White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC

Facility

$38,057.00

Service Code	MSDRG 064
Min. Negotiated Rate	$15,065.48
Max. Negotiated Rate	$38,057.00
Rate for Payer: Aetna Commercial	$22,533.75
Rate for Payer: Aetna Medicare	$25,722.48
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$17,148.32
Rate for Payer: Amerigroup Medicare	$17,148.32
Rate for Payer: BCBS of TX Blue Advantage	$15,065.48
Rate for Payer: BCBS of TX Blue Essentials	$19,288.27
Rate for Payer: BCBS of TX Medicare	$17,148.32
Rate for Payer: BCBS of TX PPO	$21,432.25
Rate for Payer: Cigna Commercial	$25,798.64
Rate for Payer: Cigna Medicare	$17,148.32
Rate for Payer: Employer Direct Commercial	$17,148.32
Rate for Payer: Humana Medicare/TRICARE	$17,148.32
Rate for Payer: Molina Dual Medicare/Medicaid	$17,148.32
Rate for Payer: Molina Medicare	$17,148.32
Rate for Payer: Multiplan Auto	$38,057.00
Rate for Payer: Multiplan Commercial	$38,057.00
Rate for Payer: Multiplan Workers Comp	$38,057.00
Rate for Payer: Scott and White EPO/PPO	$17,526.25
Rate for Payer: Scott and White Medicare	$17,148.32
Rate for Payer: Superior Health Plan EPO	$17,148.32
Rate for Payer: Superior Health Plan Medicare	$17,148.32
Rate for Payer: Universal American Dual Medicare/Medicaid	$17,148.32
Rate for Payer: Universal American Medicare	$17,148.32
Rate for Payer: Wellcare Medicare	$17,148.32
Rate for Payer: Wellmed Medicare	$17,148.32

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC

Facility

$13,062.50

Service Code	MSDRG 066
Min. Negotiated Rate	$6,015.62
Max. Negotiated Rate	$13,062.50
Rate for Payer: Aetna Commercial	$7,734.38
Rate for Payer: Aetna Medicare	$11,641.24
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,760.83
Rate for Payer: Amerigroup Medicare	$7,760.83
Rate for Payer: BCBS of TX Blue Advantage	$6,419.04
Rate for Payer: BCBS of TX Blue Essentials	$7,499.85
Rate for Payer: BCBS of TX Medicare	$7,760.83
Rate for Payer: BCBS of TX PPO	$8,333.49
Rate for Payer: Cigna Commercial	$8,855.00
Rate for Payer: Cigna Medicare	$7,760.83
Rate for Payer: Employer Direct Commercial	$7,760.83
Rate for Payer: Humana Medicare/TRICARE	$7,760.83
Rate for Payer: Molina Dual Medicare/Medicaid	$7,760.83
Rate for Payer: Molina Medicare	$7,760.83
Rate for Payer: Multiplan Auto	$13,062.50
Rate for Payer: Multiplan Commercial	$13,062.50
Rate for Payer: Multiplan Workers Comp	$13,062.50
Rate for Payer: Scott and White EPO/PPO	$6,015.62
Rate for Payer: Scott and White Medicare	$7,760.83
Rate for Payer: Superior Health Plan EPO	$7,760.83
Rate for Payer: Superior Health Plan Medicare	$7,760.83
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,760.83
Rate for Payer: Universal American Medicare	$7,760.83
Rate for Payer: Wellcare Medicare	$7,760.83
Rate for Payer: Wellmed Medicare	$7,760.83

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC

Facility

$116,686.60

Service Code	MSDRG 021
Min. Negotiated Rate	$46,680.18
Max. Negotiated Rate	$116,686.60
Rate for Payer: Aetna Commercial	$69,090.75
Rate for Payer: Aetna Medicare	$70,020.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$46,680.18
Rate for Payer: Amerigroup Medicare	$46,680.18
Rate for Payer: BCBS of TX Blue Advantage	$62,702.60
Rate for Payer: BCBS of TX Blue Essentials	$81,577.89
Rate for Payer: BCBS of TX Medicare	$46,680.18
Rate for Payer: BCBS of TX PPO	$90,645.61
Rate for Payer: Cigna Commercial	$79,101.23
Rate for Payer: Cigna Medicare	$46,680.18
Rate for Payer: Employer Direct Commercial	$46,680.18
Rate for Payer: Humana Medicare/TRICARE	$46,680.18
Rate for Payer: Molina Dual Medicare/Medicaid	$46,680.18
Rate for Payer: Molina Medicare	$46,680.18
Rate for Payer: Multiplan Auto	$116,686.60
Rate for Payer: Multiplan Commercial	$116,686.60
Rate for Payer: Multiplan Workers Comp	$116,686.60
Rate for Payer: Scott and White EPO/PPO	$53,737.25
Rate for Payer: Scott and White Medicare	$46,680.18
Rate for Payer: Superior Health Plan EPO	$46,680.18
Rate for Payer: Superior Health Plan Medicare	$46,680.18
Rate for Payer: Universal American Dual Medicare/Medicaid	$46,680.18
Rate for Payer: Universal American Medicare	$46,680.18
Rate for Payer: Wellcare Medicare	$46,680.18
Rate for Payer: Wellmed Medicare	$46,680.18

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC

Facility

$160,595.60

Service Code	MSDRG 020
Min. Negotiated Rate	$63,171.62
Max. Negotiated Rate	$160,595.60
Rate for Payer: Aetna Commercial	$95,089.50
Rate for Payer: Aetna Medicare	$94,757.43
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$63,171.62
Rate for Payer: Amerigroup Medicare	$63,171.62
Rate for Payer: BCBS of TX Blue Advantage	$83,465.58
Rate for Payer: BCBS of TX Blue Essentials	$107,578.67
Rate for Payer: BCBS of TX Medicare	$63,171.62
Rate for Payer: BCBS of TX PPO	$119,536.49
Rate for Payer: Cigna Commercial	$108,866.91
Rate for Payer: Cigna Medicare	$63,171.62
Rate for Payer: Employer Direct Commercial	$63,171.62
Rate for Payer: Humana Medicare/TRICARE	$63,171.62
Rate for Payer: Molina Dual Medicare/Medicaid	$63,171.62
Rate for Payer: Molina Medicare	$63,171.62
Rate for Payer: Multiplan Auto	$160,595.60
Rate for Payer: Multiplan Commercial	$160,595.60
Rate for Payer: Multiplan Workers Comp	$160,595.60
Rate for Payer: Scott and White EPO/PPO	$73,958.50
Rate for Payer: Scott and White Medicare	$63,171.62
Rate for Payer: Superior Health Plan EPO	$63,171.62
Rate for Payer: Superior Health Plan Medicare	$63,171.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$63,171.62
Rate for Payer: Universal American Medicare	$63,171.62
Rate for Payer: Wellcare Medicare	$63,171.62
Rate for Payer: Wellmed Medicare	$63,171.62

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC

Facility

$66,057.30

Service Code	MSDRG 022
Min. Negotiated Rate	$30,421.12
Max. Negotiated Rate	$66,057.30
Rate for Payer: Aetna Commercial	$39,112.88
Rate for Payer: Aetna Medicare	$46,271.12
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$30,847.41
Rate for Payer: Amerigroup Medicare	$30,847.41
Rate for Payer: BCBS of TX Blue Advantage	$39,641.70
Rate for Payer: BCBS of TX Blue Essentials	$53,220.24
Rate for Payer: BCBS of TX Medicare	$30,847.41
Rate for Payer: BCBS of TX PPO	$59,135.90
Rate for Payer: Cigna Commercial	$44,779.90
Rate for Payer: Cigna Medicare	$30,847.41
Rate for Payer: Employer Direct Commercial	$30,847.41
Rate for Payer: Humana Medicare/TRICARE	$30,847.41
Rate for Payer: Molina Dual Medicare/Medicaid	$30,847.41
Rate for Payer: Molina Medicare	$30,847.41
Rate for Payer: Multiplan Auto	$66,057.30
Rate for Payer: Multiplan Commercial	$66,057.30
Rate for Payer: Multiplan Workers Comp	$66,057.30
Rate for Payer: Scott and White EPO/PPO	$30,421.12
Rate for Payer: Scott and White Medicare	$30,847.41
Rate for Payer: Superior Health Plan EPO	$30,847.41
Rate for Payer: Superior Health Plan Medicare	$30,847.41
Rate for Payer: Universal American Dual Medicare/Medicaid	$30,847.41
Rate for Payer: Universal American Medicare	$30,847.41
Rate for Payer: Wellcare Medicare	$30,847.41
Rate for Payer: Wellmed Medicare	$30,847.41

INTRAOCULAR PROCEDURES WITH CC/MCC

Facility

$34,785.20

Service Code	MSDRG 116
Min. Negotiated Rate	$13,559.62
Max. Negotiated Rate	$34,785.20
Rate for Payer: Aetna Commercial	$20,596.50
Rate for Payer: Aetna Medicare	$23,879.24
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15,919.49
Rate for Payer: Amerigroup Medicare	$15,919.49
Rate for Payer: BCBS of TX Blue Advantage	$13,559.62
Rate for Payer: BCBS of TX Blue Essentials	$17,624.85
Rate for Payer: BCBS of TX Medicare	$15,919.49
Rate for Payer: BCBS of TX PPO	$19,583.93
Rate for Payer: Cigna Commercial	$23,580.70
Rate for Payer: Cigna Medicare	$15,919.49
Rate for Payer: Employer Direct Commercial	$15,919.49
Rate for Payer: Humana Medicare/TRICARE	$15,919.49
Rate for Payer: Molina Dual Medicare/Medicaid	$15,919.49
Rate for Payer: Molina Medicare	$15,919.49
Rate for Payer: Multiplan Auto	$34,785.20
Rate for Payer: Multiplan Commercial	$34,785.20
Rate for Payer: Multiplan Workers Comp	$34,785.20
Rate for Payer: Scott and White EPO/PPO	$16,019.50
Rate for Payer: Scott and White Medicare	$15,919.49
Rate for Payer: Superior Health Plan EPO	$15,919.49
Rate for Payer: Superior Health Plan Medicare	$15,919.49
Rate for Payer: Universal American Dual Medicare/Medicaid	$15,919.49
Rate for Payer: Universal American Medicare	$15,919.49
Rate for Payer: Wellcare Medicare	$15,919.49
Rate for Payer: Wellmed Medicare	$15,919.49

INTRAOCULAR PROCEDURES WITHOUT CC/MCC

Facility

$22,769.60

Service Code	MSDRG 117
Min. Negotiated Rate	$7,328.06
Max. Negotiated Rate	$22,769.60
Rate for Payer: Aetna Commercial	$13,482.00
Rate for Payer: Aetna Medicare	$17,109.94
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,406.63
Rate for Payer: Amerigroup Medicare	$11,406.63
Rate for Payer: BCBS of TX Blue Advantage	$7,328.06
Rate for Payer: BCBS of TX Blue Essentials	$10,344.80
Rate for Payer: BCBS of TX Medicare	$11,406.63
Rate for Payer: BCBS of TX PPO	$11,494.66
Rate for Payer: Cigna Commercial	$15,435.39
Rate for Payer: Cigna Medicare	$11,406.63
Rate for Payer: Employer Direct Commercial	$11,406.63
Rate for Payer: Humana Medicare/TRICARE	$11,406.63
Rate for Payer: Molina Dual Medicare/Medicaid	$11,406.63
Rate for Payer: Molina Medicare	$11,406.63
Rate for Payer: Multiplan Auto	$22,769.60
Rate for Payer: Multiplan Commercial	$22,769.60
Rate for Payer: Multiplan Workers Comp	$22,769.60
Rate for Payer: Scott and White EPO/PPO	$10,486.00
Rate for Payer: Scott and White Medicare	$11,406.63
Rate for Payer: Superior Health Plan EPO	$11,406.63
Rate for Payer: Superior Health Plan Medicare	$11,406.63
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,406.63
Rate for Payer: Universal American Medicare	$11,406.63
Rate for Payer: Wellcare Medicare	$11,406.63
Rate for Payer: Wellmed Medicare	$11,406.63

INTRAVASCULAR STENT 1ST ARTERY

Facility

$24,854.00

Service Code	CPT 37236
Hospital Charge Code	2350071
Hospital Revenue Code	481
Min. Negotiated Rate	$179.93
Max. Negotiated Rate	$24,969.37
Rate for Payer: Aetna Commercial	$8,755.00
Rate for Payer: Aetna Medicare	$15,091.60
Rate for Payer: Amerigroup CHIP/Medicaid	$2,236.86
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,061.07
Rate for Payer: Amerigroup Medicare	$10,061.07
Rate for Payer: BCBS of TX Blue Advantage	$16,547.16
Rate for Payer: BCBS of TX Blue Essentials	$19,816.96
Rate for Payer: BCBS of TX Medicare	$10,061.07
Rate for Payer: BCBS of TX PPO	$24,969.37
Rate for Payer: Cash Price	$21,871.52
Rate for Payer: Cash Price	$21,871.52
Rate for Payer: Cash Price	$21,871.52
Rate for Payer: Cigna Commercial	$22,791.24
Rate for Payer: Cigna Medicaid	$5,004.56
Rate for Payer: Cigna Medicare	$10,061.07
Rate for Payer: Employer Direct Commercial	$10,061.07
Rate for Payer: Humana Medicare/TRICARE	$10,061.07
Rate for Payer: Molina CHIP/Medicaid	$5,004.56
Rate for Payer: Molina Dual Medicare/Medicaid	$10,061.07
Rate for Payer: Molina Medicare	$10,061.07
Rate for Payer: Multiplan Auto	$16,155.10
Rate for Payer: Multiplan Commercial	$16,155.10
Rate for Payer: Multiplan Workers Comp	$16,155.10
Rate for Payer: Parkland Medicaid	$5,004.56
Rate for Payer: Scott and White EPO/PPO	$179.93
Rate for Payer: Scott and White Medicare	$10,061.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,004.56
Rate for Payer: Superior Health Plan EPO	$10,061.07
Rate for Payer: Superior Health Plan Medicare	$10,061.07
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,061.07
Rate for Payer: Universal American Medicare	$10,061.07
Rate for Payer: Wellcare Medicare	$10,061.07
Rate for Payer: Wellmed Medicare	$10,061.07

INTRAVASCULAR STENT 1ST ARTERY

Facility

$24,854.00

Service Code	CPT 37236
Hospital Charge Code	2350071
Hospital Revenue Code	481
Rate for Payer: Cash Price	$21,871.52

Intravenous infusion, hydration; each additional hour (List separately in addition to code for prima

Facility

$10,000.00

Service Code	CPT 96361
Hospital Charge Code	36096361
Hospital Revenue Code	360
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Medicare	$65.16
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$43.44
Rate for Payer: Amerigroup Medicare	$43.44
Rate for Payer: BCBS of TX Blue Advantage	$23.82
Rate for Payer: BCBS of TX Blue Essentials	$28.48
Rate for Payer: BCBS of TX Medicare	$43.44
Rate for Payer: BCBS of TX PPO	$31.76
Rate for Payer: Cigna Commercial	$98.40
Rate for Payer: Cigna Medicare	$43.44
Rate for Payer: Employer Direct Commercial	$43.44
Rate for Payer: Humana Medicare/TRICARE	$43.44
Rate for Payer: Molina Dual Medicare/Medicaid	$43.44
Rate for Payer: Molina Medicare	$43.44
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	$0.78
Rate for Payer: Scott and White Medicare	$43.44
Rate for Payer: Superior Health Plan EPO	$43.44
Rate for Payer: Superior Health Plan Medicare	$43.44
Rate for Payer: Universal American Dual Medicare/Medicaid	$43.44
Rate for Payer: Universal American Medicare	$43.44
Rate for Payer: Wellcare Medicare	$43.44
Rate for Payer: Wellmed Medicare	$43.44

Intravenous infusion, hydration; initial, 31 minutes to 1 hour

Facility

$10,000.00

Service Code	CPT 96360
Hospital Charge Code	36096360
Hospital Revenue Code	360
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Medicare	$294.03
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$196.02
Rate for Payer: Amerigroup Medicare	$196.02
Rate for Payer: BCBS of TX Blue Advantage	$67.09
Rate for Payer: BCBS of TX Blue Essentials	$80.20
Rate for Payer: BCBS of TX Medicare	$196.02
Rate for Payer: BCBS of TX PPO	$89.46
Rate for Payer: Cigna Commercial	$444.05
Rate for Payer: Cigna Medicare	$196.02
Rate for Payer: Employer Direct Commercial	$196.02
Rate for Payer: Humana Medicare/TRICARE	$196.02
Rate for Payer: Molina Dual Medicare/Medicaid	$196.02
Rate for Payer: Molina Medicare	$196.02
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	$3.51
Rate for Payer: Scott and White Medicare	$196.02
Rate for Payer: Superior Health Plan EPO	$196.02
Rate for Payer: Superior Health Plan Medicare	$196.02
Rate for Payer: Universal American Dual Medicare/Medicaid	$196.02
Rate for Payer: Universal American Medicare	$196.02
Rate for Payer: Wellcare Medicare	$196.02
Rate for Payer: Wellmed Medicare	$196.02

INTRCRD EP 3DMAP

Facility

$8,562.00

Service Code	CPT 93613
Hospital Charge Code	4613613
Hospital Revenue Code	480
Rate for Payer: Cash Price	$7,534.56

INTRCRD EP 3DMAP

Facility

$8,562.00

Service Code	CPT 93613
Hospital Charge Code	4613613
Hospital Revenue Code	480
Min. Negotiated Rate	$541.17
Max. Negotiated Rate	$5,565.30
Rate for Payer: Aetna Commercial	$4,709.10
Rate for Payer: Amerigroup CHIP/Medicaid	$770.58
Rate for Payer: BCBS of TX Blue Advantage	$541.17
Rate for Payer: BCBS of TX Blue Essentials	$646.92
Rate for Payer: BCBS of TX PPO	$721.57
Rate for Payer: Cash Price	$7,534.56
Rate for Payer: Cash Price	$7,534.56
Rate for Payer: Multiplan Auto	$5,565.30
Rate for Payer: Multiplan Commercial	$5,565.30
Rate for Payer: Multiplan Workers Comp	$5,565.30
Rate for Payer: Scott and White EPO/PPO	$4,281.00
Rate for Payer: Superior Health Plan EPO	$1,164.43

INTRO CATH -- DHF

Facility

$267.72

Hospital Charge Code	81826307
Hospital Revenue Code	272
Min. Negotiated Rate	$24.09
Max. Negotiated Rate	$174.02
Rate for Payer: Aetna Commercial	$147.25
Rate for Payer: Amerigroup CHIP/Medicaid	$24.09
Rate for Payer: BCBS of TX Blue Advantage	$80.32
Rate for Payer: BCBS of TX Blue Essentials	$96.38
Rate for Payer: BCBS of TX PPO	$107.09
Rate for Payer: Cash Price	$235.59
Rate for Payer: Multiplan Auto	$174.02
Rate for Payer: Multiplan Commercial	$174.02
Rate for Payer: Multiplan Workers Comp	$174.02
Rate for Payer: Scott and White EPO/PPO	$133.86
Rate for Payer: Superior Health Plan EPO	$36.41

INTRO CATH -- DHF

Facility

$267.72

Hospital Charge Code	81826307
Hospital Revenue Code	272
Rate for Payer: Cash Price	$235.59

INTRO, CATHETER AORTA

Facility

$2,583.00

Service Code	CPT 36200
Hospital Charge Code	2301778
Hospital Revenue Code	360
Min. Negotiated Rate	$232.47
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$1,420.65
Rate for Payer: Amerigroup CHIP/Medicaid	$232.47
Rate for Payer: Cash Price	$2,273.04
Rate for Payer: Cash Price	$2,273.04
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	$1,291.50
Rate for Payer: Superior Health Plan EPO	$351.29

INTRO, CATHETER AORTA

Facility

$2,583.00

Service Code	CPT 36200
Hospital Charge Code	2301778
Hospital Revenue Code	360
Rate for Payer: Cash Price	$2,273.04

INTRO CATH/NDL DIAL-CIRC +S&I

Facility

$3,242.00

Service Code	CPT 36901
Hospital Charge Code	2351100
Hospital Revenue Code	360
Rate for Payer: Cash Price	$2,852.96

INTRO CATH/NDL DIAL-CIRC +S&I

Facility

$3,242.00

Service Code	CPT 36901
Hospital Charge Code	2351100
Hospital Revenue Code	360
Min. Negotiated Rate	$32.31
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$2,197.02
Rate for Payer: Amerigroup CHIP/Medicaid	$446.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,464.68
Rate for Payer: Amerigroup Medicare	$1,464.68
Rate for Payer: BCBS of TX Blue Advantage	$957.68
Rate for Payer: BCBS of TX Blue Essentials	$1,146.92
Rate for Payer: BCBS of TX Medicare	$1,464.68
Rate for Payer: BCBS of TX PPO	$1,445.12
Rate for Payer: Cash Price	$2,852.96
Rate for Payer: Cash Price	$2,852.96
Rate for Payer: Cigna Commercial	$3,317.93
Rate for Payer: Cigna Medicaid	$446.27
Rate for Payer: Cigna Medicare	$1,464.68
Rate for Payer: Employer Direct Commercial	$1,464.68
Rate for Payer: Humana Medicare/TRICARE	$1,464.68
Rate for Payer: Molina CHIP/Medicaid	$446.27
Rate for Payer: Molina Dual Medicare/Medicaid	$1,464.68
Rate for Payer: Molina Medicare	$1,464.68
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	$446.27
Rate for Payer: Scott and White EPO/PPO	$32.31
Rate for Payer: Scott and White Medicare	$1,464.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$446.27
Rate for Payer: Superior Health Plan EPO	$1,464.68
Rate for Payer: Superior Health Plan Medicare	$1,464.68
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,464.68
Rate for Payer: Universal American Medicare	$1,464.68
Rate for Payer: Wellcare Medicare	$1,464.68
Rate for Payer: Wellmed Medicare	$1,464.68

INTRO CATHVAS -- DHF

Facility

$772.26

Hospital Charge Code	81826455
Hospital Revenue Code	272
Rate for Payer: Cash Price	$679.59

INTRO CATHVAS -- DHF

Facility

$772.26

Hospital Charge Code	81826455
Hospital Revenue Code	272
Min. Negotiated Rate	$69.50
Max. Negotiated Rate	$501.97
Rate for Payer: Aetna Commercial	$424.74
Rate for Payer: Amerigroup CHIP/Medicaid	$69.50
Rate for Payer: BCBS of TX Blue Advantage	$231.68
Rate for Payer: BCBS of TX Blue Essentials	$278.01
Rate for Payer: BCBS of TX PPO	$308.90
Rate for Payer: Cash Price	$679.59
Rate for Payer: Multiplan Auto	$501.97
Rate for Payer: Multiplan Commercial	$501.97
Rate for Payer: Multiplan Workers Comp	$501.97
Rate for Payer: Scott and White EPO/PPO	$386.13
Rate for Payer: Superior Health Plan EPO	$105.03

INTRODUCER ACC VALVE

Facility

$227.00

Service Code	HCPCS C1894
Hospital Charge Code	8414456
Hospital Revenue Code	272
Rate for Payer: Cash Price	$199.76

INTRODUCER ACC VALVE

Facility

$227.00

Service Code	HCPCS C1894
Hospital Charge Code	8414456
Hospital Revenue Code	272
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$147.55
Rate for Payer: Aetna Commercial	$124.85
Rate for Payer: Amerigroup CHIP/Medicaid	$20.43
Rate for Payer: BCBS of TX Blue Advantage	$68.10
Rate for Payer: BCBS of TX Blue Essentials	$81.72
Rate for Payer: BCBS of TX PPO	$90.80
Rate for Payer: Cash Price	$199.76
Rate for Payer: Multiplan Auto	$147.55
Rate for Payer: Multiplan Commercial	$147.55
Rate for Payer: Multiplan Workers Comp	$147.55
Rate for Payer: Scott and White EPO/PPO	$113.50
Rate for Payer: Superior Health Plan EPO	$30.87

INTRODUCER MERIT PRELUDE

Facility

$227.00

Hospital Charge Code	8478524
Hospital Revenue Code	272
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$147.55
Rate for Payer: Aetna Commercial	$124.85
Rate for Payer: Amerigroup CHIP/Medicaid	$20.43
Rate for Payer: BCBS of TX Blue Advantage	$68.10
Rate for Payer: BCBS of TX Blue Essentials	$81.72
Rate for Payer: BCBS of TX PPO	$90.80
Rate for Payer: Cash Price	$199.76
Rate for Payer: Multiplan Auto	$147.55
Rate for Payer: Multiplan Commercial	$147.55
Rate for Payer: Multiplan Workers Comp	$147.55
Rate for Payer: Scott and White EPO/PPO	$113.50
Rate for Payer: Superior Health Plan EPO	$30.87

INTRODUCER MERIT PRELUDE

Facility

$227.00

Hospital Charge Code	8478524
Hospital Revenue Code	272
Rate for Payer: Cash Price	$199.76

Know your out-of-pocket cost for care.

All Charges