negotiated Rate	$349.76
Rate for Payer: Amerigroup CHIP/Medicaid	$43.72
Rate for Payer: BCBS of TX Blue Advantage	$145.73
Rate for Payer: BCBS of TX Blue Essentials	$174.88
Rate for Payer: BCBS of TX PPO	$194.31
Rate for Payer: Cash Price	$330.33
Rate for Payer: Cigna Medicaid	$349.76
Rate for Payer: Molina CHIP/Medicaid	$349.76
Rate for Payer: Multiplan Auto	$315.76
Rate for Payer: Multiplan Commercial	$315.76
Rate for Payer: Multiplan Workers Comp	$315.76
Rate for Payer: Parkland Medicaid	$349.76
Rate for Payer: Scott and White EPO/PPO	$242.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$349.76
Rate for Payer: Superior Health Plan EPO	$66.07

CATHETER PICC 5F TL PROVENA 3CG TPS STYL MAX TRAY

Facility

$908.60

Service Code	HCPCS C1750
Hospital Charge Code	993416
Hospital Revenue Code	272
Rate for Payer: Cash Price	$617.85

CATHETER PICC 5F TL PROVENA 3CG TPS STYL MAX TRAY

Facility

$908.60

Service Code	HCPCS C1750
Hospital Charge Code	993416
Hospital Revenue Code	272
Min. Negotiated Rate	$81.77
Max. Negotiated Rate	$654.19
Rate for Payer: Amerigroup CHIP/Medicaid	$81.77
Rate for Payer: BCBS of TX Blue Advantage	$272.58
Rate for Payer: BCBS of TX Blue Essentials	$327.10
Rate for Payer: BCBS of TX PPO	$363.44
Rate for Payer: Cash Price	$617.85
Rate for Payer: Cigna Medicaid	$654.19
Rate for Payer: Molina CHIP/Medicaid	$654.19
Rate for Payer: Multiplan Auto	$590.59
Rate for Payer: Multiplan Commercial	$590.59
Rate for Payer: Multiplan Workers Comp	$590.59
Rate for Payer: Parkland Medicaid	$654.19
Rate for Payer: Scott and White EPO/PPO	$454.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$654.19
Rate for Payer: Superior Health Plan EPO	$123.57

CATHETER PRUITT OCCLUSION

Facility

$1,402.86

Hospital Charge Code	137106
Hospital Revenue Code	272
Rate for Payer: Cash Price	$953.94

CATHETER PRUITT OCCLUSION

Facility

$1,402.86

Hospital Charge Code	137106
Hospital Revenue Code	272
Min. Negotiated Rate	$126.26
Max. Negotiated Rate	$1,010.06
Rate for Payer: Amerigroup CHIP/Medicaid	$126.26
Rate for Payer: BCBS of TX Blue Advantage	$420.86
Rate for Payer: BCBS of TX Blue Essentials	$505.03
Rate for Payer: BCBS of TX PPO	$561.14
Rate for Payer: Cash Price	$953.94
Rate for Payer: Cigna Medicaid	$1,010.06
Rate for Payer: Molina CHIP/Medicaid	$1,010.06
Rate for Payer: Multiplan Auto	$911.86
Rate for Payer: Multiplan Commercial	$911.86
Rate for Payer: Multiplan Workers Comp	$911.86
Rate for Payer: Parkland Medicaid	$1,010.06
Rate for Payer: Scott and White EPO/PPO	$701.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,010.06
Rate for Payer: Superior Health Plan EPO	$190.79

CATHETER PTA BALLOON PASEO 2.5X220

Facility

$544.80

Hospital Charge Code	145374
Hospital Revenue Code	272
Rate for Payer: Cash Price	$370.46

Know your out-of-pocket cost for care.

All Charges