White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CATHETER, PALINDROME DUAL LUMEN 14.5X19

Facility

$1,387.33

Service Code	HCPCS C1752
Hospital Charge Code	8568496
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,220.85

CATHETER, PALINDROME DUAL LUMEN 14.5 X 23

Facility

$1,387.33

Hospital Charge Code	8576477
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,220.85

CATHETER, PALINDROME DUAL LUMEN 14.5 X 23

Facility

$1,387.33

Hospital Charge Code	8576477
Hospital Revenue Code	272
Min. Negotiated Rate	$124.86
Max. Negotiated Rate	$901.76
Rate for Payer: Aetna Commercial	$763.03
Rate for Payer: Amerigroup CHIP/Medicaid	$124.86
Rate for Payer: BCBS of TX Blue Advantage	$416.20
Rate for Payer: BCBS of TX Blue Essentials	$499.44
Rate for Payer: BCBS of TX PPO	$554.93
Rate for Payer: Cash Price	$1,220.85
Rate for Payer: Multiplan Auto	$901.76
Rate for Payer: Multiplan Commercial	$901.76
Rate for Payer: Multiplan Workers Comp	$901.76
Rate for Payer: Scott and White EPO/PPO	$693.66
Rate for Payer: Superior Health Plan EPO	$188.68

CATHETER, PALINDROME DUAL LUMEN 14.5 X 28

Facility

$1,387.33

Hospital Charge Code	8576474
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,220.85

CATHETER, PALINDROME DUAL LUMEN 14.5 X 28

Facility

$1,387.33

Hospital Charge Code	8576474
Hospital Revenue Code	272
Min. Negotiated Rate	$124.86
Max. Negotiated Rate	$901.76
Rate for Payer: Aetna Commercial	$763.03
Rate for Payer: Amerigroup CHIP/Medicaid	$124.86
Rate for Payer: BCBS of TX Blue Advantage	$416.20
Rate for Payer: BCBS of TX Blue Essentials	$499.44
Rate for Payer: BCBS of TX PPO	$554.93
Rate for Payer: Cash Price	$1,220.85
Rate for Payer: Multiplan Auto	$901.76
Rate for Payer: Multiplan Commercial	$901.76
Rate for Payer: Multiplan Workers Comp	$901.76
Rate for Payer: Scott and White EPO/PPO	$693.66
Rate for Payer: Superior Health Plan EPO	$188.68

CATHETER, PALINDROME DUAL LUMEN 14.5 X 33

Facility

$1,387.33

Hospital Charge Code	8576476
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,220.85

CATHETER, PALINDROME DUAL LUMEN 14.5 X 33

Facility

$1,387.33

Hospital Charge Code	8576476
Hospital Revenue Code	272
Min. Negotiated Rate	$124.86
Max. Negotiated Rate	$901.76
Rate for Payer: Aetna Commercial	$763.03
Rate for Payer: Amerigroup CHIP/Medicaid	$124.86
Rate for Payer: BCBS of TX Blue Advantage	$416.20
Rate for Payer: BCBS of TX Blue Essentials	$499.44
Rate for Payer: BCBS of TX PPO	$554.93
Rate for Payer: Cash Price	$1,220.85
Rate for Payer: Multiplan Auto	$901.76
Rate for Payer: Multiplan Commercial	$901.76
Rate for Payer: Multiplan Workers Comp	$901.76
Rate for Payer: Scott and White EPO/PPO	$693.66
Rate for Payer: Superior Health Plan EPO	$188.68

catheter perifix poly epidural 19gx36

Facility

$47.49

Hospital Charge Code	8634511
Hospital Revenue Code	272
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$30.87
Rate for Payer: Aetna Commercial	$26.12
Rate for Payer: Amerigroup CHIP/Medicaid	$4.27
Rate for Payer: BCBS of TX Blue Advantage	$14.25
Rate for Payer: BCBS of TX Blue Essentials	$17.10
Rate for Payer: BCBS of TX PPO	$19.00
Rate for Payer: Cash Price	$41.79
Rate for Payer: Multiplan Auto	$30.87
Rate for Payer: Multiplan Commercial	$30.87
Rate for Payer: Multiplan Workers Comp	$30.87
Rate for Payer: Scott and White EPO/PPO	$23.74
Rate for Payer: Superior Health Plan EPO	$6.46

catheter perifix poly epidural 19gx36

Facility

$47.49

Hospital Charge Code	8634511
Hospital Revenue Code	272
Rate for Payer: Cash Price	$41.79

CATHETER PERITONEAL PD

Facility

$485.78

Service Code	HCPCS C1729
Hospital Charge Code	8484506
Hospital Revenue Code	272
Min. Negotiated Rate	$43.72
Max. Negotiated Rate	$315.76
Rate for Payer: Aetna Commercial	$267.18
Rate for Payer: Amerigroup CHIP/Medicaid	$43.72
Rate for Payer: BCBS of TX Blue Advantage	$145.73
Rate for Payer: BCBS of TX Blue Essentials	$174.88
Rate for Payer: BCBS of TX PPO	$194.31
Rate for Payer: Cash Price	$427.49
Rate for Payer: Multiplan Auto	$315.76
Rate for Payer: Multiplan Commercial	$315.76
Rate for Payer: Multiplan Workers Comp	$315.76
Rate for Payer: Scott and White EPO/PPO	$242.89
Rate for Payer: Superior Health Plan EPO	$66.07

CATHETER PERITONEAL PD

Facility

$485.78

Service Code	HCPCS C1729
Hospital Charge Code	8484506
Hospital Revenue Code	272
Rate for Payer: Cash Price	$427.49

CATHETER PTA BALLOON PASEO 2.5X220

Facility

$544.80

Service Code	HCPCS C1725
Hospital Charge Code	145374
Hospital Revenue Code	272
Rate for Payer: Cash Price	$479.42

CATHETER PTA BALLOON PASEO 2.5X220

Facility

$544.80

Service Code	HCPCS C1725
Hospital Charge Code	145374
Hospital Revenue Code	272
Min. Negotiated Rate	$49.03
Max. Negotiated Rate	$354.12
Rate for Payer: Aetna Commercial	$299.64
Rate for Payer: Amerigroup CHIP/Medicaid	$49.03
Rate for Payer: BCBS of TX Blue Advantage	$163.44
Rate for Payer: BCBS of TX Blue Essentials	$196.13
Rate for Payer: BCBS of TX PPO	$217.92
Rate for Payer: Cash Price	$479.42
Rate for Payer: Multiplan Auto	$354.12
Rate for Payer: Multiplan Commercial	$354.12
Rate for Payer: Multiplan Workers Comp	$354.12
Rate for Payer: Scott and White EPO/PPO	$272.40
Rate for Payer: Superior Health Plan EPO	$74.09

CATHETER PTA BLN PASSEO-18 2.5X200X130

Facility

$499.40

Service Code	HCPCS C1726
Hospital Charge Code	145595
Hospital Revenue Code	272
Rate for Payer: Cash Price	$439.47

CATHETER PTA BLN PASSEO-18 2.5X200X130

Facility

$499.40

Service Code	HCPCS C1726
Hospital Charge Code	145595
Hospital Revenue Code	272
Min. Negotiated Rate	$44.95
Max. Negotiated Rate	$324.61
Rate for Payer: Aetna Commercial	$274.67
Rate for Payer: Amerigroup CHIP/Medicaid	$44.95
Rate for Payer: BCBS of TX Blue Advantage	$149.82
Rate for Payer: BCBS of TX Blue Essentials	$179.78
Rate for Payer: BCBS of TX PPO	$199.76
Rate for Payer: Cash Price	$439.47
Rate for Payer: Multiplan Auto	$324.61
Rate for Payer: Multiplan Commercial	$324.61
Rate for Payer: Multiplan Workers Comp	$324.61
Rate for Payer: Scott and White EPO/PPO	$249.70
Rate for Payer: Superior Health Plan EPO	$67.92

CATHETER PUREWICK URETHRAL

Facility

$63.29

Service Code	HCPCS C1729
Hospital Charge Code	8484507
Hospital Revenue Code	272
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$41.14
Rate for Payer: Aetna Commercial	$34.81
Rate for Payer: Amerigroup CHIP/Medicaid	$5.70
Rate for Payer: BCBS of TX Blue Advantage	$18.99
Rate for Payer: BCBS of TX Blue Essentials	$22.78
Rate for Payer: BCBS of TX PPO	$25.32
Rate for Payer: Cash Price	$55.70
Rate for Payer: Multiplan Auto	$41.14
Rate for Payer: Multiplan Commercial	$41.14
Rate for Payer: Multiplan Workers Comp	$41.14
Rate for Payer: Scott and White EPO/PPO	$31.64
Rate for Payer: Superior Health Plan EPO	$8.61

CATHETER PUREWICK URETHRAL

Facility

$63.29

Service Code	HCPCS C1729
Hospital Charge Code	8484507
Hospital Revenue Code	272
Rate for Payer: Cash Price	$55.70

CATHETER, SINGL LMN PORT 8.4F DETCH W/INTRO 9F PLS -- DHF

Facility

$2,702.77

Service Code	HCPCS C1788
Hospital Charge Code	82402074
Hospital Revenue Code	278
Min. Negotiated Rate	$675.69
Max. Negotiated Rate	$1,351.38
Rate for Payer: Aetna Commercial	$810.83
Rate for Payer: Cash Price	$2,378.44
Rate for Payer: Cigna Commercial	$675.69
Rate for Payer: Multiplan Auto	$1,351.38
Rate for Payer: Multiplan Commercial	$1,351.38
Rate for Payer: Multiplan Workers Comp	$1,351.38
Rate for Payer: Scott and White EPO/PPO	$1,351.38

CATHETER, SINGL LMN PORT 8.4F DETCH W/INTRO 9F PLS -- DHF

Facility

$2,702.77

Service Code	HCPCS C1788
Hospital Charge Code	82402074
Hospital Revenue Code	278
Min. Negotiated Rate	$243.25
Max. Negotiated Rate	$1,351.38
Rate for Payer: Aetna Commercial	$810.83
Rate for Payer: Amerigroup CHIP/Medicaid	$243.25
Rate for Payer: BCBS of TX Blue Advantage	$810.83
Rate for Payer: BCBS of TX Blue Essentials	$973.00
Rate for Payer: BCBS of TX PPO	$1,081.11
Rate for Payer: Cash Price	$2,378.44
Rate for Payer: Multiplan Auto	$1,351.38
Rate for Payer: Multiplan Commercial	$1,351.38
Rate for Payer: Multiplan Workers Comp	$1,351.38
Rate for Payer: Scott and White EPO/PPO	$1,351.38
Rate for Payer: Superior Health Plan EPO	$367.58

CATHETER SYMETREX HEMODIALYSIS

Facility

$808.19

Service Code	HCPCS C1752
Hospital Charge Code	8484505
Hospital Revenue Code	278
Min. Negotiated Rate	$72.74
Max. Negotiated Rate	$404.10
Rate for Payer: Aetna Commercial	$242.46
Rate for Payer: Amerigroup CHIP/Medicaid	$72.74
Rate for Payer: BCBS of TX Blue Advantage	$242.46
Rate for Payer: BCBS of TX Blue Essentials	$290.95
Rate for Payer: BCBS of TX PPO	$323.28
Rate for Payer: Cash Price	$711.21
Rate for Payer: Multiplan Auto	$404.10
Rate for Payer: Multiplan Commercial	$404.10
Rate for Payer: Multiplan Workers Comp	$404.10
Rate for Payer: Scott and White EPO/PPO	$404.10
Rate for Payer: Superior Health Plan EPO	$109.91

CATHETER SYMETREX HEMODIALYSIS

Facility

$808.19

Service Code	HCPCS C1752
Hospital Charge Code	8484505
Hospital Revenue Code	278
Min. Negotiated Rate	$202.05
Max. Negotiated Rate	$404.10
Rate for Payer: Aetna Commercial	$242.46
Rate for Payer: Cash Price	$711.21
Rate for Payer: Cigna Commercial	$202.05
Rate for Payer: Multiplan Auto	$404.10
Rate for Payer: Multiplan Commercial	$404.10
Rate for Payer: Multiplan Workers Comp	$404.10
Rate for Payer: Scott and White EPO/PPO	$404.10

Catheter Tip Culture

Facility

$309.00

Service Code	CPT 87070
Hospital Charge Code	4107069
Hospital Revenue Code	306
Rate for Payer: Cash Price	$271.92

Catheter Tip Culture

Facility

$309.00

Service Code	CPT 87070
Hospital Charge Code	4107069
Hospital Revenue Code	306
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$200.85
Rate for Payer: Aetna Commercial	$9.05
Rate for Payer: Aetna Medicare	$12.93
Rate for Payer: Amerigroup CHIP/Medicaid	$3.36
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8.62
Rate for Payer: Amerigroup Medicare	$8.62
Rate for Payer: BCBS of TX Blue Advantage	$14.22
Rate for Payer: BCBS of TX Blue Essentials	$17.07
Rate for Payer: BCBS of TX Medicare	$8.62
Rate for Payer: BCBS of TX PPO	$19.05
Rate for Payer: Cash Price	$271.92
Rate for Payer: Cash Price	$271.92
Rate for Payer: Cigna Medicaid	$8.62
Rate for Payer: Cigna Medicare	$8.62
Rate for Payer: Employer Direct Commercial	$8.62
Rate for Payer: Humana Medicare/TRICARE	$8.62
Rate for Payer: Molina CHIP/Medicaid	$8.62
Rate for Payer: Molina Dual Medicare/Medicaid	$8.62
Rate for Payer: Molina Medicare	$8.62
Rate for Payer: Multiplan Auto	$200.85
Rate for Payer: Multiplan Commercial	$200.85
Rate for Payer: Multiplan Workers Comp	$200.85
Rate for Payer: Parkland Medicaid	$8.62
Rate for Payer: Scott and White EPO/PPO	$10.78
Rate for Payer: Scott and White Medicare	$8.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.62
Rate for Payer: Superior Health Plan EPO	$8.62
Rate for Payer: Superior Health Plan Medicare	$8.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$8.62
Rate for Payer: Universal American Medicare	$8.62
Rate for Payer: Wellcare Medicare	$8.62
Rate for Payer: Wellmed Medicare	$8.62

CATH EXT -- DHF

Facility

$50.69

Hospital Charge Code	80411259
Hospital Revenue Code	270
Rate for Payer: Cash Price	$44.61

CATH EXT -- DHF

Facility

$50.69

Hospital Charge Code	80411259
Hospital Revenue Code	270
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$32.95
Rate for Payer: Aetna Commercial	$27.88
Rate for Payer: Amerigroup CHIP/Medicaid	$4.56
Rate for Payer: BCBS of TX Blue Advantage	$15.21
Rate for Payer: BCBS of TX Blue Essentials	$18.25
Rate for Payer: BCBS of TX PPO	$20.28
Rate for Payer: Cash Price	$44.61
Rate for Payer: Multiplan Auto	$32.95
Rate for Payer: Multiplan Commercial	$32.95
Rate for Payer: Multiplan Workers Comp	$32.95
Rate for Payer: Scott and White EPO/PPO	$25.34
Rate for Payer: Superior Health Plan EPO	$6.89

Know your out-of-pocket cost for care.

All Charges