White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CATH RADIAL ART -- DHF

Facility

$54.48

Hospital Charge Code	80566854
Hospital Revenue Code	272
Rate for Payer: Cash Price	$37.05

CATH RENAL ARTERY BILAT 1ST ORDER

Facility

$12,148.00

Service Code	HCPCS 36252
Hospital Charge Code	2320552
Hospital Revenue Code	361
Min. Negotiated Rate	$1,093.32
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,093.32
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Amerigroup Medicare	$3,171.87
Rate for Payer: BCBS of TX Blue Advantage	$4,628.04
Rate for Payer: BCBS of TX Blue Essentials	$5,542.56
Rate for Payer: BCBS of TX Medicare	$3,171.87
Rate for Payer: BCBS of TX PPO	$6,983.63
Rate for Payer: Cash Price	$8,260.64
Rate for Payer: Cash Price	$8,260.64
Rate for Payer: Cash Price	$8,260.64
Rate for Payer: Cigna Commercial	$6,704.76
Rate for Payer: Cigna Medicaid	$8,746.56
Rate for Payer: Cigna Medicare	$3,171.87
Rate for Payer: Employer Direct Commercial	$3,171.87
Rate for Payer: Humana Medicare/TRICARE	$3,171.87
Rate for Payer: Molina CHIP/Medicaid	$8,746.56
Rate for Payer: Molina Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Molina Medicare	$3,171.87
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$8,746.56
Rate for Payer: Scott and White EPO/PPO	$5,392.94
Rate for Payer: Scott and White Medicare	$3,171.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,746.56
Rate for Payer: Superior Health Plan EPO	$3,171.87
Rate for Payer: Superior Health Plan Medicare	$3,171.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Universal American Medicare	$3,171.87
Rate for Payer: Wellcare Medicare	$3,171.87
Rate for Payer: Wellmed Medicare	$3,171.87

CATH RENAL ARTERY BILAT 1ST ORDER

Facility

$12,148.00

Service Code	HCPCS 36252
Hospital Charge Code	2320552
Hospital Revenue Code	361
Rate for Payer: Cash Price	$8,260.64

CATH R HRT ART/GRFT ANGI

Facility

$22,830.00

Service Code	HCPCS 93457
Hospital Charge Code	2320526
Hospital Revenue Code	481
Rate for Payer: Cash Price	$15,524.40

CATH R HRT ART/GRFT ANGI

Facility

$22,830.00

Service Code	HCPCS 93457
Hospital Charge Code	2320526
Hospital Revenue Code	481
Min. Negotiated Rate	$1,488.64
Max. Negotiated Rate	$16,437.60
Rate for Payer: Amerigroup CHIP/Medicaid	$2,054.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,256.70
Rate for Payer: Amerigroup Medicare	$3,256.70
Rate for Payer: BCBS of TX Blue Advantage	$4,759.42
Rate for Payer: BCBS of TX Blue Essentials	$5,699.90
Rate for Payer: BCBS of TX Medicare	$3,256.70
Rate for Payer: BCBS of TX PPO	$7,181.87
Rate for Payer: Cash Price	$15,524.40
Rate for Payer: Cash Price	$15,524.40
Rate for Payer: Cash Price	$15,524.40
Rate for Payer: Cigna Commercial	$6,884.08
Rate for Payer: Cigna Medicaid	$16,437.60
Rate for Payer: Cigna Medicare	$3,256.70
Rate for Payer: Employer Direct Commercial	$3,256.70
Rate for Payer: Humana Medicare/TRICARE	$3,256.70
Rate for Payer: Molina CHIP/Medicaid	$16,437.60
Rate for Payer: Molina Dual Medicare/Medicaid	$3,256.70
Rate for Payer: Molina Medicare	$3,256.70
Rate for Payer: Multiplan Auto	$14,839.50
Rate for Payer: Multiplan Commercial	$14,839.50
Rate for Payer: Multiplan Workers Comp	$14,839.50
Rate for Payer: Parkland Medicaid	$16,437.60
Rate for Payer: Scott and White EPO/PPO	$1,488.64
Rate for Payer: Scott and White Medicare	$3,256.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,437.60
Rate for Payer: Superior Health Plan EPO	$3,256.70
Rate for Payer: Superior Health Plan Medicare	$3,256.70
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,256.70
Rate for Payer: Universal American Medicare	$3,256.70
Rate for Payer: Wellcare Medicare	$3,256.70
Rate for Payer: Wellmed Medicare	$3,256.70

CATH R&L HRT ART/VENT

Facility

$25,230.00

Service Code	HCPCS 93460
Hospital Charge Code	2320529
Hospital Revenue Code	481
Rate for Payer: Cash Price	$17,156.40

CATH R&L HRT ART/VENT

Facility

$25,230.00

Service Code	HCPCS 93460
Hospital Charge Code	2320529
Hospital Revenue Code	481
Min. Negotiated Rate	$1,506.78
Max. Negotiated Rate	$18,165.60
Rate for Payer: Amerigroup CHIP/Medicaid	$2,270.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,256.70
Rate for Payer: Amerigroup Medicare	$3,256.70
Rate for Payer: BCBS of TX Blue Advantage	$4,759.42
Rate for Payer: BCBS of TX Blue Essentials	$5,699.90
Rate for Payer: BCBS of TX Medicare	$3,256.70
Rate for Payer: BCBS of TX PPO	$7,181.87
Rate for Payer: Cash Price	$17,156.40
Rate for Payer: Cash Price	$17,156.40
Rate for Payer: Cash Price	$17,156.40
Rate for Payer: Cigna Commercial	$6,884.08
Rate for Payer: Cigna Medicaid	$18,165.60
Rate for Payer: Cigna Medicare	$3,256.70
Rate for Payer: Employer Direct Commercial	$3,256.70
Rate for Payer: Humana Medicare/TRICARE	$3,256.70
Rate for Payer: Molina CHIP/Medicaid	$18,165.60
Rate for Payer: Molina Dual Medicare/Medicaid	$3,256.70
Rate for Payer: Molina Medicare	$3,256.70
Rate for Payer: Multiplan Auto	$16,399.50
Rate for Payer: Multiplan Commercial	$16,399.50
Rate for Payer: Multiplan Workers Comp	$16,399.50
Rate for Payer: Parkland Medicaid	$18,165.60
Rate for Payer: Scott and White EPO/PPO	$1,506.78
Rate for Payer: Scott and White Medicare	$3,256.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18,165.60
Rate for Payer: Superior Health Plan EPO	$3,256.70
Rate for Payer: Superior Health Plan Medicare	$3,256.70
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,256.70
Rate for Payer: Universal American Medicare	$3,256.70
Rate for Payer: Wellcare Medicare	$3,256.70
Rate for Payer: Wellmed Medicare	$3,256.70

CATH R&L HRT AR/VNT BPGF

Facility

$26,826.07

Service Code	HCPCS 93461
Hospital Charge Code	2320530
Hospital Revenue Code	481
Rate for Payer: Cash Price	$18,241.73

CATH R&L HRT AR/VNT BPGF

Facility

$26,826.07

Service Code	HCPCS 93461
Hospital Charge Code	2320530
Hospital Revenue Code	481
Min. Negotiated Rate	$1,662.26
Max. Negotiated Rate	$19,314.77
Rate for Payer: Amerigroup CHIP/Medicaid	$2,414.35
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,256.70
Rate for Payer: Amerigroup Medicare	$3,256.70
Rate for Payer: BCBS of TX Blue Advantage	$4,759.42
Rate for Payer: BCBS of TX Blue Essentials	$5,699.90
Rate for Payer: BCBS of TX Medicare	$3,256.70
Rate for Payer: BCBS of TX PPO	$7,181.87
Rate for Payer: Cash Price	$18,241.73
Rate for Payer: Cash Price	$18,241.73
Rate for Payer: Cash Price	$18,241.73
Rate for Payer: Cigna Commercial	$6,884.08
Rate for Payer: Cigna Medicaid	$19,314.77
Rate for Payer: Cigna Medicare	$3,256.70
Rate for Payer: Employer Direct Commercial	$3,256.70
Rate for Payer: Humana Medicare/TRICARE	$3,256.70
Rate for Payer: Molina CHIP/Medicaid	$19,314.77
Rate for Payer: Molina Dual Medicare/Medicaid	$3,256.70
Rate for Payer: Molina Medicare	$3,256.70
Rate for Payer: Multiplan Auto	$17,436.95
Rate for Payer: Multiplan Commercial	$17,436.95
Rate for Payer: Multiplan Workers Comp	$17,436.95
Rate for Payer: Parkland Medicaid	$19,314.77
Rate for Payer: Scott and White EPO/PPO	$1,662.26
Rate for Payer: Scott and White Medicare	$3,256.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$19,314.77
Rate for Payer: Superior Health Plan EPO	$3,256.70
Rate for Payer: Superior Health Plan Medicare	$3,256.70
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,256.70
Rate for Payer: Universal American Medicare	$3,256.70
Rate for Payer: Wellcare Medicare	$3,256.70
Rate for Payer: Wellmed Medicare	$3,256.70

CATH SET COOKWAYNE PNEUMO

Facility

$911.36

Hospital Charge Code	145580
Hospital Revenue Code	272
Min. Negotiated Rate	$82.02
Max. Negotiated Rate	$656.18
Rate for Payer: Amerigroup CHIP/Medicaid	$82.02
Rate for Payer: BCBS of TX Blue Advantage	$273.41
Rate for Payer: BCBS of TX Blue Essentials	$328.09
Rate for Payer: BCBS of TX PPO	$364.54
Rate for Payer: Cash Price	$619.72
Rate for Payer: Cigna Medicaid	$656.18
Rate for Payer: Molina CHIP/Medicaid	$656.18
Rate for Payer: Multiplan Auto	$592.38
Rate for Payer: Multiplan Commercial	$592.38
Rate for Payer: Multiplan Workers Comp	$592.38
Rate for Payer: Parkland Medicaid	$656.18
Rate for Payer: Scott and White EPO/PPO	$455.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$656.18
Rate for Payer: Superior Health Plan EPO	$123.94

CATH SET COOKWAYNE PNEUMO

Facility

$911.36

Hospital Charge Code	145580
Hospital Revenue Code	272
Rate for Payer: Cash Price	$619.72

CATH SPEC -- DHF

Facility

$364.30

Hospital Charge Code	80567050
Hospital Revenue Code	272
Min. Negotiated Rate	$32.79
Max. Negotiated Rate	$262.30
Rate for Payer: Amerigroup CHIP/Medicaid	$32.79
Rate for Payer: BCBS of TX Blue Advantage	$109.29
Rate for Payer: BCBS of TX Blue Essentials	$131.15
Rate for Payer: BCBS of TX PPO	$145.72
Rate for Payer: Cash Price	$247.72
Rate for Payer: Cigna Medicaid	$262.30
Rate for Payer: Molina CHIP/Medicaid	$262.30
Rate for Payer: Multiplan Auto	$236.79
Rate for Payer: Multiplan Commercial	$236.79
Rate for Payer: Multiplan Workers Comp	$236.79
Rate for Payer: Parkland Medicaid	$262.30
Rate for Payer: Scott and White EPO/PPO	$182.15
Rate for Payer: Superior Health Plan CHIP/Medicaid	$262.30
Rate for Payer: Superior Health Plan EPO	$49.54

CATH SPEC -- DHF

Facility

$364.30

Hospital Charge Code	80567050
Hospital Revenue Code	272
Rate for Payer: Cash Price	$247.72

CATH SUCT A/S -- DHF

Facility

$45.82

Hospital Charge Code	80316300
Hospital Revenue Code	272
Rate for Payer: Cash Price	$31.16

CATH SUCT A/S -- DHF

Facility

$45.82

Hospital Charge Code	80316300
Hospital Revenue Code	272
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$32.99
Rate for Payer: Amerigroup CHIP/Medicaid	$4.12
Rate for Payer: BCBS of TX Blue Advantage	$13.75
Rate for Payer: BCBS of TX Blue Essentials	$16.50
Rate for Payer: BCBS of TX PPO	$18.33
Rate for Payer: Cash Price	$31.16
Rate for Payer: Cigna Medicaid	$32.99
Rate for Payer: Molina CHIP/Medicaid	$32.99
Rate for Payer: Multiplan Auto	$29.78
Rate for Payer: Multiplan Commercial	$29.78
Rate for Payer: Multiplan Workers Comp	$29.78
Rate for Payer: Parkland Medicaid	$32.99
Rate for Payer: Scott and White EPO/PPO	$22.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$32.99
Rate for Payer: Superior Health Plan EPO	$6.23

CATH SUPPORT ANGL NC35151

Facility

$983.36

Service Code	HCPCS C1769
Hospital Charge Code	993811
Hospital Revenue Code	272
Rate for Payer: Cash Price	$668.68

CATH SUPPORT ANGL NC35151

Facility

$983.36

Service Code	HCPCS C1769
Hospital Charge Code	993811
Hospital Revenue Code	272
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

CATH SW-GZ MNTR -- DHF

Facility

$3,404.88

Hospital Charge Code	80567555
Hospital Revenue Code	272
Min. Negotiated Rate	$306.44
Max. Negotiated Rate	$2,451.51
Rate for Payer: Amerigroup CHIP/Medicaid	$306.44
Rate for Payer: BCBS of TX Blue Advantage	$1,021.46
Rate for Payer: BCBS of TX Blue Essentials	$1,225.76
Rate for Payer: BCBS of TX PPO	$1,361.95
Rate for Payer: Cash Price	$2,315.32
Rate for Payer: Cigna Medicaid	$2,451.51
Rate for Payer: Molina CHIP/Medicaid	$2,451.51
Rate for Payer: Multiplan Auto	$2,213.17
Rate for Payer: Multiplan Commercial	$2,213.17
Rate for Payer: Multiplan Workers Comp	$2,213.17
Rate for Payer: Parkland Medicaid	$2,451.51
Rate for Payer: Scott and White EPO/PPO	$1,702.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,451.51
Rate for Payer: Superior Health Plan EPO	$463.06

CATH SW-GZ MNTR -- DHF

Facility

$3,404.88

Hospital Charge Code	80567555
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,315.32

CATH TEMPO 5F UF 65CM 5SH

Facility

$61.97

Service Code	HCPCS C2623
Hospital Charge Code	82401282
Hospital Revenue Code	272
Min. Negotiated Rate	$5.58
Max. Negotiated Rate	$44.62
Rate for Payer: Amerigroup CHIP/Medicaid	$5.58
Rate for Payer: BCBS of TX Blue Advantage	$18.59
Rate for Payer: BCBS of TX Blue Essentials	$22.31
Rate for Payer: BCBS of TX PPO	$24.79
Rate for Payer: Cash Price	$42.14
Rate for Payer: Cigna Medicaid	$44.62
Rate for Payer: Molina CHIP/Medicaid	$44.62
Rate for Payer: Multiplan Auto	$40.28
Rate for Payer: Multiplan Commercial	$40.28
Rate for Payer: Multiplan Workers Comp	$40.28
Rate for Payer: Parkland Medicaid	$44.62
Rate for Payer: Scott and White EPO/PPO	$30.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$44.62
Rate for Payer: Superior Health Plan EPO	$8.43

CATH TEMPO 5F UF 65CM 5SH

Facility

$61.97

Service Code	HCPCS C2623
Hospital Charge Code	82401282
Hospital Revenue Code	272
Rate for Payer: Cash Price	$42.14

CATH TEMPO 5F UF 9

Facility

$154.93

Service Code	HCPCS C2623
Hospital Charge Code	992414
Hospital Revenue Code	272
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$111.55
Rate for Payer: Amerigroup CHIP/Medicaid	$13.94
Rate for Payer: BCBS of TX Blue Advantage	$46.48
Rate for Payer: BCBS of TX Blue Essentials	$55.77
Rate for Payer: BCBS of TX PPO	$61.97
Rate for Payer: Cash Price	$105.35
Rate for Payer: Cigna Medicaid	$111.55
Rate for Payer: Molina CHIP/Medicaid	$111.55
Rate for Payer: Multiplan Auto	$100.70
Rate for Payer: Multiplan Commercial	$100.70
Rate for Payer: Multiplan Workers Comp	$100.70
Rate for Payer: Parkland Medicaid	$111.55
Rate for Payer: Scott and White EPO/PPO	$77.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$111.55
Rate for Payer: Superior Health Plan EPO	$21.07

CATH TEMPO 5F UF 9

Facility

$154.93

Service Code	HCPCS C2623
Hospital Charge Code	992414
Hospital Revenue Code	272
Rate for Payer: Cash Price	$105.35

CATH TEMPO 5F UF 9

Facility

$154.93

Service Code	HCPCS C2623
Hospital Charge Code	992415
Hospital Revenue Code	272
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$111.55
Rate for Payer: Amerigroup CHIP/Medicaid	$13.94
Rate for Payer: BCBS of TX Blue Advantage	$46.48
Rate for Payer: BCBS of TX Blue Essentials	$55.77
Rate for Payer: BCBS of TX PPO	$61.97
Rate for Payer: Cash Price	$105.35
Rate for Payer: Cigna Medicaid	$111.55
Rate for Payer: Molina CHIP/Medicaid	$111.55
Rate for Payer: Multiplan Auto	$100.70
Rate for Payer: Multiplan Commercial	$100.70
Rate for Payer: Multiplan Workers Comp	$100.70
Rate for Payer: Parkland Medicaid	$111.55
Rate for Payer: Scott and White EPO/PPO	$77.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$111.55
Rate for Payer: Superior Health Plan EPO	$21.07

CATH TEMPO 5F UF 9

Facility

$154.93

Service Code	HCPCS C2623
Hospital Charge Code	992415
Hospital Revenue Code	272
Rate for Payer: Cash Price	$105.35

Know your out-of-pocket cost for care.

All Charges