White Rock Medical Center

All Charges

Charge

Type

Setting

Price

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC

Facility

$11,298.70

Service Code	MSDRG 156
Min. Negotiated Rate	$5,723.30
Max. Negotiated Rate	$11,298.70
Rate for Payer: Aetna Commercial	$7,374.38
Rate for Payer: Aetna Medicare	$11,298.70
Rate for Payer: BCBS of TX Blue Advantage	$5,723.30
Rate for Payer: BCBS of TX Blue Essentials	$6,809.51
Rate for Payer: BCBS of TX PPO	$7,566.41
Rate for Payer: Cigna Commercial	$8,442.84

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC

Facility

$22,805.61

Service Code	MSDRG 144
Min. Negotiated Rate	$19,468.12
Max. Negotiated Rate	$22,805.61
Rate for Payer: Aetna Commercial	$19,468.12
Rate for Payer: Aetna Medicare	$22,805.61
Rate for Payer: Cigna Commercial	$22,288.84

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC

Facility

$42,833.73

Service Code	MSDRG 143
Min. Negotiated Rate	$37,413.00
Max. Negotiated Rate	$42,833.73
Rate for Payer: Aetna Commercial	$37,413.00
Rate for Payer: Aetna Medicare	$39,879.71
Rate for Payer: Cigna Commercial	$42,833.73

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$17,352.94

Service Code	MSDRG 145
Min. Negotiated Rate	$13,737.38
Max. Negotiated Rate	$17,352.94
Rate for Payer: Aetna Commercial	$13,737.38
Rate for Payer: Aetna Medicare	$17,352.94
Rate for Payer: Cigna Commercial	$15,727.77

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC

Facility

$29,144.86

Service Code	MSDRG 629
Min. Negotiated Rate	$18,666.30
Max. Negotiated Rate	$29,144.86
Rate for Payer: Aetna Commercial	$25,456.50
Rate for Payer: Aetna Medicare	$28,503.40
Rate for Payer: BCBS of TX Blue Advantage	$18,666.30
Rate for Payer: BCBS of TX Blue Essentials	$24,133.05
Rate for Payer: BCBS of TX PPO	$26,815.53
Rate for Payer: Cigna Commercial	$29,144.86

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC

Facility

$51,706.76

Service Code	MSDRG 628
Min. Negotiated Rate	$28,808.28
Max. Negotiated Rate	$51,706.76
Rate for Payer: Aetna Commercial	$45,163.12
Rate for Payer: Aetna Medicare	$47,253.74
Rate for Payer: BCBS of TX Blue Advantage	$28,808.28
Rate for Payer: BCBS of TX Blue Essentials	$37,922.32
Rate for Payer: BCBS of TX PPO	$42,137.55
Rate for Payer: Cigna Commercial	$51,706.76

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC

Facility

$19,228.29

Service Code	MSDRG 630
Min. Negotiated Rate	$12,947.30
Max. Negotiated Rate	$19,228.29
Rate for Payer: Aetna Commercial	$15,708.38
Rate for Payer: Aetna Medicare	$19,228.29
Rate for Payer: BCBS of TX Blue Advantage	$12,947.30
Rate for Payer: BCBS of TX Blue Essentials	$15,834.51
Rate for Payer: BCBS of TX PPO	$17,594.58
Rate for Payer: Cigna Commercial	$17,984.34

OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC

Facility

$56,181.27

Service Code	MSDRG 319
Min. Negotiated Rate	$49,071.38
Max. Negotiated Rate	$56,181.27
Rate for Payer: Aetna Commercial	$49,071.38
Rate for Payer: Aetna Medicare	$50,972.34
Rate for Payer: Cigna Commercial	$56,181.27

OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC

Facility

$28,670.88

Service Code	MSDRG 320
Min. Negotiated Rate	$25,042.50
Max. Negotiated Rate	$28,670.88
Rate for Payer: Aetna Commercial	$25,042.50
Rate for Payer: Aetna Medicare	$28,109.47
Rate for Payer: Cigna Commercial	$28,670.88

OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$10,597.58

Service Code	MSDRG 951
Min. Negotiated Rate	$6,637.50
Max. Negotiated Rate	$10,597.58
Rate for Payer: Aetna Commercial	$6,637.50
Rate for Payer: Aetna Medicare	$10,597.58
Rate for Payer: BCBS of TX Blue Advantage	$7,949.84
Rate for Payer: BCBS of TX Blue Essentials	$8,238.69
Rate for Payer: BCBS of TX PPO	$9,154.45
Rate for Payer: Cigna Commercial	$7,599.20

OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC

Facility

$32,421.54

Service Code	MSDRG 749
Min. Negotiated Rate	$23,693.00
Max. Negotiated Rate	$32,421.54
Rate for Payer: Aetna Commercial	$28,318.50
Rate for Payer: Aetna Medicare	$31,226.49
Rate for Payer: BCBS of TX Blue Advantage	$23,693.00
Rate for Payer: BCBS of TX Blue Essentials	$26,850.04
Rate for Payer: BCBS of TX PPO	$29,834.53
Rate for Payer: Cigna Commercial	$32,421.54

OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$18,839.73

Service Code	MSDRG 750
Min. Negotiated Rate	$11,173.98
Max. Negotiated Rate	$18,839.73
Rate for Payer: Aetna Commercial	$15,300.00
Rate for Payer: Aetna Medicare	$18,839.73
Rate for Payer: BCBS of TX Blue Advantage	$11,173.98
Rate for Payer: BCBS of TX Blue Essentials	$12,629.42
Rate for Payer: BCBS of TX PPO	$14,033.24
Rate for Payer: Cigna Commercial	$17,516.80

OTHER HEART ASSIST SYSTEM IMPLANT

Facility

$147,752.02

Service Code	MSDRG 215
Min. Negotiated Rate	$113,622.30
Max. Negotiated Rate	$147,752.02
Rate for Payer: Aetna Commercial	$114,916.50
Rate for Payer: Aetna Medicare	$113,622.30
Rate for Payer: BCBS of TX Blue Advantage	$138,525.36
Rate for Payer: BCBS of TX Blue Essentials	$132,971.67
Rate for Payer: BCBS of TX PPO	$147,752.02
Rate for Payer: Cigna Commercial	$131,566.62

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC

Facility

$27,100.08

Service Code	MSDRG 424
Min. Negotiated Rate	$20,255.58
Max. Negotiated Rate	$27,100.08
Rate for Payer: Aetna Commercial	$23,482.12
Rate for Payer: Aetna Medicare	$27,100.08
Rate for Payer: BCBS of TX Blue Advantage	$20,255.58
Rate for Payer: BCBS of TX Blue Essentials	$22,609.96
Rate for Payer: BCBS of TX PPO	$25,123.15
Rate for Payer: Cigna Commercial	$26,884.42

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC

Facility

$50,372.39

Service Code	MSDRG 423
Min. Negotiated Rate	$38,542.62
Max. Negotiated Rate	$50,372.39
Rate for Payer: Aetna Commercial	$43,997.62
Rate for Payer: Aetna Medicare	$46,144.79
Rate for Payer: BCBS of TX Blue Advantage	$38,542.62
Rate for Payer: BCBS of TX Blue Essentials	$40,718.77
Rate for Payer: BCBS of TX PPO	$45,244.84
Rate for Payer: Cigna Commercial	$50,372.39

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC

Facility

$21,429.06

Service Code	MSDRG 425
Min. Negotiated Rate	$13,078.02
Max. Negotiated Rate	$21,429.06
Rate for Payer: Aetna Commercial	$18,021.38
Rate for Payer: Aetna Medicare	$21,429.06
Rate for Payer: BCBS of TX Blue Advantage	$13,078.02
Rate for Payer: BCBS of TX Blue Essentials	$15,405.24
Rate for Payer: BCBS of TX PPO	$17,117.59
Rate for Payer: Cigna Commercial	$20,632.47

OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC

Facility

$15,901.45

Service Code	MSDRG 868
Min. Negotiated Rate	$9,111.70
Max. Negotiated Rate	$15,901.45
Rate for Payer: Aetna Commercial	$12,211.88
Rate for Payer: Aetna Medicare	$15,901.45
Rate for Payer: BCBS of TX Blue Advantage	$9,111.70
Rate for Payer: BCBS of TX Blue Essentials	$11,112.53
Rate for Payer: BCBS of TX PPO	$12,347.74
Rate for Payer: Cigna Commercial	$13,981.24

OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC

Facility

$26,948.82

Service Code	MSDRG 867
Min. Negotiated Rate	$22,009.40
Max. Negotiated Rate	$26,948.82
Rate for Payer: Aetna Commercial	$23,538.38
Rate for Payer: Aetna Medicare	$26,678.34
Rate for Payer: BCBS of TX Blue Advantage	$22,761.62
Rate for Payer: BCBS of TX Blue Essentials	$22,009.40
Rate for Payer: BCBS of TX PPO	$24,455.83
Rate for Payer: Cigna Commercial	$26,948.82

OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC

Facility

$11,675.49

Service Code	MSDRG 869
Min. Negotiated Rate	$5,710.40
Max. Negotiated Rate	$11,675.49
Rate for Payer: Aetna Commercial	$7,770.38
Rate for Payer: Aetna Medicare	$11,675.49
Rate for Payer: BCBS of TX Blue Advantage	$5,710.40
Rate for Payer: BCBS of TX Blue Essentials	$7,923.96
Rate for Payer: BCBS of TX PPO	$8,804.74
Rate for Payer: Cigna Commercial	$8,896.22

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC

Facility

$22,959.74

Service Code	MSDRG 922
Min. Negotiated Rate	$12,417.54
Max. Negotiated Rate	$22,959.74
Rate for Payer: Aetna Commercial	$19,630.12
Rate for Payer: Aetna Medicare	$22,959.74
Rate for Payer: BCBS of TX Blue Advantage	$12,417.54
Rate for Payer: BCBS of TX Blue Essentials	$16,081.13
Rate for Payer: BCBS of TX PPO	$17,868.61
Rate for Payer: Cigna Commercial	$22,474.31

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC

Facility

$15,108.28

Service Code	MSDRG 923
Min. Negotiated Rate	$7,067.48
Max. Negotiated Rate	$15,108.28
Rate for Payer: Aetna Commercial	$11,378.25
Rate for Payer: Aetna Medicare	$15,108.28
Rate for Payer: BCBS of TX Blue Advantage	$7,067.48
Rate for Payer: BCBS of TX Blue Essentials	$8,975.47
Rate for Payer: BCBS of TX PPO	$9,973.13
Rate for Payer: Cigna Commercial	$13,026.83

OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC

Facility

$15,208.91

Service Code	MSDRG 699
Min. Negotiated Rate	$8,908.74
Max. Negotiated Rate	$15,208.91
Rate for Payer: Aetna Commercial	$11,484.00
Rate for Payer: Aetna Medicare	$15,208.91
Rate for Payer: BCBS of TX Blue Advantage	$8,908.74
Rate for Payer: BCBS of TX Blue Essentials	$10,606.90
Rate for Payer: BCBS of TX PPO	$11,785.90
Rate for Payer: Cigna Commercial	$13,147.90

OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC

Facility

$21,991.03

Service Code	MSDRG 698
Min. Negotiated Rate	$13,468.46
Max. Negotiated Rate	$21,991.03
Rate for Payer: Aetna Commercial	$18,612.00
Rate for Payer: Aetna Medicare	$21,991.03
Rate for Payer: BCBS of TX Blue Advantage	$13,468.46
Rate for Payer: BCBS of TX Blue Essentials	$16,666.22
Rate for Payer: BCBS of TX PPO	$18,518.74
Rate for Payer: Cigna Commercial	$21,308.67

OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC

Facility

$11,863.88

Service Code	MSDRG 700
Min. Negotiated Rate	$6,392.38
Max. Negotiated Rate	$11,863.88
Rate for Payer: Aetna Commercial	$7,968.38
Rate for Payer: Aetna Medicare	$11,863.88
Rate for Payer: BCBS of TX Blue Advantage	$6,392.38
Rate for Payer: BCBS of TX Blue Essentials	$7,839.34
Rate for Payer: BCBS of TX PPO	$8,710.72
Rate for Payer: Cigna Commercial	$9,122.90

OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC

Facility

$30,682.74

Service Code	MSDRG 674
Min. Negotiated Rate	$19,391.28
Max. Negotiated Rate	$30,682.74
Rate for Payer: Aetna Commercial	$26,799.75
Rate for Payer: Aetna Medicare	$29,781.45
Rate for Payer: BCBS of TX Blue Advantage	$19,391.28
Rate for Payer: BCBS of TX Blue Essentials	$23,858.56
Rate for Payer: BCBS of TX PPO	$26,510.54
Rate for Payer: Cigna Commercial	$30,682.74

Know your out-of-pocket cost for care.

All Charges