CPT 46050
The standard charge for Incision and drainage, perianal abscess, superficial is $1,869.00. 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
$1,869.00Insurance Discount
-$1,700.79Price Negotiated by Insurer
$168.21Deductible 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
$312.0885025 CBC W/AUTOMATED DIFFERENTIAL
$3.03cefTRIAXone 500 mg Inj
$11.52CHED 96365- IV tx, first hour BCE
$27.00CHED 99285 - Level 5 BCE
$280.00CHED Pneum Initial Admin Charge 90471/G0009 BCE
$5.22Comprehensive Metabolic Panel
$4.12ferrous gluconate 324 mg (38 mg elemental iron) Tab
$0.72iodixanol 320 mg/mL Inj Soln 100 mL
$19.53ketorolac 15 mg/mL Inj Soln 1 mL
$11.52morphine 2 mg/mL Inj Soln 1 mL
$11.52ondansetron 2 mg/mL Inj Soln 2 mL
$11.52sterile water Inj Soln 10 mL
$11.54tetanus/diphth/pertussis (Adacel Tdap) IM Susp 0.5 mL
$12.84Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$29.70This 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
$1,869.00Insurance Discount
-$934.80Price Negotiated by Insurer
$934.20Deductible 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
$350.4685025 CBC W/AUTOMATED DIFFERENTIAL
$7.77CHED 96365- IV tx, first hour BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Pneum Initial Admin Charge 90471/G0009 BCE
$72.33Comprehensive Metabolic Panel
$10.56ketorolac 15 mg/mL Inj Soln 1 mL
$0.29Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04This 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
$1,869.00Insurance Discount
-$934.80Price Negotiated by Insurer
$934.20Deductible 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
$350.4685025 CBC W/AUTOMATED DIFFERENTIAL
$7.77CHED 96365- IV tx, first hour BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Pneum Initial Admin Charge 90471/G0009 BCE
$72.33Comprehensive Metabolic Panel
$10.56ketorolac 15 mg/mL Inj Soln 1 mL
$0.29Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04This 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
$1,869.00Insurance Discount
-$593.32Price Negotiated by Insurer
$1,275.68Deductible 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
$630.0585025 CBC W/AUTOMATED DIFFERENTIAL
$116.10cefTRIAXone 500 mg Inj
$3.67CHED 96365- IV tx, first hour BCE
$90.00CHED 99285 - Level 5 BCE
$2,640.00CHED Pneum Initial Admin Charge 90471/G0009 BCE
$17.40Comprehensive Metabolic Panel
$198.30ferrous gluconate 324 mg (38 mg elemental iron) Tab
$2.40iodixanol 320 mg/mL Inj Soln 100 mL
$0.46ketorolac 15 mg/mL Inj Soln 1 mL
$0.26morphine 2 mg/mL Inj Soln 1 mL
$12.04ondansetron 2 mg/mL Inj Soln 2 mL
$0.86sterile water Inj Soln 10 mL
$0.64tetanus/diphth/pertussis (Adacel Tdap) IM Susp 0.5 mL
$57.30Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$99.00This 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
$1,869.00Insurance Discount
-$341.24Price Negotiated by Insurer
$1,527.76Deductible 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
$756.0685025 CBC W/AUTOMATED DIFFERENTIAL
$139.32cefTRIAXone 500 mg Inj
$4.40CHED 96365- IV tx, first hour BCE
$108.00CHED 99285 - Level 5 BCE
$3,168.00CHED Pneum Initial Admin Charge 90471/G0009 BCE
$20.88Comprehensive Metabolic Panel
$237.96ferrous gluconate 324 mg (38 mg elemental iron) Tab
$2.88iodixanol 320 mg/mL Inj Soln 100 mL
$0.56ketorolac 15 mg/mL Inj Soln 1 mL
$0.31morphine 2 mg/mL Inj Soln 1 mL
$14.44ondansetron 2 mg/mL Inj Soln 2 mL
$1.03sterile water Inj Soln 10 mL
$0.77tetanus/diphth/pertussis (Adacel Tdap) IM Susp 0.5 mL
$68.76Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$118.80This 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
$1,869.00Insurance Discount
-$934.80Price Negotiated by Insurer
$934.20Deductible 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
$350.4685025 CBC W/AUTOMATED DIFFERENTIAL
$7.77CHED 96365- IV tx, first hour BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Pneum Initial Admin Charge 90471/G0009 BCE
$72.33Comprehensive Metabolic Panel
$10.56ketorolac 15 mg/mL Inj Soln 1 mL
$0.29Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04This 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
$1,869.00Price Negotiated by Insurer
$1,924.98Deductible 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
$843.8985025 CBC W/AUTOMATED DIFFERENTIAL
$154.80cefTRIAXone 500 mg Inj
$4.88CHED 96365- IV tx, first hour BCE
$120.00CHED 99285 - Level 5 BCE
$3,520.00CHED Pneum Initial Admin Charge 90471/G0009 BCE
$23.20Comprehensive Metabolic Panel
$264.40ferrous gluconate 324 mg (38 mg elemental iron) Tab
$3.20iodixanol 320 mg/mL Inj Soln 100 mL
$0.62ketorolac 15 mg/mL Inj Soln 1 mL
$0.35morphine 2 mg/mL Inj Soln 1 mL
$16.02ondansetron 2 mg/mL Inj Soln 2 mL
$1.14sterile water Inj Soln 10 mL
$0.85tetanus/diphth/pertussis (Adacel Tdap) IM Susp 0.5 mL
$76.27Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$132.00This 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
$1,869.00Insurance Discount
-$598.08Price Negotiated by Insurer
$1,270.92Deductible 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
$5,385.6085025 CBC W/AUTOMATED DIFFERENTIAL
$263.16cefTRIAXone 500 mg Inj
$87.04CHED 96365- IV tx, first hour BCE
$204.00CHED 99285 - Level 5 BCE
$2,067.20CHED Pneum Initial Admin Charge 90471/G0009 BCE
$39.44Comprehensive Metabolic Panel
$449.48ferrous gluconate 324 mg (38 mg elemental iron) Tab
$5.44iodixanol 320 mg/mL Inj Soln 100 mL
$147.56ketorolac 15 mg/mL Inj Soln 1 mL
$87.04morphine 2 mg/mL Inj Soln 1 mL
$87.04ondansetron 2 mg/mL Inj Soln 2 mL
$87.04sterile water Inj Soln 10 mL
$87.16tetanus/diphth/pertussis (Adacel Tdap) IM Susp 0.5 mL
$97.04Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$224.40This 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
$1,869.00Price Negotiated by Insurer
$1,974.73Deductible 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 96365- IV tx, first hour BCE
$451.67CHED 99285 - Level 5 BCE
$2,968.44CHED Pneum Initial Admin Charge 90471/G0009 BCE
$152.89Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$99.43This 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
$1,869.00Insurance Discount
-$523.32Price Negotiated by Insurer
$1,345.68Deductible 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
$5,702.4085025 CBC W/AUTOMATED DIFFERENTIAL
$278.64cefTRIAXone 500 mg Inj
$92.16CHED 96365- IV tx, first hour BCE
$216.00CHED 99285 - Level 5 BCE
$2,188.80CHED Pneum Initial Admin Charge 90471/G0009 BCE
$41.76Comprehensive Metabolic Panel
$475.92ferrous gluconate 324 mg (38 mg elemental iron) Tab
$5.76iodixanol 320 mg/mL Inj Soln 100 mL
$156.24ketorolac 15 mg/mL Inj Soln 1 mL
$92.16morphine 2 mg/mL Inj Soln 1 mL
$92.16ondansetron 2 mg/mL Inj Soln 2 mL
$92.16sterile water Inj Soln 10 mL
$92.28tetanus/diphth/pertussis (Adacel Tdap) IM Susp 0.5 mL
$102.74Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$237.60This 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
$1,869.00Insurance Discount
-$934.80Price Negotiated by Insurer
$934.20Deductible 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
$350.4685025 CBC W/AUTOMATED DIFFERENTIAL
$7.77CHED 96365- IV tx, first hour BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Pneum Initial Admin Charge 90471/G0009 BCE
$72.33Comprehensive Metabolic Panel
$10.56ketorolac 15 mg/mL Inj Soln 1 mL
$0.29Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04This 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
$1,869.00Insurance Discount
-$934.80Price Negotiated by Insurer
$934.20Deductible 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
$350.4685025 CBC W/AUTOMATED DIFFERENTIAL
$7.77CHED 96365- IV tx, first hour BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Pneum Initial Admin Charge 90471/G0009 BCE
$72.33Comprehensive Metabolic Panel
$10.56ketorolac 15 mg/mL Inj Soln 1 mL
$0.29Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04This 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
$1,869.00Insurance Discount
-$934.80Price Negotiated by Insurer
$934.20Deductible 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
$350.4685025 CBC W/AUTOMATED DIFFERENTIAL
$7.77CHED 96365- IV tx, first hour BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Pneum Initial Admin Charge 90471/G0009 BCE
$72.33Comprehensive Metabolic Panel
$10.56ketorolac 15 mg/mL Inj Soln 1 mL
$0.29Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04This 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
$1,869.00Insurance Discount
-$523.32Price Negotiated by Insurer
$1,345.68Deductible 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
$5,702.4085025 CBC W/AUTOMATED DIFFERENTIAL
$278.64cefTRIAXone 500 mg Inj
$92.16CHED 96365- IV tx, first hour BCE
$216.00CHED 99285 - Level 5 BCE
$2,188.80CHED Pneum Initial Admin Charge 90471/G0009 BCE
$41.76Comprehensive Metabolic Panel
$475.92ferrous gluconate 324 mg (38 mg elemental iron) Tab
$5.76iodixanol 320 mg/mL Inj Soln 100 mL
$156.24ketorolac 15 mg/mL Inj Soln 1 mL
$92.16morphine 2 mg/mL Inj Soln 1 mL
$92.16ondansetron 2 mg/mL Inj Soln 2 mL
$92.16sterile water Inj Soln 10 mL
$92.28tetanus/diphth/pertussis (Adacel Tdap) IM Susp 0.5 mL
$102.74Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$237.60This 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
$1,869.00Insurance Discount
-$934.80Price Negotiated by Insurer
$934.20Deductible 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
$350.4685025 CBC W/AUTOMATED DIFFERENTIAL
$7.77CHED 96365- IV tx, first hour BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Pneum Initial Admin Charge 90471/G0009 BCE
$72.33Comprehensive Metabolic Panel
$10.56ketorolac 15 mg/mL Inj Soln 1 mL
$0.29Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04This 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
$1,869.00Insurance Discount
-$934.80Price Negotiated by Insurer
$934.20Deductible 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
$350.4685025 CBC W/AUTOMATED DIFFERENTIAL
$7.77CHED 96365- IV tx, first hour BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Pneum Initial Admin Charge 90471/G0009 BCE
$72.33Comprehensive Metabolic Panel
$10.56ketorolac 15 mg/mL Inj Soln 1 mL
$0.29Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04This 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
$1,869.00Insurance Discount
-$654.15Price Negotiated by Insurer
$1,214.85Deductible 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
$5,148.0085025 CBC W/AUTOMATED DIFFERENTIAL
$251.55cefTRIAXone 500 mg Inj
$83.20CHED 96365- IV tx, first hour BCE
$195.00CHED 99285 - Level 5 BCE
$1,976.00CHED Pneum Initial Admin Charge 90471/G0009 BCE
$37.70Comprehensive Metabolic Panel
$429.65ferrous gluconate 324 mg (38 mg elemental iron) Tab
$5.20iodixanol 320 mg/mL Inj Soln 100 mL
$141.05ketorolac 15 mg/mL Inj Soln 1 mL
$83.20morphine 2 mg/mL Inj Soln 1 mL
$83.20ondansetron 2 mg/mL Inj Soln 2 mL
$83.20sterile water Inj Soln 10 mL
$83.31tetanus/diphth/pertussis (Adacel Tdap) IM Susp 0.5 mL
$92.75Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$214.50This 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
$1,869.00Insurance Discount
-$654.15Price Negotiated by Insurer
$1,214.85Deductible 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
$5,148.0085025 CBC W/AUTOMATED DIFFERENTIAL
$251.55cefTRIAXone 500 mg Inj
$83.20CHED 96365- IV tx, first hour BCE
$195.00CHED 99285 - Level 5 BCE
$1,976.00CHED Pneum Initial Admin Charge 90471/G0009 BCE
$37.70Comprehensive Metabolic Panel
$429.65ferrous gluconate 324 mg (38 mg elemental iron) Tab
$5.20iodixanol 320 mg/mL Inj Soln 100 mL
$141.05ketorolac 15 mg/mL Inj Soln 1 mL
$83.20morphine 2 mg/mL Inj Soln 1 mL
$83.20ondansetron 2 mg/mL Inj Soln 2 mL
$83.20sterile water Inj Soln 10 mL
$83.31tetanus/diphth/pertussis (Adacel Tdap) IM Susp 0.5 mL
$92.75Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$214.50This 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
$1,869.00Insurance Discount
-$654.15Price Negotiated by Insurer
$1,214.85Deductible 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
$5,148.0085025 CBC W/AUTOMATED DIFFERENTIAL
$251.55cefTRIAXone 500 mg Inj
$83.20CHED 96365- IV tx, first hour BCE
$195.00CHED 99285 - Level 5 BCE
$1,976.00CHED Pneum Initial Admin Charge 90471/G0009 BCE
$37.70Comprehensive Metabolic Panel
$429.65ferrous gluconate 324 mg (38 mg elemental iron) Tab
$5.20iodixanol 320 mg/mL Inj Soln 100 mL
$141.05ketorolac 15 mg/mL Inj Soln 1 mL
$83.20morphine 2 mg/mL Inj Soln 1 mL
$83.20ondansetron 2 mg/mL Inj Soln 2 mL
$83.20sterile water Inj Soln 10 mL
$83.31tetanus/diphth/pertussis (Adacel Tdap) IM Susp 0.5 mL
$92.75Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$214.50This 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
$1,869.00Insurance Discount
-$523.32Price Negotiated by Insurer
$1,345.68Deductible 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
$5,702.4085025 CBC W/AUTOMATED DIFFERENTIAL
$278.64cefTRIAXone 500 mg Inj
$92.16CHED 96365- IV tx, first hour BCE
$216.00CHED 99285 - Level 5 BCE
$2,188.80CHED Pneum Initial Admin Charge 90471/G0009 BCE
$41.76Comprehensive Metabolic Panel
$475.92ferrous gluconate 324 mg (38 mg elemental iron) Tab
$5.76iodixanol 320 mg/mL Inj Soln 100 mL
$156.24ketorolac 15 mg/mL Inj Soln 1 mL
$92.16morphine 2 mg/mL Inj Soln 1 mL
$92.16ondansetron 2 mg/mL Inj Soln 2 mL
$92.16sterile water Inj Soln 10 mL
$92.28tetanus/diphth/pertussis (Adacel Tdap) IM Susp 0.5 mL
$102.74Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$237.60This 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
$1,869.00Insurance Discount
-$934.50Price Negotiated by Insurer
$934.50Deductible 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
$3,960.0085025 CBC W/AUTOMATED DIFFERENTIAL
$9.71cefTRIAXone 500 mg Inj
$64.00CHED 96365- IV tx, first hour BCE
$150.00CHED 99285 - Level 5 BCE
$2,900.00CHED Pneum Initial Admin Charge 90471/G0009 BCE
$29.00Comprehensive Metabolic Panel
$13.20ferrous gluconate 324 mg (38 mg elemental iron) Tab
$4.00iodixanol 320 mg/mL Inj Soln 100 mL
$108.50ketorolac 15 mg/mL Inj Soln 1 mL
$64.00morphine 2 mg/mL Inj Soln 1 mL
$64.00ondansetron 2 mg/mL Inj Soln 2 mL
$64.00sterile water Inj Soln 10 mL
$64.08tetanus/diphth/pertussis (Adacel Tdap) IM Susp 0.5 mL
$71.35Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$165.00This 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
$1,869.00Insurance Discount
-$934.80Price Negotiated by Insurer
$934.20Deductible 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
$350.4685025 CBC W/AUTOMATED DIFFERENTIAL
$7.77CHED 96365- IV tx, first hour BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Pneum Initial Admin Charge 90471/G0009 BCE
$72.33Comprehensive Metabolic Panel
$10.56ketorolac 15 mg/mL Inj Soln 1 mL
$0.29Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04This 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
$1,869.00Insurance Discount
-$523.32Price Negotiated by Insurer
$1,345.68Deductible 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
$5,702.4085025 CBC W/AUTOMATED DIFFERENTIAL
$278.64cefTRIAXone 500 mg Inj
$92.16CHED 96365- IV tx, first hour BCE
$216.00CHED 99285 - Level 5 BCE
$2,188.80CHED Pneum Initial Admin Charge 90471/G0009 BCE
$41.76Comprehensive Metabolic Panel
$475.92ferrous gluconate 324 mg (38 mg elemental iron) Tab
$5.76iodixanol 320 mg/mL Inj Soln 100 mL
$156.24ketorolac 15 mg/mL Inj Soln 1 mL
$92.16morphine 2 mg/mL Inj Soln 1 mL
$92.16ondansetron 2 mg/mL Inj Soln 2 mL
$92.16sterile water Inj Soln 10 mL
$92.28tetanus/diphth/pertussis (Adacel Tdap) IM Susp 0.5 mL
$102.74Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$237.60This 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
$1,869.00Insurance Discount
-$934.80Price Negotiated by Insurer
$934.20Deductible 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
$350.4685025 CBC W/AUTOMATED DIFFERENTIAL
$7.77cefTRIAXone 500 mg Inj
$17.41CHED 96365- IV tx, first hour BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Pneum Initial Admin Charge 90471/G0009 BCE
$72.33Comprehensive Metabolic Panel
$10.56ferrous gluconate 324 mg (38 mg elemental iron) Tab
$1.09iodixanol 320 mg/mL Inj Soln 100 mL
$29.51ketorolac 15 mg/mL Inj Soln 1 mL
$0.29morphine 2 mg/mL Inj Soln 1 mL
$17.41ondansetron 2 mg/mL Inj Soln 2 mL
$17.41sterile water Inj Soln 10 mL
$17.43tetanus/diphth/pertussis (Adacel Tdap) IM Susp 0.5 mL
$19.41Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04This 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
$1,869.00Insurance Discount
-$934.80Price Negotiated by Insurer
$934.20Deductible 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
$350.4685025 CBC W/AUTOMATED DIFFERENTIAL
$7.77CHED 96365- IV tx, first hour BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Pneum Initial Admin Charge 90471/G0009 BCE
$72.33Comprehensive Metabolic Panel
$10.56ketorolac 15 mg/mL Inj Soln 1 mL
$0.29Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04This 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
$1,869.00Insurance Discount
-$934.80Price Negotiated by Insurer
$934.20Deductible 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
$350.4685025 CBC W/AUTOMATED DIFFERENTIAL
$7.77CHED 96365- IV tx, first hour BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Pneum Initial Admin Charge 90471/G0009 BCE
$72.33Comprehensive Metabolic Panel
$10.56ketorolac 15 mg/mL Inj Soln 1 mL
$0.29Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04This 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
$1,869.00Insurance Discount
-$934.80Price Negotiated by Insurer
$934.20Deductible 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
$350.4685025 CBC W/AUTOMATED DIFFERENTIAL
$7.77CHED 96365- IV tx, first hour BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Pneum Initial Admin Charge 90471/G0009 BCE
$72.33Comprehensive Metabolic Panel
$10.56ketorolac 15 mg/mL Inj Soln 1 mL
$0.29Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04This 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
$1,869.00Insurance Discount
-$934.80Price Negotiated by Insurer
$934.20Deductible 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
$350.4685025 CBC W/AUTOMATED DIFFERENTIAL
$7.77CHED 96365- IV tx, first hour BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Pneum Initial Admin Charge 90471/G0009 BCE
$72.33Comprehensive Metabolic Panel
$10.56ketorolac 15 mg/mL Inj Soln 1 mL
$0.29Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04This 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
$1,869.00Insurance Discount
-$934.80Price Negotiated by Insurer
$934.20Deductible 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
$350.4685025 CBC W/AUTOMATED DIFFERENTIAL
$7.77CHED 96365- IV tx, first hour BCE
$213.67CHED 99285 - Level 5 BCE
$598.24CHED Pneum Initial Admin Charge 90471/G0009 BCE
$72.33Comprehensive Metabolic Panel
$10.56ketorolac 15 mg/mL Inj Soln 1 mL
$0.29Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375
$47.04This 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.