White Rock Medical Center

All Charges

Charge

Type

Setting

Price

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC

Facility

$19,600.80

Service Code	MSDRG 818
Min. Negotiated Rate	$13,197.38
Max. Negotiated Rate	$19,600.80
Rate for Payer: Aetna Commercial	$13,197.38
Rate for Payer: Aetna Medicare	$19,600.80
Rate for Payer: BCBS of TX Blue Essentials	$14,018.36
Rate for Payer: BCBS of TX PPO	$15,576.56
Rate for Payer: Cigna Commercial	$15,109.53

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC

Facility

$34,433.44

Service Code	MSDRG 817
Min. Negotiated Rate	$25,368.75
Max. Negotiated Rate	$34,433.44
Rate for Payer: Aetna Commercial	$25,368.75
Rate for Payer: Aetna Medicare	$34,433.44
Rate for Payer: BCBS of TX Blue Essentials	$26,124.61
Rate for Payer: BCBS of TX PPO	$29,028.47
Rate for Payer: Cigna Commercial	$29,044.40

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$13,992.90

Service Code	MSDRG 819
Min. Negotiated Rate	$8,657.64
Max. Negotiated Rate	$13,992.90
Rate for Payer: Aetna Commercial	$10,206.00
Rate for Payer: Aetna Medicare	$13,992.90
Rate for Payer: BCBS of TX Blue Essentials	$8,657.64
Rate for Payer: BCBS of TX PPO	$9,619.97
Rate for Payer: Cigna Commercial	$11,684.74

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC

Facility

$12,178.56

Service Code	MSDRG 832
Min. Negotiated Rate	$7,417.30
Max. Negotiated Rate	$12,178.56
Rate for Payer: Aetna Commercial	$8,299.12
Rate for Payer: Aetna Medicare	$12,178.56
Rate for Payer: BCBS of TX Blue Essentials	$7,417.30
Rate for Payer: BCBS of TX PPO	$8,241.76
Rate for Payer: Cigna Commercial	$9,501.58

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC

Facility

$15,792.27

Service Code	MSDRG 831
Min. Negotiated Rate	$10,608.96
Max. Negotiated Rate	$15,792.27
Rate for Payer: Aetna Commercial	$11,360.25
Rate for Payer: Aetna Medicare	$15,792.27
Rate for Payer: BCBS of TX Blue Essentials	$10,608.96
Rate for Payer: BCBS of TX PPO	$11,788.19
Rate for Payer: Cigna Commercial	$13,006.22

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$9,760.51

Service Code	MSDRG 833
Min. Negotiated Rate	$4,956.22
Max. Negotiated Rate	$9,760.51
Rate for Payer: Aetna Commercial	$5,757.75
Rate for Payer: Aetna Medicare	$9,760.51
Rate for Payer: BCBS of TX Blue Essentials	$4,956.22
Rate for Payer: BCBS of TX PPO	$5,507.12
Rate for Payer: Cigna Commercial	$6,591.98

OTHER CARDIOTHORACIC PROCEDURES WITH MCC

Facility

$75,402.71

Service Code	MSDRG 228
Min. Negotiated Rate	$56,685.38
Max. Negotiated Rate	$75,402.71
Rate for Payer: Aetna Commercial	$56,685.38
Rate for Payer: Aetna Medicare	$58,216.88
Rate for Payer: BCBS of TX Blue Advantage	$60,947.34
Rate for Payer: BCBS of TX Blue Essentials	$67,859.81
Rate for Payer: BCBS of TX PPO	$75,402.71
Rate for Payer: Cigna Commercial	$64,898.46

OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC

Facility

$53,298.55

Service Code	MSDRG 229
Min. Negotiated Rate	$35,770.50
Max. Negotiated Rate	$53,298.55
Rate for Payer: Aetna Commercial	$35,770.50
Rate for Payer: Aetna Medicare	$38,316.89
Rate for Payer: BCBS of TX Blue Advantage	$40,814.74
Rate for Payer: BCBS of TX Blue Essentials	$47,966.84
Rate for Payer: BCBS of TX PPO	$53,298.55
Rate for Payer: Cigna Commercial	$40,953.25

OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC

Facility

$14,636.22

Service Code	MSDRG 315
Min. Negotiated Rate	$8,348.88
Max. Negotiated Rate	$14,636.22
Rate for Payer: Aetna Commercial	$10,882.12
Rate for Payer: Aetna Medicare	$14,636.22
Rate for Payer: BCBS of TX Blue Advantage	$8,348.88
Rate for Payer: BCBS of TX Blue Essentials	$9,863.93
Rate for Payer: BCBS of TX PPO	$10,960.35
Rate for Payer: Cigna Commercial	$12,458.82

OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC

Facility

$26,964.28

Service Code	MSDRG 314
Min. Negotiated Rate	$16,865.46
Max. Negotiated Rate	$26,964.28
Rate for Payer: Aetna Commercial	$23,551.88
Rate for Payer: Aetna Medicare	$26,691.19
Rate for Payer: BCBS of TX Blue Advantage	$16,865.46
Rate for Payer: BCBS of TX Blue Essentials	$20,876.37
Rate for Payer: BCBS of TX PPO	$23,196.86
Rate for Payer: Cigna Commercial	$26,964.28

OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$11,696.88

Service Code	MSDRG 316
Min. Negotiated Rate	$5,817.90
Max. Negotiated Rate	$11,696.88
Rate for Payer: Aetna Commercial	$7,792.88
Rate for Payer: Aetna Medicare	$11,696.88
Rate for Payer: BCBS of TX Blue Advantage	$5,817.90
Rate for Payer: BCBS of TX Blue Essentials	$7,752.66
Rate for Payer: BCBS of TX PPO	$8,614.41
Rate for Payer: Cigna Commercial	$8,921.98

OTHER CIRCULATORY SYSTEM O.R. PROCEDURES

Facility

$42,066.08

Service Code	MSDRG 264
Min. Negotiated Rate	$25,401.82
Max. Negotiated Rate	$42,066.08
Rate for Payer: Aetna Commercial	$36,742.50
Rate for Payer: Aetna Medicare	$39,241.71
Rate for Payer: BCBS of TX Blue Advantage	$25,401.82
Rate for Payer: BCBS of TX Blue Essentials	$32,593.59
Rate for Payer: BCBS of TX PPO	$36,216.51
Rate for Payer: Cigna Commercial	$42,066.08

OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC

Facility

$14,310.83

Service Code	MSDRG 394
Min. Negotiated Rate	$8,041.86
Max. Negotiated Rate	$14,310.83
Rate for Payer: Aetna Commercial	$10,540.12
Rate for Payer: Aetna Medicare	$14,310.83
Rate for Payer: BCBS of TX Blue Advantage	$8,041.86
Rate for Payer: BCBS of TX Blue Essentials	$9,711.21
Rate for Payer: BCBS of TX PPO	$10,790.65
Rate for Payer: Cigna Commercial	$12,067.27

OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC

Facility

$21,618.51

Service Code	MSDRG 393
Min. Negotiated Rate	$14,380.06
Max. Negotiated Rate	$21,618.51
Rate for Payer: Aetna Commercial	$18,220.50
Rate for Payer: Aetna Medicare	$21,618.51
Rate for Payer: BCBS of TX Blue Advantage	$14,380.06
Rate for Payer: BCBS of TX Blue Essentials	$16,846.80
Rate for Payer: BCBS of TX PPO	$18,719.39
Rate for Payer: Cigna Commercial	$20,860.45

OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$11,213.07

Service Code	MSDRG 395
Min. Negotiated Rate	$5,672.56
Max. Negotiated Rate	$11,213.07
Rate for Payer: Aetna Commercial	$7,284.38
Rate for Payer: Aetna Medicare	$11,213.07
Rate for Payer: BCBS of TX Blue Advantage	$5,672.56
Rate for Payer: BCBS of TX Blue Essentials	$6,980.80
Rate for Payer: BCBS of TX PPO	$7,756.75
Rate for Payer: Cigna Commercial	$8,339.80

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC

Facility

$28,294.78

Service Code	MSDRG 357
Min. Negotiated Rate	$17,844.14
Max. Negotiated Rate	$28,294.78
Rate for Payer: Aetna Commercial	$24,714.00
Rate for Payer: Aetna Medicare	$27,796.92
Rate for Payer: BCBS of TX Blue Advantage	$17,844.14
Rate for Payer: BCBS of TX Blue Essentials	$22,048.61
Rate for Payer: BCBS of TX PPO	$24,499.40
Rate for Payer: Cigna Commercial	$28,294.78

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC

Facility

$55,109.66

Service Code	MSDRG 356
Min. Negotiated Rate	$33,112.58
Max. Negotiated Rate	$55,109.66
Rate for Payer: Aetna Commercial	$48,135.38
Rate for Payer: Aetna Medicare	$50,081.76
Rate for Payer: BCBS of TX Blue Advantage	$33,112.58
Rate for Payer: BCBS of TX Blue Essentials	$41,025.25
Rate for Payer: BCBS of TX PPO	$45,585.38
Rate for Payer: Cigna Commercial	$55,109.66

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$17,995.20

Service Code	MSDRG 358
Min. Negotiated Rate	$11,653.00
Max. Negotiated Rate	$17,995.20
Rate for Payer: Aetna Commercial	$14,412.38
Rate for Payer: Aetna Medicare	$17,995.20
Rate for Payer: BCBS of TX Blue Advantage	$11,653.00
Rate for Payer: BCBS of TX Blue Essentials	$13,913.11
Rate for Payer: BCBS of TX PPO	$15,459.61
Rate for Payer: Cigna Commercial	$16,500.57

OTHER DISORDERS OF NERVOUS SYSTEM WITH CC

Facility

$15,265.62

Service Code	MSDRG 092
Min. Negotiated Rate	$7,912.86
Max. Negotiated Rate	$15,265.62
Rate for Payer: Aetna Commercial	$11,543.62
Rate for Payer: Aetna Medicare	$15,265.62
Rate for Payer: BCBS of TX Blue Advantage	$7,912.86
Rate for Payer: BCBS of TX Blue Essentials	$9,733.91
Rate for Payer: BCBS of TX PPO	$10,815.88
Rate for Payer: Cigna Commercial	$13,216.17

OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC

Facility

$23,433.93

Service Code	MSDRG 091
Min. Negotiated Rate	$13,557.04
Max. Negotiated Rate	$23,433.93
Rate for Payer: Aetna Commercial	$20,128.50
Rate for Payer: Aetna Medicare	$23,433.93
Rate for Payer: BCBS of TX Blue Advantage	$13,557.04
Rate for Payer: BCBS of TX Blue Essentials	$16,634.23
Rate for Payer: BCBS of TX PPO	$18,483.19
Rate for Payer: Cigna Commercial	$23,044.90

OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$12,571.41

Service Code	MSDRG 093
Min. Negotiated Rate	$6,075.04
Max. Negotiated Rate	$12,571.41
Rate for Payer: Aetna Commercial	$8,712.00
Rate for Payer: Aetna Medicare	$12,571.41
Rate for Payer: BCBS of TX Blue Advantage	$6,075.04
Rate for Payer: BCBS of TX Blue Essentials	$7,613.36
Rate for Payer: BCBS of TX PPO	$8,459.61
Rate for Payer: Cigna Commercial	$9,974.27

OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT

Facility

$18,431.91

Service Code	MSDRG 124
Min. Negotiated Rate	$10,545.32
Max. Negotiated Rate	$18,431.91
Rate for Payer: Aetna Commercial	$14,871.38
Rate for Payer: Aetna Medicare	$18,431.91
Rate for Payer: BCBS of TX Blue Advantage	$10,545.32
Rate for Payer: BCBS of TX Blue Essentials	$13,737.68
Rate for Payer: BCBS of TX PPO	$15,264.69
Rate for Payer: Cigna Commercial	$17,026.07

OTHER DISORDERS OF THE EYE WITHOUT MCC

Facility

$12,818.68

Service Code	MSDRG 125
Min. Negotiated Rate	$6,511.92
Max. Negotiated Rate	$12,818.68
Rate for Payer: Aetna Commercial	$8,971.88
Rate for Payer: Aetna Medicare	$12,818.68
Rate for Payer: BCBS of TX Blue Advantage	$6,511.92
Rate for Payer: BCBS of TX Blue Essentials	$8,360.45
Rate for Payer: BCBS of TX PPO	$9,289.75
Rate for Payer: Cigna Commercial	$10,271.80

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC

Facility

$14,414.66

Service Code	MSDRG 155
Min. Negotiated Rate	$7,659.16
Max. Negotiated Rate	$14,414.66
Rate for Payer: Aetna Commercial	$10,649.25
Rate for Payer: Aetna Medicare	$14,414.66
Rate for Payer: BCBS of TX Blue Advantage	$7,659.16
Rate for Payer: BCBS of TX Blue Essentials	$9,114.77
Rate for Payer: BCBS of TX PPO	$10,127.92
Rate for Payer: Cigna Commercial	$12,192.21

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC

Facility

$20,747.21

Service Code	MSDRG 154
Min. Negotiated Rate	$12,243.82
Max. Negotiated Rate	$20,747.21
Rate for Payer: Aetna Commercial	$17,304.75
Rate for Payer: Aetna Medicare	$20,747.21
Rate for Payer: BCBS of TX Blue Advantage	$12,243.82
Rate for Payer: BCBS of TX Blue Essentials	$14,926.43
Rate for Payer: BCBS of TX PPO	$16,585.57
Rate for Payer: Cigna Commercial	$19,812.02

Know your out-of-pocket cost for care.

All Charges