White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CARDIAC PACEMAKER DEVICE REPLACEMENT W/O MCC

Facility

$37,887.90

Service Code	MSDRG 259
Min. Negotiated Rate	$17,448.38
Max. Negotiated Rate	$37,887.90
Rate for Payer: BCBS of TX Blue Advantage	$18,034.20
Rate for Payer: BCBS of TX Blue Essentials	$21,638.94
Rate for Payer: BCBS of TX PPO	$24,044.20

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W CC

Facility

$36,305.20

Service Code	MSDRG 261
Min. Negotiated Rate	$16,719.50
Max. Negotiated Rate	$36,305.20
Rate for Payer: BCBS of TX Blue Advantage	$17,129.48
Rate for Payer: BCBS of TX Blue Essentials	$20,553.38
Rate for Payer: BCBS of TX PPO	$22,837.98

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC

Facility

$36,305.20

Service Code	MSDRG 261
Min. Negotiated Rate	$16,719.50
Max. Negotiated Rate	$36,305.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$18,615.61
Rate for Payer: Amerigroup Medicare	$18,615.61
Rate for Payer: BCBS of TX Medicare	$18,615.61
Rate for Payer: Cigna Commercial	$24,349.64
Rate for Payer: Cigna Medicare	$18,615.61
Rate for Payer: Employer Direct Commercial	$18,615.61
Rate for Payer: Humana Medicare/TRICARE	$18,615.61
Rate for Payer: Molina Dual Medicare/Medicaid	$18,615.61
Rate for Payer: Molina Medicare	$18,615.61
Rate for Payer: Multiplan Auto	$36,305.20
Rate for Payer: Multiplan Commercial	$36,305.20
Rate for Payer: Multiplan Workers Comp	$36,305.20
Rate for Payer: Scott and White EPO/PPO	$16,719.50
Rate for Payer: Scott and White Medicare	$18,615.61
Rate for Payer: Superior Health Plan EPO	$18,615.61
Rate for Payer: Superior Health Plan Medicare	$18,615.61
Rate for Payer: Universal American Dual Medicare/Medicaid	$18,615.61
Rate for Payer: Universal American Medicare	$18,615.61
Rate for Payer: Wellcare Medicare	$18,615.61
Rate for Payer: Wellmed Medicare	$18,615.61

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC

Facility

$66,473.40

Service Code	MSDRG 260
Min. Negotiated Rate	$28,599.94
Max. Negotiated Rate	$66,473.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$28,599.94
Rate for Payer: Amerigroup Medicare	$28,599.94
Rate for Payer: BCBS of TX Medicare	$28,599.94
Rate for Payer: Cigna Commercial	$41,896.06
Rate for Payer: Cigna Medicare	$28,599.94
Rate for Payer: Employer Direct Commercial	$28,599.94
Rate for Payer: Humana Medicare/TRICARE	$28,599.94
Rate for Payer: Molina Dual Medicare/Medicaid	$28,599.94
Rate for Payer: Molina Medicare	$28,599.94
Rate for Payer: Multiplan Auto	$66,473.40
Rate for Payer: Multiplan Commercial	$66,473.40
Rate for Payer: Multiplan Workers Comp	$66,473.40
Rate for Payer: Scott and White EPO/PPO	$30,612.75
Rate for Payer: Scott and White Medicare	$28,599.94
Rate for Payer: Superior Health Plan EPO	$28,599.94
Rate for Payer: Superior Health Plan Medicare	$28,599.94
Rate for Payer: Universal American Dual Medicare/Medicaid	$28,599.94
Rate for Payer: Universal American Medicare	$28,599.94
Rate for Payer: Wellcare Medicare	$28,599.94
Rate for Payer: Wellmed Medicare	$28,599.94

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC

Facility

$31,859.20

Service Code	MSDRG 262
Min. Negotiated Rate	$14,025.74
Max. Negotiated Rate	$31,859.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16,705.67
Rate for Payer: Amerigroup Medicare	$16,705.67
Rate for Payer: BCBS of TX Medicare	$16,705.67
Rate for Payer: Cigna Commercial	$20,993.11
Rate for Payer: Cigna Medicare	$16,705.67
Rate for Payer: Employer Direct Commercial	$16,705.67
Rate for Payer: Humana Medicare/TRICARE	$16,705.67
Rate for Payer: Molina Dual Medicare/Medicaid	$16,705.67
Rate for Payer: Molina Medicare	$16,705.67
Rate for Payer: Multiplan Auto	$31,859.20
Rate for Payer: Multiplan Commercial	$31,859.20
Rate for Payer: Multiplan Workers Comp	$31,859.20
Rate for Payer: Scott and White EPO/PPO	$14,672.00
Rate for Payer: Scott and White Medicare	$16,705.67
Rate for Payer: Superior Health Plan EPO	$16,705.67
Rate for Payer: Superior Health Plan Medicare	$16,705.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$16,705.67
Rate for Payer: Universal American Medicare	$16,705.67
Rate for Payer: Wellcare Medicare	$16,705.67
Rate for Payer: Wellmed Medicare	$16,705.67

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W MCC

Facility

$66,473.40

Service Code	MSDRG 260
Min. Negotiated Rate	$28,599.94
Max. Negotiated Rate	$66,473.40
Rate for Payer: BCBS of TX Blue Advantage	$31,127.70
Rate for Payer: BCBS of TX Blue Essentials	$37,349.62
Rate for Payer: BCBS of TX PPO	$41,501.19

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W/O CC/MCC

Facility

$31,859.20

Service Code	MSDRG 262
Min. Negotiated Rate	$14,025.74
Max. Negotiated Rate	$31,859.20
Rate for Payer: BCBS of TX Blue Advantage	$14,025.74
Rate for Payer: BCBS of TX Blue Essentials	$16,829.26
Rate for Payer: BCBS of TX PPO	$18,699.90

Cardiac Rehab Phase I Units

Facility

$186.00

Service Code	HCPCS 93799
Hospital Charge Code	1150309
Hospital Revenue Code	943
Rate for Payer: Cash Price	$126.48

Cardiac Rehab Phase I Units

Facility

$186.00

Service Code	HCPCS 93799
Hospital Charge Code	1150309
Hospital Revenue Code	943
Min. Negotiated Rate	$16.74
Max. Negotiated Rate	$273.24
Rate for Payer: Amerigroup CHIP/Medicaid	$16.74
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$129.26
Rate for Payer: Amerigroup Medicare	$129.26
Rate for Payer: BCBS of TX Blue Advantage	$55.80
Rate for Payer: BCBS of TX Blue Essentials	$66.96
Rate for Payer: BCBS of TX Medicare	$129.26
Rate for Payer: BCBS of TX PPO	$74.40
Rate for Payer: Cash Price	$126.48
Rate for Payer: Cash Price	$126.48
Rate for Payer: Cash Price	$126.48
Rate for Payer: Cigna Commercial	$273.24
Rate for Payer: Cigna Medicaid	$133.92
Rate for Payer: Cigna Medicare	$129.26
Rate for Payer: Employer Direct Commercial	$129.26
Rate for Payer: Humana Medicare/TRICARE	$129.26
Rate for Payer: Molina CHIP/Medicaid	$133.92
Rate for Payer: Molina Dual Medicare/Medicaid	$129.26
Rate for Payer: Molina Medicare	$129.26
Rate for Payer: Multiplan Auto	$120.90
Rate for Payer: Multiplan Commercial	$120.90
Rate for Payer: Multiplan Workers Comp	$120.90
Rate for Payer: Parkland Medicaid	$133.92
Rate for Payer: Scott and White EPO/PPO	$93.00
Rate for Payer: Scott and White Medicare	$129.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$133.92
Rate for Payer: Superior Health Plan EPO	$129.26
Rate for Payer: Superior Health Plan Medicare	$129.26
Rate for Payer: Universal American Dual Medicare/Medicaid	$129.26
Rate for Payer: Universal American Medicare	$129.26
Rate for Payer: Wellcare Medicare	$129.26
Rate for Payer: Wellmed Medicare	$129.26

CARDIAC REHAB PII W/ECG MNTR Units

Facility

$349.00

Service Code	HCPCS 93798
Hospital Charge Code	1100098
Hospital Revenue Code	943
Rate for Payer: Cash Price	$237.32

CARDIAC REHAB PII W/ECG MNTR Units

Facility

$349.00

Service Code	HCPCS 93798
Hospital Charge Code	1100098
Hospital Revenue Code	943
Min. Negotiated Rate	$16.43
Max. Negotiated Rate	$273.73
Rate for Payer: Amerigroup CHIP/Medicaid	$31.41
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$129.50
Rate for Payer: Amerigroup Medicare	$129.50
Rate for Payer: BCBS of TX Blue Advantage	$104.70
Rate for Payer: BCBS of TX Blue Essentials	$125.64
Rate for Payer: BCBS of TX Medicare	$129.50
Rate for Payer: BCBS of TX PPO	$139.60
Rate for Payer: Cash Price	$237.32
Rate for Payer: Cash Price	$237.32
Rate for Payer: Cash Price	$237.32
Rate for Payer: Cigna Commercial	$273.73
Rate for Payer: Cigna Medicaid	$251.28
Rate for Payer: Cigna Medicare	$129.50
Rate for Payer: Employer Direct Commercial	$129.50
Rate for Payer: Humana Medicare/TRICARE	$129.50
Rate for Payer: Molina CHIP/Medicaid	$251.28
Rate for Payer: Molina Dual Medicare/Medicaid	$129.50
Rate for Payer: Molina Medicare	$129.50
Rate for Payer: Multiplan Auto	$226.85
Rate for Payer: Multiplan Commercial	$226.85
Rate for Payer: Multiplan Workers Comp	$226.85
Rate for Payer: Parkland Medicaid	$251.28
Rate for Payer: Scott and White EPO/PPO	$16.43
Rate for Payer: Scott and White Medicare	$129.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$251.28
Rate for Payer: Superior Health Plan EPO	$129.50
Rate for Payer: Superior Health Plan Medicare	$129.50
Rate for Payer: Universal American Dual Medicare/Medicaid	$129.50
Rate for Payer: Universal American Medicare	$129.50
Rate for Payer: Wellcare Medicare	$129.50
Rate for Payer: Wellmed Medicare	$129.50

CARDIAC REHAB PII W/O ECG MTR Units

Facility

$291.00

Service Code	HCPCS 93797
Hospital Charge Code	1100114
Hospital Revenue Code	943
Min. Negotiated Rate	$10.69
Max. Negotiated Rate	$273.73
Rate for Payer: Amerigroup CHIP/Medicaid	$26.19
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$129.50
Rate for Payer: Amerigroup Medicare	$129.50
Rate for Payer: BCBS of TX Blue Advantage	$87.30
Rate for Payer: BCBS of TX Blue Essentials	$104.76
Rate for Payer: BCBS of TX Medicare	$129.50
Rate for Payer: BCBS of TX PPO	$116.40
Rate for Payer: Cash Price	$197.88
Rate for Payer: Cash Price	$197.88
Rate for Payer: Cash Price	$197.88
Rate for Payer: Cigna Commercial	$273.73
Rate for Payer: Cigna Medicaid	$209.52
Rate for Payer: Cigna Medicare	$129.50
Rate for Payer: Employer Direct Commercial	$129.50
Rate for Payer: Humana Medicare/TRICARE	$129.50
Rate for Payer: Molina CHIP/Medicaid	$209.52
Rate for Payer: Molina Dual Medicare/Medicaid	$129.50
Rate for Payer: Molina Medicare	$129.50
Rate for Payer: Multiplan Auto	$189.15
Rate for Payer: Multiplan Commercial	$189.15
Rate for Payer: Multiplan Workers Comp	$189.15
Rate for Payer: Parkland Medicaid	$209.52
Rate for Payer: Scott and White EPO/PPO	$10.69
Rate for Payer: Scott and White Medicare	$129.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$209.52
Rate for Payer: Superior Health Plan EPO	$129.50
Rate for Payer: Superior Health Plan Medicare	$129.50
Rate for Payer: Universal American Dual Medicare/Medicaid	$129.50
Rate for Payer: Universal American Medicare	$129.50
Rate for Payer: Wellcare Medicare	$129.50
Rate for Payer: Wellmed Medicare	$129.50

CARDIAC REHAB PII W/O ECG MTR Units

Facility

$291.00

Service Code	HCPCS 93797
Hospital Charge Code	1100114
Hospital Revenue Code	943
Rate for Payer: Cash Price	$197.88

CARDIAC STRUCTURAL AND VALVULAR DISORDERS

Facility

$13,383.42

Service Code	APR-DRG 2003
Min. Negotiated Rate	$12,618.36
Max. Negotiated Rate	$13,383.42
Rate for Payer: Amerigroup CHIP/Medicaid	$12,618.36
Rate for Payer: Cigna Medicaid	$12,618.36
Rate for Payer: Molina CHIP/Medicaid	$12,618.36
Rate for Payer: Parkland Medicaid	$12,618.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13,383.42

CARDIAC STRUCTURAL AND VALVULAR DISORDERS

Facility

$5,715.17

Service Code	APR-DRG 2001
Min. Negotiated Rate	$5,388.46
Max. Negotiated Rate	$5,715.17
Rate for Payer: Amerigroup CHIP/Medicaid	$5,388.46
Rate for Payer: Cigna Medicaid	$5,388.46
Rate for Payer: Molina CHIP/Medicaid	$5,388.46
Rate for Payer: Parkland Medicaid	$5,388.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,715.17

CARDIAC STRUCTURAL AND VALVULAR DISORDERS

Facility

$106,658.49

Service Code	APR-DRG 2004
Min. Negotiated Rate	$100,561.36
Max. Negotiated Rate	$106,658.49
Rate for Payer: Amerigroup CHIP/Medicaid	$100,561.36
Rate for Payer: Cigna Medicaid	$100,561.36
Rate for Payer: Molina CHIP/Medicaid	$100,561.36
Rate for Payer: Parkland Medicaid	$100,561.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$106,658.49

CARDIAC STRUCTURAL AND VALVULAR DISORDERS

Facility

$9,549.29

Service Code	APR-DRG 2002
Min. Negotiated Rate	$9,003.41
Max. Negotiated Rate	$9,549.29
Rate for Payer: Amerigroup CHIP/Medicaid	$9,003.41
Rate for Payer: Cigna Medicaid	$9,003.41
Rate for Payer: Molina CHIP/Medicaid	$9,003.41
Rate for Payer: Parkland Medicaid	$9,003.41
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,549.29

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC

Facility

$120,627.20

Service Code	MSDRG 217
Min. Negotiated Rate	$52,950.63
Max. Negotiated Rate	$120,627.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$52,950.63
Rate for Payer: Amerigroup Medicare	$52,950.63
Rate for Payer: BCBS of TX Medicare	$52,950.63
Rate for Payer: Cigna Commercial	$84,689.86
Rate for Payer: Cigna Medicare	$52,950.63
Rate for Payer: Employer Direct Commercial	$52,950.63
Rate for Payer: Humana Medicare/TRICARE	$52,950.63
Rate for Payer: Molina Dual Medicare/Medicaid	$52,950.63
Rate for Payer: Molina Medicare	$52,950.63
Rate for Payer: Multiplan Auto	$120,627.20
Rate for Payer: Multiplan Commercial	$120,627.20
Rate for Payer: Multiplan Workers Comp	$120,627.20
Rate for Payer: Scott and White EPO/PPO	$55,552.00
Rate for Payer: Scott and White Medicare	$52,950.63
Rate for Payer: Superior Health Plan EPO	$52,950.63
Rate for Payer: Superior Health Plan Medicare	$52,950.63
Rate for Payer: Universal American Dual Medicare/Medicaid	$52,950.63
Rate for Payer: Universal American Medicare	$52,950.63
Rate for Payer: Wellcare Medicare	$52,950.63
Rate for Payer: Wellmed Medicare	$52,950.63

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$185,096.10

Service Code	MSDRG 216
Min. Negotiated Rate	$76,458.48
Max. Negotiated Rate	$185,096.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$76,458.48
Rate for Payer: Amerigroup Medicare	$76,458.48
Rate for Payer: BCBS of TX Medicare	$76,458.48
Rate for Payer: Cigna Commercial	$126,002.46
Rate for Payer: Cigna Medicare	$76,458.48
Rate for Payer: Employer Direct Commercial	$76,458.48
Rate for Payer: Humana Medicare/TRICARE	$76,458.48
Rate for Payer: Molina Dual Medicare/Medicaid	$76,458.48
Rate for Payer: Molina Medicare	$76,458.48
Rate for Payer: Multiplan Auto	$185,096.10
Rate for Payer: Multiplan Commercial	$185,096.10
Rate for Payer: Multiplan Workers Comp	$185,096.10
Rate for Payer: Scott and White EPO/PPO	$85,241.62
Rate for Payer: Scott and White Medicare	$76,458.48
Rate for Payer: Superior Health Plan EPO	$76,458.48
Rate for Payer: Superior Health Plan Medicare	$76,458.48
Rate for Payer: Universal American Dual Medicare/Medicaid	$76,458.48
Rate for Payer: Universal American Medicare	$76,458.48
Rate for Payer: Wellcare Medicare	$76,458.48
Rate for Payer: Wellmed Medicare	$76,458.48

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$112,835.30

Service Code	MSDRG 218
Min. Negotiated Rate	$50,785.58
Max. Negotiated Rate	$112,835.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$52,950.63
Rate for Payer: Amerigroup Medicare	$52,950.63
Rate for Payer: BCBS of TX Medicare	$52,950.63
Rate for Payer: Cigna Commercial	$84,689.86
Rate for Payer: Cigna Medicare	$52,950.63
Rate for Payer: Employer Direct Commercial	$52,950.63
Rate for Payer: Humana Medicare/TRICARE	$52,950.63
Rate for Payer: Molina Dual Medicare/Medicaid	$52,950.63
Rate for Payer: Molina Medicare	$52,950.63
Rate for Payer: Multiplan Auto	$112,835.30
Rate for Payer: Multiplan Commercial	$112,835.30
Rate for Payer: Multiplan Workers Comp	$112,835.30
Rate for Payer: Scott and White EPO/PPO	$51,963.62
Rate for Payer: Scott and White Medicare	$52,950.63
Rate for Payer: Superior Health Plan EPO	$52,950.63
Rate for Payer: Superior Health Plan Medicare	$52,950.63
Rate for Payer: Universal American Dual Medicare/Medicaid	$52,950.63
Rate for Payer: Universal American Medicare	$52,950.63
Rate for Payer: Wellcare Medicare	$52,950.63
Rate for Payer: Wellmed Medicare	$52,950.63

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC

Facility

$103,266.90

Service Code	MSDRG 220
Min. Negotiated Rate	$43,844.31
Max. Negotiated Rate	$103,266.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$43,844.31
Rate for Payer: Amerigroup Medicare	$43,844.31
Rate for Payer: BCBS of TX Medicare	$43,844.31
Rate for Payer: Cigna Commercial	$68,686.46
Rate for Payer: Cigna Medicare	$43,844.31
Rate for Payer: Employer Direct Commercial	$43,844.31
Rate for Payer: Humana Medicare/TRICARE	$43,844.31
Rate for Payer: Molina Dual Medicare/Medicaid	$43,844.31
Rate for Payer: Molina Medicare	$43,844.31
Rate for Payer: Multiplan Auto	$103,266.90
Rate for Payer: Multiplan Commercial	$103,266.90
Rate for Payer: Multiplan Workers Comp	$103,266.90
Rate for Payer: Scott and White EPO/PPO	$47,557.12
Rate for Payer: Scott and White Medicare	$43,844.31
Rate for Payer: Superior Health Plan EPO	$43,844.31
Rate for Payer: Superior Health Plan Medicare	$43,844.31
Rate for Payer: Universal American Dual Medicare/Medicaid	$43,844.31
Rate for Payer: Universal American Medicare	$43,844.31
Rate for Payer: Wellcare Medicare	$43,844.31
Rate for Payer: Wellmed Medicare	$43,844.31

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$154,437.70

Service Code	MSDRG 219
Min. Negotiated Rate	$61,034.55
Max. Negotiated Rate	$154,437.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$61,034.55
Rate for Payer: Amerigroup Medicare	$61,034.55
Rate for Payer: BCBS of TX Medicare	$61,034.55
Rate for Payer: Cigna Commercial	$98,896.50
Rate for Payer: Cigna Medicare	$61,034.55
Rate for Payer: Employer Direct Commercial	$61,034.55
Rate for Payer: Humana Medicare/TRICARE	$61,034.55
Rate for Payer: Molina Dual Medicare/Medicaid	$61,034.55
Rate for Payer: Molina Medicare	$61,034.55
Rate for Payer: Multiplan Auto	$154,437.70
Rate for Payer: Multiplan Commercial	$154,437.70
Rate for Payer: Multiplan Workers Comp	$154,437.70
Rate for Payer: Scott and White EPO/PPO	$71,122.62
Rate for Payer: Scott and White Medicare	$61,034.55
Rate for Payer: Superior Health Plan EPO	$61,034.55
Rate for Payer: Superior Health Plan Medicare	$61,034.55
Rate for Payer: Universal American Dual Medicare/Medicaid	$61,034.55
Rate for Payer: Universal American Medicare	$61,034.55
Rate for Payer: Wellcare Medicare	$61,034.55
Rate for Payer: Wellmed Medicare	$61,034.55

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$89,900.40

Service Code	MSDRG 221
Min. Negotiated Rate	$39,623.64
Max. Negotiated Rate	$89,900.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$41,699.85
Rate for Payer: Amerigroup Medicare	$41,699.85
Rate for Payer: BCBS of TX Medicare	$41,699.85
Rate for Payer: Cigna Commercial	$64,917.78
Rate for Payer: Cigna Medicare	$41,699.85
Rate for Payer: Employer Direct Commercial	$41,699.85
Rate for Payer: Humana Medicare/TRICARE	$41,699.85
Rate for Payer: Molina Dual Medicare/Medicaid	$41,699.85
Rate for Payer: Molina Medicare	$41,699.85
Rate for Payer: Multiplan Auto	$89,900.40
Rate for Payer: Multiplan Commercial	$89,900.40
Rate for Payer: Multiplan Workers Comp	$89,900.40
Rate for Payer: Scott and White EPO/PPO	$41,401.50
Rate for Payer: Scott and White Medicare	$41,699.85
Rate for Payer: Superior Health Plan EPO	$41,699.85
Rate for Payer: Superior Health Plan Medicare	$41,699.85
Rate for Payer: Universal American Dual Medicare/Medicaid	$41,699.85
Rate for Payer: Universal American Medicare	$41,699.85
Rate for Payer: Wellcare Medicare	$41,699.85
Rate for Payer: Wellmed Medicare	$41,699.85

CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W CC

Facility

$120,627.20

Service Code	MSDRG 217
Min. Negotiated Rate	$52,950.63
Max. Negotiated Rate	$120,627.20
Rate for Payer: BCBS of TX Blue Advantage	$54,720.08
Rate for Payer: BCBS of TX Blue Essentials	$65,657.73
Rate for Payer: BCBS of TX PPO	$72,955.86

CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W MCC

Facility

$185,096.10

Service Code	MSDRG 216
Min. Negotiated Rate	$76,458.48
Max. Negotiated Rate	$185,096.10
Rate for Payer: BCBS of TX Blue Advantage	$84,459.74
Rate for Payer: BCBS of TX Blue Essentials	$101,341.87
Rate for Payer: BCBS of TX PPO	$112,606.44

Know your out-of-pocket cost for care.

All Charges