White Rock Medical Center

All Charges

Charge

Type

Setting

Price

OTHER EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility

$7,555.10

Service Code	APR-DRG 0982
Min. Negotiated Rate	$7,123.21
Max. Negotiated Rate	$7,555.10
Rate for Payer: Amerigroup CHIP/Medicaid	$7,123.21
Rate for Payer: Cigna Medicaid	$7,123.21
Rate for Payer: Molina CHIP/Medicaid	$7,123.21
Rate for Payer: Parkland Medicaid	$7,123.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,555.10

OTHER EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility

$24,281.54

Service Code	APR-DRG 0984
Min. Negotiated Rate	$22,893.49
Max. Negotiated Rate	$24,281.54
Rate for Payer: Amerigroup CHIP/Medicaid	$22,893.49
Rate for Payer: Cigna Medicaid	$22,893.49
Rate for Payer: Molina CHIP/Medicaid	$22,893.49
Rate for Payer: Parkland Medicaid	$22,893.49
Rate for Payer: Superior Health Plan CHIP/Medicaid	$24,281.54

OTHER EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility

$5,353.07

Service Code	APR-DRG 0981
Min. Negotiated Rate	$5,047.06
Max. Negotiated Rate	$5,353.07
Rate for Payer: Amerigroup CHIP/Medicaid	$5,047.06
Rate for Payer: Cigna Medicaid	$5,047.06
Rate for Payer: Molina CHIP/Medicaid	$5,047.06
Rate for Payer: Parkland Medicaid	$5,047.06
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,353.07

OTHER EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility

$13,060.55

Service Code	APR-DRG 0983
Min. Negotiated Rate	$12,313.94
Max. Negotiated Rate	$13,060.55
Rate for Payer: Amerigroup CHIP/Medicaid	$12,313.94
Rate for Payer: Cigna Medicaid	$12,313.94
Rate for Payer: Molina CHIP/Medicaid	$12,313.94
Rate for Payer: Parkland Medicaid	$12,313.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13,060.55

OTHER EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL DIAGNOSES

Facility

$14,228.32

Service Code	APR-DRG 1154
Min. Negotiated Rate	$13,414.96
Max. Negotiated Rate	$14,228.32
Rate for Payer: Amerigroup CHIP/Medicaid	$13,414.96
Rate for Payer: Cigna Medicaid	$13,414.96
Rate for Payer: Molina CHIP/Medicaid	$13,414.96
Rate for Payer: Parkland Medicaid	$13,414.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14,228.32

OTHER EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL DIAGNOSES

Facility

$3,969.91

Service Code	APR-DRG 1152
Min. Negotiated Rate	$3,742.97
Max. Negotiated Rate	$3,969.91
Rate for Payer: Amerigroup CHIP/Medicaid	$3,742.97
Rate for Payer: Cigna Medicaid	$3,742.97
Rate for Payer: Molina CHIP/Medicaid	$3,742.97
Rate for Payer: Parkland Medicaid	$3,742.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,969.91

OTHER EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL DIAGNOSES

Facility

$7,739.92

Service Code	APR-DRG 1153
Min. Negotiated Rate	$7,297.47
Max. Negotiated Rate	$7,739.92
Rate for Payer: Amerigroup CHIP/Medicaid	$7,297.47
Rate for Payer: Cigna Medicaid	$7,297.47
Rate for Payer: Molina CHIP/Medicaid	$7,297.47
Rate for Payer: Parkland Medicaid	$7,297.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,739.92

OTHER EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL DIAGNOSES

Facility

$2,221.27

Service Code	APR-DRG 1151
Min. Negotiated Rate	$2,094.29
Max. Negotiated Rate	$2,221.27
Rate for Payer: Amerigroup CHIP/Medicaid	$2,094.29
Rate for Payer: Cigna Medicaid	$2,094.29
Rate for Payer: Molina CHIP/Medicaid	$2,094.29
Rate for Payer: Parkland Medicaid	$2,094.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,221.27

OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W CC

Facility

$17,466.70

Service Code	MSDRG 155
Min. Negotiated Rate	$7,596.38
Max. Negotiated Rate	$17,466.70
Rate for Payer: BCBS of TX Blue Advantage	$7,596.38
Rate for Payer: BCBS of TX Blue Essentials	$9,114.77
Rate for Payer: BCBS of TX PPO	$10,127.92

OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W MCC

Facility

$28,555.10

Service Code	MSDRG 154
Min. Negotiated Rate	$12,439.90
Max. Negotiated Rate	$28,555.10
Rate for Payer: BCBS of TX Blue Advantage	$12,439.90
Rate for Payer: BCBS of TX Blue Essentials	$14,926.43
Rate for Payer: BCBS of TX PPO	$16,585.57

OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W/O CC/MCC

Facility

$12,952.30

Service Code	MSDRG 156
Min. Negotiated Rate	$5,675.14
Max. Negotiated Rate	$12,952.30
Rate for Payer: BCBS of TX Blue Advantage	$5,675.14
Rate for Payer: BCBS of TX Blue Essentials	$6,809.51
Rate for Payer: BCBS of TX PPO	$7,566.41

OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W CC/MCC

Facility

$24,062.55

Service Code	MSDRG 133
Min. Negotiated Rate	$18,047.96
Max. Negotiated Rate	$24,062.55
Rate for Payer: BCBS of TX Blue Advantage	$18,047.96
Rate for Payer: BCBS of TX Blue Essentials	$21,655.45
Rate for Payer: BCBS of TX PPO	$24,062.55

OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W/O CC/MCC

Facility

$13,744.29

Service Code	MSDRG 134
Min. Negotiated Rate	$10,308.82
Max. Negotiated Rate	$13,744.29
Rate for Payer: BCBS of TX Blue Advantage	$10,308.82
Rate for Payer: BCBS of TX Blue Essentials	$12,369.39
Rate for Payer: BCBS of TX PPO	$13,744.29

OTHER ENDOCRINE DISORDERS

Facility

$4,106.83

Service Code	APR-DRG 4242
Min. Negotiated Rate	$3,872.07
Max. Negotiated Rate	$4,106.83
Rate for Payer: Amerigroup CHIP/Medicaid	$3,872.07
Rate for Payer: Cigna Medicaid	$3,872.07
Rate for Payer: Molina CHIP/Medicaid	$3,872.07
Rate for Payer: Parkland Medicaid	$3,872.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,106.83

OTHER ENDOCRINE DISORDERS

Facility

$17,077.23

Service Code	APR-DRG 4244
Min. Negotiated Rate	$16,101.01
Max. Negotiated Rate	$17,077.23
Rate for Payer: Amerigroup CHIP/Medicaid	$16,101.01
Rate for Payer: Cigna Medicaid	$16,101.01
Rate for Payer: Molina CHIP/Medicaid	$16,101.01
Rate for Payer: Parkland Medicaid	$16,101.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17,077.23

OTHER ENDOCRINE DISORDERS

Facility

$6,579.31

Service Code	APR-DRG 4243
Min. Negotiated Rate	$6,203.20
Max. Negotiated Rate	$6,579.31
Rate for Payer: Amerigroup CHIP/Medicaid	$6,203.20
Rate for Payer: Cigna Medicaid	$6,203.20
Rate for Payer: Molina CHIP/Medicaid	$6,203.20
Rate for Payer: Parkland Medicaid	$6,203.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,579.31

OTHER ENDOCRINE DISORDERS

Facility

$3,234.40

Service Code	APR-DRG 4241
Min. Negotiated Rate	$3,049.50
Max. Negotiated Rate	$3,234.40
Rate for Payer: Amerigroup CHIP/Medicaid	$3,049.50
Rate for Payer: Cigna Medicaid	$3,049.50
Rate for Payer: Molina CHIP/Medicaid	$3,049.50
Rate for Payer: Parkland Medicaid	$3,049.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,234.40

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC

Facility

$42,632.20

Service Code	MSDRG 629
Min. Negotiated Rate	$19,633.25
Max. Negotiated Rate	$42,632.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$20,728.55
Rate for Payer: Amerigroup Medicare	$20,728.55
Rate for Payer: BCBS of TX Medicare	$20,728.55
Rate for Payer: Cigna Commercial	$28,062.94
Rate for Payer: Cigna Medicare	$20,728.55
Rate for Payer: Employer Direct Commercial	$20,728.55
Rate for Payer: Humana Medicare/TRICARE	$20,728.55
Rate for Payer: Molina Dual Medicare/Medicaid	$20,728.55
Rate for Payer: Molina Medicare	$20,728.55
Rate for Payer: Multiplan Auto	$42,632.20
Rate for Payer: Multiplan Commercial	$42,632.20
Rate for Payer: Multiplan Workers Comp	$42,632.20
Rate for Payer: Scott and White EPO/PPO	$19,633.25
Rate for Payer: Scott and White Medicare	$20,728.55
Rate for Payer: Superior Health Plan EPO	$20,728.55
Rate for Payer: Superior Health Plan Medicare	$20,728.55
Rate for Payer: Universal American Dual Medicare/Medicaid	$20,728.55
Rate for Payer: Universal American Medicare	$20,728.55
Rate for Payer: Wellcare Medicare	$20,728.55
Rate for Payer: Wellmed Medicare	$20,728.55

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC

Facility

$69,251.20

Service Code	MSDRG 628
Min. Negotiated Rate	$31,605.00
Max. Negotiated Rate	$69,251.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$32,073.89
Rate for Payer: Amerigroup Medicare	$32,073.89
Rate for Payer: BCBS of TX Medicare	$32,073.89
Rate for Payer: Cigna Commercial	$48,001.18
Rate for Payer: Cigna Medicare	$32,073.89
Rate for Payer: Employer Direct Commercial	$32,073.89
Rate for Payer: Humana Medicare/TRICARE	$32,073.89
Rate for Payer: Molina Dual Medicare/Medicaid	$32,073.89
Rate for Payer: Molina Medicare	$32,073.89
Rate for Payer: Multiplan Auto	$69,251.20
Rate for Payer: Multiplan Commercial	$69,251.20
Rate for Payer: Multiplan Workers Comp	$69,251.20
Rate for Payer: Scott and White EPO/PPO	$31,892.00
Rate for Payer: Scott and White Medicare	$32,073.89
Rate for Payer: Superior Health Plan EPO	$32,073.89
Rate for Payer: Superior Health Plan Medicare	$32,073.89
Rate for Payer: Universal American Dual Medicare/Medicaid	$32,073.89
Rate for Payer: Universal American Medicare	$32,073.89
Rate for Payer: Wellcare Medicare	$32,073.89
Rate for Payer: Wellmed Medicare	$32,073.89

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC

Facility

$26,679.80

Service Code	MSDRG 630
Min. Negotiated Rate	$12,286.75
Max. Negotiated Rate	$26,679.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15,456.78
Rate for Payer: Amerigroup Medicare	$15,456.78
Rate for Payer: BCBS of TX Medicare	$15,456.78
Rate for Payer: Cigna Commercial	$18,798.36
Rate for Payer: Cigna Medicare	$15,456.78
Rate for Payer: Employer Direct Commercial	$15,456.78
Rate for Payer: Humana Medicare/TRICARE	$15,456.78
Rate for Payer: Molina Dual Medicare/Medicaid	$15,456.78
Rate for Payer: Molina Medicare	$15,456.78
Rate for Payer: Multiplan Auto	$26,679.80
Rate for Payer: Multiplan Commercial	$26,679.80
Rate for Payer: Multiplan Workers Comp	$26,679.80
Rate for Payer: Scott and White EPO/PPO	$12,286.75
Rate for Payer: Scott and White Medicare	$15,456.78
Rate for Payer: Superior Health Plan EPO	$15,456.78
Rate for Payer: Superior Health Plan Medicare	$15,456.78
Rate for Payer: Universal American Dual Medicare/Medicaid	$15,456.78
Rate for Payer: Universal American Medicare	$15,456.78
Rate for Payer: Wellcare Medicare	$15,456.78
Rate for Payer: Wellmed Medicare	$15,456.78

OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W CC

Facility

$42,632.20

Service Code	MSDRG 629
Min. Negotiated Rate	$19,633.25
Max. Negotiated Rate	$42,632.20
Rate for Payer: BCBS of TX Blue Advantage	$20,112.82
Rate for Payer: BCBS of TX Blue Essentials	$24,133.05
Rate for Payer: BCBS of TX PPO	$26,815.53

OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W MCC

Facility

$69,251.20

Service Code	MSDRG 628
Min. Negotiated Rate	$31,605.00
Max. Negotiated Rate	$69,251.20
Rate for Payer: BCBS of TX Blue Advantage	$31,605.00
Rate for Payer: BCBS of TX Blue Essentials	$37,922.32
Rate for Payer: BCBS of TX PPO	$42,137.55

OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W/O CC/MCC

Facility

$26,679.80

Service Code	MSDRG 630
Min. Negotiated Rate	$12,286.75
Max. Negotiated Rate	$26,679.80
Rate for Payer: BCBS of TX Blue Advantage	$13,196.70
Rate for Payer: BCBS of TX Blue Essentials	$15,834.51
Rate for Payer: BCBS of TX PPO	$17,594.58

OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC

Facility

$81,825.40

Service Code	MSDRG 319
Min. Negotiated Rate	$37,468.78
Max. Negotiated Rate	$81,825.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$37,468.78
Rate for Payer: Amerigroup Medicare	$37,468.78
Rate for Payer: BCBS of TX Medicare	$37,468.78
Rate for Payer: Cigna Commercial	$57,482.15
Rate for Payer: Cigna Medicare	$37,468.78
Rate for Payer: Employer Direct Commercial	$37,468.78
Rate for Payer: Humana Medicare/TRICARE	$37,468.78
Rate for Payer: Molina Dual Medicare/Medicaid	$37,468.78
Rate for Payer: Molina Medicare	$37,468.78
Rate for Payer: Multiplan Auto	$81,825.40
Rate for Payer: Multiplan Commercial	$81,825.40
Rate for Payer: Multiplan Workers Comp	$81,825.40
Rate for Payer: Scott and White EPO/PPO	$37,682.75
Rate for Payer: Scott and White Medicare	$37,468.78
Rate for Payer: Superior Health Plan EPO	$37,468.78
Rate for Payer: Superior Health Plan Medicare	$37,468.78
Rate for Payer: Universal American Dual Medicare/Medicaid	$37,468.78
Rate for Payer: Universal American Medicare	$37,468.78
Rate for Payer: Wellcare Medicare	$37,468.78
Rate for Payer: Wellmed Medicare	$37,468.78

OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC

Facility

$46,956.60

Service Code	MSDRG 320
Min. Negotiated Rate	$21,624.75
Max. Negotiated Rate	$46,956.60
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$22,388.58
Rate for Payer: Amerigroup Medicare	$22,388.58
Rate for Payer: BCBS of TX Medicare	$22,388.58
Rate for Payer: Cigna Commercial	$30,980.26
Rate for Payer: Cigna Medicare	$22,388.58
Rate for Payer: Employer Direct Commercial	$22,388.58
Rate for Payer: Humana Medicare/TRICARE	$22,388.58
Rate for Payer: Molina Dual Medicare/Medicaid	$22,388.58
Rate for Payer: Molina Medicare	$22,388.58
Rate for Payer: Multiplan Auto	$46,956.60
Rate for Payer: Multiplan Commercial	$46,956.60
Rate for Payer: Multiplan Workers Comp	$46,956.60
Rate for Payer: Scott and White EPO/PPO	$21,624.75
Rate for Payer: Scott and White Medicare	$22,388.58
Rate for Payer: Superior Health Plan EPO	$22,388.58
Rate for Payer: Superior Health Plan Medicare	$22,388.58
Rate for Payer: Universal American Dual Medicare/Medicaid	$22,388.58
Rate for Payer: Universal American Medicare	$22,388.58
Rate for Payer: Wellcare Medicare	$22,388.58
Rate for Payer: Wellmed Medicare	$22,388.58

Know your out-of-pocket cost for care.

All Charges