White Rock Medical Center

All Charges

Charge

Type

Setting

Price

OTHER OPEN CRANIOTOMY

Facility

$14,941.21

Service Code	APR-DRG 0272
Min. Negotiated Rate	$14,087.10
Max. Negotiated Rate	$14,941.21
Rate for Payer: Amerigroup CHIP/Medicaid	$14,087.10
Rate for Payer: Cigna Medicaid	$14,087.10
Rate for Payer: Molina CHIP/Medicaid	$14,087.10
Rate for Payer: Parkland Medicaid	$14,087.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14,941.21

OTHER OPEN CRANIOTOMY

Facility

$8,982.00

Service Code	APR-DRG 0271
Min. Negotiated Rate	$8,468.55
Max. Negotiated Rate	$8,982.00
Rate for Payer: Amerigroup CHIP/Medicaid	$8,468.55
Rate for Payer: Cigna Medicaid	$8,468.55
Rate for Payer: Molina CHIP/Medicaid	$8,468.55
Rate for Payer: Parkland Medicaid	$8,468.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,982.00

OTHER OPEN CRANIOTOMY

Facility

$20,900.42

Service Code	APR-DRG 0273
Min. Negotiated Rate	$19,705.65
Max. Negotiated Rate	$20,900.42
Rate for Payer: Amerigroup CHIP/Medicaid	$19,705.65
Rate for Payer: Cigna Medicaid	$19,705.65
Rate for Payer: Molina CHIP/Medicaid	$19,705.65
Rate for Payer: Parkland Medicaid	$19,705.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$20,900.42

OTHER O.R. PROCEDURES FOR INJURIES W CC

Facility

$37,908.80

Service Code	MSDRG 908
Min. Negotiated Rate	$17,138.08
Max. Negotiated Rate	$37,908.80
Rate for Payer: BCBS of TX Blue Advantage	$17,138.08
Rate for Payer: BCBS of TX Blue Essentials	$20,563.70
Rate for Payer: BCBS of TX PPO	$22,849.44

OTHER O.R. PROCEDURES FOR INJURIES WITH CC

Facility

$37,908.80

Service Code	MSDRG 908
Min. Negotiated Rate	$17,138.08
Max. Negotiated Rate	$37,908.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$19,382.95
Rate for Payer: Amerigroup Medicare	$19,382.95
Rate for Payer: BCBS of TX Medicare	$19,382.95
Rate for Payer: Cigna Commercial	$25,698.18
Rate for Payer: Cigna Medicare	$19,382.95
Rate for Payer: Employer Direct Commercial	$19,382.95
Rate for Payer: Humana Medicare/TRICARE	$19,382.95
Rate for Payer: Molina Dual Medicare/Medicaid	$19,382.95
Rate for Payer: Molina Medicare	$19,382.95
Rate for Payer: Multiplan Auto	$37,908.80
Rate for Payer: Multiplan Commercial	$37,908.80
Rate for Payer: Multiplan Workers Comp	$37,908.80
Rate for Payer: Scott and White EPO/PPO	$17,458.00
Rate for Payer: Scott and White Medicare	$19,382.95
Rate for Payer: Superior Health Plan EPO	$19,382.95
Rate for Payer: Superior Health Plan Medicare	$19,382.95
Rate for Payer: Universal American Dual Medicare/Medicaid	$19,382.95
Rate for Payer: Universal American Medicare	$19,382.95
Rate for Payer: Wellcare Medicare	$19,382.95
Rate for Payer: Wellmed Medicare	$19,382.95

OTHER O.R. PROCEDURES FOR INJURIES WITH MCC

Facility

$72,946.70

Service Code	MSDRG 907
Min. Negotiated Rate	$32,898.41
Max. Negotiated Rate	$72,946.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$32,898.41
Rate for Payer: Amerigroup Medicare	$32,898.41
Rate for Payer: BCBS of TX Medicare	$32,898.41
Rate for Payer: Cigna Commercial	$49,450.18
Rate for Payer: Cigna Medicare	$32,898.41
Rate for Payer: Employer Direct Commercial	$32,898.41
Rate for Payer: Humana Medicare/TRICARE	$32,898.41
Rate for Payer: Molina Dual Medicare/Medicaid	$32,898.41
Rate for Payer: Molina Medicare	$32,898.41
Rate for Payer: Multiplan Auto	$72,946.70
Rate for Payer: Multiplan Commercial	$72,946.70
Rate for Payer: Multiplan Workers Comp	$72,946.70
Rate for Payer: Scott and White EPO/PPO	$33,593.88
Rate for Payer: Scott and White Medicare	$32,898.41
Rate for Payer: Superior Health Plan EPO	$32,898.41
Rate for Payer: Superior Health Plan Medicare	$32,898.41
Rate for Payer: Universal American Dual Medicare/Medicaid	$32,898.41
Rate for Payer: Universal American Medicare	$32,898.41
Rate for Payer: Wellcare Medicare	$32,898.41
Rate for Payer: Wellmed Medicare	$32,898.41

OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC

Facility

$24,941.30

Service Code	MSDRG 909
Min. Negotiated Rate	$11,398.44
Max. Negotiated Rate	$24,941.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14,380.89
Rate for Payer: Amerigroup Medicare	$14,380.89
Rate for Payer: BCBS of TX Medicare	$14,380.89
Rate for Payer: Cigna Commercial	$16,907.58
Rate for Payer: Cigna Medicare	$14,380.89
Rate for Payer: Employer Direct Commercial	$14,380.89
Rate for Payer: Humana Medicare/TRICARE	$14,380.89
Rate for Payer: Molina Dual Medicare/Medicaid	$14,380.89
Rate for Payer: Molina Medicare	$14,380.89
Rate for Payer: Multiplan Auto	$24,941.30
Rate for Payer: Multiplan Commercial	$24,941.30
Rate for Payer: Multiplan Workers Comp	$24,941.30
Rate for Payer: Scott and White EPO/PPO	$11,486.12
Rate for Payer: Scott and White Medicare	$14,380.89
Rate for Payer: Superior Health Plan EPO	$14,380.89
Rate for Payer: Superior Health Plan Medicare	$14,380.89
Rate for Payer: Universal American Dual Medicare/Medicaid	$14,380.89
Rate for Payer: Universal American Medicare	$14,380.89
Rate for Payer: Wellcare Medicare	$14,380.89
Rate for Payer: Wellmed Medicare	$14,380.89

OTHER O.R. PROCEDURES FOR INJURIES W MCC

Facility

$72,946.70

Service Code	MSDRG 907
Min. Negotiated Rate	$32,898.41
Max. Negotiated Rate	$72,946.70
Rate for Payer: BCBS of TX Blue Advantage	$36,258.46
Rate for Payer: BCBS of TX Blue Essentials	$43,505.94
Rate for Payer: BCBS of TX PPO	$48,341.80

OTHER O.R. PROCEDURES FOR INJURIES W/O CC/MCC

Facility

$24,941.30

Service Code	MSDRG 909
Min. Negotiated Rate	$11,398.44
Max. Negotiated Rate	$24,941.30
Rate for Payer: BCBS of TX Blue Advantage	$11,398.44
Rate for Payer: BCBS of TX Blue Essentials	$13,676.80
Rate for Payer: BCBS of TX PPO	$15,197.04

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

Facility

$9,621.34

Service Code	APR-DRG 6811
Min. Negotiated Rate	$9,071.33
Max. Negotiated Rate	$9,621.34
Rate for Payer: Amerigroup CHIP/Medicaid	$9,071.33
Rate for Payer: Cigna Medicaid	$9,071.33
Rate for Payer: Molina CHIP/Medicaid	$9,071.33
Rate for Payer: Parkland Medicaid	$9,071.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,621.34

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

Facility

$10,126.39

Service Code	APR-DRG 6812
Min. Negotiated Rate	$9,547.52
Max. Negotiated Rate	$10,126.39
Rate for Payer: Amerigroup CHIP/Medicaid	$9,547.52
Rate for Payer: Cigna Medicaid	$9,547.52
Rate for Payer: Molina CHIP/Medicaid	$9,547.52
Rate for Payer: Parkland Medicaid	$9,547.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,126.39

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

Facility

$81,777.59

Service Code	APR-DRG 6814
Min. Negotiated Rate	$77,102.78
Max. Negotiated Rate	$81,777.59
Rate for Payer: Amerigroup CHIP/Medicaid	$77,102.78
Rate for Payer: Cigna Medicaid	$77,102.78
Rate for Payer: Molina CHIP/Medicaid	$77,102.78
Rate for Payer: Parkland Medicaid	$77,102.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$81,777.59

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

Facility

$21,711.00

Service Code	APR-DRG 6813
Min. Negotiated Rate	$20,469.89
Max. Negotiated Rate	$21,711.00
Rate for Payer: Amerigroup CHIP/Medicaid	$20,469.89
Rate for Payer: Cigna Medicaid	$20,469.89
Rate for Payer: Molina CHIP/Medicaid	$20,469.89
Rate for Payer: Parkland Medicaid	$20,469.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$21,711.00

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W CC

Facility

$80,064.10

Service Code	MSDRG 958
Min. Negotiated Rate	$35,643.86
Max. Negotiated Rate	$80,064.10
Rate for Payer: BCBS of TX Blue Advantage	$35,946.28
Rate for Payer: BCBS of TX Blue Essentials	$43,131.36
Rate for Payer: BCBS of TX PPO	$47,925.59

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$80,064.10

Service Code	MSDRG 958
Min. Negotiated Rate	$35,643.86
Max. Negotiated Rate	$80,064.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$35,643.86
Rate for Payer: Amerigroup Medicare	$35,643.86
Rate for Payer: BCBS of TX Medicare	$35,643.86
Rate for Payer: Cigna Commercial	$54,275.03
Rate for Payer: Cigna Medicare	$35,643.86
Rate for Payer: Employer Direct Commercial	$35,643.86
Rate for Payer: Humana Medicare/TRICARE	$35,643.86
Rate for Payer: Molina Dual Medicare/Medicaid	$35,643.86
Rate for Payer: Molina Medicare	$35,643.86
Rate for Payer: Multiplan Auto	$80,064.10
Rate for Payer: Multiplan Commercial	$80,064.10
Rate for Payer: Multiplan Workers Comp	$80,064.10
Rate for Payer: Scott and White EPO/PPO	$36,871.62
Rate for Payer: Scott and White Medicare	$35,643.86
Rate for Payer: Superior Health Plan EPO	$35,643.86
Rate for Payer: Superior Health Plan Medicare	$35,643.86
Rate for Payer: Universal American Dual Medicare/Medicaid	$35,643.86
Rate for Payer: Universal American Medicare	$35,643.86
Rate for Payer: Wellcare Medicare	$35,643.86
Rate for Payer: Wellmed Medicare	$35,643.86

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$144,778.10

Service Code	MSDRG 957
Min. Negotiated Rate	$60,606.53
Max. Negotiated Rate	$144,778.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$60,606.53
Rate for Payer: Amerigroup Medicare	$60,606.53
Rate for Payer: BCBS of TX Medicare	$60,606.53
Rate for Payer: Cigna Commercial	$98,144.31
Rate for Payer: Cigna Medicare	$60,606.53
Rate for Payer: Employer Direct Commercial	$60,606.53
Rate for Payer: Humana Medicare/TRICARE	$60,606.53
Rate for Payer: Molina Dual Medicare/Medicaid	$60,606.53
Rate for Payer: Molina Medicare	$60,606.53
Rate for Payer: Multiplan Auto	$144,778.10
Rate for Payer: Multiplan Commercial	$144,778.10
Rate for Payer: Multiplan Workers Comp	$144,778.10
Rate for Payer: Scott and White EPO/PPO	$66,674.12
Rate for Payer: Scott and White Medicare	$60,606.53
Rate for Payer: Superior Health Plan EPO	$60,606.53
Rate for Payer: Superior Health Plan Medicare	$60,606.53
Rate for Payer: Universal American Dual Medicare/Medicaid	$60,606.53
Rate for Payer: Universal American Medicare	$60,606.53
Rate for Payer: Wellcare Medicare	$60,606.53
Rate for Payer: Wellmed Medicare	$60,606.53

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$55,937.90

Service Code	MSDRG 959
Min. Negotiated Rate	$21,076.02
Max. Negotiated Rate	$55,937.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$26,337.47
Rate for Payer: Amerigroup Medicare	$26,337.47
Rate for Payer: BCBS of TX Medicare	$26,337.47
Rate for Payer: Cigna Commercial	$37,920.01
Rate for Payer: Cigna Medicare	$26,337.47
Rate for Payer: Employer Direct Commercial	$26,337.47
Rate for Payer: Humana Medicare/TRICARE	$26,337.47
Rate for Payer: Molina Dual Medicare/Medicaid	$26,337.47
Rate for Payer: Molina Medicare	$26,337.47
Rate for Payer: Multiplan Auto	$55,937.90
Rate for Payer: Multiplan Commercial	$55,937.90
Rate for Payer: Multiplan Workers Comp	$55,937.90
Rate for Payer: Scott and White EPO/PPO	$25,760.88
Rate for Payer: Scott and White Medicare	$26,337.47
Rate for Payer: Superior Health Plan EPO	$26,337.47
Rate for Payer: Superior Health Plan Medicare	$26,337.47
Rate for Payer: Universal American Dual Medicare/Medicaid	$26,337.47
Rate for Payer: Universal American Medicare	$26,337.47
Rate for Payer: Wellcare Medicare	$26,337.47
Rate for Payer: Wellmed Medicare	$26,337.47

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W MCC

Facility

$144,778.10

Service Code	MSDRG 957
Min. Negotiated Rate	$60,606.53
Max. Negotiated Rate	$144,778.10
Rate for Payer: BCBS of TX Blue Advantage	$65,347.10
Rate for Payer: BCBS of TX Blue Essentials	$78,408.92
Rate for Payer: BCBS of TX PPO	$87,124.40

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W/O CC/MCC

Facility

$55,937.90

Service Code	MSDRG 959
Min. Negotiated Rate	$21,076.02
Max. Negotiated Rate	$55,937.90
Rate for Payer: BCBS of TX Blue Advantage	$21,076.02
Rate for Payer: BCBS of TX Blue Essentials	$25,288.77
Rate for Payer: BCBS of TX PPO	$28,099.73

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC

Facility

$35,319.10

Service Code	MSDRG 803
Min. Negotiated Rate	$14,810.06
Max. Negotiated Rate	$35,319.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$18,384.00
Rate for Payer: Amerigroup Medicare	$18,384.00
Rate for Payer: BCBS of TX Medicare	$18,384.00
Rate for Payer: Cigna Commercial	$23,942.63
Rate for Payer: Cigna Medicare	$18,384.00
Rate for Payer: Employer Direct Commercial	$18,384.00
Rate for Payer: Humana Medicare/TRICARE	$18,384.00
Rate for Payer: Molina Dual Medicare/Medicaid	$18,384.00
Rate for Payer: Molina Medicare	$18,384.00
Rate for Payer: Multiplan Auto	$35,319.10
Rate for Payer: Multiplan Commercial	$35,319.10
Rate for Payer: Multiplan Workers Comp	$35,319.10
Rate for Payer: Scott and White EPO/PPO	$16,265.38
Rate for Payer: Scott and White Medicare	$18,384.00
Rate for Payer: Superior Health Plan EPO	$18,384.00
Rate for Payer: Superior Health Plan Medicare	$18,384.00
Rate for Payer: Universal American Dual Medicare/Medicaid	$18,384.00
Rate for Payer: Universal American Medicare	$18,384.00
Rate for Payer: Wellcare Medicare	$18,384.00
Rate for Payer: Wellmed Medicare	$18,384.00

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC

Facility

$75,697.90

Service Code	MSDRG 802
Min. Negotiated Rate	$28,785.92
Max. Negotiated Rate	$75,697.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$33,959.65
Rate for Payer: Amerigroup Medicare	$33,959.65
Rate for Payer: BCBS of TX Medicare	$33,959.65
Rate for Payer: Cigna Commercial	$51,315.21
Rate for Payer: Cigna Medicare	$33,959.65
Rate for Payer: Employer Direct Commercial	$33,959.65
Rate for Payer: Humana Medicare/TRICARE	$33,959.65
Rate for Payer: Molina Dual Medicare/Medicaid	$33,959.65
Rate for Payer: Molina Medicare	$33,959.65
Rate for Payer: Multiplan Auto	$75,697.90
Rate for Payer: Multiplan Commercial	$75,697.90
Rate for Payer: Multiplan Workers Comp	$75,697.90
Rate for Payer: Scott and White EPO/PPO	$34,860.88
Rate for Payer: Scott and White Medicare	$33,959.65
Rate for Payer: Superior Health Plan EPO	$33,959.65
Rate for Payer: Superior Health Plan Medicare	$33,959.65
Rate for Payer: Universal American Dual Medicare/Medicaid	$33,959.65
Rate for Payer: Universal American Medicare	$33,959.65
Rate for Payer: Wellcare Medicare	$33,959.65
Rate for Payer: Wellmed Medicare	$33,959.65

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC

Facility

$25,764.00

Service Code	MSDRG 804
Min. Negotiated Rate	$10,582.30
Max. Negotiated Rate	$25,764.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14,698.25
Rate for Payer: Amerigroup Medicare	$14,698.25
Rate for Payer: BCBS of TX Medicare	$14,698.25
Rate for Payer: Cigna Commercial	$17,465.28
Rate for Payer: Cigna Medicare	$14,698.25
Rate for Payer: Employer Direct Commercial	$14,698.25
Rate for Payer: Humana Medicare/TRICARE	$14,698.25
Rate for Payer: Molina Dual Medicare/Medicaid	$14,698.25
Rate for Payer: Molina Medicare	$14,698.25
Rate for Payer: Multiplan Auto	$25,764.00
Rate for Payer: Multiplan Commercial	$25,764.00
Rate for Payer: Multiplan Workers Comp	$25,764.00
Rate for Payer: Scott and White EPO/PPO	$11,865.00
Rate for Payer: Scott and White Medicare	$14,698.25
Rate for Payer: Superior Health Plan EPO	$14,698.25
Rate for Payer: Superior Health Plan Medicare	$14,698.25
Rate for Payer: Universal American Dual Medicare/Medicaid	$14,698.25
Rate for Payer: Universal American Medicare	$14,698.25
Rate for Payer: Wellcare Medicare	$14,698.25
Rate for Payer: Wellmed Medicare	$14,698.25

OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W CC

Facility

$35,319.10

Service Code	MSDRG 803
Min. Negotiated Rate	$14,810.06
Max. Negotiated Rate	$35,319.10
Rate for Payer: BCBS of TX Blue Advantage	$14,810.06
Rate for Payer: BCBS of TX Blue Essentials	$17,770.35
Rate for Payer: BCBS of TX PPO	$19,745.60

OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W MCC

Facility

$75,697.90

Service Code	MSDRG 802
Min. Negotiated Rate	$28,785.92
Max. Negotiated Rate	$75,697.90
Rate for Payer: BCBS of TX Blue Advantage	$28,785.92
Rate for Payer: BCBS of TX Blue Essentials	$34,539.76
Rate for Payer: BCBS of TX PPO	$38,379.00

OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W/O CC/MCC

Facility

$25,764.00

Service Code	MSDRG 804
Min. Negotiated Rate	$10,582.30
Max. Negotiated Rate	$25,764.00
Rate for Payer: BCBS of TX Blue Advantage	$10,582.30
Rate for Payer: BCBS of TX Blue Essentials	$12,697.53
Rate for Payer: BCBS of TX PPO	$14,108.91

Know your out-of-pocket cost for care.

All Charges