CPT 51701

Insertion of temporary bladder catheter

The standard charge for Insertion of temporary bladder catheter is $564.00. 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

    $564.00

  • Insurance Discount

    -$513.24

  • Price Negotiated by Insurer

    $50.76

  • 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.

  • 83735 MAGNESIUM

    $2.61

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $3.03

  • albuterol-ipratropium 2.5 mg-0.5 mg/3 mL Inh Soln 3 mL

    $0.69

  • amiodarone 50 mg/mL IV Soln 3 mL

    $11.54

  • Basic Metabolic Panel

    $3.30

  • cefTRIAXone 500 mg Inj

    $11.52

  • CHED 96374- IV Injection, single/initial BCE

    $32.40

  • CHED 99284 - Level 4 BCE

    $280.00

  • CHED 99285 - Level 5 BCE

    $280.00

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $60.57

  • Comprehensive Metabolic Panel

    $4.12

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $188.11

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $4.91

  • enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL

    $11.54

  • famotidine 10 mg/mL IV Soln 2 mL

    $11.54

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

    $0.72

  • insulin isophane 100 units/mL human recombinant Subcut Susp 10 mL

    $11.52

  • Lactic Acid Level

    $4.51

  • Lipase Level

    $2.69

  • morphine 1 mg/mL Inj Soln 30 mL

    $11.52

  • morphine 2 mg/mL Inj Soln 1 mL

    $11.52

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $11.52

  • Phosphorus Level

    $1.85

  • Prothrombin Time (PT)

    $1.67

  • ROOM/BED: Observation

    $400.00

  • Sedimentation Rate

    $1.05

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $11.54

  • sterile water Inj Soln 10 mL

    $11.54

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $29.70

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $2.34

  • Urinalysis Microscopic

    $1.24

  • Urine Culture

    $3.16

  • WRNR OT THERAPEUT ACTVITY DIRECT PT CNTCT EA 15 MIN BCE

    $16.96

  • WRNR OT Therapeutic Exercise Units BCE

    $13.68

  • WRNR PT Evaluation Low Complexity BCE

    $80.00

  • WRNR PT Gait Training Units BCE

    $13.77

  • XR Abdomen KUB 1 View

    $30.40

  • XR Elbow Complete 3+ Views Right

    $33.08

  • XR Hand Complete 3+ Views Left

    $37.43

  • XR Knee 3 Views Left

    $41.10

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

    $564.00

  • Insurance Discount

    -$430.35

  • Price Negotiated by Insurer

    $133.65

  • 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.

  • 83735 MAGNESIUM

    $6.70

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • Basic Metabolic Panel

    $8.46

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • CHED 99284 - Level 4 BCE

    $419.16

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $239.69

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $12.60

  • Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

    $47.04

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Phosphorus Level

    $4.74

  • Prothrombin Time (PT)

    $4.29

  • Sedimentation Rate

    $2.70

  • Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intr

    $72.33

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $47.04

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $6.01

  • Urinalysis Microscopic

    $3.17

  • Urine Culture

    $8.09

  • XR Abdomen KUB 1 View

    $87.42

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

    $564.00

  • Insurance Discount

    -$430.35

  • Price Negotiated by Insurer

    $133.65

  • 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.

  • 83735 MAGNESIUM

    $6.70

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • Basic Metabolic Panel

    $8.46

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • CHED 99284 - Level 4 BCE

    $419.16

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $239.69

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $12.60

  • Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

    $47.04

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Phosphorus Level

    $4.74

  • Prothrombin Time (PT)

    $4.29

  • Sedimentation Rate

    $2.70

  • Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intr

    $72.33

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $47.04

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $6.01

  • Urinalysis Microscopic

    $3.17

  • Urine Culture

    $8.09

  • XR Abdomen KUB 1 View

    $87.42

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

    $564.00

  • Insurance Discount

    -$381.92

  • Price Negotiated by Insurer

    $182.08

  • 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.

  • 83735 MAGNESIUM

    $70.20

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $116.10

  • albuterol-ipratropium 2.5 mg-0.5 mg/3 mL Inh Soln 3 mL

    $0.35

  • amiodarone 50 mg/mL IV Soln 3 mL

    $0.29

  • Basic Metabolic Panel

    $148.80

  • cefTRIAXone 500 mg Inj

    $3.67

  • CHED 96374- IV Injection, single/initial BCE

    $108.00

  • CHED 99284 - Level 4 BCE

    $1,875.00

  • CHED 99285 - Level 5 BCE

    $2,640.00

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $201.90

  • Comprehensive Metabolic Panel

    $198.30

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $384.52

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $95.10

  • enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL

    $1.77

  • famotidine 10 mg/mL IV Soln 2 mL

    $38.45

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

    $2.40

  • insulin isophane 100 units/mL human recombinant Subcut Susp 10 mL

    $0.20

  • Lactic Acid Level

    $81.00

  • Lipase Level

    $82.20

  • morphine 1 mg/mL Inj Soln 30 mL

    $0.10

  • morphine 2 mg/mL Inj Soln 1 mL

    $12.04

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $0.86

  • Phosphorus Level

    $66.30

  • Prothrombin Time (PT)

    $55.20

  • ROOM/BED: Observation

    $2,745.00

  • Sedimentation Rate

    $57.30

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $21.61

  • sterile water Inj Soln 10 mL

    $0.64

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $99.00

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $66.00

  • Urinalysis Microscopic

    $56.40

  • Urine Culture

    $42.30

  • WRNR OT THERAPEUT ACTVITY DIRECT PT CNTCT EA 15 MIN BCE

    $56.52

  • WRNR OT Therapeutic Exercise Units BCE

    $45.60

  • WRNR PT Evaluation Low Complexity BCE

    $38.10

  • WRNR PT Gait Training Units BCE

    $45.90

  • XR Abdomen KUB 1 View

    $131.69

  • XR Elbow Complete 3+ Views Right

    $131.69

  • XR Hand Complete 3+ Views Left

    $131.69

  • XR Knee 3 Views Left

    $131.69

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

    $564.00

  • Insurance Discount

    -$345.94

  • Price Negotiated by Insurer

    $218.06

  • 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.

  • 83735 MAGNESIUM

    $84.24

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $139.32

  • albuterol-ipratropium 2.5 mg-0.5 mg/3 mL Inh Soln 3 mL

    $0.42

  • amiodarone 50 mg/mL IV Soln 3 mL

    $0.35

  • Basic Metabolic Panel

    $178.56

  • cefTRIAXone 500 mg Inj

    $4.40

  • CHED 96374- IV Injection, single/initial BCE

    $129.60

  • CHED 99284 - Level 4 BCE

    $2,250.00

  • CHED 99285 - Level 5 BCE

    $3,168.00

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $242.28

  • Comprehensive Metabolic Panel

    $237.96

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $461.42

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $114.12

  • enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL

    $2.12

  • famotidine 10 mg/mL IV Soln 2 mL

    $46.14

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

    $2.88

  • insulin isophane 100 units/mL human recombinant Subcut Susp 10 mL

    $0.24

  • Lactic Acid Level

    $97.20

  • Lipase Level

    $98.64

  • morphine 1 mg/mL Inj Soln 30 mL

    $0.12

  • morphine 2 mg/mL Inj Soln 1 mL

    $14.44

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $1.03

  • Phosphorus Level

    $79.56

  • Prothrombin Time (PT)

    $66.24

  • ROOM/BED: Observation

    $3,294.00

  • Sedimentation Rate

    $68.76

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $25.93

  • sterile water Inj Soln 10 mL

    $0.77

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $118.80

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $79.20

  • Urinalysis Microscopic

    $67.68

  • Urine Culture

    $50.76

  • WRNR OT THERAPEUT ACTVITY DIRECT PT CNTCT EA 15 MIN BCE

    $67.83

  • WRNR OT Therapeutic Exercise Units BCE

    $54.72

  • WRNR PT Evaluation Low Complexity BCE

    $45.72

  • WRNR PT Gait Training Units BCE

    $55.08

  • XR Abdomen KUB 1 View

    $158.02

  • XR Elbow Complete 3+ Views Right

    $158.02

  • XR Hand Complete 3+ Views Left

    $158.02

  • XR Knee 3 Views Left

    $158.02

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

    $564.00

  • Insurance Discount

    -$430.35

  • Price Negotiated by Insurer

    $133.65

  • 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.

  • 83735 MAGNESIUM

    $6.70

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • Basic Metabolic Panel

    $8.46

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • CHED 99284 - Level 4 BCE

    $419.16

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $239.69

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $12.60

  • Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

    $47.04

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Phosphorus Level

    $4.74

  • Prothrombin Time (PT)

    $4.29

  • Sedimentation Rate

    $2.70

  • Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intr

    $72.33

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $47.04

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $6.01

  • Urinalysis Microscopic

    $3.17

  • Urine Culture

    $8.09

  • XR Abdomen KUB 1 View

    $87.42

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

    $564.00

  • Insurance Discount

    -$289.24

  • Price Negotiated by Insurer

    $274.76

  • 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.

  • 83735 MAGNESIUM

    $93.60

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $154.80

  • albuterol-ipratropium 2.5 mg-0.5 mg/3 mL Inh Soln 3 mL

    $0.46

  • amiodarone 50 mg/mL IV Soln 3 mL

    $0.39

  • Basic Metabolic Panel

    $198.40

  • cefTRIAXone 500 mg Inj

    $4.88

  • CHED 96374- IV Injection, single/initial BCE

    $144.00

  • CHED 99284 - Level 4 BCE

    $2,500.00

  • CHED 99285 - Level 5 BCE

    $3,520.00

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $269.20

  • Comprehensive Metabolic Panel

    $264.40

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $515.02

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $126.80

  • enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL

    $2.35

  • famotidine 10 mg/mL IV Soln 2 mL

    $51.27

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

    $3.20

  • insulin isophane 100 units/mL human recombinant Subcut Susp 10 mL

    $0.27

  • Lactic Acid Level

    $108.00

  • Lipase Level

    $109.60

  • morphine 1 mg/mL Inj Soln 30 mL

    $0.14

  • morphine 2 mg/mL Inj Soln 1 mL

    $16.02

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $1.14

  • Phosphorus Level

    $88.40

  • Prothrombin Time (PT)

    $73.60

  • ROOM/BED: Observation

    $3,660.00

  • Sedimentation Rate

    $76.40

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $28.76

  • sterile water Inj Soln 10 mL

    $0.85

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $132.00

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $88.00

  • Urinalysis Microscopic

    $75.20

  • Urine Culture

    $56.40

  • WRNR OT THERAPEUT ACTVITY DIRECT PT CNTCT EA 15 MIN BCE

    $75.36

  • WRNR OT Therapeutic Exercise Units BCE

    $60.80

  • WRNR PT Evaluation Low Complexity BCE

    $50.80

  • WRNR PT Gait Training Units BCE

    $61.20

  • XR Abdomen KUB 1 View

    $176.38

  • XR Elbow Complete 3+ Views Right

    $176.38

  • XR Hand Complete 3+ Views Left

    $176.38

  • XR Knee 3 Views Left

    $176.38

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

    $564.00

  • Insurance Discount

    -$180.48

  • Price Negotiated by Insurer

    $383.52

  • 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.

  • 83735 MAGNESIUM

    $159.12

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $263.16

  • albuterol-ipratropium 2.5 mg-0.5 mg/3 mL Inh Soln 3 mL

    $5.20

  • amiodarone 50 mg/mL IV Soln 3 mL

    $87.16

  • Basic Metabolic Panel

    $337.28

  • cefTRIAXone 500 mg Inj

    $87.04

  • CHED 96374- IV Injection, single/initial BCE

    $244.80

  • CHED 99284 - Level 4 BCE

    $1,439.56

  • CHED 99285 - Level 5 BCE

    $2,067.20

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $457.64

  • Comprehensive Metabolic Panel

    $449.48

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $5,303.32

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $215.56

  • enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL

    $87.16

  • famotidine 10 mg/mL IV Soln 2 mL

    $87.16

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

    $5.44

  • insulin isophane 100 units/mL human recombinant Subcut Susp 10 mL

    $87.04

  • Lactic Acid Level

    $183.60

  • Lipase Level

    $186.32

  • morphine 1 mg/mL Inj Soln 30 mL

    $87.04

  • morphine 2 mg/mL Inj Soln 1 mL

    $87.04

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $87.04

  • Phosphorus Level

    $150.28

  • Prothrombin Time (PT)

    $125.12

  • ROOM/BED: Observation

    $74.80

  • Sedimentation Rate

    $129.88

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $87.16

  • sterile water Inj Soln 10 mL

    $87.16

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $224.40

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $149.60

  • Urinalysis Microscopic

    $127.84

  • Urine Culture

    $95.88

  • WRNR OT THERAPEUT ACTVITY DIRECT PT CNTCT EA 15 MIN BCE

    $128.12

  • WRNR OT Therapeutic Exercise Units BCE

    $103.36

  • WRNR PT Evaluation Low Complexity BCE

    $86.36

  • WRNR PT Gait Training Units BCE

    $104.04

  • XR Abdomen KUB 1 View

    $502.52

  • XR Elbow Complete 3+ Views Right

    $451.52

  • XR Hand Complete 3+ Views Left

    $552.84

  • XR Knee 3 Views Left

    $497.76

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

    $564.00

  • Insurance Discount

    -$281.47

  • Price Negotiated by Insurer

    $282.53

  • 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

  • CHED 99284 - Level 4 BCE

    $1,557.58

  • CHED 99285 - Level 5 BCE

    $2,968.44

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $125.27

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $506.65

  • Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

    $99.43

  • Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intr

    $152.89

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $99.43

  • WRNR OT THERAPEUT ACTVITY DIRECT PT CNTCT EA 15 MIN BCE

    $200.00

  • WRNR OT Therapeutic Exercise Units BCE

    $200.00

  • WRNR PT Evaluation Low Complexity BCE

    $200.00

  • WRNR PT Gait Training Units BCE

    $200.00

  • XR Abdomen KUB 1 View

    $184.79

  • XR Elbow Complete 3+ Views Right

    $184.79

  • XR Hand Complete 3+ Views Left

    $184.79

  • XR Knee 3 Views Left

    $184.79

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

    $564.00

  • Insurance Discount

    -$157.92

  • Price Negotiated by Insurer

    $406.08

  • 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.

  • 83735 MAGNESIUM

    $168.48

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $278.64

  • albuterol-ipratropium 2.5 mg-0.5 mg/3 mL Inh Soln 3 mL

    $5.51

  • amiodarone 50 mg/mL IV Soln 3 mL

    $92.28

  • Basic Metabolic Panel

    $357.12

  • cefTRIAXone 500 mg Inj

    $92.16

  • CHED 96374- IV Injection, single/initial BCE

    $259.20

  • CHED 99284 - Level 4 BCE

    $1,524.24

  • CHED 99285 - Level 5 BCE

    $2,188.80

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $484.56

  • Comprehensive Metabolic Panel

    $475.92

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $5,615.28

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $228.24

  • enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL

    $92.28

  • famotidine 10 mg/mL IV Soln 2 mL

    $92.28

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

    $5.76

  • insulin isophane 100 units/mL human recombinant Subcut Susp 10 mL

    $92.16

  • Lactic Acid Level

    $194.40

  • Lipase Level

    $197.28

  • morphine 1 mg/mL Inj Soln 30 mL

    $92.16

  • morphine 2 mg/mL Inj Soln 1 mL

    $92.16

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $92.16

  • Phosphorus Level

    $159.12

  • Prothrombin Time (PT)

    $132.48

  • ROOM/BED: Observation

    $79.20

  • Sedimentation Rate

    $137.52

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $92.28

  • sterile water Inj Soln 10 mL

    $92.28

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $237.60

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $158.40

  • Urinalysis Microscopic

    $135.36

  • Urine Culture

    $101.52

  • WRNR OT THERAPEUT ACTVITY DIRECT PT CNTCT EA 15 MIN BCE

    $135.66

  • WRNR OT Therapeutic Exercise Units BCE

    $109.44

  • WRNR PT Evaluation Low Complexity BCE

    $91.44

  • WRNR PT Gait Training Units BCE

    $110.16

  • XR Abdomen KUB 1 View

    $532.08

  • XR Elbow Complete 3+ Views Right

    $478.08

  • XR Hand Complete 3+ Views Left

    $585.36

  • XR Knee 3 Views Left

    $527.04

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

    $564.00

  • Insurance Discount

    -$430.35

  • Price Negotiated by Insurer

    $133.65

  • 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.

  • 83735 MAGNESIUM

    $6.70

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • Basic Metabolic Panel

    $8.46

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • CHED 99284 - Level 4 BCE

    $419.16

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $239.69

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $12.60

  • Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

    $47.04

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Phosphorus Level

    $4.74

  • Prothrombin Time (PT)

    $4.29

  • Sedimentation Rate

    $2.70

  • Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intr

    $72.33

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $47.04

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $6.01

  • Urinalysis Microscopic

    $3.17

  • Urine Culture

    $8.09

  • XR Abdomen KUB 1 View

    $87.42

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

    $564.00

  • Insurance Discount

    -$430.35

  • Price Negotiated by Insurer

    $133.65

  • 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.

  • 83735 MAGNESIUM

    $6.70

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • Basic Metabolic Panel

    $8.46

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • CHED 99284 - Level 4 BCE

    $419.16

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $239.69

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $12.60

  • Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

    $47.04

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Phosphorus Level

    $4.74

  • Prothrombin Time (PT)

    $4.29

  • Sedimentation Rate

    $2.70

  • Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intr

    $72.33

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $47.04

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $6.01

  • Urinalysis Microscopic

    $3.17

  • Urine Culture

    $8.09

  • XR Abdomen KUB 1 View

    $87.42

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

    $564.00

  • Insurance Discount

    -$430.35

  • Price Negotiated by Insurer

    $133.65

  • 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.

  • 83735 MAGNESIUM

    $6.70

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • Basic Metabolic Panel

    $8.46

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • CHED 99284 - Level 4 BCE

    $419.16

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $239.69

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $12.60

  • Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

    $47.04

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Phosphorus Level

    $4.74

  • Prothrombin Time (PT)

    $4.29

  • Sedimentation Rate

    $2.70

  • Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intr

    $72.33

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $47.04

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $6.01

  • Urinalysis Microscopic

    $3.17

  • Urine Culture

    $8.09

  • XR Abdomen KUB 1 View

    $87.42

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

    $564.00

  • Insurance Discount

    -$157.92

  • Price Negotiated by Insurer

    $406.08

  • 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.

  • 83735 MAGNESIUM

    $168.48

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $278.64

  • albuterol-ipratropium 2.5 mg-0.5 mg/3 mL Inh Soln 3 mL

    $5.51

  • amiodarone 50 mg/mL IV Soln 3 mL

    $92.28

  • Basic Metabolic Panel

    $357.12

  • cefTRIAXone 500 mg Inj

    $92.16

  • CHED 96374- IV Injection, single/initial BCE

    $259.20

  • CHED 99284 - Level 4 BCE

    $1,524.24

  • CHED 99285 - Level 5 BCE

    $2,188.80

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $484.56

  • Comprehensive Metabolic Panel

    $475.92

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $5,615.28

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $228.24

  • enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL

    $92.28

  • famotidine 10 mg/mL IV Soln 2 mL

    $92.28

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

    $5.76

  • insulin isophane 100 units/mL human recombinant Subcut Susp 10 mL

    $92.16

  • Lactic Acid Level

    $194.40

  • Lipase Level

    $197.28

  • morphine 1 mg/mL Inj Soln 30 mL

    $92.16

  • morphine 2 mg/mL Inj Soln 1 mL

    $92.16

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $92.16

  • Phosphorus Level

    $159.12

  • Prothrombin Time (PT)

    $132.48

  • ROOM/BED: Observation

    $79.20

  • Sedimentation Rate

    $137.52

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $92.28

  • sterile water Inj Soln 10 mL

    $92.28

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $237.60

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $158.40

  • Urinalysis Microscopic

    $135.36

  • Urine Culture

    $101.52

  • WRNR OT THERAPEUT ACTVITY DIRECT PT CNTCT EA 15 MIN BCE

    $135.66

  • WRNR OT Therapeutic Exercise Units BCE

    $109.44

  • WRNR PT Evaluation Low Complexity BCE

    $91.44

  • WRNR PT Gait Training Units BCE

    $110.16

  • XR Abdomen KUB 1 View

    $532.08

  • XR Elbow Complete 3+ Views Right

    $478.08

  • XR Hand Complete 3+ Views Left

    $585.36

  • XR Knee 3 Views Left

    $527.04

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

    $564.00

  • Insurance Discount

    -$430.35

  • Price Negotiated by Insurer

    $133.65

  • 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.

  • 83735 MAGNESIUM

    $6.70

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • Basic Metabolic Panel

    $8.46

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • CHED 99284 - Level 4 BCE

    $419.16

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $239.69

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $12.60

  • Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

    $47.04

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Phosphorus Level

    $4.74

  • Prothrombin Time (PT)

    $4.29

  • Sedimentation Rate

    $2.70

  • Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intr

    $72.33

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $47.04

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $6.01

  • Urinalysis Microscopic

    $3.17

  • Urine Culture

    $8.09

  • XR Abdomen KUB 1 View

    $87.42

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

    $564.00

  • Insurance Discount

    -$430.35

  • Price Negotiated by Insurer

    $133.65

  • 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.

  • 83735 MAGNESIUM

    $6.70

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • Basic Metabolic Panel

    $8.46

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • CHED 99284 - Level 4 BCE

    $419.16

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $239.69

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $12.60

  • Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

    $47.04

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Phosphorus Level

    $4.74

  • Prothrombin Time (PT)

    $4.29

  • Sedimentation Rate

    $2.70

  • Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intr

    $72.33

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $47.04

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $6.01

  • Urinalysis Microscopic

    $3.17

  • Urine Culture

    $8.09

  • XR Abdomen KUB 1 View

    $87.42

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

    $564.00

  • Insurance Discount

    -$197.40

  • Price Negotiated by Insurer

    $366.60

  • 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.

  • 83735 MAGNESIUM

    $152.10

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $251.55

  • albuterol-ipratropium 2.5 mg-0.5 mg/3 mL Inh Soln 3 mL

    $4.97

  • amiodarone 50 mg/mL IV Soln 3 mL

    $83.31

  • Basic Metabolic Panel

    $322.40

  • cefTRIAXone 500 mg Inj

    $83.20

  • CHED 96374- IV Injection, single/initial BCE

    $234.00

  • CHED 99284 - Level 4 BCE

    $1,376.05

  • CHED 99285 - Level 5 BCE

    $1,976.00

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $437.45

  • Comprehensive Metabolic Panel

    $429.65

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $5,069.35

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $206.05

  • enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL

    $83.31

  • famotidine 10 mg/mL IV Soln 2 mL

    $83.31

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

    $5.20

  • insulin isophane 100 units/mL human recombinant Subcut Susp 10 mL

    $83.20

  • Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

    $10,000.00

  • Lactic Acid Level

    $175.50

  • Lipase Level

    $178.10

  • morphine 1 mg/mL Inj Soln 30 mL

    $83.20

  • morphine 2 mg/mL Inj Soln 1 mL

    $83.20

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $83.20

  • Phosphorus Level

    $143.65

  • Prothrombin Time (PT)

    $119.60

  • ROOM/BED: Observation

    $71.50

  • Sedimentation Rate

    $124.15

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $83.31

  • sterile water Inj Soln 10 mL

    $83.31

  • Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intr

    $10,000.00

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $214.50

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $143.00

  • Urinalysis Microscopic

    $122.20

  • Urine Culture

    $91.65

  • WRNR OT THERAPEUT ACTVITY DIRECT PT CNTCT EA 15 MIN BCE

    $122.47

  • WRNR OT Therapeutic Exercise Units BCE

    $98.80

  • WRNR PT Evaluation Low Complexity BCE

    $82.55

  • WRNR PT Gait Training Units BCE

    $99.45

  • XR Abdomen KUB 1 View

    $480.35

  • XR Elbow Complete 3+ Views Right

    $431.60

  • XR Hand Complete 3+ Views Left

    $528.45

  • XR Knee 3 Views Left

    $475.80

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

    $564.00

  • Insurance Discount

    -$197.40

  • Price Negotiated by Insurer

    $366.60

  • 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.

  • 83735 MAGNESIUM

    $152.10

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $251.55

  • albuterol-ipratropium 2.5 mg-0.5 mg/3 mL Inh Soln 3 mL

    $4.97

  • amiodarone 50 mg/mL IV Soln 3 mL

    $83.31

  • Basic Metabolic Panel

    $322.40

  • cefTRIAXone 500 mg Inj

    $83.20

  • CHED 96374- IV Injection, single/initial BCE

    $234.00

  • CHED 99284 - Level 4 BCE

    $1,376.05

  • CHED 99285 - Level 5 BCE

    $1,976.00

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $437.45

  • Comprehensive Metabolic Panel

    $429.65

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $5,069.35

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $206.05

  • enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL

    $83.31

  • famotidine 10 mg/mL IV Soln 2 mL

    $83.31

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

    $5.20

  • insulin isophane 100 units/mL human recombinant Subcut Susp 10 mL

    $83.20

  • Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

    $10,000.00

  • Lactic Acid Level

    $175.50

  • Lipase Level

    $178.10

  • morphine 1 mg/mL Inj Soln 30 mL

    $83.20

  • morphine 2 mg/mL Inj Soln 1 mL

    $83.20

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $83.20

  • Phosphorus Level

    $143.65

  • Prothrombin Time (PT)

    $119.60

  • ROOM/BED: Observation

    $71.50

  • Sedimentation Rate

    $124.15

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $83.31

  • sterile water Inj Soln 10 mL

    $83.31

  • Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intr

    $10,000.00

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $214.50

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $143.00

  • Urinalysis Microscopic

    $122.20

  • Urine Culture

    $91.65

  • WRNR OT THERAPEUT ACTVITY DIRECT PT CNTCT EA 15 MIN BCE

    $122.47

  • WRNR OT Therapeutic Exercise Units BCE

    $98.80

  • WRNR PT Evaluation Low Complexity BCE

    $82.55

  • WRNR PT Gait Training Units BCE

    $99.45

  • XR Abdomen KUB 1 View

    $480.35

  • XR Elbow Complete 3+ Views Right

    $431.60

  • XR Hand Complete 3+ Views Left

    $528.45

  • XR Knee 3 Views Left

    $475.80

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

    $564.00

  • Insurance Discount

    -$197.40

  • Price Negotiated by Insurer

    $366.60

  • 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.

  • 83735 MAGNESIUM

    $152.10

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $251.55

  • albuterol-ipratropium 2.5 mg-0.5 mg/3 mL Inh Soln 3 mL

    $4.97

  • amiodarone 50 mg/mL IV Soln 3 mL

    $83.31

  • Basic Metabolic Panel

    $322.40

  • cefTRIAXone 500 mg Inj

    $83.20

  • CHED 96374- IV Injection, single/initial BCE

    $234.00

  • CHED 99284 - Level 4 BCE

    $1,376.05

  • CHED 99285 - Level 5 BCE

    $1,976.00

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $437.45

  • Comprehensive Metabolic Panel

    $429.65

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $5,069.35

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $206.05

  • enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL

    $83.31

  • famotidine 10 mg/mL IV Soln 2 mL

    $83.31

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

    $5.20

  • insulin isophane 100 units/mL human recombinant Subcut Susp 10 mL

    $83.20

  • Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

    $10,000.00

  • Lactic Acid Level

    $175.50

  • Lipase Level

    $178.10

  • morphine 1 mg/mL Inj Soln 30 mL

    $83.20

  • morphine 2 mg/mL Inj Soln 1 mL

    $83.20

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $83.20

  • Phosphorus Level

    $143.65

  • Prothrombin Time (PT)

    $119.60

  • ROOM/BED: Observation

    $71.50

  • Sedimentation Rate

    $124.15

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $83.31

  • sterile water Inj Soln 10 mL

    $83.31

  • Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intr

    $10,000.00

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $214.50

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $143.00

  • Urinalysis Microscopic

    $122.20

  • Urine Culture

    $91.65

  • WRNR OT THERAPEUT ACTVITY DIRECT PT CNTCT EA 15 MIN BCE

    $122.47

  • WRNR OT Therapeutic Exercise Units BCE

    $98.80

  • WRNR PT Evaluation Low Complexity BCE

    $82.55

  • WRNR PT Gait Training Units BCE

    $99.45

  • XR Abdomen KUB 1 View

    $480.35

  • XR Elbow Complete 3+ Views Right

    $431.60

  • XR Hand Complete 3+ Views Left

    $528.45

  • XR Knee 3 Views Left

    $475.80

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

    $564.00

  • Insurance Discount

    -$157.92

  • Price Negotiated by Insurer

    $406.08

  • 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.

  • 83735 MAGNESIUM

    $168.48

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $278.64

  • albuterol-ipratropium 2.5 mg-0.5 mg/3 mL Inh Soln 3 mL

    $5.51

  • amiodarone 50 mg/mL IV Soln 3 mL

    $92.28

  • Basic Metabolic Panel

    $357.12

  • cefTRIAXone 500 mg Inj

    $92.16

  • CHED 96374- IV Injection, single/initial BCE

    $259.20

  • CHED 99284 - Level 4 BCE

    $1,524.24

  • CHED 99285 - Level 5 BCE

    $2,188.80

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $484.56

  • Comprehensive Metabolic Panel

    $475.92

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $5,615.28

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $228.24

  • enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL

    $92.28

  • famotidine 10 mg/mL IV Soln 2 mL

    $92.28

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

    $5.76

  • insulin isophane 100 units/mL human recombinant Subcut Susp 10 mL

    $92.16

  • Lactic Acid Level

    $194.40

  • Lipase Level

    $197.28

  • morphine 1 mg/mL Inj Soln 30 mL

    $92.16

  • morphine 2 mg/mL Inj Soln 1 mL

    $92.16

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $92.16

  • Phosphorus Level

    $159.12

  • Prothrombin Time (PT)

    $132.48

  • ROOM/BED: Observation

    $79.20

  • Sedimentation Rate

    $137.52

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $92.28

  • sterile water Inj Soln 10 mL

    $92.28

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $237.60

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $158.40

  • Urinalysis Microscopic

    $135.36

  • Urine Culture

    $101.52

  • WRNR OT THERAPEUT ACTVITY DIRECT PT CNTCT EA 15 MIN BCE

    $135.66

  • WRNR OT Therapeutic Exercise Units BCE

    $109.44

  • WRNR PT Evaluation Low Complexity BCE

    $91.44

  • WRNR PT Gait Training Units BCE

    $110.16

  • XR Abdomen KUB 1 View

    $532.08

  • XR Elbow Complete 3+ Views Right

    $478.08

  • XR Hand Complete 3+ Views Left

    $585.36

  • XR Knee 3 Views Left

    $527.04

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

    $564.00

  • Insurance Discount

    -$282.00

  • Price Negotiated by Insurer

    $282.00

  • 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.

  • 83735 MAGNESIUM

    $8.38

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $9.71

  • albuterol-ipratropium 2.5 mg-0.5 mg/3 mL Inh Soln 3 mL

    $3.83

  • amiodarone 50 mg/mL IV Soln 3 mL

    $64.08

  • Basic Metabolic Panel

    $10.57

  • cefTRIAXone 500 mg Inj

    $64.00

  • CHED 96374- IV Injection, single/initial BCE

    $180.00

  • CHED 99284 - Level 4 BCE

    $2,500.00

  • CHED 99285 - Level 5 BCE

    $2,900.00

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $336.50

  • Comprehensive Metabolic Panel

    $13.20

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $3,899.50

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $15.75

  • enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL

    $64.08

  • famotidine 10 mg/mL IV Soln 2 mL

    $64.08

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

    $4.00

  • insulin isophane 100 units/mL human recombinant Subcut Susp 10 mL

    $64.00

  • Lactic Acid Level

    $14.46

  • Lipase Level

    $8.61

  • morphine 1 mg/mL Inj Soln 30 mL

    $64.00

  • morphine 2 mg/mL Inj Soln 1 mL

    $64.00

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $64.00

  • Phosphorus Level

    $5.92

  • Prothrombin Time (PT)

    $5.36

  • ROOM/BED: Observation

    $55.00

  • Sedimentation Rate

    $3.38

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $64.08

  • sterile water Inj Soln 10 mL

    $64.08

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $165.00

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $7.51

  • Urinalysis Microscopic

    $3.96

  • Urine Culture

    $10.11

  • WRNR OT THERAPEUT ACTVITY DIRECT PT CNTCT EA 15 MIN BCE

    $180.00

  • WRNR OT Therapeutic Exercise Units BCE

    $180.00

  • WRNR PT Evaluation Low Complexity BCE

    $180.00

  • WRNR PT Gait Training Units BCE

    $180.00

  • XR Abdomen KUB 1 View

    $131.13

  • XR Elbow Complete 3+ Views Right

    $332.00

  • XR Hand Complete 3+ Views Left

    $406.50

  • XR Knee 3 Views Left

    $366.00

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

    $564.00

  • Insurance Discount

    -$430.35

  • Price Negotiated by Insurer

    $133.65

  • 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.

  • 83735 MAGNESIUM

    $6.70

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • Basic Metabolic Panel

    $8.46

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • CHED 99284 - Level 4 BCE

    $419.16

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $239.69

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $12.60

  • Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

    $47.04

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Phosphorus Level

    $4.74

  • Prothrombin Time (PT)

    $4.29

  • Sedimentation Rate

    $2.70

  • Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intr

    $72.33

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $47.04

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $6.01

  • Urinalysis Microscopic

    $3.17

  • Urine Culture

    $8.09

  • XR Abdomen KUB 1 View

    $87.42

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

    $564.00

  • Insurance Discount

    -$157.92

  • Price Negotiated by Insurer

    $406.08

  • 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.

  • 83735 MAGNESIUM

    $168.48

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $278.64

  • albuterol-ipratropium 2.5 mg-0.5 mg/3 mL Inh Soln 3 mL

    $5.51

  • amiodarone 50 mg/mL IV Soln 3 mL

    $92.28

  • Basic Metabolic Panel

    $357.12

  • cefTRIAXone 500 mg Inj

    $92.16

  • CHED 96374- IV Injection, single/initial BCE

    $259.20

  • CHED 99284 - Level 4 BCE

    $1,524.24

  • CHED 99285 - Level 5 BCE

    $2,188.80

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $484.56

  • Comprehensive Metabolic Panel

    $475.92

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $5,615.28

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $228.24

  • enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL

    $92.28

  • famotidine 10 mg/mL IV Soln 2 mL

    $92.28

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

    $5.76

  • insulin isophane 100 units/mL human recombinant Subcut Susp 10 mL

    $92.16

  • Lactic Acid Level

    $194.40

  • Lipase Level

    $197.28

  • morphine 1 mg/mL Inj Soln 30 mL

    $92.16

  • morphine 2 mg/mL Inj Soln 1 mL

    $92.16

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $92.16

  • Phosphorus Level

    $159.12

  • Prothrombin Time (PT)

    $132.48

  • ROOM/BED: Observation

    $79.20

  • Sedimentation Rate

    $137.52

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $92.28

  • sterile water Inj Soln 10 mL

    $92.28

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $237.60

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $158.40

  • Urinalysis Microscopic

    $135.36

  • Urine Culture

    $101.52

  • WRNR OT THERAPEUT ACTVITY DIRECT PT CNTCT EA 15 MIN BCE

    $135.66

  • WRNR OT Therapeutic Exercise Units BCE

    $109.44

  • WRNR PT Evaluation Low Complexity BCE

    $91.44

  • WRNR PT Gait Training Units BCE

    $110.16

  • XR Abdomen KUB 1 View

    $532.08

  • XR Elbow Complete 3+ Views Right

    $478.08

  • XR Hand Complete 3+ Views Left

    $585.36

  • XR Knee 3 Views Left

    $527.04

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

    $564.00

  • Insurance Discount

    -$430.35

  • Price Negotiated by Insurer

    $133.65

  • 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.

  • 83735 MAGNESIUM

    $6.70

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • albuterol-ipratropium 2.5 mg-0.5 mg/3 mL Inh Soln 3 mL

    $1.04

  • amiodarone 50 mg/mL IV Soln 3 mL

    $17.43

  • Basic Metabolic Panel

    $8.46

  • cefTRIAXone 500 mg Inj

    $17.41

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • CHED 99284 - Level 4 BCE

    $419.16

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $239.69

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $12.60

  • enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL

    $17.43

  • famotidine 10 mg/mL IV Soln 2 mL

    $17.43

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

    $1.09

  • insulin isophane 100 units/mL human recombinant Subcut Susp 10 mL

    $17.41

  • Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

    $47.04

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • morphine 1 mg/mL Inj Soln 30 mL

    $17.41

  • morphine 2 mg/mL Inj Soln 1 mL

    $17.41

  • ondansetron 2 mg/mL Inj Soln 2 mL

    $17.41

  • Phosphorus Level

    $4.74

  • Prothrombin Time (PT)

    $4.29

  • ROOM/BED: Observation

    $14.96

  • Sedimentation Rate

    $2.70

  • Sodium Chloride 0.9% IV Soln 1000 mL

    $17.43

  • sterile water Inj Soln 10 mL

    $17.43

  • Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intr

    $72.33

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $47.04

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $6.01

  • Urinalysis Microscopic

    $3.17

  • Urine Culture

    $8.09

  • WRNR OT THERAPEUT ACTVITY DIRECT PT CNTCT EA 15 MIN BCE

    $25.62

  • WRNR OT Therapeutic Exercise Units BCE

    $20.67

  • WRNR PT Evaluation Low Complexity BCE

    $17.27

  • WRNR PT Gait Training Units BCE

    $20.81

  • XR Abdomen KUB 1 View

    $87.42

  • XR Elbow Complete 3+ Views Right

    $90.30

  • XR Hand Complete 3+ Views Left

    $110.57

  • XR Knee 3 Views Left

    $99.55

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

    $564.00

  • Insurance Discount

    -$430.35

  • Price Negotiated by Insurer

    $133.65

  • 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.

  • 83735 MAGNESIUM

    $6.70

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • Basic Metabolic Panel

    $8.46

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • CHED 99284 - Level 4 BCE

    $419.16

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $239.69

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $12.60

  • Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

    $47.04

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Phosphorus Level

    $4.74

  • Prothrombin Time (PT)

    $4.29

  • Sedimentation Rate

    $2.70

  • Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intr

    $72.33

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $47.04

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $6.01

  • Urinalysis Microscopic

    $3.17

  • Urine Culture

    $8.09

  • XR Abdomen KUB 1 View

    $87.42

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

    $564.00

  • Insurance Discount

    -$430.35

  • Price Negotiated by Insurer

    $133.65

  • 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.

  • 83735 MAGNESIUM

    $6.70

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • Basic Metabolic Panel

    $8.46

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • CHED 99284 - Level 4 BCE

    $419.16

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $239.69

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $12.60

  • Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

    $47.04

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Phosphorus Level

    $4.74

  • Prothrombin Time (PT)

    $4.29

  • Sedimentation Rate

    $2.70

  • Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intr

    $72.33

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $47.04

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $6.01

  • Urinalysis Microscopic

    $3.17

  • Urine Culture

    $8.09

  • XR Abdomen KUB 1 View

    $87.42

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

    $564.00

  • Insurance Discount

    -$430.35

  • Price Negotiated by Insurer

    $133.65

  • 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.

  • 83735 MAGNESIUM

    $6.70

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • Basic Metabolic Panel

    $8.46

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • CHED 99284 - Level 4 BCE

    $419.16

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $239.69

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $12.60

  • Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

    $47.04

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Phosphorus Level

    $4.74

  • Prothrombin Time (PT)

    $4.29

  • Sedimentation Rate

    $2.70

  • Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intr

    $72.33

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $47.04

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $6.01

  • Urinalysis Microscopic

    $3.17

  • Urine Culture

    $8.09

  • XR Abdomen KUB 1 View

    $87.42

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

    $564.00

  • Insurance Discount

    -$430.35

  • Price Negotiated by Insurer

    $133.65

  • 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.

  • 83735 MAGNESIUM

    $6.70

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • Basic Metabolic Panel

    $8.46

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • CHED 99284 - Level 4 BCE

    $419.16

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $239.69

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $12.60

  • Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

    $47.04

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Phosphorus Level

    $4.74

  • Prothrombin Time (PT)

    $4.29

  • Sedimentation Rate

    $2.70

  • Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intr

    $72.33

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $47.04

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $6.01

  • Urinalysis Microscopic

    $3.17

  • Urine Culture

    $8.09

  • XR Abdomen KUB 1 View

    $87.42

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

    $564.00

  • Insurance Discount

    -$430.35

  • Price Negotiated by Insurer

    $133.65

  • 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.

  • 83735 MAGNESIUM

    $6.70

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $7.77

  • Basic Metabolic Panel

    $8.46

  • CHED 96374- IV Injection, single/initial BCE

    $213.67

  • CHED 99284 - Level 4 BCE

    $419.16

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Routine ECG 12 lead/15 lead tracing only BCE

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Abd/Pelvis w/o IV and Oral Contrast

    $239.69

  • Drug test(s), presumptive, any number of drug classes, any number of dev

    $12.60

  • Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

    $47.04

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Phosphorus Level

    $4.74

  • Prothrombin Time (PT)

    $4.29

  • Sedimentation Rate

    $2.70

  • Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intr

    $72.33

  • Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375

    $47.04

  • Thromboplastin time, partial (PTT); plasma or whole blood

    $6.01

  • Urinalysis Microscopic

    $3.17

  • Urine Culture

    $8.09

  • XR Abdomen KUB 1 View

    $87.42

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.