White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CATH CARD SON AB -- DHF

Facility

$8,381.62

Hospital Charge Code	80562705
Hospital Revenue Code	272
Rate for Payer: Cash Price	$7,375.83

CATH CEREBRAL -- DHF

Facility

$72.64

Hospital Charge Code	80563216
Hospital Revenue Code	272
Rate for Payer: Cash Price	$63.92

CATH CEREBRAL -- DHF

Facility

$72.64

Hospital Charge Code	80563216
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 CHOLANG A/S -- DHF

Facility

$117.99

Hospital Charge Code	80315906
Hospital Revenue Code	272
Rate for Payer: Cash Price	$103.83

CATH CHOLANG A/S -- DHF

Facility

$117.99

Hospital Charge Code	80315906
Hospital Revenue Code	272
Min. Negotiated Rate	$10.62
Max. Negotiated Rate	$76.69
Rate for Payer: Aetna Commercial	$64.89
Rate for Payer: Amerigroup CHIP/Medicaid	$10.62
Rate for Payer: BCBS of TX Blue Advantage	$35.40
Rate for Payer: BCBS of TX Blue Essentials	$42.48
Rate for Payer: BCBS of TX PPO	$47.20
Rate for Payer: Cash Price	$103.83
Rate for Payer: Multiplan Auto	$76.69
Rate for Payer: Multiplan Commercial	$76.69
Rate for Payer: Multiplan Workers Comp	$76.69
Rate for Payer: Scott and White EPO/PPO	$59.00
Rate for Payer: Superior Health Plan EPO	$16.05

CATH CHOLNG -- DHF

Facility

$1,499.40

Hospital Charge Code	80563455
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,319.47

CATH CHOLNG -- DHF

Facility

$1,499.40

Hospital Charge Code	80563455
Hospital Revenue Code	272
Min. Negotiated Rate	$134.95
Max. Negotiated Rate	$974.61
Rate for Payer: Aetna Commercial	$824.67
Rate for Payer: Amerigroup CHIP/Medicaid	$134.95
Rate for Payer: BCBS of TX Blue Advantage	$449.82
Rate for Payer: BCBS of TX Blue Essentials	$539.78
Rate for Payer: BCBS of TX PPO	$599.76
Rate for Payer: Cash Price	$1,319.47
Rate for Payer: Multiplan Auto	$974.61
Rate for Payer: Multiplan Commercial	$974.61
Rate for Payer: Multiplan Workers Comp	$974.61
Rate for Payer: Scott and White EPO/PPO	$749.70
Rate for Payer: Superior Health Plan EPO	$203.92

CATH CNTRL VEIN -- DHF

Facility

$1,692.72

Service Code	HCPCS C1751
Hospital Charge Code	80563653
Hospital Revenue Code	278
Min. Negotiated Rate	$423.18
Max. Negotiated Rate	$846.36
Rate for Payer: Aetna Commercial	$507.82
Rate for Payer: Cash Price	$1,489.59
Rate for Payer: Cigna Commercial	$423.18
Rate for Payer: Multiplan Auto	$846.36
Rate for Payer: Multiplan Commercial	$846.36
Rate for Payer: Multiplan Workers Comp	$846.36
Rate for Payer: Scott and White EPO/PPO	$846.36

CATH CNTRL VEIN -- DHF

Facility

$1,692.72

Service Code	HCPCS C1751
Hospital Charge Code	80563653
Hospital Revenue Code	278
Min. Negotiated Rate	$152.34
Max. Negotiated Rate	$846.36
Rate for Payer: Aetna Commercial	$507.82
Rate for Payer: Amerigroup CHIP/Medicaid	$152.34
Rate for Payer: BCBS of TX Blue Advantage	$507.82
Rate for Payer: BCBS of TX Blue Essentials	$609.38
Rate for Payer: BCBS of TX PPO	$677.09
Rate for Payer: Cash Price	$1,489.59
Rate for Payer: Multiplan Auto	$846.36
Rate for Payer: Multiplan Commercial	$846.36
Rate for Payer: Multiplan Workers Comp	$846.36
Rate for Payer: Scott and White EPO/PPO	$846.36
Rate for Payer: Superior Health Plan EPO	$230.21

CATH COR DIAG OPTITORQUE -- DHF

Facility

$129.04

Service Code	HCPCS C1887
Hospital Charge Code	80580459
Hospital Revenue Code	278
Min. Negotiated Rate	$32.26
Max. Negotiated Rate	$64.52
Rate for Payer: Aetna Commercial	$38.71
Rate for Payer: Cash Price	$113.56
Rate for Payer: Cigna Commercial	$32.26
Rate for Payer: Multiplan Auto	$64.52
Rate for Payer: Multiplan Commercial	$64.52
Rate for Payer: Multiplan Workers Comp	$64.52
Rate for Payer: Scott and White EPO/PPO	$64.52

CATH COR DIAG OPTITORQUE -- DHF

Facility

$129.04

Service Code	HCPCS C1887
Hospital Charge Code	80580459
Hospital Revenue Code	278
Min. Negotiated Rate	$11.61
Max. Negotiated Rate	$64.52
Rate for Payer: Aetna Commercial	$38.71
Rate for Payer: Amerigroup CHIP/Medicaid	$11.61
Rate for Payer: BCBS of TX Blue Advantage	$38.71
Rate for Payer: BCBS of TX Blue Essentials	$46.45
Rate for Payer: BCBS of TX PPO	$51.62
Rate for Payer: Cash Price	$113.56
Rate for Payer: Multiplan Auto	$64.52
Rate for Payer: Multiplan Commercial	$64.52
Rate for Payer: Multiplan Workers Comp	$64.52
Rate for Payer: Scott and White EPO/PPO	$64.52
Rate for Payer: Superior Health Plan EPO	$17.55

CATH COUDE ALL -- DHF

Facility

$546.91

Hospital Charge Code	80411002
Hospital Revenue Code	272
Rate for Payer: Cash Price	$481.28

CATH COUDE ALL -- DHF

Facility

$546.91

Hospital Charge Code	80411002
Hospital Revenue Code	272
Min. Negotiated Rate	$49.22
Max. Negotiated Rate	$355.49
Rate for Payer: Aetna Commercial	$300.80
Rate for Payer: Amerigroup CHIP/Medicaid	$49.22
Rate for Payer: BCBS of TX Blue Advantage	$164.07
Rate for Payer: BCBS of TX Blue Essentials	$196.89
Rate for Payer: BCBS of TX PPO	$218.76
Rate for Payer: Cash Price	$481.28
Rate for Payer: Multiplan Auto	$355.49
Rate for Payer: Multiplan Commercial	$355.49
Rate for Payer: Multiplan Workers Comp	$355.49
Rate for Payer: Scott and White EPO/PPO	$273.46
Rate for Payer: Superior Health Plan EPO	$74.38

CATH DIAG ELECT TORQR -- DHF

Facility

$652.60

Service Code	HCPCS C1730
Hospital Charge Code	82407784
Hospital Revenue Code	272
Min. Negotiated Rate	$58.73
Max. Negotiated Rate	$424.19
Rate for Payer: Aetna Commercial	$358.93
Rate for Payer: Amerigroup CHIP/Medicaid	$58.73
Rate for Payer: BCBS of TX Blue Advantage	$195.78
Rate for Payer: BCBS of TX Blue Essentials	$234.94
Rate for Payer: BCBS of TX PPO	$261.04
Rate for Payer: Cash Price	$574.29
Rate for Payer: Multiplan Auto	$424.19
Rate for Payer: Multiplan Commercial	$424.19
Rate for Payer: Multiplan Workers Comp	$424.19
Rate for Payer: Scott and White EPO/PPO	$326.30
Rate for Payer: Superior Health Plan EPO	$88.75

CATH DIAG ELECT TORQR -- DHF

Facility

$652.60

Service Code	HCPCS C1730
Hospital Charge Code	82407784
Hospital Revenue Code	272
Rate for Payer: Cash Price	$574.29

CATH DIALYS HEMO -- DHF

Facility

$2,210.51

Hospital Charge Code	80563901
Hospital Revenue Code	272
Min. Negotiated Rate	$198.95
Max. Negotiated Rate	$1,436.83
Rate for Payer: Aetna Commercial	$1,215.78
Rate for Payer: Amerigroup CHIP/Medicaid	$198.95
Rate for Payer: BCBS of TX Blue Advantage	$663.15
Rate for Payer: BCBS of TX Blue Essentials	$795.78
Rate for Payer: BCBS of TX PPO	$884.20
Rate for Payer: Cash Price	$1,945.25
Rate for Payer: Multiplan Auto	$1,436.83
Rate for Payer: Multiplan Commercial	$1,436.83
Rate for Payer: Multiplan Workers Comp	$1,436.83
Rate for Payer: Scott and White EPO/PPO	$1,105.26
Rate for Payer: Superior Health Plan EPO	$300.63

CATH DIALYS HEMO -- DHF

Facility

$2,210.51

Hospital Charge Code	80563901
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,945.25

CATH DIAMOND BACK SYS-CLASSIC DBP-EX-150CLA145

Facility

$16,775.30

Service Code	HCPCS C1724
Hospital Charge Code	145241
Hospital Revenue Code	272
Min. Negotiated Rate	$1,509.78
Max. Negotiated Rate	$10,903.94
Rate for Payer: Aetna Commercial	$9,226.42
Rate for Payer: Amerigroup CHIP/Medicaid	$1,509.78
Rate for Payer: BCBS of TX Blue Advantage	$5,032.59
Rate for Payer: BCBS of TX Blue Essentials	$6,039.11
Rate for Payer: BCBS of TX PPO	$6,710.12
Rate for Payer: Cash Price	$14,762.26
Rate for Payer: Multiplan Auto	$10,903.94
Rate for Payer: Multiplan Commercial	$10,903.94
Rate for Payer: Multiplan Workers Comp	$10,903.94
Rate for Payer: Scott and White EPO/PPO	$8,387.65
Rate for Payer: Superior Health Plan EPO	$2,281.44

CATH DIAMOND BACK SYS-CLASSIC DBP-EX-150CLA145

Facility

$16,775.30

Service Code	HCPCS C1724
Hospital Charge Code	145241
Hospital Revenue Code	272
Rate for Payer: Cash Price	$14,762.26

CATH DIAMOND BACK SYS-CLASSIC DBP-EX-200CLA145

Facility

$16,775.30

Service Code	HCPCS C1724
Hospital Charge Code	145242
Hospital Revenue Code	272
Min. Negotiated Rate	$1,509.78
Max. Negotiated Rate	$10,903.94
Rate for Payer: Aetna Commercial	$9,226.42
Rate for Payer: Amerigroup CHIP/Medicaid	$1,509.78
Rate for Payer: BCBS of TX Blue Advantage	$5,032.59
Rate for Payer: BCBS of TX Blue Essentials	$6,039.11
Rate for Payer: BCBS of TX PPO	$6,710.12
Rate for Payer: Cash Price	$14,762.26
Rate for Payer: Multiplan Auto	$10,903.94
Rate for Payer: Multiplan Commercial	$10,903.94
Rate for Payer: Multiplan Workers Comp	$10,903.94
Rate for Payer: Scott and White EPO/PPO	$8,387.65
Rate for Payer: Superior Health Plan EPO	$2,281.44

CATH DIAMOND BACK SYS-CLASSIC DBP-EX-200CLA145

Facility

$16,775.30

Service Code	HCPCS C1724
Hospital Charge Code	145242
Hospital Revenue Code	272
Rate for Payer: Cash Price	$14,762.26

CATH DIAMOND BACK SYS MICRO DBP-EX-125MIC145

Facility

$16,775.30

Service Code	HCPCS C1724
Hospital Charge Code	8684559
Hospital Revenue Code	272
Rate for Payer: Cash Price	$14,762.26

CATH DIAMOND BACK SYS MICRO DBP-EX-125MIC145

Facility

$16,775.30

Service Code	HCPCS C1724
Hospital Charge Code	8684559
Hospital Revenue Code	272
Min. Negotiated Rate	$1,509.78
Max. Negotiated Rate	$10,903.94
Rate for Payer: Aetna Commercial	$9,226.42
Rate for Payer: Amerigroup CHIP/Medicaid	$1,509.78
Rate for Payer: BCBS of TX Blue Advantage	$5,032.59
Rate for Payer: BCBS of TX Blue Essentials	$6,039.11
Rate for Payer: BCBS of TX PPO	$6,710.12
Rate for Payer: Cash Price	$14,762.26
Rate for Payer: Multiplan Auto	$10,903.94
Rate for Payer: Multiplan Commercial	$10,903.94
Rate for Payer: Multiplan Workers Comp	$10,903.94
Rate for Payer: Scott and White EPO/PPO	$8,387.65
Rate for Payer: Superior Health Plan EPO	$2,281.44

CATH DIAMONDBACK SYS-SOLID DBP-EX-125SOL145

Facility

$16,775.30

Service Code	HCPCS C1724
Hospital Charge Code	145243
Hospital Revenue Code	272
Min. Negotiated Rate	$1,509.78
Max. Negotiated Rate	$10,903.94
Rate for Payer: Aetna Commercial	$9,226.42
Rate for Payer: Amerigroup CHIP/Medicaid	$1,509.78
Rate for Payer: BCBS of TX Blue Advantage	$5,032.59
Rate for Payer: BCBS of TX Blue Essentials	$6,039.11
Rate for Payer: BCBS of TX PPO	$6,710.12
Rate for Payer: Cash Price	$14,762.26
Rate for Payer: Multiplan Auto	$10,903.94
Rate for Payer: Multiplan Commercial	$10,903.94
Rate for Payer: Multiplan Workers Comp	$10,903.94
Rate for Payer: Scott and White EPO/PPO	$8,387.65
Rate for Payer: Superior Health Plan EPO	$2,281.44

CATH DIAMONDBACK SYS-SOLID DBP-EX-125SOL145

Facility

$16,775.30

Service Code	HCPCS C1724
Hospital Charge Code	145243
Hospital Revenue Code	272
Rate for Payer: Cash Price	$14,762.26

Know your out-of-pocket cost for care.

All Charges