White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CATH L HRT ARTERY/VENTR

Facility

$21,615.00

Service Code	CPT 93458
Hospital Charge Code	2320527
Hospital Revenue Code	481
Rate for Payer: Cash Price	$19,021.20

CATH L HRT ARTERY/VENTR

Facility

$21,615.00

Service Code	CPT 93458
Hospital Charge Code	2320527
Hospital Revenue Code	481
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$14,049.75
Rate for Payer: Aetna Commercial	$6,077.00
Rate for Payer: Aetna Medicare	$4,470.16
Rate for Payer: Amerigroup CHIP/Medicaid	$1,945.35
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,980.11
Rate for Payer: Amerigroup Medicare	$2,980.11
Rate for Payer: BCBS of TX Blue Advantage	$4,759.42
Rate for Payer: BCBS of TX Blue Essentials	$5,699.90
Rate for Payer: BCBS of TX Medicare	$2,980.11
Rate for Payer: BCBS of TX PPO	$7,181.87
Rate for Payer: Cash Price	$19,021.20
Rate for Payer: Cash Price	$19,021.20
Rate for Payer: Cash Price	$19,021.20
Rate for Payer: Cigna Commercial	$6,750.80
Rate for Payer: Cigna Medicare	$2,980.11
Rate for Payer: Employer Direct Commercial	$2,980.11
Rate for Payer: Humana Medicare/TRICARE	$2,980.11
Rate for Payer: Molina Dual Medicare/Medicaid	$2,980.11
Rate for Payer: Molina Medicare	$2,980.11
Rate for Payer: Multiplan Auto	$14,049.75
Rate for Payer: Multiplan Commercial	$14,049.75
Rate for Payer: Multiplan Workers Comp	$14,049.75
Rate for Payer: Scott and White EPO/PPO	$53.30
Rate for Payer: Scott and White Medicare	$2,980.11
Rate for Payer: Superior Health Plan EPO	$2,980.11
Rate for Payer: Superior Health Plan Medicare	$2,980.11
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,980.11
Rate for Payer: Universal American Medicare	$2,980.11
Rate for Payer: Wellcare Medicare	$2,980.11
Rate for Payer: Wellmed Medicare	$2,980.11

CATH L VENTRICAL/ATRIAL

Facility

$2,166.00

Service Code	CPT 93565
Hospital Charge Code	4613566
Hospital Revenue Code	481
Min. Negotiated Rate	$194.94
Max. Negotiated Rate	$7,287.00
Rate for Payer: Aetna Commercial	$7,287.00
Rate for Payer: Amerigroup CHIP/Medicaid	$194.94
Rate for Payer: Cash Price	$1,906.08
Rate for Payer: Cash Price	$1,906.08
Rate for Payer: Multiplan Auto	$1,407.90
Rate for Payer: Multiplan Commercial	$1,407.90
Rate for Payer: Multiplan Workers Comp	$1,407.90
Rate for Payer: Scott and White EPO/PPO	$1,083.00
Rate for Payer: Superior Health Plan EPO	$294.58

CATH L VENTRICAL/ATRIAL

Facility

$2,166.00

Service Code	CPT 93565
Hospital Charge Code	4613566
Hospital Revenue Code	481
Rate for Payer: Cash Price	$1,906.08

CATH MUSTANG BLN DIL 6X100X135

Facility

$1,144.58

Service Code	HCPCS C1725
Hospital Charge Code	108493
Hospital Revenue Code	278
Min. Negotiated Rate	$286.14
Max. Negotiated Rate	$572.29
Rate for Payer: Aetna Commercial	$343.37
Rate for Payer: Cash Price	$1,007.23
Rate for Payer: Cigna Commercial	$286.14
Rate for Payer: Multiplan Auto	$572.29
Rate for Payer: Multiplan Commercial	$572.29
Rate for Payer: Multiplan Workers Comp	$572.29
Rate for Payer: Scott and White EPO/PPO	$572.29

CATH MUSTANG BLN DIL 6X100X135

Facility

$1,144.58

Service Code	HCPCS C1725
Hospital Charge Code	108493
Hospital Revenue Code	278
Min. Negotiated Rate	$103.01
Max. Negotiated Rate	$572.29
Rate for Payer: Aetna Commercial	$343.37
Rate for Payer: Amerigroup CHIP/Medicaid	$103.01
Rate for Payer: BCBS of TX Blue Advantage	$343.37
Rate for Payer: BCBS of TX Blue Essentials	$412.05
Rate for Payer: BCBS of TX PPO	$457.83
Rate for Payer: Cash Price	$1,007.23
Rate for Payer: Multiplan Auto	$572.29
Rate for Payer: Multiplan Commercial	$572.29
Rate for Payer: Multiplan Workers Comp	$572.29
Rate for Payer: Scott and White EPO/PPO	$572.29
Rate for Payer: Superior Health Plan EPO	$155.66

CATH MUSTANG BLN DIL 9X40X75

Facility

$1,144.58

Service Code	HCPCS C1726
Hospital Charge Code	108501
Hospital Revenue Code	278
Min. Negotiated Rate	$103.01
Max. Negotiated Rate	$572.29
Rate for Payer: Aetna Commercial	$343.37
Rate for Payer: Amerigroup CHIP/Medicaid	$103.01
Rate for Payer: BCBS of TX Blue Advantage	$343.37
Rate for Payer: BCBS of TX Blue Essentials	$412.05
Rate for Payer: BCBS of TX PPO	$457.83
Rate for Payer: Cash Price	$1,007.23
Rate for Payer: Multiplan Auto	$572.29
Rate for Payer: Multiplan Commercial	$572.29
Rate for Payer: Multiplan Workers Comp	$572.29
Rate for Payer: Scott and White EPO/PPO	$572.29
Rate for Payer: Superior Health Plan EPO	$155.66

CATH MUSTANG BLN DIL 9X40X75

Facility

$1,144.58

Service Code	HCPCS C1726
Hospital Charge Code	108501
Hospital Revenue Code	278
Min. Negotiated Rate	$286.14
Max. Negotiated Rate	$572.29
Rate for Payer: Aetna Commercial	$343.37
Rate for Payer: Cash Price	$1,007.23
Rate for Payer: Cigna Commercial	$286.14
Rate for Payer: Multiplan Auto	$572.29
Rate for Payer: Multiplan Commercial	$572.29
Rate for Payer: Multiplan Workers Comp	$572.29
Rate for Payer: Scott and White EPO/PPO	$572.29

CATH PERI DIALYSIS -- DHF

Facility

$220.32

Hospital Charge Code	80566458
Hospital Revenue Code	272
Min. Negotiated Rate	$19.83
Max. Negotiated Rate	$143.21
Rate for Payer: Aetna Commercial	$121.18
Rate for Payer: Amerigroup CHIP/Medicaid	$19.83
Rate for Payer: BCBS of TX Blue Advantage	$66.10
Rate for Payer: BCBS of TX Blue Essentials	$79.32
Rate for Payer: BCBS of TX PPO	$88.13
Rate for Payer: Cash Price	$193.88
Rate for Payer: Multiplan Auto	$143.21
Rate for Payer: Multiplan Commercial	$143.21
Rate for Payer: Multiplan Workers Comp	$143.21
Rate for Payer: Scott and White EPO/PPO	$110.16
Rate for Payer: Superior Health Plan EPO	$29.96

CATH PERI DIALYSIS -- DHF

Facility

$220.32

Hospital Charge Code	80566458
Hospital Revenue Code	272
Rate for Payer: Cash Price	$193.88

CATH PICC BARD GROSHONG -- DHF

Facility

$1,564.76

Service Code	HCPCS C1751
Hospital Charge Code	82458506
Hospital Revenue Code	278
Min. Negotiated Rate	$391.19
Max. Negotiated Rate	$782.38
Rate for Payer: Aetna Commercial	$469.43
Rate for Payer: Cash Price	$1,376.99
Rate for Payer: Cigna Commercial	$391.19
Rate for Payer: Multiplan Auto	$782.38
Rate for Payer: Multiplan Commercial	$782.38
Rate for Payer: Multiplan Workers Comp	$782.38
Rate for Payer: Scott and White EPO/PPO	$782.38

CATH PICC BARD GROSHONG -- DHF

Facility

$1,564.76

Service Code	HCPCS C1751
Hospital Charge Code	82458506
Hospital Revenue Code	278
Min. Negotiated Rate	$140.83
Max. Negotiated Rate	$782.38
Rate for Payer: Aetna Commercial	$469.43
Rate for Payer: Amerigroup CHIP/Medicaid	$140.83
Rate for Payer: BCBS of TX Blue Advantage	$469.43
Rate for Payer: BCBS of TX Blue Essentials	$563.31
Rate for Payer: BCBS of TX PPO	$625.90
Rate for Payer: Cash Price	$1,376.99
Rate for Payer: Multiplan Auto	$782.38
Rate for Payer: Multiplan Commercial	$782.38
Rate for Payer: Multiplan Workers Comp	$782.38
Rate for Payer: Scott and White EPO/PPO	$782.38
Rate for Payer: Superior Health Plan EPO	$212.81

CATH PLC IN BYPASS GRAFT ANGIOGRAPH

Facility

$21,165.00

Service Code	CPT 93455
Hospital Charge Code	2320524
Hospital Revenue Code	481
Rate for Payer: Cash Price	$18,625.20

CATH PLC IN BYPASS GRAFT ANGIOGRAPH

Facility

$21,165.00

Service Code	CPT 93455
Hospital Charge Code	2320524
Hospital Revenue Code	481
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$13,757.25
Rate for Payer: Aetna Commercial	$6,077.00
Rate for Payer: Aetna Medicare	$4,470.16
Rate for Payer: Amerigroup CHIP/Medicaid	$1,904.85
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,980.11
Rate for Payer: Amerigroup Medicare	$2,980.11
Rate for Payer: BCBS of TX Blue Advantage	$4,759.42
Rate for Payer: BCBS of TX Blue Essentials	$5,699.90
Rate for Payer: BCBS of TX Medicare	$2,980.11
Rate for Payer: BCBS of TX PPO	$7,181.87
Rate for Payer: Cash Price	$18,625.20
Rate for Payer: Cash Price	$18,625.20
Rate for Payer: Cash Price	$18,625.20
Rate for Payer: Cigna Commercial	$6,750.80
Rate for Payer: Cigna Medicare	$2,980.11
Rate for Payer: Employer Direct Commercial	$2,980.11
Rate for Payer: Humana Medicare/TRICARE	$2,980.11
Rate for Payer: Molina Dual Medicare/Medicaid	$2,980.11
Rate for Payer: Molina Medicare	$2,980.11
Rate for Payer: Multiplan Auto	$13,757.25
Rate for Payer: Multiplan Commercial	$13,757.25
Rate for Payer: Multiplan Workers Comp	$13,757.25
Rate for Payer: Scott and White EPO/PPO	$53.30
Rate for Payer: Scott and White Medicare	$2,980.11
Rate for Payer: Superior Health Plan EPO	$2,980.11
Rate for Payer: Superior Health Plan Medicare	$2,980.11
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,980.11
Rate for Payer: Universal American Medicare	$2,980.11
Rate for Payer: Wellcare Medicare	$2,980.11
Rate for Payer: Wellmed Medicare	$2,980.11

CATH POST ERGOTR STDY

Facility

$2,649.00

Service Code	CPT 93024
Hospital Charge Code	4613552
Hospital Revenue Code	482
Rate for Payer: Cash Price	$2,331.12

CATH POST ERGOTR STDY

Facility

$2,649.00

Service Code	CPT 93024
Hospital Charge Code	4613552
Hospital Revenue Code	482
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$1,721.85
Rate for Payer: Aetna Commercial	$91.25
Rate for Payer: Aetna Medicare	$546.58
Rate for Payer: Amerigroup CHIP/Medicaid	$238.41
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$364.39
Rate for Payer: Amerigroup Medicare	$364.39
Rate for Payer: BCBS of TX Blue Advantage	$632.65
Rate for Payer: BCBS of TX Blue Essentials	$756.27
Rate for Payer: BCBS of TX Medicare	$364.39
Rate for Payer: BCBS of TX PPO	$843.53
Rate for Payer: Cash Price	$2,331.12
Rate for Payer: Cash Price	$2,331.12
Rate for Payer: Cash Price	$2,331.12
Rate for Payer: Cigna Commercial	$825.46
Rate for Payer: Cigna Medicare	$364.39
Rate for Payer: Employer Direct Commercial	$364.39
Rate for Payer: Humana Medicare/TRICARE	$364.39
Rate for Payer: Molina Dual Medicare/Medicaid	$364.39
Rate for Payer: Molina Medicare	$364.39
Rate for Payer: Multiplan Auto	$1,721.85
Rate for Payer: Multiplan Commercial	$1,721.85
Rate for Payer: Multiplan Workers Comp	$1,721.85
Rate for Payer: Scott and White EPO/PPO	$6.52
Rate for Payer: Scott and White Medicare	$364.39
Rate for Payer: Superior Health Plan EPO	$364.39
Rate for Payer: Superior Health Plan Medicare	$364.39
Rate for Payer: Universal American Dual Medicare/Medicaid	$364.39
Rate for Payer: Universal American Medicare	$364.39
Rate for Payer: Wellcare Medicare	$364.39
Rate for Payer: Wellmed Medicare	$364.39

CATH PTA ANGIOSCULPT -- DHF

Facility

$7,768.59

Service Code	HCPCS C1725
Hospital Charge Code	40314957
Hospital Revenue Code	278
Min. Negotiated Rate	$699.17
Max. Negotiated Rate	$3,884.30
Rate for Payer: Aetna Commercial	$2,330.58
Rate for Payer: Amerigroup CHIP/Medicaid	$699.17
Rate for Payer: BCBS of TX Blue Advantage	$2,330.58
Rate for Payer: BCBS of TX Blue Essentials	$2,796.69
Rate for Payer: BCBS of TX PPO	$3,107.44
Rate for Payer: Cash Price	$6,836.36
Rate for Payer: Multiplan Auto	$3,884.30
Rate for Payer: Multiplan Commercial	$3,884.30
Rate for Payer: Multiplan Workers Comp	$3,884.30
Rate for Payer: Scott and White EPO/PPO	$3,884.30
Rate for Payer: Superior Health Plan EPO	$1,056.53

CATH PTA ANGIOSCULPT -- DHF

Facility

$7,768.59

Service Code	HCPCS C1725
Hospital Charge Code	40314957
Hospital Revenue Code	278
Min. Negotiated Rate	$1,942.15
Max. Negotiated Rate	$3,884.30
Rate for Payer: Aetna Commercial	$2,330.58
Rate for Payer: Cash Price	$6,836.36
Rate for Payer: Cigna Commercial	$1,942.15
Rate for Payer: Multiplan Auto	$3,884.30
Rate for Payer: Multiplan Commercial	$3,884.30
Rate for Payer: Multiplan Workers Comp	$3,884.30
Rate for Payer: Scott and White EPO/PPO	$3,884.30

CATH RADIAL ART -- DHF

Facility

$54.48

Hospital Charge Code	80566854
Hospital Revenue Code	272
Rate for Payer: Cash Price	$47.94

CATH RADIAL ART -- DHF

Facility

$54.48

Hospital Charge Code	80566854
Hospital Revenue Code	272
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$35.41
Rate for Payer: Aetna Commercial	$29.96
Rate for Payer: Amerigroup CHIP/Medicaid	$4.90
Rate for Payer: BCBS of TX Blue Advantage	$16.34
Rate for Payer: BCBS of TX Blue Essentials	$19.61
Rate for Payer: BCBS of TX PPO	$21.79
Rate for Payer: Cash Price	$47.94
Rate for Payer: Multiplan Auto	$35.41
Rate for Payer: Multiplan Commercial	$35.41
Rate for Payer: Multiplan Workers Comp	$35.41
Rate for Payer: Scott and White EPO/PPO	$27.24
Rate for Payer: Superior Health Plan EPO	$7.41

CATH RENAL ARTERY BILAT 1ST ORDER

Facility

$12,148.00

Service Code	CPT 36252
Hospital Charge Code	2320552
Hospital Revenue Code	361
Rate for Payer: Cash Price	$10,690.24

CATH RENAL ARTERY BILAT 1ST ORDER

Facility

$12,148.00

Service Code	CPT 36252
Hospital Charge Code	2320552
Hospital Revenue Code	361
Min. Negotiated Rate	$64.30
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$4,635.00
Rate for Payer: Aetna Medicare	$4,372.65
Rate for Payer: Amerigroup CHIP/Medicaid	$1,093.32
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,915.10
Rate for Payer: Amerigroup Medicare	$2,915.10
Rate for Payer: BCBS of TX Blue Advantage	$4,628.04
Rate for Payer: BCBS of TX Blue Essentials	$5,542.56
Rate for Payer: BCBS of TX Medicare	$2,915.10
Rate for Payer: BCBS of TX PPO	$6,983.63
Rate for Payer: Cash Price	$10,690.24
Rate for Payer: Cash Price	$10,690.24
Rate for Payer: Cash Price	$10,690.24
Rate for Payer: Cigna Commercial	$6,603.56
Rate for Payer: Cigna Medicare	$2,915.10
Rate for Payer: Employer Direct Commercial	$2,915.10
Rate for Payer: Humana Medicare/TRICARE	$2,915.10
Rate for Payer: Molina Dual Medicare/Medicaid	$2,915.10
Rate for Payer: Molina Medicare	$2,915.10
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Scott and White EPO/PPO	$64.30
Rate for Payer: Scott and White Medicare	$2,915.10
Rate for Payer: Superior Health Plan EPO	$2,915.10
Rate for Payer: Superior Health Plan Medicare	$2,915.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,915.10
Rate for Payer: Universal American Medicare	$2,915.10
Rate for Payer: Wellcare Medicare	$2,915.10
Rate for Payer: Wellmed Medicare	$2,915.10

CATH R HRT ART/GRFT ANGI

Facility

$22,830.00

Service Code	CPT 93457
Hospital Charge Code	2320526
Hospital Revenue Code	481
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$14,839.50
Rate for Payer: Aetna Commercial	$6,077.00
Rate for Payer: Aetna Medicare	$4,470.16
Rate for Payer: Amerigroup CHIP/Medicaid	$2,054.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,980.11
Rate for Payer: Amerigroup Medicare	$2,980.11
Rate for Payer: BCBS of TX Blue Advantage	$4,759.42
Rate for Payer: BCBS of TX Blue Essentials	$5,699.90
Rate for Payer: BCBS of TX Medicare	$2,980.11
Rate for Payer: BCBS of TX PPO	$7,181.87
Rate for Payer: Cash Price	$20,090.40
Rate for Payer: Cash Price	$20,090.40
Rate for Payer: Cash Price	$20,090.40
Rate for Payer: Cigna Commercial	$6,750.80
Rate for Payer: Cigna Medicare	$2,980.11
Rate for Payer: Employer Direct Commercial	$2,980.11
Rate for Payer: Humana Medicare/TRICARE	$2,980.11
Rate for Payer: Molina Dual Medicare/Medicaid	$2,980.11
Rate for Payer: Molina Medicare	$2,980.11
Rate for Payer: Multiplan Auto	$14,839.50
Rate for Payer: Multiplan Commercial	$14,839.50
Rate for Payer: Multiplan Workers Comp	$14,839.50
Rate for Payer: Scott and White EPO/PPO	$53.30
Rate for Payer: Scott and White Medicare	$2,980.11
Rate for Payer: Superior Health Plan EPO	$2,980.11
Rate for Payer: Superior Health Plan Medicare	$2,980.11
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,980.11
Rate for Payer: Universal American Medicare	$2,980.11
Rate for Payer: Wellcare Medicare	$2,980.11
Rate for Payer: Wellmed Medicare	$2,980.11

CATH R HRT ART/GRFT ANGI

Facility

$22,830.00

Service Code	CPT 93457
Hospital Charge Code	2320526
Hospital Revenue Code	481
Rate for Payer: Cash Price	$20,090.40

CATH R&L HRT ART/VENT

Facility

$25,230.00

Service Code	CPT 93460
Hospital Charge Code	2320529
Hospital Revenue Code	481
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$16,399.50
Rate for Payer: Aetna Commercial	$6,077.00
Rate for Payer: Aetna Medicare	$4,470.16
Rate for Payer: Amerigroup CHIP/Medicaid	$2,270.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,980.11
Rate for Payer: Amerigroup Medicare	$2,980.11
Rate for Payer: BCBS of TX Blue Advantage	$4,759.42
Rate for Payer: BCBS of TX Blue Essentials	$5,699.90
Rate for Payer: BCBS of TX Medicare	$2,980.11
Rate for Payer: BCBS of TX PPO	$7,181.87
Rate for Payer: Cash Price	$22,202.40
Rate for Payer: Cash Price	$22,202.40
Rate for Payer: Cash Price	$22,202.40
Rate for Payer: Cigna Commercial	$6,750.80
Rate for Payer: Cigna Medicare	$2,980.11
Rate for Payer: Employer Direct Commercial	$2,980.11
Rate for Payer: Humana Medicare/TRICARE	$2,980.11
Rate for Payer: Molina Dual Medicare/Medicaid	$2,980.11
Rate for Payer: Molina Medicare	$2,980.11
Rate for Payer: Multiplan Auto	$16,399.50
Rate for Payer: Multiplan Commercial	$16,399.50
Rate for Payer: Multiplan Workers Comp	$16,399.50
Rate for Payer: Scott and White EPO/PPO	$53.30
Rate for Payer: Scott and White Medicare	$2,980.11
Rate for Payer: Superior Health Plan EPO	$2,980.11
Rate for Payer: Superior Health Plan Medicare	$2,980.11
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,980.11
Rate for Payer: Universal American Medicare	$2,980.11
Rate for Payer: Wellcare Medicare	$2,980.11
Rate for Payer: Wellmed Medicare	$2,980.11

Know your out-of-pocket cost for care.

All Charges