White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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 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, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC

Facility

$41,397.20

Service Code	MSDRG 629
Min. Negotiated Rate	$19,064.50
Max. Negotiated Rate	$41,397.20
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	$41,397.20
Rate for Payer: Multiplan Commercial	$41,397.20
Rate for Payer: Multiplan Workers Comp	$41,397.20
Rate for Payer: Scott and White EPO/PPO	$19,064.50
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

$70,809.20

Service Code	MSDRG 628
Min. Negotiated Rate	$31,605.00
Max. Negotiated Rate	$70,809.20
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	$70,809.20
Rate for Payer: Multiplan Commercial	$70,809.20
Rate for Payer: Multiplan Workers Comp	$70,809.20
Rate for Payer: Scott and White EPO/PPO	$32,609.50
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

$27,730.50

Service Code	MSDRG 630
Min. Negotiated Rate	$12,770.62
Max. Negotiated Rate	$27,730.50
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	$27,730.50
Rate for Payer: Multiplan Commercial	$27,730.50
Rate for Payer: Multiplan Workers Comp	$27,730.50
Rate for Payer: Scott and White EPO/PPO	$12,770.62
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

$41,397.20

Service Code	MSDRG 629
Min. Negotiated Rate	$19,064.50
Max. Negotiated Rate	$41,397.20
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

$70,809.20

Service Code	MSDRG 628
Min. Negotiated Rate	$31,605.00
Max. Negotiated Rate	$70,809.20
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

$27,730.50

Service Code	MSDRG 630
Min. Negotiated Rate	$12,770.62
Max. Negotiated Rate	$27,730.50
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

$84,795.10

Service Code	MSDRG 319
Min. Negotiated Rate	$37,468.78
Max. Negotiated Rate	$84,795.10
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	$84,795.10
Rate for Payer: Multiplan Commercial	$84,795.10
Rate for Payer: Multiplan Workers Comp	$84,795.10
Rate for Payer: Scott and White EPO/PPO	$39,050.38
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

$45,700.70

Service Code	MSDRG 320
Min. Negotiated Rate	$21,046.38
Max. Negotiated Rate	$45,700.70
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	$45,700.70
Rate for Payer: Multiplan Commercial	$45,700.70
Rate for Payer: Multiplan Workers Comp	$45,700.70
Rate for Payer: Scott and White EPO/PPO	$21,046.38
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

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

$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

$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

$10,564.00

Service Code	MSDRG 951
Min. Negotiated Rate	$4,865.00
Max. Negotiated Rate	$10,564.00
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	$10,564.00
Rate for Payer: Multiplan Commercial	$10,564.00
Rate for Payer: Multiplan Workers Comp	$10,564.00
Rate for Payer: Scott and White EPO/PPO	$4,865.00
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

$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 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

$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

$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 O.R. PROCEDURES W CC/MCC

Facility

$48,784.40

Service Code	MSDRG 749
Min. Negotiated Rate	$22,377.20
Max. Negotiated Rate	$48,784.40
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

$48,784.40

Service Code	MSDRG 749
Min. Negotiated Rate	$22,377.20
Max. Negotiated Rate	$48,784.40
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	$48,784.40
Rate for Payer: Multiplan Commercial	$48,784.40
Rate for Payer: Multiplan Workers Comp	$48,784.40
Rate for Payer: Scott and White EPO/PPO	$22,466.50
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

$28,040.20

Service Code	MSDRG 750
Min. Negotiated Rate	$10,525.54
Max. Negotiated Rate	$28,040.20
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	$28,040.20
Rate for Payer: Multiplan Commercial	$28,040.20
Rate for Payer: Multiplan Workers Comp	$28,040.20
Rate for Payer: Scott and White EPO/PPO	$12,913.25
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

$28,040.20

Service Code	MSDRG 750
Min. Negotiated Rate	$10,525.54
Max. Negotiated Rate	$28,040.20
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

Know your out-of-pocket cost for care.

All Charges