White Rock Medical Center

All Charges

Charge

Type

Setting

Price

ACUTE AND SUBACUTE ENDOCARDITIS WITH CC

Facility

$30,534.90

Service Code	MSDRG 289
Min. Negotiated Rate	$14,062.12
Max. Negotiated Rate	$30,534.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$17,269.99
Rate for Payer: Amerigroup Medicare	$17,269.99
Rate for Payer: BCBS of TX Medicare	$17,269.99
Rate for Payer: Cigna Commercial	$21,984.87
Rate for Payer: Cigna Medicare	$17,269.99
Rate for Payer: Employer Direct Commercial	$17,269.99
Rate for Payer: Humana Medicare/TRICARE	$17,269.99
Rate for Payer: Molina Dual Medicare/Medicaid	$17,269.99
Rate for Payer: Molina Medicare	$17,269.99
Rate for Payer: Multiplan Auto	$30,534.90
Rate for Payer: Multiplan Commercial	$30,534.90
Rate for Payer: Multiplan Workers Comp	$30,534.90
Rate for Payer: Scott and White EPO/PPO	$14,062.12
Rate for Payer: Scott and White Medicare	$17,269.99
Rate for Payer: Superior Health Plan EPO	$17,269.99
Rate for Payer: Superior Health Plan Medicare	$17,269.99
Rate for Payer: Universal American Dual Medicare/Medicaid	$17,269.99
Rate for Payer: Universal American Medicare	$17,269.99
Rate for Payer: Wellcare Medicare	$17,269.99
Rate for Payer: Wellmed Medicare	$17,269.99

ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC

Facility

$51,233.50

Service Code	MSDRG 288
Min. Negotiated Rate	$23,169.26
Max. Negotiated Rate	$51,233.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$24,593.89
Rate for Payer: Amerigroup Medicare	$24,593.89
Rate for Payer: BCBS of TX Medicare	$24,593.89
Rate for Payer: Cigna Commercial	$34,855.86
Rate for Payer: Cigna Medicare	$24,593.89
Rate for Payer: Employer Direct Commercial	$24,593.89
Rate for Payer: Humana Medicare/TRICARE	$24,593.89
Rate for Payer: Molina Dual Medicare/Medicaid	$24,593.89
Rate for Payer: Molina Medicare	$24,593.89
Rate for Payer: Multiplan Auto	$51,233.50
Rate for Payer: Multiplan Commercial	$51,233.50
Rate for Payer: Multiplan Workers Comp	$51,233.50
Rate for Payer: Scott and White EPO/PPO	$23,594.38
Rate for Payer: Scott and White Medicare	$24,593.89
Rate for Payer: Superior Health Plan EPO	$24,593.89
Rate for Payer: Superior Health Plan Medicare	$24,593.89
Rate for Payer: Universal American Dual Medicare/Medicaid	$24,593.89
Rate for Payer: Universal American Medicare	$24,593.89
Rate for Payer: Wellcare Medicare	$24,593.89
Rate for Payer: Wellmed Medicare	$24,593.89

ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC

Facility

$22,908.30

Service Code	MSDRG 290
Min. Negotiated Rate	$8,698.04
Max. Negotiated Rate	$22,908.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,573.88
Rate for Payer: Amerigroup Medicare	$11,573.88
Rate for Payer: BCBS of TX Medicare	$11,573.88
Rate for Payer: Cigna Commercial	$11,974.54
Rate for Payer: Cigna Medicare	$11,573.88
Rate for Payer: Employer Direct Commercial	$11,573.88
Rate for Payer: Humana Medicare/TRICARE	$11,573.88
Rate for Payer: Molina Dual Medicare/Medicaid	$11,573.88
Rate for Payer: Molina Medicare	$11,573.88
Rate for Payer: Multiplan Auto	$22,908.30
Rate for Payer: Multiplan Commercial	$22,908.30
Rate for Payer: Multiplan Workers Comp	$22,908.30
Rate for Payer: Scott and White EPO/PPO	$10,549.88
Rate for Payer: Scott and White Medicare	$11,573.88
Rate for Payer: Superior Health Plan EPO	$11,573.88
Rate for Payer: Superior Health Plan Medicare	$11,573.88
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,573.88
Rate for Payer: Universal American Medicare	$11,573.88
Rate for Payer: Wellcare Medicare	$11,573.88
Rate for Payer: Wellmed Medicare	$11,573.88

ACUTE ANXIETY AND DELIRIUM STATES

Facility

$4,113.25

Service Code	APR-DRG 7563
Min. Negotiated Rate	$3,878.11
Max. Negotiated Rate	$4,113.25
Rate for Payer: Amerigroup CHIP/Medicaid	$3,878.11
Rate for Payer: Cigna Medicaid	$3,878.11
Rate for Payer: Molina CHIP/Medicaid	$3,878.11
Rate for Payer: Parkland Medicaid	$3,878.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,113.25

ACUTE ANXIETY AND DELIRIUM STATES

Facility

$2,732.36

Service Code	APR-DRG 7562
Min. Negotiated Rate	$2,576.16
Max. Negotiated Rate	$2,732.36
Rate for Payer: Amerigroup CHIP/Medicaid	$2,576.16
Rate for Payer: Cigna Medicaid	$2,576.16
Rate for Payer: Molina CHIP/Medicaid	$2,576.16
Rate for Payer: Parkland Medicaid	$2,576.16
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,732.36

ACUTE ANXIETY AND DELIRIUM STATES

Facility

$2,146.96

Service Code	APR-DRG 7561
Min. Negotiated Rate	$2,024.23
Max. Negotiated Rate	$2,146.96
Rate for Payer: Amerigroup CHIP/Medicaid	$2,024.23
Rate for Payer: Cigna Medicaid	$2,024.23
Rate for Payer: Molina CHIP/Medicaid	$2,024.23
Rate for Payer: Parkland Medicaid	$2,024.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,146.96

ACUTE ANXIETY AND DELIRIUM STATES

Facility

$4,823.12

Service Code	APR-DRG 7564
Min. Negotiated Rate	$4,547.40
Max. Negotiated Rate	$4,823.12
Rate for Payer: Amerigroup CHIP/Medicaid	$4,547.40
Rate for Payer: Cigna Medicaid	$4,547.40
Rate for Payer: Molina CHIP/Medicaid	$4,547.40
Rate for Payer: Parkland Medicaid	$4,547.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,823.12

ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$7,062.11

Service Code	APR-DRG 1454
Min. Negotiated Rate	$6,658.40
Max. Negotiated Rate	$7,062.11
Rate for Payer: Amerigroup CHIP/Medicaid	$6,658.40
Rate for Payer: Cigna Medicaid	$6,658.40
Rate for Payer: Molina CHIP/Medicaid	$6,658.40
Rate for Payer: Parkland Medicaid	$6,658.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,062.11

ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$4,707.32

Service Code	APR-DRG 1453
Min. Negotiated Rate	$4,438.22
Max. Negotiated Rate	$4,707.32
Rate for Payer: Amerigroup CHIP/Medicaid	$4,438.22
Rate for Payer: Cigna Medicaid	$4,438.22
Rate for Payer: Molina CHIP/Medicaid	$4,438.22
Rate for Payer: Parkland Medicaid	$4,438.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,707.32

ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$1,519.32

Service Code	APR-DRG 1451
Min. Negotiated Rate	$1,432.47
Max. Negotiated Rate	$1,519.32
Rate for Payer: Amerigroup CHIP/Medicaid	$1,432.47
Rate for Payer: Cigna Medicaid	$1,432.47
Rate for Payer: Molina CHIP/Medicaid	$1,432.47
Rate for Payer: Parkland Medicaid	$1,432.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,519.32

ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$2,816.09

Service Code	APR-DRG 1452
Min. Negotiated Rate	$2,655.11
Max. Negotiated Rate	$2,816.09
Rate for Payer: Amerigroup CHIP/Medicaid	$2,655.11
Rate for Payer: Cigna Medicaid	$2,655.11
Rate for Payer: Molina CHIP/Medicaid	$2,655.11
Rate for Payer: Parkland Medicaid	$2,655.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,816.09

ACUTE KIDNEY INJURY

Facility

$2,487.18

Service Code	APR-DRG 4691
Min. Negotiated Rate	$2,345.00
Max. Negotiated Rate	$2,487.18
Rate for Payer: Amerigroup CHIP/Medicaid	$2,345.00
Rate for Payer: Cigna Medicaid	$2,345.00
Rate for Payer: Molina CHIP/Medicaid	$2,345.00
Rate for Payer: Parkland Medicaid	$2,345.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,487.18

ACUTE KIDNEY INJURY

Facility

$3,144.62

Service Code	APR-DRG 4692
Min. Negotiated Rate	$2,964.86
Max. Negotiated Rate	$3,144.62
Rate for Payer: Amerigroup CHIP/Medicaid	$2,964.86
Rate for Payer: Cigna Medicaid	$2,964.86
Rate for Payer: Molina CHIP/Medicaid	$2,964.86
Rate for Payer: Parkland Medicaid	$2,964.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,144.62

ACUTE KIDNEY INJURY

Facility

$5,453.02

Service Code	APR-DRG 4693
Min. Negotiated Rate	$5,141.30
Max. Negotiated Rate	$5,453.02
Rate for Payer: Amerigroup CHIP/Medicaid	$5,141.30
Rate for Payer: Cigna Medicaid	$5,141.30
Rate for Payer: Molina CHIP/Medicaid	$5,141.30
Rate for Payer: Parkland Medicaid	$5,141.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,453.02

ACUTE KIDNEY INJURY

Facility

$13,366.82

Service Code	APR-DRG 4694
Min. Negotiated Rate	$12,602.71
Max. Negotiated Rate	$13,366.82
Rate for Payer: Amerigroup CHIP/Medicaid	$12,602.71
Rate for Payer: Cigna Medicaid	$12,602.71
Rate for Payer: Molina CHIP/Medicaid	$12,602.71
Rate for Payer: Parkland Medicaid	$12,602.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13,366.82

ACUTE LEUKEMIA

Facility

$53,694.36

Service Code	APR-DRG 6904
Min. Negotiated Rate	$50,624.93
Max. Negotiated Rate	$53,694.36
Rate for Payer: Amerigroup CHIP/Medicaid	$50,624.93
Rate for Payer: Cigna Medicaid	$50,624.93
Rate for Payer: Molina CHIP/Medicaid	$50,624.93
Rate for Payer: Parkland Medicaid	$50,624.93
Rate for Payer: Superior Health Plan CHIP/Medicaid	$53,694.36

ACUTE LEUKEMIA

Facility

$23,633.15

Service Code	APR-DRG 6903
Min. Negotiated Rate	$22,282.17
Max. Negotiated Rate	$23,633.15
Rate for Payer: Amerigroup CHIP/Medicaid	$22,282.17
Rate for Payer: Cigna Medicaid	$22,282.17
Rate for Payer: Molina CHIP/Medicaid	$22,282.17
Rate for Payer: Parkland Medicaid	$22,282.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$23,633.15

ACUTE LEUKEMIA

Facility

$16,754.36

Service Code	APR-DRG 6901
Min. Negotiated Rate	$15,796.60
Max. Negotiated Rate	$16,754.36
Rate for Payer: Amerigroup CHIP/Medicaid	$15,796.60
Rate for Payer: Cigna Medicaid	$15,796.60
Rate for Payer: Molina CHIP/Medicaid	$15,796.60
Rate for Payer: Parkland Medicaid	$15,796.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,754.36

ACUTE LEUKEMIA

Facility

$20,193.94

Service Code	APR-DRG 6902
Min. Negotiated Rate	$19,039.56
Max. Negotiated Rate	$20,193.94
Rate for Payer: Amerigroup CHIP/Medicaid	$19,039.56
Rate for Payer: Cigna Medicaid	$19,039.56
Rate for Payer: Molina CHIP/Medicaid	$19,039.56
Rate for Payer: Parkland Medicaid	$19,039.56
Rate for Payer: Superior Health Plan CHIP/Medicaid	$20,193.94

ACUTE LEUKEMIA WITH CC

Facility

$39,844.90

Service Code	MSDRG 835
Min. Negotiated Rate	$18,349.62
Max. Negotiated Rate	$39,844.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$20,046.97
Rate for Payer: Amerigroup Medicare	$20,046.97
Rate for Payer: BCBS of TX Medicare	$20,046.97
Rate for Payer: Cigna Commercial	$26,865.10
Rate for Payer: Cigna Medicare	$20,046.97
Rate for Payer: Employer Direct Commercial	$20,046.97
Rate for Payer: Humana Medicare/TRICARE	$20,046.97
Rate for Payer: Molina Dual Medicare/Medicaid	$20,046.97
Rate for Payer: Molina Medicare	$20,046.97
Rate for Payer: Scott and White Medicare	$20,046.97
Rate for Payer: Superior Health Plan EPO	$20,046.97
Rate for Payer: Superior Health Plan Medicare	$20,046.97
Rate for Payer: Universal American Dual Medicare/Medicaid	$20,046.97
Rate for Payer: Universal American Medicare	$20,046.97
Rate for Payer: Wellcare Medicare	$20,046.97
Rate for Payer: Wellmed Medicare	$20,046.97

ACUTE LEUKEMIA WITH MCC

Facility

$105,070.00

Service Code	MSDRG 834
Min. Negotiated Rate	$44,995.69
Max. Negotiated Rate	$105,070.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$44,995.69
Rate for Payer: Amerigroup Medicare	$44,995.69
Rate for Payer: BCBS of TX Medicare	$44,995.69
Rate for Payer: Cigna Commercial	$70,709.91
Rate for Payer: Cigna Medicare	$44,995.69
Rate for Payer: Employer Direct Commercial	$44,995.69
Rate for Payer: Humana Medicare/TRICARE	$44,995.69
Rate for Payer: Molina Dual Medicare/Medicaid	$44,995.69
Rate for Payer: Molina Medicare	$44,995.69
Rate for Payer: Scott and White Medicare	$44,995.69
Rate for Payer: Superior Health Plan EPO	$44,995.69
Rate for Payer: Superior Health Plan Medicare	$44,995.69
Rate for Payer: Universal American Dual Medicare/Medicaid	$44,995.69
Rate for Payer: Universal American Medicare	$44,995.69
Rate for Payer: Wellcare Medicare	$44,995.69
Rate for Payer: Wellmed Medicare	$44,995.69

ACUTE LEUKEMIA WITH OTHER PROCEDURES

Facility

$111,534.36

Service Code	MSDRG 850
Min. Negotiated Rate	$68,225.78
Max. Negotiated Rate	$111,534.36
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$68,225.78
Rate for Payer: Amerigroup Medicare	$68,225.78
Rate for Payer: BCBS of TX Medicare	$68,225.78
Rate for Payer: Cigna Commercial	$111,534.36
Rate for Payer: Cigna Medicare	$68,225.78
Rate for Payer: Employer Direct Commercial	$68,225.78
Rate for Payer: Humana Medicare/TRICARE	$68,225.78
Rate for Payer: Molina Dual Medicare/Medicaid	$68,225.78
Rate for Payer: Molina Medicare	$68,225.78
Rate for Payer: Scott and White Medicare	$68,225.78
Rate for Payer: Superior Health Plan EPO	$68,225.78
Rate for Payer: Superior Health Plan Medicare	$68,225.78
Rate for Payer: Universal American Dual Medicare/Medicaid	$68,225.78
Rate for Payer: Universal American Medicare	$68,225.78
Rate for Payer: Wellcare Medicare	$68,225.78
Rate for Payer: Wellmed Medicare	$68,225.78

ACUTE LEUKEMIA WITHOUT CC/MCC

Facility

$29,807.20

Service Code	MSDRG 836
Min. Negotiated Rate	$10,428.36
Max. Negotiated Rate	$29,807.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13,697.82
Rate for Payer: Amerigroup Medicare	$13,697.82
Rate for Payer: BCBS of TX Medicare	$13,697.82
Rate for Payer: Cigna Commercial	$15,707.16
Rate for Payer: Cigna Medicare	$13,697.82
Rate for Payer: Employer Direct Commercial	$13,697.82
Rate for Payer: Humana Medicare/TRICARE	$13,697.82
Rate for Payer: Molina Dual Medicare/Medicaid	$13,697.82
Rate for Payer: Molina Medicare	$13,697.82
Rate for Payer: Scott and White Medicare	$13,697.82
Rate for Payer: Superior Health Plan EPO	$13,697.82
Rate for Payer: Superior Health Plan Medicare	$13,697.82
Rate for Payer: Universal American Dual Medicare/Medicaid	$13,697.82
Rate for Payer: Universal American Medicare	$13,697.82
Rate for Payer: Wellcare Medicare	$13,697.82
Rate for Payer: Wellmed Medicare	$13,697.82

ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC

Facility

$39,844.90

Service Code	MSDRG 835
Min. Negotiated Rate	$18,349.62
Max. Negotiated Rate	$39,844.90
Rate for Payer: Multiplan Auto	$39,844.90
Rate for Payer: Multiplan Commercial	$39,844.90
Rate for Payer: Multiplan Workers Comp	$39,844.90
Rate for Payer: Scott and White EPO/PPO	$18,349.62

ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC

Facility

$105,070.00

Service Code	MSDRG 834
Min. Negotiated Rate	$44,995.69
Max. Negotiated Rate	$105,070.00
Rate for Payer: Multiplan Auto	$105,070.00
Rate for Payer: Multiplan Commercial	$105,070.00
Rate for Payer: Multiplan Workers Comp	$105,070.00
Rate for Payer: Scott and White EPO/PPO	$48,387.50

Know your out-of-pocket cost for care.

All Charges