White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CATH DIAMOND BACK SYS-SOLID DBP-EX-150SOL145

Facility

$16,775.30

Service Code	HCPCS C1724
Hospital Charge Code	144465
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-SOLID DBP-EX-150SOL145

Facility

$16,775.30

Service Code	HCPCS C1724
Hospital Charge Code	144465
Hospital Revenue Code	272
Rate for Payer: Cash Price	$14,762.26

CATH DRAINAGE 2 -- DHF

Facility

$294.64

Service Code	HCPCS C1729
Hospital Charge Code	82400839
Hospital Revenue Code	278
Min. Negotiated Rate	$73.66
Max. Negotiated Rate	$147.32
Rate for Payer: Aetna Commercial	$88.39
Rate for Payer: Cash Price	$259.28
Rate for Payer: Cigna Commercial	$73.66
Rate for Payer: Multiplan Auto	$147.32
Rate for Payer: Multiplan Commercial	$147.32
Rate for Payer: Multiplan Workers Comp	$147.32
Rate for Payer: Scott and White EPO/PPO	$147.32

CATH DRAINAGE 2 -- DHF

Facility

$294.64

Service Code	HCPCS C1729
Hospital Charge Code	82400839
Hospital Revenue Code	278
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$147.32
Rate for Payer: Aetna Commercial	$88.39
Rate for Payer: Amerigroup CHIP/Medicaid	$26.52
Rate for Payer: BCBS of TX Blue Advantage	$88.39
Rate for Payer: BCBS of TX Blue Essentials	$106.07
Rate for Payer: BCBS of TX PPO	$117.86
Rate for Payer: Cash Price	$259.28
Rate for Payer: Multiplan Auto	$147.32
Rate for Payer: Multiplan Commercial	$147.32
Rate for Payer: Multiplan Workers Comp	$147.32
Rate for Payer: Scott and White EPO/PPO	$147.32
Rate for Payer: Superior Health Plan EPO	$40.07

CATH DRAINAGE 3

Facility

$209.92

Hospital Charge Code	8430488
Hospital Revenue Code	272
Min. Negotiated Rate	$18.89
Max. Negotiated Rate	$136.45
Rate for Payer: Aetna Commercial	$115.46
Rate for Payer: Amerigroup CHIP/Medicaid	$18.89
Rate for Payer: BCBS of TX Blue Advantage	$62.98
Rate for Payer: BCBS of TX Blue Essentials	$75.57
Rate for Payer: BCBS of TX PPO	$83.97
Rate for Payer: Cash Price	$184.73
Rate for Payer: Multiplan Auto	$136.45
Rate for Payer: Multiplan Commercial	$136.45
Rate for Payer: Multiplan Workers Comp	$136.45
Rate for Payer: Scott and White EPO/PPO	$104.96
Rate for Payer: Superior Health Plan EPO	$28.55

CATH DRAINAGE 3

Facility

$209.92

Hospital Charge Code	8430488
Hospital Revenue Code	272
Rate for Payer: Cash Price	$184.73

CATH DRAINAGE -- DHF

Facility

$430.12

Service Code	HCPCS C1729
Hospital Charge Code	82400821
Hospital Revenue Code	278
Min. Negotiated Rate	$38.71
Max. Negotiated Rate	$215.06
Rate for Payer: Aetna Commercial	$129.04
Rate for Payer: Amerigroup CHIP/Medicaid	$38.71
Rate for Payer: BCBS of TX Blue Advantage	$129.04
Rate for Payer: BCBS of TX Blue Essentials	$154.84
Rate for Payer: BCBS of TX PPO	$172.05
Rate for Payer: Cash Price	$378.51
Rate for Payer: Multiplan Auto	$215.06
Rate for Payer: Multiplan Commercial	$215.06
Rate for Payer: Multiplan Workers Comp	$215.06
Rate for Payer: Scott and White EPO/PPO	$215.06
Rate for Payer: Superior Health Plan EPO	$58.50

CATH DRAINAGE -- DHF

Facility

$430.12

Service Code	HCPCS C1729
Hospital Charge Code	82400821
Hospital Revenue Code	278
Min. Negotiated Rate	$107.53
Max. Negotiated Rate	$215.06
Rate for Payer: Aetna Commercial	$129.04
Rate for Payer: Cash Price	$378.51
Rate for Payer: Cigna Commercial	$107.53
Rate for Payer: Multiplan Auto	$215.06
Rate for Payer: Multiplan Commercial	$215.06
Rate for Payer: Multiplan Workers Comp	$215.06
Rate for Payer: Scott and White EPO/PPO	$215.06

CATH EP FC SUPREME -- DHF

Facility

$856.43

Service Code	HCPCS C1730
Hospital Charge Code	82455742
Hospital Revenue Code	272
Rate for Payer: Cash Price	$753.66

CATH EP FC SUPREME -- DHF

Facility

$856.43

Service Code	HCPCS C1730
Hospital Charge Code	82455742
Hospital Revenue Code	272
Min. Negotiated Rate	$77.08
Max. Negotiated Rate	$556.68
Rate for Payer: Aetna Commercial	$471.04
Rate for Payer: Amerigroup CHIP/Medicaid	$77.08
Rate for Payer: BCBS of TX Blue Advantage	$256.93
Rate for Payer: BCBS of TX Blue Essentials	$308.31
Rate for Payer: BCBS of TX PPO	$342.57
Rate for Payer: Cash Price	$753.66
Rate for Payer: Multiplan Auto	$556.68
Rate for Payer: Multiplan Commercial	$556.68
Rate for Payer: Multiplan Workers Comp	$556.68
Rate for Payer: Scott and White EPO/PPO	$428.22
Rate for Payer: Superior Health Plan EPO	$116.47

CATH EPIDURAL -- DHF

Facility

$705.67

Hospital Charge Code	80563430
Hospital Revenue Code	272
Min. Negotiated Rate	$63.51
Max. Negotiated Rate	$458.69
Rate for Payer: Aetna Commercial	$388.12
Rate for Payer: Amerigroup CHIP/Medicaid	$63.51
Rate for Payer: BCBS of TX Blue Advantage	$211.70
Rate for Payer: BCBS of TX Blue Essentials	$254.04
Rate for Payer: BCBS of TX PPO	$282.27
Rate for Payer: Cash Price	$620.99
Rate for Payer: Multiplan Auto	$458.69
Rate for Payer: Multiplan Commercial	$458.69
Rate for Payer: Multiplan Workers Comp	$458.69
Rate for Payer: Scott and White EPO/PPO	$352.84
Rate for Payer: Superior Health Plan EPO	$95.97

CATH EPIDURAL -- DHF

Facility

$705.67

Hospital Charge Code	80563430
Hospital Revenue Code	272
Rate for Payer: Cash Price	$620.99

CATH EP LVWR STEERABLE -- DHF

Facility

$3,491.31

Service Code	HCPCS C1730
Hospital Charge Code	82408188
Hospital Revenue Code	272
Rate for Payer: Cash Price	$3,072.35

CATH EP LVWR STEERABLE -- DHF

Facility

$3,491.31

Service Code	HCPCS C1730
Hospital Charge Code	82408188
Hospital Revenue Code	272
Min. Negotiated Rate	$314.22
Max. Negotiated Rate	$2,269.35
Rate for Payer: Aetna Commercial	$1,920.22
Rate for Payer: Amerigroup CHIP/Medicaid	$314.22
Rate for Payer: BCBS of TX Blue Advantage	$1,047.39
Rate for Payer: BCBS of TX Blue Essentials	$1,256.87
Rate for Payer: BCBS of TX PPO	$1,396.52
Rate for Payer: Cash Price	$3,072.35
Rate for Payer: Multiplan Auto	$2,269.35
Rate for Payer: Multiplan Commercial	$2,269.35
Rate for Payer: Multiplan Workers Comp	$2,269.35
Rate for Payer: Scott and White EPO/PPO	$1,745.66
Rate for Payer: Superior Health Plan EPO	$474.82

CATH EP STD 7FR BLAZER II

Facility

$5,334.50

Service Code	HCPCS C1713
Hospital Charge Code	109406
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.62
Max. Negotiated Rate	$2,667.25
Rate for Payer: Aetna Commercial	$1,600.35
Rate for Payer: Cash Price	$4,694.36
Rate for Payer: Cigna Commercial	$1,333.62
Rate for Payer: Multiplan Auto	$2,667.25
Rate for Payer: Multiplan Commercial	$2,667.25
Rate for Payer: Multiplan Workers Comp	$2,667.25
Rate for Payer: Scott and White EPO/PPO	$2,667.25

CATH EP STD 7FR BLAZER II

Facility

$5,334.50

Service Code	HCPCS C1713
Hospital Charge Code	109406
Hospital Revenue Code	278
Min. Negotiated Rate	$480.10
Max. Negotiated Rate	$2,667.25
Rate for Payer: Aetna Commercial	$1,600.35
Rate for Payer: Amerigroup CHIP/Medicaid	$480.10
Rate for Payer: BCBS of TX Blue Advantage	$1,600.35
Rate for Payer: BCBS of TX Blue Essentials	$1,920.42
Rate for Payer: BCBS of TX PPO	$2,133.80
Rate for Payer: Cash Price	$4,694.36
Rate for Payer: Multiplan Auto	$2,667.25
Rate for Payer: Multiplan Commercial	$2,667.25
Rate for Payer: Multiplan Workers Comp	$2,667.25
Rate for Payer: Scott and White EPO/PPO	$2,667.25
Rate for Payer: Superior Health Plan EPO	$725.49

CATH EP SUPREME QUAD -- DHF

Facility

$1,804.65

Service Code	HCPCS C1730
Hospital Charge Code	40313553
Hospital Revenue Code	272
Min. Negotiated Rate	$162.42
Max. Negotiated Rate	$1,173.02
Rate for Payer: Aetna Commercial	$992.56
Rate for Payer: Amerigroup CHIP/Medicaid	$162.42
Rate for Payer: BCBS of TX Blue Advantage	$541.40
Rate for Payer: BCBS of TX Blue Essentials	$649.67
Rate for Payer: BCBS of TX PPO	$721.86
Rate for Payer: Cash Price	$1,588.09
Rate for Payer: Multiplan Auto	$1,173.02
Rate for Payer: Multiplan Commercial	$1,173.02
Rate for Payer: Multiplan Workers Comp	$1,173.02
Rate for Payer: Scott and White EPO/PPO	$902.32
Rate for Payer: Superior Health Plan EPO	$245.43

CATH EP SUPREME QUAD -- DHF

Facility

$1,804.65

Service Code	HCPCS C1730
Hospital Charge Code	40313553
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,588.09

CATHETER, ALL-PUR. URETHRAL X-RAY RUB. 2-EYES 18FR -- DHF

Facility

$19.84

Hospital Charge Code	80412018
Hospital Revenue Code	272
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$12.90
Rate for Payer: Aetna Commercial	$10.91
Rate for Payer: Amerigroup CHIP/Medicaid	$1.79
Rate for Payer: BCBS of TX Blue Advantage	$5.95
Rate for Payer: BCBS of TX Blue Essentials	$7.14
Rate for Payer: BCBS of TX PPO	$7.94
Rate for Payer: Cash Price	$17.46
Rate for Payer: Multiplan Auto	$12.90
Rate for Payer: Multiplan Commercial	$12.90
Rate for Payer: Multiplan Workers Comp	$12.90
Rate for Payer: Scott and White EPO/PPO	$9.92
Rate for Payer: Superior Health Plan EPO	$2.70

CATHETER, ALL-PUR. URETHRAL X-RAY RUB. 2-EYES 18FR -- DHF

Facility

$19.84

Hospital Charge Code	80412018
Hospital Revenue Code	272
Rate for Payer: Cash Price	$17.46

catheter angio beacon tip- cook

Facility

$113.50

Service Code	HCPCS C1725
Hospital Charge Code	8688552
Hospital Revenue Code	272
Min. Negotiated Rate	$10.22
Max. Negotiated Rate	$73.78
Rate for Payer: Aetna Commercial	$62.42
Rate for Payer: Amerigroup CHIP/Medicaid	$10.22
Rate for Payer: BCBS of TX Blue Advantage	$34.05
Rate for Payer: BCBS of TX Blue Essentials	$40.86
Rate for Payer: BCBS of TX PPO	$45.40
Rate for Payer: Cash Price	$99.88
Rate for Payer: Multiplan Auto	$73.78
Rate for Payer: Multiplan Commercial	$73.78
Rate for Payer: Multiplan Workers Comp	$73.78
Rate for Payer: Scott and White EPO/PPO	$56.75
Rate for Payer: Superior Health Plan EPO	$15.44

catheter angio beacon tip- cook

Facility

$113.50

Service Code	HCPCS C1725
Hospital Charge Code	8688552
Hospital Revenue Code	272
Rate for Payer: Cash Price	$99.88

CATHETER ARROW PKGD WEDGE 5 FRX 110CM

Facility

$612.90

Hospital Charge Code	145410
Hospital Revenue Code	272
Min. Negotiated Rate	$55.16
Max. Negotiated Rate	$398.38
Rate for Payer: Aetna Commercial	$337.10
Rate for Payer: Amerigroup CHIP/Medicaid	$55.16
Rate for Payer: BCBS of TX Blue Advantage	$183.87
Rate for Payer: BCBS of TX Blue Essentials	$220.64
Rate for Payer: BCBS of TX PPO	$245.16
Rate for Payer: Cash Price	$539.35
Rate for Payer: Multiplan Auto	$398.38
Rate for Payer: Multiplan Commercial	$398.38
Rate for Payer: Multiplan Workers Comp	$398.38
Rate for Payer: Scott and White EPO/PPO	$306.45
Rate for Payer: Superior Health Plan EPO	$83.35

CATHETER ARROW PKGD WEDGE 5 FRX 110CM

Facility

$612.90

Hospital Charge Code	145410
Hospital Revenue Code	272
Rate for Payer: Cash Price	$539.35

CATHETER ASPIRATION 50CM CATD KIT

Facility

$16,084.34

Service Code	HCPCS C1887
Hospital Charge Code	8598514
Hospital Revenue Code	278
Min. Negotiated Rate	$1,447.59
Max. Negotiated Rate	$8,042.17
Rate for Payer: Aetna Commercial	$4,825.30
Rate for Payer: Amerigroup CHIP/Medicaid	$1,447.59
Rate for Payer: BCBS of TX Blue Advantage	$4,825.30
Rate for Payer: BCBS of TX Blue Essentials	$5,790.36
Rate for Payer: BCBS of TX PPO	$6,433.74
Rate for Payer: Cash Price	$14,154.22
Rate for Payer: Multiplan Auto	$8,042.17
Rate for Payer: Multiplan Commercial	$8,042.17
Rate for Payer: Multiplan Workers Comp	$8,042.17
Rate for Payer: Scott and White EPO/PPO	$8,042.17
Rate for Payer: Superior Health Plan EPO	$2,187.47

Know your out-of-pocket cost for care.

All Charges