White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC

Facility

$17,316.60

Service Code	MSDRG 307
Min. Negotiated Rate	$7,361.60
Max. Negotiated Rate	$17,316.60
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	$17,316.60
Rate for Payer: Multiplan Commercial	$17,316.60
Rate for Payer: Multiplan Workers Comp	$17,316.60
Rate for Payer: Scott and White EPO/PPO	$7,974.75
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

$28,040.20

Service Code	MSDRG 306
Min. Negotiated Rate	$12,115.68
Max. Negotiated Rate	$28,040.20
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

$17,316.60

Service Code	MSDRG 307
Min. Negotiated Rate	$7,361.60
Max. Negotiated Rate	$17,316.60
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

$145,475.40

Service Code	MSDRG 222
Min. Negotiated Rate	$66,995.25
Max. Negotiated Rate	$145,475.40
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

$99,155.30

Service Code	MSDRG 223
Min. Negotiated Rate	$45,663.62
Max. Negotiated Rate	$99,155.30
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

$134,694.80

Service Code	MSDRG 224
Min. Negotiated Rate	$62,030.50
Max. Negotiated Rate	$134,694.80
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

$96,096.30

Service Code	MSDRG 225
Min. Negotiated Rate	$44,254.88
Max. Negotiated Rate	$96,096.30
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

$91,839.55

Service Code	MSDRG 275
Min. Negotiated Rate	$57,018.97
Max. Negotiated Rate	$91,839.55
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: 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 CARDIAC CATHETERIZATION WITH AMI, HF OR SHOCK WITH MCC

Facility

$145,475.40

Service Code	MSDRG 222
Min. Negotiated Rate	$66,995.25
Max. Negotiated Rate	$145,475.40
Rate for Payer: Multiplan Auto	$145,475.40
Rate for Payer: Multiplan Commercial	$145,475.40
Rate for Payer: Multiplan Workers Comp	$145,475.40
Rate for Payer: Scott and White EPO/PPO	$66,995.25

CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI, HF OR SHOCK WITHOUT MCC

Facility

$99,155.30

Service Code	MSDRG 223
Min. Negotiated Rate	$45,663.62
Max. Negotiated Rate	$99,155.30
Rate for Payer: Multiplan Auto	$99,155.30
Rate for Payer: Multiplan Commercial	$99,155.30
Rate for Payer: Multiplan Workers Comp	$99,155.30
Rate for Payer: Scott and White EPO/PPO	$45,663.62

CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITH MCC

Facility

$134,694.80

Service Code	MSDRG 224
Min. Negotiated Rate	$62,030.50
Max. Negotiated Rate	$134,694.80
Rate for Payer: Multiplan Auto	$134,694.80
Rate for Payer: Multiplan Commercial	$134,694.80
Rate for Payer: Multiplan Workers Comp	$134,694.80
Rate for Payer: Scott and White EPO/PPO	$62,030.50

CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITHOUT MCC

Facility

$96,096.30

Service Code	MSDRG 225
Min. Negotiated Rate	$44,254.88
Max. Negotiated Rate	$96,096.30
Rate for Payer: Multiplan Auto	$96,096.30
Rate for Payer: Multiplan Commercial	$96,096.30
Rate for Payer: Multiplan Workers Comp	$96,096.30
Rate for Payer: Scott and White EPO/PPO	$44,254.88

CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR

Facility

$77,365.01

Service Code	MSDRG 276
Min. Negotiated Rate	$48,782.60
Max. Negotiated Rate	$77,365.01
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: 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 CARDIAC CATHETERIZATION WITH MCC

Facility

$121,617.10

Service Code	MSDRG 226
Min. Negotiated Rate	$56,007.88
Max. Negotiated Rate	$121,617.10
Rate for Payer: Multiplan Auto	$121,617.10
Rate for Payer: Multiplan Commercial	$121,617.10
Rate for Payer: Multiplan Workers Comp	$121,617.10
Rate for Payer: Scott and White EPO/PPO	$56,007.88

CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$95,393.30

Service Code	MSDRG 227
Min. Negotiated Rate	$43,931.12
Max. Negotiated Rate	$95,393.30
Rate for Payer: Multiplan Auto	$95,393.30
Rate for Payer: Multiplan Commercial	$95,393.30
Rate for Payer: Multiplan Workers Comp	$95,393.30
Rate for Payer: Scott and White EPO/PPO	$43,931.12

CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC

Facility

$59,486.28

Service Code	MSDRG 277
Min. Negotiated Rate	$38,609.19
Max. Negotiated Rate	$59,486.28
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: 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

$121,617.10

Service Code	MSDRG 226
Min. Negotiated Rate	$56,007.88
Max. Negotiated Rate	$121,617.10
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

$95,393.30

Service Code	MSDRG 227
Min. Negotiated Rate	$43,931.12
Max. Negotiated Rate	$95,393.30
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

$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 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 DEVICE REPLACEMENT WITH MCC

Facility

$54,174.70

Service Code	MSDRG 258
Min. Negotiated Rate	$24,948.88
Max. Negotiated Rate	$54,174.70
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	$54,174.70
Rate for Payer: Multiplan Commercial	$54,174.70
Rate for Payer: Multiplan Workers Comp	$54,174.70
Rate for Payer: Scott and White EPO/PPO	$24,948.88
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

$37,887.90

Service Code	MSDRG 259
Min. Negotiated Rate	$17,448.38
Max. Negotiated Rate	$37,887.90
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	$37,887.90
Rate for Payer: Multiplan Commercial	$37,887.90
Rate for Payer: Multiplan Workers Comp	$37,887.90
Rate for Payer: Scott and White EPO/PPO	$17,448.38
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

$54,174.70

Service Code	MSDRG 258
Min. Negotiated Rate	$24,948.88
Max. Negotiated Rate	$54,174.70
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