White Rock Medical Center

All Charges

Charge

Type

Setting

Price

KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC

Facility

$21,817.70

Service Code	MSDRG 695
Min. Negotiated Rate	$9,878.82
Max. Negotiated Rate	$21,817.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13,143.03
Rate for Payer: Amerigroup Medicare	$13,143.03
Rate for Payer: BCBS of TX Medicare	$13,143.03
Rate for Payer: Cigna Commercial	$14,732.14
Rate for Payer: Cigna Medicare	$13,143.03
Rate for Payer: Employer Direct Commercial	$13,143.03
Rate for Payer: Humana Medicare/TRICARE	$13,143.03
Rate for Payer: Molina Dual Medicare/Medicaid	$13,143.03
Rate for Payer: Molina Medicare	$13,143.03
Rate for Payer: Multiplan Auto	$21,817.70
Rate for Payer: Multiplan Commercial	$21,817.70
Rate for Payer: Multiplan Workers Comp	$21,817.70
Rate for Payer: Scott and White EPO/PPO	$10,047.62
Rate for Payer: Scott and White Medicare	$13,143.03
Rate for Payer: Superior Health Plan EPO	$13,143.03
Rate for Payer: Superior Health Plan Medicare	$13,143.03
Rate for Payer: Universal American Dual Medicare/Medicaid	$13,143.03
Rate for Payer: Universal American Medicare	$13,143.03
Rate for Payer: Wellcare Medicare	$13,143.03
Rate for Payer: Wellmed Medicare	$13,143.03

KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC

Facility

$13,167.00

Service Code	MSDRG 696
Min. Negotiated Rate	$5,921.96
Max. Negotiated Rate	$13,167.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$9,809.78
Rate for Payer: Amerigroup Medicare	$9,809.78
Rate for Payer: BCBS of TX Medicare	$9,809.78
Rate for Payer: Cigna Commercial	$8,874.32
Rate for Payer: Cigna Medicare	$9,809.78
Rate for Payer: Employer Direct Commercial	$9,809.78
Rate for Payer: Humana Medicare/TRICARE	$9,809.78
Rate for Payer: Molina Dual Medicare/Medicaid	$9,809.78
Rate for Payer: Molina Medicare	$9,809.78
Rate for Payer: Multiplan Auto	$13,167.00
Rate for Payer: Multiplan Commercial	$13,167.00
Rate for Payer: Multiplan Workers Comp	$13,167.00
Rate for Payer: Scott and White EPO/PPO	$6,063.75
Rate for Payer: Scott and White Medicare	$9,809.78
Rate for Payer: Superior Health Plan EPO	$9,809.78
Rate for Payer: Superior Health Plan Medicare	$9,809.78
Rate for Payer: Universal American Dual Medicare/Medicaid	$9,809.78
Rate for Payer: Universal American Medicare	$9,809.78
Rate for Payer: Wellcare Medicare	$9,809.78
Rate for Payer: Wellmed Medicare	$9,809.78

KIDNEY TRANSPLANT

Facility

$23,032.67

Service Code	APR-DRG 4401
Min. Negotiated Rate	$21,716.01
Max. Negotiated Rate	$23,032.67
Rate for Payer: Amerigroup CHIP/Medicaid	$21,716.01
Rate for Payer: Cigna Medicaid	$21,716.01
Rate for Payer: Molina CHIP/Medicaid	$21,716.01
Rate for Payer: Parkland Medicaid	$21,716.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$23,032.67

KIDNEY TRANSPLANT

Facility

$38,202.46

Service Code	APR-DRG 4403
Min. Negotiated Rate	$36,018.61
Max. Negotiated Rate	$38,202.46
Rate for Payer: Amerigroup CHIP/Medicaid	$36,018.61
Rate for Payer: Cigna Medicaid	$36,018.61
Rate for Payer: Molina CHIP/Medicaid	$36,018.61
Rate for Payer: Parkland Medicaid	$36,018.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$38,202.46

KIDNEY TRANSPLANT

Facility

$58,616.90

Service Code	MSDRG 652
Min. Negotiated Rate	$26,994.62
Max. Negotiated Rate	$58,616.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$28,429.17
Rate for Payer: Amerigroup Medicare	$28,429.17
Rate for Payer: BCBS of TX Blue Advantage	$28,505.56
Rate for Payer: BCBS of TX Blue Essentials	$34,203.36
Rate for Payer: BCBS of TX Medicare	$28,429.17
Rate for Payer: BCBS of TX PPO	$38,005.20
Rate for Payer: Cigna Commercial	$41,595.96
Rate for Payer: Cigna Medicare	$28,429.17
Rate for Payer: Employer Direct Commercial	$28,429.17
Rate for Payer: Molina Dual Medicare/Medicaid	$28,429.17
Rate for Payer: Molina Medicare	$28,429.17
Rate for Payer: Multiplan Auto	$58,616.90
Rate for Payer: Multiplan Commercial	$58,616.90
Rate for Payer: Multiplan Workers Comp	$58,616.90
Rate for Payer: Scott and White EPO/PPO	$26,994.62
Rate for Payer: Scott and White Medicare	$28,429.17
Rate for Payer: Superior Health Plan EPO	$28,429.17
Rate for Payer: Superior Health Plan Medicare	$28,429.17
Rate for Payer: Universal American Dual Medicare/Medicaid	$28,429.17
Rate for Payer: Universal American Medicare	$28,429.17
Rate for Payer: Wellcare Medicare	$28,429.17
Rate for Payer: Wellmed Medicare	$28,429.17

KIDNEY TRANSPLANT

Facility

$62,417.61

Service Code	APR-DRG 4404
Min. Negotiated Rate	$58,849.51
Max. Negotiated Rate	$62,417.61
Rate for Payer: Amerigroup CHIP/Medicaid	$58,849.51
Rate for Payer: Cigna Medicaid	$58,849.51
Rate for Payer: Molina CHIP/Medicaid	$58,849.51
Rate for Payer: Parkland Medicaid	$58,849.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$62,417.61

KIDNEY TRANSPLANT

Facility

$24,571.22

Service Code	APR-DRG 4402
Min. Negotiated Rate	$23,166.61
Max. Negotiated Rate	$24,571.22
Rate for Payer: Amerigroup CHIP/Medicaid	$23,166.61
Rate for Payer: Cigna Medicaid	$23,166.61
Rate for Payer: Molina CHIP/Medicaid	$23,166.61
Rate for Payer: Parkland Medicaid	$23,166.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$24,571.22

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC

Facility

$88,234.10

Service Code	MSDRG 650
Min. Negotiated Rate	$39,216.76
Max. Negotiated Rate	$88,234.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$39,216.76
Rate for Payer: Amerigroup Medicare	$39,216.76
Rate for Payer: BCBS of TX Medicare	$39,216.76
Rate for Payer: Cigna Commercial	$60,554.03
Rate for Payer: Cigna Medicare	$39,216.76
Rate for Payer: Employer Direct Commercial	$39,216.76
Rate for Payer: Humana Medicare/TRICARE	$39,216.76
Rate for Payer: Molina Dual Medicare/Medicaid	$39,216.76
Rate for Payer: Molina Medicare	$39,216.76
Rate for Payer: Multiplan Auto	$88,234.10
Rate for Payer: Multiplan Commercial	$88,234.10
Rate for Payer: Multiplan Workers Comp	$88,234.10
Rate for Payer: Scott and White EPO/PPO	$40,634.12
Rate for Payer: Scott and White Medicare	$39,216.76
Rate for Payer: Superior Health Plan EPO	$39,216.76
Rate for Payer: Superior Health Plan Medicare	$39,216.76
Rate for Payer: Universal American Dual Medicare/Medicaid	$39,216.76
Rate for Payer: Universal American Medicare	$39,216.76
Rate for Payer: Wellcare Medicare	$39,216.76
Rate for Payer: Wellmed Medicare	$39,216.76

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC

Facility

$67,377.80

Service Code	MSDRG 651
Min. Negotiated Rate	$31,029.25
Max. Negotiated Rate	$67,377.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$31,919.99
Rate for Payer: Amerigroup Medicare	$31,919.99
Rate for Payer: BCBS of TX Medicare	$31,919.99
Rate for Payer: Cigna Commercial	$47,730.70
Rate for Payer: Cigna Medicare	$31,919.99
Rate for Payer: Employer Direct Commercial	$31,919.99
Rate for Payer: Humana Medicare/TRICARE	$31,919.99
Rate for Payer: Molina Dual Medicare/Medicaid	$31,919.99
Rate for Payer: Molina Medicare	$31,919.99
Rate for Payer: Multiplan Auto	$67,377.80
Rate for Payer: Multiplan Commercial	$67,377.80
Rate for Payer: Multiplan Workers Comp	$67,377.80
Rate for Payer: Scott and White EPO/PPO	$31,029.25
Rate for Payer: Scott and White Medicare	$31,919.99
Rate for Payer: Superior Health Plan EPO	$31,919.99
Rate for Payer: Superior Health Plan Medicare	$31,919.99
Rate for Payer: Universal American Dual Medicare/Medicaid	$31,919.99
Rate for Payer: Universal American Medicare	$31,919.99
Rate for Payer: Wellcare Medicare	$31,919.99
Rate for Payer: Wellmed Medicare	$31,919.99

KIDNEY & URETER PROCEDURES FOR NEOPLASM W CC

Facility

$35,682.00

Service Code	MSDRG 657
Min. Negotiated Rate	$16,432.50
Max. Negotiated Rate	$35,682.00
Rate for Payer: BCBS of TX Blue Advantage	$16,747.64
Rate for Payer: BCBS of TX Blue Essentials	$20,095.22
Rate for Payer: BCBS of TX PPO	$22,328.89

KIDNEY & URETER PROCEDURES FOR NEOPLASM W MCC

Facility

$62,800.70

Service Code	MSDRG 656
Min. Negotiated Rate	$28,094.23
Max. Negotiated Rate	$62,800.70
Rate for Payer: BCBS of TX Blue Advantage	$28,617.36
Rate for Payer: BCBS of TX Blue Essentials	$34,337.50
Rate for Payer: BCBS of TX PPO	$38,154.26

KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC

Facility

$30,001.00

Service Code	MSDRG 658
Min. Negotiated Rate	$13,471.04
Max. Negotiated Rate	$30,001.00
Rate for Payer: BCBS of TX Blue Advantage	$13,471.04
Rate for Payer: BCBS of TX Blue Essentials	$16,163.68
Rate for Payer: BCBS of TX PPO	$17,960.34

KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W CC

Facility

$26,812.80

Service Code	MSDRG 660
Min. Negotiated Rate	$12,348.00
Max. Negotiated Rate	$26,812.80
Rate for Payer: BCBS of TX Blue Advantage	$12,449.36
Rate for Payer: BCBS of TX Blue Essentials	$14,937.78
Rate for Payer: BCBS of TX PPO	$16,598.18

KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W MCC

Facility

$48,961.10

Service Code	MSDRG 659
Min. Negotiated Rate	$22,547.88
Max. Negotiated Rate	$48,961.10
Rate for Payer: BCBS of TX Blue Advantage	$23,453.06
Rate for Payer: BCBS of TX Blue Essentials	$28,140.94
Rate for Payer: BCBS of TX PPO	$31,268.93

KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W/O CC/MCC

Facility

$20,480.10

Service Code	MSDRG 661
Min. Negotiated Rate	$9,226.08
Max. Negotiated Rate	$20,480.10
Rate for Payer: BCBS of TX Blue Advantage	$9,226.08
Rate for Payer: BCBS of TX Blue Essentials	$11,070.22
Rate for Payer: BCBS of TX PPO	$12,300.72

KIDNEY & URINARY TRACT INFECTIONS W MCC

Facility

$21,794.90

Service Code	MSDRG 689
Min. Negotiated Rate	$9,559.76
Max. Negotiated Rate	$21,794.90
Rate for Payer: BCBS of TX Blue Advantage	$9,559.76
Rate for Payer: BCBS of TX Blue Essentials	$11,470.60
Rate for Payer: BCBS of TX PPO	$12,745.61

KIDNEY & URINARY TRACT INFECTIONS W/O MCC

Facility

$15,116.40

Service Code	MSDRG 690
Min. Negotiated Rate	$6,829.26
Max. Negotiated Rate	$15,116.40
Rate for Payer: BCBS of TX Blue Advantage	$6,829.26
Rate for Payer: BCBS of TX Blue Essentials	$8,194.32
Rate for Payer: BCBS of TX PPO	$9,105.15

KIDNEY & URINARY TRACT NEOPLASMS W CC

Facility

$19,756.20

Service Code	MSDRG 687
Min. Negotiated Rate	$9,061.82
Max. Negotiated Rate	$19,756.20
Rate for Payer: BCBS of TX Blue Advantage	$9,061.82
Rate for Payer: BCBS of TX Blue Essentials	$10,873.13
Rate for Payer: BCBS of TX PPO	$12,081.72

KIDNEY & URINARY TRACT NEOPLASMS W MCC

Facility

$32,258.20

Service Code	MSDRG 686
Min. Negotiated Rate	$14,771.36
Max. Negotiated Rate	$32,258.20
Rate for Payer: BCBS of TX Blue Advantage	$14,771.36
Rate for Payer: BCBS of TX Blue Essentials	$17,723.91
Rate for Payer: BCBS of TX PPO	$19,694.00

KIDNEY & URINARY TRACT NEOPLASMS W/O CC/MCC

Facility

$16,461.60

Service Code	MSDRG 688
Min. Negotiated Rate	$6,801.74
Max. Negotiated Rate	$16,461.60
Rate for Payer: BCBS of TX Blue Advantage	$6,801.74
Rate for Payer: BCBS of TX Blue Essentials	$8,161.30
Rate for Payer: BCBS of TX PPO	$9,068.46

KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W MCC

Facility

$21,817.70

Service Code	MSDRG 695
Min. Negotiated Rate	$9,878.82
Max. Negotiated Rate	$21,817.70
Rate for Payer: BCBS of TX Blue Advantage	$9,878.82
Rate for Payer: BCBS of TX Blue Essentials	$11,853.44
Rate for Payer: BCBS of TX PPO	$13,170.99

KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W/O MCC

Facility

$13,167.00

Service Code	MSDRG 696
Min. Negotiated Rate	$5,921.96
Max. Negotiated Rate	$13,167.00
Rate for Payer: BCBS of TX Blue Advantage	$5,921.96
Rate for Payer: BCBS of TX Blue Essentials	$7,105.66
Rate for Payer: BCBS of TX PPO	$7,895.49

kit 15mm elite fracture inflation

Facility

$9,783.70

Hospital Charge Code	8634509
Hospital Revenue Code	272
Min. Negotiated Rate	$880.53
Max. Negotiated Rate	$7,044.26
Rate for Payer: Amerigroup CHIP/Medicaid	$880.53
Rate for Payer: BCBS of TX Blue Advantage	$2,935.11
Rate for Payer: BCBS of TX Blue Essentials	$3,522.13
Rate for Payer: BCBS of TX PPO	$3,913.48
Rate for Payer: Cash Price	$6,652.92
Rate for Payer: Cigna Medicaid	$7,044.26
Rate for Payer: Molina CHIP/Medicaid	$7,044.26
Rate for Payer: Multiplan Auto	$6,359.40
Rate for Payer: Multiplan Commercial	$6,359.40
Rate for Payer: Multiplan Workers Comp	$6,359.40
Rate for Payer: Parkland Medicaid	$7,044.26
Rate for Payer: Scott and White EPO/PPO	$4,891.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,044.26
Rate for Payer: Superior Health Plan EPO	$1,330.58

kit 15mm elite fracture inflation

Facility

$9,783.70

Hospital Charge Code	8634509
Hospital Revenue Code	272
Rate for Payer: Cash Price	$6,652.92

KIT 6FT 3/8IN VAC CRTG HNDL SLP RNG TBG

Facility

$166.57

Hospital Charge Code	993937
Hospital Revenue Code	272
Min. Negotiated Rate	$14.99
Max. Negotiated Rate	$119.93
Rate for Payer: Amerigroup CHIP/Medicaid	$14.99
Rate for Payer: BCBS of TX Blue Advantage	$49.97
Rate for Payer: BCBS of TX Blue Essentials	$59.97
Rate for Payer: BCBS of TX PPO	$66.63
Rate for Payer: Cash Price	$113.27
Rate for Payer: Cigna Medicaid	$119.93
Rate for Payer: Molina CHIP/Medicaid	$119.93
Rate for Payer: Multiplan Auto	$108.27
Rate for Payer: Multiplan Commercial	$108.27
Rate for Payer: Multiplan Workers Comp	$108.27
Rate for Payer: Parkland Medicaid	$119.93
Rate for Payer: Scott and White EPO/PPO	$83.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$119.93
Rate for Payer: Superior Health Plan EPO	$22.65

Know your out-of-pocket cost for care.

All Charges