White Rock Medical Center

All Charges

Charge

Type

Setting

Price

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC

Facility

$13,309.50

Service Code	MSDRG 832
Min. Negotiated Rate	$6,129.38
Max. Negotiated Rate	$13,309.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,048.71
Rate for Payer: Amerigroup Medicare	$10,048.71
Rate for Payer: BCBS of TX Medicare	$10,048.71
Rate for Payer: Cigna Commercial	$9,294.21
Rate for Payer: Cigna Medicare	$10,048.71
Rate for Payer: Employer Direct Commercial	$10,048.71
Rate for Payer: Humana Medicare/TRICARE	$10,048.71
Rate for Payer: Molina Dual Medicare/Medicaid	$10,048.71
Rate for Payer: Molina Medicare	$10,048.71
Rate for Payer: Multiplan Auto	$13,309.50
Rate for Payer: Multiplan Commercial	$13,309.50
Rate for Payer: Multiplan Workers Comp	$13,309.50
Rate for Payer: Scott and White EPO/PPO	$6,129.38
Rate for Payer: Scott and White Medicare	$10,048.71
Rate for Payer: Superior Health Plan EPO	$10,048.71
Rate for Payer: Superior Health Plan Medicare	$10,048.71
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,048.71
Rate for Payer: Universal American Medicare	$10,048.71
Rate for Payer: Wellcare Medicare	$10,048.71
Rate for Payer: Wellmed Medicare	$10,048.71

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC

Facility

$22,701.20

Service Code	MSDRG 831
Min. Negotiated Rate	$8,841.66
Max. Negotiated Rate	$22,701.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13,573.23
Rate for Payer: Amerigroup Medicare	$13,573.23
Rate for Payer: BCBS of TX Medicare	$13,573.23
Rate for Payer: Cigna Commercial	$15,488.20
Rate for Payer: Cigna Medicare	$13,573.23
Rate for Payer: Employer Direct Commercial	$13,573.23
Rate for Payer: Humana Medicare/TRICARE	$13,573.23
Rate for Payer: Molina Dual Medicare/Medicaid	$13,573.23
Rate for Payer: Molina Medicare	$13,573.23
Rate for Payer: Multiplan Auto	$22,701.20
Rate for Payer: Multiplan Commercial	$22,701.20
Rate for Payer: Multiplan Workers Comp	$22,701.20
Rate for Payer: Scott and White EPO/PPO	$10,454.50
Rate for Payer: Scott and White Medicare	$13,573.23
Rate for Payer: Superior Health Plan EPO	$13,573.23
Rate for Payer: Superior Health Plan Medicare	$13,573.23
Rate for Payer: Universal American Dual Medicare/Medicaid	$13,573.23
Rate for Payer: Universal American Medicare	$13,573.23
Rate for Payer: Wellcare Medicare	$13,573.23
Rate for Payer: Wellmed Medicare	$13,573.23

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$9,576.00

Service Code	MSDRG 833
Min. Negotiated Rate	$4,130.58
Max. Negotiated Rate	$9,576.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8,592.43
Rate for Payer: Amerigroup Medicare	$8,592.43
Rate for Payer: BCBS of TX Medicare	$8,592.43
Rate for Payer: Cigna Commercial	$6,734.95
Rate for Payer: Cigna Medicare	$8,592.43
Rate for Payer: Employer Direct Commercial	$8,592.43
Rate for Payer: Humana Medicare/TRICARE	$8,592.43
Rate for Payer: Molina Dual Medicare/Medicaid	$8,592.43
Rate for Payer: Molina Medicare	$8,592.43
Rate for Payer: Multiplan Auto	$9,576.00
Rate for Payer: Multiplan Commercial	$9,576.00
Rate for Payer: Multiplan Workers Comp	$9,576.00
Rate for Payer: Scott and White EPO/PPO	$4,410.00
Rate for Payer: Scott and White Medicare	$8,592.43
Rate for Payer: Superior Health Plan EPO	$8,592.43
Rate for Payer: Superior Health Plan Medicare	$8,592.43
Rate for Payer: Universal American Dual Medicare/Medicaid	$8,592.43
Rate for Payer: Universal American Medicare	$8,592.43
Rate for Payer: Wellcare Medicare	$8,592.43
Rate for Payer: Wellmed Medicare	$8,592.43

OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CC

Facility

$13,309.50

Service Code	MSDRG 832
Min. Negotiated Rate	$6,129.38
Max. Negotiated Rate	$13,309.50
Rate for Payer: BCBS of TX Blue Advantage	$6,181.68
Rate for Payer: BCBS of TX Blue Essentials	$7,417.30
Rate for Payer: BCBS of TX PPO	$8,241.76

OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W MCC

Facility

$22,701.20

Service Code	MSDRG 831
Min. Negotiated Rate	$8,841.66
Max. Negotiated Rate	$22,701.20
Rate for Payer: BCBS of TX Blue Advantage	$8,841.66
Rate for Payer: BCBS of TX Blue Essentials	$10,608.96
Rate for Payer: BCBS of TX PPO	$11,788.19

OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC

Facility

$9,576.00

Service Code	MSDRG 833
Min. Negotiated Rate	$4,130.58
Max. Negotiated Rate	$9,576.00
Rate for Payer: BCBS of TX Blue Advantage	$4,130.58
Rate for Payer: BCBS of TX Blue Essentials	$4,956.22
Rate for Payer: BCBS of TX PPO	$5,507.12

OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W CC

Facility

$30,211.90

Service Code	MSDRG 818
Min. Negotiated Rate	$11,683.10
Max. Negotiated Rate	$30,211.90
Rate for Payer: BCBS of TX Blue Advantage	$11,683.10
Rate for Payer: BCBS of TX Blue Essentials	$14,018.36
Rate for Payer: BCBS of TX PPO	$15,576.56

OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W MCC

Facility

$59,466.20

Service Code	MSDRG 817
Min. Negotiated Rate	$21,481.98
Max. Negotiated Rate	$59,466.20
Rate for Payer: BCBS of TX Blue Advantage	$21,772.62
Rate for Payer: BCBS of TX Blue Essentials	$26,124.61
Rate for Payer: BCBS of TX PPO	$29,028.47

OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W/O CC/MCC

Facility

$16,881.50

Service Code	MSDRG 819
Min. Negotiated Rate	$7,215.40
Max. Negotiated Rate	$16,881.50
Rate for Payer: BCBS of TX Blue Advantage	$7,215.40
Rate for Payer: BCBS of TX Blue Essentials	$8,657.64
Rate for Payer: BCBS of TX PPO	$9,619.97

OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility

$14,399.57

Service Code	APR-DRG 3474
Min. Negotiated Rate	$13,576.42
Max. Negotiated Rate	$14,399.57
Rate for Payer: Amerigroup CHIP/Medicaid	$13,576.42
Rate for Payer: Cigna Medicaid	$13,576.42
Rate for Payer: Molina CHIP/Medicaid	$13,576.42
Rate for Payer: Parkland Medicaid	$13,576.42
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14,399.57

OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility

$4,853.67

Service Code	APR-DRG 3472
Min. Negotiated Rate	$4,576.21
Max. Negotiated Rate	$4,853.67
Rate for Payer: Amerigroup CHIP/Medicaid	$4,576.21
Rate for Payer: Cigna Medicaid	$4,576.21
Rate for Payer: Molina CHIP/Medicaid	$4,576.21
Rate for Payer: Parkland Medicaid	$4,576.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,853.67

OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility

$6,179.11

Service Code	APR-DRG 3473
Min. Negotiated Rate	$5,825.88
Max. Negotiated Rate	$6,179.11
Rate for Payer: Amerigroup CHIP/Medicaid	$5,825.88
Rate for Payer: Cigna Medicaid	$5,825.88
Rate for Payer: Molina CHIP/Medicaid	$5,825.88
Rate for Payer: Parkland Medicaid	$5,825.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,179.11

OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility

$3,364.15

Service Code	APR-DRG 3471
Min. Negotiated Rate	$3,171.84
Max. Negotiated Rate	$3,364.15
Rate for Payer: Amerigroup CHIP/Medicaid	$3,171.84
Rate for Payer: Cigna Medicaid	$3,171.84
Rate for Payer: Molina CHIP/Medicaid	$3,171.84
Rate for Payer: Parkland Medicaid	$3,171.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,364.15

OTHER BLADDER PROCEDURES

Facility

$4,221.50

Service Code	APR-DRG 4451
Min. Negotiated Rate	$3,980.18
Max. Negotiated Rate	$4,221.50
Rate for Payer: Amerigroup CHIP/Medicaid	$3,980.18
Rate for Payer: Cigna Medicaid	$3,980.18
Rate for Payer: Molina CHIP/Medicaid	$3,980.18
Rate for Payer: Parkland Medicaid	$3,980.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,221.50

OTHER BLADDER PROCEDURES

Facility

$20,365.19

Service Code	APR-DRG 4454
Min. Negotiated Rate	$19,201.01
Max. Negotiated Rate	$20,365.19
Rate for Payer: Amerigroup CHIP/Medicaid	$19,201.01
Rate for Payer: Cigna Medicaid	$19,201.01
Rate for Payer: Molina CHIP/Medicaid	$19,201.01
Rate for Payer: Parkland Medicaid	$19,201.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$20,365.19

OTHER BLADDER PROCEDURES

Facility

$6,500.10

Service Code	APR-DRG 4452
Min. Negotiated Rate	$6,128.52
Max. Negotiated Rate	$6,500.10
Rate for Payer: Amerigroup CHIP/Medicaid	$6,128.52
Rate for Payer: Cigna Medicaid	$6,128.52
Rate for Payer: Molina CHIP/Medicaid	$6,128.52
Rate for Payer: Parkland Medicaid	$6,128.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,500.10

OTHER BLADDER PROCEDURES

Facility

$9,960.43

Service Code	APR-DRG 4453
Min. Negotiated Rate	$9,391.04
Max. Negotiated Rate	$9,960.43
Rate for Payer: Amerigroup CHIP/Medicaid	$9,391.04
Rate for Payer: Cigna Medicaid	$9,391.04
Rate for Payer: Molina CHIP/Medicaid	$9,391.04
Rate for Payer: Parkland Medicaid	$9,391.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,960.43

OTHER CARDIOTHORACIC AND THORACIC VASCULAR PROCEDURES

Facility

$23,535.08

Service Code	APR-DRG 1673
Min. Negotiated Rate	$22,189.70
Max. Negotiated Rate	$23,535.08
Rate for Payer: Amerigroup CHIP/Medicaid	$22,189.70
Rate for Payer: Cigna Medicaid	$22,189.70
Rate for Payer: Molina CHIP/Medicaid	$22,189.70
Rate for Payer: Parkland Medicaid	$22,189.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$23,535.08

OTHER CARDIOTHORACIC AND THORACIC VASCULAR PROCEDURES

Facility

$54,180.94

Service Code	APR-DRG 1674
Min. Negotiated Rate	$51,083.68
Max. Negotiated Rate	$54,180.94
Rate for Payer: Amerigroup CHIP/Medicaid	$51,083.68
Rate for Payer: Cigna Medicaid	$51,083.68
Rate for Payer: Molina CHIP/Medicaid	$51,083.68
Rate for Payer: Parkland Medicaid	$51,083.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$54,180.94

OTHER CARDIOTHORACIC AND THORACIC VASCULAR PROCEDURES

Facility

$18,416.63

Service Code	APR-DRG 1672
Min. Negotiated Rate	$17,363.84
Max. Negotiated Rate	$18,416.63
Rate for Payer: Amerigroup CHIP/Medicaid	$17,363.84
Rate for Payer: Cigna Medicaid	$17,363.84
Rate for Payer: Molina CHIP/Medicaid	$17,363.84
Rate for Payer: Parkland Medicaid	$17,363.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18,416.63

OTHER CARDIOTHORACIC AND THORACIC VASCULAR PROCEDURES

Facility

$15,130.56

Service Code	APR-DRG 1671
Min. Negotiated Rate	$14,265.62
Max. Negotiated Rate	$15,130.56
Rate for Payer: Amerigroup CHIP/Medicaid	$14,265.62
Rate for Payer: Cigna Medicaid	$14,265.62
Rate for Payer: Molina CHIP/Medicaid	$14,265.62
Rate for Payer: Parkland Medicaid	$14,265.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$15,130.56

OTHER CARDIOTHORACIC PROCEDURES WITH MCC

Facility

$93,637.70

Service Code	MSDRG 228
Min. Negotiated Rate	$41,019.71
Max. Negotiated Rate	$93,637.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$41,019.71
Rate for Payer: Amerigroup Medicare	$41,019.71
Rate for Payer: BCBS of TX Medicare	$41,019.71
Rate for Payer: Cigna Commercial	$63,722.51
Rate for Payer: Cigna Medicare	$41,019.71
Rate for Payer: Employer Direct Commercial	$41,019.71
Rate for Payer: Humana Medicare/TRICARE	$41,019.71
Rate for Payer: Molina Dual Medicare/Medicaid	$41,019.71
Rate for Payer: Molina Medicare	$41,019.71
Rate for Payer: Multiplan Auto	$93,637.70
Rate for Payer: Multiplan Commercial	$93,637.70
Rate for Payer: Multiplan Workers Comp	$93,637.70
Rate for Payer: Scott and White EPO/PPO	$43,122.62
Rate for Payer: Scott and White Medicare	$41,019.71
Rate for Payer: Superior Health Plan EPO	$41,019.71
Rate for Payer: Superior Health Plan Medicare	$41,019.71
Rate for Payer: Universal American Dual Medicare/Medicaid	$41,019.71
Rate for Payer: Universal American Medicare	$41,019.71
Rate for Payer: Wellcare Medicare	$41,019.71
Rate for Payer: Wellmed Medicare	$41,019.71

OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC

Facility

$62,717.10

Service Code	MSDRG 229
Min. Negotiated Rate	$27,842.86
Max. Negotiated Rate	$62,717.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$27,842.86
Rate for Payer: Amerigroup Medicare	$27,842.86
Rate for Payer: BCBS of TX Medicare	$27,842.86
Rate for Payer: Cigna Commercial	$40,565.56
Rate for Payer: Cigna Medicare	$27,842.86
Rate for Payer: Employer Direct Commercial	$27,842.86
Rate for Payer: Humana Medicare/TRICARE	$27,842.86
Rate for Payer: Molina Dual Medicare/Medicaid	$27,842.86
Rate for Payer: Molina Medicare	$27,842.86
Rate for Payer: Multiplan Auto	$62,717.10
Rate for Payer: Multiplan Commercial	$62,717.10
Rate for Payer: Multiplan Workers Comp	$62,717.10
Rate for Payer: Scott and White EPO/PPO	$28,882.88
Rate for Payer: Scott and White Medicare	$27,842.86
Rate for Payer: Superior Health Plan EPO	$27,842.86
Rate for Payer: Superior Health Plan Medicare	$27,842.86
Rate for Payer: Universal American Dual Medicare/Medicaid	$27,842.86
Rate for Payer: Universal American Medicare	$27,842.86
Rate for Payer: Wellcare Medicare	$27,842.86
Rate for Payer: Wellmed Medicare	$27,842.86

OTHER CARDIOTHORACIC PROCEDURES W MCC

Facility

$93,637.70

Service Code	MSDRG 228
Min. Negotiated Rate	$41,019.71
Max. Negotiated Rate	$93,637.70
Rate for Payer: BCBS of TX Blue Advantage	$56,555.32
Rate for Payer: BCBS of TX Blue Essentials	$67,859.81
Rate for Payer: BCBS of TX PPO	$75,402.71

OTHER CARDIOTHORACIC PROCEDURES W/O MCC

Facility

$62,717.10

Service Code	MSDRG 229
Min. Negotiated Rate	$27,842.86
Max. Negotiated Rate	$62,717.10
Rate for Payer: BCBS of TX Blue Advantage	$39,976.24
Rate for Payer: BCBS of TX Blue Essentials	$47,966.84
Rate for Payer: BCBS of TX PPO	$53,298.55

Know your out-of-pocket cost for care.

All Charges