White Rock Medical Center

All Charges

Charge

Type

Setting

Price

CERVICAL SPINAL FUSION WITH CC

Facility

$58,349.00

Service Code	MSDRG 472
Min. Negotiated Rate	$25,342.48
Max. Negotiated Rate	$58,349.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$26,352.12
Rate for Payer: Amerigroup Medicare	$26,352.12
Rate for Payer: BCBS of TX Medicare	$26,352.12
Rate for Payer: Cigna Commercial	$37,945.77
Rate for Payer: Cigna Medicare	$26,352.12
Rate for Payer: Employer Direct Commercial	$26,352.12
Rate for Payer: Humana Medicare/TRICARE	$26,352.12
Rate for Payer: Molina Dual Medicare/Medicaid	$26,352.12
Rate for Payer: Molina Medicare	$26,352.12
Rate for Payer: Multiplan Auto	$58,349.00
Rate for Payer: Multiplan Commercial	$58,349.00
Rate for Payer: Multiplan Workers Comp	$58,349.00
Rate for Payer: Scott and White EPO/PPO	$26,871.25
Rate for Payer: Scott and White Medicare	$26,352.12
Rate for Payer: Superior Health Plan EPO	$26,352.12
Rate for Payer: Superior Health Plan Medicare	$26,352.12
Rate for Payer: Universal American Dual Medicare/Medicaid	$26,352.12
Rate for Payer: Universal American Medicare	$26,352.12
Rate for Payer: Wellcare Medicare	$26,352.12
Rate for Payer: Wellmed Medicare	$26,352.12

CERVICAL SPINAL FUSION WITH MCC

Facility

$95,703.00

Service Code	MSDRG 471
Min. Negotiated Rate	$40,149.76
Max. Negotiated Rate	$95,703.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$40,149.76
Rate for Payer: Amerigroup Medicare	$40,149.76
Rate for Payer: BCBS of TX Medicare	$40,149.76
Rate for Payer: Cigna Commercial	$62,193.66
Rate for Payer: Cigna Medicare	$40,149.76
Rate for Payer: Employer Direct Commercial	$40,149.76
Rate for Payer: Humana Medicare/TRICARE	$40,149.76
Rate for Payer: Molina Dual Medicare/Medicaid	$40,149.76
Rate for Payer: Molina Medicare	$40,149.76
Rate for Payer: Multiplan Auto	$95,703.00
Rate for Payer: Multiplan Commercial	$95,703.00
Rate for Payer: Multiplan Workers Comp	$95,703.00
Rate for Payer: Scott and White EPO/PPO	$44,073.75
Rate for Payer: Scott and White Medicare	$40,149.76
Rate for Payer: Superior Health Plan EPO	$40,149.76
Rate for Payer: Superior Health Plan Medicare	$40,149.76
Rate for Payer: Universal American Dual Medicare/Medicaid	$40,149.76
Rate for Payer: Universal American Medicare	$40,149.76
Rate for Payer: Wellcare Medicare	$40,149.76
Rate for Payer: Wellmed Medicare	$40,149.76

CERVICAL SPINAL FUSION WITHOUT CC/MCC

Facility

$48,166.90

Service Code	MSDRG 473
Min. Negotiated Rate	$20,406.94
Max. Negotiated Rate	$48,166.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$22,652.44
Rate for Payer: Amerigroup Medicare	$22,652.44
Rate for Payer: BCBS of TX Medicare	$22,652.44
Rate for Payer: Cigna Commercial	$31,443.94
Rate for Payer: Cigna Medicare	$22,652.44
Rate for Payer: Employer Direct Commercial	$22,652.44
Rate for Payer: Humana Medicare/TRICARE	$22,652.44
Rate for Payer: Molina Dual Medicare/Medicaid	$22,652.44
Rate for Payer: Molina Medicare	$22,652.44
Rate for Payer: Multiplan Auto	$48,166.90
Rate for Payer: Multiplan Commercial	$48,166.90
Rate for Payer: Multiplan Workers Comp	$48,166.90
Rate for Payer: Scott and White EPO/PPO	$22,182.12
Rate for Payer: Scott and White Medicare	$22,652.44
Rate for Payer: Superior Health Plan EPO	$22,652.44
Rate for Payer: Superior Health Plan Medicare	$22,652.44
Rate for Payer: Universal American Dual Medicare/Medicaid	$22,652.44
Rate for Payer: Universal American Medicare	$22,652.44
Rate for Payer: Wellcare Medicare	$22,652.44
Rate for Payer: Wellmed Medicare	$22,652.44

CERVICAL SPINAL FUSION W MCC

Facility

$95,703.00

Service Code	MSDRG 471
Min. Negotiated Rate	$40,149.76
Max. Negotiated Rate	$95,703.00
Rate for Payer: BCBS of TX Blue Advantage	$43,092.02
Rate for Payer: BCBS of TX Blue Essentials	$51,705.41
Rate for Payer: BCBS of TX PPO	$57,452.69

CERVICAL SPINAL FUSION W/O CC/MCC

Facility

$48,166.90

Service Code	MSDRG 473
Min. Negotiated Rate	$20,406.94
Max. Negotiated Rate	$48,166.90
Rate for Payer: BCBS of TX Blue Advantage	$20,406.94
Rate for Payer: BCBS of TX Blue Essentials	$24,485.96
Rate for Payer: BCBS of TX PPO	$27,207.67

CESAREAN SECTION WITHOUT STERILIZATION

Facility

$2,725.57

Service Code	APR-DRG 5402
Min. Negotiated Rate	$2,569.76
Max. Negotiated Rate	$2,725.57
Rate for Payer: Amerigroup CHIP/Medicaid	$2,569.76
Rate for Payer: Cigna Medicaid	$2,569.76
Rate for Payer: Molina CHIP/Medicaid	$2,569.76
Rate for Payer: Parkland Medicaid	$2,569.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,725.57

CESAREAN SECTION WITHOUT STERILIZATION

Facility

$7,303.51

Service Code	APR-DRG 5404
Min. Negotiated Rate	$6,886.01
Max. Negotiated Rate	$7,303.51
Rate for Payer: Amerigroup CHIP/Medicaid	$6,886.01
Rate for Payer: Cigna Medicaid	$6,886.01
Rate for Payer: Molina CHIP/Medicaid	$6,886.01
Rate for Payer: Parkland Medicaid	$6,886.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,303.51

CESAREAN SECTION WITHOUT STERILIZATION

Facility

$2,198.63

Service Code	APR-DRG 5401
Min. Negotiated Rate	$2,072.95
Max. Negotiated Rate	$2,198.63
Rate for Payer: Amerigroup CHIP/Medicaid	$2,072.95
Rate for Payer: Cigna Medicaid	$2,072.95
Rate for Payer: Molina CHIP/Medicaid	$2,072.95
Rate for Payer: Parkland Medicaid	$2,072.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,198.63

CESAREAN SECTION WITHOUT STERILIZATION

Facility

$3,723.99

Service Code	APR-DRG 5403
Min. Negotiated Rate	$3,511.11
Max. Negotiated Rate	$3,723.99
Rate for Payer: Amerigroup CHIP/Medicaid	$3,511.11
Rate for Payer: Cigna Medicaid	$3,511.11
Rate for Payer: Molina CHIP/Medicaid	$3,511.11
Rate for Payer: Parkland Medicaid	$3,511.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,723.99

CESAREAN SECTION WITHOUT STERILIZATION WITH CC

Facility

$20,240.70

Service Code	MSDRG 787
Min. Negotiated Rate	$6,879.00
Max. Negotiated Rate	$20,240.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,945.14
Rate for Payer: Amerigroup Medicare	$12,945.14
Rate for Payer: BCBS of TX Medicare	$12,945.14
Rate for Payer: Cigna Commercial	$6,879.00
Rate for Payer: Cigna Medicare	$12,945.14
Rate for Payer: Employer Direct Commercial	$12,945.14
Rate for Payer: Humana Medicare/TRICARE	$12,945.14
Rate for Payer: Molina Dual Medicare/Medicaid	$12,945.14
Rate for Payer: Molina Medicare	$12,945.14
Rate for Payer: Multiplan Auto	$20,240.70
Rate for Payer: Multiplan Commercial	$20,240.70
Rate for Payer: Multiplan Workers Comp	$20,240.70
Rate for Payer: Scott and White EPO/PPO	$9,321.38
Rate for Payer: Scott and White Medicare	$12,945.14
Rate for Payer: Superior Health Plan EPO	$12,945.14
Rate for Payer: Superior Health Plan Medicare	$12,945.14
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,945.14
Rate for Payer: Universal American Medicare	$12,945.14
Rate for Payer: Wellcare Medicare	$12,945.14
Rate for Payer: Wellmed Medicare	$12,945.14

CESAREAN SECTION WITHOUT STERILIZATION WITH MCC

Facility

$30,685.00

Service Code	MSDRG 786
Min. Negotiated Rate	$6,879.00
Max. Negotiated Rate	$30,685.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16,849.32
Rate for Payer: Amerigroup Medicare	$16,849.32
Rate for Payer: BCBS of TX Medicare	$16,849.32
Rate for Payer: Cigna Commercial	$6,879.00
Rate for Payer: Cigna Medicare	$16,849.32
Rate for Payer: Employer Direct Commercial	$16,849.32
Rate for Payer: Humana Medicare/TRICARE	$16,849.32
Rate for Payer: Molina Dual Medicare/Medicaid	$16,849.32
Rate for Payer: Molina Medicare	$16,849.32
Rate for Payer: Multiplan Auto	$30,685.00
Rate for Payer: Multiplan Commercial	$30,685.00
Rate for Payer: Multiplan Workers Comp	$30,685.00
Rate for Payer: Scott and White EPO/PPO	$14,131.25
Rate for Payer: Scott and White Medicare	$16,849.32
Rate for Payer: Superior Health Plan EPO	$16,849.32
Rate for Payer: Superior Health Plan Medicare	$16,849.32
Rate for Payer: Universal American Dual Medicare/Medicaid	$16,849.32
Rate for Payer: Universal American Medicare	$16,849.32
Rate for Payer: Wellcare Medicare	$16,849.32
Rate for Payer: Wellmed Medicare	$16,849.32

CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC

Facility

$16,575.60

Service Code	MSDRG 788
Min. Negotiated Rate	$6,879.00
Max. Negotiated Rate	$16,575.60
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,787.15
Rate for Payer: Amerigroup Medicare	$11,787.15
Rate for Payer: BCBS of TX Medicare	$11,787.15
Rate for Payer: Cigna Commercial	$6,879.00
Rate for Payer: Cigna Medicare	$11,787.15
Rate for Payer: Employer Direct Commercial	$11,787.15
Rate for Payer: Humana Medicare/TRICARE	$11,787.15
Rate for Payer: Molina Dual Medicare/Medicaid	$11,787.15
Rate for Payer: Molina Medicare	$11,787.15
Rate for Payer: Multiplan Auto	$16,575.60
Rate for Payer: Multiplan Commercial	$16,575.60
Rate for Payer: Multiplan Workers Comp	$16,575.60
Rate for Payer: Scott and White EPO/PPO	$7,633.50
Rate for Payer: Scott and White Medicare	$11,787.15
Rate for Payer: Superior Health Plan EPO	$11,787.15
Rate for Payer: Superior Health Plan Medicare	$11,787.15
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,787.15
Rate for Payer: Universal American Medicare	$11,787.15
Rate for Payer: Wellcare Medicare	$11,787.15
Rate for Payer: Wellmed Medicare	$11,787.15

CESAREAN SECTION WITH STERILIZATION

Facility

$2,303.87

Service Code	APR-DRG 5391
Min. Negotiated Rate	$2,172.17
Max. Negotiated Rate	$2,303.87
Rate for Payer: Amerigroup CHIP/Medicaid	$2,172.17
Rate for Payer: Cigna Medicaid	$2,172.17
Rate for Payer: Molina CHIP/Medicaid	$2,172.17
Rate for Payer: Parkland Medicaid	$2,172.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,303.87

CESAREAN SECTION WITH STERILIZATION

Facility

$10,981.48

Service Code	APR-DRG 5394
Min. Negotiated Rate	$10,353.72
Max. Negotiated Rate	$10,981.48
Rate for Payer: Amerigroup CHIP/Medicaid	$10,353.72
Rate for Payer: Cigna Medicaid	$10,353.72
Rate for Payer: Molina CHIP/Medicaid	$10,353.72
Rate for Payer: Parkland Medicaid	$10,353.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,981.48

CESAREAN SECTION WITH STERILIZATION

Facility

$4,383.69

Service Code	APR-DRG 5393
Min. Negotiated Rate	$4,133.10
Max. Negotiated Rate	$4,383.69
Rate for Payer: Amerigroup CHIP/Medicaid	$4,133.10
Rate for Payer: Cigna Medicaid	$4,133.10
Rate for Payer: Molina CHIP/Medicaid	$4,133.10
Rate for Payer: Parkland Medicaid	$4,133.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,383.69

CESAREAN SECTION WITH STERILIZATION

Facility

$2,778.00

Service Code	APR-DRG 5392
Min. Negotiated Rate	$2,619.19
Max. Negotiated Rate	$2,778.00
Rate for Payer: Amerigroup CHIP/Medicaid	$2,619.19
Rate for Payer: Cigna Medicaid	$2,619.19
Rate for Payer: Molina CHIP/Medicaid	$2,619.19
Rate for Payer: Parkland Medicaid	$2,619.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,778.00

CESAREAN SECTION WITH STERILIZATION WITH CC

Facility

$19,836.00

Service Code	MSDRG 784
Min. Negotiated Rate	$6,879.00
Max. Negotiated Rate	$19,836.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,529.59
Rate for Payer: Amerigroup Medicare	$12,529.59
Rate for Payer: BCBS of TX Medicare	$12,529.59
Rate for Payer: Cigna Commercial	$6,879.00
Rate for Payer: Cigna Medicare	$12,529.59
Rate for Payer: Employer Direct Commercial	$12,529.59
Rate for Payer: Humana Medicare/TRICARE	$12,529.59
Rate for Payer: Molina Dual Medicare/Medicaid	$12,529.59
Rate for Payer: Molina Medicare	$12,529.59
Rate for Payer: Multiplan Auto	$19,836.00
Rate for Payer: Multiplan Commercial	$19,836.00
Rate for Payer: Multiplan Workers Comp	$19,836.00
Rate for Payer: Scott and White EPO/PPO	$9,135.00
Rate for Payer: Scott and White Medicare	$12,529.59
Rate for Payer: Superior Health Plan EPO	$12,529.59
Rate for Payer: Superior Health Plan Medicare	$12,529.59
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,529.59
Rate for Payer: Universal American Medicare	$12,529.59
Rate for Payer: Wellcare Medicare	$12,529.59
Rate for Payer: Wellmed Medicare	$12,529.59

CESAREAN SECTION WITH STERILIZATION WITH MCC

Facility

$36,664.30

Service Code	MSDRG 783
Min. Negotiated Rate	$6,879.00
Max. Negotiated Rate	$36,664.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$22,753.57
Rate for Payer: Amerigroup Medicare	$22,753.57
Rate for Payer: BCBS of TX Medicare	$22,753.57
Rate for Payer: Cigna Commercial	$6,879.00
Rate for Payer: Cigna Medicare	$22,753.57
Rate for Payer: Employer Direct Commercial	$22,753.57
Rate for Payer: Humana Medicare/TRICARE	$22,753.57
Rate for Payer: Molina Dual Medicare/Medicaid	$22,753.57
Rate for Payer: Molina Medicare	$22,753.57
Rate for Payer: Multiplan Auto	$36,664.30
Rate for Payer: Multiplan Commercial	$36,664.30
Rate for Payer: Multiplan Workers Comp	$36,664.30
Rate for Payer: Scott and White EPO/PPO	$16,884.88
Rate for Payer: Scott and White Medicare	$22,753.57
Rate for Payer: Superior Health Plan EPO	$22,753.57
Rate for Payer: Superior Health Plan Medicare	$22,753.57
Rate for Payer: Universal American Dual Medicare/Medicaid	$22,753.57
Rate for Payer: Universal American Medicare	$22,753.57
Rate for Payer: Wellcare Medicare	$22,753.57
Rate for Payer: Wellmed Medicare	$22,753.57

CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC

Facility

$17,329.90

Service Code	MSDRG 785
Min. Negotiated Rate	$6,879.00
Max. Negotiated Rate	$17,329.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,779.83
Rate for Payer: Amerigroup Medicare	$11,779.83
Rate for Payer: BCBS of TX Medicare	$11,779.83
Rate for Payer: Cigna Commercial	$6,879.00
Rate for Payer: Cigna Medicare	$11,779.83
Rate for Payer: Employer Direct Commercial	$11,779.83
Rate for Payer: Humana Medicare/TRICARE	$11,779.83
Rate for Payer: Molina Dual Medicare/Medicaid	$11,779.83
Rate for Payer: Molina Medicare	$11,779.83
Rate for Payer: Multiplan Auto	$17,329.90
Rate for Payer: Multiplan Commercial	$17,329.90
Rate for Payer: Multiplan Workers Comp	$17,329.90
Rate for Payer: Scott and White EPO/PPO	$7,980.88
Rate for Payer: Scott and White Medicare	$11,779.83
Rate for Payer: Superior Health Plan EPO	$11,779.83
Rate for Payer: Superior Health Plan Medicare	$11,779.83
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,779.83
Rate for Payer: Universal American Medicare	$11,779.83
Rate for Payer: Wellcare Medicare	$11,779.83
Rate for Payer: Wellmed Medicare	$11,779.83

CESAREAN SECTION W/O STERILIZATION W CC

Facility

$20,240.70

Service Code	MSDRG 787
Min. Negotiated Rate	$6,879.00
Max. Negotiated Rate	$20,240.70
Rate for Payer: BCBS of TX Blue Advantage	$9,297.46
Rate for Payer: BCBS of TX Blue Essentials	$11,155.87
Rate for Payer: BCBS of TX PPO	$12,395.89

CESAREAN SECTION W/O STERILIZATION W MCC

Facility

$30,685.00

Service Code	MSDRG 786
Min. Negotiated Rate	$6,879.00
Max. Negotiated Rate	$30,685.00
Rate for Payer: BCBS of TX Blue Advantage	$13,371.28
Rate for Payer: BCBS of TX Blue Essentials	$16,043.98
Rate for Payer: BCBS of TX PPO	$17,827.34

CESAREAN SECTION W/O STERILIZATION W/O CC/MCC

Facility

$16,575.60

Service Code	MSDRG 788
Min. Negotiated Rate	$6,879.00
Max. Negotiated Rate	$16,575.60
Rate for Payer: BCBS of TX Blue Advantage	$7,746.02
Rate for Payer: BCBS of TX Blue Essentials	$9,294.32
Rate for Payer: BCBS of TX PPO	$10,327.43

CESAREAN SECTION W STERILIZATION W CC

Facility

$19,836.00

Service Code	MSDRG 784
Min. Negotiated Rate	$6,879.00
Max. Negotiated Rate	$19,836.00
Rate for Payer: BCBS of TX Blue Advantage	$9,478.06
Rate for Payer: BCBS of TX Blue Essentials	$11,372.57
Rate for Payer: BCBS of TX PPO	$12,636.68

CESAREAN SECTION W STERILIZATION W MCC

Facility

$36,664.30

Service Code	MSDRG 783
Min. Negotiated Rate	$6,879.00
Max. Negotiated Rate	$36,664.30
Rate for Payer: BCBS of TX Blue Advantage	$15,011.30
Rate for Payer: BCBS of TX Blue Essentials	$18,011.81
Rate for Payer: BCBS of TX PPO	$20,013.90

CESAREAN SECTION W STERILIZATION W/O CC/MCC

Facility

$17,329.90

Service Code	MSDRG 785
Min. Negotiated Rate	$6,879.00
Max. Negotiated Rate	$17,329.90
Rate for Payer: BCBS of TX Blue Advantage	$7,271.30
Rate for Payer: BCBS of TX Blue Essentials	$8,724.71
Rate for Payer: BCBS of TX PPO	$9,694.50

Know your out-of-pocket cost for care.

All Charges