White Rock Medical Center

All Charges

Charge

Type

Setting

Price

carvedilol 6.25 mg Tab

Facility

$9.30

Service Code	HCPCS J3490
Hospital Charge Code	78404151
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$6.04
Rate for Payer: Amerigroup CHIP/Medicaid	$0.84
Rate for Payer: BCBS of TX Blue Advantage	$2.79
Rate for Payer: BCBS of TX Blue Essentials	$3.35
Rate for Payer: BCBS of TX PPO	$3.72
Rate for Payer: Cash Price	$6.32
Rate for Payer: Multiplan Auto	$6.04
Rate for Payer: Multiplan Commercial	$6.04
Rate for Payer: Multiplan Workers Comp	$6.04
Rate for Payer: Scott and White EPO/PPO	$4.65
Rate for Payer: Superior Health Plan EPO	$1.26

CASSETTE VAC VERALINK ULTLNK0500.S

Facility

$237.22

Hospital Charge Code	122725
Hospital Revenue Code	272
Min. Negotiated Rate	$21.35
Max. Negotiated Rate	$154.19
Rate for Payer: Aetna Commercial	$130.47
Rate for Payer: Amerigroup CHIP/Medicaid	$21.35
Rate for Payer: BCBS of TX Blue Advantage	$71.17
Rate for Payer: BCBS of TX Blue Essentials	$85.40
Rate for Payer: BCBS of TX PPO	$94.89
Rate for Payer: Cash Price	$208.75
Rate for Payer: Multiplan Auto	$154.19
Rate for Payer: Multiplan Commercial	$154.19
Rate for Payer: Multiplan Workers Comp	$154.19
Rate for Payer: Scott and White EPO/PPO	$118.61
Rate for Payer: Superior Health Plan EPO	$32.26

CASSETTE VAC VERALINK ULTLNK0500.S

Facility

$237.22

Hospital Charge Code	122725
Hospital Revenue Code	272
Rate for Payer: Cash Price	$208.75

Catecholamines,Ur.,Free,24 Hr SO

Facility

$193.00

Service Code	CPT 82384
Hospital Charge Code	1701945
Hospital Revenue Code	301
Rate for Payer: Cash Price	$169.84

Catecholamines,Ur.,Free,24 Hr SO

Facility

$193.00

Service Code	CPT 82384
Hospital Charge Code	1701945
Hospital Revenue Code	301
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$125.45
Rate for Payer: Aetna Commercial	$26.51
Rate for Payer: Aetna Medicare	$37.88
Rate for Payer: Amerigroup CHIP/Medicaid	$9.85
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$25.25
Rate for Payer: Amerigroup Medicare	$25.25
Rate for Payer: BCBS of TX Blue Advantage	$41.66
Rate for Payer: BCBS of TX Blue Essentials	$50.00
Rate for Payer: BCBS of TX Medicare	$25.25
Rate for Payer: BCBS of TX PPO	$55.80
Rate for Payer: Cash Price	$169.84
Rate for Payer: Cash Price	$169.84
Rate for Payer: Cigna Medicaid	$25.25
Rate for Payer: Cigna Medicare	$25.25
Rate for Payer: Employer Direct Commercial	$25.25
Rate for Payer: Humana Medicare/TRICARE	$25.25
Rate for Payer: Molina CHIP/Medicaid	$25.25
Rate for Payer: Molina Dual Medicare/Medicaid	$25.25
Rate for Payer: Molina Medicare	$25.25
Rate for Payer: Multiplan Auto	$125.45
Rate for Payer: Multiplan Commercial	$125.45
Rate for Payer: Multiplan Workers Comp	$125.45
Rate for Payer: Parkland Medicaid	$25.25
Rate for Payer: Scott and White EPO/PPO	$31.56
Rate for Payer: Scott and White Medicare	$25.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$25.25
Rate for Payer: Superior Health Plan EPO	$25.25
Rate for Payer: Superior Health Plan Medicare	$25.25
Rate for Payer: Universal American Dual Medicare/Medicaid	$25.25
Rate for Payer: Universal American Medicare	$25.25
Rate for Payer: Wellcare Medicare	$25.25
Rate for Payer: Wellmed Medicare	$25.25

CATH ABL BLAZER 4MM

Facility

$2,465.42

Service Code	HCPCS C1731
Hospital Charge Code	8494508
Hospital Revenue Code	278
Min. Negotiated Rate	$221.89
Max. Negotiated Rate	$1,232.71
Rate for Payer: Aetna Commercial	$739.63
Rate for Payer: Amerigroup CHIP/Medicaid	$221.89
Rate for Payer: BCBS of TX Blue Advantage	$739.63
Rate for Payer: BCBS of TX Blue Essentials	$887.55
Rate for Payer: BCBS of TX PPO	$986.17
Rate for Payer: Cash Price	$2,169.57
Rate for Payer: Multiplan Auto	$1,232.71
Rate for Payer: Multiplan Commercial	$1,232.71
Rate for Payer: Multiplan Workers Comp	$1,232.71
Rate for Payer: Scott and White EPO/PPO	$1,232.71
Rate for Payer: Superior Health Plan EPO	$335.30

CATH ABL BLAZER 4MM

Facility

$2,465.42

Service Code	HCPCS C1731
Hospital Charge Code	8494508
Hospital Revenue Code	278
Min. Negotiated Rate	$616.36
Max. Negotiated Rate	$1,232.71
Rate for Payer: Aetna Commercial	$739.63
Rate for Payer: Cash Price	$2,169.57
Rate for Payer: Cigna Commercial	$616.36
Rate for Payer: Multiplan Auto	$1,232.71
Rate for Payer: Multiplan Commercial	$1,232.71
Rate for Payer: Multiplan Workers Comp	$1,232.71
Rate for Payer: Scott and White EPO/PPO	$1,232.71

CATH ABL NAVISTR DEFL TI -- DHF

Facility

$12,289.72

Service Code	HCPCS C1732
Hospital Charge Code	82406455
Hospital Revenue Code	272
Min. Negotiated Rate	$1,106.07
Max. Negotiated Rate	$7,988.32
Rate for Payer: Aetna Commercial	$6,759.35
Rate for Payer: Amerigroup CHIP/Medicaid	$1,106.07
Rate for Payer: BCBS of TX Blue Advantage	$3,686.92
Rate for Payer: BCBS of TX Blue Essentials	$4,424.30
Rate for Payer: BCBS of TX PPO	$4,915.89
Rate for Payer: Cash Price	$10,814.95
Rate for Payer: Multiplan Auto	$7,988.32
Rate for Payer: Multiplan Commercial	$7,988.32
Rate for Payer: Multiplan Workers Comp	$7,988.32
Rate for Payer: Scott and White EPO/PPO	$6,144.86
Rate for Payer: Superior Health Plan EPO	$1,671.40

CATH ABL NAVISTR DEFL TI -- DHF

Facility

$12,289.72

Service Code	HCPCS C1732
Hospital Charge Code	82406455
Hospital Revenue Code	272
Rate for Payer: Cash Price	$10,814.95

CATH ANGIO -- DHF

Facility

$72.64

Hospital Charge Code	80560147
Hospital Revenue Code	272
Rate for Payer: Cash Price	$63.92

CATH ANGIO -- DHF

Facility

$72.64

Hospital Charge Code	80560147
Hospital Revenue Code	272
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$47.22
Rate for Payer: Aetna Commercial	$39.95
Rate for Payer: Amerigroup CHIP/Medicaid	$6.54
Rate for Payer: BCBS of TX Blue Advantage	$21.79
Rate for Payer: BCBS of TX Blue Essentials	$26.15
Rate for Payer: BCBS of TX PPO	$29.06
Rate for Payer: Cash Price	$63.92
Rate for Payer: Multiplan Auto	$47.22
Rate for Payer: Multiplan Commercial	$47.22
Rate for Payer: Multiplan Workers Comp	$47.22
Rate for Payer: Scott and White EPO/PPO	$36.32
Rate for Payer: Superior Health Plan EPO	$9.88

CATH ANGIOSPRV TRQ HCOAT -- DHF

Facility

$302.07

Hospital Charge Code	80560212
Hospital Revenue Code	272
Rate for Payer: Cash Price	$265.82

CATH ANGIOSPRV TRQ HCOAT -- DHF

Facility

$302.07

Hospital Charge Code	80560212
Hospital Revenue Code	272
Min. Negotiated Rate	$27.19
Max. Negotiated Rate	$196.35
Rate for Payer: Aetna Commercial	$166.14
Rate for Payer: Amerigroup CHIP/Medicaid	$27.19
Rate for Payer: BCBS of TX Blue Advantage	$90.62
Rate for Payer: BCBS of TX Blue Essentials	$108.75
Rate for Payer: BCBS of TX PPO	$120.83
Rate for Payer: Cash Price	$265.82
Rate for Payer: Multiplan Auto	$196.35
Rate for Payer: Multiplan Commercial	$196.35
Rate for Payer: Multiplan Workers Comp	$196.35
Rate for Payer: Scott and White EPO/PPO	$151.04
Rate for Payer: Superior Health Plan EPO	$41.08

CATH ANG QUICK-CROSS -- DHF

Facility

$797.17

Service Code	HCPCS C1887
Hospital Charge Code	82400292
Hospital Revenue Code	278
Min. Negotiated Rate	$71.75
Max. Negotiated Rate	$398.58
Rate for Payer: Aetna Commercial	$239.15
Rate for Payer: Amerigroup CHIP/Medicaid	$71.75
Rate for Payer: BCBS of TX Blue Advantage	$239.15
Rate for Payer: BCBS of TX Blue Essentials	$286.98
Rate for Payer: BCBS of TX PPO	$318.87
Rate for Payer: Cash Price	$701.51
Rate for Payer: Multiplan Auto	$398.58
Rate for Payer: Multiplan Commercial	$398.58
Rate for Payer: Multiplan Workers Comp	$398.58
Rate for Payer: Scott and White EPO/PPO	$398.58
Rate for Payer: Superior Health Plan EPO	$108.42

CATH ANG QUICK-CROSS -- DHF

Facility

$797.17

Service Code	HCPCS C1887
Hospital Charge Code	82400292
Hospital Revenue Code	278
Min. Negotiated Rate	$199.29
Max. Negotiated Rate	$398.58
Rate for Payer: Aetna Commercial	$239.15
Rate for Payer: Cash Price	$701.51
Rate for Payer: Cigna Commercial	$199.29
Rate for Payer: Multiplan Auto	$398.58
Rate for Payer: Multiplan Commercial	$398.58
Rate for Payer: Multiplan Workers Comp	$398.58
Rate for Payer: Scott and White EPO/PPO	$398.58

CATH ANG TRANSLUM NLSR3 -- DHF

Facility

$3,029.70

Service Code	HCPCS C1725
Hospital Charge Code	82401282
Hospital Revenue Code	278
Min. Negotiated Rate	$272.67
Max. Negotiated Rate	$1,514.85
Rate for Payer: Aetna Commercial	$908.91
Rate for Payer: Amerigroup CHIP/Medicaid	$272.67
Rate for Payer: BCBS of TX Blue Advantage	$908.91
Rate for Payer: BCBS of TX Blue Essentials	$1,090.69
Rate for Payer: BCBS of TX PPO	$1,211.88
Rate for Payer: Cash Price	$2,666.14
Rate for Payer: Multiplan Auto	$1,514.85
Rate for Payer: Multiplan Commercial	$1,514.85
Rate for Payer: Multiplan Workers Comp	$1,514.85
Rate for Payer: Scott and White EPO/PPO	$1,514.85
Rate for Payer: Superior Health Plan EPO	$412.04

CATH ANG TRANSLUM NLSR3 -- DHF

Facility

$3,029.70

Service Code	HCPCS C1725
Hospital Charge Code	82401282
Hospital Revenue Code	278
Min. Negotiated Rate	$757.42
Max. Negotiated Rate	$1,514.85
Rate for Payer: Aetna Commercial	$908.91
Rate for Payer: Cash Price	$2,666.14
Rate for Payer: Cigna Commercial	$757.42
Rate for Payer: Multiplan Auto	$1,514.85
Rate for Payer: Multiplan Commercial	$1,514.85
Rate for Payer: Multiplan Workers Comp	$1,514.85
Rate for Payer: Scott and White EPO/PPO	$1,514.85

CATH ARMADA BALLOON 35

Facility

$861.45

Service Code	HCPCS C1725
Hospital Charge Code	82401258
Hospital Revenue Code	278
Min. Negotiated Rate	$77.53
Max. Negotiated Rate	$430.72
Rate for Payer: Aetna Commercial	$258.44
Rate for Payer: Amerigroup CHIP/Medicaid	$77.53
Rate for Payer: BCBS of TX Blue Advantage	$258.44
Rate for Payer: BCBS of TX Blue Essentials	$310.12
Rate for Payer: BCBS of TX PPO	$344.58
Rate for Payer: Cash Price	$758.08
Rate for Payer: Multiplan Auto	$430.72
Rate for Payer: Multiplan Commercial	$430.72
Rate for Payer: Multiplan Workers Comp	$430.72
Rate for Payer: Scott and White EPO/PPO	$430.72
Rate for Payer: Superior Health Plan EPO	$117.16

CATH ARMADA BALLOON 35

Facility

$861.45

Service Code	HCPCS C1725
Hospital Charge Code	82401258
Hospital Revenue Code	278
Min. Negotiated Rate	$215.36
Max. Negotiated Rate	$430.72
Rate for Payer: Aetna Commercial	$258.44
Rate for Payer: Cash Price	$758.08
Rate for Payer: Cigna Commercial	$215.36
Rate for Payer: Multiplan Auto	$430.72
Rate for Payer: Multiplan Commercial	$430.72
Rate for Payer: Multiplan Workers Comp	$430.72
Rate for Payer: Scott and White EPO/PPO	$430.72

CATH ASPIRATION EXPORTAP -- DHF

Facility

$2,518.07

Service Code	HCPCS C1757
Hospital Charge Code	80560527
Hospital Revenue Code	278
Min. Negotiated Rate	$629.52
Max. Negotiated Rate	$1,259.04
Rate for Payer: Aetna Commercial	$755.42
Rate for Payer: Cash Price	$2,215.90
Rate for Payer: Cigna Commercial	$629.52
Rate for Payer: Multiplan Auto	$1,259.04
Rate for Payer: Multiplan Commercial	$1,259.04
Rate for Payer: Multiplan Workers Comp	$1,259.04
Rate for Payer: Scott and White EPO/PPO	$1,259.04

CATH ASPIRATION EXPORTAP -- DHF

Facility

$2,518.07

Service Code	HCPCS C1757
Hospital Charge Code	80560527
Hospital Revenue Code	278
Min. Negotiated Rate	$226.63
Max. Negotiated Rate	$1,259.04
Rate for Payer: Aetna Commercial	$755.42
Rate for Payer: Amerigroup CHIP/Medicaid	$226.63
Rate for Payer: BCBS of TX Blue Advantage	$755.42
Rate for Payer: BCBS of TX Blue Essentials	$906.51
Rate for Payer: BCBS of TX PPO	$1,007.23
Rate for Payer: Cash Price	$2,215.90
Rate for Payer: Multiplan Auto	$1,259.04
Rate for Payer: Multiplan Commercial	$1,259.04
Rate for Payer: Multiplan Workers Comp	$1,259.04
Rate for Payer: Scott and White EPO/PPO	$1,259.04
Rate for Payer: Superior Health Plan EPO	$342.46

CATH ATRIAL PACING

Facility

$3,198.00

Service Code	CPT 93610
Hospital Charge Code	4613551
Hospital Revenue Code	481
Rate for Payer: Cash Price	$2,814.24

CATH ATRIAL PACING

Facility

$3,198.00

Service Code	CPT 93610
Hospital Charge Code	4613551
Hospital Revenue Code	481
Min. Negotiated Rate	$122.15
Max. Negotiated Rate	$15,471.93
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$10,245.00
Rate for Payer: Amerigroup CHIP/Medicaid	$287.82
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6,830.00
Rate for Payer: Amerigroup Medicare	$6,830.00
Rate for Payer: BCBS of TX Blue Advantage	$9,829.14
Rate for Payer: BCBS of TX Blue Essentials	$11,771.42
Rate for Payer: BCBS of TX Medicare	$6,830.00
Rate for Payer: BCBS of TX PPO	$14,831.99
Rate for Payer: Cash Price	$2,814.24
Rate for Payer: Cash Price	$2,814.24
Rate for Payer: Cash Price	$2,814.24
Rate for Payer: Cigna Commercial	$15,471.93
Rate for Payer: Cigna Medicare	$6,830.00
Rate for Payer: Employer Direct Commercial	$6,830.00
Rate for Payer: Humana Medicare/TRICARE	$6,830.00
Rate for Payer: Molina Dual Medicare/Medicaid	$6,830.00
Rate for Payer: Molina Medicare	$6,830.00
Rate for Payer: Multiplan Auto	$2,078.70
Rate for Payer: Multiplan Commercial	$2,078.70
Rate for Payer: Multiplan Workers Comp	$2,078.70
Rate for Payer: Scott and White EPO/PPO	$122.15
Rate for Payer: Scott and White Medicare	$6,830.00
Rate for Payer: Superior Health Plan EPO	$6,830.00
Rate for Payer: Superior Health Plan Medicare	$6,830.00
Rate for Payer: Universal American Dual Medicare/Medicaid	$6,830.00
Rate for Payer: Universal American Medicare	$6,830.00
Rate for Payer: Wellcare Medicare	$6,830.00
Rate for Payer: Wellmed Medicare	$6,830.00

CATH BLN BVCS618

Facility

$449.46

Service Code	HCPCS C1725
Hospital Charge Code	8504477
Hospital Revenue Code	272
Min. Negotiated Rate	$40.45
Max. Negotiated Rate	$292.15
Rate for Payer: Aetna Commercial	$247.20
Rate for Payer: Amerigroup CHIP/Medicaid	$40.45
Rate for Payer: BCBS of TX Blue Advantage	$134.84
Rate for Payer: BCBS of TX Blue Essentials	$161.81
Rate for Payer: BCBS of TX PPO	$179.78
Rate for Payer: Cash Price	$395.52
Rate for Payer: Multiplan Auto	$292.15
Rate for Payer: Multiplan Commercial	$292.15
Rate for Payer: Multiplan Workers Comp	$292.15
Rate for Payer: Scott and White EPO/PPO	$224.73
Rate for Payer: Superior Health Plan EPO	$61.13

CATH BLN BVCS618

Facility

$449.46

Service Code	HCPCS C1725
Hospital Charge Code	8504477
Hospital Revenue Code	272
Rate for Payer: Cash Price	$395.52

Know your out-of-pocket cost for care.

All Charges