White Rock Medical Center

All Charges

Charge

Type

Setting

Price

KIT, CATH 4FR DL PROVENA

Facility

$1,429.03

Hospital Charge Code	993417
Hospital Revenue Code	272
Rate for Payer: Cash Price	$971.74

KIT, CATH 4FR DL PROVENA

Facility

$1,429.03

Hospital Charge Code	993417
Hospital Revenue Code	272
Min. Negotiated Rate	$128.61
Max. Negotiated Rate	$1,028.90
Rate for Payer: Amerigroup CHIP/Medicaid	$128.61
Rate for Payer: BCBS of TX Blue Advantage	$428.71
Rate for Payer: BCBS of TX Blue Essentials	$514.45
Rate for Payer: BCBS of TX PPO	$571.61
Rate for Payer: Cash Price	$971.74
Rate for Payer: Cigna Medicaid	$1,028.90
Rate for Payer: Molina CHIP/Medicaid	$1,028.90
Rate for Payer: Multiplan Auto	$928.87
Rate for Payer: Multiplan Commercial	$928.87
Rate for Payer: Multiplan Workers Comp	$928.87
Rate for Payer: Parkland Medicaid	$1,028.90
Rate for Payer: Scott and White EPO/PPO	$714.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,028.90
Rate for Payer: Superior Health Plan EPO	$194.35

kit cath art 20gx1.75'

Facility

$43.54

Hospital Charge Code	2514602
Hospital Revenue Code	272
Rate for Payer: Cash Price	$29.61

kit cath art 20gx1.75'

Facility

$43.54

Hospital Charge Code	2514602
Hospital Revenue Code	272
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$31.35
Rate for Payer: Amerigroup CHIP/Medicaid	$3.92
Rate for Payer: BCBS of TX Blue Advantage	$13.06
Rate for Payer: BCBS of TX Blue Essentials	$15.67
Rate for Payer: BCBS of TX PPO	$17.42
Rate for Payer: Cash Price	$29.61
Rate for Payer: Cigna Medicaid	$31.35
Rate for Payer: Molina CHIP/Medicaid	$31.35
Rate for Payer: Multiplan Auto	$28.30
Rate for Payer: Multiplan Commercial	$28.30
Rate for Payer: Multiplan Workers Comp	$28.30
Rate for Payer: Parkland Medicaid	$31.35
Rate for Payer: Scott and White EPO/PPO	$21.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$31.35
Rate for Payer: Superior Health Plan EPO	$5.92

KIT CATH DX DXTERITY JL-JR4.0 100 PGTL STR 110 6F

Facility

$136.20

Hospital Charge Code	80325772
Hospital Revenue Code	270
Rate for Payer: Cash Price	$92.62

KIT CATH DX DXTERITY JL-JR4.0 100 PGTL STR 110 6F

Facility

$136.20

Hospital Charge Code	80325772
Hospital Revenue Code	270
Min. Negotiated Rate	$12.26
Max. Negotiated Rate	$98.06
Rate for Payer: Amerigroup CHIP/Medicaid	$12.26
Rate for Payer: BCBS of TX Blue Advantage	$40.86
Rate for Payer: BCBS of TX Blue Essentials	$49.03
Rate for Payer: BCBS of TX PPO	$54.48
Rate for Payer: Cash Price	$92.62
Rate for Payer: Cigna Medicaid	$98.06
Rate for Payer: Molina CHIP/Medicaid	$98.06
Rate for Payer: Multiplan Auto	$88.53
Rate for Payer: Multiplan Commercial	$88.53
Rate for Payer: Multiplan Workers Comp	$88.53
Rate for Payer: Parkland Medicaid	$98.06
Rate for Payer: Scott and White EPO/PPO	$68.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$98.06
Rate for Payer: Superior Health Plan EPO	$18.52

KIT, CATHETER ARTERIAL PE

Facility

$88.80

Hospital Charge Code	135266
Hospital Revenue Code	272
Rate for Payer: Cash Price	$60.38

KIT, CATHETER ARTERIAL PE

Facility

$88.80

Hospital Charge Code	135266
Hospital Revenue Code	272
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$63.94
Rate for Payer: Amerigroup CHIP/Medicaid	$7.99
Rate for Payer: BCBS of TX Blue Advantage	$26.64
Rate for Payer: BCBS of TX Blue Essentials	$31.97
Rate for Payer: BCBS of TX PPO	$35.52
Rate for Payer: Cash Price	$60.38
Rate for Payer: Cigna Medicaid	$63.94
Rate for Payer: Molina CHIP/Medicaid	$63.94
Rate for Payer: Multiplan Auto	$57.72
Rate for Payer: Multiplan Commercial	$57.72
Rate for Payer: Multiplan Workers Comp	$57.72
Rate for Payer: Parkland Medicaid	$63.94
Rate for Payer: Scott and White EPO/PPO	$44.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$63.94
Rate for Payer: Superior Health Plan EPO	$12.08

KIT CATHETER ARTERIAL PED 20GA 6 NDL 21GA X 2

Facility

$121.67

Hospital Charge Code	993441
Hospital Revenue Code	272
Rate for Payer: Cash Price	$82.74

KIT CATHETER ARTERIAL PED 20GA 6 NDL 21GA X 2

Facility

$121.67

Hospital Charge Code	993441
Hospital Revenue Code	272
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$87.60
Rate for Payer: Amerigroup CHIP/Medicaid	$10.95
Rate for Payer: BCBS of TX Blue Advantage	$36.50
Rate for Payer: BCBS of TX Blue Essentials	$43.80
Rate for Payer: BCBS of TX PPO	$48.67
Rate for Payer: Cash Price	$82.74
Rate for Payer: Cigna Medicaid	$87.60
Rate for Payer: Molina CHIP/Medicaid	$87.60
Rate for Payer: Multiplan Auto	$79.09
Rate for Payer: Multiplan Commercial	$79.09
Rate for Payer: Multiplan Workers Comp	$79.09
Rate for Payer: Parkland Medicaid	$87.60
Rate for Payer: Scott and White EPO/PPO	$60.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$87.60
Rate for Payer: Superior Health Plan EPO	$16.55

KIT, CATH HICKMAN DL LMN

Facility

$1,467.23

Hospital Charge Code	80564859
Hospital Revenue Code	278
Min. Negotiated Rate	$366.81
Max. Negotiated Rate	$733.62
Rate for Payer: Cash Price	$997.72
Rate for Payer: Cigna Commercial	$366.81
Rate for Payer: Multiplan Auto	$733.62
Rate for Payer: Multiplan Commercial	$733.62
Rate for Payer: Multiplan Workers Comp	$733.62
Rate for Payer: Scott and White EPO/PPO	$733.62

KIT, CATH HICKMAN DL LMN

Facility

$1,467.23

Hospital Charge Code	80564859
Hospital Revenue Code	278
Min. Negotiated Rate	$132.05
Max. Negotiated Rate	$1,056.41
Rate for Payer: Amerigroup CHIP/Medicaid	$132.05
Rate for Payer: BCBS of TX Blue Advantage	$440.17
Rate for Payer: BCBS of TX Blue Essentials	$528.20
Rate for Payer: BCBS of TX PPO	$586.89
Rate for Payer: Cash Price	$997.72
Rate for Payer: Cigna Medicaid	$1,056.41
Rate for Payer: Molina CHIP/Medicaid	$1,056.41
Rate for Payer: Multiplan Auto	$733.62
Rate for Payer: Multiplan Commercial	$733.62
Rate for Payer: Multiplan Workers Comp	$733.62
Rate for Payer: Parkland Medicaid	$1,056.41
Rate for Payer: Scott and White EPO/PPO	$733.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,056.41
Rate for Payer: Superior Health Plan EPO	$199.54

KIT CATH VENOUS VANTEX CVC BUNDLE, 7FR 17CM

Facility

$1,118.84

Hospital Charge Code	993598
Hospital Revenue Code	270
Rate for Payer: Cash Price	$760.81

KIT CATH VENOUS VANTEX CVC BUNDLE, 7FR 17CM

Facility

$1,118.84

Hospital Charge Code	993598
Hospital Revenue Code	270
Min. Negotiated Rate	$100.70
Max. Negotiated Rate	$805.56
Rate for Payer: Amerigroup CHIP/Medicaid	$100.70
Rate for Payer: BCBS of TX Blue Advantage	$335.65
Rate for Payer: BCBS of TX Blue Essentials	$402.78
Rate for Payer: BCBS of TX PPO	$447.54
Rate for Payer: Cash Price	$760.81
Rate for Payer: Cigna Medicaid	$805.56
Rate for Payer: Molina CHIP/Medicaid	$805.56
Rate for Payer: Multiplan Auto	$727.25
Rate for Payer: Multiplan Commercial	$727.25
Rate for Payer: Multiplan Workers Comp	$727.25
Rate for Payer: Parkland Medicaid	$805.56
Rate for Payer: Scott and White EPO/PPO	$559.42
Rate for Payer: Superior Health Plan CHIP/Medicaid	$805.56
Rate for Payer: Superior Health Plan EPO	$152.16

KIT CENT VEN CATH 3 LMN 7F 16CM EXP INTERSAFETY

Facility

$267.24

Service Code	HCPCS C1725
Hospital Charge Code	993466
Hospital Revenue Code	270
Rate for Payer: Cash Price	$181.72

KIT CENT VEN CATH 3 LMN 7F 16CM EXP INTERSAFETY

Facility

$267.24

Service Code	HCPCS C1725
Hospital Charge Code	993590
Hospital Revenue Code	270
Min. Negotiated Rate	$24.05
Max. Negotiated Rate	$192.41
Rate for Payer: Amerigroup CHIP/Medicaid	$24.05
Rate for Payer: BCBS of TX Blue Advantage	$80.17
Rate for Payer: BCBS of TX Blue Essentials	$96.21
Rate for Payer: BCBS of TX PPO	$106.90
Rate for Payer: Cash Price	$181.72
Rate for Payer: Cigna Medicaid	$192.41
Rate for Payer: Molina CHIP/Medicaid	$192.41
Rate for Payer: Multiplan Auto	$173.71
Rate for Payer: Multiplan Commercial	$173.71
Rate for Payer: Multiplan Workers Comp	$173.71
Rate for Payer: Parkland Medicaid	$192.41
Rate for Payer: Scott and White EPO/PPO	$133.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$192.41
Rate for Payer: Superior Health Plan EPO	$36.34

KIT CENT VEN CATH 3 LMN 7F 16CM EXP INTERSAFETY

Facility

$267.24

Service Code	HCPCS C1725
Hospital Charge Code	993590
Hospital Revenue Code	270
Rate for Payer: Cash Price	$181.72

KIT CENT VEN CATH 3 LMN 7F 16CM EXP INTERSAFETY

Facility

$267.24

Service Code	HCPCS C1725
Hospital Charge Code	993466
Hospital Revenue Code	270
Min. Negotiated Rate	$24.05
Max. Negotiated Rate	$192.41
Rate for Payer: Amerigroup CHIP/Medicaid	$24.05
Rate for Payer: BCBS of TX Blue Advantage	$80.17
Rate for Payer: BCBS of TX Blue Essentials	$96.21
Rate for Payer: BCBS of TX PPO	$106.90
Rate for Payer: Cash Price	$181.72
Rate for Payer: Cigna Medicaid	$192.41
Rate for Payer: Molina CHIP/Medicaid	$192.41
Rate for Payer: Multiplan Auto	$173.71
Rate for Payer: Multiplan Commercial	$173.71
Rate for Payer: Multiplan Workers Comp	$173.71
Rate for Payer: Parkland Medicaid	$192.41
Rate for Payer: Scott and White EPO/PPO	$133.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$192.41
Rate for Payer: Superior Health Plan EPO	$36.34

KIT, CIRCUIT, BIPAP, EX PORT

Facility

$136.45

Hospital Charge Code	993828
Hospital Revenue Code	270
Min. Negotiated Rate	$12.28
Max. Negotiated Rate	$98.24
Rate for Payer: Amerigroup CHIP/Medicaid	$12.28
Rate for Payer: BCBS of TX Blue Advantage	$40.94
Rate for Payer: BCBS of TX Blue Essentials	$49.12
Rate for Payer: BCBS of TX PPO	$54.58
Rate for Payer: Cash Price	$92.79
Rate for Payer: Cigna Medicaid	$98.24
Rate for Payer: Molina CHIP/Medicaid	$98.24
Rate for Payer: Multiplan Auto	$88.69
Rate for Payer: Multiplan Commercial	$88.69
Rate for Payer: Multiplan Workers Comp	$88.69
Rate for Payer: Parkland Medicaid	$98.24
Rate for Payer: Scott and White EPO/PPO	$68.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$98.24
Rate for Payer: Superior Health Plan EPO	$18.56

KIT, CIRCUIT, BIPAP, EX PORT

Facility

$136.45

Hospital Charge Code	993828
Hospital Revenue Code	270
Rate for Payer: Cash Price	$92.79

KIT CIRCUIT PATIENT WITH CHAMBER FLOW GENERATOR

Facility

$272.89

Hospital Charge Code	992744
Hospital Revenue Code	270
Min. Negotiated Rate	$24.56
Max. Negotiated Rate	$196.48
Rate for Payer: Amerigroup CHIP/Medicaid	$24.56
Rate for Payer: BCBS of TX Blue Advantage	$81.87
Rate for Payer: BCBS of TX Blue Essentials	$98.24
Rate for Payer: BCBS of TX PPO	$109.16
Rate for Payer: Cash Price	$185.57
Rate for Payer: Cigna Medicaid	$196.48
Rate for Payer: Molina CHIP/Medicaid	$196.48
Rate for Payer: Multiplan Auto	$177.38
Rate for Payer: Multiplan Commercial	$177.38
Rate for Payer: Multiplan Workers Comp	$177.38
Rate for Payer: Parkland Medicaid	$196.48
Rate for Payer: Scott and White EPO/PPO	$136.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$196.48
Rate for Payer: Superior Health Plan EPO	$37.11

KIT CIRCUIT PATIENT WITH CHAMBER FLOW GENERATOR

Facility

$272.89

Hospital Charge Code	992744
Hospital Revenue Code	270
Rate for Payer: Cash Price	$185.57

KIT, CLOSURE PROCEDURE 5MM & 10-12MM TROCAR DISP

Facility

$180.91

Hospital Charge Code	130957
Hospital Revenue Code	272
Rate for Payer: Cash Price	$123.02

KIT, CLOSURE PROCEDURE 5MM & 10-12MM TROCAR DISP

Facility

$180.91

Hospital Charge Code	130957
Hospital Revenue Code	272
Min. Negotiated Rate	$16.28
Max. Negotiated Rate	$130.26
Rate for Payer: Amerigroup CHIP/Medicaid	$16.28
Rate for Payer: BCBS of TX Blue Advantage	$54.27
Rate for Payer: BCBS of TX Blue Essentials	$65.13
Rate for Payer: BCBS of TX PPO	$72.36
Rate for Payer: Cash Price	$123.02
Rate for Payer: Cigna Medicaid	$130.26
Rate for Payer: Molina CHIP/Medicaid	$130.26
Rate for Payer: Multiplan Auto	$117.59
Rate for Payer: Multiplan Commercial	$117.59
Rate for Payer: Multiplan Workers Comp	$117.59
Rate for Payer: Parkland Medicaid	$130.26
Rate for Payer: Scott and White EPO/PPO	$90.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$130.26
Rate for Payer: Superior Health Plan EPO	$24.60

KIT CLOSURE SUTURE PASSER W/ 10/12MM & 15MM GUIDE

Facility

$363.31

Hospital Charge Code	992659
Hospital Revenue Code	270
Min. Negotiated Rate	$32.70
Max. Negotiated Rate	$261.58
Rate for Payer: Amerigroup CHIP/Medicaid	$32.70
Rate for Payer: BCBS of TX Blue Advantage	$108.99
Rate for Payer: BCBS of TX Blue Essentials	$130.79
Rate for Payer: BCBS of TX PPO	$145.32
Rate for Payer: Cash Price	$247.05
Rate for Payer: Cigna Medicaid	$261.58
Rate for Payer: Molina CHIP/Medicaid	$261.58
Rate for Payer: Multiplan Auto	$236.15
Rate for Payer: Multiplan Commercial	$236.15
Rate for Payer: Multiplan Workers Comp	$236.15
Rate for Payer: Parkland Medicaid	$261.58
Rate for Payer: Scott and White EPO/PPO	$181.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$261.58
Rate for Payer: Superior Health Plan EPO	$49.41

Know your out-of-pocket cost for care.

All Charges