White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CATHETER PTA BALLOON PASEO 2.5X220

Facility

$544.80

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

CATHETER PTA BLN PASSEO-18 2.5X200X130

Facility

$499.40

Hospital Charge Code	145595
Hospital Revenue Code	272
Rate for Payer: Cash Price	$339.59

CATHETER PTA BLN PASSEO-18 2.5X200X130

Facility

$499.40

Hospital Charge Code	145595
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 PUREWICK URETHRAL

Facility

$63.29

Hospital Charge Code	8484507
Hospital Revenue Code	272
Rate for Payer: Cash Price	$43.04

CATHETER PUREWICK URETHRAL

Facility

$63.29

Hospital Charge Code	8484507
Hospital Revenue Code	272
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$45.57
Rate for Payer: Amerigroup CHIP/Medicaid	$5.70
Rate for Payer: BCBS of TX Blue Advantage	$18.99
Rate for Payer: BCBS of TX Blue Essentials	$22.78
Rate for Payer: BCBS of TX PPO	$25.32
Rate for Payer: Cash Price	$43.04
Rate for Payer: Cigna Medicaid	$45.57
Rate for Payer: Molina CHIP/Medicaid	$45.57
Rate for Payer: Multiplan Auto	$41.14
Rate for Payer: Multiplan Commercial	$41.14
Rate for Payer: Multiplan Workers Comp	$41.14
Rate for Payer: Parkland Medicaid	$45.57
Rate for Payer: Scott and White EPO/PPO	$31.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$45.57
Rate for Payer: Superior Health Plan EPO	$8.61

CATHETER, SAFETY, VIAVALVE, IV, 18'X1 1

Facility

$9.28

Hospital Charge Code	993346
Hospital Revenue Code	270
Rate for Payer: Cash Price	$6.31

CATHETER, SAFETY, VIAVALVE, IV, 18'X1 1

Facility

$9.28

Hospital Charge Code	993346
Hospital Revenue Code	270
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$6.68
Rate for Payer: Amerigroup CHIP/Medicaid	$0.84
Rate for Payer: BCBS of TX Blue Advantage	$2.78
Rate for Payer: BCBS of TX Blue Essentials	$3.34
Rate for Payer: BCBS of TX PPO	$3.71
Rate for Payer: Cash Price	$6.31
Rate for Payer: Cigna Medicaid	$6.68
Rate for Payer: Molina CHIP/Medicaid	$6.68
Rate for Payer: Multiplan Auto	$6.03
Rate for Payer: Multiplan Commercial	$6.03
Rate for Payer: Multiplan Workers Comp	$6.03
Rate for Payer: Parkland Medicaid	$6.68
Rate for Payer: Scott and White EPO/PPO	$4.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.68
Rate for Payer: Superior Health Plan EPO	$1.26

CATHETER, SINGL LMN PORT 8.4F DETCH W/INTRO 9F PLS -- DHF

Facility

$2,703.00

Service Code	HCPCS C1788
Hospital Charge Code	82402074
Hospital Revenue Code	278
Min. Negotiated Rate	$243.27
Max. Negotiated Rate	$1,946.16
Rate for Payer: Amerigroup CHIP/Medicaid	$243.27
Rate for Payer: BCBS of TX Blue Advantage	$810.90
Rate for Payer: BCBS of TX Blue Essentials	$973.08
Rate for Payer: BCBS of TX PPO	$1,081.20
Rate for Payer: Cash Price	$1,838.04
Rate for Payer: Cigna Medicaid	$1,946.16
Rate for Payer: Molina CHIP/Medicaid	$1,946.16
Rate for Payer: Multiplan Auto	$1,351.50
Rate for Payer: Multiplan Commercial	$1,351.50
Rate for Payer: Multiplan Workers Comp	$1,351.50
Rate for Payer: Parkland Medicaid	$1,946.16
Rate for Payer: Scott and White EPO/PPO	$1,351.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,946.16
Rate for Payer: Superior Health Plan EPO	$367.61

CATHETER, SINGL LMN PORT 8.4F DETCH W/INTRO 9F PLS -- DHF

Facility

$2,703.00

Service Code	HCPCS C1788
Hospital Charge Code	82402074
Hospital Revenue Code	278
Min. Negotiated Rate	$675.75
Max. Negotiated Rate	$1,351.50
Rate for Payer: Cash Price	$1,838.04
Rate for Payer: Cigna Commercial	$675.75
Rate for Payer: Multiplan Auto	$1,351.50
Rate for Payer: Multiplan Commercial	$1,351.50
Rate for Payer: Multiplan Workers Comp	$1,351.50
Rate for Payer: Scott and White EPO/PPO	$1,351.50

CATHETER, SUPPORT STRAIGH

Facility

$983.36

Hospital Charge Code	993810
Hospital Revenue Code	270
Min. Negotiated Rate	$88.50
Max. Negotiated Rate	$708.02
Rate for Payer: Amerigroup CHIP/Medicaid	$88.50
Rate for Payer: BCBS of TX Blue Advantage	$295.01
Rate for Payer: BCBS of TX Blue Essentials	$354.01
Rate for Payer: BCBS of TX PPO	$393.34
Rate for Payer: Cash Price	$668.68
Rate for Payer: Cigna Medicaid	$708.02
Rate for Payer: Molina CHIP/Medicaid	$708.02
Rate for Payer: Multiplan Auto	$639.18
Rate for Payer: Multiplan Commercial	$639.18
Rate for Payer: Multiplan Workers Comp	$639.18
Rate for Payer: Parkland Medicaid	$708.02
Rate for Payer: Scott and White EPO/PPO	$491.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$708.02
Rate for Payer: Superior Health Plan EPO	$133.74

CATHETER, SUPPORT STRAIGH

Facility

$983.36

Hospital Charge Code	993810
Hospital Revenue Code	270
Rate for Payer: Cash Price	$668.68

CATHETER, THORACIC, STRGTH, ARGYLE, 36FRX20'

Facility

$37.72

Service Code	HCPCS C1725
Hospital Charge Code	993379
Hospital Revenue Code	272
Rate for Payer: Cash Price	$25.65

CATHETER, THORACIC, STRGTH, ARGYLE, 36FRX20'

Facility

$37.72

Service Code	HCPCS C1725
Hospital Charge Code	993379
Hospital Revenue Code	272
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$27.16
Rate for Payer: Amerigroup CHIP/Medicaid	$3.39
Rate for Payer: BCBS of TX Blue Advantage	$11.32
Rate for Payer: BCBS of TX Blue Essentials	$13.58
Rate for Payer: BCBS of TX PPO	$15.09
Rate for Payer: Cash Price	$25.65
Rate for Payer: Cigna Medicaid	$27.16
Rate for Payer: Molina CHIP/Medicaid	$27.16
Rate for Payer: Multiplan Auto	$24.52
Rate for Payer: Multiplan Commercial	$24.52
Rate for Payer: Multiplan Workers Comp	$24.52
Rate for Payer: Parkland Medicaid	$27.16
Rate for Payer: Scott and White EPO/PPO	$18.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$27.16
Rate for Payer: Superior Health Plan EPO	$5.13

Catheter Tip Culture

Facility

$309.00

Service Code	HCPCS 87070
Hospital Charge Code	4107069
Hospital Revenue Code	306
Rate for Payer: Cash Price	$210.12

Catheter Tip Culture

Facility

$309.00

Service Code	HCPCS 87070
Hospital Charge Code	4107069
Hospital Revenue Code	306
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$222.48
Rate for Payer: Amerigroup CHIP/Medicaid	$3.36
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8.62
Rate for Payer: Amerigroup Medicare	$8.62
Rate for Payer: BCBS of TX Blue Advantage	$92.70
Rate for Payer: BCBS of TX Blue Essentials	$111.24
Rate for Payer: BCBS of TX Medicare	$8.62
Rate for Payer: BCBS of TX PPO	$123.60
Rate for Payer: Cash Price	$210.12
Rate for Payer: Cash Price	$210.12
Rate for Payer: Cigna Medicaid	$222.48
Rate for Payer: Cigna Medicare	$8.62
Rate for Payer: Employer Direct Commercial	$8.62
Rate for Payer: Humana Medicare/TRICARE	$8.62
Rate for Payer: Molina CHIP/Medicaid	$222.48
Rate for Payer: Molina Dual Medicare/Medicaid	$8.62
Rate for Payer: Molina Medicare	$8.62
Rate for Payer: Multiplan Auto	$200.85
Rate for Payer: Multiplan Commercial	$200.85
Rate for Payer: Multiplan Workers Comp	$200.85
Rate for Payer: Parkland Medicaid	$222.48
Rate for Payer: Scott and White EPO/PPO	$10.78
Rate for Payer: Scott and White Medicare	$8.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$222.48
Rate for Payer: Superior Health Plan EPO	$8.62
Rate for Payer: Superior Health Plan Medicare	$8.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$8.62
Rate for Payer: Universal American Medicare	$8.62
Rate for Payer: Wellcare Medicare	$8.62
Rate for Payer: Wellmed Medicare	$8.62

CATHETER, TRACH CARE MULTI ACCESS SYS Y ADAPTER 5F

Facility

$23.36

Hospital Charge Code	993541
Hospital Revenue Code	270
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$16.82
Rate for Payer: Amerigroup CHIP/Medicaid	$2.10
Rate for Payer: BCBS of TX Blue Advantage	$7.01
Rate for Payer: BCBS of TX Blue Essentials	$8.41
Rate for Payer: BCBS of TX PPO	$9.34
Rate for Payer: Cash Price	$15.88
Rate for Payer: Cigna Medicaid	$16.82
Rate for Payer: Molina CHIP/Medicaid	$16.82
Rate for Payer: Multiplan Auto	$15.18
Rate for Payer: Multiplan Commercial	$15.18
Rate for Payer: Multiplan Workers Comp	$15.18
Rate for Payer: Parkland Medicaid	$16.82
Rate for Payer: Scott and White EPO/PPO	$11.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16.82
Rate for Payer: Superior Health Plan EPO	$3.18

CATHETER, TRACH CARE MULTI ACCESS SYS Y ADAPTER 5F

Facility

$23.36

Hospital Charge Code	993541
Hospital Revenue Code	270
Rate for Payer: Cash Price	$15.88

Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Facility

$5,189.46

Service Code	HCPCS C1725
Hospital Charge Code	990966
Hospital Revenue Code	275
Min. Negotiated Rate	$467.05
Max. Negotiated Rate	$3,736.41
Rate for Payer: Amerigroup CHIP/Medicaid	$467.05
Rate for Payer: BCBS of TX Blue Advantage	$1,556.84
Rate for Payer: BCBS of TX Blue Essentials	$1,868.21
Rate for Payer: BCBS of TX PPO	$2,075.78
Rate for Payer: Cash Price	$3,528.83
Rate for Payer: Cigna Medicaid	$3,736.41
Rate for Payer: Molina CHIP/Medicaid	$3,736.41
Rate for Payer: Multiplan Auto	$2,594.73
Rate for Payer: Multiplan Commercial	$2,594.73
Rate for Payer: Multiplan Workers Comp	$2,594.73
Rate for Payer: Parkland Medicaid	$3,736.41
Rate for Payer: Scott and White EPO/PPO	$2,594.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,736.41
Rate for Payer: Superior Health Plan EPO	$705.77

Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Facility

$5,189.46

Service Code	HCPCS C1725
Hospital Charge Code	990966
Hospital Revenue Code	275
Min. Negotiated Rate	$1,297.37
Max. Negotiated Rate	$2,594.73
Rate for Payer: Cash Price	$3,528.83
Rate for Payer: Cigna Commercial	$1,297.37
Rate for Payer: Multiplan Auto	$2,594.73
Rate for Payer: Multiplan Commercial	$2,594.73
Rate for Payer: Multiplan Workers Comp	$2,594.73
Rate for Payer: Scott and White EPO/PPO	$2,594.73

Catheter, transluminal atherectomy, rotational

Facility

$101,056.02

Service Code	HCPCS C1724
Hospital Charge Code	990967
Hospital Revenue Code	275
Min. Negotiated Rate	$25,264.01
Max. Negotiated Rate	$50,528.01
Rate for Payer: Cash Price	$68,718.09
Rate for Payer: Cigna Commercial	$25,264.01
Rate for Payer: Multiplan Auto	$50,528.01
Rate for Payer: Multiplan Commercial	$50,528.01
Rate for Payer: Multiplan Workers Comp	$50,528.01
Rate for Payer: Scott and White EPO/PPO	$50,528.01

Catheter, transluminal atherectomy, rotational

Facility

$101,056.02

Service Code	HCPCS C1724
Hospital Charge Code	990967
Hospital Revenue Code	275
Min. Negotiated Rate	$9,095.04
Max. Negotiated Rate	$72,760.33
Rate for Payer: Amerigroup CHIP/Medicaid	$9,095.04
Rate for Payer: BCBS of TX Blue Advantage	$30,316.81
Rate for Payer: BCBS of TX Blue Essentials	$36,380.17
Rate for Payer: BCBS of TX PPO	$40,422.41
Rate for Payer: Cash Price	$68,718.09
Rate for Payer: Cigna Medicaid	$72,760.33
Rate for Payer: Molina CHIP/Medicaid	$72,760.33
Rate for Payer: Multiplan Auto	$50,528.01
Rate for Payer: Multiplan Commercial	$50,528.01
Rate for Payer: Multiplan Workers Comp	$50,528.01
Rate for Payer: Parkland Medicaid	$72,760.33
Rate for Payer: Scott and White EPO/PPO	$50,528.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$72,760.33
Rate for Payer: Superior Health Plan EPO	$13,743.62

CATHETER, URETHRL, BARDX, RED-RUBBER, 20

Facility

$15.07

Service Code	HCPCS C1758
Hospital Charge Code	992506
Hospital Revenue Code	272
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$10.85
Rate for Payer: Amerigroup CHIP/Medicaid	$1.36
Rate for Payer: BCBS of TX Blue Advantage	$4.52
Rate for Payer: BCBS of TX Blue Essentials	$5.43
Rate for Payer: BCBS of TX PPO	$6.03
Rate for Payer: Cash Price	$10.25
Rate for Payer: Cigna Medicaid	$10.85
Rate for Payer: Molina CHIP/Medicaid	$10.85
Rate for Payer: Multiplan Auto	$9.80
Rate for Payer: Multiplan Commercial	$9.80
Rate for Payer: Multiplan Workers Comp	$9.80
Rate for Payer: Parkland Medicaid	$10.85
Rate for Payer: Scott and White EPO/PPO	$7.54
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10.85
Rate for Payer: Superior Health Plan EPO	$2.05

CATHETER, URETHRL, BARDX, RED-RUBBER, 20

Facility

$15.07

Service Code	HCPCS C1758
Hospital Charge Code	992506
Hospital Revenue Code	272
Rate for Payer: Cash Price	$10.25

CATH EXT -- DHF

Facility

$50.69

Hospital Charge Code	80411259
Hospital Revenue Code	270
Rate for Payer: Cash Price	$34.47

CATH EXT -- DHF

Facility

$50.69

Hospital Charge Code	80411259
Hospital Revenue Code	270
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$36.50
Rate for Payer: Amerigroup CHIP/Medicaid	$4.56
Rate for Payer: BCBS of TX Blue Advantage	$15.21
Rate for Payer: BCBS of TX Blue Essentials	$18.25
Rate for Payer: BCBS of TX PPO	$20.28
Rate for Payer: Cash Price	$34.47
Rate for Payer: Cigna Medicaid	$36.50
Rate for Payer: Molina CHIP/Medicaid	$36.50
Rate for Payer: Multiplan Auto	$32.95
Rate for Payer: Multiplan Commercial	$32.95
Rate for Payer: Multiplan Workers Comp	$32.95
Rate for Payer: Parkland Medicaid	$36.50
Rate for Payer: Scott and White EPO/PPO	$25.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$36.50
Rate for Payer: Superior Health Plan EPO	$6.89

Know your out-of-pocket cost for care.

All Charges