White Rock Medical Center

All Charges

Charge

Type

Setting

Price

OTHER CEREBROVASCULAR DISORDERS WITH CC

Facility

$20,311.00

Service Code	MSDRG 071
Min. Negotiated Rate	$8,477.88
Max. Negotiated Rate	$20,311.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,279.66
Rate for Payer: Amerigroup Medicare	$12,279.66
Rate for Payer: BCBS of TX Medicare	$12,279.66
Rate for Payer: Cigna Commercial	$13,214.88
Rate for Payer: Cigna Medicare	$12,279.66
Rate for Payer: Employer Direct Commercial	$12,279.66
Rate for Payer: Humana Medicare/TRICARE	$12,279.66
Rate for Payer: Molina Dual Medicare/Medicaid	$12,279.66
Rate for Payer: Molina Medicare	$12,279.66
Rate for Payer: Scott and White Medicare	$12,279.66
Rate for Payer: Superior Health Plan EPO	$12,279.66
Rate for Payer: Superior Health Plan Medicare	$12,279.66
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,279.66
Rate for Payer: Universal American Medicare	$12,279.66
Rate for Payer: Wellcare Medicare	$12,279.66
Rate for Payer: Wellmed Medicare	$12,279.66

OTHER CEREBROVASCULAR DISORDERS WITH MCC

Facility

$32,759.80

Service Code	MSDRG 070
Min. Negotiated Rate	$14,149.58
Max. Negotiated Rate	$32,759.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16,961.45
Rate for Payer: Amerigroup Medicare	$16,961.45
Rate for Payer: BCBS of TX Medicare	$16,961.45
Rate for Payer: Cigna Commercial	$21,442.62
Rate for Payer: Cigna Medicare	$16,961.45
Rate for Payer: Employer Direct Commercial	$16,961.45
Rate for Payer: Humana Medicare/TRICARE	$16,961.45
Rate for Payer: Molina Dual Medicare/Medicaid	$16,961.45
Rate for Payer: Molina Medicare	$16,961.45
Rate for Payer: Scott and White Medicare	$16,961.45
Rate for Payer: Superior Health Plan EPO	$16,961.45
Rate for Payer: Superior Health Plan Medicare	$16,961.45
Rate for Payer: Universal American Dual Medicare/Medicaid	$16,961.45
Rate for Payer: Universal American Medicare	$16,961.45
Rate for Payer: Wellcare Medicare	$16,961.45
Rate for Payer: Wellmed Medicare	$16,961.45

OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC

Facility

$14,668.00

Service Code	MSDRG 072
Min. Negotiated Rate	$6,381.20
Max. Negotiated Rate	$14,668.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,302.29
Rate for Payer: Amerigroup Medicare	$10,302.29
Rate for Payer: BCBS of TX Medicare	$10,302.29
Rate for Payer: Cigna Commercial	$9,739.86
Rate for Payer: Cigna Medicare	$10,302.29
Rate for Payer: Employer Direct Commercial	$10,302.29
Rate for Payer: Humana Medicare/TRICARE	$10,302.29
Rate for Payer: Molina Dual Medicare/Medicaid	$10,302.29
Rate for Payer: Molina Medicare	$10,302.29
Rate for Payer: Scott and White Medicare	$10,302.29
Rate for Payer: Superior Health Plan EPO	$10,302.29
Rate for Payer: Superior Health Plan Medicare	$10,302.29
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,302.29
Rate for Payer: Universal American Medicare	$10,302.29
Rate for Payer: Wellcare Medicare	$10,302.29
Rate for Payer: Wellmed Medicare	$10,302.29

OTHER CHEMOTHERAPY

Facility

$16,019.22

Service Code	APR-DRG 6964
Min. Negotiated Rate	$15,103.48
Max. Negotiated Rate	$16,019.22
Rate for Payer: Amerigroup CHIP/Medicaid	$15,103.48
Rate for Payer: Cigna Medicaid	$15,103.48
Rate for Payer: Molina CHIP/Medicaid	$15,103.48
Rate for Payer: Parkland Medicaid	$15,103.48
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,019.22

OTHER CHEMOTHERAPY

Facility

$3,735.30

Service Code	APR-DRG 6961
Min. Negotiated Rate	$3,521.77
Max. Negotiated Rate	$3,735.30
Rate for Payer: Amerigroup CHIP/Medicaid	$3,521.77
Rate for Payer: Cigna Medicaid	$3,521.77
Rate for Payer: Molina CHIP/Medicaid	$3,521.77
Rate for Payer: Parkland Medicaid	$3,521.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,735.30

OTHER CHEMOTHERAPY

Facility

$9,034.05

Service Code	APR-DRG 6963
Min. Negotiated Rate	$8,517.62
Max. Negotiated Rate	$9,034.05
Rate for Payer: Amerigroup CHIP/Medicaid	$8,517.62
Rate for Payer: Cigna Medicaid	$8,517.62
Rate for Payer: Molina CHIP/Medicaid	$8,517.62
Rate for Payer: Parkland Medicaid	$8,517.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,034.05

OTHER CHEMOTHERAPY

Facility

$5,307.43

Service Code	APR-DRG 6962
Min. Negotiated Rate	$5,004.03
Max. Negotiated Rate	$5,307.43
Rate for Payer: Amerigroup CHIP/Medicaid	$5,004.03
Rate for Payer: Cigna Medicaid	$5,004.03
Rate for Payer: Molina CHIP/Medicaid	$5,004.03
Rate for Payer: Parkland Medicaid	$5,004.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,307.43

OTHER CIRCULATORY SYSTEM DIAGNOSES

Facility

$3,919.37

Service Code	APR-DRG 2072
Min. Negotiated Rate	$3,695.32
Max. Negotiated Rate	$3,919.37
Rate for Payer: Amerigroup CHIP/Medicaid	$3,695.32
Rate for Payer: Cigna Medicaid	$3,695.32
Rate for Payer: Molina CHIP/Medicaid	$3,695.32
Rate for Payer: Parkland Medicaid	$3,695.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,919.37

OTHER CIRCULATORY SYSTEM DIAGNOSES

Facility

$5,596.35

Service Code	APR-DRG 2073
Min. Negotiated Rate	$5,276.44
Max. Negotiated Rate	$5,596.35
Rate for Payer: Amerigroup CHIP/Medicaid	$5,276.44
Rate for Payer: Cigna Medicaid	$5,276.44
Rate for Payer: Molina CHIP/Medicaid	$5,276.44
Rate for Payer: Parkland Medicaid	$5,276.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,596.35

OTHER CIRCULATORY SYSTEM DIAGNOSES

Facility

$20,593.39

Service Code	APR-DRG 2074
Min. Negotiated Rate	$19,416.17
Max. Negotiated Rate	$20,593.39
Rate for Payer: Amerigroup CHIP/Medicaid	$19,416.17
Rate for Payer: Cigna Medicaid	$19,416.17
Rate for Payer: Molina CHIP/Medicaid	$19,416.17
Rate for Payer: Parkland Medicaid	$19,416.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$20,593.39

OTHER CIRCULATORY SYSTEM DIAGNOSES

Facility

$3,005.06

Service Code	APR-DRG 2071
Min. Negotiated Rate	$2,833.28
Max. Negotiated Rate	$3,005.06
Rate for Payer: Amerigroup CHIP/Medicaid	$2,833.28
Rate for Payer: Cigna Medicaid	$2,833.28
Rate for Payer: Molina CHIP/Medicaid	$2,833.28
Rate for Payer: Parkland Medicaid	$2,833.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,005.06

OTHER CIRCULATORY SYSTEM DIAGNOSES W CC

Facility

$18,401.50

Service Code	MSDRG 315
Min. Negotiated Rate	$8,220.74
Max. Negotiated Rate	$18,401.50
Rate for Payer: BCBS of TX Blue Advantage	$8,220.74
Rate for Payer: BCBS of TX Blue Essentials	$9,863.93
Rate for Payer: BCBS of TX PPO	$10,960.35

OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC

Facility

$18,401.50

Service Code	MSDRG 315
Min. Negotiated Rate	$8,220.74
Max. Negotiated Rate	$18,401.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,820.12
Rate for Payer: Amerigroup Medicare	$11,820.12
Rate for Payer: BCBS of TX Medicare	$11,820.12
Rate for Payer: Cigna Commercial	$12,407.30
Rate for Payer: Cigna Medicare	$11,820.12
Rate for Payer: Employer Direct Commercial	$11,820.12
Rate for Payer: Humana Medicare/TRICARE	$11,820.12
Rate for Payer: Molina Dual Medicare/Medicaid	$11,820.12
Rate for Payer: Molina Medicare	$11,820.12
Rate for Payer: Multiplan Auto	$18,401.50
Rate for Payer: Multiplan Commercial	$18,401.50
Rate for Payer: Multiplan Workers Comp	$18,401.50
Rate for Payer: Scott and White EPO/PPO	$8,474.38
Rate for Payer: Scott and White Medicare	$11,820.12
Rate for Payer: Superior Health Plan EPO	$11,820.12
Rate for Payer: Superior Health Plan Medicare	$11,820.12
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,820.12
Rate for Payer: Universal American Medicare	$11,820.12
Rate for Payer: Wellcare Medicare	$11,820.12
Rate for Payer: Wellmed Medicare	$11,820.12

OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC

Facility

$39,569.40

Service Code	MSDRG 314
Min. Negotiated Rate	$17,398.66
Max. Negotiated Rate	$39,569.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$20,042.57
Rate for Payer: Amerigroup Medicare	$20,042.57
Rate for Payer: BCBS of TX Medicare	$20,042.57
Rate for Payer: Cigna Commercial	$26,857.38
Rate for Payer: Cigna Medicare	$20,042.57
Rate for Payer: Employer Direct Commercial	$20,042.57
Rate for Payer: Humana Medicare/TRICARE	$20,042.57
Rate for Payer: Molina Dual Medicare/Medicaid	$20,042.57
Rate for Payer: Molina Medicare	$20,042.57
Rate for Payer: Multiplan Auto	$39,569.40
Rate for Payer: Multiplan Commercial	$39,569.40
Rate for Payer: Multiplan Workers Comp	$39,569.40
Rate for Payer: Scott and White EPO/PPO	$18,222.75
Rate for Payer: Scott and White Medicare	$20,042.57
Rate for Payer: Superior Health Plan EPO	$20,042.57
Rate for Payer: Superior Health Plan Medicare	$20,042.57
Rate for Payer: Universal American Dual Medicare/Medicaid	$20,042.57
Rate for Payer: Universal American Medicare	$20,042.57
Rate for Payer: Wellcare Medicare	$20,042.57
Rate for Payer: Wellmed Medicare	$20,042.57

OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$12,958.00

Service Code	MSDRG 316
Min. Negotiated Rate	$5,967.50
Max. Negotiated Rate	$12,958.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$9,759.21
Rate for Payer: Amerigroup Medicare	$9,759.21
Rate for Payer: BCBS of TX Medicare	$9,759.21
Rate for Payer: Cigna Commercial	$8,785.45
Rate for Payer: Cigna Medicare	$9,759.21
Rate for Payer: Employer Direct Commercial	$9,759.21
Rate for Payer: Humana Medicare/TRICARE	$9,759.21
Rate for Payer: Molina Dual Medicare/Medicaid	$9,759.21
Rate for Payer: Molina Medicare	$9,759.21
Rate for Payer: Multiplan Auto	$12,958.00
Rate for Payer: Multiplan Commercial	$12,958.00
Rate for Payer: Multiplan Workers Comp	$12,958.00
Rate for Payer: Scott and White EPO/PPO	$5,967.50
Rate for Payer: Scott and White Medicare	$9,759.21
Rate for Payer: Superior Health Plan EPO	$9,759.21
Rate for Payer: Superior Health Plan Medicare	$9,759.21
Rate for Payer: Universal American Dual Medicare/Medicaid	$9,759.21
Rate for Payer: Universal American Medicare	$9,759.21
Rate for Payer: Wellcare Medicare	$9,759.21
Rate for Payer: Wellmed Medicare	$9,759.21

OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC

Facility

$39,569.40

Service Code	MSDRG 314
Min. Negotiated Rate	$17,398.66
Max. Negotiated Rate	$39,569.40
Rate for Payer: BCBS of TX Blue Advantage	$17,398.66
Rate for Payer: BCBS of TX Blue Essentials	$20,876.37
Rate for Payer: BCBS of TX PPO	$23,196.86

OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC/MCC

Facility

$12,958.00

Service Code	MSDRG 316
Min. Negotiated Rate	$5,967.50
Max. Negotiated Rate	$12,958.00
Rate for Payer: BCBS of TX Blue Advantage	$6,461.18
Rate for Payer: BCBS of TX Blue Essentials	$7,752.66
Rate for Payer: BCBS of TX PPO	$8,614.41

OTHER CIRCULATORY SYSTEM O.R. PROCEDURES

Facility

$62,884.30

Service Code	MSDRG 264
Min. Negotiated Rate	$27,163.96
Max. Negotiated Rate	$62,884.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$29,243.42
Rate for Payer: Amerigroup Medicare	$29,243.42
Rate for Payer: BCBS of TX Blue Advantage	$27,163.96
Rate for Payer: BCBS of TX Blue Essentials	$32,593.59
Rate for Payer: BCBS of TX Medicare	$29,243.42
Rate for Payer: BCBS of TX PPO	$36,216.51
Rate for Payer: Cigna Commercial	$43,026.93
Rate for Payer: Cigna Medicare	$29,243.42
Rate for Payer: Employer Direct Commercial	$29,243.42
Rate for Payer: Humana Medicare/TRICARE	$29,243.42
Rate for Payer: Molina Dual Medicare/Medicaid	$29,243.42
Rate for Payer: Molina Medicare	$29,243.42
Rate for Payer: Multiplan Auto	$62,884.30
Rate for Payer: Multiplan Commercial	$62,884.30
Rate for Payer: Multiplan Workers Comp	$62,884.30
Rate for Payer: Scott and White EPO/PPO	$28,959.88
Rate for Payer: Scott and White Medicare	$29,243.42
Rate for Payer: Superior Health Plan EPO	$29,243.42
Rate for Payer: Superior Health Plan Medicare	$29,243.42
Rate for Payer: Universal American Dual Medicare/Medicaid	$29,243.42
Rate for Payer: Universal American Medicare	$29,243.42
Rate for Payer: Wellcare Medicare	$29,243.42
Rate for Payer: Wellmed Medicare	$29,243.42

OTHER CIRCULATORY SYSTEM PROCEDURES

Facility

$22,688.30

Service Code	APR-DRG 1801
Min. Negotiated Rate	$21,391.32
Max. Negotiated Rate	$22,688.30
Rate for Payer: Amerigroup CHIP/Medicaid	$21,391.32
Rate for Payer: Cigna Medicaid	$21,391.32
Rate for Payer: Molina CHIP/Medicaid	$21,391.32
Rate for Payer: Parkland Medicaid	$21,391.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$22,688.30

OTHER CIRCULATORY SYSTEM PROCEDURES

Facility

$19,448.24

Service Code	APR-DRG 1802
Min. Negotiated Rate	$18,336.48
Max. Negotiated Rate	$19,448.24
Rate for Payer: Amerigroup CHIP/Medicaid	$18,336.48
Rate for Payer: Cigna Medicaid	$18,336.48
Rate for Payer: Molina CHIP/Medicaid	$18,336.48
Rate for Payer: Parkland Medicaid	$18,336.48
Rate for Payer: Superior Health Plan CHIP/Medicaid	$19,448.24

OTHER CIRCULATORY SYSTEM PROCEDURES

Facility

$25,043.09

Service Code	APR-DRG 1804
Min. Negotiated Rate	$23,611.50
Max. Negotiated Rate	$25,043.09
Rate for Payer: Amerigroup CHIP/Medicaid	$23,611.50
Rate for Payer: Cigna Medicaid	$23,611.50
Rate for Payer: Molina CHIP/Medicaid	$23,611.50
Rate for Payer: Parkland Medicaid	$23,611.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$25,043.09

OTHER CIRCULATORY SYSTEM PROCEDURES

Facility

$16,208.19

Service Code	APR-DRG 1803
Min. Negotiated Rate	$15,281.65
Max. Negotiated Rate	$16,208.19
Rate for Payer: Amerigroup CHIP/Medicaid	$15,281.65
Rate for Payer: Cigna Medicaid	$15,281.65
Rate for Payer: Molina CHIP/Medicaid	$15,281.65
Rate for Payer: Parkland Medicaid	$15,281.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,208.19

OTHER COMPLICATIONS OF TREATMENT

Facility

$3,628.56

Service Code	APR-DRG 8132
Min. Negotiated Rate	$3,421.13
Max. Negotiated Rate	$3,628.56
Rate for Payer: Amerigroup CHIP/Medicaid	$3,421.13
Rate for Payer: Cigna Medicaid	$3,421.13
Rate for Payer: Molina CHIP/Medicaid	$3,421.13
Rate for Payer: Parkland Medicaid	$3,421.13
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,628.56

OTHER COMPLICATIONS OF TREATMENT

Facility

$15,286.72

Service Code	APR-DRG 8134
Min. Negotiated Rate	$14,412.85
Max. Negotiated Rate	$15,286.72
Rate for Payer: Amerigroup CHIP/Medicaid	$14,412.85
Rate for Payer: Cigna Medicaid	$14,412.85
Rate for Payer: Molina CHIP/Medicaid	$14,412.85
Rate for Payer: Parkland Medicaid	$14,412.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$15,286.72

OTHER COMPLICATIONS OF TREATMENT

Facility

$5,802.30

Service Code	APR-DRG 8133
Min. Negotiated Rate	$5,470.61
Max. Negotiated Rate	$5,802.30
Rate for Payer: Amerigroup CHIP/Medicaid	$5,470.61
Rate for Payer: Cigna Medicaid	$5,470.61
Rate for Payer: Molina CHIP/Medicaid	$5,470.61
Rate for Payer: Parkland Medicaid	$5,470.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,802.30

Know your out-of-pocket cost for care.

All Charges