White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE

Facility

$4,094.01

Service Code	APR-DRG 1911
Min. Negotiated Rate	$3,859.98
Max. Negotiated Rate	$4,094.01
Rate for Payer: Amerigroup CHIP/Medicaid	$3,859.98
Rate for Payer: Cigna Medicaid	$3,859.98
Rate for Payer: Molina CHIP/Medicaid	$3,859.98
Rate for Payer: Parkland Medicaid	$3,859.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,094.01

CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS

Facility

$10,708.40

Service Code	APR-DRG 1923
Min. Negotiated Rate	$10,096.25
Max. Negotiated Rate	$10,708.40
Rate for Payer: Amerigroup CHIP/Medicaid	$10,096.25
Rate for Payer: Cigna Medicaid	$10,096.25
Rate for Payer: Molina CHIP/Medicaid	$10,096.25
Rate for Payer: Parkland Medicaid	$10,096.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,708.40

CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS

Facility

$17,320.52

Service Code	APR-DRG 1924
Min. Negotiated Rate	$16,330.39
Max. Negotiated Rate	$17,320.52
Rate for Payer: Amerigroup CHIP/Medicaid	$16,330.39
Rate for Payer: Cigna Medicaid	$16,330.39
Rate for Payer: Molina CHIP/Medicaid	$16,330.39
Rate for Payer: Parkland Medicaid	$16,330.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17,320.52

CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS

Facility

$6,267.75

Service Code	APR-DRG 1922
Min. Negotiated Rate	$5,909.45
Max. Negotiated Rate	$6,267.75
Rate for Payer: Amerigroup CHIP/Medicaid	$5,909.45
Rate for Payer: Cigna Medicaid	$5,909.45
Rate for Payer: Molina CHIP/Medicaid	$5,909.45
Rate for Payer: Parkland Medicaid	$5,909.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,267.75

CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS

Facility

$5,826.82

Service Code	APR-DRG 1921
Min. Negotiated Rate	$5,493.73
Max. Negotiated Rate	$5,826.82
Rate for Payer: Amerigroup CHIP/Medicaid	$5,493.73
Rate for Payer: Cigna Medicaid	$5,493.73
Rate for Payer: Molina CHIP/Medicaid	$5,493.73
Rate for Payer: Parkland Medicaid	$5,493.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,826.82

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC

Facility

$29,940.20

Service Code	MSDRG 306
Min. Negotiated Rate	$12,115.68
Max. Negotiated Rate	$29,940.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16,309.15
Rate for Payer: Amerigroup Medicare	$16,309.15
Rate for Payer: BCBS of TX Medicare	$16,309.15
Rate for Payer: Cigna Commercial	$20,296.30
Rate for Payer: Cigna Medicare	$16,309.15
Rate for Payer: Employer Direct Commercial	$16,309.15
Rate for Payer: Humana Medicare/TRICARE	$16,309.15
Rate for Payer: Molina Dual Medicare/Medicaid	$16,309.15
Rate for Payer: Molina Medicare	$16,309.15
Rate for Payer: Multiplan Auto	$29,940.20
Rate for Payer: Multiplan Commercial	$29,940.20
Rate for Payer: Multiplan Workers Comp	$29,940.20
Rate for Payer: Scott and White EPO/PPO	$13,788.25
Rate for Payer: Scott and White Medicare	$16,309.15
Rate for Payer: Superior Health Plan EPO	$16,309.15
Rate for Payer: Superior Health Plan Medicare	$16,309.15
Rate for Payer: Universal American Dual Medicare/Medicaid	$16,309.15
Rate for Payer: Universal American Medicare	$16,309.15
Rate for Payer: Wellcare Medicare	$16,309.15
Rate for Payer: Wellmed Medicare	$16,309.15

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC

Facility

$17,350.80

Service Code	MSDRG 307
Min. Negotiated Rate	$7,361.60
Max. Negotiated Rate	$17,350.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,452.95
Rate for Payer: Amerigroup Medicare	$11,452.95
Rate for Payer: BCBS of TX Medicare	$11,452.95
Rate for Payer: Cigna Commercial	$11,762.02
Rate for Payer: Cigna Medicare	$11,452.95
Rate for Payer: Employer Direct Commercial	$11,452.95
Rate for Payer: Humana Medicare/TRICARE	$11,452.95
Rate for Payer: Molina Dual Medicare/Medicaid	$11,452.95
Rate for Payer: Molina Medicare	$11,452.95
Rate for Payer: Multiplan Auto	$17,350.80
Rate for Payer: Multiplan Commercial	$17,350.80
Rate for Payer: Multiplan Workers Comp	$17,350.80
Rate for Payer: Scott and White EPO/PPO	$7,990.50
Rate for Payer: Scott and White Medicare	$11,452.95
Rate for Payer: Superior Health Plan EPO	$11,452.95
Rate for Payer: Superior Health Plan Medicare	$11,452.95
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,452.95
Rate for Payer: Universal American Medicare	$11,452.95
Rate for Payer: Wellcare Medicare	$11,452.95
Rate for Payer: Wellmed Medicare	$11,452.95

CARDIAC CONGENITAL & VALVULAR DISORDERS W MCC

Facility

$29,940.20

Service Code	MSDRG 306
Min. Negotiated Rate	$12,115.68
Max. Negotiated Rate	$29,940.20
Rate for Payer: BCBS of TX Blue Advantage	$12,115.68
Rate for Payer: BCBS of TX Blue Essentials	$14,537.41
Rate for Payer: BCBS of TX PPO	$16,153.30

CARDIAC CONGENITAL & VALVULAR DISORDERS W/O MCC

Facility

$17,350.80

Service Code	MSDRG 307
Min. Negotiated Rate	$7,361.60
Max. Negotiated Rate	$17,350.80
Rate for Payer: BCBS of TX Blue Advantage	$7,361.60
Rate for Payer: BCBS of TX Blue Essentials	$8,833.06
Rate for Payer: BCBS of TX PPO	$9,814.90

CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W MCC

Facility

$93,301.14

Service Code	MSDRG 222
Min. Negotiated Rate	$69,979.92
Max. Negotiated Rate	$93,301.14
Rate for Payer: BCBS of TX Blue Advantage	$69,979.92
Rate for Payer: BCBS of TX Blue Essentials	$83,967.77
Rate for Payer: BCBS of TX PPO	$93,301.14

CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W/O MCC

Facility

$72,880.19

Service Code	MSDRG 223
Min. Negotiated Rate	$54,663.32
Max. Negotiated Rate	$72,880.19
Rate for Payer: BCBS of TX Blue Advantage	$54,663.32
Rate for Payer: BCBS of TX Blue Essentials	$65,589.63
Rate for Payer: BCBS of TX PPO	$72,880.19

CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W MCC

Facility

$85,131.61

Service Code	MSDRG 224
Min. Negotiated Rate	$63,852.42
Max. Negotiated Rate	$85,131.61
Rate for Payer: BCBS of TX Blue Advantage	$63,852.42
Rate for Payer: BCBS of TX Blue Essentials	$76,615.48
Rate for Payer: BCBS of TX PPO	$85,131.61

CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W/O MCC

Facility

$65,578.64

Service Code	MSDRG 225
Min. Negotiated Rate	$49,186.84
Max. Negotiated Rate	$65,578.64
Rate for Payer: BCBS of TX Blue Advantage	$49,186.84
Rate for Payer: BCBS of TX Blue Essentials	$59,018.49
Rate for Payer: BCBS of TX PPO	$65,578.64

CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC

Facility

$135,477.60

Service Code	MSDRG 275
Min. Negotiated Rate	$57,018.97
Max. Negotiated Rate	$135,477.60
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$57,018.97
Rate for Payer: Amerigroup Medicare	$57,018.97
Rate for Payer: BCBS of TX Medicare	$57,018.97
Rate for Payer: Cigna Commercial	$91,839.55
Rate for Payer: Cigna Medicare	$57,018.97
Rate for Payer: Employer Direct Commercial	$57,018.97
Rate for Payer: Humana Medicare/TRICARE	$57,018.97
Rate for Payer: Molina Dual Medicare/Medicaid	$57,018.97
Rate for Payer: Molina Medicare	$57,018.97
Rate for Payer: Multiplan Auto	$135,477.60
Rate for Payer: Multiplan Commercial	$135,477.60
Rate for Payer: Multiplan Workers Comp	$135,477.60
Rate for Payer: Scott and White EPO/PPO	$62,391.00
Rate for Payer: Scott and White Medicare	$57,018.97
Rate for Payer: Superior Health Plan EPO	$57,018.97
Rate for Payer: Superior Health Plan Medicare	$57,018.97
Rate for Payer: Universal American Dual Medicare/Medicaid	$57,018.97
Rate for Payer: Universal American Medicare	$57,018.97
Rate for Payer: Wellcare Medicare	$57,018.97
Rate for Payer: Wellmed Medicare	$57,018.97

CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR

Facility

$114,125.40

Service Code	MSDRG 276
Min. Negotiated Rate	$48,782.60
Max. Negotiated Rate	$114,125.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$48,782.60
Rate for Payer: Amerigroup Medicare	$48,782.60
Rate for Payer: BCBS of TX Medicare	$48,782.60
Rate for Payer: Cigna Commercial	$77,365.01
Rate for Payer: Cigna Medicare	$48,782.60
Rate for Payer: Employer Direct Commercial	$48,782.60
Rate for Payer: Humana Medicare/TRICARE	$48,782.60
Rate for Payer: Molina Dual Medicare/Medicaid	$48,782.60
Rate for Payer: Molina Medicare	$48,782.60
Rate for Payer: Multiplan Auto	$114,125.40
Rate for Payer: Multiplan Commercial	$114,125.40
Rate for Payer: Multiplan Workers Comp	$114,125.40
Rate for Payer: Scott and White EPO/PPO	$52,557.75
Rate for Payer: Scott and White Medicare	$48,782.60
Rate for Payer: Superior Health Plan EPO	$48,782.60
Rate for Payer: Superior Health Plan Medicare	$48,782.60
Rate for Payer: Universal American Dual Medicare/Medicaid	$48,782.60
Rate for Payer: Universal American Medicare	$48,782.60
Rate for Payer: Wellcare Medicare	$48,782.60
Rate for Payer: Wellmed Medicare	$48,782.60

CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC

Facility

$87,751.50

Service Code	MSDRG 277
Min. Negotiated Rate	$38,609.19
Max. Negotiated Rate	$87,751.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$38,609.19
Rate for Payer: Amerigroup Medicare	$38,609.19
Rate for Payer: BCBS of TX Medicare	$38,609.19
Rate for Payer: Cigna Commercial	$59,486.28
Rate for Payer: Cigna Medicare	$38,609.19
Rate for Payer: Employer Direct Commercial	$38,609.19
Rate for Payer: Humana Medicare/TRICARE	$38,609.19
Rate for Payer: Molina Dual Medicare/Medicaid	$38,609.19
Rate for Payer: Molina Medicare	$38,609.19
Rate for Payer: Multiplan Auto	$87,751.50
Rate for Payer: Multiplan Commercial	$87,751.50
Rate for Payer: Multiplan Workers Comp	$87,751.50
Rate for Payer: Scott and White EPO/PPO	$40,411.88
Rate for Payer: Scott and White Medicare	$38,609.19
Rate for Payer: Superior Health Plan EPO	$38,609.19
Rate for Payer: Superior Health Plan Medicare	$38,609.19
Rate for Payer: Universal American Dual Medicare/Medicaid	$38,609.19
Rate for Payer: Universal American Medicare	$38,609.19
Rate for Payer: Wellcare Medicare	$38,609.19
Rate for Payer: Wellmed Medicare	$38,609.19

CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W MCC

Facility

$78,177.48

Service Code	MSDRG 226
Min. Negotiated Rate	$58,636.52
Max. Negotiated Rate	$78,177.48
Rate for Payer: BCBS of TX Blue Advantage	$58,636.52
Rate for Payer: BCBS of TX Blue Essentials	$70,357.01
Rate for Payer: BCBS of TX PPO	$78,177.48

CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W/O MCC

Facility

$60,961.28

Service Code	MSDRG 227
Min. Negotiated Rate	$45,723.62
Max. Negotiated Rate	$60,961.28
Rate for Payer: BCBS of TX Blue Advantage	$45,723.62
Rate for Payer: BCBS of TX Blue Essentials	$54,863.03
Rate for Payer: BCBS of TX PPO	$60,961.28

CARDIAC PACEMAKER AND DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$18,887.74

Service Code	APR-DRG 1774
Min. Negotiated Rate	$17,808.02
Max. Negotiated Rate	$18,887.74
Rate for Payer: Amerigroup CHIP/Medicaid	$17,808.02
Rate for Payer: Cigna Medicaid	$17,808.02
Rate for Payer: Molina CHIP/Medicaid	$17,808.02
Rate for Payer: Parkland Medicaid	$17,808.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18,887.74

CARDIAC PACEMAKER AND DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$13,244.61

Service Code	APR-DRG 1773
Min. Negotiated Rate	$12,487.49
Max. Negotiated Rate	$13,244.61
Rate for Payer: Amerigroup CHIP/Medicaid	$12,487.49
Rate for Payer: Cigna Medicaid	$12,487.49
Rate for Payer: Molina CHIP/Medicaid	$12,487.49
Rate for Payer: Parkland Medicaid	$12,487.49
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13,244.61

CARDIAC PACEMAKER AND DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$5,416.81

Service Code	APR-DRG 1771
Min. Negotiated Rate	$5,107.16
Max. Negotiated Rate	$5,416.81
Rate for Payer: Amerigroup CHIP/Medicaid	$5,107.16
Rate for Payer: Cigna Medicaid	$5,107.16
Rate for Payer: Molina CHIP/Medicaid	$5,107.16
Rate for Payer: Parkland Medicaid	$5,107.16
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,416.81

CARDIAC PACEMAKER AND DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$9,330.90

Service Code	APR-DRG 1772
Min. Negotiated Rate	$8,797.50
Max. Negotiated Rate	$9,330.90
Rate for Payer: Amerigroup CHIP/Medicaid	$8,797.50
Rate for Payer: Cigna Medicaid	$8,797.50
Rate for Payer: Molina CHIP/Medicaid	$8,797.50
Rate for Payer: Parkland Medicaid	$8,797.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,330.90

CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC

Facility

$59,699.90

Service Code	MSDRG 258
Min. Negotiated Rate	$25,703.68
Max. Negotiated Rate	$59,699.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$27,788.62
Rate for Payer: Amerigroup Medicare	$27,788.62
Rate for Payer: BCBS of TX Medicare	$27,788.62
Rate for Payer: Cigna Commercial	$40,470.25
Rate for Payer: Cigna Medicare	$27,788.62
Rate for Payer: Employer Direct Commercial	$27,788.62
Rate for Payer: Humana Medicare/TRICARE	$27,788.62
Rate for Payer: Molina Dual Medicare/Medicaid	$27,788.62
Rate for Payer: Molina Medicare	$27,788.62
Rate for Payer: Multiplan Auto	$59,699.90
Rate for Payer: Multiplan Commercial	$59,699.90
Rate for Payer: Multiplan Workers Comp	$59,699.90
Rate for Payer: Scott and White EPO/PPO	$27,493.38
Rate for Payer: Scott and White Medicare	$27,788.62
Rate for Payer: Superior Health Plan EPO	$27,788.62
Rate for Payer: Superior Health Plan Medicare	$27,788.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$27,788.62
Rate for Payer: Universal American Medicare	$27,788.62
Rate for Payer: Wellcare Medicare	$27,788.62
Rate for Payer: Wellmed Medicare	$27,788.62

CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC

Facility

$38,419.90

Service Code	MSDRG 259
Min. Negotiated Rate	$17,693.38
Max. Negotiated Rate	$38,419.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$19,580.09
Rate for Payer: Amerigroup Medicare	$19,580.09
Rate for Payer: BCBS of TX Medicare	$19,580.09
Rate for Payer: Cigna Commercial	$26,044.65
Rate for Payer: Cigna Medicare	$19,580.09
Rate for Payer: Employer Direct Commercial	$19,580.09
Rate for Payer: Humana Medicare/TRICARE	$19,580.09
Rate for Payer: Molina Dual Medicare/Medicaid	$19,580.09
Rate for Payer: Molina Medicare	$19,580.09
Rate for Payer: Multiplan Auto	$38,419.90
Rate for Payer: Multiplan Commercial	$38,419.90
Rate for Payer: Multiplan Workers Comp	$38,419.90
Rate for Payer: Scott and White EPO/PPO	$17,693.38
Rate for Payer: Scott and White Medicare	$19,580.09
Rate for Payer: Superior Health Plan EPO	$19,580.09
Rate for Payer: Superior Health Plan Medicare	$19,580.09
Rate for Payer: Universal American Dual Medicare/Medicaid	$19,580.09
Rate for Payer: Universal American Medicare	$19,580.09
Rate for Payer: Wellcare Medicare	$19,580.09
Rate for Payer: Wellmed Medicare	$19,580.09

CARDIAC PACEMAKER DEVICE REPLACEMENT W MCC

Facility

$59,699.90

Service Code	MSDRG 258
Min. Negotiated Rate	$25,703.68
Max. Negotiated Rate	$59,699.90
Rate for Payer: BCBS of TX Blue Advantage	$25,703.68
Rate for Payer: BCBS of TX Blue Essentials	$30,841.43
Rate for Payer: BCBS of TX PPO	$34,269.58

Know your out-of-pocket cost for care.

All Charges