White Rock Medical Center

All Charges

Charge

Type

Setting

Price

MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES

Facility

$52,666.10

Service Code	MSDRG 483
Min. Negotiated Rate	$20,498.10
Max. Negotiated Rate	$52,666.10
Rate for Payer: BCBS of TX Blue Advantage	$20,498.10
Rate for Payer: BCBS of TX Blue Essentials	$24,595.34
Rate for Payer: BCBS of TX PPO	$27,329.21

MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES

Facility

$52,666.10

Service Code	MSDRG 483
Min. Negotiated Rate	$20,498.10
Max. Negotiated Rate	$52,666.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$25,075.42
Rate for Payer: Amerigroup Medicare	$25,075.42
Rate for Payer: BCBS of TX Medicare	$25,075.42
Rate for Payer: Cigna Commercial	$35,702.07
Rate for Payer: Cigna Medicare	$25,075.42
Rate for Payer: Employer Direct Commercial	$25,075.42
Rate for Payer: Humana Medicare/TRICARE	$25,075.42
Rate for Payer: Molina Dual Medicare/Medicaid	$25,075.42
Rate for Payer: Molina Medicare	$25,075.42
Rate for Payer: Multiplan Auto	$52,666.10
Rate for Payer: Multiplan Commercial	$52,666.10
Rate for Payer: Multiplan Workers Comp	$52,666.10
Rate for Payer: Scott and White EPO/PPO	$24,254.12
Rate for Payer: Scott and White Medicare	$25,075.42
Rate for Payer: Superior Health Plan EPO	$25,075.42
Rate for Payer: Superior Health Plan Medicare	$25,075.42
Rate for Payer: Universal American Dual Medicare/Medicaid	$25,075.42
Rate for Payer: Universal American Medicare	$25,075.42
Rate for Payer: Wellcare Medicare	$25,075.42
Rate for Payer: Wellmed Medicare	$25,075.42

MAJOR LARGE BOWEL PROCEDURES

Facility

$8,283.45

Service Code	APR-DRG 2312
Min. Negotiated Rate	$7,809.92
Max. Negotiated Rate	$8,283.45
Rate for Payer: Amerigroup CHIP/Medicaid	$7,809.92
Rate for Payer: Cigna Medicaid	$7,809.92
Rate for Payer: Molina CHIP/Medicaid	$7,809.92
Rate for Payer: Parkland Medicaid	$7,809.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,283.45

MAJOR LARGE BOWEL PROCEDURES

Facility

$6,525.37

Service Code	APR-DRG 2311
Min. Negotiated Rate	$6,152.35
Max. Negotiated Rate	$6,525.37
Rate for Payer: Amerigroup CHIP/Medicaid	$6,152.35
Rate for Payer: Cigna Medicaid	$6,152.35
Rate for Payer: Molina CHIP/Medicaid	$6,152.35
Rate for Payer: Parkland Medicaid	$6,152.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,525.37

MAJOR LARGE BOWEL PROCEDURES

Facility

$24,189.13

Service Code	APR-DRG 2314
Min. Negotiated Rate	$22,806.36
Max. Negotiated Rate	$24,189.13
Rate for Payer: Amerigroup CHIP/Medicaid	$22,806.36
Rate for Payer: Cigna Medicaid	$22,806.36
Rate for Payer: Molina CHIP/Medicaid	$22,806.36
Rate for Payer: Parkland Medicaid	$22,806.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$24,189.13

MAJOR LARGE BOWEL PROCEDURES

Facility

$11,623.46

Service Code	APR-DRG 2313
Min. Negotiated Rate	$10,959.00
Max. Negotiated Rate	$11,623.46
Rate for Payer: Amerigroup CHIP/Medicaid	$10,959.00
Rate for Payer: Cigna Medicaid	$10,959.00
Rate for Payer: Molina CHIP/Medicaid	$10,959.00
Rate for Payer: Parkland Medicaid	$10,959.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,623.46

MAJOR MALE PELVIC PROCEDURES

Facility

$25,628.86

Service Code	APR-DRG 4804
Min. Negotiated Rate	$24,163.79
Max. Negotiated Rate	$25,628.86
Rate for Payer: Amerigroup CHIP/Medicaid	$24,163.79
Rate for Payer: Cigna Medicaid	$24,163.79
Rate for Payer: Molina CHIP/Medicaid	$24,163.79
Rate for Payer: Parkland Medicaid	$24,163.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$25,628.86

MAJOR MALE PELVIC PROCEDURES

Facility

$6,442.77

Service Code	APR-DRG 4801
Min. Negotiated Rate	$6,074.46
Max. Negotiated Rate	$6,442.77
Rate for Payer: Amerigroup CHIP/Medicaid	$6,074.46
Rate for Payer: Cigna Medicaid	$6,074.46
Rate for Payer: Molina CHIP/Medicaid	$6,074.46
Rate for Payer: Parkland Medicaid	$6,074.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,442.77

MAJOR MALE PELVIC PROCEDURES

Facility

$11,912.76

Service Code	APR-DRG 4803
Min. Negotiated Rate	$11,231.77
Max. Negotiated Rate	$11,912.76
Rate for Payer: Amerigroup CHIP/Medicaid	$11,231.77
Rate for Payer: Cigna Medicaid	$11,231.77
Rate for Payer: Molina CHIP/Medicaid	$11,231.77
Rate for Payer: Parkland Medicaid	$11,231.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,912.76

MAJOR MALE PELVIC PROCEDURES

Facility

$11,806.39

Service Code	APR-DRG 4802
Min. Negotiated Rate	$11,131.48
Max. Negotiated Rate	$11,806.39
Rate for Payer: Amerigroup CHIP/Medicaid	$11,131.48
Rate for Payer: Cigna Medicaid	$11,131.48
Rate for Payer: Molina CHIP/Medicaid	$11,131.48
Rate for Payer: Parkland Medicaid	$11,131.48
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,806.39

MAJOR MALE PELVIC PROCEDURES W CC/MCC

Facility

$38,005.70

Service Code	MSDRG 707
Min. Negotiated Rate	$15,406.04
Max. Negotiated Rate	$38,005.70
Rate for Payer: BCBS of TX Blue Advantage	$15,406.04
Rate for Payer: BCBS of TX Blue Essentials	$18,485.46
Rate for Payer: BCBS of TX PPO	$20,540.19

MAJOR MALE PELVIC PROCEDURES WITH CC/MCC

Facility

$38,005.70

Service Code	MSDRG 707
Min. Negotiated Rate	$15,406.04
Max. Negotiated Rate	$38,005.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$19,420.33
Rate for Payer: Amerigroup Medicare	$19,420.33
Rate for Payer: BCBS of TX Medicare	$19,420.33
Rate for Payer: Cigna Commercial	$25,763.86
Rate for Payer: Cigna Medicare	$19,420.33
Rate for Payer: Employer Direct Commercial	$19,420.33
Rate for Payer: Humana Medicare/TRICARE	$19,420.33
Rate for Payer: Molina Dual Medicare/Medicaid	$19,420.33
Rate for Payer: Molina Medicare	$19,420.33
Rate for Payer: Multiplan Auto	$38,005.70
Rate for Payer: Multiplan Commercial	$38,005.70
Rate for Payer: Multiplan Workers Comp	$38,005.70
Rate for Payer: Scott and White EPO/PPO	$17,502.62
Rate for Payer: Scott and White Medicare	$19,420.33
Rate for Payer: Superior Health Plan EPO	$19,420.33
Rate for Payer: Superior Health Plan Medicare	$19,420.33
Rate for Payer: Universal American Dual Medicare/Medicaid	$19,420.33
Rate for Payer: Universal American Medicare	$19,420.33
Rate for Payer: Wellcare Medicare	$19,420.33
Rate for Payer: Wellmed Medicare	$19,420.33

MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC

Facility

$29,149.80

Service Code	MSDRG 708
Min. Negotiated Rate	$12,095.90
Max. Negotiated Rate	$29,149.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16,004.28
Rate for Payer: Amerigroup Medicare	$16,004.28
Rate for Payer: BCBS of TX Medicare	$16,004.28
Rate for Payer: Cigna Commercial	$19,760.50
Rate for Payer: Cigna Medicare	$16,004.28
Rate for Payer: Employer Direct Commercial	$16,004.28
Rate for Payer: Humana Medicare/TRICARE	$16,004.28
Rate for Payer: Molina Dual Medicare/Medicaid	$16,004.28
Rate for Payer: Molina Medicare	$16,004.28
Rate for Payer: Multiplan Auto	$29,149.80
Rate for Payer: Multiplan Commercial	$29,149.80
Rate for Payer: Multiplan Workers Comp	$29,149.80
Rate for Payer: Scott and White EPO/PPO	$13,424.25
Rate for Payer: Scott and White Medicare	$16,004.28
Rate for Payer: Superior Health Plan EPO	$16,004.28
Rate for Payer: Superior Health Plan Medicare	$16,004.28
Rate for Payer: Universal American Dual Medicare/Medicaid	$16,004.28
Rate for Payer: Universal American Medicare	$16,004.28
Rate for Payer: Wellcare Medicare	$16,004.28
Rate for Payer: Wellmed Medicare	$16,004.28

MAJOR MALE PELVIC PROCEDURES W/O CC/MCC

Facility

$29,149.80

Service Code	MSDRG 708
Min. Negotiated Rate	$12,095.90
Max. Negotiated Rate	$29,149.80
Rate for Payer: BCBS of TX Blue Advantage	$12,095.90
Rate for Payer: BCBS of TX Blue Essentials	$14,513.67
Rate for Payer: BCBS of TX PPO	$16,126.93

MAJOR O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$10,028.70

Service Code	APR-DRG 6802
Min. Negotiated Rate	$9,455.41
Max. Negotiated Rate	$10,028.70
Rate for Payer: Amerigroup CHIP/Medicaid	$9,455.41
Rate for Payer: Cigna Medicaid	$9,455.41
Rate for Payer: Molina CHIP/Medicaid	$9,455.41
Rate for Payer: Parkland Medicaid	$9,455.41
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,028.70

MAJOR O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$8,782.85

Service Code	APR-DRG 6801
Min. Negotiated Rate	$8,280.77
Max. Negotiated Rate	$8,782.85
Rate for Payer: Amerigroup CHIP/Medicaid	$8,280.77
Rate for Payer: Cigna Medicaid	$8,280.77
Rate for Payer: Molina CHIP/Medicaid	$8,280.77
Rate for Payer: Parkland Medicaid	$8,280.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,782.85

MAJOR O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$22,134.96

Service Code	APR-DRG 6803
Min. Negotiated Rate	$20,869.61
Max. Negotiated Rate	$22,134.96
Rate for Payer: Amerigroup CHIP/Medicaid	$20,869.61
Rate for Payer: Cigna Medicaid	$20,869.61
Rate for Payer: Molina CHIP/Medicaid	$20,869.61
Rate for Payer: Parkland Medicaid	$20,869.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$22,134.96

MAJOR O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$60,508.66

Service Code	APR-DRG 6804
Min. Negotiated Rate	$57,049.68
Max. Negotiated Rate	$60,508.66
Rate for Payer: Amerigroup CHIP/Medicaid	$57,049.68
Rate for Payer: Cigna Medicaid	$57,049.68
Rate for Payer: Molina CHIP/Medicaid	$57,049.68
Rate for Payer: Parkland Medicaid	$57,049.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$60,508.66

MAJOR PACK-LF

Facility

$2,299.51

Hospital Charge Code	993787
Hospital Revenue Code	272
Min. Negotiated Rate	$206.96
Max. Negotiated Rate	$1,655.65
Rate for Payer: Amerigroup CHIP/Medicaid	$206.96
Rate for Payer: BCBS of TX Blue Advantage	$689.85
Rate for Payer: BCBS of TX Blue Essentials	$827.82
Rate for Payer: BCBS of TX PPO	$919.80
Rate for Payer: Cash Price	$1,563.67
Rate for Payer: Cigna Medicaid	$1,655.65
Rate for Payer: Molina CHIP/Medicaid	$1,655.65
Rate for Payer: Multiplan Auto	$1,494.68
Rate for Payer: Multiplan Commercial	$1,494.68
Rate for Payer: Multiplan Workers Comp	$1,494.68
Rate for Payer: Parkland Medicaid	$1,655.65
Rate for Payer: Scott and White EPO/PPO	$1,149.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,655.65
Rate for Payer: Superior Health Plan EPO	$312.73

MAJOR PACK-LF

Facility

$2,299.51

Hospital Charge Code	993787
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,563.67

MAJOR PANCREAS, LIVER AND SHUNT PROCEDURES

Facility

$10,967.15

Service Code	APR-DRG 2602
Min. Negotiated Rate	$10,340.21
Max. Negotiated Rate	$10,967.15
Rate for Payer: Amerigroup CHIP/Medicaid	$10,340.21
Rate for Payer: Cigna Medicaid	$10,340.21
Rate for Payer: Molina CHIP/Medicaid	$10,340.21
Rate for Payer: Parkland Medicaid	$10,340.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,967.15

MAJOR PANCREAS, LIVER AND SHUNT PROCEDURES

Facility

$10,064.53

Service Code	APR-DRG 2601
Min. Negotiated Rate	$9,489.20
Max. Negotiated Rate	$10,064.53
Rate for Payer: Amerigroup CHIP/Medicaid	$9,489.20
Rate for Payer: Cigna Medicaid	$9,489.20
Rate for Payer: Molina CHIP/Medicaid	$9,489.20
Rate for Payer: Parkland Medicaid	$9,489.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,064.53

MAJOR PANCREAS, LIVER AND SHUNT PROCEDURES

Facility

$16,452.61

Service Code	APR-DRG 2603
Min. Negotiated Rate	$15,512.09
Max. Negotiated Rate	$16,452.61
Rate for Payer: Amerigroup CHIP/Medicaid	$15,512.09
Rate for Payer: Cigna Medicaid	$15,512.09
Rate for Payer: Molina CHIP/Medicaid	$15,512.09
Rate for Payer: Parkland Medicaid	$15,512.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,452.61

MAJOR PANCREAS, LIVER AND SHUNT PROCEDURES

Facility

$35,824.66

Service Code	APR-DRG 2604
Min. Negotiated Rate	$33,776.74
Max. Negotiated Rate	$35,824.66
Rate for Payer: Amerigroup CHIP/Medicaid	$33,776.74
Rate for Payer: Cigna Medicaid	$33,776.74
Rate for Payer: Molina CHIP/Medicaid	$33,776.74
Rate for Payer: Parkland Medicaid	$33,776.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$35,824.66

MAJOR PROCEDURE - BREAST

Facility

$9,777.99

Service Code	HCPCS 19328
Hospital Charge Code	9900158
Hospital Revenue Code	360
Rate for Payer: Cash Price	$6,649.03

Know your out-of-pocket cost for care.

All Charges