White Rock Medical Center

All Charges

Charge

Type

Setting

Price

MAJOR BLADDER PROCEDURES W CC

Facility

$53,186.70

Service Code	MSDRG 654
Min. Negotiated Rate	$24,493.88
Max. Negotiated Rate	$53,186.70
Rate for Payer: BCBS of TX Blue Advantage	$24,710.38
Rate for Payer: BCBS of TX Blue Essentials	$29,649.58
Rate for Payer: BCBS of TX PPO	$32,945.26

MAJOR BLADDER PROCEDURES WITH CC

Facility

$53,186.70

Service Code	MSDRG 654
Min. Negotiated Rate	$24,493.88
Max. Negotiated Rate	$53,186.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$25,276.23
Rate for Payer: Amerigroup Medicare	$25,276.23
Rate for Payer: BCBS of TX Medicare	$25,276.23
Rate for Payer: Cigna Commercial	$36,054.98
Rate for Payer: Cigna Medicare	$25,276.23
Rate for Payer: Employer Direct Commercial	$25,276.23
Rate for Payer: Humana Medicare/TRICARE	$25,276.23
Rate for Payer: Molina Dual Medicare/Medicaid	$25,276.23
Rate for Payer: Molina Medicare	$25,276.23
Rate for Payer: Multiplan Auto	$53,186.70
Rate for Payer: Multiplan Commercial	$53,186.70
Rate for Payer: Multiplan Workers Comp	$53,186.70
Rate for Payer: Scott and White EPO/PPO	$24,493.88
Rate for Payer: Scott and White Medicare	$25,276.23
Rate for Payer: Superior Health Plan EPO	$25,276.23
Rate for Payer: Superior Health Plan Medicare	$25,276.23
Rate for Payer: Universal American Dual Medicare/Medicaid	$25,276.23
Rate for Payer: Universal American Medicare	$25,276.23
Rate for Payer: Wellcare Medicare	$25,276.23
Rate for Payer: Wellmed Medicare	$25,276.23

MAJOR BLADDER PROCEDURES WITH MCC

Facility

$98,731.60

Service Code	MSDRG 653
Min. Negotiated Rate	$42,844.65
Max. Negotiated Rate	$98,731.60
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$42,844.65
Rate for Payer: Amerigroup Medicare	$42,844.65
Rate for Payer: BCBS of TX Medicare	$42,844.65
Rate for Payer: Cigna Commercial	$66,929.63
Rate for Payer: Cigna Medicare	$42,844.65
Rate for Payer: Employer Direct Commercial	$42,844.65
Rate for Payer: Humana Medicare/TRICARE	$42,844.65
Rate for Payer: Molina Dual Medicare/Medicaid	$42,844.65
Rate for Payer: Molina Medicare	$42,844.65
Rate for Payer: Multiplan Auto	$98,731.60
Rate for Payer: Multiplan Commercial	$98,731.60
Rate for Payer: Multiplan Workers Comp	$98,731.60
Rate for Payer: Scott and White EPO/PPO	$45,468.50
Rate for Payer: Scott and White Medicare	$42,844.65
Rate for Payer: Superior Health Plan EPO	$42,844.65
Rate for Payer: Superior Health Plan Medicare	$42,844.65
Rate for Payer: Universal American Dual Medicare/Medicaid	$42,844.65
Rate for Payer: Universal American Medicare	$42,844.65
Rate for Payer: Wellcare Medicare	$42,844.65
Rate for Payer: Wellmed Medicare	$42,844.65

MAJOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$40,215.40

Service Code	MSDRG 655
Min. Negotiated Rate	$17,863.92
Max. Negotiated Rate	$40,215.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$20,272.70
Rate for Payer: Amerigroup Medicare	$20,272.70
Rate for Payer: BCBS of TX Medicare	$20,272.70
Rate for Payer: Cigna Commercial	$27,261.81
Rate for Payer: Cigna Medicare	$20,272.70
Rate for Payer: Employer Direct Commercial	$20,272.70
Rate for Payer: Humana Medicare/TRICARE	$20,272.70
Rate for Payer: Molina Dual Medicare/Medicaid	$20,272.70
Rate for Payer: Molina Medicare	$20,272.70
Rate for Payer: Multiplan Auto	$40,215.40
Rate for Payer: Multiplan Commercial	$40,215.40
Rate for Payer: Multiplan Workers Comp	$40,215.40
Rate for Payer: Scott and White EPO/PPO	$18,520.25
Rate for Payer: Scott and White Medicare	$20,272.70
Rate for Payer: Superior Health Plan EPO	$20,272.70
Rate for Payer: Superior Health Plan Medicare	$20,272.70
Rate for Payer: Universal American Dual Medicare/Medicaid	$20,272.70
Rate for Payer: Universal American Medicare	$20,272.70
Rate for Payer: Wellcare Medicare	$20,272.70
Rate for Payer: Wellmed Medicare	$20,272.70

MAJOR BLADDER PROCEDURES W MCC

Facility

$98,731.60

Service Code	MSDRG 653
Min. Negotiated Rate	$42,844.65
Max. Negotiated Rate	$98,731.60
Rate for Payer: BCBS of TX Blue Advantage	$47,205.40
Rate for Payer: BCBS of TX Blue Essentials	$56,640.99
Rate for Payer: BCBS of TX PPO	$62,936.87

MAJOR BLADDER PROCEDURES W/O CC/MCC

Facility

$40,215.40

Service Code	MSDRG 655
Min. Negotiated Rate	$17,863.92
Max. Negotiated Rate	$40,215.40
Rate for Payer: BCBS of TX Blue Advantage	$17,863.92
Rate for Payer: BCBS of TX Blue Essentials	$21,434.63
Rate for Payer: BCBS of TX PPO	$23,817.18

MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$23,998.65

Service Code	APR-DRG 1602
Min. Negotiated Rate	$22,626.77
Max. Negotiated Rate	$23,998.65
Rate for Payer: Amerigroup CHIP/Medicaid	$22,626.77
Rate for Payer: Cigna Medicaid	$22,626.77
Rate for Payer: Molina CHIP/Medicaid	$22,626.77
Rate for Payer: Parkland Medicaid	$22,626.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$23,998.65

MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$18,833.05

Service Code	APR-DRG 1601
Min. Negotiated Rate	$17,756.46
Max. Negotiated Rate	$18,833.05
Rate for Payer: Amerigroup CHIP/Medicaid	$17,756.46
Rate for Payer: Cigna Medicaid	$17,756.46
Rate for Payer: Molina CHIP/Medicaid	$17,756.46
Rate for Payer: Parkland Medicaid	$17,756.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18,833.05

MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$34,539.20

Service Code	APR-DRG 1603
Min. Negotiated Rate	$32,564.76
Max. Negotiated Rate	$34,539.20
Rate for Payer: Amerigroup CHIP/Medicaid	$32,564.76
Rate for Payer: Cigna Medicaid	$32,564.76
Rate for Payer: Molina CHIP/Medicaid	$32,564.76
Rate for Payer: Parkland Medicaid	$32,564.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$34,539.20

MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$81,731.95

Service Code	APR-DRG 1604
Min. Negotiated Rate	$77,059.75
Max. Negotiated Rate	$81,731.95
Rate for Payer: Amerigroup CHIP/Medicaid	$77,059.75
Rate for Payer: Cigna Medicaid	$77,059.75
Rate for Payer: Molina CHIP/Medicaid	$77,059.75
Rate for Payer: Parkland Medicaid	$77,059.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$81,731.95

MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$9,316.57

Service Code	APR-DRG 1354
Min. Negotiated Rate	$8,783.99
Max. Negotiated Rate	$9,316.57
Rate for Payer: Amerigroup CHIP/Medicaid	$8,783.99
Rate for Payer: Cigna Medicaid	$8,783.99
Rate for Payer: Molina CHIP/Medicaid	$8,783.99
Rate for Payer: Parkland Medicaid	$8,783.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,316.57

MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$5,662.74

Service Code	APR-DRG 1353
Min. Negotiated Rate	$5,339.03
Max. Negotiated Rate	$5,662.74
Rate for Payer: Amerigroup CHIP/Medicaid	$5,339.03
Rate for Payer: Cigna Medicaid	$5,339.03
Rate for Payer: Molina CHIP/Medicaid	$5,339.03
Rate for Payer: Parkland Medicaid	$5,339.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,662.74

MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$4,735.61

Service Code	APR-DRG 1352
Min. Negotiated Rate	$4,464.90
Max. Negotiated Rate	$4,735.61
Rate for Payer: Amerigroup CHIP/Medicaid	$4,464.90
Rate for Payer: Cigna Medicaid	$4,464.90
Rate for Payer: Molina CHIP/Medicaid	$4,464.90
Rate for Payer: Parkland Medicaid	$4,464.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,735.61

MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$3,575.00

Service Code	APR-DRG 1351
Min. Negotiated Rate	$3,370.63
Max. Negotiated Rate	$3,575.00
Rate for Payer: Amerigroup CHIP/Medicaid	$3,370.63
Rate for Payer: Cigna Medicaid	$3,370.63
Rate for Payer: Molina CHIP/Medicaid	$3,370.63
Rate for Payer: Parkland Medicaid	$3,370.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,575.00

MAJOR CHEST PROCEDURES W CC

Facility

$47,956.00

Service Code	MSDRG 164
Min. Negotiated Rate	$22,085.00
Max. Negotiated Rate	$47,956.00
Rate for Payer: BCBS of TX Blue Advantage	$22,092.54
Rate for Payer: BCBS of TX Blue Essentials	$26,508.48
Rate for Payer: BCBS of TX PPO	$29,455.01

MAJOR CHEST PROCEDURES WITH CC

Facility

$47,956.00

Service Code	MSDRG 164
Min. Negotiated Rate	$22,085.00
Max. Negotiated Rate	$47,956.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$23,258.54
Rate for Payer: Amerigroup Medicare	$23,258.54
Rate for Payer: BCBS of TX Medicare	$23,258.54
Rate for Payer: Cigna Commercial	$32,509.12
Rate for Payer: Cigna Medicare	$23,258.54
Rate for Payer: Employer Direct Commercial	$23,258.54
Rate for Payer: Humana Medicare/TRICARE	$23,258.54
Rate for Payer: Molina Dual Medicare/Medicaid	$23,258.54
Rate for Payer: Molina Medicare	$23,258.54
Rate for Payer: Multiplan Auto	$47,956.00
Rate for Payer: Multiplan Commercial	$47,956.00
Rate for Payer: Multiplan Workers Comp	$47,956.00
Rate for Payer: Scott and White EPO/PPO	$22,085.00
Rate for Payer: Scott and White Medicare	$23,258.54
Rate for Payer: Superior Health Plan EPO	$23,258.54
Rate for Payer: Superior Health Plan Medicare	$23,258.54
Rate for Payer: Universal American Dual Medicare/Medicaid	$23,258.54
Rate for Payer: Universal American Medicare	$23,258.54
Rate for Payer: Wellcare Medicare	$23,258.54
Rate for Payer: Wellmed Medicare	$23,258.54

MAJOR CHEST PROCEDURES WITH MCC

Facility

$85,154.20

Service Code	MSDRG 163
Min. Negotiated Rate	$37,607.31
Max. Negotiated Rate	$85,154.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$37,607.31
Rate for Payer: Amerigroup Medicare	$37,607.31
Rate for Payer: BCBS of TX Medicare	$37,607.31
Rate for Payer: Cigna Commercial	$57,725.58
Rate for Payer: Cigna Medicare	$37,607.31
Rate for Payer: Employer Direct Commercial	$37,607.31
Rate for Payer: Humana Medicare/TRICARE	$37,607.31
Rate for Payer: Molina Dual Medicare/Medicaid	$37,607.31
Rate for Payer: Molina Medicare	$37,607.31
Rate for Payer: Multiplan Auto	$85,154.20
Rate for Payer: Multiplan Commercial	$85,154.20
Rate for Payer: Multiplan Workers Comp	$85,154.20
Rate for Payer: Scott and White EPO/PPO	$39,215.75
Rate for Payer: Scott and White Medicare	$37,607.31
Rate for Payer: Superior Health Plan EPO	$37,607.31
Rate for Payer: Superior Health Plan Medicare	$37,607.31
Rate for Payer: Universal American Dual Medicare/Medicaid	$37,607.31
Rate for Payer: Universal American Medicare	$37,607.31
Rate for Payer: Wellcare Medicare	$37,607.31
Rate for Payer: Wellmed Medicare	$37,607.31

MAJOR CHEST PROCEDURES WITHOUT CC/MCC

Facility

$36,369.80

Service Code	MSDRG 165
Min. Negotiated Rate	$15,930.64
Max. Negotiated Rate	$36,369.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$18,789.30
Rate for Payer: Amerigroup Medicare	$18,789.30
Rate for Payer: BCBS of TX Medicare	$18,789.30
Rate for Payer: Cigna Commercial	$24,654.90
Rate for Payer: Cigna Medicare	$18,789.30
Rate for Payer: Employer Direct Commercial	$18,789.30
Rate for Payer: Humana Medicare/TRICARE	$18,789.30
Rate for Payer: Molina Dual Medicare/Medicaid	$18,789.30
Rate for Payer: Molina Medicare	$18,789.30
Rate for Payer: Multiplan Auto	$36,369.80
Rate for Payer: Multiplan Commercial	$36,369.80
Rate for Payer: Multiplan Workers Comp	$36,369.80
Rate for Payer: Scott and White EPO/PPO	$16,749.25
Rate for Payer: Scott and White Medicare	$18,789.30
Rate for Payer: Superior Health Plan EPO	$18,789.30
Rate for Payer: Superior Health Plan Medicare	$18,789.30
Rate for Payer: Universal American Dual Medicare/Medicaid	$18,789.30
Rate for Payer: Universal American Medicare	$18,789.30
Rate for Payer: Wellcare Medicare	$18,789.30
Rate for Payer: Wellmed Medicare	$18,789.30

MAJOR CHEST PROCEDURES W MCC

Facility

$85,154.20

Service Code	MSDRG 163
Min. Negotiated Rate	$37,607.31
Max. Negotiated Rate	$85,154.20
Rate for Payer: BCBS of TX Blue Advantage	$42,305.98
Rate for Payer: BCBS of TX Blue Essentials	$50,762.26
Rate for Payer: BCBS of TX PPO	$56,404.69

MAJOR CHEST PROCEDURES W/O CC/MCC

Facility

$36,369.80

Service Code	MSDRG 165
Min. Negotiated Rate	$15,930.64
Max. Negotiated Rate	$36,369.80
Rate for Payer: BCBS of TX Blue Advantage	$15,930.64
Rate for Payer: BCBS of TX Blue Essentials	$19,114.92
Rate for Payer: BCBS of TX PPO	$21,239.62

MAJOR CHEST TRAUMA W CC

Facility

$20,217.90

Service Code	MSDRG 184
Min. Negotiated Rate	$8,637.84
Max. Negotiated Rate	$20,217.90
Rate for Payer: BCBS of TX Blue Advantage	$8,637.84
Rate for Payer: BCBS of TX Blue Essentials	$10,364.40
Rate for Payer: BCBS of TX PPO	$11,516.45

MAJOR CHEST TRAUMA WITH CC

Facility

$20,217.90

Service Code	MSDRG 184
Min. Negotiated Rate	$8,637.84
Max. Negotiated Rate	$20,217.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,558.89
Rate for Payer: Amerigroup Medicare	$12,558.89
Rate for Payer: BCBS of TX Medicare	$12,558.89
Rate for Payer: Cigna Commercial	$13,705.61
Rate for Payer: Cigna Medicare	$12,558.89
Rate for Payer: Employer Direct Commercial	$12,558.89
Rate for Payer: Humana Medicare/TRICARE	$12,558.89
Rate for Payer: Molina Dual Medicare/Medicaid	$12,558.89
Rate for Payer: Molina Medicare	$12,558.89
Rate for Payer: Multiplan Auto	$20,217.90
Rate for Payer: Multiplan Commercial	$20,217.90
Rate for Payer: Multiplan Workers Comp	$20,217.90
Rate for Payer: Scott and White EPO/PPO	$9,310.88
Rate for Payer: Scott and White Medicare	$12,558.89
Rate for Payer: Superior Health Plan EPO	$12,558.89
Rate for Payer: Superior Health Plan Medicare	$12,558.89
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,558.89
Rate for Payer: Universal American Medicare	$12,558.89
Rate for Payer: Wellcare Medicare	$12,558.89
Rate for Payer: Wellmed Medicare	$12,558.89

MAJOR CHEST TRAUMA WITH MCC

Facility

$29,068.10

Service Code	MSDRG 183
Min. Negotiated Rate	$12,821.74
Max. Negotiated Rate	$29,068.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15,972.77
Rate for Payer: Amerigroup Medicare	$15,972.77
Rate for Payer: BCBS of TX Medicare	$15,972.77
Rate for Payer: Cigna Commercial	$19,705.11
Rate for Payer: Cigna Medicare	$15,972.77
Rate for Payer: Employer Direct Commercial	$15,972.77
Rate for Payer: Humana Medicare/TRICARE	$15,972.77
Rate for Payer: Molina Dual Medicare/Medicaid	$15,972.77
Rate for Payer: Molina Medicare	$15,972.77
Rate for Payer: Multiplan Auto	$29,068.10
Rate for Payer: Multiplan Commercial	$29,068.10
Rate for Payer: Multiplan Workers Comp	$29,068.10
Rate for Payer: Scott and White EPO/PPO	$13,386.62
Rate for Payer: Scott and White Medicare	$15,972.77
Rate for Payer: Superior Health Plan EPO	$15,972.77
Rate for Payer: Superior Health Plan Medicare	$15,972.77
Rate for Payer: Universal American Dual Medicare/Medicaid	$15,972.77
Rate for Payer: Universal American Medicare	$15,972.77
Rate for Payer: Wellcare Medicare	$15,972.77
Rate for Payer: Wellmed Medicare	$15,972.77

MAJOR CHEST TRAUMA WITHOUT CC/MCC

Facility

$14,943.50

Service Code	MSDRG 185
Min. Negotiated Rate	$6,297.78
Max. Negotiated Rate	$14,943.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,524.36
Rate for Payer: Amerigroup Medicare	$10,524.36
Rate for Payer: BCBS of TX Medicare	$10,524.36
Rate for Payer: Cigna Commercial	$10,130.12
Rate for Payer: Cigna Medicare	$10,524.36
Rate for Payer: Employer Direct Commercial	$10,524.36
Rate for Payer: Humana Medicare/TRICARE	$10,524.36
Rate for Payer: Molina Dual Medicare/Medicaid	$10,524.36
Rate for Payer: Molina Medicare	$10,524.36
Rate for Payer: Multiplan Auto	$14,943.50
Rate for Payer: Multiplan Commercial	$14,943.50
Rate for Payer: Multiplan Workers Comp	$14,943.50
Rate for Payer: Scott and White EPO/PPO	$6,881.88
Rate for Payer: Scott and White Medicare	$10,524.36
Rate for Payer: Superior Health Plan EPO	$10,524.36
Rate for Payer: Superior Health Plan Medicare	$10,524.36
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,524.36
Rate for Payer: Universal American Medicare	$10,524.36
Rate for Payer: Wellcare Medicare	$10,524.36
Rate for Payer: Wellmed Medicare	$10,524.36

MAJOR CHEST TRAUMA W MCC

Facility

$29,068.10

Service Code	MSDRG 183
Min. Negotiated Rate	$12,821.74
Max. Negotiated Rate	$29,068.10
Rate for Payer: BCBS of TX Blue Advantage	$12,821.74
Rate for Payer: BCBS of TX Blue Essentials	$15,384.60
Rate for Payer: BCBS of TX PPO	$17,094.66

Know your out-of-pocket cost for care.

All Charges