CPT 74183
The standard charge for MRI of abdomen without & with contrast material is $7,151.00. 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:
LOCATION
9440 Poppy Drive, Dallas, TX, 75218CONTACT
(214) 324-6100 Visit WebsiteChoose a plan to view the insurance rate estimate.
Total estimated charges
$7,151.00Insurance Discount
-$6,802.50Price Negotiated by Insurer
$348.50Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$312.0883735 MAGNESIUM
$2.6185025 CBC W/AUTOMATED DIFFERENTIAL
$3.03Basic Metabolic Panel
$3.30Blood count; complete (CBC), automated
$2.52Blood Culture
$4.02cefepime 2 g Inj
$11.54CHED 96374- IV Injection, single/initial BCE
$32.40CHED 99285 - Level 5 BCE
$280.00CHED Routine ECG 12 lead/15 lead tracing only BCE
$60.57Comprehensive Metabolic Panel
$4.12CT Brain Stroke Protocol w/o Contrast
$104.75EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$359.19enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL
$11.54fentaNYL 50 mcg/mL Inj Soln 10 mL
$11.52ferrous gluconate 324 mg (38 mg elemental iron) Tab
$0.72gadoteridol 279.3 mg/mL IV Soln 10 mL
$11.52GLUCOSE BLOOD TEST
$1.28HCG Qualitative Urine
$3.36Hemoglobin A1C
$3.79Lipase Level
$2.69Lipid Panel
$5.22ondansetron 2 mg/mL Inj Soln 2 mL
$11.52Phosphorus Level
$1.85ROOM/BED: Observation
$400.00Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$29.70Thyroid Stimulating Hormone
$6.55Urinalysis Microscopic
$1.24US Carotid Duplex Bilateral
$298.53WRNR OT EVAL LOW COMPLEXITY BCE
$80.00WRNR PT Evaluation Low Complexity BCE
$80.00WRNR PT Gait Training Units BCE
$13.77XR Chest
$25.73This 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.
Total estimated charges
$7,151.00Insurance Discount
-$6,800.54Price Negotiated by Insurer
$350.46Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$350.4683735 MAGNESIUM
$6.7085025 CBC W/AUTOMATED DIFFERENTIAL
$7.77Basic Metabolic Panel
$8.46Blood count; complete (CBC), automated
$6.47Blood Culture
$10.32CHED 96374- IV Injection, single/initial BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Routine ECG 12 lead/15 lead tracing only BCE
$59.26Comprehensive Metabolic Panel
$10.56CT Brain Stroke Protocol w/o Contrast
$105.02EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$239.69GLUCOSE BLOOD TEST
$3.28HCG Qualitative Urine
$8.61Hemoglobin A1C
$9.71Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
$47.04Lipase Level
$6.89Lipid Panel
$13.39Phosphorus Level
$4.74Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04Thyroid Stimulating Hormone
$16.80Urinalysis Microscopic
$3.17US Carotid Duplex Bilateral
$239.69XR Chest
$87.42This 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.
Total estimated charges
$7,151.00Insurance Discount
-$6,800.54Price Negotiated by Insurer
$350.46Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$350.4683735 MAGNESIUM
$6.7085025 CBC W/AUTOMATED DIFFERENTIAL
$7.77Basic Metabolic Panel
$8.46Blood count; complete (CBC), automated
$6.47Blood Culture
$10.32CHED 96374- IV Injection, single/initial BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Routine ECG 12 lead/15 lead tracing only BCE
$59.26Comprehensive Metabolic Panel
$10.56CT Brain Stroke Protocol w/o Contrast
$105.02EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$239.69GLUCOSE BLOOD TEST
$3.28HCG Qualitative Urine
$8.61Hemoglobin A1C
$9.71Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
$47.04Lipase Level
$6.89Lipid Panel
$13.39Phosphorus Level
$4.74Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04Thyroid Stimulating Hormone
$16.80Urinalysis Microscopic
$3.17US Carotid Duplex Bilateral
$239.69XR Chest
$87.42This 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.
Total estimated charges
$7,151.00Insurance Discount
-$6,520.95Price Negotiated by Insurer
$630.05Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$630.0583735 MAGNESIUM
$70.2085025 CBC W/AUTOMATED DIFFERENTIAL
$116.10Basic Metabolic Panel
$148.80Blood count; complete (CBC), automated
$72.90Blood Culture
$117.30cefepime 2 g Inj
$2.49CHED 96374- IV Injection, single/initial BCE
$108.00CHED 99285 - Level 5 BCE
$2,640.00CHED Routine ECG 12 lead/15 lead tracing only BCE
$201.90Comprehensive Metabolic Panel
$198.30CT Brain Stroke Protocol w/o Contrast
$184.93EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$1,197.30enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL
$1.77fentaNYL 50 mcg/mL Inj Soln 10 mL
$0.57ferrous gluconate 324 mg (38 mg elemental iron) Tab
$2.40gadoteridol 279.3 mg/mL IV Soln 10 mL
$2.57GLUCOSE BLOOD TEST
$12.90HCG Qualitative Urine
$110.10Hemoglobin A1C
$83.70Lipase Level
$82.20Lipid Panel
$131.40ondansetron 2 mg/mL Inj Soln 2 mL
$0.86Phosphorus Level
$66.30ROOM/BED: Observation
$2,745.00Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$99.00Thyroid Stimulating Hormone
$150.60Urinalysis Microscopic
$56.40US Carotid Duplex Bilateral
$995.10WRNR OT EVAL LOW COMPLEXITY BCE
$57.30WRNR PT Evaluation Low Complexity BCE
$38.10WRNR PT Gait Training Units BCE
$45.90XR Chest
$131.69This 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.
Total estimated charges
$7,151.00Insurance Discount
-$6,394.94Price Negotiated by Insurer
$756.06Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$756.0683735 MAGNESIUM
$84.2485025 CBC W/AUTOMATED DIFFERENTIAL
$139.32Basic Metabolic Panel
$178.56Blood count; complete (CBC), automated
$87.48Blood Culture
$140.76cefepime 2 g Inj
$2.99CHED 96374- IV Injection, single/initial BCE
$129.60CHED 99285 - Level 5 BCE
$3,168.00CHED Routine ECG 12 lead/15 lead tracing only BCE
$242.28Comprehensive Metabolic Panel
$237.96CT Brain Stroke Protocol w/o Contrast
$221.92EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$1,436.76enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL
$2.12fentaNYL 50 mcg/mL Inj Soln 10 mL
$0.68ferrous gluconate 324 mg (38 mg elemental iron) Tab
$2.88gadoteridol 279.3 mg/mL IV Soln 10 mL
$3.08GLUCOSE BLOOD TEST
$15.48HCG Qualitative Urine
$132.12Hemoglobin A1C
$100.44Lipase Level
$98.64Lipid Panel
$157.68ondansetron 2 mg/mL Inj Soln 2 mL
$1.03Phosphorus Level
$79.56ROOM/BED: Observation
$3,294.00Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$118.80Thyroid Stimulating Hormone
$180.72Urinalysis Microscopic
$67.68US Carotid Duplex Bilateral
$1,194.12WRNR OT EVAL LOW COMPLEXITY BCE
$68.76WRNR PT Evaluation Low Complexity BCE
$45.72WRNR PT Gait Training Units BCE
$55.08XR Chest
$158.02This 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.
Total estimated charges
$7,151.00Insurance Discount
-$6,800.54Price Negotiated by Insurer
$350.46Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$350.4683735 MAGNESIUM
$6.7085025 CBC W/AUTOMATED DIFFERENTIAL
$7.77Basic Metabolic Panel
$8.46Blood count; complete (CBC), automated
$6.47Blood Culture
$10.32CHED 96374- IV Injection, single/initial BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Routine ECG 12 lead/15 lead tracing only BCE
$59.26Comprehensive Metabolic Panel
$10.56CT Brain Stroke Protocol w/o Contrast
$105.02EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$239.69GLUCOSE BLOOD TEST
$3.28HCG Qualitative Urine
$8.61Hemoglobin A1C
$9.71Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
$47.04Lipase Level
$6.89Lipid Panel
$13.39Phosphorus Level
$4.74Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04Thyroid Stimulating Hormone
$16.80Urinalysis Microscopic
$3.17US Carotid Duplex Bilateral
$239.69XR Chest
$87.42This 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.
Total estimated charges
$7,151.00Insurance Discount
-$6,307.11Price Negotiated by Insurer
$843.89Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$843.8983735 MAGNESIUM
$93.6085025 CBC W/AUTOMATED DIFFERENTIAL
$154.80Basic Metabolic Panel
$198.40Blood count; complete (CBC), automated
$97.20Blood Culture
$156.40cefepime 2 g Inj
$3.32CHED 96374- IV Injection, single/initial BCE
$144.00CHED 99285 - Level 5 BCE
$3,520.00CHED Routine ECG 12 lead/15 lead tracing only BCE
$269.20Comprehensive Metabolic Panel
$264.40CT Brain Stroke Protocol w/o Contrast
$247.70EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$1,596.40enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL
$2.35fentaNYL 50 mcg/mL Inj Soln 10 mL
$0.75ferrous gluconate 324 mg (38 mg elemental iron) Tab
$3.20gadoteridol 279.3 mg/mL IV Soln 10 mL
$3.42GLUCOSE BLOOD TEST
$17.20HCG Qualitative Urine
$146.80Hemoglobin A1C
$111.60Lipase Level
$109.60Lipid Panel
$175.20ondansetron 2 mg/mL Inj Soln 2 mL
$1.14Phosphorus Level
$88.40ROOM/BED: Observation
$3,660.00Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$132.00Thyroid Stimulating Hormone
$200.80Urinalysis Microscopic
$75.20US Carotid Duplex Bilateral
$1,326.80WRNR OT EVAL LOW COMPLEXITY BCE
$76.40WRNR PT Evaluation Low Complexity BCE
$50.80WRNR PT Gait Training Units BCE
$61.20XR Chest
$176.38This 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.
Total estimated charges
$7,151.00Insurance Discount
-$2,288.32Price Negotiated by Insurer
$4,862.68Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$5,385.6083735 MAGNESIUM
$159.1285025 CBC W/AUTOMATED DIFFERENTIAL
$263.16Basic Metabolic Panel
$337.28Blood count; complete (CBC), automated
$165.24Blood Culture
$265.88cefepime 2 g Inj
$87.16CHED 96374- IV Injection, single/initial BCE
$244.80CHED 99285 - Level 5 BCE
$2,067.20CHED Routine ECG 12 lead/15 lead tracing only BCE
$457.64Comprehensive Metabolic Panel
$449.48CT Brain Stroke Protocol w/o Contrast
$3,056.60EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$2,713.88enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL
$87.16fentaNYL 50 mcg/mL Inj Soln 10 mL
$87.04ferrous gluconate 324 mg (38 mg elemental iron) Tab
$5.44gadoteridol 279.3 mg/mL IV Soln 10 mL
$87.04GLUCOSE BLOOD TEST
$29.24HCG Qualitative Urine
$249.56Hemoglobin A1C
$189.72Lipase Level
$186.32Lipid Panel
$297.84ondansetron 2 mg/mL Inj Soln 2 mL
$87.04Phosphorus Level
$150.28ROOM/BED: Observation
$74.80Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$224.40Thyroid Stimulating Hormone
$341.36Urinalysis Microscopic
$127.84US Carotid Duplex Bilateral
$2,255.56WRNR OT EVAL LOW COMPLEXITY BCE
$129.88WRNR PT Evaluation Low Complexity BCE
$86.36WRNR PT Gait Training Units BCE
$104.04XR Chest
$451.52This 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.
Total estimated charges
$7,151.00Insurance Discount
-$6,410.19Price Negotiated by Insurer
$740.81Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$740.81CHED 96374- IV Injection, single/initial BCE
$451.67CHED 99285 - Level 5 BCE
$2,968.44CHED Routine ECG 12 lead/15 lead tracing only BCE
$125.27CT Brain Stroke Protocol w/o Contrast
$222.00EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$506.65Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
$99.43Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$99.43US Carotid Duplex Bilateral
$506.65WRNR OT EVAL LOW COMPLEXITY BCE
$200.00WRNR PT Evaluation Low Complexity BCE
$200.00WRNR PT Gait Training Units BCE
$200.00XR Chest
$184.79This 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.
Total estimated charges
$7,151.00Insurance Discount
-$2,002.28Price Negotiated by Insurer
$5,148.72Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$5,702.4083735 MAGNESIUM
$168.4885025 CBC W/AUTOMATED DIFFERENTIAL
$278.64Basic Metabolic Panel
$357.12Blood count; complete (CBC), automated
$174.96Blood Culture
$281.52cefepime 2 g Inj
$92.28CHED 96374- IV Injection, single/initial BCE
$259.20CHED 99285 - Level 5 BCE
$2,188.80CHED Routine ECG 12 lead/15 lead tracing only BCE
$484.56Comprehensive Metabolic Panel
$475.92CT Brain Stroke Protocol w/o Contrast
$3,236.40EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$2,873.52enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL
$92.28fentaNYL 50 mcg/mL Inj Soln 10 mL
$92.16ferrous gluconate 324 mg (38 mg elemental iron) Tab
$5.76gadoteridol 279.3 mg/mL IV Soln 10 mL
$92.16GLUCOSE BLOOD TEST
$30.96HCG Qualitative Urine
$264.24Hemoglobin A1C
$200.88Lipase Level
$197.28Lipid Panel
$315.36ondansetron 2 mg/mL Inj Soln 2 mL
$92.16Phosphorus Level
$159.12ROOM/BED: Observation
$79.20Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$237.60Thyroid Stimulating Hormone
$361.44Urinalysis Microscopic
$135.36US Carotid Duplex Bilateral
$2,388.24WRNR OT EVAL LOW COMPLEXITY BCE
$137.52WRNR PT Evaluation Low Complexity BCE
$91.44WRNR PT Gait Training Units BCE
$110.16XR Chest
$478.08This 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.
Total estimated charges
$7,151.00Insurance Discount
-$6,800.54Price Negotiated by Insurer
$350.46Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$350.4683735 MAGNESIUM
$6.7085025 CBC W/AUTOMATED DIFFERENTIAL
$7.77Basic Metabolic Panel
$8.46Blood count; complete (CBC), automated
$6.47Blood Culture
$10.32CHED 96374- IV Injection, single/initial BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Routine ECG 12 lead/15 lead tracing only BCE
$59.26Comprehensive Metabolic Panel
$10.56CT Brain Stroke Protocol w/o Contrast
$105.02EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$239.69GLUCOSE BLOOD TEST
$3.28HCG Qualitative Urine
$8.61Hemoglobin A1C
$9.71Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
$47.04Lipase Level
$6.89Lipid Panel
$13.39Phosphorus Level
$4.74Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04Thyroid Stimulating Hormone
$16.80Urinalysis Microscopic
$3.17US Carotid Duplex Bilateral
$239.69XR Chest
$87.42This 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.
Total estimated charges
$7,151.00Insurance Discount
-$6,800.54Price Negotiated by Insurer
$350.46Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$350.4683735 MAGNESIUM
$6.7085025 CBC W/AUTOMATED DIFFERENTIAL
$7.77Basic Metabolic Panel
$8.46Blood count; complete (CBC), automated
$6.47Blood Culture
$10.32CHED 96374- IV Injection, single/initial BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Routine ECG 12 lead/15 lead tracing only BCE
$59.26Comprehensive Metabolic Panel
$10.56CT Brain Stroke Protocol w/o Contrast
$105.02EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$239.69GLUCOSE BLOOD TEST
$3.28HCG Qualitative Urine
$8.61Hemoglobin A1C
$9.71Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
$47.04Lipase Level
$6.89Lipid Panel
$13.39Phosphorus Level
$4.74Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04Thyroid Stimulating Hormone
$16.80Urinalysis Microscopic
$3.17US Carotid Duplex Bilateral
$239.69XR Chest
$87.42This 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.
Total estimated charges
$7,151.00Insurance Discount
-$6,800.54Price Negotiated by Insurer
$350.46Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$350.4683735 MAGNESIUM
$6.7085025 CBC W/AUTOMATED DIFFERENTIAL
$7.77Basic Metabolic Panel
$8.46Blood count; complete (CBC), automated
$6.47Blood Culture
$10.32CHED 96374- IV Injection, single/initial BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Routine ECG 12 lead/15 lead tracing only BCE
$59.26Comprehensive Metabolic Panel
$10.56CT Brain Stroke Protocol w/o Contrast
$105.02EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$239.69GLUCOSE BLOOD TEST
$3.28HCG Qualitative Urine
$8.61Hemoglobin A1C
$9.71Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
$47.04Lipase Level
$6.89Lipid Panel
$13.39Phosphorus Level
$4.74Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04Thyroid Stimulating Hormone
$16.80Urinalysis Microscopic
$3.17US Carotid Duplex Bilateral
$239.69XR Chest
$87.42This 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.
Total estimated charges
$7,151.00Insurance Discount
-$2,002.28Price Negotiated by Insurer
$5,148.72Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$5,702.4083735 MAGNESIUM
$168.4885025 CBC W/AUTOMATED DIFFERENTIAL
$278.64Basic Metabolic Panel
$357.12Blood count; complete (CBC), automated
$174.96Blood Culture
$281.52cefepime 2 g Inj
$92.28CHED 96374- IV Injection, single/initial BCE
$259.20CHED 99285 - Level 5 BCE
$2,188.80CHED Routine ECG 12 lead/15 lead tracing only BCE
$484.56Comprehensive Metabolic Panel
$475.92CT Brain Stroke Protocol w/o Contrast
$3,236.40EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$2,873.52enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL
$92.28fentaNYL 50 mcg/mL Inj Soln 10 mL
$92.16ferrous gluconate 324 mg (38 mg elemental iron) Tab
$5.76gadoteridol 279.3 mg/mL IV Soln 10 mL
$92.16GLUCOSE BLOOD TEST
$30.96HCG Qualitative Urine
$264.24Hemoglobin A1C
$200.88Lipase Level
$197.28Lipid Panel
$315.36ondansetron 2 mg/mL Inj Soln 2 mL
$92.16Phosphorus Level
$159.12ROOM/BED: Observation
$79.20Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$237.60Thyroid Stimulating Hormone
$361.44Urinalysis Microscopic
$135.36US Carotid Duplex Bilateral
$2,388.24WRNR OT EVAL LOW COMPLEXITY BCE
$137.52WRNR PT Evaluation Low Complexity BCE
$91.44WRNR PT Gait Training Units BCE
$110.16XR Chest
$478.08This 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.
Total estimated charges
$7,151.00Insurance Discount
-$6,800.54Price Negotiated by Insurer
$350.46Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$350.4683735 MAGNESIUM
$6.7085025 CBC W/AUTOMATED DIFFERENTIAL
$7.77Basic Metabolic Panel
$8.46Blood count; complete (CBC), automated
$6.47Blood Culture
$10.32CHED 96374- IV Injection, single/initial BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Routine ECG 12 lead/15 lead tracing only BCE
$59.26Comprehensive Metabolic Panel
$10.56CT Brain Stroke Protocol w/o Contrast
$105.02EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$239.69GLUCOSE BLOOD TEST
$3.28HCG Qualitative Urine
$8.61Hemoglobin A1C
$9.71Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
$47.04Lipase Level
$6.89Lipid Panel
$13.39Phosphorus Level
$4.74Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04Thyroid Stimulating Hormone
$16.80Urinalysis Microscopic
$3.17US Carotid Duplex Bilateral
$239.69XR Chest
$87.42This 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.
Total estimated charges
$7,151.00Insurance Discount
-$6,800.54Price Negotiated by Insurer
$350.46Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$350.4683735 MAGNESIUM
$6.7085025 CBC W/AUTOMATED DIFFERENTIAL
$7.77Basic Metabolic Panel
$8.46Blood count; complete (CBC), automated
$6.47Blood Culture
$10.32CHED 96374- IV Injection, single/initial BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Routine ECG 12 lead/15 lead tracing only BCE
$59.26Comprehensive Metabolic Panel
$10.56CT Brain Stroke Protocol w/o Contrast
$105.02EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$239.69GLUCOSE BLOOD TEST
$3.28HCG Qualitative Urine
$8.61Hemoglobin A1C
$9.71Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
$47.04Lipase Level
$6.89Lipid Panel
$13.39Phosphorus Level
$4.74Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04Thyroid Stimulating Hormone
$16.80Urinalysis Microscopic
$3.17US Carotid Duplex Bilateral
$239.69XR Chest
$87.42This 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.
Total estimated charges
$7,151.00Insurance Discount
-$2,502.85Price Negotiated by Insurer
$4,648.15Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$5,148.0083735 MAGNESIUM
$152.1085025 CBC W/AUTOMATED DIFFERENTIAL
$251.55Basic Metabolic Panel
$322.40Blood count; complete (CBC), automated
$157.95Blood Culture
$254.15cefepime 2 g Inj
$83.31CHED 96374- IV Injection, single/initial BCE
$234.00CHED 99285 - Level 5 BCE
$1,976.00CHED Routine ECG 12 lead/15 lead tracing only BCE
$437.45Comprehensive Metabolic Panel
$429.65CT Brain Stroke Protocol w/o Contrast
$2,921.75EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$2,594.15enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL
$83.31fentaNYL 50 mcg/mL Inj Soln 10 mL
$83.20ferrous gluconate 324 mg (38 mg elemental iron) Tab
$5.20gadoteridol 279.3 mg/mL IV Soln 10 mL
$83.20GLUCOSE BLOOD TEST
$27.95HCG Qualitative Urine
$238.55Hemoglobin A1C
$181.35Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
$10,000.00Lipase Level
$178.10Lipid Panel
$284.70ondansetron 2 mg/mL Inj Soln 2 mL
$83.20Phosphorus Level
$143.65ROOM/BED: Observation
$71.50Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$214.50Thyroid Stimulating Hormone
$326.30Urinalysis Microscopic
$122.20US Carotid Duplex Bilateral
$2,156.05WRNR OT EVAL LOW COMPLEXITY BCE
$124.15WRNR PT Evaluation Low Complexity BCE
$82.55WRNR PT Gait Training Units BCE
$99.45XR Chest
$431.60This 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.
Total estimated charges
$7,151.00Insurance Discount
-$2,502.85Price Negotiated by Insurer
$4,648.15Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$5,148.0083735 MAGNESIUM
$152.1085025 CBC W/AUTOMATED DIFFERENTIAL
$251.55Basic Metabolic Panel
$322.40Blood count; complete (CBC), automated
$157.95Blood Culture
$254.15cefepime 2 g Inj
$83.31CHED 96374- IV Injection, single/initial BCE
$234.00CHED 99285 - Level 5 BCE
$1,976.00CHED Routine ECG 12 lead/15 lead tracing only BCE
$437.45Comprehensive Metabolic Panel
$429.65CT Brain Stroke Protocol w/o Contrast
$2,921.75EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$2,594.15enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL
$83.31fentaNYL 50 mcg/mL Inj Soln 10 mL
$83.20ferrous gluconate 324 mg (38 mg elemental iron) Tab
$5.20gadoteridol 279.3 mg/mL IV Soln 10 mL
$83.20GLUCOSE BLOOD TEST
$27.95HCG Qualitative Urine
$238.55Hemoglobin A1C
$181.35Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
$10,000.00Lipase Level
$178.10Lipid Panel
$284.70ondansetron 2 mg/mL Inj Soln 2 mL
$83.20Phosphorus Level
$143.65ROOM/BED: Observation
$71.50Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$214.50Thyroid Stimulating Hormone
$326.30Urinalysis Microscopic
$122.20US Carotid Duplex Bilateral
$2,156.05WRNR OT EVAL LOW COMPLEXITY BCE
$124.15WRNR PT Evaluation Low Complexity BCE
$82.55WRNR PT Gait Training Units BCE
$99.45XR Chest
$431.60This 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.
Total estimated charges
$7,151.00Insurance Discount
-$2,502.85Price Negotiated by Insurer
$4,648.15Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$5,148.0083735 MAGNESIUM
$152.1085025 CBC W/AUTOMATED DIFFERENTIAL
$251.55Basic Metabolic Panel
$322.40Blood count; complete (CBC), automated
$157.95Blood Culture
$254.15cefepime 2 g Inj
$83.31CHED 96374- IV Injection, single/initial BCE
$234.00CHED 99285 - Level 5 BCE
$1,976.00CHED Routine ECG 12 lead/15 lead tracing only BCE
$437.45Comprehensive Metabolic Panel
$429.65CT Brain Stroke Protocol w/o Contrast
$2,921.75EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$2,594.15enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL
$83.31fentaNYL 50 mcg/mL Inj Soln 10 mL
$83.20ferrous gluconate 324 mg (38 mg elemental iron) Tab
$5.20gadoteridol 279.3 mg/mL IV Soln 10 mL
$83.20GLUCOSE BLOOD TEST
$27.95HCG Qualitative Urine
$238.55Hemoglobin A1C
$181.35Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
$10,000.00Lipase Level
$178.10Lipid Panel
$284.70ondansetron 2 mg/mL Inj Soln 2 mL
$83.20Phosphorus Level
$143.65ROOM/BED: Observation
$71.50Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$214.50Thyroid Stimulating Hormone
$326.30Urinalysis Microscopic
$122.20US Carotid Duplex Bilateral
$2,156.05WRNR OT EVAL LOW COMPLEXITY BCE
$124.15WRNR PT Evaluation Low Complexity BCE
$82.55WRNR PT Gait Training Units BCE
$99.45XR Chest
$431.60This 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.
Total estimated charges
$7,151.00Insurance Discount
-$2,002.28Price Negotiated by Insurer
$5,148.72Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$5,702.4083735 MAGNESIUM
$168.4885025 CBC W/AUTOMATED DIFFERENTIAL
$278.64Basic Metabolic Panel
$357.12Blood count; complete (CBC), automated
$174.96Blood Culture
$281.52cefepime 2 g Inj
$92.28CHED 96374- IV Injection, single/initial BCE
$259.20CHED 99285 - Level 5 BCE
$2,188.80CHED Routine ECG 12 lead/15 lead tracing only BCE
$484.56Comprehensive Metabolic Panel
$475.92CT Brain Stroke Protocol w/o Contrast
$3,236.40EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$2,873.52enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL
$92.28fentaNYL 50 mcg/mL Inj Soln 10 mL
$92.16ferrous gluconate 324 mg (38 mg elemental iron) Tab
$5.76gadoteridol 279.3 mg/mL IV Soln 10 mL
$92.16GLUCOSE BLOOD TEST
$30.96HCG Qualitative Urine
$264.24Hemoglobin A1C
$200.88Lipase Level
$197.28Lipid Panel
$315.36ondansetron 2 mg/mL Inj Soln 2 mL
$92.16Phosphorus Level
$159.12ROOM/BED: Observation
$79.20Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$237.60Thyroid Stimulating Hormone
$361.44Urinalysis Microscopic
$135.36US Carotid Duplex Bilateral
$2,388.24WRNR OT EVAL LOW COMPLEXITY BCE
$137.52WRNR PT Evaluation Low Complexity BCE
$91.44WRNR PT Gait Training Units BCE
$110.16XR Chest
$478.08This 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.
Total estimated charges
$7,151.00Insurance Discount
-$3,575.50Price Negotiated by Insurer
$3,575.50Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$3,960.0083735 MAGNESIUM
$8.3885025 CBC W/AUTOMATED DIFFERENTIAL
$9.71Basic Metabolic Panel
$10.57Blood count; complete (CBC), automated
$8.09Blood Culture
$12.90cefepime 2 g Inj
$64.08CHED 96374- IV Injection, single/initial BCE
$180.00CHED 99285 - Level 5 BCE
$2,900.00CHED Routine ECG 12 lead/15 lead tracing only BCE
$336.50Comprehensive Metabolic Panel
$13.20CT Brain Stroke Protocol w/o Contrast
$2,247.50EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$1,995.50enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL
$64.08fentaNYL 50 mcg/mL Inj Soln 10 mL
$64.00ferrous gluconate 324 mg (38 mg elemental iron) Tab
$4.00gadoteridol 279.3 mg/mL IV Soln 10 mL
$64.00GLUCOSE BLOOD TEST
$4.10HCG Qualitative Urine
$10.76Hemoglobin A1C
$12.14Lipase Level
$8.61Lipid Panel
$16.74ondansetron 2 mg/mL Inj Soln 2 mL
$64.00Phosphorus Level
$5.92ROOM/BED: Observation
$55.00Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$165.00Thyroid Stimulating Hormone
$21.00Urinalysis Microscopic
$3.96US Carotid Duplex Bilateral
$1,658.50WRNR OT EVAL LOW COMPLEXITY BCE
$180.00WRNR PT Evaluation Low Complexity BCE
$180.00WRNR PT Gait Training Units BCE
$180.00XR Chest
$131.13This 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.
Total estimated charges
$7,151.00Insurance Discount
-$6,800.54Price Negotiated by Insurer
$350.46Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$350.4683735 MAGNESIUM
$6.7085025 CBC W/AUTOMATED DIFFERENTIAL
$7.77Basic Metabolic Panel
$8.46Blood count; complete (CBC), automated
$6.47Blood Culture
$10.32CHED 96374- IV Injection, single/initial BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Routine ECG 12 lead/15 lead tracing only BCE
$59.26Comprehensive Metabolic Panel
$10.56CT Brain Stroke Protocol w/o Contrast
$105.02EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$239.69GLUCOSE BLOOD TEST
$3.28HCG Qualitative Urine
$8.61Hemoglobin A1C
$9.71Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
$47.04Lipase Level
$6.89Lipid Panel
$13.39Phosphorus Level
$4.74Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04Thyroid Stimulating Hormone
$16.80Urinalysis Microscopic
$3.17US Carotid Duplex Bilateral
$239.69XR Chest
$87.42This 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.
Total estimated charges
$7,151.00Insurance Discount
-$2,002.28Price Negotiated by Insurer
$5,148.72Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$5,702.4083735 MAGNESIUM
$168.4885025 CBC W/AUTOMATED DIFFERENTIAL
$278.64Basic Metabolic Panel
$357.12Blood count; complete (CBC), automated
$174.96Blood Culture
$281.52cefepime 2 g Inj
$92.28CHED 96374- IV Injection, single/initial BCE
$259.20CHED 99285 - Level 5 BCE
$2,188.80CHED Routine ECG 12 lead/15 lead tracing only BCE
$484.56Comprehensive Metabolic Panel
$475.92CT Brain Stroke Protocol w/o Contrast
$3,236.40EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$2,873.52enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL
$92.28fentaNYL 50 mcg/mL Inj Soln 10 mL
$92.16ferrous gluconate 324 mg (38 mg elemental iron) Tab
$5.76gadoteridol 279.3 mg/mL IV Soln 10 mL
$92.16GLUCOSE BLOOD TEST
$30.96HCG Qualitative Urine
$264.24Hemoglobin A1C
$200.88Lipase Level
$197.28Lipid Panel
$315.36ondansetron 2 mg/mL Inj Soln 2 mL
$92.16Phosphorus Level
$159.12ROOM/BED: Observation
$79.20Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$237.60Thyroid Stimulating Hormone
$361.44Urinalysis Microscopic
$135.36US Carotid Duplex Bilateral
$2,388.24WRNR OT EVAL LOW COMPLEXITY BCE
$137.52WRNR PT Evaluation Low Complexity BCE
$91.44WRNR PT Gait Training Units BCE
$110.16XR Chest
$478.08This 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.
Total estimated charges
$7,151.00Insurance Discount
-$6,800.54Price Negotiated by Insurer
$350.46Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$350.4683735 MAGNESIUM
$6.7085025 CBC W/AUTOMATED DIFFERENTIAL
$7.77Basic Metabolic Panel
$8.46Blood count; complete (CBC), automated
$6.47Blood Culture
$10.32cefepime 2 g Inj
$17.43CHED 96374- IV Injection, single/initial BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Routine ECG 12 lead/15 lead tracing only BCE
$59.26Comprehensive Metabolic Panel
$10.56CT Brain Stroke Protocol w/o Contrast
$105.02EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$239.69enoxaparin 30 mg/0.3 mL Inj Soln 0.3 mL
$17.43fentaNYL 50 mcg/mL Inj Soln 10 mL
$17.41ferrous gluconate 324 mg (38 mg elemental iron) Tab
$1.09gadoteridol 279.3 mg/mL IV Soln 10 mL
$17.41GLUCOSE BLOOD TEST
$3.28HCG Qualitative Urine
$8.61Hemoglobin A1C
$9.71Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
$47.04Lipase Level
$6.89Lipid Panel
$13.39ondansetron 2 mg/mL Inj Soln 2 mL
$17.41Phosphorus Level
$4.74ROOM/BED: Observation
$14.96Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04Thyroid Stimulating Hormone
$16.80Urinalysis Microscopic
$3.17US Carotid Duplex Bilateral
$239.69WRNR OT EVAL LOW COMPLEXITY BCE
$25.98WRNR PT Evaluation Low Complexity BCE
$17.27WRNR PT Gait Training Units BCE
$20.81XR Chest
$87.42This 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.
Total estimated charges
$7,151.00Insurance Discount
-$6,800.54Price Negotiated by Insurer
$350.46Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$350.4683735 MAGNESIUM
$6.7085025 CBC W/AUTOMATED DIFFERENTIAL
$7.77Basic Metabolic Panel
$8.46Blood count; complete (CBC), automated
$6.47Blood Culture
$10.32CHED 96374- IV Injection, single/initial BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Routine ECG 12 lead/15 lead tracing only BCE
$59.26Comprehensive Metabolic Panel
$10.56CT Brain Stroke Protocol w/o Contrast
$105.02EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$239.69GLUCOSE BLOOD TEST
$3.28HCG Qualitative Urine
$8.61Hemoglobin A1C
$9.71Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
$47.04Lipase Level
$6.89Lipid Panel
$13.39Phosphorus Level
$4.74Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04Thyroid Stimulating Hormone
$16.80Urinalysis Microscopic
$3.17US Carotid Duplex Bilateral
$239.69XR Chest
$87.42This 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.
Total estimated charges
$7,151.00Insurance Discount
-$6,800.54Price Negotiated by Insurer
$350.46Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$350.4683735 MAGNESIUM
$6.7085025 CBC W/AUTOMATED DIFFERENTIAL
$7.77Basic Metabolic Panel
$8.46Blood count; complete (CBC), automated
$6.47Blood Culture
$10.32CHED 96374- IV Injection, single/initial BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Routine ECG 12 lead/15 lead tracing only BCE
$59.26Comprehensive Metabolic Panel
$10.56CT Brain Stroke Protocol w/o Contrast
$105.02EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$239.69GLUCOSE BLOOD TEST
$3.28HCG Qualitative Urine
$8.61Hemoglobin A1C
$9.71Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
$47.04Lipase Level
$6.89Lipid Panel
$13.39Phosphorus Level
$4.74Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04Thyroid Stimulating Hormone
$16.80Urinalysis Microscopic
$3.17US Carotid Duplex Bilateral
$239.69XR Chest
$87.42This 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.
Total estimated charges
$7,151.00Insurance Discount
-$6,800.54Price Negotiated by Insurer
$350.46Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$350.4683735 MAGNESIUM
$6.7085025 CBC W/AUTOMATED DIFFERENTIAL
$7.77Basic Metabolic Panel
$8.46Blood count; complete (CBC), automated
$6.47Blood Culture
$10.32CHED 96374- IV Injection, single/initial BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Routine ECG 12 lead/15 lead tracing only BCE
$59.26Comprehensive Metabolic Panel
$10.56CT Brain Stroke Protocol w/o Contrast
$105.02EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$239.69GLUCOSE BLOOD TEST
$3.28HCG Qualitative Urine
$8.61Hemoglobin A1C
$9.71Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
$47.04Lipase Level
$6.89Lipid Panel
$13.39Phosphorus Level
$4.74Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04Thyroid Stimulating Hormone
$16.80Urinalysis Microscopic
$3.17US Carotid Duplex Bilateral
$239.69XR Chest
$87.42This 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.
Total estimated charges
$7,151.00Insurance Discount
-$6,800.54Price Negotiated by Insurer
$350.46Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$350.4683735 MAGNESIUM
$6.7085025 CBC W/AUTOMATED DIFFERENTIAL
$7.77Basic Metabolic Panel
$8.46Blood count; complete (CBC), automated
$6.47Blood Culture
$10.32CHED 96374- IV Injection, single/initial BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Routine ECG 12 lead/15 lead tracing only BCE
$59.26Comprehensive Metabolic Panel
$10.56CT Brain Stroke Protocol w/o Contrast
$105.02EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$239.69GLUCOSE BLOOD TEST
$3.28HCG Qualitative Urine
$8.61Hemoglobin A1C
$9.71Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
$47.04Lipase Level
$6.89Lipid Panel
$13.39Phosphorus Level
$4.74Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04Thyroid Stimulating Hormone
$16.80Urinalysis Microscopic
$3.17US Carotid Duplex Bilateral
$239.69XR Chest
$87.42This 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.
Total estimated charges
$7,151.00Insurance Discount
-$6,800.54Price Negotiated by Insurer
$350.46Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
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.
74177 CT ABDOMEN+PELVIS WITH CONTRAST
$350.4683735 MAGNESIUM
$6.7085025 CBC W/AUTOMATED DIFFERENTIAL
$7.77Basic Metabolic Panel
$8.46Blood count; complete (CBC), automated
$6.47Blood Culture
$10.32CHED 96374- IV Injection, single/initial BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Routine ECG 12 lead/15 lead tracing only BCE
$59.26Comprehensive Metabolic Panel
$10.56CT Brain Stroke Protocol w/o Contrast
$105.02EKG Charges - EKG -> Echocardiogram w/ Contrast 99307
$239.69GLUCOSE BLOOD TEST
$3.28HCG Qualitative Urine
$8.61Hemoglobin A1C
$9.71Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima
$47.04Lipase Level
$6.89Lipid Panel
$13.39Phosphorus Level
$4.74Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04Thyroid Stimulating Hormone
$16.80Urinalysis Microscopic
$3.17US Carotid Duplex Bilateral
$239.69XR Chest
$87.42This 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.