White Rock Medical Center

All Charges

Charge

Type

Setting

Price

OTHER AFTERCARE AND CONVALESCENCE

Facility

$11,036.17

Service Code	APR-DRG 8623
Min. Negotiated Rate	$10,405.29
Max. Negotiated Rate	$11,036.17
Rate for Payer: Amerigroup CHIP/Medicaid	$10,405.29
Rate for Payer: Cigna Medicaid	$10,405.29
Rate for Payer: Molina CHIP/Medicaid	$10,405.29
Rate for Payer: Parkland Medicaid	$10,405.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,036.17

OTHER AFTERCARE AND CONVALESCENCE

Facility

$5,465.47

Service Code	APR-DRG 8621
Min. Negotiated Rate	$5,153.04
Max. Negotiated Rate	$5,465.47
Rate for Payer: Amerigroup CHIP/Medicaid	$5,153.04
Rate for Payer: Cigna Medicaid	$5,153.04
Rate for Payer: Molina CHIP/Medicaid	$5,153.04
Rate for Payer: Parkland Medicaid	$5,153.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,465.47

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$8,206.88

Service Code	APR-DRG 2534
Min. Negotiated Rate	$7,737.73
Max. Negotiated Rate	$8,206.88
Rate for Payer: Amerigroup CHIP/Medicaid	$7,737.73
Rate for Payer: Cigna Medicaid	$7,737.73
Rate for Payer: Molina CHIP/Medicaid	$7,737.73
Rate for Payer: Parkland Medicaid	$7,737.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,206.88

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$4,843.86

Service Code	APR-DRG 2533
Min. Negotiated Rate	$4,566.96
Max. Negotiated Rate	$4,843.86
Rate for Payer: Amerigroup CHIP/Medicaid	$4,566.96
Rate for Payer: Cigna Medicaid	$4,566.96
Rate for Payer: Molina CHIP/Medicaid	$4,566.96
Rate for Payer: Parkland Medicaid	$4,566.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,843.86

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$3,534.26

Service Code	APR-DRG 2532
Min. Negotiated Rate	$3,332.22
Max. Negotiated Rate	$3,534.26
Rate for Payer: Amerigroup CHIP/Medicaid	$3,332.22
Rate for Payer: Cigna Medicaid	$3,332.22
Rate for Payer: Molina CHIP/Medicaid	$3,332.22
Rate for Payer: Parkland Medicaid	$3,332.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,534.26

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$2,602.60

Service Code	APR-DRG 2531
Min. Negotiated Rate	$2,453.83
Max. Negotiated Rate	$2,602.60
Rate for Payer: Amerigroup CHIP/Medicaid	$2,453.83
Rate for Payer: Cigna Medicaid	$2,453.83
Rate for Payer: Molina CHIP/Medicaid	$2,453.83
Rate for Payer: Parkland Medicaid	$2,453.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,602.60

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$3,159.34

Service Code	APR-DRG 6632
Min. Negotiated Rate	$2,978.73
Max. Negotiated Rate	$3,159.34
Rate for Payer: Amerigroup CHIP/Medicaid	$2,978.73
Rate for Payer: Cigna Medicaid	$2,978.73
Rate for Payer: Molina CHIP/Medicaid	$2,978.73
Rate for Payer: Parkland Medicaid	$2,978.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,159.34

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$2,272.56

Service Code	APR-DRG 6631
Min. Negotiated Rate	$2,142.65
Max. Negotiated Rate	$2,272.56
Rate for Payer: Amerigroup CHIP/Medicaid	$2,142.65
Rate for Payer: Cigna Medicaid	$2,142.65
Rate for Payer: Molina CHIP/Medicaid	$2,142.65
Rate for Payer: Parkland Medicaid	$2,142.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,272.56

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$5,186.73

Service Code	APR-DRG 6633
Min. Negotiated Rate	$4,890.23
Max. Negotiated Rate	$5,186.73
Rate for Payer: Amerigroup CHIP/Medicaid	$4,890.23
Rate for Payer: Cigna Medicaid	$4,890.23
Rate for Payer: Molina CHIP/Medicaid	$4,890.23
Rate for Payer: Parkland Medicaid	$4,890.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,186.73

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$8,791.14

Service Code	APR-DRG 6634
Min. Negotiated Rate	$8,288.60
Max. Negotiated Rate	$8,791.14
Rate for Payer: Amerigroup CHIP/Medicaid	$8,288.60
Rate for Payer: Cigna Medicaid	$8,288.60
Rate for Payer: Molina CHIP/Medicaid	$8,288.60
Rate for Payer: Parkland Medicaid	$8,288.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,791.14

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC

Facility

$20,029.80

Service Code	MSDRG 818
Min. Negotiated Rate	$9,224.25
Max. Negotiated Rate	$20,029.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13,255.88
Rate for Payer: Amerigroup Medicare	$13,255.88
Rate for Payer: BCBS of TX Medicare	$13,255.88
Rate for Payer: Cigna Commercial	$13,578.10
Rate for Payer: Cigna Medicare	$13,255.88
Rate for Payer: Employer Direct Commercial	$13,255.88
Rate for Payer: Humana Medicare/TRICARE	$13,255.88
Rate for Payer: Molina Dual Medicare/Medicaid	$13,255.88
Rate for Payer: Molina Medicare	$13,255.88
Rate for Payer: Multiplan Auto	$20,029.80
Rate for Payer: Multiplan Commercial	$20,029.80
Rate for Payer: Multiplan Workers Comp	$20,029.80
Rate for Payer: Scott and White EPO/PPO	$9,224.25
Rate for Payer: Scott and White Medicare	$13,255.88
Rate for Payer: Superior Health Plan EPO	$13,255.88
Rate for Payer: Superior Health Plan Medicare	$13,255.88
Rate for Payer: Universal American Dual Medicare/Medicaid	$13,255.88
Rate for Payer: Universal American Medicare	$13,255.88
Rate for Payer: Wellcare Medicare	$13,255.88
Rate for Payer: Wellmed Medicare	$13,255.88

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC

Facility

$32,072.00

Service Code	MSDRG 817
Min. Negotiated Rate	$14,770.00
Max. Negotiated Rate	$32,072.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$21,481.98
Rate for Payer: Amerigroup Medicare	$21,481.98
Rate for Payer: BCBS of TX Medicare	$21,481.98
Rate for Payer: Cigna Commercial	$21,741.44
Rate for Payer: Cigna Medicare	$21,481.98
Rate for Payer: Employer Direct Commercial	$21,481.98
Rate for Payer: Humana Medicare/TRICARE	$21,481.98
Rate for Payer: Molina Dual Medicare/Medicaid	$21,481.98
Rate for Payer: Molina Medicare	$21,481.98
Rate for Payer: Multiplan Auto	$32,072.00
Rate for Payer: Multiplan Commercial	$32,072.00
Rate for Payer: Multiplan Workers Comp	$32,072.00
Rate for Payer: Scott and White EPO/PPO	$14,770.00
Rate for Payer: Scott and White Medicare	$21,481.98
Rate for Payer: Superior Health Plan EPO	$21,481.98
Rate for Payer: Superior Health Plan Medicare	$21,481.98
Rate for Payer: Universal American Dual Medicare/Medicaid	$21,481.98
Rate for Payer: Universal American Medicare	$21,481.98
Rate for Payer: Wellcare Medicare	$21,481.98
Rate for Payer: Wellmed Medicare	$21,481.98

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$16,338.10

Service Code	MSDRG 819
Min. Negotiated Rate	$7,215.40
Max. Negotiated Rate	$16,338.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,062.31
Rate for Payer: Amerigroup Medicare	$11,062.31
Rate for Payer: BCBS of TX Medicare	$11,062.31
Rate for Payer: Cigna Commercial	$11,075.51
Rate for Payer: Cigna Medicare	$11,062.31
Rate for Payer: Employer Direct Commercial	$11,062.31
Rate for Payer: Humana Medicare/TRICARE	$11,062.31
Rate for Payer: Molina Dual Medicare/Medicaid	$11,062.31
Rate for Payer: Molina Medicare	$11,062.31
Rate for Payer: Multiplan Auto	$16,338.10
Rate for Payer: Multiplan Commercial	$16,338.10
Rate for Payer: Multiplan Workers Comp	$16,338.10
Rate for Payer: Scott and White EPO/PPO	$7,524.12
Rate for Payer: Scott and White Medicare	$11,062.31
Rate for Payer: Superior Health Plan EPO	$11,062.31
Rate for Payer: Superior Health Plan Medicare	$11,062.31
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,062.31
Rate for Payer: Universal American Medicare	$11,062.31
Rate for Payer: Wellcare Medicare	$11,062.31
Rate for Payer: Wellmed Medicare	$11,062.31

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC

Facility

$13,710.40

Service Code	MSDRG 832
Min. Negotiated Rate	$6,181.68
Max. Negotiated Rate	$13,710.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,048.71
Rate for Payer: Amerigroup Medicare	$10,048.71
Rate for Payer: BCBS of TX Medicare	$10,048.71
Rate for Payer: Cigna Commercial	$9,294.21
Rate for Payer: Cigna Medicare	$10,048.71
Rate for Payer: Employer Direct Commercial	$10,048.71
Rate for Payer: Humana Medicare/TRICARE	$10,048.71
Rate for Payer: Molina Dual Medicare/Medicaid	$10,048.71
Rate for Payer: Molina Medicare	$10,048.71
Rate for Payer: Multiplan Auto	$13,710.40
Rate for Payer: Multiplan Commercial	$13,710.40
Rate for Payer: Multiplan Workers Comp	$13,710.40
Rate for Payer: Scott and White EPO/PPO	$6,314.00
Rate for Payer: Scott and White Medicare	$10,048.71
Rate for Payer: Superior Health Plan EPO	$10,048.71
Rate for Payer: Superior Health Plan Medicare	$10,048.71
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,048.71
Rate for Payer: Universal American Medicare	$10,048.71
Rate for Payer: Wellcare Medicare	$10,048.71
Rate for Payer: Wellmed Medicare	$10,048.71

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC

Facility

$22,847.50

Service Code	MSDRG 831
Min. Negotiated Rate	$8,841.66
Max. Negotiated Rate	$22,847.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13,573.23
Rate for Payer: Amerigroup Medicare	$13,573.23
Rate for Payer: BCBS of TX Medicare	$13,573.23
Rate for Payer: Cigna Commercial	$15,488.20
Rate for Payer: Cigna Medicare	$13,573.23
Rate for Payer: Employer Direct Commercial	$13,573.23
Rate for Payer: Humana Medicare/TRICARE	$13,573.23
Rate for Payer: Molina Dual Medicare/Medicaid	$13,573.23
Rate for Payer: Molina Medicare	$13,573.23
Rate for Payer: Multiplan Auto	$22,847.50
Rate for Payer: Multiplan Commercial	$22,847.50
Rate for Payer: Multiplan Workers Comp	$22,847.50
Rate for Payer: Scott and White EPO/PPO	$10,521.88
Rate for Payer: Scott and White Medicare	$13,573.23
Rate for Payer: Superior Health Plan EPO	$13,573.23
Rate for Payer: Superior Health Plan Medicare	$13,573.23
Rate for Payer: Universal American Dual Medicare/Medicaid	$13,573.23
Rate for Payer: Universal American Medicare	$13,573.23
Rate for Payer: Wellcare Medicare	$13,573.23
Rate for Payer: Wellmed Medicare	$13,573.23

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$9,935.10

Service Code	MSDRG 833
Min. Negotiated Rate	$4,130.58
Max. Negotiated Rate	$9,935.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8,592.43
Rate for Payer: Amerigroup Medicare	$8,592.43
Rate for Payer: BCBS of TX Medicare	$8,592.43
Rate for Payer: Cigna Commercial	$6,734.95
Rate for Payer: Cigna Medicare	$8,592.43
Rate for Payer: Employer Direct Commercial	$8,592.43
Rate for Payer: Humana Medicare/TRICARE	$8,592.43
Rate for Payer: Molina Dual Medicare/Medicaid	$8,592.43
Rate for Payer: Molina Medicare	$8,592.43
Rate for Payer: Multiplan Auto	$9,935.10
Rate for Payer: Multiplan Commercial	$9,935.10
Rate for Payer: Multiplan Workers Comp	$9,935.10
Rate for Payer: Scott and White EPO/PPO	$4,575.38
Rate for Payer: Scott and White Medicare	$8,592.43
Rate for Payer: Superior Health Plan EPO	$8,592.43
Rate for Payer: Superior Health Plan Medicare	$8,592.43
Rate for Payer: Universal American Dual Medicare/Medicaid	$8,592.43
Rate for Payer: Universal American Medicare	$8,592.43
Rate for Payer: Wellcare Medicare	$8,592.43
Rate for Payer: Wellmed Medicare	$8,592.43

OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CC

Facility

$13,710.40

Service Code	MSDRG 832
Min. Negotiated Rate	$6,181.68
Max. Negotiated Rate	$13,710.40
Rate for Payer: BCBS of TX Blue Advantage	$6,181.68
Rate for Payer: BCBS of TX Blue Essentials	$7,417.30
Rate for Payer: BCBS of TX PPO	$8,241.76

OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W MCC

Facility

$22,847.50

Service Code	MSDRG 831
Min. Negotiated Rate	$8,841.66
Max. Negotiated Rate	$22,847.50
Rate for Payer: BCBS of TX Blue Advantage	$8,841.66
Rate for Payer: BCBS of TX Blue Essentials	$10,608.96
Rate for Payer: BCBS of TX PPO	$11,788.19

OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC

Facility

$9,935.10

Service Code	MSDRG 833
Min. Negotiated Rate	$4,130.58
Max. Negotiated Rate	$9,935.10
Rate for Payer: BCBS of TX Blue Advantage	$4,130.58
Rate for Payer: BCBS of TX Blue Essentials	$4,956.22
Rate for Payer: BCBS of TX PPO	$5,507.12

OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W CC

Facility

$20,029.80

Service Code	MSDRG 818
Min. Negotiated Rate	$9,224.25
Max. Negotiated Rate	$20,029.80
Rate for Payer: BCBS of TX Blue Advantage	$11,683.10
Rate for Payer: BCBS of TX Blue Essentials	$14,018.36
Rate for Payer: BCBS of TX PPO	$15,576.56

OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W MCC

Facility

$32,072.00

Service Code	MSDRG 817
Min. Negotiated Rate	$14,770.00
Max. Negotiated Rate	$32,072.00
Rate for Payer: BCBS of TX Blue Advantage	$21,772.62
Rate for Payer: BCBS of TX Blue Essentials	$26,124.61
Rate for Payer: BCBS of TX PPO	$29,028.47

OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W/O CC/MCC

Facility

$16,338.10

Service Code	MSDRG 819
Min. Negotiated Rate	$7,215.40
Max. Negotiated Rate	$16,338.10
Rate for Payer: BCBS of TX Blue Advantage	$7,215.40
Rate for Payer: BCBS of TX Blue Essentials	$8,657.64
Rate for Payer: BCBS of TX PPO	$9,619.97

OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility

$6,179.11

Service Code	APR-DRG 3473
Min. Negotiated Rate	$5,825.88
Max. Negotiated Rate	$6,179.11
Rate for Payer: Amerigroup CHIP/Medicaid	$5,825.88
Rate for Payer: Cigna Medicaid	$5,825.88
Rate for Payer: Molina CHIP/Medicaid	$5,825.88
Rate for Payer: Parkland Medicaid	$5,825.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,179.11

OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility

$4,853.67

Service Code	APR-DRG 3472
Min. Negotiated Rate	$4,576.21
Max. Negotiated Rate	$4,853.67
Rate for Payer: Amerigroup CHIP/Medicaid	$4,576.21
Rate for Payer: Cigna Medicaid	$4,576.21
Rate for Payer: Molina CHIP/Medicaid	$4,576.21
Rate for Payer: Parkland Medicaid	$4,576.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,853.67

OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility

$14,399.57

Service Code	APR-DRG 3474
Min. Negotiated Rate	$13,576.42
Max. Negotiated Rate	$14,399.57
Rate for Payer: Amerigroup CHIP/Medicaid	$13,576.42
Rate for Payer: Cigna Medicaid	$13,576.42
Rate for Payer: Molina CHIP/Medicaid	$13,576.42
Rate for Payer: Parkland Medicaid	$13,576.42
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14,399.57

Know your out-of-pocket cost for care.

All Charges