CPT 11772

Excision of pilonidal cyst or sinus; complicated

The standard charge for Excision of pilonidal cyst or sinus; complicated is $11,448.20. However, the price you pay depends on the rate negotiated by your insurance plan and what portion your insurance plan requires you to contribute towards that amount. Enter your info below to start your estimate.

To calculate an estimate of your cost, you will need two things:

  • Your Summary of Benefits and Coverage statement from your health insurance plan. If you don't have a paper copy, this is often also available online through your health insurance company's website.
  • Your remaining deductible amount for this year for your insurance plan. Many insurance plans require you to pay a certain amount out of pocket before the insurance kicks in. This amount is called the deductible and is different for each insurance plan.

More Information

White Rock Medical Center

Cost Estimate

Choose a plan to view the insurance rate estimate.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$10,633.00

  • Price Negotiated by Insurer

    $815.20

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $3.03

  • CHED 96374- IV Injection, single/initial BCE

    $32.40

  • Comprehensive Metabolic Panel

    $4.12

  • fentaNYL 50 mcg/mL Inj Soln 10 mL

    $11.52

  • ferrous gluconate 324 mg (38 mg elemental iron) Tab

    $0.72

  • HCG Qualitative Urine

    $3.36

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $11.52

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $11.52

  • midazolam 5 mg/mL Inj Soln 10 mL

    $11.52

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $11.52

  • propofol 10 mg/mL IV Emulsion 20 mL

    $11.54

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $11.54

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$8,530.25

  • Price Negotiated by Insurer

    $2,917.95

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • Comprehensive Metabolic Panel

    $10.56

  • HCG Qualitative Urine

    $8.61

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $0.29

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$8,530.25

  • Price Negotiated by Insurer

    $2,917.95

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • Comprehensive Metabolic Panel

    $10.56

  • HCG Qualitative Urine

    $8.61

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $0.29

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$7,575.65

  • Price Negotiated by Insurer

    $3,872.55

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $116.10

  • CHED 96374- IV Injection, single/initial BCE

    $108.00

  • Comprehensive Metabolic Panel

    $198.30

  • fentaNYL 50 mcg/mL Inj Soln 10 mL

    $0.57

  • ferrous gluconate 324 mg (38 mg elemental iron) Tab

    $2.40

  • HCG Qualitative Urine

    $110.10

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $0.03

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $0.26

  • midazolam 5 mg/mL Inj Soln 10 mL

    $0.12

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $0.86

  • propofol 10 mg/mL IV Emulsion 20 mL

    $0.25

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $21.61

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$6,810.42

  • Price Negotiated by Insurer

    $4,637.78

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $139.32

  • CHED 96374- IV Injection, single/initial BCE

    $129.60

  • Comprehensive Metabolic Panel

    $237.96

  • fentaNYL 50 mcg/mL Inj Soln 10 mL

    $0.68

  • ferrous gluconate 324 mg (38 mg elemental iron) Tab

    $2.88

  • HCG Qualitative Urine

    $132.12

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $0.03

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $0.31

  • midazolam 5 mg/mL Inj Soln 10 mL

    $0.14

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $1.03

  • propofol 10 mg/mL IV Emulsion 20 mL

    $0.30

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $25.93

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$8,530.25

  • Price Negotiated by Insurer

    $2,917.95

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • Comprehensive Metabolic Panel

    $10.56

  • HCG Qualitative Urine

    $8.61

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $0.29

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$5,604.60

  • Price Negotiated by Insurer

    $5,843.60

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $154.80

  • CHED 96374- IV Injection, single/initial BCE

    $144.00

  • Comprehensive Metabolic Panel

    $264.40

  • fentaNYL 50 mcg/mL Inj Soln 10 mL

    $0.75

  • ferrous gluconate 324 mg (38 mg elemental iron) Tab

    $3.20

  • HCG Qualitative Urine

    $146.80

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $0.04

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $0.35

  • midazolam 5 mg/mL Inj Soln 10 mL

    $0.15

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $1.14

  • propofol 10 mg/mL IV Emulsion 20 mL

    $0.33

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $28.76

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$3,663.42

  • Price Negotiated by Insurer

    $7,784.78

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $263.16

  • CHED 96374- IV Injection, single/initial BCE

    $244.80

  • Comprehensive Metabolic Panel

    $449.48

  • fentaNYL 50 mcg/mL Inj Soln 10 mL

    $87.04

  • ferrous gluconate 324 mg (38 mg elemental iron) Tab

    $5.44

  • HCG Qualitative Urine

    $249.56

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $87.04

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $87.04

  • midazolam 5 mg/mL Inj Soln 10 mL

    $87.04

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $87.04

  • propofol 10 mg/mL IV Emulsion 20 mL

    $87.16

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $87.16

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$5,280.17

  • Price Negotiated by Insurer

    $6,168.03

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • CHED 96374- IV Injection, single/initial BCE

    $451.67

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$3,205.50

  • Price Negotiated by Insurer

    $8,242.70

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $278.64

  • CHED 96374- IV Injection, single/initial BCE

    $259.20

  • Comprehensive Metabolic Panel

    $475.92

  • fentaNYL 50 mcg/mL Inj Soln 10 mL

    $92.16

  • ferrous gluconate 324 mg (38 mg elemental iron) Tab

    $5.76

  • HCG Qualitative Urine

    $264.24

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $92.16

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $92.16

  • midazolam 5 mg/mL Inj Soln 10 mL

    $92.16

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $92.16

  • propofol 10 mg/mL IV Emulsion 20 mL

    $92.28

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $92.28

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$8,530.25

  • Price Negotiated by Insurer

    $2,917.95

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • Comprehensive Metabolic Panel

    $10.56

  • HCG Qualitative Urine

    $8.61

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $0.29

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$8,530.25

  • Price Negotiated by Insurer

    $2,917.95

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • Comprehensive Metabolic Panel

    $10.56

  • HCG Qualitative Urine

    $8.61

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $0.29

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$8,530.25

  • Price Negotiated by Insurer

    $2,917.95

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • Comprehensive Metabolic Panel

    $10.56

  • HCG Qualitative Urine

    $8.61

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $0.29

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$3,205.50

  • Price Negotiated by Insurer

    $8,242.70

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $278.64

  • CHED 96374- IV Injection, single/initial BCE

    $259.20

  • Comprehensive Metabolic Panel

    $475.92

  • fentaNYL 50 mcg/mL Inj Soln 10 mL

    $92.16

  • ferrous gluconate 324 mg (38 mg elemental iron) Tab

    $5.76

  • HCG Qualitative Urine

    $264.24

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $92.16

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $92.16

  • midazolam 5 mg/mL Inj Soln 10 mL

    $92.16

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $92.16

  • propofol 10 mg/mL IV Emulsion 20 mL

    $92.28

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $92.28

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$8,530.25

  • Price Negotiated by Insurer

    $2,917.95

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • Comprehensive Metabolic Panel

    $10.56

  • HCG Qualitative Urine

    $8.61

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $0.29

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$8,530.25

  • Price Negotiated by Insurer

    $2,917.95

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • Comprehensive Metabolic Panel

    $10.56

  • HCG Qualitative Urine

    $8.61

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $0.29

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$1,448.20

  • Price Negotiated by Insurer

    $10,000.00

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $251.55

  • CHED 96374- IV Injection, single/initial BCE

    $234.00

  • Comprehensive Metabolic Panel

    $429.65

  • fentaNYL 50 mcg/mL Inj Soln 10 mL

    $83.20

  • ferrous gluconate 324 mg (38 mg elemental iron) Tab

    $5.20

  • HCG Qualitative Urine

    $238.55

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $83.20

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $83.20

  • midazolam 5 mg/mL Inj Soln 10 mL

    $83.20

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $83.20

  • propofol 10 mg/mL IV Emulsion 20 mL

    $83.31

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $83.31

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$1,448.20

  • Price Negotiated by Insurer

    $10,000.00

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $251.55

  • CHED 96374- IV Injection, single/initial BCE

    $234.00

  • Comprehensive Metabolic Panel

    $429.65

  • fentaNYL 50 mcg/mL Inj Soln 10 mL

    $83.20

  • ferrous gluconate 324 mg (38 mg elemental iron) Tab

    $5.20

  • HCG Qualitative Urine

    $238.55

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $83.20

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $83.20

  • midazolam 5 mg/mL Inj Soln 10 mL

    $83.20

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $83.20

  • propofol 10 mg/mL IV Emulsion 20 mL

    $83.31

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $83.31

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$1,448.20

  • Price Negotiated by Insurer

    $10,000.00

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $251.55

  • CHED 96374- IV Injection, single/initial BCE

    $234.00

  • Comprehensive Metabolic Panel

    $429.65

  • fentaNYL 50 mcg/mL Inj Soln 10 mL

    $83.20

  • ferrous gluconate 324 mg (38 mg elemental iron) Tab

    $5.20

  • HCG Qualitative Urine

    $238.55

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $83.20

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $83.20

  • midazolam 5 mg/mL Inj Soln 10 mL

    $83.20

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $83.20

  • propofol 10 mg/mL IV Emulsion 20 mL

    $83.31

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $83.31

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$3,205.50

  • Price Negotiated by Insurer

    $8,242.70

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $278.64

  • CHED 96374- IV Injection, single/initial BCE

    $259.20

  • Comprehensive Metabolic Panel

    $475.92

  • fentaNYL 50 mcg/mL Inj Soln 10 mL

    $92.16

  • ferrous gluconate 324 mg (38 mg elemental iron) Tab

    $5.76

  • HCG Qualitative Urine

    $264.24

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $92.16

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $92.16

  • midazolam 5 mg/mL Inj Soln 10 mL

    $92.16

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $92.16

  • propofol 10 mg/mL IV Emulsion 20 mL

    $92.28

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $92.28

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$6,049.99

  • Price Negotiated by Insurer

    $5,398.21

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $9.71

  • CHED 96374- IV Injection, single/initial BCE

    $180.00

  • Comprehensive Metabolic Panel

    $13.20

  • fentaNYL 50 mcg/mL Inj Soln 10 mL

    $64.00

  • ferrous gluconate 324 mg (38 mg elemental iron) Tab

    $4.00

  • HCG Qualitative Urine

    $10.76

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $64.00

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $64.00

  • midazolam 5 mg/mL Inj Soln 10 mL

    $64.00

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $64.00

  • propofol 10 mg/mL IV Emulsion 20 mL

    $64.08

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $64.08

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$8,530.25

  • Price Negotiated by Insurer

    $2,917.95

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • Comprehensive Metabolic Panel

    $10.56

  • HCG Qualitative Urine

    $8.61

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $0.29

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$3,205.50

  • Price Negotiated by Insurer

    $8,242.70

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $278.64

  • CHED 96374- IV Injection, single/initial BCE

    $259.20

  • Comprehensive Metabolic Panel

    $475.92

  • fentaNYL 50 mcg/mL Inj Soln 10 mL

    $92.16

  • ferrous gluconate 324 mg (38 mg elemental iron) Tab

    $5.76

  • HCG Qualitative Urine

    $264.24

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $92.16

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $92.16

  • midazolam 5 mg/mL Inj Soln 10 mL

    $92.16

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $92.16

  • propofol 10 mg/mL IV Emulsion 20 mL

    $92.28

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $92.28

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$8,530.25

  • Price Negotiated by Insurer

    $2,917.95

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • Comprehensive Metabolic Panel

    $10.56

  • fentaNYL 50 mcg/mL Inj Soln 10 mL

    $17.41

  • ferrous gluconate 324 mg (38 mg elemental iron) Tab

    $1.09

  • HCG Qualitative Urine

    $8.61

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $17.41

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $0.29

  • midazolam 5 mg/mL Inj Soln 10 mL

    $17.41

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $17.41

  • propofol 10 mg/mL IV Emulsion 20 mL

    $17.43

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $17.43

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$8,530.25

  • Price Negotiated by Insurer

    $2,917.95

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • Comprehensive Metabolic Panel

    $10.56

  • HCG Qualitative Urine

    $8.61

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $0.29

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$8,530.25

  • Price Negotiated by Insurer

    $2,917.95

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • Comprehensive Metabolic Panel

    $10.56

  • HCG Qualitative Urine

    $8.61

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $0.29

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$8,530.25

  • Price Negotiated by Insurer

    $2,917.95

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • Comprehensive Metabolic Panel

    $10.56

  • HCG Qualitative Urine

    $8.61

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $0.29

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$8,530.25

  • Price Negotiated by Insurer

    $2,917.95

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • Comprehensive Metabolic Panel

    $10.56

  • HCG Qualitative Urine

    $8.61

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $0.29

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.

Cost Estimate

  • Total estimated charges

    $11,448.20

  • Insurance Discount

    -$8,530.25

  • Price Negotiated by Insurer

    $2,917.95

  • Deductible Applied

    -

  • Copay

    -

  • Coinsurance

    -

  • Your insurance company will pay

    -

  • You will owe (Estimate)

    -

Associated Charges

Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • Comprehensive Metabolic Panel

    $10.56

  • HCG Qualitative Urine

    $8.61

  • ketorolac 15 mg/mL Inj Soln 1 mL

    $0.29

This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to White Rock Medical Center so that your price and insurance eligibility can be confirmed.

To verify this rate and discuss any other associated charges to expect, please contact White Rock Medical Center directly at (214) 324-6100.