White Rock Medical Center

All Charges

Charge

Type

Setting

Price

chlordiazePOXIDE 5 mg Cap

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77454854
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$5.20
Rate for Payer: Amerigroup CHIP/Medicaid	$0.72
Rate for Payer: BCBS of TX Blue Advantage	$2.40
Rate for Payer: BCBS of TX Blue Essentials	$2.88
Rate for Payer: BCBS of TX PPO	$3.20
Rate for Payer: Cash Price	$5.44
Rate for Payer: Multiplan Auto	$5.20
Rate for Payer: Multiplan Commercial	$5.20
Rate for Payer: Multiplan Workers Comp	$5.20
Rate for Payer: Scott and White EPO/PPO	$4.00
Rate for Payer: Superior Health Plan EPO	$1.09

chlordiazePOXIDE 5 mg Cap

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77454854
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.44

CHLORDIAZEPOXIDE HCL 25 MG CAP

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77454801
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.44

CHLORDIAZEPOXIDE HCL 25 MG CAP

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77454801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$5.20
Rate for Payer: Amerigroup CHIP/Medicaid	$0.72
Rate for Payer: BCBS of TX Blue Advantage	$2.40
Rate for Payer: BCBS of TX Blue Essentials	$2.88
Rate for Payer: BCBS of TX PPO	$3.20
Rate for Payer: Cash Price	$5.44
Rate for Payer: Multiplan Auto	$5.20
Rate for Payer: Multiplan Commercial	$5.20
Rate for Payer: Multiplan Workers Comp	$5.20
Rate for Payer: Scott and White EPO/PPO	$4.00
Rate for Payer: Superior Health Plan EPO	$1.09

Chloride, 24 hr Urine SO

Facility

$144.00

Service Code	CPT 82436
Hospital Charge Code	1602473
Hospital Revenue Code	301
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna Commercial	$6.04
Rate for Payer: Aetna Medicare	$8.62
Rate for Payer: Amerigroup CHIP/Medicaid	$2.24
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.75
Rate for Payer: Amerigroup Medicare	$5.75
Rate for Payer: BCBS of TX Blue Advantage	$9.49
Rate for Payer: BCBS of TX Blue Essentials	$11.38
Rate for Payer: BCBS of TX Medicare	$5.75
Rate for Payer: BCBS of TX PPO	$12.71
Rate for Payer: Cash Price	$126.72
Rate for Payer: Cash Price	$126.72
Rate for Payer: Cigna Medicaid	$5.75
Rate for Payer: Cigna Medicare	$5.75
Rate for Payer: Employer Direct Commercial	$5.75
Rate for Payer: Humana Medicare/TRICARE	$5.75
Rate for Payer: Molina CHIP/Medicaid	$5.75
Rate for Payer: Molina Dual Medicare/Medicaid	$5.75
Rate for Payer: Molina Medicare	$5.75
Rate for Payer: Multiplan Auto	$93.60
Rate for Payer: Multiplan Commercial	$93.60
Rate for Payer: Multiplan Workers Comp	$93.60
Rate for Payer: Parkland Medicaid	$5.75
Rate for Payer: Scott and White EPO/PPO	$7.19
Rate for Payer: Scott and White Medicare	$5.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.75
Rate for Payer: Superior Health Plan EPO	$5.75
Rate for Payer: Superior Health Plan Medicare	$5.75
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.75
Rate for Payer: Universal American Medicare	$5.75
Rate for Payer: Wellcare Medicare	$5.75
Rate for Payer: Wellmed Medicare	$5.75

Chloride, Fecal SO

Facility

$7.00

Service Code	CPT 82438
Hospital Charge Code	1602432
Hospital Revenue Code	301
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$11.05
Rate for Payer: Aetna Commercial	$5.25
Rate for Payer: Aetna Medicare	$7.50
Rate for Payer: Amerigroup CHIP/Medicaid	$1.95
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.00
Rate for Payer: Amerigroup Medicare	$5.00
Rate for Payer: BCBS of TX Blue Advantage	$8.25
Rate for Payer: BCBS of TX Blue Essentials	$9.90
Rate for Payer: BCBS of TX Medicare	$5.00
Rate for Payer: BCBS of TX PPO	$11.05
Rate for Payer: Cash Price	$6.16
Rate for Payer: Cash Price	$6.16
Rate for Payer: Cigna Medicaid	$5.00
Rate for Payer: Cigna Medicare	$5.00
Rate for Payer: Employer Direct Commercial	$5.00
Rate for Payer: Humana Medicare/TRICARE	$5.00
Rate for Payer: Molina CHIP/Medicaid	$5.00
Rate for Payer: Molina Dual Medicare/Medicaid	$5.00
Rate for Payer: Molina Medicare	$5.00
Rate for Payer: Multiplan Auto	$4.55
Rate for Payer: Multiplan Commercial	$4.55
Rate for Payer: Multiplan Workers Comp	$4.55
Rate for Payer: Parkland Medicaid	$5.00
Rate for Payer: Scott and White EPO/PPO	$6.25
Rate for Payer: Scott and White Medicare	$5.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.00
Rate for Payer: Superior Health Plan EPO	$5.00
Rate for Payer: Superior Health Plan Medicare	$5.00
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.00
Rate for Payer: Universal American Medicare	$5.00
Rate for Payer: Wellcare Medicare	$5.00
Rate for Payer: Wellmed Medicare	$5.00

Chloride, Fecal SO

Facility

$7.00

Service Code	CPT 82438
Hospital Charge Code	1602432
Hospital Revenue Code	301
Rate for Payer: Cash Price	$6.16

Chloride Level

Facility

$111.00

Service Code	CPT 82435
Hospital Charge Code	1601715
Hospital Revenue Code	301
Rate for Payer: Cash Price	$97.68

Chloride Level

Facility

$111.00

Service Code	CPT 82435
Hospital Charge Code	1601715
Hospital Revenue Code	301
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$72.15
Rate for Payer: Aetna Commercial	$4.83
Rate for Payer: Aetna Medicare	$6.90
Rate for Payer: Amerigroup CHIP/Medicaid	$1.79
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$4.60
Rate for Payer: Amerigroup Medicare	$4.60
Rate for Payer: BCBS of TX Blue Advantage	$7.59
Rate for Payer: BCBS of TX Blue Essentials	$9.11
Rate for Payer: BCBS of TX Medicare	$4.60
Rate for Payer: BCBS of TX PPO	$10.17
Rate for Payer: Cash Price	$97.68
Rate for Payer: Cash Price	$97.68
Rate for Payer: Cigna Medicaid	$4.60
Rate for Payer: Cigna Medicare	$4.60
Rate for Payer: Employer Direct Commercial	$4.60
Rate for Payer: Humana Medicare/TRICARE	$4.60
Rate for Payer: Molina CHIP/Medicaid	$4.60
Rate for Payer: Molina Dual Medicare/Medicaid	$4.60
Rate for Payer: Molina Medicare	$4.60
Rate for Payer: Multiplan Auto	$72.15
Rate for Payer: Multiplan Commercial	$72.15
Rate for Payer: Multiplan Workers Comp	$72.15
Rate for Payer: Parkland Medicaid	$4.60
Rate for Payer: Scott and White EPO/PPO	$5.75
Rate for Payer: Scott and White Medicare	$4.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.60
Rate for Payer: Superior Health Plan EPO	$4.60
Rate for Payer: Superior Health Plan Medicare	$4.60
Rate for Payer: Universal American Dual Medicare/Medicaid	$4.60
Rate for Payer: Universal American Medicare	$4.60
Rate for Payer: Wellcare Medicare	$4.60
Rate for Payer: Wellmed Medicare	$4.60

Chloride Level 24 Hour Urine

Facility

$144.00

Service Code	CPT 82436
Hospital Charge Code	1602473
Hospital Revenue Code	301
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna Commercial	$6.04
Rate for Payer: Aetna Medicare	$8.62
Rate for Payer: Amerigroup CHIP/Medicaid	$2.24
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.75
Rate for Payer: Amerigroup Medicare	$5.75
Rate for Payer: BCBS of TX Blue Advantage	$9.49
Rate for Payer: BCBS of TX Blue Essentials	$11.38
Rate for Payer: BCBS of TX Medicare	$5.75
Rate for Payer: BCBS of TX PPO	$12.71
Rate for Payer: Cash Price	$126.72
Rate for Payer: Cash Price	$126.72
Rate for Payer: Cigna Medicaid	$5.75
Rate for Payer: Cigna Medicare	$5.75
Rate for Payer: Employer Direct Commercial	$5.75
Rate for Payer: Humana Medicare/TRICARE	$5.75
Rate for Payer: Molina CHIP/Medicaid	$5.75
Rate for Payer: Molina Dual Medicare/Medicaid	$5.75
Rate for Payer: Molina Medicare	$5.75
Rate for Payer: Multiplan Auto	$93.60
Rate for Payer: Multiplan Commercial	$93.60
Rate for Payer: Multiplan Workers Comp	$93.60
Rate for Payer: Parkland Medicaid	$5.75
Rate for Payer: Scott and White EPO/PPO	$7.19
Rate for Payer: Scott and White Medicare	$5.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.75
Rate for Payer: Superior Health Plan EPO	$5.75
Rate for Payer: Superior Health Plan Medicare	$5.75
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.75
Rate for Payer: Universal American Medicare	$5.75
Rate for Payer: Wellcare Medicare	$5.75
Rate for Payer: Wellmed Medicare	$5.75

Chloride Level Urine

Facility

$144.00

Service Code	CPT 82436
Hospital Charge Code	1602473
Hospital Revenue Code	301
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna Commercial	$6.04
Rate for Payer: Aetna Medicare	$8.62
Rate for Payer: Amerigroup CHIP/Medicaid	$2.24
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.75
Rate for Payer: Amerigroup Medicare	$5.75
Rate for Payer: BCBS of TX Blue Advantage	$9.49
Rate for Payer: BCBS of TX Blue Essentials	$11.38
Rate for Payer: BCBS of TX Medicare	$5.75
Rate for Payer: BCBS of TX PPO	$12.71
Rate for Payer: Cash Price	$126.72
Rate for Payer: Cash Price	$126.72
Rate for Payer: Cigna Medicaid	$5.75
Rate for Payer: Cigna Medicare	$5.75
Rate for Payer: Employer Direct Commercial	$5.75
Rate for Payer: Humana Medicare/TRICARE	$5.75
Rate for Payer: Molina CHIP/Medicaid	$5.75
Rate for Payer: Molina Dual Medicare/Medicaid	$5.75
Rate for Payer: Molina Medicare	$5.75
Rate for Payer: Multiplan Auto	$93.60
Rate for Payer: Multiplan Commercial	$93.60
Rate for Payer: Multiplan Workers Comp	$93.60
Rate for Payer: Parkland Medicaid	$5.75
Rate for Payer: Scott and White EPO/PPO	$7.19
Rate for Payer: Scott and White Medicare	$5.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.75
Rate for Payer: Superior Health Plan EPO	$5.75
Rate for Payer: Superior Health Plan Medicare	$5.75
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.75
Rate for Payer: Universal American Medicare	$5.75
Rate for Payer: Wellcare Medicare	$5.75
Rate for Payer: Wellmed Medicare	$5.75

Chloride, Urine SO

Facility

$144.00

Service Code	CPT 82436
Hospital Charge Code	1602473
Hospital Revenue Code	301
Rate for Payer: Cash Price	$126.72

Chloride, Urine SO

Facility

$144.00

Service Code	CPT 82436
Hospital Charge Code	1602473
Hospital Revenue Code	301
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna Commercial	$6.04
Rate for Payer: Aetna Medicare	$8.62
Rate for Payer: Amerigroup CHIP/Medicaid	$2.24
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.75
Rate for Payer: Amerigroup Medicare	$5.75
Rate for Payer: BCBS of TX Blue Advantage	$9.49
Rate for Payer: BCBS of TX Blue Essentials	$11.38
Rate for Payer: BCBS of TX Medicare	$5.75
Rate for Payer: BCBS of TX PPO	$12.71
Rate for Payer: Cash Price	$126.72
Rate for Payer: Cash Price	$126.72
Rate for Payer: Cigna Medicaid	$5.75
Rate for Payer: Cigna Medicare	$5.75
Rate for Payer: Employer Direct Commercial	$5.75
Rate for Payer: Humana Medicare/TRICARE	$5.75
Rate for Payer: Molina CHIP/Medicaid	$5.75
Rate for Payer: Molina Dual Medicare/Medicaid	$5.75
Rate for Payer: Molina Medicare	$5.75
Rate for Payer: Multiplan Auto	$93.60
Rate for Payer: Multiplan Commercial	$93.60
Rate for Payer: Multiplan Workers Comp	$93.60
Rate for Payer: Parkland Medicaid	$5.75
Rate for Payer: Scott and White EPO/PPO	$7.19
Rate for Payer: Scott and White Medicare	$5.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.75
Rate for Payer: Superior Health Plan EPO	$5.75
Rate for Payer: Superior Health Plan Medicare	$5.75
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.75
Rate for Payer: Universal American Medicare	$5.75
Rate for Payer: Wellcare Medicare	$5.75
Rate for Payer: Wellmed Medicare	$5.75

CHNG EXT/INT URETR STENT

Facility

$3,529.00

Service Code	CPT 50387
Hospital Charge Code	4614483
Hospital Revenue Code	361
Rate for Payer: Cash Price	$3,105.52

CHNG EXT/INT URETR STENT

Facility

$3,529.00

Service Code	CPT 50387
Hospital Charge Code	4614483
Hospital Revenue Code	361
Min. Negotiated Rate	$652.80
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$2,794.14
Rate for Payer: Amerigroup CHIP/Medicaid	$652.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,862.76
Rate for Payer: Amerigroup Medicare	$1,862.76
Rate for Payer: BCBS of TX Blue Advantage	$2,958.49
Rate for Payer: BCBS of TX Blue Essentials	$3,543.10
Rate for Payer: BCBS of TX Medicare	$1,862.76
Rate for Payer: BCBS of TX PPO	$4,464.31
Rate for Payer: Cash Price	$3,105.52
Rate for Payer: Cash Price	$3,105.52
Rate for Payer: Cigna Commercial	$4,219.69
Rate for Payer: Cigna Medicaid	$652.80
Rate for Payer: Cigna Medicare	$1,862.76
Rate for Payer: Employer Direct Commercial	$1,862.76
Rate for Payer: Humana Medicare/TRICARE	$1,862.76
Rate for Payer: Molina CHIP/Medicaid	$652.80
Rate for Payer: Molina Dual Medicare/Medicaid	$1,862.76
Rate for Payer: Molina Medicare	$1,862.76
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$652.80
Rate for Payer: Scott and White EPO/PPO	$3,446.11
Rate for Payer: Scott and White Medicare	$1,862.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$652.80
Rate for Payer: Superior Health Plan EPO	$1,862.76
Rate for Payer: Superior Health Plan Medicare	$1,862.76
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,862.76
Rate for Payer: Universal American Medicare	$1,862.76
Rate for Payer: Wellcare Medicare	$1,862.76
Rate for Payer: Wellmed Medicare	$1,862.76

CHOLANGIO+INJ EXIST CTH

Facility

$7,278.00

Service Code	CPT 47531
Hospital Charge Code	4617531
Hospital Revenue Code	360
Min. Negotiated Rate	$655.02
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$4,635.00
Rate for Payer: Aetna Medicare	$4,746.03
Rate for Payer: Amerigroup CHIP/Medicaid	$655.02
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,164.02
Rate for Payer: Amerigroup Medicare	$3,164.02
Rate for Payer: BCBS of TX Blue Advantage	$5,192.60
Rate for Payer: BCBS of TX Blue Essentials	$6,218.68
Rate for Payer: BCBS of TX Medicare	$3,164.02
Rate for Payer: BCBS of TX PPO	$7,835.54
Rate for Payer: Cash Price	$6,404.64
Rate for Payer: Cash Price	$6,404.64
Rate for Payer: Cash Price	$6,404.64
Rate for Payer: Cigna Commercial	$7,167.43
Rate for Payer: Cigna Medicare	$3,164.02
Rate for Payer: Employer Direct Commercial	$3,164.02
Rate for Payer: Humana Medicare/TRICARE	$3,164.02
Rate for Payer: Molina Dual Medicare/Medicaid	$3,164.02
Rate for Payer: Molina Medicare	$3,164.02
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Scott and White EPO/PPO	$5,853.44
Rate for Payer: Scott and White Medicare	$3,164.02
Rate for Payer: Superior Health Plan EPO	$3,164.02
Rate for Payer: Superior Health Plan Medicare	$3,164.02
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,164.02
Rate for Payer: Universal American Medicare	$3,164.02
Rate for Payer: Wellcare Medicare	$3,164.02
Rate for Payer: Wellmed Medicare	$3,164.02

CHOLANGIO+INJ EXIST CTH

Facility

$7,278.00

Service Code	CPT 47531
Hospital Charge Code	4617531
Hospital Revenue Code	360
Rate for Payer: Cash Price	$6,404.64

CHOLANGIO+INJ NEW

Facility

$7,278.00

Service Code	CPT 47532
Hospital Charge Code	4617532
Hospital Revenue Code	360
Rate for Payer: Cash Price	$6,404.64

CHOLANGIO+INJ NEW

Facility

$7,278.00

Service Code	CPT 47532
Hospital Charge Code	4617532
Hospital Revenue Code	360
Min. Negotiated Rate	$655.02
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$4,635.00
Rate for Payer: Aetna Medicare	$4,746.03
Rate for Payer: Amerigroup CHIP/Medicaid	$655.02
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,164.02
Rate for Payer: Amerigroup Medicare	$3,164.02
Rate for Payer: BCBS of TX Blue Advantage	$5,192.60
Rate for Payer: BCBS of TX Blue Essentials	$6,218.68
Rate for Payer: BCBS of TX Medicare	$3,164.02
Rate for Payer: BCBS of TX PPO	$7,835.54
Rate for Payer: Cash Price	$6,404.64
Rate for Payer: Cash Price	$6,404.64
Rate for Payer: Cash Price	$6,404.64
Rate for Payer: Cigna Commercial	$7,167.43
Rate for Payer: Cigna Medicare	$3,164.02
Rate for Payer: Employer Direct Commercial	$3,164.02
Rate for Payer: Humana Medicare/TRICARE	$3,164.02
Rate for Payer: Molina Dual Medicare/Medicaid	$3,164.02
Rate for Payer: Molina Medicare	$3,164.02
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Scott and White EPO/PPO	$5,853.44
Rate for Payer: Scott and White Medicare	$3,164.02
Rate for Payer: Superior Health Plan EPO	$3,164.02
Rate for Payer: Superior Health Plan Medicare	$3,164.02
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,164.02
Rate for Payer: Universal American Medicare	$3,164.02
Rate for Payer: Wellcare Medicare	$3,164.02
Rate for Payer: Wellmed Medicare	$3,164.02

cholecalciferol 1,000 intl units Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77464294
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$4.97
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.29
Rate for Payer: BCBS of TX Blue Essentials	$2.75
Rate for Payer: BCBS of TX PPO	$3.06
Rate for Payer: Cash Price	$5.20
Rate for Payer: Multiplan Auto	$4.97
Rate for Payer: Multiplan Commercial	$4.97
Rate for Payer: Multiplan Workers Comp	$4.97
Rate for Payer: Scott and White EPO/PPO	$3.83
Rate for Payer: Superior Health Plan EPO	$1.04

cholecalciferol 1,000 intl units Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77464294
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC

Facility

$25,448.30

Service Code	MSDRG 415
Min. Negotiated Rate	$17,402.10
Max. Negotiated Rate	$25,448.30
Rate for Payer: Aetna Commercial	$22,227.75
Rate for Payer: Aetna Medicare	$25,431.31
Rate for Payer: BCBS of TX Blue Advantage	$17,402.10
Rate for Payer: BCBS of TX Blue Essentials	$20,832.00
Rate for Payer: BCBS of TX PPO	$23,147.56
Rate for Payer: Cigna Commercial	$25,448.30

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC

Facility

$45,404.58

Service Code	MSDRG 414
Min. Negotiated Rate	$30,181.70
Max. Negotiated Rate	$45,404.58
Rate for Payer: Aetna Commercial	$39,658.50
Rate for Payer: Aetna Medicare	$42,016.23
Rate for Payer: BCBS of TX Blue Advantage	$30,181.70
Rate for Payer: BCBS of TX Blue Essentials	$36,913.13
Rate for Payer: BCBS of TX PPO	$41,016.18
Rate for Payer: Cigna Commercial	$45,404.58

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$18,617.10

Service Code	MSDRG 416
Min. Negotiated Rate	$11,402.74
Max. Negotiated Rate	$18,617.10
Rate for Payer: Aetna Commercial	$15,066.00
Rate for Payer: Aetna Medicare	$18,617.10
Rate for Payer: BCBS of TX Blue Advantage	$11,402.74
Rate for Payer: BCBS of TX Blue Essentials	$14,375.40
Rate for Payer: BCBS of TX PPO	$15,973.28
Rate for Payer: Cigna Commercial	$17,248.90

CHOLECYSTECTOMY WITH C.D.E. WITH CC

Facility

$27,310.87

Service Code	MSDRG 412
Min. Negotiated Rate	$20,400.92
Max. Negotiated Rate	$27,310.87
Rate for Payer: Aetna Commercial	$23,011.88
Rate for Payer: Aetna Medicare	$26,397.88
Rate for Payer: BCBS of TX Blue Advantage	$20,400.92
Rate for Payer: BCBS of TX Blue Essentials	$24,578.83
Rate for Payer: BCBS of TX PPO	$27,310.87
Rate for Payer: Cigna Commercial	$26,346.04

Know your out-of-pocket cost for care.

All Charges