White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SPINAL DISORDERS & INJURIES W CC/MCC

Facility

$33,825.70

Service Code	MSDRG 052
Min. Negotiated Rate	$14,623.44
Max. Negotiated Rate	$33,825.70
Rate for Payer: BCBS of TX Blue Advantage	$14,623.44
Rate for Payer: BCBS of TX Blue Essentials	$17,546.43
Rate for Payer: BCBS of TX PPO	$19,496.79

SPINAL DISORDERS & INJURIES W/O CC/MCC

Facility

$19,433.20

Service Code	MSDRG 053
Min. Negotiated Rate	$7,861.26
Max. Negotiated Rate	$19,433.20
Rate for Payer: BCBS of TX Blue Advantage	$7,861.26
Rate for Payer: BCBS of TX Blue Essentials	$9,432.60
Rate for Payer: BCBS of TX PPO	$10,481.07

SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W CC

Facility

$114,699.20

Service Code	MSDRG 457
Min. Negotiated Rate	$48,463.80
Max. Negotiated Rate	$114,699.20
Rate for Payer: BCBS of TX Blue Advantage	$56,283.56
Rate for Payer: BCBS of TX Blue Essentials	$67,533.73
Rate for Payer: BCBS of TX PPO	$75,040.38

SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W MCC

Facility

$160,534.80

Service Code	MSDRG 456
Min. Negotiated Rate	$66,348.81
Max. Negotiated Rate	$160,534.80
Rate for Payer: BCBS of TX Blue Advantage	$78,476.72
Rate for Payer: BCBS of TX Blue Essentials	$94,162.94
Rate for Payer: BCBS of TX PPO	$104,629.54

SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W/O CC/MCC

Facility

$91,448.90

Service Code	MSDRG 458
Min. Negotiated Rate	$35,341.17
Max. Negotiated Rate	$91,448.90
Rate for Payer: BCBS of TX Blue Advantage	$44,042.32
Rate for Payer: BCBS of TX Blue Essentials	$52,845.66
Rate for Payer: BCBS of TX PPO	$58,719.68

SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$22,751.29

Service Code	APR-DRG 3214
Min. Negotiated Rate	$21,450.71
Max. Negotiated Rate	$22,751.29
Rate for Payer: Amerigroup CHIP/Medicaid	$21,450.71
Rate for Payer: Cigna Medicaid	$21,450.71
Rate for Payer: Molina CHIP/Medicaid	$21,450.71
Rate for Payer: Parkland Medicaid	$21,450.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$22,751.29

SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$9,059.33

Service Code	APR-DRG 3211
Min. Negotiated Rate	$8,541.45
Max. Negotiated Rate	$9,059.33
Rate for Payer: Amerigroup CHIP/Medicaid	$8,541.45
Rate for Payer: Cigna Medicaid	$8,541.45
Rate for Payer: Molina CHIP/Medicaid	$8,541.45
Rate for Payer: Parkland Medicaid	$8,541.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,059.33

SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$14,935.55

Service Code	APR-DRG 3213
Min. Negotiated Rate	$14,081.76
Max. Negotiated Rate	$14,935.55
Rate for Payer: Amerigroup CHIP/Medicaid	$14,081.76
Rate for Payer: Cigna Medicaid	$14,081.76
Rate for Payer: Molina CHIP/Medicaid	$14,081.76
Rate for Payer: Parkland Medicaid	$14,081.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14,935.55

SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$11,469.94

Service Code	APR-DRG 3212
Min. Negotiated Rate	$10,814.26
Max. Negotiated Rate	$11,469.94
Rate for Payer: Amerigroup CHIP/Medicaid	$10,814.26
Rate for Payer: Cigna Medicaid	$10,814.26
Rate for Payer: Molina CHIP/Medicaid	$10,814.26
Rate for Payer: Parkland Medicaid	$10,814.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,469.94

SPINAL FUSION EXCEPT CERVICAL WITH MCC

Facility

$126,027.00

Service Code	MSDRG 459
Min. Negotiated Rate	$54,909.28
Max. Negotiated Rate	$126,027.00
Rate for Payer: Multiplan Auto	$126,027.00
Rate for Payer: Multiplan Commercial	$126,027.00
Rate for Payer: Multiplan Workers Comp	$126,027.00
Rate for Payer: Scott and White EPO/PPO	$58,038.75

SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC

Facility

$71,554.00

Service Code	MSDRG 460
Min. Negotiated Rate	$32,952.50
Max. Negotiated Rate	$71,554.00
Rate for Payer: Multiplan Auto	$71,554.00
Rate for Payer: Multiplan Commercial	$71,554.00
Rate for Payer: Multiplan Workers Comp	$71,554.00
Rate for Payer: Scott and White EPO/PPO	$32,952.50

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC

Facility

$114,699.20

Service Code	MSDRG 457
Min. Negotiated Rate	$48,463.80
Max. Negotiated Rate	$114,699.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$48,463.80
Rate for Payer: Amerigroup Medicare	$48,463.80
Rate for Payer: BCBS of TX Medicare	$48,463.80
Rate for Payer: Cigna Commercial	$76,804.73
Rate for Payer: Cigna Medicare	$48,463.80
Rate for Payer: Employer Direct Commercial	$48,463.80
Rate for Payer: Humana Medicare/TRICARE	$48,463.80
Rate for Payer: Molina Dual Medicare/Medicaid	$48,463.80
Rate for Payer: Molina Medicare	$48,463.80
Rate for Payer: Multiplan Auto	$114,699.20
Rate for Payer: Multiplan Commercial	$114,699.20
Rate for Payer: Multiplan Workers Comp	$114,699.20
Rate for Payer: Scott and White EPO/PPO	$52,822.00
Rate for Payer: Scott and White Medicare	$48,463.80
Rate for Payer: Superior Health Plan EPO	$48,463.80
Rate for Payer: Superior Health Plan Medicare	$48,463.80
Rate for Payer: Universal American Dual Medicare/Medicaid	$48,463.80
Rate for Payer: Universal American Medicare	$48,463.80
Rate for Payer: Wellcare Medicare	$48,463.80
Rate for Payer: Wellmed Medicare	$48,463.80

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC

Facility

$160,534.80

Service Code	MSDRG 456
Min. Negotiated Rate	$66,348.81
Max. Negotiated Rate	$160,534.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$66,348.81
Rate for Payer: Amerigroup Medicare	$66,348.81
Rate for Payer: BCBS of TX Medicare	$66,348.81
Rate for Payer: Cigna Commercial	$108,235.79
Rate for Payer: Cigna Medicare	$66,348.81
Rate for Payer: Employer Direct Commercial	$66,348.81
Rate for Payer: Humana Medicare/TRICARE	$66,348.81
Rate for Payer: Molina Dual Medicare/Medicaid	$66,348.81
Rate for Payer: Molina Medicare	$66,348.81
Rate for Payer: Multiplan Auto	$160,534.80
Rate for Payer: Multiplan Commercial	$160,534.80
Rate for Payer: Multiplan Workers Comp	$160,534.80
Rate for Payer: Scott and White EPO/PPO	$73,930.50
Rate for Payer: Scott and White Medicare	$66,348.81
Rate for Payer: Superior Health Plan EPO	$66,348.81
Rate for Payer: Superior Health Plan Medicare	$66,348.81
Rate for Payer: Universal American Dual Medicare/Medicaid	$66,348.81
Rate for Payer: Universal American Medicare	$66,348.81
Rate for Payer: Wellcare Medicare	$66,348.81
Rate for Payer: Wellmed Medicare	$66,348.81

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC

Facility

$91,448.90

Service Code	MSDRG 458
Min. Negotiated Rate	$35,341.17
Max. Negotiated Rate	$91,448.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$35,341.17
Rate for Payer: Amerigroup Medicare	$35,341.17
Rate for Payer: BCBS of TX Medicare	$35,341.17
Rate for Payer: Cigna Commercial	$53,743.09
Rate for Payer: Cigna Medicare	$35,341.17
Rate for Payer: Employer Direct Commercial	$35,341.17
Rate for Payer: Humana Medicare/TRICARE	$35,341.17
Rate for Payer: Molina Dual Medicare/Medicaid	$35,341.17
Rate for Payer: Molina Medicare	$35,341.17
Rate for Payer: Multiplan Auto	$91,448.90
Rate for Payer: Multiplan Commercial	$91,448.90
Rate for Payer: Multiplan Workers Comp	$91,448.90
Rate for Payer: Scott and White EPO/PPO	$42,114.62
Rate for Payer: Scott and White Medicare	$35,341.17
Rate for Payer: Superior Health Plan EPO	$35,341.17
Rate for Payer: Superior Health Plan Medicare	$35,341.17
Rate for Payer: Universal American Dual Medicare/Medicaid	$35,341.17
Rate for Payer: Universal American Medicare	$35,341.17
Rate for Payer: Wellcare Medicare	$35,341.17
Rate for Payer: Wellmed Medicare	$35,341.17

SPINAL FUSION EXCEPT CERVICAL W MCC

Facility

$126,027.00

Service Code	MSDRG 459
Min. Negotiated Rate	$54,909.28
Max. Negotiated Rate	$126,027.00
Rate for Payer: BCBS of TX Blue Advantage	$54,909.28
Rate for Payer: BCBS of TX Blue Essentials	$65,884.75
Rate for Payer: BCBS of TX PPO	$73,208.12

SPINAL FUSION EXCEPT CERVICAL W/O MCC

Facility

$71,554.00

Service Code	MSDRG 460
Min. Negotiated Rate	$32,952.50
Max. Negotiated Rate	$71,554.00
Rate for Payer: BCBS of TX Blue Advantage	$34,722.50
Rate for Payer: BCBS of TX Blue Essentials	$41,662.96
Rate for Payer: BCBS of TX PPO	$46,293.97

Spinal Muscular Atrophy (SMA) SO

Facility

$702.75

Service Code	HCPCS 81329
Hospital Charge Code	9164982
Hospital Revenue Code	300
Min. Negotiated Rate	$53.43
Max. Negotiated Rate	$505.98
Rate for Payer: Amerigroup CHIP/Medicaid	$53.43
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$137.00
Rate for Payer: Amerigroup Medicare	$137.00
Rate for Payer: BCBS of TX Blue Advantage	$210.82
Rate for Payer: BCBS of TX Blue Essentials	$252.99
Rate for Payer: BCBS of TX Medicare	$137.00
Rate for Payer: BCBS of TX PPO	$281.10
Rate for Payer: Cash Price	$477.87
Rate for Payer: Cash Price	$477.87
Rate for Payer: Cigna Medicaid	$505.98
Rate for Payer: Cigna Medicare	$137.00
Rate for Payer: Employer Direct Commercial	$137.00
Rate for Payer: Humana Medicare/TRICARE	$137.00
Rate for Payer: Molina CHIP/Medicaid	$505.98
Rate for Payer: Molina Dual Medicare/Medicaid	$137.00
Rate for Payer: Molina Medicare	$137.00
Rate for Payer: Multiplan Auto	$456.79
Rate for Payer: Multiplan Commercial	$456.79
Rate for Payer: Multiplan Workers Comp	$456.79
Rate for Payer: Parkland Medicaid	$505.98
Rate for Payer: Scott and White EPO/PPO	$171.25
Rate for Payer: Scott and White Medicare	$137.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$505.98
Rate for Payer: Superior Health Plan EPO	$137.00
Rate for Payer: Superior Health Plan Medicare	$137.00
Rate for Payer: Universal American Dual Medicare/Medicaid	$137.00
Rate for Payer: Universal American Medicare	$137.00
Rate for Payer: Wellcare Medicare	$137.00
Rate for Payer: Wellmed Medicare	$137.00

Spinal Muscular Atrophy (SMA) SO

Facility

$702.75

Service Code	HCPCS 81329
Hospital Charge Code	9164982
Hospital Revenue Code	300
Rate for Payer: Cash Price	$477.87

Spinal, per interval cumulative, 15 Minutes

Facility

$2,105.00

Hospital Charge Code	9900042
Hospital Revenue Code	370
Rate for Payer: Cash Price	$1,431.40

Spinal, per interval cumulative, 15 Minutes

Facility

$2,105.00

Hospital Charge Code	9900042
Hospital Revenue Code	370
Min. Negotiated Rate	$189.45
Max. Negotiated Rate	$1,515.60
Rate for Payer: Amerigroup CHIP/Medicaid	$189.45
Rate for Payer: BCBS of TX Blue Advantage	$631.50
Rate for Payer: BCBS of TX Blue Essentials	$757.80
Rate for Payer: BCBS of TX PPO	$842.00
Rate for Payer: Cash Price	$1,431.40
Rate for Payer: Cigna Medicaid	$1,515.60
Rate for Payer: Molina CHIP/Medicaid	$1,515.60
Rate for Payer: Multiplan Auto	$1,368.25
Rate for Payer: Multiplan Commercial	$1,368.25
Rate for Payer: Multiplan Workers Comp	$1,368.25
Rate for Payer: Parkland Medicaid	$1,515.60
Rate for Payer: Scott and White EPO/PPO	$1,052.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,515.60
Rate for Payer: Superior Health Plan EPO	$286.28

Spinal, per unit cumulative, 15 Minutes

Facility

$625.00

Hospital Charge Code	9900043
Hospital Revenue Code	370
Rate for Payer: Cash Price	$425.00

Spinal, per unit cumulative, 15 Minutes

Facility

$625.00

Hospital Charge Code	9900043
Hospital Revenue Code	370
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$450.00
Rate for Payer: Amerigroup CHIP/Medicaid	$56.25
Rate for Payer: BCBS of TX Blue Advantage	$187.50
Rate for Payer: BCBS of TX Blue Essentials	$225.00
Rate for Payer: BCBS of TX PPO	$250.00
Rate for Payer: Cash Price	$425.00
Rate for Payer: Cigna Medicaid	$450.00
Rate for Payer: Molina CHIP/Medicaid	$450.00
Rate for Payer: Multiplan Auto	$406.25
Rate for Payer: Multiplan Commercial	$406.25
Rate for Payer: Multiplan Workers Comp	$406.25
Rate for Payer: Parkland Medicaid	$450.00
Rate for Payer: Scott and White EPO/PPO	$312.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$450.00
Rate for Payer: Superior Health Plan EPO	$85.00

SPINAL PROCEDURES

Facility

$22,434.07

Service Code	APR-DRG 0233
Min. Negotiated Rate	$21,151.63
Max. Negotiated Rate	$22,434.07
Rate for Payer: Amerigroup CHIP/Medicaid	$21,151.63
Rate for Payer: Cigna Medicaid	$21,151.63
Rate for Payer: Molina CHIP/Medicaid	$21,151.63
Rate for Payer: Parkland Medicaid	$21,151.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$22,434.07

SPINAL PROCEDURES

Facility

$11,012.79

Service Code	APR-DRG 0232
Min. Negotiated Rate	$10,383.24
Max. Negotiated Rate	$11,012.79
Rate for Payer: Amerigroup CHIP/Medicaid	$10,383.24
Rate for Payer: Cigna Medicaid	$10,383.24
Rate for Payer: Molina CHIP/Medicaid	$10,383.24
Rate for Payer: Parkland Medicaid	$10,383.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,012.79

SPINAL PROCEDURES

Facility

$46,081.56

Service Code	APR-DRG 0234
Min. Negotiated Rate	$43,447.31
Max. Negotiated Rate	$46,081.56
Rate for Payer: Amerigroup CHIP/Medicaid	$43,447.31
Rate for Payer: Cigna Medicaid	$43,447.31
Rate for Payer: Molina CHIP/Medicaid	$43,447.31
Rate for Payer: Parkland Medicaid	$43,447.31
Rate for Payer: Superior Health Plan CHIP/Medicaid	$46,081.56

Know your out-of-pocket cost for care.

All Charges