White Rock Medical Center

All Charges

Charge

Type

Setting

Price

MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY

Facility

$4,657.15

Service Code	APR-DRG 5013
Min. Negotiated Rate	$4,390.93
Max. Negotiated Rate	$4,657.15
Rate for Payer: Amerigroup CHIP/Medicaid	$4,390.93
Rate for Payer: Cigna Medicaid	$4,390.93
Rate for Payer: Molina CHIP/Medicaid	$4,390.93
Rate for Payer: Parkland Medicaid	$4,390.93
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,657.15

MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY

Facility

$3,139.34

Service Code	APR-DRG 5012
Min. Negotiated Rate	$2,959.88
Max. Negotiated Rate	$3,139.34
Rate for Payer: Amerigroup CHIP/Medicaid	$2,959.88
Rate for Payer: Cigna Medicaid	$2,959.88
Rate for Payer: Molina CHIP/Medicaid	$2,959.88
Rate for Payer: Parkland Medicaid	$2,959.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,139.34

MALFUNCTION, REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE

Facility

$18,075.65

Service Code	APR-DRG 2524
Min. Negotiated Rate	$17,042.36
Max. Negotiated Rate	$18,075.65
Rate for Payer: Amerigroup CHIP/Medicaid	$17,042.36
Rate for Payer: Cigna Medicaid	$17,042.36
Rate for Payer: Molina CHIP/Medicaid	$17,042.36
Rate for Payer: Parkland Medicaid	$17,042.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18,075.65

MALFUNCTION, REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE

Facility

$2,966.21

Service Code	APR-DRG 2521
Min. Negotiated Rate	$2,796.65
Max. Negotiated Rate	$2,966.21
Rate for Payer: Amerigroup CHIP/Medicaid	$2,796.65
Rate for Payer: Cigna Medicaid	$2,796.65
Rate for Payer: Molina CHIP/Medicaid	$2,796.65
Rate for Payer: Parkland Medicaid	$2,796.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,966.21

MALFUNCTION, REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE

Facility

$5,154.29

Service Code	APR-DRG 2523
Min. Negotiated Rate	$4,859.64
Max. Negotiated Rate	$5,154.29
Rate for Payer: Amerigroup CHIP/Medicaid	$4,859.64
Rate for Payer: Cigna Medicaid	$4,859.64
Rate for Payer: Molina CHIP/Medicaid	$4,859.64
Rate for Payer: Parkland Medicaid	$4,859.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,154.29

MALFUNCTION, REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE

Facility

$3,493.52

Service Code	APR-DRG 2522
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

MALFUNCTION, REACTION, COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE

Facility

$18,095.64

Service Code	APR-DRG 2064
Min. Negotiated Rate	$17,061.21
Max. Negotiated Rate	$18,095.64
Rate for Payer: Amerigroup CHIP/Medicaid	$17,061.21
Rate for Payer: Cigna Medicaid	$17,061.21
Rate for Payer: Molina CHIP/Medicaid	$17,061.21
Rate for Payer: Parkland Medicaid	$17,061.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18,095.64

MALFUNCTION, REACTION, COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE

Facility

$3,355.10

Service Code	APR-DRG 2061
Min. Negotiated Rate	$3,163.30
Max. Negotiated Rate	$3,355.10
Rate for Payer: Amerigroup CHIP/Medicaid	$3,163.30
Rate for Payer: Cigna Medicaid	$3,163.30
Rate for Payer: Molina CHIP/Medicaid	$3,163.30
Rate for Payer: Parkland Medicaid	$3,163.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,355.10

MALFUNCTION, REACTION, COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE

Facility

$3,928.80

Service Code	APR-DRG 2062
Min. Negotiated Rate	$3,704.21
Max. Negotiated Rate	$3,928.80
Rate for Payer: Amerigroup CHIP/Medicaid	$3,704.21
Rate for Payer: Cigna Medicaid	$3,704.21
Rate for Payer: Molina CHIP/Medicaid	$3,704.21
Rate for Payer: Parkland Medicaid	$3,704.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,928.80

MALFUNCTION, REACTION, COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE

Facility

$8,185.38

Service Code	APR-DRG 2063
Min. Negotiated Rate	$7,717.46
Max. Negotiated Rate	$8,185.38
Rate for Payer: Amerigroup CHIP/Medicaid	$7,717.46
Rate for Payer: Cigna Medicaid	$7,717.46
Rate for Payer: Molina CHIP/Medicaid	$7,717.46
Rate for Payer: Parkland Medicaid	$7,717.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,185.38

MALFUNCTION, REACTION, COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE

Facility

$4,998.13

Service Code	APR-DRG 4663
Min. Negotiated Rate	$4,712.41
Max. Negotiated Rate	$4,998.13
Rate for Payer: Amerigroup CHIP/Medicaid	$4,712.41
Rate for Payer: Cigna Medicaid	$4,712.41
Rate for Payer: Molina CHIP/Medicaid	$4,712.41
Rate for Payer: Parkland Medicaid	$4,712.41
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,998.13

MALFUNCTION, REACTION, COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE

Facility

$2,589.78

Service Code	APR-DRG 4661
Min. Negotiated Rate	$2,441.73
Max. Negotiated Rate	$2,589.78
Rate for Payer: Amerigroup CHIP/Medicaid	$2,441.73
Rate for Payer: Cigna Medicaid	$2,441.73
Rate for Payer: Molina CHIP/Medicaid	$2,441.73
Rate for Payer: Parkland Medicaid	$2,441.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,589.78

MALFUNCTION, REACTION, COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE

Facility

$7,965.85

Service Code	APR-DRG 4664
Min. Negotiated Rate	$7,510.49
Max. Negotiated Rate	$7,965.85
Rate for Payer: Amerigroup CHIP/Medicaid	$7,510.49
Rate for Payer: Cigna Medicaid	$7,510.49
Rate for Payer: Molina CHIP/Medicaid	$7,510.49
Rate for Payer: Parkland Medicaid	$7,510.49
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,965.85

MALFUNCTION, REACTION, COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE

Facility

$3,127.27

Service Code	APR-DRG 4662
Min. Negotiated Rate	$2,948.50
Max. Negotiated Rate	$3,127.27
Rate for Payer: Amerigroup CHIP/Medicaid	$2,948.50
Rate for Payer: Cigna Medicaid	$2,948.50
Rate for Payer: Molina CHIP/Medicaid	$2,948.50
Rate for Payer: Parkland Medicaid	$2,948.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,127.27

MALFUNCTION, REACTION, COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$4,127.20

Service Code	APR-DRG 3492
Min. Negotiated Rate	$3,891.27
Max. Negotiated Rate	$4,127.20
Rate for Payer: Amerigroup CHIP/Medicaid	$3,891.27
Rate for Payer: Cigna Medicaid	$3,891.27
Rate for Payer: Molina CHIP/Medicaid	$3,891.27
Rate for Payer: Parkland Medicaid	$3,891.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,127.20

MALFUNCTION, REACTION, COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$2,311.79

Service Code	APR-DRG 3491
Min. Negotiated Rate	$2,179.64
Max. Negotiated Rate	$2,311.79
Rate for Payer: Amerigroup CHIP/Medicaid	$2,179.64
Rate for Payer: Cigna Medicaid	$2,179.64
Rate for Payer: Molina CHIP/Medicaid	$2,179.64
Rate for Payer: Parkland Medicaid	$2,179.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,311.79

MALFUNCTION, REACTION, COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$11,319.82

Service Code	APR-DRG 3494
Min. Negotiated Rate	$10,672.72
Max. Negotiated Rate	$11,319.82
Rate for Payer: Amerigroup CHIP/Medicaid	$10,672.72
Rate for Payer: Cigna Medicaid	$10,672.72
Rate for Payer: Molina CHIP/Medicaid	$10,672.72
Rate for Payer: Parkland Medicaid	$10,672.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,319.82

MALFUNCTION, REACTION, COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$5,399.08

Service Code	APR-DRG 3493
Min. Negotiated Rate	$5,090.44
Max. Negotiated Rate	$5,399.08
Rate for Payer: Amerigroup CHIP/Medicaid	$5,090.44
Rate for Payer: Cigna Medicaid	$5,090.44
Rate for Payer: Molina CHIP/Medicaid	$5,090.44
Rate for Payer: Parkland Medicaid	$5,090.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,399.08

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W CC

Facility

$20,540.90

Service Code	MSDRG 755
Min. Negotiated Rate	$9,201.14
Max. Negotiated Rate	$20,540.90
Rate for Payer: BCBS of TX Blue Advantage	$9,201.14
Rate for Payer: BCBS of TX Blue Essentials	$11,040.30
Rate for Payer: BCBS of TX PPO	$12,267.47

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC

Facility

$20,540.90

Service Code	MSDRG 755
Min. Negotiated Rate	$9,201.14
Max. Negotiated Rate	$20,540.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,732.61
Rate for Payer: Amerigroup Medicare	$12,732.61
Rate for Payer: BCBS of TX Medicare	$12,732.61
Rate for Payer: Cigna Commercial	$14,010.86
Rate for Payer: Cigna Medicare	$12,732.61
Rate for Payer: Employer Direct Commercial	$12,732.61
Rate for Payer: Humana Medicare/TRICARE	$12,732.61
Rate for Payer: Molina Dual Medicare/Medicaid	$12,732.61
Rate for Payer: Molina Medicare	$12,732.61
Rate for Payer: Multiplan Auto	$20,540.90
Rate for Payer: Multiplan Commercial	$20,540.90
Rate for Payer: Multiplan Workers Comp	$20,540.90
Rate for Payer: Scott and White EPO/PPO	$9,459.62
Rate for Payer: Scott and White Medicare	$12,732.61
Rate for Payer: Superior Health Plan EPO	$12,732.61
Rate for Payer: Superior Health Plan Medicare	$12,732.61
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,732.61
Rate for Payer: Universal American Medicare	$12,732.61
Rate for Payer: Wellcare Medicare	$12,732.61
Rate for Payer: Wellmed Medicare	$12,732.61

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$33,001.10

Service Code	MSDRG 754
Min. Negotiated Rate	$15,197.88
Max. Negotiated Rate	$33,001.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$18,257.96
Rate for Payer: Amerigroup Medicare	$18,257.96
Rate for Payer: BCBS of TX Medicare	$18,257.96
Rate for Payer: Cigna Commercial	$23,721.10
Rate for Payer: Cigna Medicare	$18,257.96
Rate for Payer: Employer Direct Commercial	$18,257.96
Rate for Payer: Humana Medicare/TRICARE	$18,257.96
Rate for Payer: Molina Dual Medicare/Medicaid	$18,257.96
Rate for Payer: Molina Medicare	$18,257.96
Rate for Payer: Multiplan Auto	$33,001.10
Rate for Payer: Multiplan Commercial	$33,001.10
Rate for Payer: Multiplan Workers Comp	$33,001.10
Rate for Payer: Scott and White EPO/PPO	$15,197.88
Rate for Payer: Scott and White Medicare	$18,257.96
Rate for Payer: Superior Health Plan EPO	$18,257.96
Rate for Payer: Superior Health Plan Medicare	$18,257.96
Rate for Payer: Universal American Dual Medicare/Medicaid	$18,257.96
Rate for Payer: Universal American Medicare	$18,257.96
Rate for Payer: Wellcare Medicare	$18,257.96
Rate for Payer: Wellmed Medicare	$18,257.96

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$18,939.20

Service Code	MSDRG 756
Min. Negotiated Rate	$6,708.86
Max. Negotiated Rate	$18,939.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,799.60
Rate for Payer: Amerigroup Medicare	$11,799.60
Rate for Payer: BCBS of TX Medicare	$11,799.60
Rate for Payer: Cigna Commercial	$12,371.24
Rate for Payer: Cigna Medicare	$11,799.60
Rate for Payer: Employer Direct Commercial	$11,799.60
Rate for Payer: Humana Medicare/TRICARE	$11,799.60
Rate for Payer: Molina Dual Medicare/Medicaid	$11,799.60
Rate for Payer: Molina Medicare	$11,799.60
Rate for Payer: Multiplan Auto	$18,939.20
Rate for Payer: Multiplan Commercial	$18,939.20
Rate for Payer: Multiplan Workers Comp	$18,939.20
Rate for Payer: Scott and White EPO/PPO	$8,722.00
Rate for Payer: Scott and White Medicare	$11,799.60
Rate for Payer: Superior Health Plan EPO	$11,799.60
Rate for Payer: Superior Health Plan Medicare	$11,799.60
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,799.60
Rate for Payer: Universal American Medicare	$11,799.60
Rate for Payer: Wellcare Medicare	$11,799.60
Rate for Payer: Wellmed Medicare	$11,799.60

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W MCC

Facility

$33,001.10

Service Code	MSDRG 754
Min. Negotiated Rate	$15,197.88
Max. Negotiated Rate	$33,001.10
Rate for Payer: BCBS of TX Blue Advantage	$15,836.04
Rate for Payer: BCBS of TX Blue Essentials	$19,001.41
Rate for Payer: BCBS of TX PPO	$21,113.49

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC

Facility

$18,939.20

Service Code	MSDRG 756
Min. Negotiated Rate	$6,708.86
Max. Negotiated Rate	$18,939.20
Rate for Payer: BCBS of TX Blue Advantage	$6,708.86
Rate for Payer: BCBS of TX Blue Essentials	$8,049.85
Rate for Payer: BCBS of TX PPO	$8,944.63

MALIGNANCY, MALE REPRODUCTIVE SYSTEM

Facility

$5,215.77

Service Code	APR-DRG 5002
Min. Negotiated Rate	$4,917.61
Max. Negotiated Rate	$5,215.77
Rate for Payer: Amerigroup CHIP/Medicaid	$4,917.61
Rate for Payer: Cigna Medicaid	$4,917.61
Rate for Payer: Molina CHIP/Medicaid	$4,917.61
Rate for Payer: Parkland Medicaid	$4,917.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,215.77

Know your out-of-pocket cost for care.

All Charges