White Rock Medical Center

All Charges

Charge

Type

Setting

Price

OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC

Facility

$47,630.24

Service Code	MSDRG 673
Min. Negotiated Rate	$28,748.08
Max. Negotiated Rate	$47,630.24
Rate for Payer: Aetna Commercial	$41,602.50
Rate for Payer: Aetna Medicare	$43,865.89
Rate for Payer: BCBS of TX Blue Advantage	$28,748.08
Rate for Payer: BCBS of TX Blue Essentials	$36,914.16
Rate for Payer: BCBS of TX PPO	$41,017.32
Rate for Payer: Cigna Commercial	$47,630.24

OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC

Facility

$21,264.19

Service Code	MSDRG 675
Min. Negotiated Rate	$13,310.22
Max. Negotiated Rate	$21,264.19
Rate for Payer: Aetna Commercial	$17,848.12
Rate for Payer: Aetna Medicare	$21,264.19
Rate for Payer: BCBS of TX Blue Advantage	$13,310.22
Rate for Payer: BCBS of TX Blue Essentials	$16,771.47
Rate for Payer: BCBS of TX PPO	$18,635.69
Rate for Payer: Cigna Commercial	$20,434.12

OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC

Facility

$44,515.86

Service Code	MSDRG 271
Min. Negotiated Rate	$26,893.92
Max. Negotiated Rate	$44,515.86
Rate for Payer: Aetna Commercial	$38,882.25
Rate for Payer: Aetna Medicare	$41,277.66
Rate for Payer: BCBS of TX Blue Advantage	$26,893.92
Rate for Payer: BCBS of TX Blue Essentials	$36,052.52
Rate for Payer: BCBS of TX PPO	$40,059.91
Rate for Payer: Cigna Commercial	$44,515.86

OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC

Facility

$65,132.87

Service Code	MSDRG 270
Min. Negotiated Rate	$40,926.54
Max. Negotiated Rate	$65,132.87
Rate for Payer: Aetna Commercial	$56,890.12
Rate for Payer: Aetna Medicare	$58,411.68
Rate for Payer: BCBS of TX Blue Advantage	$40,926.54
Rate for Payer: BCBS of TX Blue Essentials	$52,231.68
Rate for Payer: BCBS of TX PPO	$58,037.45
Rate for Payer: Cigna Commercial	$65,132.87

OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$31,420.76

Service Code	MSDRG 272
Min. Negotiated Rate	$19,883.20
Max. Negotiated Rate	$31,420.76
Rate for Payer: Aetna Commercial	$27,444.38
Rate for Payer: Aetna Medicare	$30,394.78
Rate for Payer: BCBS of TX Blue Advantage	$19,883.20
Rate for Payer: BCBS of TX Blue Essentials	$27,016.17
Rate for Payer: BCBS of TX PPO	$30,019.13
Rate for Payer: Cigna Commercial	$31,420.76

OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC

Facility

$15,028.00

Service Code	MSDRG 729
Min. Negotiated Rate	$9,215.76
Max. Negotiated Rate	$15,028.00
Rate for Payer: Aetna Commercial	$11,293.88
Rate for Payer: Aetna Medicare	$15,028.00
Rate for Payer: BCBS of TX Blue Advantage	$9,215.76
Rate for Payer: BCBS of TX Blue Essentials	$11,165.16
Rate for Payer: BCBS of TX PPO	$12,406.21
Rate for Payer: Cigna Commercial	$12,930.23

OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$10,935.83

Service Code	MSDRG 730
Min. Negotiated Rate	$5,634.72
Max. Negotiated Rate	$10,935.83
Rate for Payer: Aetna Commercial	$6,993.00
Rate for Payer: Aetna Medicare	$10,935.83
Rate for Payer: BCBS of TX Blue Advantage	$5,634.72
Rate for Payer: BCBS of TX Blue Essentials	$5,865.32
Rate for Payer: BCBS of TX PPO	$6,517.27
Rate for Payer: Cigna Commercial	$8,006.21

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC

Facility

$23,696.17

Service Code	MSDRG 717
Min. Negotiated Rate	$14,129.80
Max. Negotiated Rate	$23,696.17
Rate for Payer: Aetna Commercial	$20,404.12
Rate for Payer: Aetna Medicare	$23,696.17
Rate for Payer: BCBS of TX Blue Advantage	$14,129.80
Rate for Payer: BCBS of TX Blue Essentials	$20,166.42
Rate for Payer: BCBS of TX PPO	$22,408.00
Rate for Payer: Cigna Commercial	$23,360.46

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility

$16,868.04

Service Code	MSDRG 718
Min. Negotiated Rate	$8,965.50
Max. Negotiated Rate	$16,868.04
Rate for Payer: Aetna Commercial	$13,227.75
Rate for Payer: Aetna Medicare	$16,868.04
Rate for Payer: BCBS of TX Blue Advantage	$8,965.50
Rate for Payer: BCBS of TX Blue Essentials	$12,719.20
Rate for Payer: BCBS of TX PPO	$14,132.99
Rate for Payer: Cigna Commercial	$15,144.30

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC

Facility

$28,432.60

Service Code	MSDRG 715
Min. Negotiated Rate	$17,765.02
Max. Negotiated Rate	$28,432.60
Rate for Payer: Aetna Commercial	$24,834.38
Rate for Payer: Aetna Medicare	$27,911.44
Rate for Payer: BCBS of TX Blue Advantage	$17,765.02
Rate for Payer: BCBS of TX Blue Essentials	$22,803.96
Rate for Payer: BCBS of TX PPO	$25,338.71
Rate for Payer: Cigna Commercial	$28,432.60

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC

Facility

$19,505.52

Service Code	MSDRG 716
Min. Negotiated Rate	$10,403.42
Max. Negotiated Rate	$19,505.52
Rate for Payer: Aetna Commercial	$15,999.75
Rate for Payer: Aetna Medicare	$19,505.52
Rate for Payer: BCBS of TX Blue Advantage	$10,403.42
Rate for Payer: BCBS of TX Blue Essentials	$15,096.70
Rate for Payer: BCBS of TX PPO	$16,774.76
Rate for Payer: Cigna Commercial	$18,317.94

OTHER MENTAL DISORDER DIAGNOSES

Facility

$18,150.39

Service Code	MSDRG 887
Min. Negotiated Rate	$8,666.22
Max. Negotiated Rate	$18,150.39
Rate for Payer: Aetna Commercial	$14,575.50
Rate for Payer: Aetna Medicare	$18,150.39
Rate for Payer: BCBS of TX Blue Advantage	$8,666.22
Rate for Payer: BCBS of TX Blue Essentials	$10,984.58
Rate for Payer: BCBS of TX PPO	$12,205.56
Rate for Payer: Cigna Commercial	$16,687.33

OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$20,349.00

Service Code	MSDRG 964
Min. Negotiated Rate	$12,192.22
Max. Negotiated Rate	$20,349.00
Rate for Payer: Aetna Commercial	$16,886.25
Rate for Payer: Aetna Medicare	$20,349.00
Rate for Payer: BCBS of TX Blue Advantage	$12,192.22
Rate for Payer: BCBS of TX Blue Essentials	$15,219.49
Rate for Payer: BCBS of TX PPO	$16,911.20
Rate for Payer: Cigna Commercial	$19,332.88

OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$35,217.78

Service Code	MSDRG 963
Min. Negotiated Rate	$22,206.92
Max. Negotiated Rate	$35,217.78
Rate for Payer: Aetna Commercial	$30,760.88
Rate for Payer: Aetna Medicare	$33,550.36
Rate for Payer: BCBS of TX Blue Advantage	$22,206.92
Rate for Payer: BCBS of TX Blue Essentials	$28,841.60
Rate for Payer: BCBS of TX PPO	$32,047.47
Rate for Payer: Cigna Commercial	$35,217.78

OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$14,514.21

Service Code	MSDRG 965
Min. Negotiated Rate	$8,329.96
Max. Negotiated Rate	$14,514.21
Rate for Payer: Aetna Commercial	$10,753.88
Rate for Payer: Aetna Medicare	$14,514.21
Rate for Payer: BCBS of TX Blue Advantage	$8,329.96
Rate for Payer: BCBS of TX Blue Essentials	$10,053.80
Rate for Payer: BCBS of TX PPO	$11,171.32
Rate for Payer: Cigna Commercial	$12,311.99

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC

Facility

$14,979.85

Service Code	MSDRG 565
Min. Negotiated Rate	$8,307.60
Max. Negotiated Rate	$14,979.85
Rate for Payer: Aetna Commercial	$11,243.25
Rate for Payer: Aetna Medicare	$14,979.85
Rate for Payer: BCBS of TX Blue Advantage	$8,307.60
Rate for Payer: BCBS of TX Blue Essentials	$10,069.28
Rate for Payer: BCBS of TX PPO	$11,188.52
Rate for Payer: Cigna Commercial	$12,872.27

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC

Facility

$21,000.87

Service Code	MSDRG 564
Min. Negotiated Rate	$13,665.40
Max. Negotiated Rate	$21,000.87
Rate for Payer: Aetna Commercial	$17,571.38
Rate for Payer: Aetna Medicare	$21,000.87
Rate for Payer: BCBS of TX Blue Advantage	$13,665.40
Rate for Payer: BCBS of TX Blue Essentials	$16,223.53
Rate for Payer: BCBS of TX PPO	$18,026.85
Rate for Payer: Cigna Commercial	$20,117.27

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC

Facility

$12,315.60

Service Code	MSDRG 566
Min. Negotiated Rate	$6,232.42
Max. Negotiated Rate	$12,315.60
Rate for Payer: Aetna Commercial	$8,443.12
Rate for Payer: Aetna Medicare	$12,315.60
Rate for Payer: BCBS of TX Blue Advantage	$6,232.42
Rate for Payer: BCBS of TX Blue Essentials	$7,866.17
Rate for Payer: BCBS of TX PPO	$8,740.53
Rate for Payer: Cigna Commercial	$9,666.44

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC

Facility

$26,285.50

Service Code	MSDRG 516
Min. Negotiated Rate	$17,809.74
Max. Negotiated Rate	$26,285.50
Rate for Payer: Aetna Commercial	$22,959.00
Rate for Payer: Aetna Medicare	$26,127.08
Rate for Payer: BCBS of TX Blue Advantage	$17,809.74
Rate for Payer: BCBS of TX Blue Essentials	$19,455.44
Rate for Payer: BCBS of TX PPO	$21,618.00
Rate for Payer: Cigna Commercial	$26,285.50

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC

Facility

$40,720.12

Service Code	MSDRG 515
Min. Negotiated Rate	$26,965.30
Max. Negotiated Rate	$40,720.12
Rate for Payer: Aetna Commercial	$35,566.88
Rate for Payer: Aetna Medicare	$38,123.14
Rate for Payer: BCBS of TX Blue Advantage	$26,965.30
Rate for Payer: BCBS of TX Blue Essentials	$31,803.16
Rate for Payer: BCBS of TX PPO	$35,338.21
Rate for Payer: Cigna Commercial	$40,720.12

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC

Facility

$20,278.37

Service Code	MSDRG 517
Min. Negotiated Rate	$14,249.51
Max. Negotiated Rate	$20,278.37
Rate for Payer: Aetna Commercial	$16,812.00
Rate for Payer: Aetna Medicare	$20,278.37
Rate for Payer: BCBS of TX Blue Advantage	$15,437.86
Rate for Payer: BCBS of TX Blue Essentials	$14,249.51
Rate for Payer: BCBS of TX PPO	$15,833.40
Rate for Payer: Cigna Commercial	$19,247.87

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC

Facility

$16,668.94

Service Code	MSDRG 844
Min. Negotiated Rate	$10,162.62
Max. Negotiated Rate	$16,668.94
Rate for Payer: Aetna Commercial	$13,018.50
Rate for Payer: Aetna Medicare	$16,668.94
Rate for Payer: BCBS of TX Blue Advantage	$10,162.62
Rate for Payer: BCBS of TX Blue Essentials	$12,164.04
Rate for Payer: BCBS of TX PPO	$13,516.12
Rate for Payer: Cigna Commercial	$14,904.74

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC

Facility

$24,198.19

Service Code	MSDRG 843
Min. Negotiated Rate	$15,507.52
Max. Negotiated Rate	$24,198.19
Rate for Payer: Aetna Commercial	$20,931.75
Rate for Payer: Aetna Medicare	$24,198.19
Rate for Payer: BCBS of TX Blue Advantage	$15,507.52
Rate for Payer: BCBS of TX Blue Essentials	$19,048.87
Rate for Payer: BCBS of TX PPO	$21,166.24
Rate for Payer: Cigna Commercial	$23,964.53

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC

Facility

$13,540.12

Service Code	MSDRG 845
Min. Negotiated Rate	$7,326.34
Max. Negotiated Rate	$13,540.12
Rate for Payer: Aetna Commercial	$9,730.12
Rate for Payer: Aetna Medicare	$13,540.12
Rate for Payer: BCBS of TX Blue Advantage	$7,326.34
Rate for Payer: BCBS of TX Blue Essentials	$8,938.32
Rate for Payer: BCBS of TX PPO	$9,931.85
Rate for Payer: Cigna Commercial	$11,139.91

OTHER O.R. PROCEDURES FOR INJURIES WITH CC

Facility

$25,812.81

Service Code	MSDRG 908
Min. Negotiated Rate	$17,702.24
Max. Negotiated Rate	$25,812.81
Rate for Payer: Aetna Commercial	$22,546.12
Rate for Payer: Aetna Medicare	$25,734.26
Rate for Payer: BCBS of TX Blue Advantage	$17,702.24
Rate for Payer: BCBS of TX Blue Essentials	$20,563.70
Rate for Payer: BCBS of TX PPO	$22,849.44
Rate for Payer: Cigna Commercial	$25,812.81

Know your out-of-pocket cost for care.

All Charges