White Rock Medical Center

All Charges

Charge

Type

Setting

Price

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC

Facility

$17,174.16

Service Code	MSDRG 809
Min. Negotiated Rate	$10,362.14
Max. Negotiated Rate	$17,174.16
Rate for Payer: Aetna Commercial	$13,549.50
Rate for Payer: Aetna Medicare	$17,174.16
Rate for Payer: BCBS of TX Blue Advantage	$10,362.14
Rate for Payer: BCBS of TX Blue Essentials	$12,429.24
Rate for Payer: BCBS of TX PPO	$13,810.80
Rate for Payer: Cigna Commercial	$15,512.67

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC

Facility

$28,208.49

Service Code	MSDRG 808
Min. Negotiated Rate	$18,682.64
Max. Negotiated Rate	$28,208.49
Rate for Payer: Aetna Commercial	$24,638.62
Rate for Payer: Aetna Medicare	$27,725.21
Rate for Payer: BCBS of TX Blue Advantage	$18,682.64
Rate for Payer: BCBS of TX Blue Essentials	$22,177.59
Rate for Payer: BCBS of TX PPO	$24,642.73
Rate for Payer: Cigna Commercial	$28,208.49

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC

Facility

$15,034.42

Service Code	MSDRG 810
Min. Negotiated Rate	$8,072.82
Max. Negotiated Rate	$15,034.42
Rate for Payer: Aetna Commercial	$11,300.62
Rate for Payer: Aetna Medicare	$15,034.42
Rate for Payer: BCBS of TX Blue Advantage	$8,072.82
Rate for Payer: BCBS of TX Blue Essentials	$9,514.12
Rate for Payer: BCBS of TX PPO	$10,571.65
Rate for Payer: Cigna Commercial	$12,937.96

MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT

Facility

$42,887.82

Service Code	MSDRG 469
Min. Negotiated Rate	$28,299.16
Max. Negotiated Rate	$42,887.82
Rate for Payer: Aetna Commercial	$37,460.25
Rate for Payer: Aetna Medicare	$39,924.64
Rate for Payer: BCBS of TX Blue Advantage	$28,299.16
Rate for Payer: BCBS of TX Blue Essentials	$32,754.57
Rate for Payer: BCBS of TX PPO	$36,395.38
Rate for Payer: Cigna Commercial	$42,887.82

MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC

Facility

$24,424.06

Service Code	MSDRG 470
Min. Negotiated Rate	$17,777.06
Max. Negotiated Rate	$24,424.06
Rate for Payer: Aetna Commercial	$21,169.12
Rate for Payer: Aetna Medicare	$24,424.06
Rate for Payer: BCBS of TX Blue Advantage	$17,777.06
Rate for Payer: BCBS of TX Blue Essentials	$20,532.75
Rate for Payer: BCBS of TX PPO	$22,815.05
Rate for Payer: Cigna Commercial	$24,236.30

MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES

Facility

$31,996.50

Service Code	MSDRG 483
Min. Negotiated Rate	$20,723.42
Max. Negotiated Rate	$31,996.50
Rate for Payer: Aetna Commercial	$27,947.25
Rate for Payer: Aetna Medicare	$30,873.27
Rate for Payer: BCBS of TX Blue Advantage	$20,723.42
Rate for Payer: BCBS of TX Blue Essentials	$24,595.34
Rate for Payer: BCBS of TX PPO	$27,329.21
Rate for Payer: Cigna Commercial	$31,996.50

MAJOR MALE PELVIC PROCEDURES WITH CC/MCC

Facility

$25,282.50

Service Code	MSDRG 707
Min. Negotiated Rate	$15,558.26
Max. Negotiated Rate	$25,282.50
Rate for Payer: Aetna Commercial	$22,071.38
Rate for Payer: Aetna Medicare	$25,282.50
Rate for Payer: BCBS of TX Blue Advantage	$15,558.26
Rate for Payer: BCBS of TX Blue Essentials	$18,485.46
Rate for Payer: BCBS of TX PPO	$20,540.19
Rate for Payer: Cigna Commercial	$25,269.27

MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC

Facility

$19,894.08

Service Code	MSDRG 708
Min. Negotiated Rate	$11,589.36
Max. Negotiated Rate	$19,894.08
Rate for Payer: Aetna Commercial	$16,408.12
Rate for Payer: Aetna Medicare	$19,894.08
Rate for Payer: BCBS of TX Blue Advantage	$11,589.36
Rate for Payer: BCBS of TX Blue Essentials	$14,513.67
Rate for Payer: BCBS of TX PPO	$16,126.93
Rate for Payer: Cigna Commercial	$18,785.48

MAJOR PROCEDURE - BREAST

Facility

$10,000.00

Service Code	CPT 19328
Hospital Charge Code	36019328
Hospital Revenue Code	360
Min. Negotiated Rate	$963.66
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$4,635.00
Rate for Payer: Aetna Medicare	$5,229.02
Rate for Payer: Amerigroup CHIP/Medicaid	$963.66
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,486.01
Rate for Payer: Amerigroup Medicare	$3,486.01
Rate for Payer: BCBS of TX Blue Advantage	$5,059.35
Rate for Payer: BCBS of TX Blue Essentials	$6,059.10
Rate for Payer: BCBS of TX Medicare	$3,486.01
Rate for Payer: BCBS of TX PPO	$7,634.47
Rate for Payer: Cigna Commercial	$7,896.82
Rate for Payer: Cigna Medicaid	$963.66
Rate for Payer: Cigna Medicare	$3,486.01
Rate for Payer: Employer Direct Commercial	$3,486.01
Rate for Payer: Humana Medicare/TRICARE	$3,486.01
Rate for Payer: Molina CHIP/Medicaid	$963.66
Rate for Payer: Molina Dual Medicare/Medicaid	$3,486.01
Rate for Payer: Molina Medicare	$3,486.01
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	$963.66
Rate for Payer: Scott and White EPO/PPO	$6,449.12
Rate for Payer: Scott and White Medicare	$3,486.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$963.66
Rate for Payer: Superior Health Plan EPO	$3,486.01
Rate for Payer: Superior Health Plan Medicare	$3,486.01
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,486.01
Rate for Payer: Universal American Medicare	$3,486.01
Rate for Payer: Wellcare Medicare	$3,486.01
Rate for Payer: Wellmed Medicare	$3,486.01

MAJOR PROCEDURE, ORTHOPEDIC - OTHER

Facility

$10,000.00

Service Code	CPT 22852
Hospital Charge Code	36022852
Hospital Revenue Code	360
Min. Negotiated Rate	$875.88
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$7,210.00
Rate for Payer: BCBS of TX Blue Advantage	$1,216.34
Rate for Payer: BCBS of TX Blue Essentials	$1,456.70
Rate for Payer: BCBS of TX PPO	$1,835.44
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	$875.88

MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC

Facility

$27,456.30

Service Code	MSDRG 507
Min. Negotiated Rate	$16,791.50
Max. Negotiated Rate	$27,456.30
Rate for Payer: Aetna Commercial	$23,981.62
Rate for Payer: Aetna Medicare	$27,100.08
Rate for Payer: BCBS of TX Blue Advantage	$16,791.50
Rate for Payer: BCBS of TX Blue Essentials	$20,044.66
Rate for Payer: BCBS of TX PPO	$22,272.71
Rate for Payer: Cigna Commercial	$27,456.30

MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC

Facility

$19,631.83

Service Code	MSDRG 508
Min. Negotiated Rate	$14,491.00
Max. Negotiated Rate	$19,631.83
Rate for Payer: Aetna Commercial	$16,132.50
Rate for Payer: Aetna Medicare	$19,631.83
Rate for Payer: BCBS of TX Blue Advantage	$14,491.00
Rate for Payer: BCBS of TX Blue Essentials	$14,935.72
Rate for Payer: BCBS of TX PPO	$16,595.89
Rate for Payer: Cigna Commercial	$18,469.92

MAJOR SKIN DISORDERS WITH MCC

Facility

$28,014.00

Service Code	MSDRG 595
Min. Negotiated Rate	$17,374.58
Max. Negotiated Rate	$28,014.00
Rate for Payer: Aetna Commercial	$24,468.75
Rate for Payer: Aetna Medicare	$27,563.58
Rate for Payer: BCBS of TX Blue Advantage	$17,374.58
Rate for Payer: BCBS of TX Blue Essentials	$20,502.82
Rate for Payer: BCBS of TX PPO	$22,781.80
Rate for Payer: Cigna Commercial	$28,014.00

MAJOR SKIN DISORDERS WITHOUT MCC

Facility

$15,082.60

Service Code	MSDRG 596
Min. Negotiated Rate	$8,317.06
Max. Negotiated Rate	$15,082.60
Rate for Payer: Aetna Commercial	$11,351.25
Rate for Payer: Aetna Medicare	$15,082.60
Rate for Payer: BCBS of TX Blue Advantage	$8,317.06
Rate for Payer: BCBS of TX Blue Essentials	$10,437.67
Rate for Payer: BCBS of TX PPO	$11,597.86
Rate for Payer: Cigna Commercial	$12,995.92

MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC

Facility

$30,552.65

Service Code	MSDRG 330
Min. Negotiated Rate	$21,848.30
Max. Negotiated Rate	$30,552.65
Rate for Payer: Aetna Commercial	$26,686.12
Rate for Payer: Aetna Medicare	$29,673.31
Rate for Payer: BCBS of TX Blue Advantage	$21,848.30
Rate for Payer: BCBS of TX Blue Essentials	$26,037.93
Rate for Payer: BCBS of TX PPO	$28,932.16
Rate for Payer: Cigna Commercial	$30,552.65

MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC

Facility

$58,176.38

Service Code	MSDRG 329
Min. Negotiated Rate	$42,666.32
Max. Negotiated Rate	$58,176.38
Rate for Payer: Aetna Commercial	$50,814.00
Rate for Payer: Aetna Medicare	$52,630.39
Rate for Payer: BCBS of TX Blue Advantage	$42,666.32
Rate for Payer: BCBS of TX Blue Essentials	$51,519.67
Rate for Payer: BCBS of TX PPO	$57,246.30
Rate for Payer: Cigna Commercial	$58,176.38

MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility

$22,179.42

Service Code	MSDRG 331
Min. Negotiated Rate	$14,295.78
Max. Negotiated Rate	$22,179.42
Rate for Payer: Aetna Commercial	$18,810.00
Rate for Payer: Aetna Medicare	$22,179.42
Rate for Payer: BCBS of TX Blue Advantage	$14,295.78
Rate for Payer: BCBS of TX Blue Essentials	$17,487.61
Rate for Payer: BCBS of TX PPO	$19,431.43
Rate for Payer: Cigna Commercial	$21,535.36

MAJOR THUMB OR JOINT PROCEDURES

Facility

$19,937.99

Service Code	MSDRG 506
Min. Negotiated Rate	$11,351.14
Max. Negotiated Rate	$19,937.99
Rate for Payer: Aetna Commercial	$16,454.25
Rate for Payer: Aetna Medicare	$19,937.99
Rate for Payer: BCBS of TX Blue Advantage	$11,351.14
Rate for Payer: BCBS of TX Blue Essentials	$14,552.89
Rate for Payer: BCBS of TX PPO	$16,170.50
Rate for Payer: Cigna Commercial	$18,838.29

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC

Facility

$15,892.91

Service Code	MSDRG 755
Min. Negotiated Rate	$9,653.50
Max. Negotiated Rate	$15,892.91
Rate for Payer: Aetna Commercial	$12,202.88
Rate for Payer: Aetna Medicare	$15,892.91
Rate for Payer: BCBS of TX Blue Advantage	$9,653.50
Rate for Payer: BCBS of TX Blue Essentials	$11,040.30
Rate for Payer: BCBS of TX PPO	$12,267.47
Rate for Payer: Cigna Commercial	$13,970.94

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$24,111.49

Service Code	MSDRG 754
Min. Negotiated Rate	$16,432.02
Max. Negotiated Rate	$24,111.49
Rate for Payer: Aetna Commercial	$20,840.62
Rate for Payer: Aetna Medicare	$24,111.49
Rate for Payer: BCBS of TX Blue Advantage	$16,432.02
Rate for Payer: BCBS of TX Blue Essentials	$19,001.41
Rate for Payer: BCBS of TX PPO	$21,113.49
Rate for Payer: Cigna Commercial	$23,860.20

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$14,876.01

Service Code	MSDRG 756
Min. Negotiated Rate	$5,754.26
Max. Negotiated Rate	$14,876.01
Rate for Payer: Aetna Commercial	$11,134.12
Rate for Payer: Aetna Medicare	$14,876.01
Rate for Payer: BCBS of TX Blue Advantage	$5,754.26
Rate for Payer: BCBS of TX Blue Essentials	$8,049.85
Rate for Payer: BCBS of TX PPO	$8,944.63
Rate for Payer: Cigna Commercial	$12,747.34

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC

Facility

$16,209.72

Service Code	MSDRG 723
Min. Negotiated Rate	$9,328.42
Max. Negotiated Rate	$16,209.72
Rate for Payer: Aetna Commercial	$12,535.88
Rate for Payer: Aetna Medicare	$16,209.72
Rate for Payer: BCBS of TX Blue Advantage	$9,328.42
Rate for Payer: BCBS of TX Blue Essentials	$11,366.38
Rate for Payer: BCBS of TX PPO	$12,629.80
Rate for Payer: Cigna Commercial	$14,352.18

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$24,350.19

Service Code	MSDRG 722
Min. Negotiated Rate	$14,546.04
Max. Negotiated Rate	$24,350.19
Rate for Payer: Aetna Commercial	$21,091.50
Rate for Payer: Aetna Medicare	$24,350.19
Rate for Payer: BCBS of TX Blue Advantage	$14,546.04
Rate for Payer: BCBS of TX Blue Essentials	$17,126.44
Rate for Payer: BCBS of TX PPO	$19,030.12
Rate for Payer: Cigna Commercial	$24,147.42

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$12,947.11

Service Code	MSDRG 724
Min. Negotiated Rate	$6,326.16
Max. Negotiated Rate	$12,947.11
Rate for Payer: Aetna Commercial	$9,106.88
Rate for Payer: Aetna Medicare	$12,947.11
Rate for Payer: BCBS of TX Blue Advantage	$6,326.16
Rate for Payer: BCBS of TX Blue Essentials	$7,111.85
Rate for Payer: BCBS of TX PPO	$7,902.37
Rate for Payer: Cigna Commercial	$10,426.36

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC

Facility

$16,064.16

Service Code	MSDRG 436
Min. Negotiated Rate	$9,834.10
Max. Negotiated Rate	$16,064.16
Rate for Payer: Aetna Commercial	$12,382.88
Rate for Payer: Aetna Medicare	$16,064.16
Rate for Payer: BCBS of TX Blue Advantage	$9,834.10
Rate for Payer: BCBS of TX Blue Essentials	$11,721.35
Rate for Payer: BCBS of TX PPO	$13,024.23
Rate for Payer: Cigna Commercial	$14,177.02

Know your out-of-pocket cost for care.

All Charges