White Rock Medical Center

All Charges

Charge

Type

Setting

Price

MAJOR BLADDER PROCEDURES

Facility

$11,293.79

Service Code	APR-DRG 4412
Min. Negotiated Rate	$10,648.18
Max. Negotiated Rate	$11,293.79
Rate for Payer: Amerigroup CHIP/Medicaid	$10,648.18
Rate for Payer: Cigna Medicaid	$10,648.18
Rate for Payer: Molina CHIP/Medicaid	$10,648.18
Rate for Payer: Parkland Medicaid	$10,648.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,293.79

MAJOR BLADDER PROCEDURES

Facility

$59,069.68

Service Code	APR-DRG 4414
Min. Negotiated Rate	$55,692.97
Max. Negotiated Rate	$59,069.68
Rate for Payer: Amerigroup CHIP/Medicaid	$55,692.97
Rate for Payer: Cigna Medicaid	$55,692.97
Rate for Payer: Molina CHIP/Medicaid	$55,692.97
Rate for Payer: Parkland Medicaid	$55,692.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$59,069.68

MAJOR BLADDER PROCEDURES

Facility

$7,260.51

Service Code	APR-DRG 4411
Min. Negotiated Rate	$6,845.46
Max. Negotiated Rate	$7,260.51
Rate for Payer: Amerigroup CHIP/Medicaid	$6,845.46
Rate for Payer: Cigna Medicaid	$6,845.46
Rate for Payer: Molina CHIP/Medicaid	$6,845.46
Rate for Payer: Parkland Medicaid	$6,845.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,260.51

MAJOR BLADDER PROCEDURES

Facility

$14,280.38

Service Code	APR-DRG 4413
Min. Negotiated Rate	$13,464.04
Max. Negotiated Rate	$14,280.38
Rate for Payer: Amerigroup CHIP/Medicaid	$13,464.04
Rate for Payer: Cigna Medicaid	$13,464.04
Rate for Payer: Molina CHIP/Medicaid	$13,464.04
Rate for Payer: Parkland Medicaid	$13,464.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14,280.38

MAJOR BLADDER PROCEDURES W CC

Facility

$54,007.50

Service Code	MSDRG 654
Min. Negotiated Rate	$24,710.38
Max. Negotiated Rate	$54,007.50
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

$54,007.50

Service Code	MSDRG 654
Min. Negotiated Rate	$24,710.38
Max. Negotiated Rate	$54,007.50
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	$54,007.50
Rate for Payer: Multiplan Commercial	$54,007.50
Rate for Payer: Multiplan Workers Comp	$54,007.50
Rate for Payer: Scott and White EPO/PPO	$24,871.88
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

$105,577.30

Service Code	MSDRG 653
Min. Negotiated Rate	$42,844.65
Max. Negotiated Rate	$105,577.30
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	$105,577.30
Rate for Payer: Multiplan Commercial	$105,577.30
Rate for Payer: Multiplan Workers Comp	$105,577.30
Rate for Payer: Scott and White EPO/PPO	$48,621.12
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

$41,015.30

Service Code	MSDRG 655
Min. Negotiated Rate	$17,863.92
Max. Negotiated Rate	$41,015.30
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	$41,015.30
Rate for Payer: Multiplan Commercial	$41,015.30
Rate for Payer: Multiplan Workers Comp	$41,015.30
Rate for Payer: Scott and White EPO/PPO	$18,888.62
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

$105,577.30

Service Code	MSDRG 653
Min. Negotiated Rate	$42,844.65
Max. Negotiated Rate	$105,577.30
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

$41,015.30

Service Code	MSDRG 655
Min. Negotiated Rate	$17,863.92
Max. Negotiated Rate	$41,015.30
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

$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 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

$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 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 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

$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 PROCEDURES W CC

Facility

$49,071.30

Service Code	MSDRG 164
Min. Negotiated Rate	$22,092.54
Max. Negotiated Rate	$49,071.30
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

$49,071.30

Service Code	MSDRG 164
Min. Negotiated Rate	$22,092.54
Max. Negotiated Rate	$49,071.30
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	$49,071.30
Rate for Payer: Multiplan Commercial	$49,071.30
Rate for Payer: Multiplan Workers Comp	$49,071.30
Rate for Payer: Scott and White EPO/PPO	$22,598.62
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

$92,030.30

Service Code	MSDRG 163
Min. Negotiated Rate	$37,607.31
Max. Negotiated Rate	$92,030.30
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	$92,030.30
Rate for Payer: Multiplan Commercial	$92,030.30
Rate for Payer: Multiplan Workers Comp	$92,030.30
Rate for Payer: Scott and White EPO/PPO	$42,382.38
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

$36,611.10

Service Code	MSDRG 165
Min. Negotiated Rate	$15,930.64
Max. Negotiated Rate	$36,611.10
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	$36,611.10
Rate for Payer: Multiplan Commercial	$36,611.10
Rate for Payer: Multiplan Workers Comp	$36,611.10
Rate for Payer: Scott and White EPO/PPO	$16,860.38
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

$92,030.30

Service Code	MSDRG 163
Min. Negotiated Rate	$37,607.31
Max. Negotiated Rate	$92,030.30
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

$36,611.10

Service Code	MSDRG 165
Min. Negotiated Rate	$15,930.64
Max. Negotiated Rate	$36,611.10
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

$19,858.80

Service Code	MSDRG 184
Min. Negotiated Rate	$8,637.84
Max. Negotiated Rate	$19,858.80
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

Know your out-of-pocket cost for care.

All Charges