White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CATH BLN DIL 4MM VIATRAC

Facility

$703.70

Service Code	HCPCS C1725
Hospital Charge Code	8504480
Hospital Revenue Code	272
Rate for Payer: Cash Price	$619.26

CATH BLN DIL 4MM VIATRAC

Facility

$703.70

Service Code	HCPCS C1725
Hospital Charge Code	8504480
Hospital Revenue Code	272
Min. Negotiated Rate	$63.33
Max. Negotiated Rate	$457.40
Rate for Payer: Aetna Commercial	$387.04
Rate for Payer: Amerigroup CHIP/Medicaid	$63.33
Rate for Payer: BCBS of TX Blue Advantage	$211.11
Rate for Payer: BCBS of TX Blue Essentials	$253.33
Rate for Payer: BCBS of TX PPO	$281.48
Rate for Payer: Cash Price	$619.26
Rate for Payer: Multiplan Auto	$457.40
Rate for Payer: Multiplan Commercial	$457.40
Rate for Payer: Multiplan Workers Comp	$457.40
Rate for Payer: Scott and White EPO/PPO	$351.85
Rate for Payer: Superior Health Plan EPO	$95.70

CATH BLN DIL CRE FX WIRE -- DHF

Facility

$1,036.14

Service Code	HCPCS C1726
Hospital Charge Code	82400714
Hospital Revenue Code	278
Min. Negotiated Rate	$93.25
Max. Negotiated Rate	$518.07
Rate for Payer: Aetna Commercial	$310.84
Rate for Payer: Amerigroup CHIP/Medicaid	$93.25
Rate for Payer: BCBS of TX Blue Advantage	$310.84
Rate for Payer: BCBS of TX Blue Essentials	$373.01
Rate for Payer: BCBS of TX PPO	$414.46
Rate for Payer: Cash Price	$911.80
Rate for Payer: Multiplan Auto	$518.07
Rate for Payer: Multiplan Commercial	$518.07
Rate for Payer: Multiplan Workers Comp	$518.07
Rate for Payer: Scott and White EPO/PPO	$518.07
Rate for Payer: Superior Health Plan EPO	$140.92

CATH BLN DIL CRE FX WIRE -- DHF

Facility

$1,036.14

Service Code	HCPCS C1726
Hospital Charge Code	82400714
Hospital Revenue Code	278
Min. Negotiated Rate	$259.04
Max. Negotiated Rate	$518.07
Rate for Payer: Aetna Commercial	$310.84
Rate for Payer: Cash Price	$911.80
Rate for Payer: Cigna Commercial	$259.04
Rate for Payer: Multiplan Auto	$518.07
Rate for Payer: Multiplan Commercial	$518.07
Rate for Payer: Multiplan Workers Comp	$518.07
Rate for Payer: Scott and White EPO/PPO	$518.07

CATH BLN DIL MARSHAL -- DHF

Facility

$2,029.76

Service Code	HCPCS C1725
Hospital Charge Code	82400706
Hospital Revenue Code	278
Min. Negotiated Rate	$182.68
Max. Negotiated Rate	$1,014.88
Rate for Payer: Aetna Commercial	$608.93
Rate for Payer: Amerigroup CHIP/Medicaid	$182.68
Rate for Payer: BCBS of TX Blue Advantage	$608.93
Rate for Payer: BCBS of TX Blue Essentials	$730.71
Rate for Payer: BCBS of TX PPO	$811.90
Rate for Payer: Cash Price	$1,786.19
Rate for Payer: Multiplan Auto	$1,014.88
Rate for Payer: Multiplan Commercial	$1,014.88
Rate for Payer: Multiplan Workers Comp	$1,014.88
Rate for Payer: Scott and White EPO/PPO	$1,014.88
Rate for Payer: Superior Health Plan EPO	$276.05

CATH BLN DIL MARSHAL -- DHF

Facility

$2,029.76

Service Code	HCPCS C1725
Hospital Charge Code	82400706
Hospital Revenue Code	278
Min. Negotiated Rate	$507.44
Max. Negotiated Rate	$1,014.88
Rate for Payer: Aetna Commercial	$608.93
Rate for Payer: Cash Price	$1,786.19
Rate for Payer: Cigna Commercial	$507.44
Rate for Payer: Multiplan Auto	$1,014.88
Rate for Payer: Multiplan Commercial	$1,014.88
Rate for Payer: Multiplan Workers Comp	$1,014.88
Rate for Payer: Scott and White EPO/PPO	$1,014.88

CATH BLN DIL MINI TREK -- DHF

Facility

$736.09

Service Code	HCPCS C1725
Hospital Charge Code	80517261
Hospital Revenue Code	278
Min. Negotiated Rate	$66.25
Max. Negotiated Rate	$368.05
Rate for Payer: Aetna Commercial	$220.83
Rate for Payer: Amerigroup CHIP/Medicaid	$66.25
Rate for Payer: BCBS of TX Blue Advantage	$220.83
Rate for Payer: BCBS of TX Blue Essentials	$264.99
Rate for Payer: BCBS of TX PPO	$294.44
Rate for Payer: Cash Price	$647.76
Rate for Payer: Multiplan Auto	$368.05
Rate for Payer: Multiplan Commercial	$368.05
Rate for Payer: Multiplan Workers Comp	$368.05
Rate for Payer: Scott and White EPO/PPO	$368.05
Rate for Payer: Superior Health Plan EPO	$100.11

CATH BLN DIL MINI TREK -- DHF

Facility

$736.09

Service Code	HCPCS C1725
Hospital Charge Code	80517261
Hospital Revenue Code	278
Min. Negotiated Rate	$184.02
Max. Negotiated Rate	$368.05
Rate for Payer: Aetna Commercial	$220.83
Rate for Payer: Cash Price	$647.76
Rate for Payer: Cigna Commercial	$184.02
Rate for Payer: Multiplan Auto	$368.05
Rate for Payer: Multiplan Commercial	$368.05
Rate for Payer: Multiplan Workers Comp	$368.05
Rate for Payer: Scott and White EPO/PPO	$368.05

CATH BLN DIL NC EUPHORA -- DHF

Facility

$602.41

Service Code	HCPCS C1725
Hospital Charge Code	80560949
Hospital Revenue Code	278
Min. Negotiated Rate	$54.22
Max. Negotiated Rate	$301.20
Rate for Payer: Aetna Commercial	$180.72
Rate for Payer: Amerigroup CHIP/Medicaid	$54.22
Rate for Payer: BCBS of TX Blue Advantage	$180.72
Rate for Payer: BCBS of TX Blue Essentials	$216.87
Rate for Payer: BCBS of TX PPO	$240.96
Rate for Payer: Cash Price	$530.12
Rate for Payer: Multiplan Auto	$301.20
Rate for Payer: Multiplan Commercial	$301.20
Rate for Payer: Multiplan Workers Comp	$301.20
Rate for Payer: Scott and White EPO/PPO	$301.20
Rate for Payer: Superior Health Plan EPO	$81.93

CATH BLN DIL NC EUPHORA -- DHF

Facility

$602.41

Service Code	HCPCS C1725
Hospital Charge Code	80560949
Hospital Revenue Code	278
Min. Negotiated Rate	$150.60
Max. Negotiated Rate	$301.20
Rate for Payer: Aetna Commercial	$180.72
Rate for Payer: Cash Price	$530.12
Rate for Payer: Cigna Commercial	$150.60
Rate for Payer: Multiplan Auto	$301.20
Rate for Payer: Multiplan Commercial	$301.20
Rate for Payer: Multiplan Workers Comp	$301.20
Rate for Payer: Scott and White EPO/PPO	$301.20

CATH BLN DIL NONVASCULAR -- DHF

Facility

$1,523.25

Service Code	HCPCS C1726
Hospital Charge Code	82400748
Hospital Revenue Code	278
Min. Negotiated Rate	$137.09
Max. Negotiated Rate	$761.62
Rate for Payer: Aetna Commercial	$456.98
Rate for Payer: Amerigroup CHIP/Medicaid	$137.09
Rate for Payer: BCBS of TX Blue Advantage	$456.98
Rate for Payer: BCBS of TX Blue Essentials	$548.37
Rate for Payer: BCBS of TX PPO	$609.30
Rate for Payer: Cash Price	$1,340.46
Rate for Payer: Multiplan Auto	$761.62
Rate for Payer: Multiplan Commercial	$761.62
Rate for Payer: Multiplan Workers Comp	$761.62
Rate for Payer: Scott and White EPO/PPO	$761.62
Rate for Payer: Superior Health Plan EPO	$207.16

CATH BLN DIL NONVASCULAR -- DHF

Facility

$1,523.25

Service Code	HCPCS C1726
Hospital Charge Code	82400748
Hospital Revenue Code	278
Min. Negotiated Rate	$380.81
Max. Negotiated Rate	$761.62
Rate for Payer: Aetna Commercial	$456.98
Rate for Payer: Cash Price	$1,340.46
Rate for Payer: Cigna Commercial	$380.81
Rate for Payer: Multiplan Auto	$761.62
Rate for Payer: Multiplan Commercial	$761.62
Rate for Payer: Multiplan Workers Comp	$761.62
Rate for Payer: Scott and White EPO/PPO	$761.62

CATH BLN DIL OTW -- DHF

Facility

$3,986.33

Service Code	HCPCS C1725
Hospital Charge Code	80550825
Hospital Revenue Code	278
Min. Negotiated Rate	$358.77
Max. Negotiated Rate	$1,993.16
Rate for Payer: Aetna Commercial	$1,195.90
Rate for Payer: Amerigroup CHIP/Medicaid	$358.77
Rate for Payer: BCBS of TX Blue Advantage	$1,195.90
Rate for Payer: BCBS of TX Blue Essentials	$1,435.08
Rate for Payer: BCBS of TX PPO	$1,594.53
Rate for Payer: Cash Price	$3,507.97
Rate for Payer: Multiplan Auto	$1,993.16
Rate for Payer: Multiplan Commercial	$1,993.16
Rate for Payer: Multiplan Workers Comp	$1,993.16
Rate for Payer: Scott and White EPO/PPO	$1,993.16
Rate for Payer: Superior Health Plan EPO	$542.14

CATH BLN DIL OTW -- DHF

Facility

$3,986.33

Service Code	HCPCS C1725
Hospital Charge Code	80550825
Hospital Revenue Code	278
Min. Negotiated Rate	$996.58
Max. Negotiated Rate	$1,993.16
Rate for Payer: Aetna Commercial	$1,195.90
Rate for Payer: Cash Price	$3,507.97
Rate for Payer: Cigna Commercial	$996.58
Rate for Payer: Multiplan Auto	$1,993.16
Rate for Payer: Multiplan Commercial	$1,993.16
Rate for Payer: Multiplan Workers Comp	$1,993.16
Rate for Payer: Scott and White EPO/PPO	$1,993.16

CATH BLN DIL SC EUPHORA -- DHF

Facility

$602.41

Service Code	HCPCS C1725
Hospital Charge Code	80560931
Hospital Revenue Code	278
Min. Negotiated Rate	$54.22
Max. Negotiated Rate	$301.20
Rate for Payer: Aetna Commercial	$180.72
Rate for Payer: Amerigroup CHIP/Medicaid	$54.22
Rate for Payer: BCBS of TX Blue Advantage	$180.72
Rate for Payer: BCBS of TX Blue Essentials	$216.87
Rate for Payer: BCBS of TX PPO	$240.96
Rate for Payer: Cash Price	$530.12
Rate for Payer: Multiplan Auto	$301.20
Rate for Payer: Multiplan Commercial	$301.20
Rate for Payer: Multiplan Workers Comp	$301.20
Rate for Payer: Scott and White EPO/PPO	$301.20
Rate for Payer: Superior Health Plan EPO	$81.93

CATH BLN DIL SC EUPHORA -- DHF

Facility

$602.41

Service Code	HCPCS C1725
Hospital Charge Code	80560931
Hospital Revenue Code	278
Min. Negotiated Rate	$150.60
Max. Negotiated Rate	$301.20
Rate for Payer: Aetna Commercial	$180.72
Rate for Payer: Cash Price	$530.12
Rate for Payer: Cigna Commercial	$150.60
Rate for Payer: Multiplan Auto	$301.20
Rate for Payer: Multiplan Commercial	$301.20
Rate for Payer: Multiplan Workers Comp	$301.20
Rate for Payer: Scott and White EPO/PPO	$301.20

CATH BLN PTA POWERFLX P3 -- DHF

Facility

$948.31

Service Code	HCPCS C1725
Hospital Charge Code	82452400
Hospital Revenue Code	278
Min. Negotiated Rate	$85.35
Max. Negotiated Rate	$474.15
Rate for Payer: Aetna Commercial	$284.49
Rate for Payer: Amerigroup CHIP/Medicaid	$85.35
Rate for Payer: BCBS of TX Blue Advantage	$284.49
Rate for Payer: BCBS of TX Blue Essentials	$341.39
Rate for Payer: BCBS of TX PPO	$379.32
Rate for Payer: Cash Price	$834.51
Rate for Payer: Multiplan Auto	$474.15
Rate for Payer: Multiplan Commercial	$474.15
Rate for Payer: Multiplan Workers Comp	$474.15
Rate for Payer: Scott and White EPO/PPO	$474.15
Rate for Payer: Superior Health Plan EPO	$128.97

CATH BLN PTA POWERFLX P3 -- DHF

Facility

$948.31

Service Code	HCPCS C1725
Hospital Charge Code	82452400
Hospital Revenue Code	278
Min. Negotiated Rate	$237.08
Max. Negotiated Rate	$474.15
Rate for Payer: Aetna Commercial	$284.49
Rate for Payer: Cash Price	$834.51
Rate for Payer: Cigna Commercial	$237.08
Rate for Payer: Multiplan Auto	$474.15
Rate for Payer: Multiplan Commercial	$474.15
Rate for Payer: Multiplan Workers Comp	$474.15
Rate for Payer: Scott and White EPO/PPO	$474.15

CATH BLN VENOGRAM -- DHF

Facility

$423.49

Hospital Charge Code	80561012
Hospital Revenue Code	272
Rate for Payer: Cash Price	$372.67

CATH BLN VENOGRAM -- DHF

Facility

$423.49

Hospital Charge Code	80561012
Hospital Revenue Code	272
Min. Negotiated Rate	$38.11
Max. Negotiated Rate	$275.27
Rate for Payer: Aetna Commercial	$232.92
Rate for Payer: Amerigroup CHIP/Medicaid	$38.11
Rate for Payer: BCBS of TX Blue Advantage	$127.05
Rate for Payer: BCBS of TX Blue Essentials	$152.46
Rate for Payer: BCBS of TX PPO	$169.40
Rate for Payer: Cash Price	$372.67
Rate for Payer: Multiplan Auto	$275.27
Rate for Payer: Multiplan Commercial	$275.27
Rate for Payer: Multiplan Workers Comp	$275.27
Rate for Payer: Scott and White EPO/PPO	$211.75
Rate for Payer: Superior Health Plan EPO	$57.59

CATH CARD F-S B -- DHF

Facility

$813.75

Hospital Charge Code	80561657
Hospital Revenue Code	272
Min. Negotiated Rate	$73.24
Max. Negotiated Rate	$528.94
Rate for Payer: Aetna Commercial	$447.56
Rate for Payer: Amerigroup CHIP/Medicaid	$73.24
Rate for Payer: BCBS of TX Blue Advantage	$244.12
Rate for Payer: BCBS of TX Blue Essentials	$292.95
Rate for Payer: BCBS of TX PPO	$325.50
Rate for Payer: Cash Price	$716.10
Rate for Payer: Multiplan Auto	$528.94
Rate for Payer: Multiplan Commercial	$528.94
Rate for Payer: Multiplan Workers Comp	$528.94
Rate for Payer: Scott and White EPO/PPO	$406.88
Rate for Payer: Superior Health Plan EPO	$110.67

CATH CARD F-S B -- DHF

Facility

$813.75

Hospital Charge Code	80561657
Hospital Revenue Code	272
Rate for Payer: Cash Price	$716.10

CATH CARD INFUSN -- DHF

Facility

$881.41

Hospital Charge Code	80561905
Hospital Revenue Code	272
Rate for Payer: Cash Price	$775.64

CATH CARD INFUSN -- DHF

Facility

$881.41

Hospital Charge Code	80561905
Hospital Revenue Code	272
Min. Negotiated Rate	$79.33
Max. Negotiated Rate	$572.92
Rate for Payer: Aetna Commercial	$484.78
Rate for Payer: Amerigroup CHIP/Medicaid	$79.33
Rate for Payer: BCBS of TX Blue Advantage	$264.42
Rate for Payer: BCBS of TX Blue Essentials	$317.31
Rate for Payer: BCBS of TX PPO	$352.56
Rate for Payer: Cash Price	$775.64
Rate for Payer: Multiplan Auto	$572.92
Rate for Payer: Multiplan Commercial	$572.92
Rate for Payer: Multiplan Workers Comp	$572.92
Rate for Payer: Scott and White EPO/PPO	$440.70
Rate for Payer: Superior Health Plan EPO	$119.87

CATH CARD SON AB -- DHF

Facility

$8,381.62

Hospital Charge Code	80562705
Hospital Revenue Code	272
Min. Negotiated Rate	$754.35
Max. Negotiated Rate	$5,448.05
Rate for Payer: Aetna Commercial	$4,609.89
Rate for Payer: Amerigroup CHIP/Medicaid	$754.35
Rate for Payer: BCBS of TX Blue Advantage	$2,514.49
Rate for Payer: BCBS of TX Blue Essentials	$3,017.38
Rate for Payer: BCBS of TX PPO	$3,352.65
Rate for Payer: Cash Price	$7,375.83
Rate for Payer: Multiplan Auto	$5,448.05
Rate for Payer: Multiplan Commercial	$5,448.05
Rate for Payer: Multiplan Workers Comp	$5,448.05
Rate for Payer: Scott and White EPO/PPO	$4,190.81
Rate for Payer: Superior Health Plan EPO	$1,139.90

Know your out-of-pocket cost for care.

All Charges