White Rock Medical Center

All Charges

Charge

Type

Setting

Price

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC

Facility

$21,711.30

Service Code	MSDRG 723
Min. Negotiated Rate	$9,472.90
Max. Negotiated Rate	$21,711.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13,134.96
Rate for Payer: Amerigroup Medicare	$13,134.96
Rate for Payer: BCBS of TX Medicare	$13,134.96
Rate for Payer: Cigna Commercial	$14,717.98
Rate for Payer: Cigna Medicare	$13,134.96
Rate for Payer: Employer Direct Commercial	$13,134.96
Rate for Payer: Humana Medicare/TRICARE	$13,134.96
Rate for Payer: Molina Dual Medicare/Medicaid	$13,134.96
Rate for Payer: Molina Medicare	$13,134.96
Rate for Payer: Multiplan Auto	$21,711.30
Rate for Payer: Multiplan Commercial	$21,711.30
Rate for Payer: Multiplan Workers Comp	$21,711.30
Rate for Payer: Scott and White EPO/PPO	$9,998.62
Rate for Payer: Scott and White Medicare	$13,134.96
Rate for Payer: Superior Health Plan EPO	$13,134.96
Rate for Payer: Superior Health Plan Medicare	$13,134.96
Rate for Payer: Universal American Dual Medicare/Medicaid	$13,134.96
Rate for Payer: Universal American Medicare	$13,134.96
Rate for Payer: Wellcare Medicare	$13,134.96
Rate for Payer: Wellmed Medicare	$13,134.96

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$34,384.30

Service Code	MSDRG 722
Min. Negotiated Rate	$14,273.42
Max. Negotiated Rate	$34,384.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$18,023.42
Rate for Payer: Amerigroup Medicare	$18,023.42
Rate for Payer: BCBS of TX Medicare	$18,023.42
Rate for Payer: Cigna Commercial	$23,308.94
Rate for Payer: Cigna Medicare	$18,023.42
Rate for Payer: Employer Direct Commercial	$18,023.42
Rate for Payer: Humana Medicare/TRICARE	$18,023.42
Rate for Payer: Molina Dual Medicare/Medicaid	$18,023.42
Rate for Payer: Molina Medicare	$18,023.42
Rate for Payer: Multiplan Auto	$34,384.30
Rate for Payer: Multiplan Commercial	$34,384.30
Rate for Payer: Multiplan Workers Comp	$34,384.30
Rate for Payer: Scott and White EPO/PPO	$15,834.88
Rate for Payer: Scott and White Medicare	$18,023.42
Rate for Payer: Superior Health Plan EPO	$18,023.42
Rate for Payer: Superior Health Plan Medicare	$18,023.42
Rate for Payer: Universal American Dual Medicare/Medicaid	$18,023.42
Rate for Payer: Universal American Medicare	$18,023.42
Rate for Payer: Wellcare Medicare	$18,023.42
Rate for Payer: Wellmed Medicare	$18,023.42

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$11,622.30

Service Code	MSDRG 724
Min. Negotiated Rate	$5,352.38
Max. Negotiated Rate	$11,622.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$9,565.72
Rate for Payer: Amerigroup Medicare	$9,565.72
Rate for Payer: BCBS of TX Medicare	$9,565.72
Rate for Payer: Cigna Commercial	$7,878.70
Rate for Payer: Cigna Medicare	$9,565.72
Rate for Payer: Employer Direct Commercial	$9,565.72
Rate for Payer: Humana Medicare/TRICARE	$9,565.72
Rate for Payer: Molina Dual Medicare/Medicaid	$9,565.72
Rate for Payer: Molina Medicare	$9,565.72
Rate for Payer: Multiplan Auto	$11,622.30
Rate for Payer: Multiplan Commercial	$11,622.30
Rate for Payer: Multiplan Workers Comp	$11,622.30
Rate for Payer: Scott and White EPO/PPO	$5,352.38
Rate for Payer: Scott and White Medicare	$9,565.72
Rate for Payer: Superior Health Plan EPO	$9,565.72
Rate for Payer: Superior Health Plan Medicare	$9,565.72
Rate for Payer: Universal American Dual Medicare/Medicaid	$9,565.72
Rate for Payer: Universal American Medicare	$9,565.72
Rate for Payer: Wellcare Medicare	$9,565.72
Rate for Payer: Wellmed Medicare	$9,565.72

MALIGNANCY, MALE REPRODUCTIVE SYSTEM W MCC

Facility

$34,384.30

Service Code	MSDRG 722
Min. Negotiated Rate	$14,273.42
Max. Negotiated Rate	$34,384.30
Rate for Payer: BCBS of TX Blue Advantage	$14,273.42
Rate for Payer: BCBS of TX Blue Essentials	$17,126.44
Rate for Payer: BCBS of TX PPO	$19,030.12

MALIGNANCY, MALE REPRODUCTIVE SYSTEM W/O CC/MCC

Facility

$11,622.30

Service Code	MSDRG 724
Min. Negotiated Rate	$5,352.38
Max. Negotiated Rate	$11,622.30
Rate for Payer: BCBS of TX Blue Advantage	$5,927.12
Rate for Payer: BCBS of TX Blue Essentials	$7,111.85
Rate for Payer: BCBS of TX PPO	$7,902.37

MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS

Facility

$4,379.54

Service Code	APR-DRG 2812
Min. Negotiated Rate	$4,129.19
Max. Negotiated Rate	$4,379.54
Rate for Payer: Amerigroup CHIP/Medicaid	$4,129.19
Rate for Payer: Cigna Medicaid	$4,129.19
Rate for Payer: Molina CHIP/Medicaid	$4,129.19
Rate for Payer: Parkland Medicaid	$4,129.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,379.54

MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS

Facility

$8,667.43

Service Code	APR-DRG 2814
Min. Negotiated Rate	$8,171.95
Max. Negotiated Rate	$8,667.43
Rate for Payer: Amerigroup CHIP/Medicaid	$8,171.95
Rate for Payer: Cigna Medicaid	$8,171.95
Rate for Payer: Molina CHIP/Medicaid	$8,171.95
Rate for Payer: Parkland Medicaid	$8,171.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,667.43

MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS

Facility

$3,860.15

Service Code	APR-DRG 2811
Min. Negotiated Rate	$3,639.49
Max. Negotiated Rate	$3,860.15
Rate for Payer: Amerigroup CHIP/Medicaid	$3,639.49
Rate for Payer: Cigna Medicaid	$3,639.49
Rate for Payer: Molina CHIP/Medicaid	$3,639.49
Rate for Payer: Parkland Medicaid	$3,639.49
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,860.15

MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS

Facility

$5,785.70

Service Code	APR-DRG 2813
Min. Negotiated Rate	$5,454.96
Max. Negotiated Rate	$5,785.70
Rate for Payer: Amerigroup CHIP/Medicaid	$5,454.96
Rate for Payer: Cigna Medicaid	$5,454.96
Rate for Payer: Molina CHIP/Medicaid	$5,454.96
Rate for Payer: Parkland Medicaid	$5,454.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,785.70

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W CC

Facility

$21,490.90

Service Code	MSDRG 436
Min. Negotiated Rate	$9,768.74
Max. Negotiated Rate	$21,490.90
Rate for Payer: BCBS of TX Blue Advantage	$9,768.74
Rate for Payer: BCBS of TX Blue Essentials	$11,721.35
Rate for Payer: BCBS of TX PPO	$13,024.23

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC

Facility

$21,490.90

Service Code	MSDRG 436
Min. Negotiated Rate	$9,768.74
Max. Negotiated Rate	$21,490.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13,049.94
Rate for Payer: Amerigroup Medicare	$13,049.94
Rate for Payer: BCBS of TX Medicare	$13,049.94
Rate for Payer: Cigna Commercial	$14,568.57
Rate for Payer: Cigna Medicare	$13,049.94
Rate for Payer: Employer Direct Commercial	$13,049.94
Rate for Payer: Humana Medicare/TRICARE	$13,049.94
Rate for Payer: Molina Dual Medicare/Medicaid	$13,049.94
Rate for Payer: Molina Medicare	$13,049.94
Rate for Payer: Multiplan Auto	$21,490.90
Rate for Payer: Multiplan Commercial	$21,490.90
Rate for Payer: Multiplan Workers Comp	$21,490.90
Rate for Payer: Scott and White EPO/PPO	$9,897.12
Rate for Payer: Scott and White Medicare	$13,049.94
Rate for Payer: Superior Health Plan EPO	$13,049.94
Rate for Payer: Superior Health Plan Medicare	$13,049.94
Rate for Payer: Universal American Dual Medicare/Medicaid	$13,049.94
Rate for Payer: Universal American Medicare	$13,049.94
Rate for Payer: Wellcare Medicare	$13,049.94
Rate for Payer: Wellmed Medicare	$13,049.94

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC

Facility

$34,897.30

Service Code	MSDRG 435
Min. Negotiated Rate	$14,600.22
Max. Negotiated Rate	$34,897.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$18,221.30
Rate for Payer: Amerigroup Medicare	$18,221.30
Rate for Payer: BCBS of TX Medicare	$18,221.30
Rate for Payer: Cigna Commercial	$23,656.70
Rate for Payer: Cigna Medicare	$18,221.30
Rate for Payer: Employer Direct Commercial	$18,221.30
Rate for Payer: Humana Medicare/TRICARE	$18,221.30
Rate for Payer: Molina Dual Medicare/Medicaid	$18,221.30
Rate for Payer: Molina Medicare	$18,221.30
Rate for Payer: Multiplan Auto	$34,897.30
Rate for Payer: Multiplan Commercial	$34,897.30
Rate for Payer: Multiplan Workers Comp	$34,897.30
Rate for Payer: Scott and White EPO/PPO	$16,071.12
Rate for Payer: Scott and White Medicare	$18,221.30
Rate for Payer: Superior Health Plan EPO	$18,221.30
Rate for Payer: Superior Health Plan Medicare	$18,221.30
Rate for Payer: Universal American Dual Medicare/Medicaid	$18,221.30
Rate for Payer: Universal American Medicare	$18,221.30
Rate for Payer: Wellcare Medicare	$18,221.30
Rate for Payer: Wellmed Medicare	$18,221.30

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC

Facility

$16,212.70

Service Code	MSDRG 437
Min. Negotiated Rate	$7,445.88
Max. Negotiated Rate	$16,212.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,013.93
Rate for Payer: Amerigroup Medicare	$11,013.93
Rate for Payer: BCBS of TX Medicare	$11,013.93
Rate for Payer: Cigna Commercial	$10,990.50
Rate for Payer: Cigna Medicare	$11,013.93
Rate for Payer: Employer Direct Commercial	$11,013.93
Rate for Payer: Humana Medicare/TRICARE	$11,013.93
Rate for Payer: Molina Dual Medicare/Medicaid	$11,013.93
Rate for Payer: Molina Medicare	$11,013.93
Rate for Payer: Multiplan Auto	$16,212.70
Rate for Payer: Multiplan Commercial	$16,212.70
Rate for Payer: Multiplan Workers Comp	$16,212.70
Rate for Payer: Scott and White EPO/PPO	$7,466.38
Rate for Payer: Scott and White Medicare	$11,013.93
Rate for Payer: Superior Health Plan EPO	$11,013.93
Rate for Payer: Superior Health Plan Medicare	$11,013.93
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,013.93
Rate for Payer: Universal American Medicare	$11,013.93
Rate for Payer: Wellcare Medicare	$11,013.93
Rate for Payer: Wellmed Medicare	$11,013.93

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W MCC

Facility

$34,897.30

Service Code	MSDRG 435
Min. Negotiated Rate	$14,600.22
Max. Negotiated Rate	$34,897.30
Rate for Payer: BCBS of TX Blue Advantage	$14,600.22
Rate for Payer: BCBS of TX Blue Essentials	$17,518.57
Rate for Payer: BCBS of TX PPO	$19,465.83

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W/O CC/MCC

Facility

$16,212.70

Service Code	MSDRG 437
Min. Negotiated Rate	$7,445.88
Max. Negotiated Rate	$16,212.70
Rate for Payer: BCBS of TX Blue Advantage	$7,445.88
Rate for Payer: BCBS of TX Blue Essentials	$8,934.19
Rate for Payer: BCBS of TX PPO	$9,927.26

MALIGNANT BREAST DISORDERS

Facility

$4,079.68

Service Code	APR-DRG 3822
Min. Negotiated Rate	$3,846.46
Max. Negotiated Rate	$4,079.68
Rate for Payer: Amerigroup CHIP/Medicaid	$3,846.46
Rate for Payer: Cigna Medicaid	$3,846.46
Rate for Payer: Molina CHIP/Medicaid	$3,846.46
Rate for Payer: Parkland Medicaid	$3,846.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,079.68

MALIGNANT BREAST DISORDERS

Facility

$3,074.09

Service Code	APR-DRG 3821
Min. Negotiated Rate	$2,898.36
Max. Negotiated Rate	$3,074.09
Rate for Payer: Amerigroup CHIP/Medicaid	$2,898.36
Rate for Payer: Cigna Medicaid	$2,898.36
Rate for Payer: Molina CHIP/Medicaid	$2,898.36
Rate for Payer: Parkland Medicaid	$2,898.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,074.09

MALIGNANT BREAST DISORDERS

Facility

$11,835.81

Service Code	APR-DRG 3824
Min. Negotiated Rate	$11,159.22
Max. Negotiated Rate	$11,835.81
Rate for Payer: Amerigroup CHIP/Medicaid	$11,159.22
Rate for Payer: Cigna Medicaid	$11,159.22
Rate for Payer: Molina CHIP/Medicaid	$11,159.22
Rate for Payer: Parkland Medicaid	$11,159.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,835.81

MALIGNANT BREAST DISORDERS

Facility

$6,261.71

Service Code	APR-DRG 3823
Min. Negotiated Rate	$5,903.76
Max. Negotiated Rate	$6,261.71
Rate for Payer: Amerigroup CHIP/Medicaid	$5,903.76
Rate for Payer: Cigna Medicaid	$5,903.76
Rate for Payer: Molina CHIP/Medicaid	$5,903.76
Rate for Payer: Parkland Medicaid	$5,903.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,261.71

MALIGNANT BREAST DISORDERS W CC

Facility

$21,494.70

Service Code	MSDRG 598
Min. Negotiated Rate	$9,898.88
Max. Negotiated Rate	$21,494.70
Rate for Payer: BCBS of TX Blue Advantage	$9,995.78
Rate for Payer: BCBS of TX Blue Essentials	$11,993.77
Rate for Payer: BCBS of TX PPO	$13,326.93

MALIGNANT BREAST DISORDERS WITH CC

Facility

$21,494.70

Service Code	MSDRG 598
Min. Negotiated Rate	$9,898.88
Max. Negotiated Rate	$21,494.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13,051.41
Rate for Payer: Amerigroup Medicare	$13,051.41
Rate for Payer: BCBS of TX Medicare	$13,051.41
Rate for Payer: Cigna Commercial	$14,571.14
Rate for Payer: Cigna Medicare	$13,051.41
Rate for Payer: Employer Direct Commercial	$13,051.41
Rate for Payer: Humana Medicare/TRICARE	$13,051.41
Rate for Payer: Molina Dual Medicare/Medicaid	$13,051.41
Rate for Payer: Molina Medicare	$13,051.41
Rate for Payer: Multiplan Auto	$21,494.70
Rate for Payer: Multiplan Commercial	$21,494.70
Rate for Payer: Multiplan Workers Comp	$21,494.70
Rate for Payer: Scott and White EPO/PPO	$9,898.88
Rate for Payer: Scott and White Medicare	$13,051.41
Rate for Payer: Superior Health Plan EPO	$13,051.41
Rate for Payer: Superior Health Plan Medicare	$13,051.41
Rate for Payer: Universal American Dual Medicare/Medicaid	$13,051.41
Rate for Payer: Universal American Medicare	$13,051.41
Rate for Payer: Wellcare Medicare	$13,051.41
Rate for Payer: Wellmed Medicare	$13,051.41

MALIGNANT BREAST DISORDERS WITH MCC

Facility

$31,674.90

Service Code	MSDRG 597
Min. Negotiated Rate	$14,587.12
Max. Negotiated Rate	$31,674.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16,978.30
Rate for Payer: Amerigroup Medicare	$16,978.30
Rate for Payer: BCBS of TX Medicare	$16,978.30
Rate for Payer: Cigna Commercial	$21,472.25
Rate for Payer: Cigna Medicare	$16,978.30
Rate for Payer: Employer Direct Commercial	$16,978.30
Rate for Payer: Humana Medicare/TRICARE	$16,978.30
Rate for Payer: Molina Dual Medicare/Medicaid	$16,978.30
Rate for Payer: Molina Medicare	$16,978.30
Rate for Payer: Multiplan Auto	$31,674.90
Rate for Payer: Multiplan Commercial	$31,674.90
Rate for Payer: Multiplan Workers Comp	$31,674.90
Rate for Payer: Scott and White EPO/PPO	$14,587.12
Rate for Payer: Scott and White Medicare	$16,978.30
Rate for Payer: Superior Health Plan EPO	$16,978.30
Rate for Payer: Superior Health Plan Medicare	$16,978.30
Rate for Payer: Universal American Dual Medicare/Medicaid	$16,978.30
Rate for Payer: Universal American Medicare	$16,978.30
Rate for Payer: Wellcare Medicare	$16,978.30
Rate for Payer: Wellmed Medicare	$16,978.30

MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$13,930.80

Service Code	MSDRG 599
Min. Negotiated Rate	$6,161.04
Max. Negotiated Rate	$13,930.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,399.03
Rate for Payer: Amerigroup Medicare	$10,399.03
Rate for Payer: BCBS of TX Medicare	$10,399.03
Rate for Payer: Cigna Commercial	$9,443.62
Rate for Payer: Cigna Medicare	$10,399.03
Rate for Payer: Employer Direct Commercial	$10,399.03
Rate for Payer: Humana Medicare/TRICARE	$10,399.03
Rate for Payer: Molina Dual Medicare/Medicaid	$10,399.03
Rate for Payer: Molina Medicare	$10,399.03
Rate for Payer: Multiplan Auto	$13,930.80
Rate for Payer: Multiplan Commercial	$13,930.80
Rate for Payer: Multiplan Workers Comp	$13,930.80
Rate for Payer: Scott and White EPO/PPO	$6,415.50
Rate for Payer: Scott and White Medicare	$10,399.03
Rate for Payer: Superior Health Plan EPO	$10,399.03
Rate for Payer: Superior Health Plan Medicare	$10,399.03
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,399.03
Rate for Payer: Universal American Medicare	$10,399.03
Rate for Payer: Wellcare Medicare	$10,399.03
Rate for Payer: Wellmed Medicare	$10,399.03

MALIGNANT BREAST DISORDERS W MCC

Facility

$31,674.90

Service Code	MSDRG 597
Min. Negotiated Rate	$14,587.12
Max. Negotiated Rate	$31,674.90
Rate for Payer: BCBS of TX Blue Advantage	$14,792.00
Rate for Payer: BCBS of TX Blue Essentials	$17,748.68
Rate for Payer: BCBS of TX PPO	$19,721.52

MALIGNANT BREAST DISORDERS W/O CC/MCC

Facility

$13,930.80

Service Code	MSDRG 599
Min. Negotiated Rate	$6,161.04
Max. Negotiated Rate	$13,930.80
Rate for Payer: BCBS of TX Blue Advantage	$6,161.04
Rate for Payer: BCBS of TX Blue Essentials	$7,392.53
Rate for Payer: BCBS of TX PPO	$8,214.24

Know your out-of-pocket cost for care.

All Charges