White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CATH FOLEY 5CC -- DHF

Facility

$16.47

Hospital Charge Code	80411358
Hospital Revenue Code	272
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$10.71
Rate for Payer: Aetna Commercial	$9.06
Rate for Payer: Amerigroup CHIP/Medicaid	$1.48
Rate for Payer: BCBS of TX Blue Advantage	$4.94
Rate for Payer: BCBS of TX Blue Essentials	$5.93
Rate for Payer: BCBS of TX PPO	$6.59
Rate for Payer: Cash Price	$14.49
Rate for Payer: Multiplan Auto	$10.71
Rate for Payer: Multiplan Commercial	$10.71
Rate for Payer: Multiplan Workers Comp	$10.71
Rate for Payer: Scott and White EPO/PPO	$8.24
Rate for Payer: Superior Health Plan EPO	$2.24

CATH FOLEY 5CC -- DHF

Facility

$16.47

Hospital Charge Code	80411358
Hospital Revenue Code	272
Rate for Payer: Cash Price	$14.49

CATH FOLY 2W ALL -- DHF

Facility

$234.19

Hospital Charge Code	80411457
Hospital Revenue Code	272
Rate for Payer: Cash Price	$206.09

CATH FOLY 2W ALL -- DHF

Facility

$234.19

Hospital Charge Code	80411457
Hospital Revenue Code	272
Min. Negotiated Rate	$21.08
Max. Negotiated Rate	$152.22
Rate for Payer: Aetna Commercial	$128.80
Rate for Payer: Amerigroup CHIP/Medicaid	$21.08
Rate for Payer: BCBS of TX Blue Advantage	$70.26
Rate for Payer: BCBS of TX Blue Essentials	$84.31
Rate for Payer: BCBS of TX PPO	$93.68
Rate for Payer: Cash Price	$206.09
Rate for Payer: Multiplan Auto	$152.22
Rate for Payer: Multiplan Commercial	$152.22
Rate for Payer: Multiplan Workers Comp	$152.22
Rate for Payer: Scott and White EPO/PPO	$117.10
Rate for Payer: Superior Health Plan EPO	$31.85

CATH FOLY 30C 2 -- DHF

Facility

$253.17

Hospital Charge Code	80411556
Hospital Revenue Code	272
Rate for Payer: Cash Price	$222.79

CATH FOLY 30C 2 -- DHF

Facility

$253.17

Hospital Charge Code	80411556
Hospital Revenue Code	272
Min. Negotiated Rate	$22.79
Max. Negotiated Rate	$164.56
Rate for Payer: Aetna Commercial	$139.24
Rate for Payer: Amerigroup CHIP/Medicaid	$22.79
Rate for Payer: BCBS of TX Blue Advantage	$75.95
Rate for Payer: BCBS of TX Blue Essentials	$91.14
Rate for Payer: BCBS of TX PPO	$101.27
Rate for Payer: Cash Price	$222.79
Rate for Payer: Multiplan Auto	$164.56
Rate for Payer: Multiplan Commercial	$164.56
Rate for Payer: Multiplan Workers Comp	$164.56
Rate for Payer: Scott and White EPO/PPO	$126.58
Rate for Payer: Superior Health Plan EPO	$34.43

CATH FOLY 30C 3 -- DHF

Facility

$523.97

Hospital Charge Code	80411606
Hospital Revenue Code	272
Rate for Payer: Cash Price	$461.09

CATH FOLY 30C 3 -- DHF

Facility

$523.97

Hospital Charge Code	80411606
Hospital Revenue Code	272
Min. Negotiated Rate	$47.16
Max. Negotiated Rate	$340.58
Rate for Payer: Aetna Commercial	$288.18
Rate for Payer: Amerigroup CHIP/Medicaid	$47.16
Rate for Payer: BCBS of TX Blue Advantage	$157.19
Rate for Payer: BCBS of TX Blue Essentials	$188.63
Rate for Payer: BCBS of TX PPO	$209.59
Rate for Payer: Cash Price	$461.09
Rate for Payer: Multiplan Auto	$340.58
Rate for Payer: Multiplan Commercial	$340.58
Rate for Payer: Multiplan Workers Comp	$340.58
Rate for Payer: Scott and White EPO/PPO	$261.98
Rate for Payer: Superior Health Plan EPO	$71.26

CATH FOLY 3W ALL -- DHF

Facility

$88.06

Hospital Charge Code	80411507
Hospital Revenue Code	272
Rate for Payer: Cash Price	$77.49

CATH FOLY 3W ALL -- DHF

Facility

$88.06

Hospital Charge Code	80411507
Hospital Revenue Code	272
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$57.24
Rate for Payer: Aetna Commercial	$48.43
Rate for Payer: Amerigroup CHIP/Medicaid	$7.93
Rate for Payer: BCBS of TX Blue Advantage	$26.42
Rate for Payer: BCBS of TX Blue Essentials	$31.70
Rate for Payer: BCBS of TX PPO	$35.22
Rate for Payer: Cash Price	$77.49
Rate for Payer: Multiplan Auto	$57.24
Rate for Payer: Multiplan Commercial	$57.24
Rate for Payer: Multiplan Workers Comp	$57.24
Rate for Payer: Scott and White EPO/PPO	$44.03
Rate for Payer: Superior Health Plan EPO	$11.98

CATH FOLY TEMPG -- DHF

Facility

$779.77

Hospital Charge Code	80564008
Hospital Revenue Code	272
Rate for Payer: Cash Price	$686.20

CATH FOLY TEMPG -- DHF

Facility

$779.77

Hospital Charge Code	80564008
Hospital Revenue Code	272
Min. Negotiated Rate	$70.18
Max. Negotiated Rate	$506.85
Rate for Payer: Aetna Commercial	$428.87
Rate for Payer: Amerigroup CHIP/Medicaid	$70.18
Rate for Payer: BCBS of TX Blue Advantage	$233.93
Rate for Payer: BCBS of TX Blue Essentials	$280.72
Rate for Payer: BCBS of TX PPO	$311.91
Rate for Payer: Cash Price	$686.20
Rate for Payer: Multiplan Auto	$506.85
Rate for Payer: Multiplan Commercial	$506.85
Rate for Payer: Multiplan Workers Comp	$506.85
Rate for Payer: Scott and White EPO/PPO	$389.88
Rate for Payer: Superior Health Plan EPO	$106.05

CATH GDE -- DHF

Facility

$1,447.97

Hospital Charge Code	80411804
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,274.21

CATH GDE -- DHF

Facility

$1,447.97

Hospital Charge Code	80411804
Hospital Revenue Code	272
Min. Negotiated Rate	$130.32
Max. Negotiated Rate	$941.18
Rate for Payer: Aetna Commercial	$796.38
Rate for Payer: Amerigroup CHIP/Medicaid	$130.32
Rate for Payer: BCBS of TX Blue Advantage	$434.39
Rate for Payer: BCBS of TX Blue Essentials	$521.27
Rate for Payer: BCBS of TX PPO	$579.19
Rate for Payer: Cash Price	$1,274.21
Rate for Payer: Multiplan Auto	$941.18
Rate for Payer: Multiplan Commercial	$941.18
Rate for Payer: Multiplan Workers Comp	$941.18
Rate for Payer: Scott and White EPO/PPO	$723.98
Rate for Payer: Superior Health Plan EPO	$196.92

CATH GOLD PRB DISP -- DHF

Facility

$695.85

Hospital Charge Code	80316177
Hospital Revenue Code	272
Rate for Payer: Cash Price	$612.35

CATH GOLD PRB DISP -- DHF

Facility

$695.85

Hospital Charge Code	80316177
Hospital Revenue Code	272
Min. Negotiated Rate	$62.63
Max. Negotiated Rate	$452.30
Rate for Payer: Aetna Commercial	$382.72
Rate for Payer: Amerigroup CHIP/Medicaid	$62.63
Rate for Payer: BCBS of TX Blue Advantage	$208.76
Rate for Payer: BCBS of TX Blue Essentials	$250.51
Rate for Payer: BCBS of TX PPO	$278.34
Rate for Payer: Cash Price	$612.35
Rate for Payer: Multiplan Auto	$452.30
Rate for Payer: Multiplan Commercial	$452.30
Rate for Payer: Multiplan Workers Comp	$452.30
Rate for Payer: Scott and White EPO/PPO	$347.92
Rate for Payer: Superior Health Plan EPO	$94.64

CATH GUIDE EXTENSION -- DHF

Facility

$1,997.60

Service Code	HCPCS C1769
Hospital Charge Code	80564578
Hospital Revenue Code	272
Min. Negotiated Rate	$179.78
Max. Negotiated Rate	$1,298.44
Rate for Payer: Aetna Commercial	$1,098.68
Rate for Payer: Amerigroup CHIP/Medicaid	$179.78
Rate for Payer: BCBS of TX Blue Advantage	$599.28
Rate for Payer: BCBS of TX Blue Essentials	$719.14
Rate for Payer: BCBS of TX PPO	$799.04
Rate for Payer: Cash Price	$1,757.89
Rate for Payer: Multiplan Auto	$1,298.44
Rate for Payer: Multiplan Commercial	$1,298.44
Rate for Payer: Multiplan Workers Comp	$1,298.44
Rate for Payer: Scott and White EPO/PPO	$998.80
Rate for Payer: Superior Health Plan EPO	$271.67

CATH GUIDE EXTENSION -- DHF

Facility

$1,997.60

Service Code	HCPCS C1769
Hospital Charge Code	80564578
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,757.89

CATH GUIDE SLIT OUTR CPS -- DHF

Facility

$1,174.23

Service Code	HCPCS C1893
Hospital Charge Code	80564362
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,033.32

CATH GUIDE SLIT OUTR CPS -- DHF

Facility

$1,174.23

Service Code	HCPCS C1893
Hospital Charge Code	80564362
Hospital Revenue Code	272
Min. Negotiated Rate	$105.68
Max. Negotiated Rate	$763.25
Rate for Payer: Aetna Commercial	$645.83
Rate for Payer: Amerigroup CHIP/Medicaid	$105.68
Rate for Payer: BCBS of TX Blue Advantage	$352.27
Rate for Payer: BCBS of TX Blue Essentials	$422.72
Rate for Payer: BCBS of TX PPO	$469.69
Rate for Payer: Cash Price	$1,033.32
Rate for Payer: Multiplan Auto	$763.25
Rate for Payer: Multiplan Commercial	$763.25
Rate for Payer: Multiplan Workers Comp	$763.25
Rate for Payer: Scott and White EPO/PPO	$587.12
Rate for Payer: Superior Health Plan EPO	$159.70

CATH GUIDING 2 -- DHF

Facility

$3,485.00

Service Code	HCPCS C1887
Hospital Charge Code	82400979
Hospital Revenue Code	278
Min. Negotiated Rate	$313.65
Max. Negotiated Rate	$1,742.50
Rate for Payer: Aetna Commercial	$1,045.50
Rate for Payer: Amerigroup CHIP/Medicaid	$313.65
Rate for Payer: BCBS of TX Blue Advantage	$1,045.50
Rate for Payer: BCBS of TX Blue Essentials	$1,254.60
Rate for Payer: BCBS of TX PPO	$1,394.00
Rate for Payer: Cash Price	$3,066.80
Rate for Payer: Multiplan Auto	$1,742.50
Rate for Payer: Multiplan Commercial	$1,742.50
Rate for Payer: Multiplan Workers Comp	$1,742.50
Rate for Payer: Scott and White EPO/PPO	$1,742.50
Rate for Payer: Superior Health Plan EPO	$473.96

CATH GUIDING 2 -- DHF

Facility

$3,485.00

Service Code	HCPCS C1887
Hospital Charge Code	82400979
Hospital Revenue Code	278
Min. Negotiated Rate	$871.25
Max. Negotiated Rate	$1,742.50
Rate for Payer: Aetna Commercial	$1,045.50
Rate for Payer: Cash Price	$3,066.80
Rate for Payer: Cigna Commercial	$871.25
Rate for Payer: Multiplan Auto	$1,742.50
Rate for Payer: Multiplan Commercial	$1,742.50
Rate for Payer: Multiplan Workers Comp	$1,742.50
Rate for Payer: Scott and White EPO/PPO	$1,742.50

CATH GUIDING 4 -- DHF

Facility

$902.77

Service Code	HCPCS C1887
Hospital Charge Code	82401035
Hospital Revenue Code	278
Min. Negotiated Rate	$81.25
Max. Negotiated Rate	$451.38
Rate for Payer: Aetna Commercial	$270.83
Rate for Payer: Amerigroup CHIP/Medicaid	$81.25
Rate for Payer: BCBS of TX Blue Advantage	$270.83
Rate for Payer: BCBS of TX Blue Essentials	$325.00
Rate for Payer: BCBS of TX PPO	$361.11
Rate for Payer: Cash Price	$794.44
Rate for Payer: Multiplan Auto	$451.38
Rate for Payer: Multiplan Commercial	$451.38
Rate for Payer: Multiplan Workers Comp	$451.38
Rate for Payer: Scott and White EPO/PPO	$451.38
Rate for Payer: Superior Health Plan EPO	$122.78

CATH GUIDING 4 -- DHF

Facility

$902.77

Service Code	HCPCS C1887
Hospital Charge Code	82401035
Hospital Revenue Code	278
Min. Negotiated Rate	$225.69
Max. Negotiated Rate	$451.38
Rate for Payer: Aetna Commercial	$270.83
Rate for Payer: Cash Price	$794.44
Rate for Payer: Cigna Commercial	$225.69
Rate for Payer: Multiplan Auto	$451.38
Rate for Payer: Multiplan Commercial	$451.38
Rate for Payer: Multiplan Workers Comp	$451.38
Rate for Payer: Scott and White EPO/PPO	$451.38

CATH GUIDING -- DHF

Facility

$1,306.27

Service Code	HCPCS C1887
Hospital Charge Code	82400961
Hospital Revenue Code	278
Min. Negotiated Rate	$117.56
Max. Negotiated Rate	$653.14
Rate for Payer: Aetna Commercial	$391.88
Rate for Payer: Amerigroup CHIP/Medicaid	$117.56
Rate for Payer: BCBS of TX Blue Advantage	$391.88
Rate for Payer: BCBS of TX Blue Essentials	$470.26
Rate for Payer: BCBS of TX PPO	$522.51
Rate for Payer: Cash Price	$1,149.52
Rate for Payer: Multiplan Auto	$653.14
Rate for Payer: Multiplan Commercial	$653.14
Rate for Payer: Multiplan Workers Comp	$653.14
Rate for Payer: Scott and White EPO/PPO	$653.14
Rate for Payer: Superior Health Plan EPO	$177.65

Know your out-of-pocket cost for care.

All Charges