White Rock Medical Center

All Charges

Charge

Type

Setting

Price

OTHER ESOPHAGEAL DISORDERS

Facility

$5,361.74

Service Code	APR-DRG 2433
Min. Negotiated Rate	$5,055.24
Max. Negotiated Rate	$5,361.74
Rate for Payer: Amerigroup CHIP/Medicaid	$5,055.24
Rate for Payer: Cigna Medicaid	$5,055.24
Rate for Payer: Molina CHIP/Medicaid	$5,055.24
Rate for Payer: Parkland Medicaid	$5,055.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,361.74

OTHER ESOPHAGEAL DISORDERS

Facility

$3,448.64

Service Code	APR-DRG 2432
Min. Negotiated Rate	$3,251.50
Max. Negotiated Rate	$3,448.64
Rate for Payer: Amerigroup CHIP/Medicaid	$3,251.50
Rate for Payer: Cigna Medicaid	$3,251.50
Rate for Payer: Molina CHIP/Medicaid	$3,251.50
Rate for Payer: Parkland Medicaid	$3,251.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,448.64

OTHER ESOPHAGEAL DISORDERS

Facility

$2,280.11

Service Code	APR-DRG 2431
Min. Negotiated Rate	$2,149.77
Max. Negotiated Rate	$2,280.11
Rate for Payer: Amerigroup CHIP/Medicaid	$2,149.77
Rate for Payer: Cigna Medicaid	$2,149.77
Rate for Payer: Molina CHIP/Medicaid	$2,149.77
Rate for Payer: Parkland Medicaid	$2,149.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,280.11

OTHER ESOPHAGEAL DISORDERS

Facility

$10,825.32

Service Code	APR-DRG 2434
Min. Negotiated Rate	$10,206.49
Max. Negotiated Rate	$10,825.32
Rate for Payer: Amerigroup CHIP/Medicaid	$10,206.49
Rate for Payer: Cigna Medicaid	$10,206.49
Rate for Payer: Molina CHIP/Medicaid	$10,206.49
Rate for Payer: Parkland Medicaid	$10,206.49
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,825.32

OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$10,814.80

Service Code	MSDRG 951
Min. Negotiated Rate	$4,980.50
Max. Negotiated Rate	$10,814.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8,835.01
Rate for Payer: Amerigroup Medicare	$8,835.01
Rate for Payer: BCBS of TX Blue Advantage	$6,866.24
Rate for Payer: BCBS of TX Blue Essentials	$8,238.69
Rate for Payer: BCBS of TX Medicare	$8,835.01
Rate for Payer: BCBS of TX PPO	$9,154.45
Rate for Payer: Cigna Commercial	$7,161.28
Rate for Payer: Cigna Medicare	$8,835.01
Rate for Payer: Employer Direct Commercial	$8,835.01
Rate for Payer: Humana Medicare/TRICARE	$8,835.01
Rate for Payer: Molina Dual Medicare/Medicaid	$8,835.01
Rate for Payer: Molina Medicare	$8,835.01
Rate for Payer: Multiplan Auto	$10,814.80
Rate for Payer: Multiplan Commercial	$10,814.80
Rate for Payer: Multiplan Workers Comp	$10,814.80
Rate for Payer: Scott and White EPO/PPO	$4,980.50
Rate for Payer: Scott and White Medicare	$8,835.01
Rate for Payer: Superior Health Plan EPO	$8,835.01
Rate for Payer: Superior Health Plan Medicare	$8,835.01
Rate for Payer: Universal American Dual Medicare/Medicaid	$8,835.01
Rate for Payer: Universal American Medicare	$8,835.01
Rate for Payer: Wellcare Medicare	$8,835.01
Rate for Payer: Wellmed Medicare	$8,835.01

OTHER FEMALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES

Facility

$5,459.43

Service Code	APR-DRG 5182
Min. Negotiated Rate	$5,147.35
Max. Negotiated Rate	$5,459.43
Rate for Payer: Amerigroup CHIP/Medicaid	$5,147.35
Rate for Payer: Cigna Medicaid	$5,147.35
Rate for Payer: Molina CHIP/Medicaid	$5,147.35
Rate for Payer: Parkland Medicaid	$5,147.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,459.43

OTHER FEMALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES

Facility

$11,155.74

Service Code	APR-DRG 5183
Min. Negotiated Rate	$10,518.02
Max. Negotiated Rate	$11,155.74
Rate for Payer: Amerigroup CHIP/Medicaid	$10,518.02
Rate for Payer: Cigna Medicaid	$10,518.02
Rate for Payer: Molina CHIP/Medicaid	$10,518.02
Rate for Payer: Parkland Medicaid	$10,518.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,155.74

OTHER FEMALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES

Facility

$19,852.21

Service Code	APR-DRG 5184
Min. Negotiated Rate	$18,717.36
Max. Negotiated Rate	$19,852.21
Rate for Payer: Amerigroup CHIP/Medicaid	$18,717.36
Rate for Payer: Cigna Medicaid	$18,717.36
Rate for Payer: Molina CHIP/Medicaid	$18,717.36
Rate for Payer: Parkland Medicaid	$18,717.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$19,852.21

OTHER FEMALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES

Facility

$3,741.34

Service Code	APR-DRG 5181
Min. Negotiated Rate	$3,527.46
Max. Negotiated Rate	$3,741.34
Rate for Payer: Amerigroup CHIP/Medicaid	$3,527.46
Rate for Payer: Cigna Medicaid	$3,527.46
Rate for Payer: Molina CHIP/Medicaid	$3,527.46
Rate for Payer: Parkland Medicaid	$3,527.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,741.34

OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES W CC/MCC

Facility

$47,997.80

Service Code	MSDRG 749
Min. Negotiated Rate	$22,104.25
Max. Negotiated Rate	$47,997.80
Rate for Payer: BCBS of TX Blue Advantage	$22,377.20
Rate for Payer: BCBS of TX Blue Essentials	$26,850.04
Rate for Payer: BCBS of TX PPO	$29,834.53

OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC

Facility

$47,997.80

Service Code	MSDRG 749
Min. Negotiated Rate	$22,104.25
Max. Negotiated Rate	$47,997.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$23,578.08
Rate for Payer: Amerigroup Medicare	$23,578.08
Rate for Payer: BCBS of TX Medicare	$23,578.08
Rate for Payer: Cigna Commercial	$33,070.69
Rate for Payer: Cigna Medicare	$23,578.08
Rate for Payer: Employer Direct Commercial	$23,578.08
Rate for Payer: Humana Medicare/TRICARE	$23,578.08
Rate for Payer: Molina Dual Medicare/Medicaid	$23,578.08
Rate for Payer: Molina Medicare	$23,578.08
Rate for Payer: Multiplan Auto	$47,997.80
Rate for Payer: Multiplan Commercial	$47,997.80
Rate for Payer: Multiplan Workers Comp	$47,997.80
Rate for Payer: Scott and White EPO/PPO	$22,104.25
Rate for Payer: Scott and White Medicare	$23,578.08
Rate for Payer: Superior Health Plan EPO	$23,578.08
Rate for Payer: Superior Health Plan Medicare	$23,578.08
Rate for Payer: Universal American Dual Medicare/Medicaid	$23,578.08
Rate for Payer: Universal American Medicare	$23,578.08
Rate for Payer: Wellcare Medicare	$23,578.08
Rate for Payer: Wellmed Medicare	$23,578.08

OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$27,113.00

Service Code	MSDRG 750
Min. Negotiated Rate	$10,525.54
Max. Negotiated Rate	$27,113.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15,576.26
Rate for Payer: Amerigroup Medicare	$15,576.26
Rate for Payer: BCBS of TX Medicare	$15,576.26
Rate for Payer: Cigna Commercial	$19,008.30
Rate for Payer: Cigna Medicare	$15,576.26
Rate for Payer: Employer Direct Commercial	$15,576.26
Rate for Payer: Humana Medicare/TRICARE	$15,576.26
Rate for Payer: Molina Dual Medicare/Medicaid	$15,576.26
Rate for Payer: Molina Medicare	$15,576.26
Rate for Payer: Multiplan Auto	$27,113.00
Rate for Payer: Multiplan Commercial	$27,113.00
Rate for Payer: Multiplan Workers Comp	$27,113.00
Rate for Payer: Scott and White EPO/PPO	$12,486.25
Rate for Payer: Scott and White Medicare	$15,576.26
Rate for Payer: Superior Health Plan EPO	$15,576.26
Rate for Payer: Superior Health Plan Medicare	$15,576.26
Rate for Payer: Universal American Dual Medicare/Medicaid	$15,576.26
Rate for Payer: Universal American Medicare	$15,576.26
Rate for Payer: Wellcare Medicare	$15,576.26
Rate for Payer: Wellmed Medicare	$15,576.26

OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES W/O CC/MCC

Facility

$27,113.00

Service Code	MSDRG 750
Min. Negotiated Rate	$10,525.54
Max. Negotiated Rate	$27,113.00
Rate for Payer: BCBS of TX Blue Advantage	$10,525.54
Rate for Payer: BCBS of TX Blue Essentials	$12,629.42
Rate for Payer: BCBS of TX PPO	$14,033.24

OTHER GASTROENTERITIS, NAUSEA AND VOMITING

Facility

$1,563.83

Service Code	APR-DRG 2491
Min. Negotiated Rate	$1,474.43
Max. Negotiated Rate	$1,563.83
Rate for Payer: Amerigroup CHIP/Medicaid	$1,474.43
Rate for Payer: Cigna Medicaid	$1,474.43
Rate for Payer: Molina CHIP/Medicaid	$1,474.43
Rate for Payer: Parkland Medicaid	$1,474.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,563.83

OTHER GASTROENTERITIS, NAUSEA AND VOMITING

Facility

$2,452.86

Service Code	APR-DRG 2492
Min. Negotiated Rate	$2,312.64
Max. Negotiated Rate	$2,452.86
Rate for Payer: Amerigroup CHIP/Medicaid	$2,312.64
Rate for Payer: Cigna Medicaid	$2,312.64
Rate for Payer: Molina CHIP/Medicaid	$2,312.64
Rate for Payer: Parkland Medicaid	$2,312.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,452.86

OTHER GASTROENTERITIS, NAUSEA AND VOMITING

Facility

$4,212.45

Service Code	APR-DRG 2493
Min. Negotiated Rate	$3,971.64
Max. Negotiated Rate	$4,212.45
Rate for Payer: Amerigroup CHIP/Medicaid	$3,971.64
Rate for Payer: Cigna Medicaid	$3,971.64
Rate for Payer: Molina CHIP/Medicaid	$3,971.64
Rate for Payer: Parkland Medicaid	$3,971.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,212.45

OTHER GASTROENTERITIS, NAUSEA AND VOMITING

Facility

$12,598.49

Service Code	APR-DRG 2494
Min. Negotiated Rate	$11,878.30
Max. Negotiated Rate	$12,598.49
Rate for Payer: Amerigroup CHIP/Medicaid	$11,878.30
Rate for Payer: Cigna Medicaid	$11,878.30
Rate for Payer: Molina CHIP/Medicaid	$11,878.30
Rate for Payer: Parkland Medicaid	$11,878.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,598.49

OTHER HEART ASSIST SYSTEM IMPLANT

Facility

$195,760.80

Service Code	MSDRG 215
Min. Negotiated Rate	$77,735.19
Max. Negotiated Rate	$195,760.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$77,735.19
Rate for Payer: Amerigroup Medicare	$77,735.19
Rate for Payer: BCBS of TX Blue Advantage	$110,820.46
Rate for Payer: BCBS of TX Blue Essentials	$132,971.67
Rate for Payer: BCBS of TX Medicare	$77,735.19
Rate for Payer: BCBS of TX PPO	$147,752.02
Rate for Payer: Cigna Commercial	$128,246.16
Rate for Payer: Cigna Medicare	$77,735.19
Rate for Payer: Employer Direct Commercial	$77,735.19
Rate for Payer: Humana Medicare/TRICARE	$77,735.19
Rate for Payer: Molina Dual Medicare/Medicaid	$77,735.19
Rate for Payer: Molina Medicare	$77,735.19
Rate for Payer: Multiplan Auto	$195,760.80
Rate for Payer: Multiplan Commercial	$195,760.80
Rate for Payer: Multiplan Workers Comp	$195,760.80
Rate for Payer: Scott and White EPO/PPO	$90,153.00
Rate for Payer: Scott and White Medicare	$77,735.19
Rate for Payer: Superior Health Plan EPO	$77,735.19
Rate for Payer: Superior Health Plan Medicare	$77,735.19
Rate for Payer: Universal American Dual Medicare/Medicaid	$77,735.19
Rate for Payer: Universal American Medicare	$77,735.19
Rate for Payer: Wellcare Medicare	$77,735.19
Rate for Payer: Wellmed Medicare	$77,735.19

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W CC

Facility

$45,003.40

Service Code	MSDRG 424
Min. Negotiated Rate	$18,843.46
Max. Negotiated Rate	$45,003.40
Rate for Payer: BCBS of TX Blue Advantage	$18,843.46
Rate for Payer: BCBS of TX Blue Essentials	$22,609.96
Rate for Payer: BCBS of TX PPO	$25,123.15

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC

Facility

$45,003.40

Service Code	MSDRG 424
Min. Negotiated Rate	$18,843.46
Max. Negotiated Rate	$45,003.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$20,795.26
Rate for Payer: Amerigroup Medicare	$20,795.26
Rate for Payer: BCBS of TX Medicare	$20,795.26
Rate for Payer: Cigna Commercial	$28,180.15
Rate for Payer: Cigna Medicare	$20,795.26
Rate for Payer: Employer Direct Commercial	$20,795.26
Rate for Payer: Humana Medicare/TRICARE	$20,795.26
Rate for Payer: Molina Dual Medicare/Medicaid	$20,795.26
Rate for Payer: Molina Medicare	$20,795.26
Rate for Payer: Multiplan Auto	$45,003.40
Rate for Payer: Multiplan Commercial	$45,003.40
Rate for Payer: Multiplan Workers Comp	$45,003.40
Rate for Payer: Scott and White EPO/PPO	$20,725.25
Rate for Payer: Scott and White Medicare	$20,795.26
Rate for Payer: Superior Health Plan EPO	$20,795.26
Rate for Payer: Superior Health Plan Medicare	$20,795.26
Rate for Payer: Universal American Dual Medicare/Medicaid	$20,795.26
Rate for Payer: Universal American Medicare	$20,795.26
Rate for Payer: Wellcare Medicare	$20,795.26
Rate for Payer: Wellmed Medicare	$20,795.26

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC

Facility

$74,706.10

Service Code	MSDRG 423
Min. Negotiated Rate	$33,935.60
Max. Negotiated Rate	$74,706.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$35,197.53
Rate for Payer: Amerigroup Medicare	$35,197.53
Rate for Payer: BCBS of TX Medicare	$35,197.53
Rate for Payer: Cigna Commercial	$53,490.64
Rate for Payer: Cigna Medicare	$35,197.53
Rate for Payer: Employer Direct Commercial	$35,197.53
Rate for Payer: Humana Medicare/TRICARE	$35,197.53
Rate for Payer: Molina Dual Medicare/Medicaid	$35,197.53
Rate for Payer: Molina Medicare	$35,197.53
Rate for Payer: Multiplan Auto	$74,706.10
Rate for Payer: Multiplan Commercial	$74,706.10
Rate for Payer: Multiplan Workers Comp	$74,706.10
Rate for Payer: Scott and White EPO/PPO	$34,404.12
Rate for Payer: Scott and White Medicare	$35,197.53
Rate for Payer: Superior Health Plan EPO	$35,197.53
Rate for Payer: Superior Health Plan Medicare	$35,197.53
Rate for Payer: Universal American Dual Medicare/Medicaid	$35,197.53
Rate for Payer: Universal American Medicare	$35,197.53
Rate for Payer: Wellcare Medicare	$35,197.53
Rate for Payer: Wellmed Medicare	$35,197.53

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC

Facility

$27,181.40

Service Code	MSDRG 425
Min. Negotiated Rate	$12,517.75
Max. Negotiated Rate	$27,181.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15,755.83
Rate for Payer: Amerigroup Medicare	$15,755.83
Rate for Payer: BCBS of TX Medicare	$15,755.83
Rate for Payer: Cigna Commercial	$19,323.86
Rate for Payer: Cigna Medicare	$15,755.83
Rate for Payer: Employer Direct Commercial	$15,755.83
Rate for Payer: Humana Medicare/TRICARE	$15,755.83
Rate for Payer: Molina Dual Medicare/Medicaid	$15,755.83
Rate for Payer: Molina Medicare	$15,755.83
Rate for Payer: Multiplan Auto	$27,181.40
Rate for Payer: Multiplan Commercial	$27,181.40
Rate for Payer: Multiplan Workers Comp	$27,181.40
Rate for Payer: Scott and White EPO/PPO	$12,517.75
Rate for Payer: Scott and White Medicare	$15,755.83
Rate for Payer: Superior Health Plan EPO	$15,755.83
Rate for Payer: Superior Health Plan Medicare	$15,755.83
Rate for Payer: Universal American Dual Medicare/Medicaid	$15,755.83
Rate for Payer: Universal American Medicare	$15,755.83
Rate for Payer: Wellcare Medicare	$15,755.83
Rate for Payer: Wellmed Medicare	$15,755.83

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W MCC

Facility

$74,706.10

Service Code	MSDRG 423
Min. Negotiated Rate	$33,935.60
Max. Negotiated Rate	$74,706.10
Rate for Payer: BCBS of TX Blue Advantage	$33,935.60
Rate for Payer: BCBS of TX Blue Essentials	$40,718.77
Rate for Payer: BCBS of TX PPO	$45,244.84

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W/O CC/MCC

Facility

$27,181.40

Service Code	MSDRG 425
Min. Negotiated Rate	$12,517.75
Max. Negotiated Rate	$27,181.40
Rate for Payer: BCBS of TX Blue Advantage	$12,838.94
Rate for Payer: BCBS of TX Blue Essentials	$15,405.24
Rate for Payer: BCBS of TX PPO	$17,117.59

OTHER HEPATOBILIARY, PANCREAS AND ABDOMINAL PROCEDURES

Facility

$8,998.60

Service Code	APR-DRG 2641
Min. Negotiated Rate	$8,484.19
Max. Negotiated Rate	$8,998.60
Rate for Payer: Amerigroup CHIP/Medicaid	$8,484.19
Rate for Payer: Cigna Medicaid	$8,484.19
Rate for Payer: Molina CHIP/Medicaid	$8,484.19
Rate for Payer: Parkland Medicaid	$8,484.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,998.60

Know your out-of-pocket cost for care.

All Charges