White Rock Medical Center

All Charges

Charge

Type

Setting

Price

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY W CC/MCC

Facility

$35,919.50

Service Code	MSDRG 717
Min. Negotiated Rate	$16,541.88
Max. Negotiated Rate	$35,919.50
Rate for Payer: BCBS of TX Blue Advantage	$16,806.98
Rate for Payer: BCBS of TX Blue Essentials	$20,166.42
Rate for Payer: BCBS of TX PPO	$22,408.00

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY W/O CC/MCC

Facility

$25,518.90

Service Code	MSDRG 718
Min. Negotiated Rate	$10,600.36
Max. Negotiated Rate	$25,518.90
Rate for Payer: BCBS of TX Blue Advantage	$10,600.36
Rate for Payer: BCBS of TX Blue Essentials	$12,719.20
Rate for Payer: BCBS of TX PPO	$14,132.99

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC FOR MALIGNANCY W CC/MCC

Facility

$42,508.70

Service Code	MSDRG 715
Min. Negotiated Rate	$19,005.14
Max. Negotiated Rate	$42,508.70
Rate for Payer: BCBS of TX Blue Advantage	$19,005.14
Rate for Payer: BCBS of TX Blue Essentials	$22,803.96
Rate for Payer: BCBS of TX PPO	$25,338.71

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC FOR MALIGNANCY W/O CC/MCC

Facility

$27,949.00

Service Code	MSDRG 716
Min. Negotiated Rate	$12,581.80
Max. Negotiated Rate	$27,949.00
Rate for Payer: BCBS of TX Blue Advantage	$12,581.80
Rate for Payer: BCBS of TX Blue Essentials	$15,096.70
Rate for Payer: BCBS of TX PPO	$16,774.76

OTHER MENTAL DISORDER DIAGNOSES

Facility

$20,347.10

Service Code	MSDRG 887
Min. Negotiated Rate	$9,154.70
Max. Negotiated Rate	$20,347.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,608.74
Rate for Payer: Amerigroup Medicare	$12,608.74
Rate for Payer: BCBS of TX Blue Advantage	$9,154.70
Rate for Payer: BCBS of TX Blue Essentials	$10,984.58
Rate for Payer: BCBS of TX Medicare	$12,608.74
Rate for Payer: BCBS of TX PPO	$12,205.56
Rate for Payer: Cigna Commercial	$13,793.19
Rate for Payer: Cigna Medicare	$12,608.74
Rate for Payer: Employer Direct Commercial	$12,608.74
Rate for Payer: Molina Dual Medicare/Medicaid	$12,608.74
Rate for Payer: Molina Medicare	$12,608.74
Rate for Payer: Multiplan Auto	$20,347.10
Rate for Payer: Multiplan Commercial	$20,347.10
Rate for Payer: Multiplan Workers Comp	$20,347.10
Rate for Payer: Scott and White EPO/PPO	$9,370.38
Rate for Payer: Scott and White Medicare	$12,608.74
Rate for Payer: Superior Health Plan EPO	$12,608.74
Rate for Payer: Superior Health Plan Medicare	$12,608.74
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,608.74
Rate for Payer: Universal American Medicare	$12,608.74
Rate for Payer: Wellcare Medicare	$12,608.74
Rate for Payer: Wellmed Medicare	$12,608.74

OTHER MENTAL HEALTH DISORDERS

Facility

$4,427.07

Service Code	APR-DRG 7602
Min. Negotiated Rate	$4,173.99
Max. Negotiated Rate	$4,427.07
Rate for Payer: Amerigroup CHIP/Medicaid	$4,173.99
Rate for Payer: Cigna Medicaid	$4,173.99
Rate for Payer: Molina CHIP/Medicaid	$4,173.99
Rate for Payer: Parkland Medicaid	$4,173.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,427.07

OTHER MENTAL HEALTH DISORDERS

Facility

$6,888.98

Service Code	APR-DRG 7603
Min. Negotiated Rate	$6,495.17
Max. Negotiated Rate	$6,888.98
Rate for Payer: Amerigroup CHIP/Medicaid	$6,495.17
Rate for Payer: Cigna Medicaid	$6,495.17
Rate for Payer: Molina CHIP/Medicaid	$6,495.17
Rate for Payer: Parkland Medicaid	$6,495.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,888.98

OTHER MENTAL HEALTH DISORDERS

Facility

$1,830.50

Service Code	APR-DRG 7601
Min. Negotiated Rate	$1,725.86
Max. Negotiated Rate	$1,830.50
Rate for Payer: Amerigroup CHIP/Medicaid	$1,725.86
Rate for Payer: Cigna Medicaid	$1,725.86
Rate for Payer: Molina CHIP/Medicaid	$1,725.86
Rate for Payer: Parkland Medicaid	$1,725.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,830.50

OTHER MENTAL HEALTH DISORDERS

Facility

$9,350.89

Service Code	APR-DRG 7604
Min. Negotiated Rate	$8,816.35
Max. Negotiated Rate	$9,350.89
Rate for Payer: Amerigroup CHIP/Medicaid	$8,816.35
Rate for Payer: Cigna Medicaid	$8,816.35
Rate for Payer: Molina CHIP/Medicaid	$8,816.35
Rate for Payer: Parkland Medicaid	$8,816.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,350.89

OTHER MULTIPLE SIGNIFICANT TRAUMA W CC

Facility

$29,119.40

Service Code	MSDRG 964
Min. Negotiated Rate	$12,684.14
Max. Negotiated Rate	$29,119.40
Rate for Payer: BCBS of TX Blue Advantage	$12,684.14
Rate for Payer: BCBS of TX Blue Essentials	$15,219.49
Rate for Payer: BCBS of TX PPO	$16,911.20

OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$29,119.40

Service Code	MSDRG 964
Min. Negotiated Rate	$12,684.14
Max. Negotiated Rate	$29,119.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15,992.54
Rate for Payer: Amerigroup Medicare	$15,992.54
Rate for Payer: BCBS of TX Medicare	$15,992.54
Rate for Payer: Cigna Commercial	$19,739.89
Rate for Payer: Cigna Medicare	$15,992.54
Rate for Payer: Employer Direct Commercial	$15,992.54
Rate for Payer: Humana Medicare/TRICARE	$15,992.54
Rate for Payer: Molina Dual Medicare/Medicaid	$15,992.54
Rate for Payer: Molina Medicare	$15,992.54
Rate for Payer: Multiplan Auto	$29,119.40
Rate for Payer: Multiplan Commercial	$29,119.40
Rate for Payer: Multiplan Workers Comp	$29,119.40
Rate for Payer: Scott and White EPO/PPO	$13,410.25
Rate for Payer: Scott and White Medicare	$15,992.54
Rate for Payer: Superior Health Plan EPO	$15,992.54
Rate for Payer: Superior Health Plan Medicare	$15,992.54
Rate for Payer: Universal American Dual Medicare/Medicaid	$15,992.54
Rate for Payer: Universal American Medicare	$15,992.54
Rate for Payer: Wellcare Medicare	$15,992.54
Rate for Payer: Wellmed Medicare	$15,992.54

OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$51,942.20

Service Code	MSDRG 963
Min. Negotiated Rate	$23,920.75
Max. Negotiated Rate	$51,942.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$24,796.16
Rate for Payer: Amerigroup Medicare	$24,796.16
Rate for Payer: BCBS of TX Medicare	$24,796.16
Rate for Payer: Cigna Commercial	$35,211.34
Rate for Payer: Cigna Medicare	$24,796.16
Rate for Payer: Employer Direct Commercial	$24,796.16
Rate for Payer: Humana Medicare/TRICARE	$24,796.16
Rate for Payer: Molina Dual Medicare/Medicaid	$24,796.16
Rate for Payer: Molina Medicare	$24,796.16
Rate for Payer: Multiplan Auto	$51,942.20
Rate for Payer: Multiplan Commercial	$51,942.20
Rate for Payer: Multiplan Workers Comp	$51,942.20
Rate for Payer: Scott and White EPO/PPO	$23,920.75
Rate for Payer: Scott and White Medicare	$24,796.16
Rate for Payer: Superior Health Plan EPO	$24,796.16
Rate for Payer: Superior Health Plan Medicare	$24,796.16
Rate for Payer: Universal American Dual Medicare/Medicaid	$24,796.16
Rate for Payer: Universal American Medicare	$24,796.16
Rate for Payer: Wellcare Medicare	$24,796.16
Rate for Payer: Wellmed Medicare	$24,796.16

OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$17,869.50

Service Code	MSDRG 965
Min. Negotiated Rate	$8,229.38
Max. Negotiated Rate	$17,869.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,653.03
Rate for Payer: Amerigroup Medicare	$11,653.03
Rate for Payer: BCBS of TX Medicare	$11,653.03
Rate for Payer: Cigna Commercial	$12,113.64
Rate for Payer: Cigna Medicare	$11,653.03
Rate for Payer: Employer Direct Commercial	$11,653.03
Rate for Payer: Humana Medicare/TRICARE	$11,653.03
Rate for Payer: Molina Dual Medicare/Medicaid	$11,653.03
Rate for Payer: Molina Medicare	$11,653.03
Rate for Payer: Multiplan Auto	$17,869.50
Rate for Payer: Multiplan Commercial	$17,869.50
Rate for Payer: Multiplan Workers Comp	$17,869.50
Rate for Payer: Scott and White EPO/PPO	$8,229.38
Rate for Payer: Scott and White Medicare	$11,653.03
Rate for Payer: Superior Health Plan EPO	$11,653.03
Rate for Payer: Superior Health Plan Medicare	$11,653.03
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,653.03
Rate for Payer: Universal American Medicare	$11,653.03
Rate for Payer: Wellcare Medicare	$11,653.03
Rate for Payer: Wellmed Medicare	$11,653.03

OTHER MULTIPLE SIGNIFICANT TRAUMA W MCC

Facility

$51,942.20

Service Code	MSDRG 963
Min. Negotiated Rate	$23,920.75
Max. Negotiated Rate	$51,942.20
Rate for Payer: BCBS of TX Blue Advantage	$24,037.00
Rate for Payer: BCBS of TX Blue Essentials	$28,841.60
Rate for Payer: BCBS of TX PPO	$32,047.47

OTHER MULTIPLE SIGNIFICANT TRAUMA W/O CC/MCC

Facility

$17,869.50

Service Code	MSDRG 965
Min. Negotiated Rate	$8,229.38
Max. Negotiated Rate	$17,869.50
Rate for Payer: BCBS of TX Blue Advantage	$8,378.98
Rate for Payer: BCBS of TX Blue Essentials	$10,053.80
Rate for Payer: BCBS of TX PPO	$11,171.32

OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W CC

Facility

$18,513.60

Service Code	MSDRG 565
Min. Negotiated Rate	$8,391.88
Max. Negotiated Rate	$18,513.60
Rate for Payer: BCBS of TX Blue Advantage	$8,391.88
Rate for Payer: BCBS of TX Blue Essentials	$10,069.28
Rate for Payer: BCBS of TX PPO	$11,188.52

OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W MCC

Facility

$29,328.40

Service Code	MSDRG 564
Min. Negotiated Rate	$13,506.50
Max. Negotiated Rate	$29,328.40
Rate for Payer: BCBS of TX Blue Advantage	$13,520.92
Rate for Payer: BCBS of TX Blue Essentials	$16,223.53
Rate for Payer: BCBS of TX PPO	$18,026.85

OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W/O CC/MCC

Facility

$14,236.70

Service Code	MSDRG 566
Min. Negotiated Rate	$6,555.78
Max. Negotiated Rate	$14,236.70
Rate for Payer: BCBS of TX Blue Advantage	$6,555.78
Rate for Payer: BCBS of TX Blue Essentials	$7,866.17
Rate for Payer: BCBS of TX PPO	$8,740.53

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES

Facility

$6,264.35

Service Code	APR-DRG 3513
Min. Negotiated Rate	$5,906.25
Max. Negotiated Rate	$6,264.35
Rate for Payer: Amerigroup CHIP/Medicaid	$5,906.25
Rate for Payer: Cigna Medicaid	$5,906.25
Rate for Payer: Molina CHIP/Medicaid	$5,906.25
Rate for Payer: Parkland Medicaid	$5,906.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,264.35

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES

Facility

$3,019.02

Service Code	APR-DRG 3511
Min. Negotiated Rate	$2,846.44
Max. Negotiated Rate	$3,019.02
Rate for Payer: Amerigroup CHIP/Medicaid	$2,846.44
Rate for Payer: Cigna Medicaid	$2,846.44
Rate for Payer: Molina CHIP/Medicaid	$2,846.44
Rate for Payer: Parkland Medicaid	$2,846.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,019.02

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES

Facility

$18,177.49

Service Code	APR-DRG 3514
Min. Negotiated Rate	$17,138.38
Max. Negotiated Rate	$18,177.49
Rate for Payer: Amerigroup CHIP/Medicaid	$17,138.38
Rate for Payer: Cigna Medicaid	$17,138.38
Rate for Payer: Molina CHIP/Medicaid	$17,138.38
Rate for Payer: Parkland Medicaid	$17,138.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18,177.49

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES

Facility

$3,493.52

Service Code	APR-DRG 3512
Min. Negotiated Rate	$3,293.82
Max. Negotiated Rate	$3,493.52
Rate for Payer: Amerigroup CHIP/Medicaid	$3,293.82
Rate for Payer: Cigna Medicaid	$3,293.82
Rate for Payer: Molina CHIP/Medicaid	$3,293.82
Rate for Payer: Parkland Medicaid	$3,293.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,493.52

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC

Facility

$18,513.60

Service Code	MSDRG 565
Min. Negotiated Rate	$8,391.88
Max. Negotiated Rate	$18,513.60
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,901.48
Rate for Payer: Amerigroup Medicare	$11,901.48
Rate for Payer: BCBS of TX Medicare	$11,901.48
Rate for Payer: Cigna Commercial	$12,550.27
Rate for Payer: Cigna Medicare	$11,901.48
Rate for Payer: Employer Direct Commercial	$11,901.48
Rate for Payer: Humana Medicare/TRICARE	$11,901.48
Rate for Payer: Molina Dual Medicare/Medicaid	$11,901.48
Rate for Payer: Molina Medicare	$11,901.48
Rate for Payer: Multiplan Auto	$18,513.60
Rate for Payer: Multiplan Commercial	$18,513.60
Rate for Payer: Multiplan Workers Comp	$18,513.60
Rate for Payer: Scott and White EPO/PPO	$8,526.00
Rate for Payer: Scott and White Medicare	$11,901.48
Rate for Payer: Superior Health Plan EPO	$11,901.48
Rate for Payer: Superior Health Plan Medicare	$11,901.48
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,901.48
Rate for Payer: Universal American Medicare	$11,901.48
Rate for Payer: Wellcare Medicare	$11,901.48
Rate for Payer: Wellmed Medicare	$11,901.48

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC

Facility

$29,328.40

Service Code	MSDRG 564
Min. Negotiated Rate	$13,506.50
Max. Negotiated Rate	$29,328.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16,073.17
Rate for Payer: Amerigroup Medicare	$16,073.17
Rate for Payer: BCBS of TX Medicare	$16,073.17
Rate for Payer: Cigna Commercial	$19,881.57
Rate for Payer: Cigna Medicare	$16,073.17
Rate for Payer: Employer Direct Commercial	$16,073.17
Rate for Payer: Humana Medicare/TRICARE	$16,073.17
Rate for Payer: Molina Dual Medicare/Medicaid	$16,073.17
Rate for Payer: Molina Medicare	$16,073.17
Rate for Payer: Multiplan Auto	$29,328.40
Rate for Payer: Multiplan Commercial	$29,328.40
Rate for Payer: Multiplan Workers Comp	$29,328.40
Rate for Payer: Scott and White EPO/PPO	$13,506.50
Rate for Payer: Scott and White Medicare	$16,073.17
Rate for Payer: Superior Health Plan EPO	$16,073.17
Rate for Payer: Superior Health Plan Medicare	$16,073.17
Rate for Payer: Universal American Dual Medicare/Medicaid	$16,073.17
Rate for Payer: Universal American Medicare	$16,073.17
Rate for Payer: Wellcare Medicare	$16,073.17
Rate for Payer: Wellmed Medicare	$16,073.17

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC

Facility

$14,236.70

Service Code	MSDRG 566
Min. Negotiated Rate	$6,555.78
Max. Negotiated Rate	$14,236.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,251.72
Rate for Payer: Amerigroup Medicare	$10,251.72
Rate for Payer: BCBS of TX Medicare	$10,251.72
Rate for Payer: Cigna Commercial	$9,650.98
Rate for Payer: Cigna Medicare	$10,251.72
Rate for Payer: Employer Direct Commercial	$10,251.72
Rate for Payer: Humana Medicare/TRICARE	$10,251.72
Rate for Payer: Molina Dual Medicare/Medicaid	$10,251.72
Rate for Payer: Molina Medicare	$10,251.72
Rate for Payer: Multiplan Auto	$14,236.70
Rate for Payer: Multiplan Commercial	$14,236.70
Rate for Payer: Multiplan Workers Comp	$14,236.70
Rate for Payer: Scott and White EPO/PPO	$6,556.38
Rate for Payer: Scott and White Medicare	$10,251.72
Rate for Payer: Superior Health Plan EPO	$10,251.72
Rate for Payer: Superior Health Plan Medicare	$10,251.72
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,251.72
Rate for Payer: Universal American Medicare	$10,251.72
Rate for Payer: Wellcare Medicare	$10,251.72
Rate for Payer: Wellmed Medicare	$10,251.72

Know your out-of-pocket cost for care.

All Charges