White Rock Medical Center

All Charges

Charge

Type

Setting

Price

OTHER HEPATOBILIARY, PANCREAS AND ABDOMINAL PROCEDURES

Facility

$11,497.48

Service Code	APR-DRG 2642
Min. Negotiated Rate	$10,840.22
Max. Negotiated Rate	$11,497.48
Rate for Payer: Amerigroup CHIP/Medicaid	$10,840.22
Rate for Payer: Cigna Medicaid	$10,840.22
Rate for Payer: Molina CHIP/Medicaid	$10,840.22
Rate for Payer: Parkland Medicaid	$10,840.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,497.48

OTHER HEPATOBILIARY, PANCREAS AND ABDOMINAL PROCEDURES

Facility

$13,995.98

Service Code	APR-DRG 2643
Min. Negotiated Rate	$13,195.90
Max. Negotiated Rate	$13,995.98
Rate for Payer: Amerigroup CHIP/Medicaid	$13,195.90
Rate for Payer: Cigna Medicaid	$13,195.90
Rate for Payer: Molina CHIP/Medicaid	$13,195.90
Rate for Payer: Parkland Medicaid	$13,195.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13,995.98

OTHER HEPATOBILIARY, PANCREAS AND ABDOMINAL PROCEDURES

Facility

$26,664.24

Service Code	APR-DRG 2644
Min. Negotiated Rate	$25,139.98
Max. Negotiated Rate	$26,664.24
Rate for Payer: Amerigroup CHIP/Medicaid	$25,139.98
Rate for Payer: Cigna Medicaid	$25,139.98
Rate for Payer: Molina CHIP/Medicaid	$25,139.98
Rate for Payer: Parkland Medicaid	$25,139.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$26,664.24

OTHER INFECTIOUS AND PARASITIC DISEASES

Facility

$6,052.00

Service Code	APR-DRG 7243
Min. Negotiated Rate	$5,706.04
Max. Negotiated Rate	$6,052.00
Rate for Payer: Amerigroup CHIP/Medicaid	$5,706.04
Rate for Payer: Cigna Medicaid	$5,706.04
Rate for Payer: Molina CHIP/Medicaid	$5,706.04
Rate for Payer: Parkland Medicaid	$5,706.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,052.00

OTHER INFECTIOUS AND PARASITIC DISEASES

Facility

$2,457.39

Service Code	APR-DRG 7241
Min. Negotiated Rate	$2,316.91
Max. Negotiated Rate	$2,457.39
Rate for Payer: Amerigroup CHIP/Medicaid	$2,316.91
Rate for Payer: Cigna Medicaid	$2,316.91
Rate for Payer: Molina CHIP/Medicaid	$2,316.91
Rate for Payer: Parkland Medicaid	$2,316.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,457.39

OTHER INFECTIOUS AND PARASITIC DISEASES

Facility

$2,865.88

Service Code	APR-DRG 7242
Min. Negotiated Rate	$2,702.05
Max. Negotiated Rate	$2,865.88
Rate for Payer: Amerigroup CHIP/Medicaid	$2,702.05
Rate for Payer: Cigna Medicaid	$2,702.05
Rate for Payer: Molina CHIP/Medicaid	$2,702.05
Rate for Payer: Parkland Medicaid	$2,702.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,865.88

OTHER INFECTIOUS AND PARASITIC DISEASES

Facility

$15,989.04

Service Code	APR-DRG 7244
Min. Negotiated Rate	$15,075.03
Max. Negotiated Rate	$15,989.04
Rate for Payer: Amerigroup CHIP/Medicaid	$15,075.03
Rate for Payer: Cigna Medicaid	$15,075.03
Rate for Payer: Molina CHIP/Medicaid	$15,075.03
Rate for Payer: Parkland Medicaid	$15,075.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$15,989.04

OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC

Facility

$20,058.30

Service Code	MSDRG 868
Min. Negotiated Rate	$9,237.38
Max. Negotiated Rate	$20,058.30
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,317.05
Rate for Payer: Amerigroup Medicare	$12,317.05
Rate for Payer: BCBS of TX Medicare	$12,317.05
Rate for Payer: Cigna Commercial	$13,280.57
Rate for Payer: Cigna Medicare	$12,317.05
Rate for Payer: Employer Direct Commercial	$12,317.05
Rate for Payer: Humana Medicare/TRICARE	$12,317.05
Rate for Payer: Molina Dual Medicare/Medicaid	$12,317.05
Rate for Payer: Molina Medicare	$12,317.05
Rate for Payer: Multiplan Auto	$20,058.30
Rate for Payer: Multiplan Commercial	$20,058.30
Rate for Payer: Multiplan Workers Comp	$20,058.30
Rate for Payer: Scott and White EPO/PPO	$9,237.38
Rate for Payer: Scott and White Medicare	$12,317.05
Rate for Payer: Superior Health Plan EPO	$12,317.05
Rate for Payer: Superior Health Plan Medicare	$12,317.05
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,317.05
Rate for Payer: Universal American Medicare	$12,317.05
Rate for Payer: Wellcare Medicare	$12,317.05
Rate for Payer: Wellmed Medicare	$12,317.05

OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC

Facility

$40,154.60

Service Code	MSDRG 867
Min. Negotiated Rate	$18,342.94
Max. Negotiated Rate	$40,154.60
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$20,101.19
Rate for Payer: Amerigroup Medicare	$20,101.19
Rate for Payer: BCBS of TX Medicare	$20,101.19
Rate for Payer: Cigna Commercial	$26,960.42
Rate for Payer: Cigna Medicare	$20,101.19
Rate for Payer: Employer Direct Commercial	$20,101.19
Rate for Payer: Humana Medicare/TRICARE	$20,101.19
Rate for Payer: Molina Dual Medicare/Medicaid	$20,101.19
Rate for Payer: Molina Medicare	$20,101.19
Rate for Payer: Multiplan Auto	$40,154.60
Rate for Payer: Multiplan Commercial	$40,154.60
Rate for Payer: Multiplan Workers Comp	$40,154.60
Rate for Payer: Scott and White EPO/PPO	$18,492.25
Rate for Payer: Scott and White Medicare	$20,101.19
Rate for Payer: Superior Health Plan EPO	$20,101.19
Rate for Payer: Superior Health Plan Medicare	$20,101.19
Rate for Payer: Universal American Dual Medicare/Medicaid	$20,101.19
Rate for Payer: Universal American Medicare	$20,101.19
Rate for Payer: Wellcare Medicare	$20,101.19
Rate for Payer: Wellmed Medicare	$20,101.19

OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC

Facility

$14,075.20

Service Code	MSDRG 869
Min. Negotiated Rate	$6,482.00
Max. Negotiated Rate	$14,075.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,108.06
Rate for Payer: Amerigroup Medicare	$10,108.06
Rate for Payer: BCBS of TX Medicare	$10,108.06
Rate for Payer: Cigna Commercial	$9,398.54
Rate for Payer: Cigna Medicare	$10,108.06
Rate for Payer: Employer Direct Commercial	$10,108.06
Rate for Payer: Humana Medicare/TRICARE	$10,108.06
Rate for Payer: Molina Dual Medicare/Medicaid	$10,108.06
Rate for Payer: Molina Medicare	$10,108.06
Rate for Payer: Multiplan Auto	$14,075.20
Rate for Payer: Multiplan Commercial	$14,075.20
Rate for Payer: Multiplan Workers Comp	$14,075.20
Rate for Payer: Scott and White EPO/PPO	$6,482.00
Rate for Payer: Scott and White Medicare	$10,108.06
Rate for Payer: Superior Health Plan EPO	$10,108.06
Rate for Payer: Superior Health Plan Medicare	$10,108.06
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,108.06
Rate for Payer: Universal American Medicare	$10,108.06
Rate for Payer: Wellcare Medicare	$10,108.06
Rate for Payer: Wellmed Medicare	$10,108.06

OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W CC

Facility

$20,058.30

Service Code	MSDRG 868
Min. Negotiated Rate	$9,237.38
Max. Negotiated Rate	$20,058.30
Rate for Payer: BCBS of TX Blue Advantage	$9,261.34
Rate for Payer: BCBS of TX Blue Essentials	$11,112.53
Rate for Payer: BCBS of TX PPO	$12,347.74

OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W MCC

Facility

$40,154.60

Service Code	MSDRG 867
Min. Negotiated Rate	$18,342.94
Max. Negotiated Rate	$40,154.60
Rate for Payer: BCBS of TX Blue Advantage	$18,342.94
Rate for Payer: BCBS of TX Blue Essentials	$22,009.40
Rate for Payer: BCBS of TX PPO	$24,455.83

OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W/O CC/MCC

Facility

$14,075.20

Service Code	MSDRG 869
Min. Negotiated Rate	$6,482.00
Max. Negotiated Rate	$14,075.20
Rate for Payer: BCBS of TX Blue Advantage	$6,603.94
Rate for Payer: BCBS of TX Blue Essentials	$7,923.96
Rate for Payer: BCBS of TX PPO	$8,804.74

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES

Facility

$24,557.64

Service Code	APR-DRG 8154
Min. Negotiated Rate	$23,153.81
Max. Negotiated Rate	$24,557.64
Rate for Payer: Amerigroup CHIP/Medicaid	$23,153.81
Rate for Payer: Cigna Medicaid	$23,153.81
Rate for Payer: Molina CHIP/Medicaid	$23,153.81
Rate for Payer: Parkland Medicaid	$23,153.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$24,557.64

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES

Facility

$2,108.11

Service Code	APR-DRG 8151
Min. Negotiated Rate	$1,987.60
Max. Negotiated Rate	$2,108.11
Rate for Payer: Amerigroup CHIP/Medicaid	$1,987.60
Rate for Payer: Cigna Medicaid	$1,987.60
Rate for Payer: Molina CHIP/Medicaid	$1,987.60
Rate for Payer: Parkland Medicaid	$1,987.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,108.11

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES

Facility

$7,484.94

Service Code	APR-DRG 8153
Min. Negotiated Rate	$7,057.06
Max. Negotiated Rate	$7,484.94
Rate for Payer: Amerigroup CHIP/Medicaid	$7,057.06
Rate for Payer: Cigna Medicaid	$7,057.06
Rate for Payer: Molina CHIP/Medicaid	$7,057.06
Rate for Payer: Parkland Medicaid	$7,057.06
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,484.94

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES

Facility

$3,211.01

Service Code	APR-DRG 8152
Min. Negotiated Rate	$3,027.45
Max. Negotiated Rate	$3,211.01
Rate for Payer: Amerigroup CHIP/Medicaid	$3,027.45
Rate for Payer: Cigna Medicaid	$3,027.45
Rate for Payer: Molina CHIP/Medicaid	$3,027.45
Rate for Payer: Parkland Medicaid	$3,027.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,211.01

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC

Facility

$29,560.20

Service Code	MSDRG 922
Min. Negotiated Rate	$13,402.24
Max. Negotiated Rate	$29,560.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$17,581.47
Rate for Payer: Amerigroup Medicare	$17,581.47
Rate for Payer: BCBS of TX Medicare	$17,581.47
Rate for Payer: Cigna Commercial	$22,532.27
Rate for Payer: Cigna Medicare	$17,581.47
Rate for Payer: Employer Direct Commercial	$17,581.47
Rate for Payer: Humana Medicare/TRICARE	$17,581.47
Rate for Payer: Molina Dual Medicare/Medicaid	$17,581.47
Rate for Payer: Molina Medicare	$17,581.47
Rate for Payer: Multiplan Auto	$29,560.20
Rate for Payer: Multiplan Commercial	$29,560.20
Rate for Payer: Multiplan Workers Comp	$29,560.20
Rate for Payer: Scott and White EPO/PPO	$13,613.25
Rate for Payer: Scott and White Medicare	$17,581.47
Rate for Payer: Superior Health Plan EPO	$17,581.47
Rate for Payer: Superior Health Plan Medicare	$17,581.47
Rate for Payer: Universal American Dual Medicare/Medicaid	$17,581.47
Rate for Payer: Universal American Medicare	$17,581.47
Rate for Payer: Wellcare Medicare	$17,581.47
Rate for Payer: Wellmed Medicare	$17,581.47

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC

Facility

$17,920.80

Service Code	MSDRG 923
Min. Negotiated Rate	$7,480.28
Max. Negotiated Rate	$17,920.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12,218.84
Rate for Payer: Amerigroup Medicare	$12,218.84
Rate for Payer: BCBS of TX Medicare	$12,218.84
Rate for Payer: Cigna Commercial	$13,107.98
Rate for Payer: Cigna Medicare	$12,218.84
Rate for Payer: Employer Direct Commercial	$12,218.84
Rate for Payer: Humana Medicare/TRICARE	$12,218.84
Rate for Payer: Molina Dual Medicare/Medicaid	$12,218.84
Rate for Payer: Molina Medicare	$12,218.84
Rate for Payer: Multiplan Auto	$17,920.80
Rate for Payer: Multiplan Commercial	$17,920.80
Rate for Payer: Multiplan Workers Comp	$17,920.80
Rate for Payer: Scott and White EPO/PPO	$8,253.00
Rate for Payer: Scott and White Medicare	$12,218.84
Rate for Payer: Superior Health Plan EPO	$12,218.84
Rate for Payer: Superior Health Plan Medicare	$12,218.84
Rate for Payer: Universal American Dual Medicare/Medicaid	$12,218.84
Rate for Payer: Universal American Medicare	$12,218.84
Rate for Payer: Wellcare Medicare	$12,218.84
Rate for Payer: Wellmed Medicare	$12,218.84

OTHER INJURY, POISONING & TOXIC EFFECT DIAG W MCC

Facility

$29,560.20

Service Code	MSDRG 922
Min. Negotiated Rate	$13,402.24
Max. Negotiated Rate	$29,560.20
Rate for Payer: BCBS of TX Blue Advantage	$13,402.24
Rate for Payer: BCBS of TX Blue Essentials	$16,081.13
Rate for Payer: BCBS of TX PPO	$17,868.61

OTHER INJURY, POISONING & TOXIC EFFECT DIAG W/O MCC

Facility

$17,920.80

Service Code	MSDRG 923
Min. Negotiated Rate	$7,480.28
Max. Negotiated Rate	$17,920.80
Rate for Payer: BCBS of TX Blue Advantage	$7,480.28
Rate for Payer: BCBS of TX Blue Essentials	$8,975.47
Rate for Payer: BCBS of TX PPO	$9,973.13

OTHER KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS AND SYMPTOMS

Facility

$24,848.08

Service Code	APR-DRG 4684
Min. Negotiated Rate	$23,427.64
Max. Negotiated Rate	$24,848.08
Rate for Payer: Amerigroup CHIP/Medicaid	$23,427.64
Rate for Payer: Cigna Medicaid	$23,427.64
Rate for Payer: Molina CHIP/Medicaid	$23,427.64
Rate for Payer: Parkland Medicaid	$23,427.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$24,848.08

OTHER KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS AND SYMPTOMS

Facility

$2,875.31

Service Code	APR-DRG 4681
Min. Negotiated Rate	$2,710.94
Max. Negotiated Rate	$2,875.31
Rate for Payer: Amerigroup CHIP/Medicaid	$2,710.94
Rate for Payer: Cigna Medicaid	$2,710.94
Rate for Payer: Molina CHIP/Medicaid	$2,710.94
Rate for Payer: Parkland Medicaid	$2,710.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,875.31

OTHER KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS AND SYMPTOMS

Facility

$5,861.52

Service Code	APR-DRG 4683
Min. Negotiated Rate	$5,526.44
Max. Negotiated Rate	$5,861.52
Rate for Payer: Amerigroup CHIP/Medicaid	$5,526.44
Rate for Payer: Cigna Medicaid	$5,526.44
Rate for Payer: Molina CHIP/Medicaid	$5,526.44
Rate for Payer: Parkland Medicaid	$5,526.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,861.52

OTHER KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS AND SYMPTOMS

Facility

$3,220.44

Service Code	APR-DRG 4682
Min. Negotiated Rate	$3,036.34
Max. Negotiated Rate	$3,220.44
Rate for Payer: Amerigroup CHIP/Medicaid	$3,036.34
Rate for Payer: Cigna Medicaid	$3,036.34
Rate for Payer: Molina CHIP/Medicaid	$3,036.34
Rate for Payer: Parkland Medicaid	$3,036.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,220.44

Know your out-of-pocket cost for care.

All Charges