White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W/O 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: BCBS of TX Blue Advantage	$50,785.58
Rate for Payer: BCBS of TX Blue Essentials	$60,936.79
Rate for Payer: BCBS of TX PPO	$67,710.17

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

Facility

$103,266.90

Service Code	MSDRG 220
Min. Negotiated Rate	$43,844.31
Max. Negotiated Rate	$103,266.90
Rate for Payer: BCBS of TX Blue Advantage	$44,765.58
Rate for Payer: BCBS of TX Blue Essentials	$53,713.49
Rate for Payer: BCBS of TX PPO	$59,683.97

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

Facility

$154,437.70

Service Code	MSDRG 219
Min. Negotiated Rate	$61,034.55
Max. Negotiated Rate	$154,437.70
Rate for Payer: BCBS of TX Blue Advantage	$66,147.76
Rate for Payer: BCBS of TX Blue Essentials	$79,369.62
Rate for Payer: BCBS of TX PPO	$88,191.89

CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W/O 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: BCBS of TX Blue Advantage	$39,623.64
Rate for Payer: BCBS of TX Blue Essentials	$47,543.76
Rate for Payer: BCBS of TX PPO	$52,828.45

CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$71,297.40

Service Code	APR-DRG 1624
Min. Negotiated Rate	$67,221.68
Max. Negotiated Rate	$71,297.40
Rate for Payer: Amerigroup CHIP/Medicaid	$67,221.68
Rate for Payer: Cigna Medicaid	$67,221.68
Rate for Payer: Molina CHIP/Medicaid	$67,221.68
Rate for Payer: Parkland Medicaid	$67,221.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$71,297.40

CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$29,954.46

Service Code	APR-DRG 1622
Min. Negotiated Rate	$28,242.12
Max. Negotiated Rate	$29,954.46
Rate for Payer: Amerigroup CHIP/Medicaid	$28,242.12
Rate for Payer: Cigna Medicaid	$28,242.12
Rate for Payer: Molina CHIP/Medicaid	$28,242.12
Rate for Payer: Parkland Medicaid	$28,242.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$29,954.46

CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$40,115.18

Service Code	APR-DRG 1623
Min. Negotiated Rate	$37,822.00
Max. Negotiated Rate	$40,115.18
Rate for Payer: Amerigroup CHIP/Medicaid	$37,822.00
Rate for Payer: Cigna Medicaid	$37,822.00
Rate for Payer: Molina CHIP/Medicaid	$37,822.00
Rate for Payer: Parkland Medicaid	$37,822.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$40,115.18

CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$26,578.25

Service Code	APR-DRG 1621
Min. Negotiated Rate	$25,058.90
Max. Negotiated Rate	$26,578.25
Rate for Payer: Amerigroup CHIP/Medicaid	$25,058.90
Rate for Payer: Cigna Medicaid	$25,058.90
Rate for Payer: Molina CHIP/Medicaid	$25,058.90
Rate for Payer: Parkland Medicaid	$25,058.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$26,578.25

CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$42,492.60

Service Code	APR-DRG 1634
Min. Negotiated Rate	$40,063.52
Max. Negotiated Rate	$42,492.60
Rate for Payer: Amerigroup CHIP/Medicaid	$40,063.52
Rate for Payer: Cigna Medicaid	$40,063.52
Rate for Payer: Molina CHIP/Medicaid	$40,063.52
Rate for Payer: Parkland Medicaid	$40,063.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$42,492.60

CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$28,458.53

Service Code	APR-DRG 1633
Min. Negotiated Rate	$26,831.70
Max. Negotiated Rate	$28,458.53
Rate for Payer: Amerigroup CHIP/Medicaid	$26,831.70
Rate for Payer: Cigna Medicaid	$26,831.70
Rate for Payer: Molina CHIP/Medicaid	$26,831.70
Rate for Payer: Parkland Medicaid	$26,831.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$28,458.53

CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$21,068.27

Service Code	APR-DRG 1632
Min. Negotiated Rate	$19,863.90
Max. Negotiated Rate	$21,068.27
Rate for Payer: Amerigroup CHIP/Medicaid	$19,863.90
Rate for Payer: Cigna Medicaid	$19,863.90
Rate for Payer: Molina CHIP/Medicaid	$19,863.90
Rate for Payer: Parkland Medicaid	$19,863.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$21,068.27

CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$16,956.91

Service Code	APR-DRG 1631
Min. Negotiated Rate	$15,987.57
Max. Negotiated Rate	$16,956.91
Rate for Payer: Amerigroup CHIP/Medicaid	$15,987.57
Rate for Payer: Cigna Medicaid	$15,987.57
Rate for Payer: Molina CHIP/Medicaid	$15,987.57
Rate for Payer: Parkland Medicaid	$15,987.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,956.91

CARDIOMYOPATHY

Facility

$41,668.82

Service Code	APR-DRG 2054
Min. Negotiated Rate	$39,286.83
Max. Negotiated Rate	$41,668.82
Rate for Payer: Amerigroup CHIP/Medicaid	$39,286.83
Rate for Payer: Cigna Medicaid	$39,286.83
Rate for Payer: Molina CHIP/Medicaid	$39,286.83
Rate for Payer: Parkland Medicaid	$39,286.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$41,668.82

CARDIOMYOPATHY

Facility

$4,445.55

Service Code	APR-DRG 2053
Min. Negotiated Rate	$4,191.42
Max. Negotiated Rate	$4,445.55
Rate for Payer: Amerigroup CHIP/Medicaid	$4,191.42
Rate for Payer: Cigna Medicaid	$4,191.42
Rate for Payer: Molina CHIP/Medicaid	$4,191.42
Rate for Payer: Parkland Medicaid	$4,191.42
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,445.55

CARDIOMYOPATHY

Facility

$3,490.88

Service Code	APR-DRG 2052
Min. Negotiated Rate	$3,291.33
Max. Negotiated Rate	$3,490.88
Rate for Payer: Amerigroup CHIP/Medicaid	$3,291.33
Rate for Payer: Cigna Medicaid	$3,291.33
Rate for Payer: Molina CHIP/Medicaid	$3,291.33
Rate for Payer: Parkland Medicaid	$3,291.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,490.88

CARDIOMYOPATHY

Facility

$2,638.81

Service Code	APR-DRG 2051
Min. Negotiated Rate	$2,487.97
Max. Negotiated Rate	$2,638.81
Rate for Payer: Amerigroup CHIP/Medicaid	$2,487.97
Rate for Payer: Cigna Medicaid	$2,487.97
Rate for Payer: Molina CHIP/Medicaid	$2,487.97
Rate for Payer: Parkland Medicaid	$2,487.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,638.81

CAROTID ARTERY STENT PROCEDURES WITH CC

Facility

$43,392.20

Service Code	MSDRG 035
Min. Negotiated Rate	$19,094.58
Max. Negotiated Rate	$43,392.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$22,280.11
Rate for Payer: Amerigroup Medicare	$22,280.11
Rate for Payer: BCBS of TX Medicare	$22,280.11
Rate for Payer: Cigna Commercial	$30,789.64
Rate for Payer: Cigna Medicare	$22,280.11
Rate for Payer: Employer Direct Commercial	$22,280.11
Rate for Payer: Humana Medicare/TRICARE	$22,280.11
Rate for Payer: Molina Dual Medicare/Medicaid	$22,280.11
Rate for Payer: Molina Medicare	$22,280.11
Rate for Payer: Multiplan Auto	$43,392.20
Rate for Payer: Multiplan Commercial	$43,392.20
Rate for Payer: Multiplan Workers Comp	$43,392.20
Rate for Payer: Scott and White EPO/PPO	$19,983.25
Rate for Payer: Scott and White Medicare	$22,280.11
Rate for Payer: Superior Health Plan EPO	$22,280.11
Rate for Payer: Superior Health Plan Medicare	$22,280.11
Rate for Payer: Universal American Dual Medicare/Medicaid	$22,280.11
Rate for Payer: Universal American Medicare	$22,280.11
Rate for Payer: Wellcare Medicare	$22,280.11
Rate for Payer: Wellmed Medicare	$22,280.11

CAROTID ARTERY STENT PROCEDURES WITH MCC

Facility

$75,988.60

Service Code	MSDRG 034
Min. Negotiated Rate	$30,958.28
Max. Negotiated Rate	$75,988.60
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$33,128.55
Rate for Payer: Amerigroup Medicare	$33,128.55
Rate for Payer: BCBS of TX Medicare	$33,128.55
Rate for Payer: Cigna Commercial	$49,854.62
Rate for Payer: Cigna Medicare	$33,128.55
Rate for Payer: Employer Direct Commercial	$33,128.55
Rate for Payer: Humana Medicare/TRICARE	$33,128.55
Rate for Payer: Molina Dual Medicare/Medicaid	$33,128.55
Rate for Payer: Molina Medicare	$33,128.55
Rate for Payer: Multiplan Auto	$75,988.60
Rate for Payer: Multiplan Commercial	$75,988.60
Rate for Payer: Multiplan Workers Comp	$75,988.60
Rate for Payer: Scott and White EPO/PPO	$34,994.75
Rate for Payer: Scott and White Medicare	$33,128.55
Rate for Payer: Superior Health Plan EPO	$33,128.55
Rate for Payer: Superior Health Plan Medicare	$33,128.55
Rate for Payer: Universal American Dual Medicare/Medicaid	$33,128.55
Rate for Payer: Universal American Medicare	$33,128.55
Rate for Payer: Wellcare Medicare	$33,128.55
Rate for Payer: Wellmed Medicare	$33,128.55

CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC

Facility

$35,733.30

Service Code	MSDRG 036
Min. Negotiated Rate	$14,843.60
Max. Negotiated Rate	$35,733.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$18,998.91
Rate for Payer: Amerigroup Medicare	$18,998.91
Rate for Payer: BCBS of TX Medicare	$18,998.91
Rate for Payer: Cigna Commercial	$25,023.26
Rate for Payer: Cigna Medicare	$18,998.91
Rate for Payer: Employer Direct Commercial	$18,998.91
Rate for Payer: Humana Medicare/TRICARE	$18,998.91
Rate for Payer: Molina Dual Medicare/Medicaid	$18,998.91
Rate for Payer: Molina Medicare	$18,998.91
Rate for Payer: Multiplan Auto	$35,733.30
Rate for Payer: Multiplan Commercial	$35,733.30
Rate for Payer: Multiplan Workers Comp	$35,733.30
Rate for Payer: Scott and White EPO/PPO	$16,456.12
Rate for Payer: Scott and White Medicare	$18,998.91
Rate for Payer: Superior Health Plan EPO	$18,998.91
Rate for Payer: Superior Health Plan Medicare	$18,998.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$18,998.91
Rate for Payer: Universal American Medicare	$18,998.91
Rate for Payer: Wellcare Medicare	$18,998.91
Rate for Payer: Wellmed Medicare	$18,998.91

CAROTID ARTERY STENT PROCEDURE W CC

Facility

$43,392.20

Service Code	MSDRG 035
Min. Negotiated Rate	$19,094.58
Max. Negotiated Rate	$43,392.20
Rate for Payer: BCBS of TX Blue Advantage	$19,094.58
Rate for Payer: BCBS of TX Blue Essentials	$22,911.28
Rate for Payer: BCBS of TX PPO	$25,457.96

CAROTID ARTERY STENT PROCEDURE W MCC

Facility

$75,988.60

Service Code	MSDRG 034
Min. Negotiated Rate	$30,958.28
Max. Negotiated Rate	$75,988.60
Rate for Payer: BCBS of TX Blue Advantage	$30,958.28
Rate for Payer: BCBS of TX Blue Essentials	$37,146.34
Rate for Payer: BCBS of TX PPO	$41,275.31

CAROTID ARTERY STENT PROCEDURE W/O CC/MCC

Facility

$35,733.30

Service Code	MSDRG 036
Min. Negotiated Rate	$14,843.60
Max. Negotiated Rate	$35,733.30
Rate for Payer: BCBS of TX Blue Advantage	$14,843.60
Rate for Payer: BCBS of TX Blue Essentials	$17,810.59
Rate for Payer: BCBS of TX PPO	$19,790.32

Carpal tunnel surgery

Facility

$10,526.34

Service Code	HCPCS 64721
Hospital Charge Code	9900842
Hospital Revenue Code	360
Min. Negotiated Rate	$659.94
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$659.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Amerigroup Medicare	$1,961.62
Rate for Payer: BCBS of TX Blue Advantage	$2,871.31
Rate for Payer: BCBS of TX Blue Essentials	$3,438.70
Rate for Payer: BCBS of TX Medicare	$1,961.62
Rate for Payer: BCBS of TX PPO	$4,332.76
Rate for Payer: Cash Price	$7,157.91
Rate for Payer: Cash Price	$7,157.91
Rate for Payer: Cash Price	$7,157.91
Rate for Payer: Cigna Commercial	$4,146.52
Rate for Payer: Cigna Medicaid	$7,578.96
Rate for Payer: Cigna Medicare	$1,961.62
Rate for Payer: Employer Direct Commercial	$1,961.62
Rate for Payer: Humana Medicare/TRICARE	$1,961.62
Rate for Payer: Molina CHIP/Medicaid	$7,578.96
Rate for Payer: Molina Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Molina Medicare	$1,961.62
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$7,578.96
Rate for Payer: Scott and White EPO/PPO	$3,266.71
Rate for Payer: Scott and White Medicare	$1,961.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,578.96
Rate for Payer: Superior Health Plan EPO	$1,961.62
Rate for Payer: Superior Health Plan Medicare	$1,961.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Universal American Medicare	$1,961.62
Rate for Payer: Wellcare Medicare	$1,961.62
Rate for Payer: Wellmed Medicare	$1,961.62

Carpal tunnel surgery

Facility

$10,000.00

Service Code	CPT 64721
Hospital Charge Code	36064721
Hospital Revenue Code	360
Min. Negotiated Rate	$659.94
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$659.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Amerigroup Medicare	$1,961.62
Rate for Payer: BCBS of TX Blue Advantage	$2,871.31
Rate for Payer: BCBS of TX Blue Essentials	$3,438.70
Rate for Payer: BCBS of TX Medicare	$1,961.62
Rate for Payer: BCBS of TX PPO	$4,332.76
Rate for Payer: Cigna Commercial	$4,146.52
Rate for Payer: Cigna Medicare	$1,961.62
Rate for Payer: Employer Direct Commercial	$1,961.62
Rate for Payer: Humana Medicare/TRICARE	$1,961.62
Rate for Payer: Molina Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Molina Medicare	$1,961.62
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Scott and White EPO/PPO	$3,266.71
Rate for Payer: Scott and White Medicare	$1,961.62
Rate for Payer: Superior Health Plan EPO	$1,961.62
Rate for Payer: Superior Health Plan Medicare	$1,961.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,961.62
Rate for Payer: Universal American Medicare	$1,961.62
Rate for Payer: Wellcare Medicare	$1,961.62
Rate for Payer: Wellmed Medicare	$1,961.62

Carpal tunnel surgery

Facility

$10,526.34

Service Code	HCPCS 64721
Hospital Charge Code	9900842
Hospital Revenue Code	360
Rate for Payer: Cash Price	$7,157.91

Know your out-of-pocket cost for care.

All Charges