White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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 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

$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 HEART ASSIST SYSTEM IMPLANT

Facility

$189,183.00

Service Code	MSDRG 215
Min. Negotiated Rate	$77,735.19
Max. Negotiated Rate	$189,183.00
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	$189,183.00
Rate for Payer: Multiplan Commercial	$189,183.00
Rate for Payer: Multiplan Workers Comp	$189,183.00
Rate for Payer: Scott and White EPO/PPO	$87,123.75
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

$41,570.10

Service Code	MSDRG 424
Min. Negotiated Rate	$18,843.46
Max. Negotiated Rate	$41,570.10
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

$41,570.10

Service Code	MSDRG 424
Min. Negotiated Rate	$18,843.46
Max. Negotiated Rate	$41,570.10
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	$41,570.10
Rate for Payer: Multiplan Commercial	$41,570.10
Rate for Payer: Multiplan Workers Comp	$41,570.10
Rate for Payer: Scott and White EPO/PPO	$19,144.12
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

$78,907.00

Service Code	MSDRG 423
Min. Negotiated Rate	$33,935.60
Max. Negotiated Rate	$78,907.00
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	$78,907.00
Rate for Payer: Multiplan Commercial	$78,907.00
Rate for Payer: Multiplan Workers Comp	$78,907.00
Rate for Payer: Scott and White EPO/PPO	$36,338.75
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

$28,505.70

Service Code	MSDRG 425
Min. Negotiated Rate	$12,838.94
Max. Negotiated Rate	$28,505.70
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	$28,505.70
Rate for Payer: Multiplan Commercial	$28,505.70
Rate for Payer: Multiplan Workers Comp	$28,505.70
Rate for Payer: Scott and White EPO/PPO	$13,127.62
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

$78,907.00

Service Code	MSDRG 423
Min. Negotiated Rate	$33,935.60
Max. Negotiated Rate	$78,907.00
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

$28,505.70

Service Code	MSDRG 425
Min. Negotiated Rate	$12,838.94
Max. Negotiated Rate	$28,505.70
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

$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 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

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

$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 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

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

$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

$2,865.88

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 DIAGNOSES WITH CC

Facility

$19,590.90

Service Code	MSDRG 868
Min. Negotiated Rate	$9,022.12
Max. Negotiated Rate	$19,590.90
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	$19,590.90
Rate for Payer: Multiplan Commercial	$19,590.90
Rate for Payer: Multiplan Workers Comp	$19,590.90
Rate for Payer: Scott and White EPO/PPO	$9,022.12
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

$39,770.80

Service Code	MSDRG 867
Min. Negotiated Rate	$18,315.50
Max. Negotiated Rate	$39,770.80
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	$39,770.80
Rate for Payer: Multiplan Commercial	$39,770.80
Rate for Payer: Multiplan Workers Comp	$39,770.80
Rate for Payer: Scott and White EPO/PPO	$18,315.50
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

$13,864.30

Service Code	MSDRG 869
Min. Negotiated Rate	$6,384.88
Max. Negotiated Rate	$13,864.30
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	$13,864.30
Rate for Payer: Multiplan Commercial	$13,864.30
Rate for Payer: Multiplan Workers Comp	$13,864.30
Rate for Payer: Scott and White EPO/PPO	$6,384.88
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

$19,590.90

Service Code	MSDRG 868
Min. Negotiated Rate	$9,022.12
Max. Negotiated Rate	$19,590.90
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

$39,770.80

Service Code	MSDRG 867
Min. Negotiated Rate	$18,315.50
Max. Negotiated Rate	$39,770.80
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

$13,864.30

Service Code	MSDRG 869
Min. Negotiated Rate	$6,384.88
Max. Negotiated Rate	$13,864.30
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

Know your out-of-pocket cost for care.

All Charges