CPT 70460

CT scan of head with contrast

The standard charge for CT scan of head with contrast is $6,082.00. 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

    $6,082.00

  • Insurance Discount

    -$5,929.64

  • Price Negotiated by Insurer

    $152.36

  • 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

  • 86901 BLOOD TYPING RH (D)

    $1.17

  • Bill Only BB ABO Type

    $1.17

  • Bill Only BB Antibody Screen RBC

    $3.81

  • CHED 96365- IV tx, first hour BCE

    $27.00

  • CHED 96366- IV tx, each additional hour BCE

    $13.77

  • CHED 99285 - Level 5 BCE

    $280.00

  • CHED Arterial Line Activity Blood Drawn BCE

    $9.18

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $324.45

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

    $60.57

  • Comprehensive Metabolic Panel

    $4.12

  • CT Angio Abdomen and Pelvis

    $366.42

  • GLUCOSE BLOOD TEST

    $1.28

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $11.52

  • iodixanol 320 mg/mL Inj Soln 100 mL

    $19.53

  • Lactated Ringers IV Soln 500 mL

    $11.52

  • Lactic Acid Level

    $4.51

  • Lipase Level

    $2.69

  • Manual Differential

    $1.48

  • O2 Sat Meas

    $30.72

  • ondansetron 4 mg Tab

    $0.69

  • RT CHARGE SpO2 -> Single

    $10.98

  • sodium chloride 0.9% Inj Soln 10 mL

    $11.54

  • Sodium Chloride 0.9% IV Soln 50 mL

    $11.54

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

    $29.70

  • Urinalysis Microscopic

    $1.24

  • XR Chest

    $25.73

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

    $6,082.00

  • Insurance Discount

    -$5,905.80

  • Price Negotiated by Insurer

    $176.20

  • 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

    $7.77

  • 86901 BLOOD TYPING RH (D)

    $2.99

  • Bill Only BB ABO Type

    $2.99

  • Bill Only BB Antibody Screen RBC

    $9.77

  • CHED 96365- IV tx, first hour BCE

    $213.67

  • CHED 96366- IV tx, each additional hour BCE

    $47.04

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Arterial Line Activity Blood Drawn BCE

    $133.65

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $829.79

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

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Angio Abdomen and Pelvis

    $350.46

  • GLUCOSE BLOOD TEST

    $3.28

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Manual Differential

    $3.80

  • O2 Sat Meas

    $78.77

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

    $47.04

  • Urinalysis Microscopic

    $3.17

  • XR Chest

    $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

    $6,082.00

  • Insurance Discount

    -$5,905.80

  • Price Negotiated by Insurer

    $176.20

  • 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

    $7.77

  • 86901 BLOOD TYPING RH (D)

    $2.99

  • Bill Only BB ABO Type

    $2.99

  • Bill Only BB Antibody Screen RBC

    $9.77

  • CHED 96365- IV tx, first hour BCE

    $213.67

  • CHED 96366- IV tx, each additional hour BCE

    $47.04

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Arterial Line Activity Blood Drawn BCE

    $133.65

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $829.79

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

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Angio Abdomen and Pelvis

    $350.46

  • GLUCOSE BLOOD TEST

    $3.28

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Manual Differential

    $3.80

  • O2 Sat Meas

    $78.77

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

    $47.04

  • Urinalysis Microscopic

    $3.17

  • XR Chest

    $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

    $6,082.00

  • Insurance Discount

    -$5,781.34

  • Price Negotiated by Insurer

    $300.66

  • 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

  • 86901 BLOOD TYPING RH (D)

    $33.90

  • Bill Only BB ABO Type

    $45.60

  • Bill Only BB Antibody Screen RBC

    $75.90

  • CHED 96365- IV tx, first hour BCE

    $90.00

  • CHED 96366- IV tx, each additional hour BCE

    $45.90

  • CHED 99285 - Level 5 BCE

    $2,640.00

  • CHED Arterial Line Activity Blood Drawn BCE

    $182.08

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $2,640.00

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

    $201.90

  • Comprehensive Metabolic Panel

    $198.30

  • CT Angio Abdomen and Pelvis

    $479.29

  • GLUCOSE BLOOD TEST

    $12.90

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $0.03

  • iodixanol 320 mg/mL Inj Soln 100 mL

    $0.46

  • Lactated Ringers IV Soln 500 mL

    $8.61

  • Lactic Acid Level

    $81.00

  • Lipase Level

    $82.20

  • Manual Differential

    $24.30

  • O2 Sat Meas

    $282.90

  • ondansetron 4 mg Tab

    $0.33

  • RT CHARGE SpO2 -> Single

    $36.60

  • sodium chloride 0.9% Inj Soln 10 mL

    $0.64

  • Sodium Chloride 0.9% IV Soln 50 mL

    $10.80

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

    $99.00

  • Urinalysis Microscopic

    $56.40

  • XR Chest

    $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

    $6,082.00

  • Insurance Discount

    -$5,721.20

  • Price Negotiated by Insurer

    $360.80

  • 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

  • 86901 BLOOD TYPING RH (D)

    $40.68

  • Bill Only BB ABO Type

    $54.72

  • Bill Only BB Antibody Screen RBC

    $91.08

  • CHED 96365- IV tx, first hour BCE

    $108.00

  • CHED 96366- IV tx, each additional hour BCE

    $55.08

  • CHED 99285 - Level 5 BCE

    $3,168.00

  • CHED Arterial Line Activity Blood Drawn BCE

    $218.06

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $3,168.00

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

    $242.28

  • Comprehensive Metabolic Panel

    $237.96

  • CT Angio Abdomen and Pelvis

    $575.15

  • GLUCOSE BLOOD TEST

    $15.48

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $0.03

  • iodixanol 320 mg/mL Inj Soln 100 mL

    $0.56

  • Lactated Ringers IV Soln 500 mL

    $10.34

  • Lactic Acid Level

    $97.20

  • Lipase Level

    $98.64

  • Manual Differential

    $29.16

  • O2 Sat Meas

    $339.48

  • ondansetron 4 mg Tab

    $0.40

  • RT CHARGE SpO2 -> Single

    $43.92

  • sodium chloride 0.9% Inj Soln 10 mL

    $0.77

  • Sodium Chloride 0.9% IV Soln 50 mL

    $12.96

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

    $118.80

  • Urinalysis Microscopic

    $67.68

  • XR Chest

    $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

    $6,082.00

  • Insurance Discount

    -$5,905.80

  • Price Negotiated by Insurer

    $176.20

  • 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

    $7.77

  • 86901 BLOOD TYPING RH (D)

    $2.99

  • Bill Only BB ABO Type

    $2.99

  • Bill Only BB Antibody Screen RBC

    $9.77

  • CHED 96365- IV tx, first hour BCE

    $213.67

  • CHED 96366- IV tx, each additional hour BCE

    $47.04

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Arterial Line Activity Blood Drawn BCE

    $133.65

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $829.79

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

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Angio Abdomen and Pelvis

    $350.46

  • GLUCOSE BLOOD TEST

    $3.28

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Manual Differential

    $3.80

  • O2 Sat Meas

    $78.77

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

    $47.04

  • Urinalysis Microscopic

    $3.17

  • XR Chest

    $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

    $6,082.00

  • Insurance Discount

    -$5,679.29

  • Price Negotiated by Insurer

    $402.71

  • 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

  • 86901 BLOOD TYPING RH (D)

    $45.20

  • Bill Only BB ABO Type

    $60.80

  • Bill Only BB Antibody Screen RBC

    $101.20

  • CHED 96365- IV tx, first hour BCE

    $120.00

  • CHED 96366- IV tx, each additional hour BCE

    $61.20

  • CHED 99285 - Level 5 BCE

    $3,520.00

  • CHED Arterial Line Activity Blood Drawn BCE

    $274.76

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $3,520.00

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

    $269.20

  • Comprehensive Metabolic Panel

    $264.40

  • CT Angio Abdomen and Pelvis

    $641.96

  • GLUCOSE BLOOD TEST

    $17.20

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $0.04

  • iodixanol 320 mg/mL Inj Soln 100 mL

    $0.62

  • Lactated Ringers IV Soln 500 mL

    $11.46

  • Lactic Acid Level

    $108.00

  • Lipase Level

    $109.60

  • Manual Differential

    $32.40

  • O2 Sat Meas

    $377.20

  • ondansetron 4 mg Tab

    $0.44

  • RT CHARGE SpO2 -> Single

    $48.80

  • sodium chloride 0.9% Inj Soln 10 mL

    $0.85

  • Sodium Chloride 0.9% IV Soln 50 mL

    $14.38

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

    $132.00

  • Urinalysis Microscopic

    $75.20

  • XR Chest

    $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

    $6,082.00

  • Insurance Discount

    -$1,946.24

  • Price Negotiated by Insurer

    $4,135.76

  • 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.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $263.16

  • 86901 BLOOD TYPING RH (D)

    $76.84

  • Bill Only BB ABO Type

    $103.36

  • Bill Only BB Antibody Screen RBC

    $172.04

  • CHED 96365- IV tx, first hour BCE

    $204.00

  • CHED 96366- IV tx, each additional hour BCE

    $104.04

  • CHED 99285 - Level 5 BCE

    $2,067.20

  • CHED Arterial Line Activity Blood Drawn BCE

    $69.36

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $2,451.40

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

    $457.64

  • Comprehensive Metabolic Panel

    $449.48

  • CT Angio Abdomen and Pelvis

    $8,774.04

  • GLUCOSE BLOOD TEST

    $29.24

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $87.04

  • iodixanol 320 mg/mL Inj Soln 100 mL

    $147.56

  • Lactated Ringers IV Soln 500 mL

    $87.04

  • Lactic Acid Level

    $183.60

  • Lipase Level

    $186.32

  • Manual Differential

    $55.08

  • O2 Sat Meas

    $641.24

  • ondansetron 4 mg Tab

    $5.20

  • RT CHARGE SpO2 -> Single

    $82.96

  • sodium chloride 0.9% Inj Soln 10 mL

    $87.16

  • Sodium Chloride 0.9% IV Soln 50 mL

    $87.16

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

    $224.40

  • Urinalysis Microscopic

    $127.84

  • XR Chest

    $451.52

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

    $6,082.00

  • Insurance Discount

    -$5,709.54

  • Price Negotiated by Insurer

    $372.46

  • 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.

  • 86901 BLOOD TYPING RH (D)

    $79.31

  • Bill Only BB ABO Type

    $282.53

  • Bill Only BB Antibody Screen RBC

    $110.66

  • CHED 96365- IV tx, first hour BCE

    $451.67

  • CHED 96366- IV tx, each additional hour BCE

    $99.43

  • CHED 99285 - Level 5 BCE

    $2,968.44

  • CHED Arterial Line Activity Blood Drawn BCE

    $282.53

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $4,117.38

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

    $125.27

  • CT Angio Abdomen and Pelvis

    $740.81

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

    $99.43

  • XR Chest

    $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

    $6,082.00

  • Insurance Discount

    -$1,702.96

  • Price Negotiated by Insurer

    $4,379.04

  • 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

  • 86901 BLOOD TYPING RH (D)

    $81.36

  • Bill Only BB ABO Type

    $109.44

  • Bill Only BB Antibody Screen RBC

    $182.16

  • CHED 96365- IV tx, first hour BCE

    $216.00

  • CHED 96366- IV tx, each additional hour BCE

    $110.16

  • CHED 99285 - Level 5 BCE

    $2,188.80

  • CHED Arterial Line Activity Blood Drawn BCE

    $73.44

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $2,595.60

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

    $484.56

  • Comprehensive Metabolic Panel

    $475.92

  • CT Angio Abdomen and Pelvis

    $9,290.16

  • GLUCOSE BLOOD TEST

    $30.96

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $92.16

  • iodixanol 320 mg/mL Inj Soln 100 mL

    $156.24

  • Lactated Ringers IV Soln 500 mL

    $92.16

  • Lactic Acid Level

    $194.40

  • Lipase Level

    $197.28

  • Manual Differential

    $58.32

  • O2 Sat Meas

    $678.96

  • ondansetron 4 mg Tab

    $5.51

  • RT CHARGE SpO2 -> Single

    $87.84

  • sodium chloride 0.9% Inj Soln 10 mL

    $92.28

  • Sodium Chloride 0.9% IV Soln 50 mL

    $92.28

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

    $237.60

  • Urinalysis Microscopic

    $135.36

  • XR Chest

    $478.08

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

    $6,082.00

  • Insurance Discount

    -$5,905.80

  • Price Negotiated by Insurer

    $176.20

  • 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

    $7.77

  • 86901 BLOOD TYPING RH (D)

    $2.99

  • Bill Only BB ABO Type

    $2.99

  • Bill Only BB Antibody Screen RBC

    $9.77

  • CHED 96365- IV tx, first hour BCE

    $213.67

  • CHED 96366- IV tx, each additional hour BCE

    $47.04

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Arterial Line Activity Blood Drawn BCE

    $133.65

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $829.79

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

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Angio Abdomen and Pelvis

    $350.46

  • GLUCOSE BLOOD TEST

    $3.28

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Manual Differential

    $3.80

  • O2 Sat Meas

    $78.77

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

    $47.04

  • Urinalysis Microscopic

    $3.17

  • XR Chest

    $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

    $6,082.00

  • Insurance Discount

    -$5,905.80

  • Price Negotiated by Insurer

    $176.20

  • 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

    $7.77

  • 86901 BLOOD TYPING RH (D)

    $2.99

  • Bill Only BB ABO Type

    $2.99

  • Bill Only BB Antibody Screen RBC

    $9.77

  • CHED 96365- IV tx, first hour BCE

    $213.67

  • CHED 96366- IV tx, each additional hour BCE

    $47.04

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Arterial Line Activity Blood Drawn BCE

    $133.65

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $829.79

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

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Angio Abdomen and Pelvis

    $350.46

  • GLUCOSE BLOOD TEST

    $3.28

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Manual Differential

    $3.80

  • O2 Sat Meas

    $78.77

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

    $47.04

  • Urinalysis Microscopic

    $3.17

  • XR Chest

    $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

    $6,082.00

  • Insurance Discount

    -$5,905.80

  • Price Negotiated by Insurer

    $176.20

  • 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

    $7.77

  • 86901 BLOOD TYPING RH (D)

    $2.99

  • Bill Only BB ABO Type

    $2.99

  • Bill Only BB Antibody Screen RBC

    $9.77

  • CHED 96365- IV tx, first hour BCE

    $213.67

  • CHED 96366- IV tx, each additional hour BCE

    $47.04

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Arterial Line Activity Blood Drawn BCE

    $133.65

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $829.79

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

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Angio Abdomen and Pelvis

    $350.46

  • GLUCOSE BLOOD TEST

    $3.28

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Manual Differential

    $3.80

  • O2 Sat Meas

    $78.77

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

    $47.04

  • Urinalysis Microscopic

    $3.17

  • XR Chest

    $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

    $6,082.00

  • Insurance Discount

    -$1,702.96

  • Price Negotiated by Insurer

    $4,379.04

  • 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

  • 86901 BLOOD TYPING RH (D)

    $81.36

  • Bill Only BB ABO Type

    $109.44

  • Bill Only BB Antibody Screen RBC

    $182.16

  • CHED 96365- IV tx, first hour BCE

    $216.00

  • CHED 96366- IV tx, each additional hour BCE

    $110.16

  • CHED 99285 - Level 5 BCE

    $2,188.80

  • CHED Arterial Line Activity Blood Drawn BCE

    $73.44

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $2,595.60

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

    $484.56

  • Comprehensive Metabolic Panel

    $475.92

  • CT Angio Abdomen and Pelvis

    $9,290.16

  • GLUCOSE BLOOD TEST

    $30.96

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $92.16

  • iodixanol 320 mg/mL Inj Soln 100 mL

    $156.24

  • Lactated Ringers IV Soln 500 mL

    $92.16

  • Lactic Acid Level

    $194.40

  • Lipase Level

    $197.28

  • Manual Differential

    $58.32

  • O2 Sat Meas

    $678.96

  • ondansetron 4 mg Tab

    $5.51

  • RT CHARGE SpO2 -> Single

    $87.84

  • sodium chloride 0.9% Inj Soln 10 mL

    $92.28

  • Sodium Chloride 0.9% IV Soln 50 mL

    $92.28

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

    $237.60

  • Urinalysis Microscopic

    $135.36

  • XR Chest

    $478.08

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

    $6,082.00

  • Insurance Discount

    -$5,905.80

  • Price Negotiated by Insurer

    $176.20

  • 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

    $7.77

  • 86901 BLOOD TYPING RH (D)

    $2.99

  • Bill Only BB ABO Type

    $2.99

  • Bill Only BB Antibody Screen RBC

    $9.77

  • CHED 96365- IV tx, first hour BCE

    $213.67

  • CHED 96366- IV tx, each additional hour BCE

    $47.04

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Arterial Line Activity Blood Drawn BCE

    $133.65

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $829.79

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

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Angio Abdomen and Pelvis

    $350.46

  • GLUCOSE BLOOD TEST

    $3.28

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Manual Differential

    $3.80

  • O2 Sat Meas

    $78.77

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

    $47.04

  • Urinalysis Microscopic

    $3.17

  • XR Chest

    $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

    $6,082.00

  • Insurance Discount

    -$5,905.80

  • Price Negotiated by Insurer

    $176.20

  • 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

    $7.77

  • 86901 BLOOD TYPING RH (D)

    $2.99

  • Bill Only BB ABO Type

    $2.99

  • Bill Only BB Antibody Screen RBC

    $9.77

  • CHED 96365- IV tx, first hour BCE

    $213.67

  • CHED 96366- IV tx, each additional hour BCE

    $47.04

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Arterial Line Activity Blood Drawn BCE

    $133.65

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $829.79

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

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Angio Abdomen and Pelvis

    $350.46

  • GLUCOSE BLOOD TEST

    $3.28

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Manual Differential

    $3.80

  • O2 Sat Meas

    $78.77

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

    $47.04

  • Urinalysis Microscopic

    $3.17

  • XR Chest

    $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

    $6,082.00

  • Insurance Discount

    -$2,128.70

  • Price Negotiated by Insurer

    $3,953.30

  • 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

  • 86901 BLOOD TYPING RH (D)

    $73.45

  • Bill Only BB ABO Type

    $98.80

  • Bill Only BB Antibody Screen RBC

    $164.45

  • CHED 96365- IV tx, first hour BCE

    $195.00

  • CHED 96366- IV tx, each additional hour BCE

    $99.45

  • CHED 99285 - Level 5 BCE

    $1,976.00

  • CHED Arterial Line Activity Blood Drawn BCE

    $66.30

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $2,343.25

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

    $437.45

  • Comprehensive Metabolic Panel

    $429.65

  • CT Angio Abdomen and Pelvis

    $8,386.95

  • GLUCOSE BLOOD TEST

    $27.95

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $83.20

  • iodixanol 320 mg/mL Inj Soln 100 mL

    $141.05

  • Lactated Ringers IV Soln 500 mL

    $83.20

  • Lactic Acid Level

    $175.50

  • Lipase Level

    $178.10

  • Manual Differential

    $52.65

  • O2 Sat Meas

    $612.95

  • ondansetron 4 mg Tab

    $4.97

  • RT CHARGE SpO2 -> Single

    $79.30

  • sodium chloride 0.9% Inj Soln 10 mL

    $83.31

  • Sodium Chloride 0.9% IV Soln 50 mL

    $83.31

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

    $214.50

  • Urinalysis Microscopic

    $122.20

  • XR Chest

    $431.60

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

    $6,082.00

  • Insurance Discount

    -$2,128.70

  • Price Negotiated by Insurer

    $3,953.30

  • 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

  • 86901 BLOOD TYPING RH (D)

    $73.45

  • Bill Only BB ABO Type

    $98.80

  • Bill Only BB Antibody Screen RBC

    $164.45

  • CHED 96365- IV tx, first hour BCE

    $195.00

  • CHED 96366- IV tx, each additional hour BCE

    $99.45

  • CHED 99285 - Level 5 BCE

    $1,976.00

  • CHED Arterial Line Activity Blood Drawn BCE

    $66.30

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $2,343.25

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

    $437.45

  • Comprehensive Metabolic Panel

    $429.65

  • CT Angio Abdomen and Pelvis

    $8,386.95

  • GLUCOSE BLOOD TEST

    $27.95

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $83.20

  • iodixanol 320 mg/mL Inj Soln 100 mL

    $141.05

  • Lactated Ringers IV Soln 500 mL

    $83.20

  • Lactic Acid Level

    $175.50

  • Lipase Level

    $178.10

  • Manual Differential

    $52.65

  • O2 Sat Meas

    $612.95

  • ondansetron 4 mg Tab

    $4.97

  • RT CHARGE SpO2 -> Single

    $79.30

  • sodium chloride 0.9% Inj Soln 10 mL

    $83.31

  • Sodium Chloride 0.9% IV Soln 50 mL

    $83.31

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

    $214.50

  • Urinalysis Microscopic

    $122.20

  • XR Chest

    $431.60

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

    $6,082.00

  • Insurance Discount

    -$2,128.70

  • Price Negotiated by Insurer

    $3,953.30

  • 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

  • 86901 BLOOD TYPING RH (D)

    $73.45

  • Bill Only BB ABO Type

    $98.80

  • Bill Only BB Antibody Screen RBC

    $164.45

  • CHED 96365- IV tx, first hour BCE

    $195.00

  • CHED 96366- IV tx, each additional hour BCE

    $99.45

  • CHED 99285 - Level 5 BCE

    $1,976.00

  • CHED Arterial Line Activity Blood Drawn BCE

    $66.30

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $2,343.25

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

    $437.45

  • Comprehensive Metabolic Panel

    $429.65

  • CT Angio Abdomen and Pelvis

    $8,386.95

  • GLUCOSE BLOOD TEST

    $27.95

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $83.20

  • iodixanol 320 mg/mL Inj Soln 100 mL

    $141.05

  • Lactated Ringers IV Soln 500 mL

    $83.20

  • Lactic Acid Level

    $175.50

  • Lipase Level

    $178.10

  • Manual Differential

    $52.65

  • O2 Sat Meas

    $612.95

  • ondansetron 4 mg Tab

    $4.97

  • RT CHARGE SpO2 -> Single

    $79.30

  • sodium chloride 0.9% Inj Soln 10 mL

    $83.31

  • Sodium Chloride 0.9% IV Soln 50 mL

    $83.31

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

    $214.50

  • Urinalysis Microscopic

    $122.20

  • XR Chest

    $431.60

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

    $6,082.00

  • Insurance Discount

    -$1,702.96

  • Price Negotiated by Insurer

    $4,379.04

  • 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

  • 86901 BLOOD TYPING RH (D)

    $81.36

  • Bill Only BB ABO Type

    $109.44

  • Bill Only BB Antibody Screen RBC

    $182.16

  • CHED 96365- IV tx, first hour BCE

    $216.00

  • CHED 96366- IV tx, each additional hour BCE

    $110.16

  • CHED 99285 - Level 5 BCE

    $2,188.80

  • CHED Arterial Line Activity Blood Drawn BCE

    $73.44

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $2,595.60

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

    $484.56

  • Comprehensive Metabolic Panel

    $475.92

  • CT Angio Abdomen and Pelvis

    $9,290.16

  • GLUCOSE BLOOD TEST

    $30.96

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $92.16

  • iodixanol 320 mg/mL Inj Soln 100 mL

    $156.24

  • Lactated Ringers IV Soln 500 mL

    $92.16

  • Lactic Acid Level

    $194.40

  • Lipase Level

    $197.28

  • Manual Differential

    $58.32

  • O2 Sat Meas

    $678.96

  • ondansetron 4 mg Tab

    $5.51

  • RT CHARGE SpO2 -> Single

    $87.84

  • sodium chloride 0.9% Inj Soln 10 mL

    $92.28

  • Sodium Chloride 0.9% IV Soln 50 mL

    $92.28

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

    $237.60

  • Urinalysis Microscopic

    $135.36

  • XR Chest

    $478.08

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

    $6,082.00

  • Insurance Discount

    -$5,894.24

  • Price Negotiated by Insurer

    $187.76

  • 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.

  • 85025 CBC W/AUTOMATED DIFFERENTIAL

    $9.71

  • 86901 BLOOD TYPING RH (D)

    $3.74

  • Bill Only BB ABO Type

    $3.74

  • Bill Only BB Antibody Screen RBC

    $12.21

  • CHED 96365- IV tx, first hour BCE

    $77.31

  • CHED 96366- IV tx, each additional hour BCE

    $25.11

  • CHED 99285 - Level 5 BCE

    $212.75

  • CHED Arterial Line Activity Blood Drawn BCE

    $18.09

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $258.57

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

    $7.78

  • Comprehensive Metabolic Panel

    $13.20

  • CT Angio Abdomen and Pelvis

    $482.16

  • GLUCOSE BLOOD TEST

    $4.10

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $64.00

  • iodixanol 320 mg/mL Inj Soln 100 mL

    $0.15

  • Lactated Ringers IV Soln 500 mL

    $64.00

  • Lactic Acid Level

    $14.46

  • Lipase Level

    $8.61

  • Manual Differential

    $4.75

  • O2 Sat Meas

    $98.46

  • ondansetron 4 mg Tab

    $3.83

  • RT CHARGE SpO2 -> Single

    $3.25

  • sodium chloride 0.9% Inj Soln 10 mL

    $0.65

  • Sodium Chloride 0.9% IV Soln 50 mL

    $64.08

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

    $18.93

  • Urinalysis Microscopic

    $3.96

  • XR Chest

    $31.66

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

    $6,082.00

  • Insurance Discount

    -$5,905.80

  • Price Negotiated by Insurer

    $176.20

  • 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

    $7.77

  • 86901 BLOOD TYPING RH (D)

    $2.99

  • Bill Only BB ABO Type

    $2.99

  • Bill Only BB Antibody Screen RBC

    $9.77

  • CHED 96365- IV tx, first hour BCE

    $213.67

  • CHED 96366- IV tx, each additional hour BCE

    $47.04

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Arterial Line Activity Blood Drawn BCE

    $133.65

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $829.79

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

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Angio Abdomen and Pelvis

    $350.46

  • GLUCOSE BLOOD TEST

    $3.28

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Manual Differential

    $3.80

  • O2 Sat Meas

    $78.77

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

    $47.04

  • Urinalysis Microscopic

    $3.17

  • XR Chest

    $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

    $6,082.00

  • Insurance Discount

    -$1,702.96

  • Price Negotiated by Insurer

    $4,379.04

  • 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

  • 86901 BLOOD TYPING RH (D)

    $81.36

  • Bill Only BB ABO Type

    $109.44

  • Bill Only BB Antibody Screen RBC

    $182.16

  • CHED 96365- IV tx, first hour BCE

    $216.00

  • CHED 96366- IV tx, each additional hour BCE

    $110.16

  • CHED 99285 - Level 5 BCE

    $2,188.80

  • CHED Arterial Line Activity Blood Drawn BCE

    $73.44

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $2,595.60

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

    $484.56

  • Comprehensive Metabolic Panel

    $475.92

  • CT Angio Abdomen and Pelvis

    $9,290.16

  • GLUCOSE BLOOD TEST

    $30.96

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $92.16

  • iodixanol 320 mg/mL Inj Soln 100 mL

    $156.24

  • Lactated Ringers IV Soln 500 mL

    $92.16

  • Lactic Acid Level

    $194.40

  • Lipase Level

    $197.28

  • Manual Differential

    $58.32

  • O2 Sat Meas

    $678.96

  • ondansetron 4 mg Tab

    $5.51

  • RT CHARGE SpO2 -> Single

    $87.84

  • sodium chloride 0.9% Inj Soln 10 mL

    $92.28

  • Sodium Chloride 0.9% IV Soln 50 mL

    $92.28

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

    $237.60

  • Urinalysis Microscopic

    $135.36

  • XR Chest

    $478.08

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

    $6,082.00

  • Insurance Discount

    -$5,905.80

  • Price Negotiated by Insurer

    $176.20

  • 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

    $7.77

  • 86901 BLOOD TYPING RH (D)

    $2.99

  • Bill Only BB ABO Type

    $2.99

  • Bill Only BB Antibody Screen RBC

    $9.77

  • CHED 96365- IV tx, first hour BCE

    $213.67

  • CHED 96366- IV tx, each additional hour BCE

    $47.04

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Arterial Line Activity Blood Drawn BCE

    $133.65

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $829.79

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

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Angio Abdomen and Pelvis

    $350.46

  • GLUCOSE BLOOD TEST

    $3.28

  • HYDROmorphone 0.5 mg/0.5 mL Inj Soln 0.5 mL

    $17.41

  • iodixanol 320 mg/mL Inj Soln 100 mL

    $29.51

  • Lactated Ringers IV Soln 500 mL

    $17.41

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Manual Differential

    $3.80

  • O2 Sat Meas

    $78.77

  • ondansetron 4 mg Tab

    $1.04

  • RT CHARGE SpO2 -> Single

    $16.59

  • sodium chloride 0.9% Inj Soln 10 mL

    $17.43

  • Sodium Chloride 0.9% IV Soln 50 mL

    $17.43

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

    $47.04

  • Urinalysis Microscopic

    $3.17

  • XR Chest

    $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

    $6,082.00

  • Insurance Discount

    -$5,905.80

  • Price Negotiated by Insurer

    $176.20

  • 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

    $7.77

  • 86901 BLOOD TYPING RH (D)

    $2.99

  • Bill Only BB ABO Type

    $2.99

  • Bill Only BB Antibody Screen RBC

    $9.77

  • CHED 96365- IV tx, first hour BCE

    $213.67

  • CHED 96366- IV tx, each additional hour BCE

    $47.04

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Arterial Line Activity Blood Drawn BCE

    $133.65

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $829.79

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

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Angio Abdomen and Pelvis

    $350.46

  • GLUCOSE BLOOD TEST

    $3.28

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Manual Differential

    $3.80

  • O2 Sat Meas

    $78.77

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

    $47.04

  • Urinalysis Microscopic

    $3.17

  • XR Chest

    $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

    $6,082.00

  • Insurance Discount

    -$5,905.80

  • Price Negotiated by Insurer

    $176.20

  • 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

    $7.77

  • 86901 BLOOD TYPING RH (D)

    $2.99

  • Bill Only BB ABO Type

    $2.99

  • Bill Only BB Antibody Screen RBC

    $9.77

  • CHED 96365- IV tx, first hour BCE

    $213.67

  • CHED 96366- IV tx, each additional hour BCE

    $47.04

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Arterial Line Activity Blood Drawn BCE

    $133.65

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $829.79

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

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Angio Abdomen and Pelvis

    $350.46

  • GLUCOSE BLOOD TEST

    $3.28

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Manual Differential

    $3.80

  • O2 Sat Meas

    $78.77

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

    $47.04

  • Urinalysis Microscopic

    $3.17

  • XR Chest

    $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

    $6,082.00

  • Insurance Discount

    -$5,905.80

  • Price Negotiated by Insurer

    $176.20

  • 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

    $7.77

  • 86901 BLOOD TYPING RH (D)

    $2.99

  • Bill Only BB ABO Type

    $2.99

  • Bill Only BB Antibody Screen RBC

    $9.77

  • CHED 96365- IV tx, first hour BCE

    $213.67

  • CHED 96366- IV tx, each additional hour BCE

    $47.04

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Arterial Line Activity Blood Drawn BCE

    $133.65

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $829.79

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

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Angio Abdomen and Pelvis

    $350.46

  • GLUCOSE BLOOD TEST

    $3.28

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Manual Differential

    $3.80

  • O2 Sat Meas

    $78.77

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

    $47.04

  • Urinalysis Microscopic

    $3.17

  • XR Chest

    $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

    $6,082.00

  • Insurance Discount

    -$5,905.80

  • Price Negotiated by Insurer

    $176.20

  • 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

    $7.77

  • 86901 BLOOD TYPING RH (D)

    $2.99

  • Bill Only BB ABO Type

    $2.99

  • Bill Only BB Antibody Screen RBC

    $9.77

  • CHED 96365- IV tx, first hour BCE

    $213.67

  • CHED 96366- IV tx, each additional hour BCE

    $47.04

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Arterial Line Activity Blood Drawn BCE

    $133.65

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $829.79

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

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Angio Abdomen and Pelvis

    $350.46

  • GLUCOSE BLOOD TEST

    $3.28

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Manual Differential

    $3.80

  • O2 Sat Meas

    $78.77

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

    $47.04

  • Urinalysis Microscopic

    $3.17

  • XR Chest

    $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

    $6,082.00

  • Insurance Discount

    -$5,905.80

  • Price Negotiated by Insurer

    $176.20

  • 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

    $7.77

  • 86901 BLOOD TYPING RH (D)

    $2.99

  • Bill Only BB ABO Type

    $2.99

  • Bill Only BB Antibody Screen RBC

    $9.77

  • CHED 96365- IV tx, first hour BCE

    $213.67

  • CHED 96366- IV tx, each additional hour BCE

    $47.04

  • CHED 99285 - Level 5 BCE

    $598.24

  • CHED Arterial Line Activity Blood Drawn BCE

    $133.65

  • CHED Critical Care Ill/Injured Patient Init 30-74 Min 99291 BCE

    $829.79

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

    $59.26

  • Comprehensive Metabolic Panel

    $10.56

  • CT Angio Abdomen and Pelvis

    $350.46

  • GLUCOSE BLOOD TEST

    $3.28

  • Lactic Acid Level

    $11.57

  • Lipase Level

    $6.89

  • Manual Differential

    $3.80

  • O2 Sat Meas

    $78.77

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

    $47.04

  • Urinalysis Microscopic

    $3.17

  • XR Chest

    $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.