White Rock Medical Center

All Charges

Charge

Type

Setting

Price

REMOVE PERM PACER PULSE GEN

Facility

$14,810.00

Service Code	HCPCS 33233
Hospital Charge Code	2302479
Hospital Revenue Code	481
Rate for Payer: Cash Price	$10,070.80

REMOVE PERM PACER PULSE GEN

Facility

$14,810.00

Service Code	HCPCS 33233
Hospital Charge Code	2302479
Hospital Revenue Code	481
Min. Negotiated Rate	$281.90
Max. Negotiated Rate	$19,257.46
Rate for Payer: Amerigroup CHIP/Medicaid	$1,332.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8,313.10
Rate for Payer: Amerigroup Medicare	$8,313.10
Rate for Payer: BCBS of TX Blue Advantage	$12,761.89
Rate for Payer: BCBS of TX Blue Essentials	$15,283.70
Rate for Payer: BCBS of TX Medicare	$8,313.10
Rate for Payer: BCBS of TX PPO	$19,257.46
Rate for Payer: Cash Price	$10,070.80
Rate for Payer: Cash Price	$10,070.80
Rate for Payer: Cash Price	$10,070.80
Rate for Payer: Cigna Commercial	$17,572.38
Rate for Payer: Cigna Medicaid	$10,663.20
Rate for Payer: Cigna Medicare	$8,313.10
Rate for Payer: Employer Direct Commercial	$8,313.10
Rate for Payer: Humana Medicare/TRICARE	$8,313.10
Rate for Payer: Molina CHIP/Medicaid	$10,663.20
Rate for Payer: Molina Dual Medicare/Medicaid	$8,313.10
Rate for Payer: Molina Medicare	$8,313.10
Rate for Payer: Multiplan Auto	$9,626.50
Rate for Payer: Multiplan Commercial	$9,626.50
Rate for Payer: Multiplan Workers Comp	$9,626.50
Rate for Payer: Parkland Medicaid	$10,663.20
Rate for Payer: Scott and White EPO/PPO	$281.90
Rate for Payer: Scott and White Medicare	$8,313.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,663.20
Rate for Payer: Superior Health Plan EPO	$8,313.10
Rate for Payer: Superior Health Plan Medicare	$8,313.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$8,313.10
Rate for Payer: Universal American Medicare	$8,313.10
Rate for Payer: Wellcare Medicare	$8,313.10
Rate for Payer: Wellmed Medicare	$8,313.10

REMOVER STPL PRX SS SQZ HNDL SKN

Facility

$9.13

Hospital Charge Code	993010
Hospital Revenue Code	270
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$6.57
Rate for Payer: Amerigroup CHIP/Medicaid	$0.82
Rate for Payer: BCBS of TX Blue Advantage	$2.74
Rate for Payer: BCBS of TX Blue Essentials	$3.29
Rate for Payer: BCBS of TX PPO	$3.65
Rate for Payer: Cash Price	$6.21
Rate for Payer: Cigna Medicaid	$6.57
Rate for Payer: Molina CHIP/Medicaid	$6.57
Rate for Payer: Multiplan Auto	$5.93
Rate for Payer: Multiplan Commercial	$5.93
Rate for Payer: Multiplan Workers Comp	$5.93
Rate for Payer: Parkland Medicaid	$6.57
Rate for Payer: Scott and White EPO/PPO	$4.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.57
Rate for Payer: Superior Health Plan EPO	$1.24

REMOVER STPL PRX SS SQZ HNDL SKN

Facility

$9.13

Hospital Charge Code	993010
Hospital Revenue Code	270
Rate for Payer: Cash Price	$6.21

REMOVE SINGL LEAD PACER ELECTRODE

Facility

$10,014.00

Service Code	HCPCS 33234
Hospital Charge Code	2302487
Hospital Revenue Code	481
Min. Negotiated Rate	$580.62
Max. Negotiated Rate	$7,935.26
Rate for Payer: Amerigroup CHIP/Medicaid	$901.26
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,753.99
Rate for Payer: Amerigroup Medicare	$3,753.99
Rate for Payer: BCBS of TX Blue Advantage	$4,983.30
Rate for Payer: BCBS of TX Blue Essentials	$5,968.02
Rate for Payer: BCBS of TX Medicare	$3,753.99
Rate for Payer: BCBS of TX PPO	$7,519.71
Rate for Payer: Cash Price	$6,809.52
Rate for Payer: Cash Price	$6,809.52
Rate for Payer: Cash Price	$6,809.52
Rate for Payer: Cigna Commercial	$7,935.26
Rate for Payer: Cigna Medicaid	$7,210.08
Rate for Payer: Cigna Medicare	$3,753.99
Rate for Payer: Employer Direct Commercial	$3,753.99
Rate for Payer: Humana Medicare/TRICARE	$3,753.99
Rate for Payer: Molina CHIP/Medicaid	$7,210.08
Rate for Payer: Molina Dual Medicare/Medicaid	$3,753.99
Rate for Payer: Molina Medicare	$3,753.99
Rate for Payer: Multiplan Auto	$6,509.10
Rate for Payer: Multiplan Commercial	$6,509.10
Rate for Payer: Multiplan Workers Comp	$6,509.10
Rate for Payer: Parkland Medicaid	$7,210.08
Rate for Payer: Scott and White EPO/PPO	$580.62
Rate for Payer: Scott and White Medicare	$3,753.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,210.08
Rate for Payer: Superior Health Plan EPO	$3,753.99
Rate for Payer: Superior Health Plan Medicare	$3,753.99
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,753.99
Rate for Payer: Universal American Medicare	$3,753.99
Rate for Payer: Wellcare Medicare	$3,753.99
Rate for Payer: Wellmed Medicare	$3,753.99

REMOVE SINGL LEAD PACER ELECTRODE

Facility

$10,014.00

Service Code	HCPCS 33234
Hospital Charge Code	2302487
Hospital Revenue Code	481
Rate for Payer: Cash Price	$6,809.52

Remove Spine Eltrd Plate

Facility

$61,088.00

Service Code	HCPCS 63662
Hospital Charge Code	9900774
Hospital Revenue Code	360
Min. Negotiated Rate	$1,499.71
Max. Negotiated Rate	$43,983.36
Rate for Payer: Amerigroup CHIP/Medicaid	$1,499.71
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,512.04
Rate for Payer: Amerigroup Medicare	$3,512.04
Rate for Payer: BCBS of TX Blue Advantage	$5,257.99
Rate for Payer: BCBS of TX Blue Essentials	$6,297.00
Rate for Payer: BCBS of TX Medicare	$3,512.04
Rate for Payer: BCBS of TX PPO	$7,934.22
Rate for Payer: Cash Price	$41,539.84
Rate for Payer: Cash Price	$41,539.84
Rate for Payer: Cash Price	$41,539.84
Rate for Payer: Cigna Commercial	$7,423.81
Rate for Payer: Cigna Medicaid	$43,983.36
Rate for Payer: Cigna Medicare	$3,512.04
Rate for Payer: Employer Direct Commercial	$3,512.04
Rate for Payer: Humana Medicare/TRICARE	$3,512.04
Rate for Payer: Molina CHIP/Medicaid	$43,983.36
Rate for Payer: Molina Dual Medicare/Medicaid	$3,512.04
Rate for Payer: Molina Medicare	$3,512.04
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: Parkland Medicaid	$43,983.36
Rate for Payer: Scott and White EPO/PPO	$5,756.77
Rate for Payer: Scott and White Medicare	$3,512.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$43,983.36
Rate for Payer: Superior Health Plan EPO	$3,512.04
Rate for Payer: Superior Health Plan Medicare	$3,512.04
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,512.04
Rate for Payer: Universal American Medicare	$3,512.04
Rate for Payer: Wellcare Medicare	$3,512.04
Rate for Payer: Wellmed Medicare	$3,512.04

Remove Spine Eltrd Plate

Facility

$61,088.00

Service Code	HCPCS 63662
Hospital Charge Code	9900774
Hospital Revenue Code	360
Rate for Payer: Cash Price	$41,539.84

Remove Spine Eltrd Plate

Facility

$10,000.00

Service Code	CPT 63662
Hospital Charge Code	36063662
Hospital Revenue Code	360
Min. Negotiated Rate	$1,499.71
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,499.71
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,512.04
Rate for Payer: Amerigroup Medicare	$3,512.04
Rate for Payer: BCBS of TX Blue Advantage	$5,257.99
Rate for Payer: BCBS of TX Blue Essentials	$6,297.00
Rate for Payer: BCBS of TX Medicare	$3,512.04
Rate for Payer: BCBS of TX PPO	$7,934.22
Rate for Payer: Cigna Commercial	$7,423.81
Rate for Payer: Cigna Medicare	$3,512.04
Rate for Payer: Employer Direct Commercial	$3,512.04
Rate for Payer: Humana Medicare/TRICARE	$3,512.04
Rate for Payer: Molina Dual Medicare/Medicaid	$3,512.04
Rate for Payer: Molina Medicare	$3,512.04
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	$5,756.77
Rate for Payer: Scott and White Medicare	$3,512.04
Rate for Payer: Superior Health Plan EPO	$3,512.04
Rate for Payer: Superior Health Plan Medicare	$3,512.04
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,512.04
Rate for Payer: Universal American Medicare	$3,512.04
Rate for Payer: Wellcare Medicare	$3,512.04
Rate for Payer: Wellmed Medicare	$3,512.04

REMOV & REPLAC PACEMAKER,DUAL LEAD

Facility

$22,751.00

Service Code	HCPCS 33228
Hospital Charge Code	2320562
Hospital Revenue Code	481
Min. Negotiated Rate	$425.74
Max. Negotiated Rate	$25,834.89
Rate for Payer: Amerigroup CHIP/Medicaid	$2,047.59
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,499.62
Rate for Payer: Amerigroup Medicare	$10,499.62
Rate for Payer: BCBS of TX Blue Advantage	$17,120.74
Rate for Payer: BCBS of TX Blue Essentials	$20,503.88
Rate for Payer: BCBS of TX Medicare	$10,499.62
Rate for Payer: BCBS of TX PPO	$25,834.89
Rate for Payer: Cash Price	$15,470.68
Rate for Payer: Cash Price	$15,470.68
Rate for Payer: Cash Price	$15,470.68
Rate for Payer: Cigna Commercial	$22,194.30
Rate for Payer: Cigna Medicaid	$16,380.72
Rate for Payer: Cigna Medicare	$10,499.62
Rate for Payer: Employer Direct Commercial	$10,499.62
Rate for Payer: Humana Medicare/TRICARE	$10,499.62
Rate for Payer: Molina CHIP/Medicaid	$16,380.72
Rate for Payer: Molina Dual Medicare/Medicaid	$10,499.62
Rate for Payer: Molina Medicare	$10,499.62
Rate for Payer: Multiplan Auto	$14,788.15
Rate for Payer: Multiplan Commercial	$14,788.15
Rate for Payer: Multiplan Workers Comp	$14,788.15
Rate for Payer: Parkland Medicaid	$16,380.72
Rate for Payer: Scott and White EPO/PPO	$425.74
Rate for Payer: Scott and White Medicare	$10,499.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,380.72
Rate for Payer: Superior Health Plan EPO	$10,499.62
Rate for Payer: Superior Health Plan Medicare	$10,499.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,499.62
Rate for Payer: Universal American Medicare	$10,499.62
Rate for Payer: Wellcare Medicare	$10,499.62
Rate for Payer: Wellmed Medicare	$10,499.62

REMOV & REPLAC PACEMAKER,DUAL LEAD

Facility

$22,751.00

Service Code	HCPCS 33228
Hospital Charge Code	2320562
Hospital Revenue Code	481
Rate for Payer: Cash Price	$15,470.68

REMOV & REPLAC PACEMAKER,MULT LEAD

Facility

$23,064.00

Service Code	HCPCS 33229
Hospital Charge Code	2320563
Hospital Revenue Code	481
Min. Negotiated Rate	$447.73
Max. Negotiated Rate	$46,149.31
Rate for Payer: Amerigroup CHIP/Medicaid	$2,075.76
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$19,349.47
Rate for Payer: Amerigroup Medicare	$19,349.47
Rate for Payer: BCBS of TX Blue Advantage	$30,583.08
Rate for Payer: BCBS of TX Blue Essentials	$36,626.44
Rate for Payer: BCBS of TX Medicare	$19,349.47
Rate for Payer: BCBS of TX PPO	$46,149.31
Rate for Payer: Cash Price	$15,683.52
Rate for Payer: Cash Price	$15,683.52
Rate for Payer: Cash Price	$15,683.52
Rate for Payer: Cigna Commercial	$40,901.26
Rate for Payer: Cigna Medicaid	$16,606.08
Rate for Payer: Cigna Medicare	$19,349.47
Rate for Payer: Employer Direct Commercial	$19,349.47
Rate for Payer: Humana Medicare/TRICARE	$19,349.47
Rate for Payer: Molina CHIP/Medicaid	$16,606.08
Rate for Payer: Molina Dual Medicare/Medicaid	$19,349.47
Rate for Payer: Molina Medicare	$19,349.47
Rate for Payer: Multiplan Auto	$14,991.60
Rate for Payer: Multiplan Commercial	$14,991.60
Rate for Payer: Multiplan Workers Comp	$14,991.60
Rate for Payer: Parkland Medicaid	$16,606.08
Rate for Payer: Scott and White EPO/PPO	$447.73
Rate for Payer: Scott and White Medicare	$19,349.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,606.08
Rate for Payer: Superior Health Plan EPO	$19,349.47
Rate for Payer: Superior Health Plan Medicare	$19,349.47
Rate for Payer: Universal American Dual Medicare/Medicaid	$19,349.47
Rate for Payer: Universal American Medicare	$19,349.47
Rate for Payer: Wellcare Medicare	$19,349.47
Rate for Payer: Wellmed Medicare	$19,349.47

REMOV & REPLAC PACEMAKER,MULT LEAD

Facility

$23,064.00

Service Code	HCPCS 33229
Hospital Charge Code	2320563
Hospital Revenue Code	481
Rate for Payer: Cash Price	$15,683.52

REMOV & REPLAC PACEMAKER,SINGL LEAD

Facility

$18,015.00

Service Code	HCPCS 33227
Hospital Charge Code	2320561
Hospital Revenue Code	481
Rate for Payer: Cash Price	$12,250.20

REMOV & REPLAC PACEMAKER,SINGL LEAD

Facility

$18,015.00

Service Code	HCPCS 33227
Hospital Charge Code	2320561
Hospital Revenue Code	481
Min. Negotiated Rate	$407.82
Max. Negotiated Rate	$19,257.46
Rate for Payer: Amerigroup CHIP/Medicaid	$1,621.35
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8,313.10
Rate for Payer: Amerigroup Medicare	$8,313.10
Rate for Payer: BCBS of TX Blue Advantage	$12,761.89
Rate for Payer: BCBS of TX Blue Essentials	$15,283.70
Rate for Payer: BCBS of TX Medicare	$8,313.10
Rate for Payer: BCBS of TX PPO	$19,257.46
Rate for Payer: Cash Price	$12,250.20
Rate for Payer: Cash Price	$12,250.20
Rate for Payer: Cash Price	$12,250.20
Rate for Payer: Cigna Commercial	$17,572.38
Rate for Payer: Cigna Medicaid	$12,970.80
Rate for Payer: Cigna Medicare	$8,313.10
Rate for Payer: Employer Direct Commercial	$8,313.10
Rate for Payer: Humana Medicare/TRICARE	$8,313.10
Rate for Payer: Molina CHIP/Medicaid	$12,970.80
Rate for Payer: Molina Dual Medicare/Medicaid	$8,313.10
Rate for Payer: Molina Medicare	$8,313.10
Rate for Payer: Multiplan Auto	$11,709.75
Rate for Payer: Multiplan Commercial	$11,709.75
Rate for Payer: Multiplan Workers Comp	$11,709.75
Rate for Payer: Parkland Medicaid	$12,970.80
Rate for Payer: Scott and White EPO/PPO	$407.82
Rate for Payer: Scott and White Medicare	$8,313.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,970.80
Rate for Payer: Superior Health Plan EPO	$8,313.10
Rate for Payer: Superior Health Plan Medicare	$8,313.10
Rate for Payer: Universal American Dual Medicare/Medicaid	$8,313.10
Rate for Payer: Universal American Medicare	$8,313.10
Rate for Payer: Wellcare Medicare	$8,313.10
Rate for Payer: Wellmed Medicare	$8,313.10

REMOV & REPLC DEFIBRI W DUAL LEAD

Facility

$31,567.00

Service Code	HCPCS 33263
Hospital Charge Code	2320567
Hospital Revenue Code	481
Min. Negotiated Rate	$464.30
Max. Negotiated Rate	$57,236.48
Rate for Payer: Amerigroup CHIP/Medicaid	$2,841.03
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$22,344.94
Rate for Payer: Amerigroup Medicare	$22,344.94
Rate for Payer: BCBS of TX Blue Advantage	$37,930.53
Rate for Payer: BCBS of TX Blue Essentials	$45,425.78
Rate for Payer: BCBS of TX Medicare	$22,344.94
Rate for Payer: BCBS of TX PPO	$57,236.48
Rate for Payer: Cash Price	$21,465.56
Rate for Payer: Cash Price	$21,465.56
Rate for Payer: Cash Price	$21,465.56
Rate for Payer: Cigna Commercial	$47,233.14
Rate for Payer: Cigna Medicaid	$22,728.24
Rate for Payer: Cigna Medicare	$22,344.94
Rate for Payer: Employer Direct Commercial	$22,344.94
Rate for Payer: Humana Medicare/TRICARE	$22,344.94
Rate for Payer: Molina CHIP/Medicaid	$22,728.24
Rate for Payer: Molina Dual Medicare/Medicaid	$22,344.94
Rate for Payer: Molina Medicare	$22,344.94
Rate for Payer: Multiplan Auto	$20,518.55
Rate for Payer: Multiplan Commercial	$20,518.55
Rate for Payer: Multiplan Workers Comp	$20,518.55
Rate for Payer: Parkland Medicaid	$22,728.24
Rate for Payer: Scott and White EPO/PPO	$464.30
Rate for Payer: Scott and White Medicare	$22,344.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$22,728.24
Rate for Payer: Superior Health Plan EPO	$22,344.94
Rate for Payer: Superior Health Plan Medicare	$22,344.94
Rate for Payer: Universal American Dual Medicare/Medicaid	$22,344.94
Rate for Payer: Universal American Medicare	$22,344.94
Rate for Payer: Wellcare Medicare	$22,344.94
Rate for Payer: Wellmed Medicare	$22,344.94

REMOV & REPLC DEFIBRI W DUAL LEAD

Facility

$31,567.00

Service Code	HCPCS 33263
Hospital Charge Code	2320567
Hospital Revenue Code	481
Rate for Payer: Cash Price	$21,465.56

REMOV & REPLC DEFIBRI W MULTI LEAD

Facility

$41,664.00

Service Code	HCPCS 33264
Hospital Charge Code	2320568
Hospital Revenue Code	481
Rate for Payer: Cash Price	$28,331.52

REMOV & REPLC DEFIBRI W MULTI LEAD

Facility

$41,664.00

Service Code	HCPCS 33264
Hospital Charge Code	2320568
Hospital Revenue Code	481
Min. Negotiated Rate	$484.16
Max. Negotiated Rate	$81,352.25
Rate for Payer: Amerigroup CHIP/Medicaid	$3,749.76
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$31,531.90
Rate for Payer: Amerigroup Medicare	$31,531.90
Rate for Payer: BCBS of TX Blue Advantage	$53,912.01
Rate for Payer: BCBS of TX Blue Essentials	$64,565.28
Rate for Payer: BCBS of TX Medicare	$31,531.90
Rate for Payer: BCBS of TX PPO	$81,352.25
Rate for Payer: Cash Price	$28,331.52
Rate for Payer: Cash Price	$28,331.52
Rate for Payer: Cash Price	$28,331.52
Rate for Payer: Cigna Commercial	$66,652.72
Rate for Payer: Cigna Medicaid	$29,998.08
Rate for Payer: Cigna Medicare	$31,531.90
Rate for Payer: Employer Direct Commercial	$31,531.90
Rate for Payer: Humana Medicare/TRICARE	$31,531.90
Rate for Payer: Molina CHIP/Medicaid	$29,998.08
Rate for Payer: Molina Dual Medicare/Medicaid	$31,531.90
Rate for Payer: Molina Medicare	$31,531.90
Rate for Payer: Multiplan Auto	$27,081.60
Rate for Payer: Multiplan Commercial	$27,081.60
Rate for Payer: Multiplan Workers Comp	$27,081.60
Rate for Payer: Parkland Medicaid	$29,998.08
Rate for Payer: Scott and White EPO/PPO	$484.16
Rate for Payer: Scott and White Medicare	$31,531.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$29,998.08
Rate for Payer: Superior Health Plan EPO	$31,531.90
Rate for Payer: Superior Health Plan Medicare	$31,531.90
Rate for Payer: Universal American Dual Medicare/Medicaid	$31,531.90
Rate for Payer: Universal American Medicare	$31,531.90
Rate for Payer: Wellcare Medicare	$31,531.90
Rate for Payer: Wellmed Medicare	$31,531.90

REMOV & REPLC DEFIBRI W SINGLE LEAD

Facility

$30,361.00

Service Code	HCPCS 33262
Hospital Charge Code	2320566
Hospital Revenue Code	481
Min. Negotiated Rate	$446.90
Max. Negotiated Rate	$57,236.48
Rate for Payer: Amerigroup CHIP/Medicaid	$2,732.49
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$22,344.94
Rate for Payer: Amerigroup Medicare	$22,344.94
Rate for Payer: BCBS of TX Blue Advantage	$37,930.53
Rate for Payer: BCBS of TX Blue Essentials	$45,425.78
Rate for Payer: BCBS of TX Medicare	$22,344.94
Rate for Payer: BCBS of TX PPO	$57,236.48
Rate for Payer: Cash Price	$20,645.48
Rate for Payer: Cash Price	$20,645.48
Rate for Payer: Cash Price	$20,645.48
Rate for Payer: Cigna Commercial	$47,233.14
Rate for Payer: Cigna Medicaid	$21,859.92
Rate for Payer: Cigna Medicare	$22,344.94
Rate for Payer: Employer Direct Commercial	$22,344.94
Rate for Payer: Humana Medicare/TRICARE	$22,344.94
Rate for Payer: Molina CHIP/Medicaid	$21,859.92
Rate for Payer: Molina Dual Medicare/Medicaid	$22,344.94
Rate for Payer: Molina Medicare	$22,344.94
Rate for Payer: Multiplan Auto	$19,734.65
Rate for Payer: Multiplan Commercial	$19,734.65
Rate for Payer: Multiplan Workers Comp	$19,734.65
Rate for Payer: Parkland Medicaid	$21,859.92
Rate for Payer: Scott and White EPO/PPO	$446.90
Rate for Payer: Scott and White Medicare	$22,344.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$21,859.92
Rate for Payer: Superior Health Plan EPO	$22,344.94
Rate for Payer: Superior Health Plan Medicare	$22,344.94
Rate for Payer: Universal American Dual Medicare/Medicaid	$22,344.94
Rate for Payer: Universal American Medicare	$22,344.94
Rate for Payer: Wellcare Medicare	$22,344.94
Rate for Payer: Wellmed Medicare	$22,344.94

REMOV & REPLC DEFIBRI W SINGLE LEAD

Facility

$30,361.00

Service Code	HCPCS 33262
Hospital Charge Code	2320566
Hospital Revenue Code	481
Rate for Payer: Cash Price	$20,645.48

REM&RPL ICD GEN/MULTI SYSTEM

Facility

$41,664.00

Service Code	HCPCS 33264
Hospital Charge Code	2350079
Hospital Revenue Code	481
Rate for Payer: Cash Price	$28,331.52

REM&RPL ICD GEN/MULTI SYSTEM

Facility

$41,664.00

Service Code	HCPCS 33264
Hospital Charge Code	2350079
Hospital Revenue Code	481
Min. Negotiated Rate	$484.16
Max. Negotiated Rate	$81,352.25
Rate for Payer: Amerigroup CHIP/Medicaid	$3,749.76
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$31,531.90
Rate for Payer: Amerigroup Medicare	$31,531.90
Rate for Payer: BCBS of TX Blue Advantage	$53,912.01
Rate for Payer: BCBS of TX Blue Essentials	$64,565.28
Rate for Payer: BCBS of TX Medicare	$31,531.90
Rate for Payer: BCBS of TX PPO	$81,352.25
Rate for Payer: Cash Price	$28,331.52
Rate for Payer: Cash Price	$28,331.52
Rate for Payer: Cash Price	$28,331.52
Rate for Payer: Cigna Commercial	$66,652.72
Rate for Payer: Cigna Medicaid	$29,998.08
Rate for Payer: Cigna Medicare	$31,531.90
Rate for Payer: Employer Direct Commercial	$31,531.90
Rate for Payer: Humana Medicare/TRICARE	$31,531.90
Rate for Payer: Molina CHIP/Medicaid	$29,998.08
Rate for Payer: Molina Dual Medicare/Medicaid	$31,531.90
Rate for Payer: Molina Medicare	$31,531.90
Rate for Payer: Multiplan Auto	$27,081.60
Rate for Payer: Multiplan Commercial	$27,081.60
Rate for Payer: Multiplan Workers Comp	$27,081.60
Rate for Payer: Parkland Medicaid	$29,998.08
Rate for Payer: Scott and White EPO/PPO	$484.16
Rate for Payer: Scott and White Medicare	$31,531.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$29,998.08
Rate for Payer: Superior Health Plan EPO	$31,531.90
Rate for Payer: Superior Health Plan Medicare	$31,531.90
Rate for Payer: Universal American Dual Medicare/Medicaid	$31,531.90
Rate for Payer: Universal American Medicare	$31,531.90
Rate for Payer: Wellcare Medicare	$31,531.90
Rate for Payer: Wellmed Medicare	$31,531.90

REMV TUNL CVC WO PMP/PRT

Facility

$1,849.00

Service Code	HCPCS 36589
Hospital Charge Code	4616589
Hospital Revenue Code	361
Min. Negotiated Rate	$223.75
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$223.75
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$630.16
Rate for Payer: Amerigroup Medicare	$630.16
Rate for Payer: BCBS of TX Blue Advantage	$1,052.95
Rate for Payer: BCBS of TX Blue Essentials	$1,261.02
Rate for Payer: BCBS of TX Medicare	$630.16
Rate for Payer: BCBS of TX PPO	$1,588.89
Rate for Payer: Cash Price	$1,257.32
Rate for Payer: Cash Price	$1,257.32
Rate for Payer: Cash Price	$1,257.32
Rate for Payer: Cigna Commercial	$1,332.05
Rate for Payer: Cigna Medicaid	$1,331.28
Rate for Payer: Cigna Medicare	$630.16
Rate for Payer: Employer Direct Commercial	$630.16
Rate for Payer: Humana Medicare/TRICARE	$630.16
Rate for Payer: Molina CHIP/Medicaid	$1,331.28
Rate for Payer: Molina Dual Medicare/Medicaid	$630.16
Rate for Payer: Molina Medicare	$630.16
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	$1,331.28
Rate for Payer: Scott and White EPO/PPO	$1,062.86
Rate for Payer: Scott and White Medicare	$630.16
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,331.28
Rate for Payer: Superior Health Plan EPO	$630.16
Rate for Payer: Superior Health Plan Medicare	$630.16
Rate for Payer: Universal American Dual Medicare/Medicaid	$630.16
Rate for Payer: Universal American Medicare	$630.16
Rate for Payer: Wellcare Medicare	$630.16
Rate for Payer: Wellmed Medicare	$630.16

REMV TUNL CVC WO PMP/PRT

Facility

$1,849.00

Service Code	HCPCS 36589
Hospital Charge Code	4616589
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,257.32

Know your out-of-pocket cost for care.

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