White Rock Medical Center

All Charges

Charge

Type

Setting

Price

exfx 10mm nut qty 20

Facility

$144.37

Hospital Charge Code	130818
Hospital Revenue Code	272
Min. Negotiated Rate	$12.99
Max. Negotiated Rate	$93.84
Rate for Payer: Aetna Commercial	$79.40
Rate for Payer: Amerigroup CHIP/Medicaid	$12.99
Rate for Payer: BCBS of TX Blue Advantage	$43.31
Rate for Payer: BCBS of TX Blue Essentials	$51.97
Rate for Payer: BCBS of TX PPO	$57.75
Rate for Payer: Cash Price	$127.05
Rate for Payer: Multiplan Auto	$93.84
Rate for Payer: Multiplan Commercial	$93.84
Rate for Payer: Multiplan Workers Comp	$93.84
Rate for Payer: Scott and White EPO/PPO	$72.18
Rate for Payer: Superior Health Plan EPO	$19.63

EXFX 1.6 THREADED WIRES 4/PK

Facility

$700.20

Hospital Charge Code	145206
Hospital Revenue Code	272
Min. Negotiated Rate	$63.02
Max. Negotiated Rate	$455.13
Rate for Payer: Aetna Commercial	$385.11
Rate for Payer: Amerigroup CHIP/Medicaid	$63.02
Rate for Payer: BCBS of TX Blue Advantage	$210.06
Rate for Payer: BCBS of TX Blue Essentials	$252.07
Rate for Payer: BCBS of TX PPO	$280.08
Rate for Payer: Cash Price	$616.18
Rate for Payer: Multiplan Auto	$455.13
Rate for Payer: Multiplan Commercial	$455.13
Rate for Payer: Multiplan Workers Comp	$455.13
Rate for Payer: Scott and White EPO/PPO	$350.10
Rate for Payer: Superior Health Plan EPO	$95.23

EXFX 1.6 THREADED WIRES 4/PK

Facility

$700.20

Hospital Charge Code	145206
Hospital Revenue Code	272
Rate for Payer: Cash Price	$616.18

EXFX 3 HOLE POST

Facility

$765.17

Hospital Charge Code	138244
Hospital Revenue Code	272
Min. Negotiated Rate	$68.87
Max. Negotiated Rate	$497.36
Rate for Payer: Aetna Commercial	$420.84
Rate for Payer: Amerigroup CHIP/Medicaid	$68.87
Rate for Payer: BCBS of TX Blue Advantage	$229.55
Rate for Payer: BCBS of TX Blue Essentials	$275.46
Rate for Payer: BCBS of TX PPO	$306.07
Rate for Payer: Cash Price	$673.35
Rate for Payer: Multiplan Auto	$497.36
Rate for Payer: Multiplan Commercial	$497.36
Rate for Payer: Multiplan Workers Comp	$497.36
Rate for Payer: Scott and White EPO/PPO	$382.58
Rate for Payer: Superior Health Plan EPO	$104.06

EXFX 3 HOLE POST

Facility

$765.17

Hospital Charge Code	138244
Hospital Revenue Code	272
Rate for Payer: Cash Price	$673.35

EXFX ALLAN WRENCH

Facility

$422.22

Hospital Charge Code	145209
Hospital Revenue Code	272
Rate for Payer: Cash Price	$371.55

EXFX ALLAN WRENCH

Facility

$422.22

Hospital Charge Code	145209
Hospital Revenue Code	272
Min. Negotiated Rate	$38.00
Max. Negotiated Rate	$274.44
Rate for Payer: Aetna Commercial	$232.22
Rate for Payer: Amerigroup CHIP/Medicaid	$38.00
Rate for Payer: BCBS of TX Blue Advantage	$126.67
Rate for Payer: BCBS of TX Blue Essentials	$152.00
Rate for Payer: BCBS of TX PPO	$168.89
Rate for Payer: Cash Price	$371.55
Rate for Payer: Multiplan Auto	$274.44
Rate for Payer: Multiplan Commercial	$274.44
Rate for Payer: Multiplan Workers Comp	$274.44
Rate for Payer: Scott and White EPO/PPO	$211.11
Rate for Payer: Superior Health Plan EPO	$57.42

EXFX APEX PIN

Facility

$506.66

Hospital Charge Code	8470496
Hospital Revenue Code	272
Min. Negotiated Rate	$45.60
Max. Negotiated Rate	$329.33
Rate for Payer: Aetna Commercial	$278.66
Rate for Payer: Amerigroup CHIP/Medicaid	$45.60
Rate for Payer: BCBS of TX Blue Advantage	$152.00
Rate for Payer: BCBS of TX Blue Essentials	$182.40
Rate for Payer: BCBS of TX PPO	$202.66
Rate for Payer: Cash Price	$445.86
Rate for Payer: Multiplan Auto	$329.33
Rate for Payer: Multiplan Commercial	$329.33
Rate for Payer: Multiplan Workers Comp	$329.33
Rate for Payer: Scott and White EPO/PPO	$253.33
Rate for Payer: Superior Health Plan EPO	$68.91

EXFX APEX PIN

Facility

$506.66

Hospital Charge Code	8470496
Hospital Revenue Code	272
Rate for Payer: Cash Price	$445.86

EXFX BAR TO BAR CLAMP

Facility

$4,112.11

Hospital Charge Code	141004
Hospital Revenue Code	272
Min. Negotiated Rate	$370.09
Max. Negotiated Rate	$2,672.87
Rate for Payer: Aetna Commercial	$2,261.66
Rate for Payer: Amerigroup CHIP/Medicaid	$370.09
Rate for Payer: BCBS of TX Blue Advantage	$1,233.63
Rate for Payer: BCBS of TX Blue Essentials	$1,480.36
Rate for Payer: BCBS of TX PPO	$1,644.84
Rate for Payer: Cash Price	$3,618.66
Rate for Payer: Multiplan Auto	$2,672.87
Rate for Payer: Multiplan Commercial	$2,672.87
Rate for Payer: Multiplan Workers Comp	$2,672.87
Rate for Payer: Scott and White EPO/PPO	$2,056.06
Rate for Payer: Superior Health Plan EPO	$559.25

EXFX BAR TO BAR CLAMP

Facility

$4,112.11

Hospital Charge Code	141004
Hospital Revenue Code	272
Rate for Payer: Cash Price	$3,618.66

EXFX BAYONET WIRE

Facility

$599.28

Service Code	HCPCS C1713
Hospital Charge Code	81321903
Hospital Revenue Code	278
Min. Negotiated Rate	$149.82
Max. Negotiated Rate	$299.64
Rate for Payer: Aetna Commercial	$179.78
Rate for Payer: Cash Price	$527.37
Rate for Payer: Cigna Commercial	$149.82
Rate for Payer: Multiplan Auto	$299.64
Rate for Payer: Multiplan Commercial	$299.64
Rate for Payer: Multiplan Workers Comp	$299.64
Rate for Payer: Scott and White EPO/PPO	$299.64

EXFX BAYONET WIRE

Facility

$599.28

Service Code	HCPCS C1713
Hospital Charge Code	81321903
Hospital Revenue Code	278
Min. Negotiated Rate	$53.94
Max. Negotiated Rate	$299.64
Rate for Payer: Aetna Commercial	$179.78
Rate for Payer: Amerigroup CHIP/Medicaid	$53.94
Rate for Payer: BCBS of TX Blue Advantage	$179.78
Rate for Payer: BCBS of TX Blue Essentials	$215.74
Rate for Payer: BCBS of TX PPO	$239.71
Rate for Payer: Cash Price	$527.37
Rate for Payer: Multiplan Auto	$299.64
Rate for Payer: Multiplan Commercial	$299.64
Rate for Payer: Multiplan Workers Comp	$299.64
Rate for Payer: Scott and White EPO/PPO	$299.64
Rate for Payer: Superior Health Plan EPO	$81.50

EXFX BOLT -- DHF

Facility

$21.61

Hospital Charge Code	81320061
Hospital Revenue Code	272
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$14.05
Rate for Payer: Aetna Commercial	$11.89
Rate for Payer: Amerigroup CHIP/Medicaid	$1.94
Rate for Payer: BCBS of TX Blue Advantage	$6.48
Rate for Payer: BCBS of TX Blue Essentials	$7.78
Rate for Payer: BCBS of TX PPO	$8.64
Rate for Payer: Cash Price	$19.02
Rate for Payer: Multiplan Auto	$14.05
Rate for Payer: Multiplan Commercial	$14.05
Rate for Payer: Multiplan Workers Comp	$14.05
Rate for Payer: Scott and White EPO/PPO	$10.80
Rate for Payer: Superior Health Plan EPO	$2.94

EXFX BOLT -- DHF

Facility

$21.61

Hospital Charge Code	81320061
Hospital Revenue Code	272
Rate for Payer: Cash Price	$19.02

EXFX CLAMP 5 HOLE W/WINGS

Facility

$4,681.56

Hospital Charge Code	132367
Hospital Revenue Code	272
Min. Negotiated Rate	$421.34
Max. Negotiated Rate	$3,043.01
Rate for Payer: Aetna Commercial	$2,574.86
Rate for Payer: Amerigroup CHIP/Medicaid	$421.34
Rate for Payer: BCBS of TX Blue Advantage	$1,404.47
Rate for Payer: BCBS of TX Blue Essentials	$1,685.36
Rate for Payer: BCBS of TX PPO	$1,872.62
Rate for Payer: Cash Price	$4,119.77
Rate for Payer: Multiplan Auto	$3,043.01
Rate for Payer: Multiplan Commercial	$3,043.01
Rate for Payer: Multiplan Workers Comp	$3,043.01
Rate for Payer: Scott and White EPO/PPO	$2,340.78
Rate for Payer: Superior Health Plan EPO	$636.69

EXFX CLAMP 5 HOLE W/WINGS

Facility

$4,681.56

Hospital Charge Code	132367
Hospital Revenue Code	272
Rate for Payer: Cash Price	$4,119.77

EXFX CLAMP LG -- DHF

Facility

$6,740.19

Hospital Charge Code	81320103
Hospital Revenue Code	272
Min. Negotiated Rate	$606.62
Max. Negotiated Rate	$4,381.12
Rate for Payer: Aetna Commercial	$3,707.10
Rate for Payer: Amerigroup CHIP/Medicaid	$606.62
Rate for Payer: BCBS of TX Blue Advantage	$2,022.06
Rate for Payer: BCBS of TX Blue Essentials	$2,426.47
Rate for Payer: BCBS of TX PPO	$2,696.08
Rate for Payer: Cash Price	$5,931.37
Rate for Payer: Multiplan Auto	$4,381.12
Rate for Payer: Multiplan Commercial	$4,381.12
Rate for Payer: Multiplan Workers Comp	$4,381.12
Rate for Payer: Scott and White EPO/PPO	$3,370.10
Rate for Payer: Superior Health Plan EPO	$916.67

EXFX CLAMP LG -- DHF

Facility

$6,740.19

Hospital Charge Code	81320103
Hospital Revenue Code	272
Rate for Payer: Cash Price	$5,931.37

EXFX CLAMP SM -- DHF

Facility

$1,661.55

Hospital Charge Code	81320152
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,462.16

EXFX CLAMP SM -- DHF

Facility

$1,661.55

Hospital Charge Code	81320152
Hospital Revenue Code	272
Min. Negotiated Rate	$149.54
Max. Negotiated Rate	$1,080.01
Rate for Payer: Aetna Commercial	$913.85
Rate for Payer: Amerigroup CHIP/Medicaid	$149.54
Rate for Payer: BCBS of TX Blue Advantage	$498.46
Rate for Payer: BCBS of TX Blue Essentials	$598.16
Rate for Payer: BCBS of TX PPO	$664.62
Rate for Payer: Cash Price	$1,462.16
Rate for Payer: Multiplan Auto	$1,080.01
Rate for Payer: Multiplan Commercial	$1,080.01
Rate for Payer: Multiplan Workers Comp	$1,080.01
Rate for Payer: Scott and White EPO/PPO	$830.78
Rate for Payer: Superior Health Plan EPO	$225.97

EXFX CONNECTING NUT M6

Facility

$117.86

Hospital Charge Code	126349
Hospital Revenue Code	272
Min. Negotiated Rate	$10.61
Max. Negotiated Rate	$76.61
Rate for Payer: Aetna Commercial	$64.82
Rate for Payer: Amerigroup CHIP/Medicaid	$10.61
Rate for Payer: BCBS of TX Blue Advantage	$35.36
Rate for Payer: BCBS of TX Blue Essentials	$42.43
Rate for Payer: BCBS of TX PPO	$47.14
Rate for Payer: Cash Price	$103.72
Rate for Payer: Multiplan Auto	$76.61
Rate for Payer: Multiplan Commercial	$76.61
Rate for Payer: Multiplan Workers Comp	$76.61
Rate for Payer: Scott and White EPO/PPO	$58.93
Rate for Payer: Superior Health Plan EPO	$16.03

EXFX CONNECTING NUT M6

Facility

$117.86

Hospital Charge Code	126349
Hospital Revenue Code	272
Rate for Payer: Cash Price	$103.72

EXFX COUP CLAMP

Facility

$3,329.90

Hospital Charge Code	8470489
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,930.31

EXFX COUP CLAMP

Facility

$3,329.90

Hospital Charge Code	8470489
Hospital Revenue Code	272
Min. Negotiated Rate	$299.69
Max. Negotiated Rate	$2,164.44
Rate for Payer: Aetna Commercial	$1,831.44
Rate for Payer: Amerigroup CHIP/Medicaid	$299.69
Rate for Payer: BCBS of TX Blue Advantage	$998.97
Rate for Payer: BCBS of TX Blue Essentials	$1,198.76
Rate for Payer: BCBS of TX PPO	$1,331.96
Rate for Payer: Cash Price	$2,930.31
Rate for Payer: Multiplan Auto	$2,164.44
Rate for Payer: Multiplan Commercial	$2,164.44
Rate for Payer: Multiplan Workers Comp	$2,164.44
Rate for Payer: Scott and White EPO/PPO	$1,664.95
Rate for Payer: Superior Health Plan EPO	$452.87

Know your out-of-pocket cost for care.

All Charges