White Rock Medical Center

All Charges

Charge

Type

Setting

Price

EXFX DISTRCT DYN JT BDY -- DHF

Facility

$2,578.67

Hospital Charge Code	81321812
Hospital Revenue Code	272
Min. Negotiated Rate	$232.08
Max. Negotiated Rate	$1,676.14
Rate for Payer: Aetna Commercial	$1,418.27
Rate for Payer: Amerigroup CHIP/Medicaid	$232.08
Rate for Payer: BCBS of TX Blue Advantage	$773.60
Rate for Payer: BCBS of TX Blue Essentials	$928.32
Rate for Payer: BCBS of TX PPO	$1,031.47
Rate for Payer: Cash Price	$2,269.23
Rate for Payer: Multiplan Auto	$1,676.14
Rate for Payer: Multiplan Commercial	$1,676.14
Rate for Payer: Multiplan Workers Comp	$1,676.14
Rate for Payer: Scott and White EPO/PPO	$1,289.34
Rate for Payer: Superior Health Plan EPO	$350.70

EXFX DISTRCT DYN JT BDY -- DHF

Facility

$2,578.67

Hospital Charge Code	81321812
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,269.23

EXFX DOUBLE ROW FOOR PLATE

Facility

$4,494.60

Hospital Charge Code	138537
Hospital Revenue Code	272
Rate for Payer: Cash Price	$3,955.25

EXFX DOUBLE ROW FOOR PLATE

Facility

$4,494.60

Hospital Charge Code	138537
Hospital Revenue Code	272
Min. Negotiated Rate	$404.51
Max. Negotiated Rate	$2,921.49
Rate for Payer: Aetna Commercial	$2,472.03
Rate for Payer: Amerigroup CHIP/Medicaid	$404.51
Rate for Payer: BCBS of TX Blue Advantage	$1,348.38
Rate for Payer: BCBS of TX Blue Essentials	$1,618.06
Rate for Payer: BCBS of TX PPO	$1,797.84
Rate for Payer: Cash Price	$3,955.25
Rate for Payer: Multiplan Auto	$2,921.49
Rate for Payer: Multiplan Commercial	$2,921.49
Rate for Payer: Multiplan Workers Comp	$2,921.49
Rate for Payer: Scott and White EPO/PPO	$2,247.30
Rate for Payer: Superior Health Plan EPO	$611.27

EXFX EXTENDED NUT

Facility

$190.59

Hospital Charge Code	138307
Hospital Revenue Code	272
Rate for Payer: Cash Price	$167.72

EXFX EXTENDED NUT

Facility

$190.59

Hospital Charge Code	138307
Hospital Revenue Code	272
Min. Negotiated Rate	$17.15
Max. Negotiated Rate	$123.88
Rate for Payer: Aetna Commercial	$104.82
Rate for Payer: Amerigroup CHIP/Medicaid	$17.15
Rate for Payer: BCBS of TX Blue Advantage	$57.18
Rate for Payer: BCBS of TX Blue Essentials	$68.61
Rate for Payer: BCBS of TX PPO	$76.24
Rate for Payer: Cash Price	$167.72
Rate for Payer: Multiplan Auto	$123.88
Rate for Payer: Multiplan Commercial	$123.88
Rate for Payer: Multiplan Workers Comp	$123.88
Rate for Payer: Scott and White EPO/PPO	$95.30
Rate for Payer: Superior Health Plan EPO	$25.92

EX FX FOOT ARCH

Facility

$8,362.04

Hospital Charge Code	145605
Hospital Revenue Code	270
Min. Negotiated Rate	$752.58
Max. Negotiated Rate	$5,435.33
Rate for Payer: Aetna Commercial	$4,599.12
Rate for Payer: Amerigroup CHIP/Medicaid	$752.58
Rate for Payer: BCBS of TX Blue Advantage	$2,508.61
Rate for Payer: BCBS of TX Blue Essentials	$3,010.33
Rate for Payer: BCBS of TX PPO	$3,344.82
Rate for Payer: Cash Price	$7,358.60
Rate for Payer: Multiplan Auto	$5,435.33
Rate for Payer: Multiplan Commercial	$5,435.33
Rate for Payer: Multiplan Workers Comp	$5,435.33
Rate for Payer: Scott and White EPO/PPO	$4,181.02
Rate for Payer: Superior Health Plan EPO	$1,137.24

EX FX FOOT ARCH

Facility

$8,362.04

Hospital Charge Code	145605
Hospital Revenue Code	270
Rate for Payer: Cash Price	$7,358.60

EXFX FOOT PLATE 160MM

Facility

$2,642.28

Hospital Charge Code	145100
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,325.21

EXFX FOOT PLATE 160MM

Facility

$2,642.28

Hospital Charge Code	145100
Hospital Revenue Code	272
Min. Negotiated Rate	$237.81
Max. Negotiated Rate	$1,717.48
Rate for Payer: Aetna Commercial	$1,453.25
Rate for Payer: Amerigroup CHIP/Medicaid	$237.81
Rate for Payer: BCBS of TX Blue Advantage	$792.68
Rate for Payer: BCBS of TX Blue Essentials	$951.22
Rate for Payer: BCBS of TX PPO	$1,056.91
Rate for Payer: Cash Price	$2,325.21
Rate for Payer: Multiplan Auto	$1,717.48
Rate for Payer: Multiplan Commercial	$1,717.48
Rate for Payer: Multiplan Workers Comp	$1,717.48
Rate for Payer: Scott and White EPO/PPO	$1,321.14
Rate for Payer: Superior Health Plan EPO	$359.35

EXFX HALF PIN BOLT

Facility

$589.02

Hospital Charge Code	138893
Hospital Revenue Code	272
Min. Negotiated Rate	$53.01
Max. Negotiated Rate	$382.86
Rate for Payer: Aetna Commercial	$323.96
Rate for Payer: Amerigroup CHIP/Medicaid	$53.01
Rate for Payer: BCBS of TX Blue Advantage	$176.71
Rate for Payer: BCBS of TX Blue Essentials	$212.05
Rate for Payer: BCBS of TX PPO	$235.61
Rate for Payer: Cash Price	$518.34
Rate for Payer: Multiplan Auto	$382.86
Rate for Payer: Multiplan Commercial	$382.86
Rate for Payer: Multiplan Workers Comp	$382.86
Rate for Payer: Scott and White EPO/PPO	$294.51
Rate for Payer: Superior Health Plan EPO	$80.11

EXFX HALF PIN BOLT

Facility

$589.02

Hospital Charge Code	138893
Hospital Revenue Code	272
Rate for Payer: Cash Price	$518.34

EXFX HALF RING

Facility

$2,529.42

Hospital Charge Code	138506
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,225.89

EXFX HALF RING

Facility

$2,529.42

Hospital Charge Code	138506
Hospital Revenue Code	272
Min. Negotiated Rate	$227.65
Max. Negotiated Rate	$1,644.12
Rate for Payer: Aetna Commercial	$1,391.18
Rate for Payer: Amerigroup CHIP/Medicaid	$227.65
Rate for Payer: BCBS of TX Blue Advantage	$758.83
Rate for Payer: BCBS of TX Blue Essentials	$910.59
Rate for Payer: BCBS of TX PPO	$1,011.77
Rate for Payer: Cash Price	$2,225.89
Rate for Payer: Multiplan Auto	$1,644.12
Rate for Payer: Multiplan Commercial	$1,644.12
Rate for Payer: Multiplan Workers Comp	$1,644.12
Rate for Payer: Scott and White EPO/PPO	$1,264.71
Rate for Payer: Superior Health Plan EPO	$344.00

EXFX HF CN RD SM -- DHF

Facility

$873.95

Hospital Charge Code	81320806
Hospital Revenue Code	272
Rate for Payer: Cash Price	$769.08

EXFX HF CN RD SM -- DHF

Facility

$873.95

Hospital Charge Code	81320806
Hospital Revenue Code	272
Min. Negotiated Rate	$78.66
Max. Negotiated Rate	$568.07
Rate for Payer: Aetna Commercial	$480.67
Rate for Payer: Amerigroup CHIP/Medicaid	$78.66
Rate for Payer: BCBS of TX Blue Advantage	$262.18
Rate for Payer: BCBS of TX Blue Essentials	$314.62
Rate for Payer: BCBS of TX PPO	$349.58
Rate for Payer: Cash Price	$769.08
Rate for Payer: Multiplan Auto	$568.07
Rate for Payer: Multiplan Commercial	$568.07
Rate for Payer: Multiplan Workers Comp	$568.07
Rate for Payer: Scott and White EPO/PPO	$436.98
Rate for Payer: Superior Health Plan EPO	$118.86

exfx micro lenthener assembly stryker

Facility

$11,092.13

Hospital Charge Code	8628565
Hospital Revenue Code	272
Rate for Payer: Cash Price	$9,761.07

exfx micro lenthener assembly stryker

Facility

$11,092.13

Hospital Charge Code	8628565
Hospital Revenue Code	272
Min. Negotiated Rate	$998.29
Max. Negotiated Rate	$7,209.88
Rate for Payer: Aetna Commercial	$6,100.67
Rate for Payer: Amerigroup CHIP/Medicaid	$998.29
Rate for Payer: BCBS of TX Blue Advantage	$3,327.64
Rate for Payer: BCBS of TX Blue Essentials	$3,993.17
Rate for Payer: BCBS of TX PPO	$4,436.85
Rate for Payer: Cash Price	$9,761.07
Rate for Payer: Multiplan Auto	$7,209.88
Rate for Payer: Multiplan Commercial	$7,209.88
Rate for Payer: Multiplan Workers Comp	$7,209.88
Rate for Payer: Scott and White EPO/PPO	$5,546.06
Rate for Payer: Superior Health Plan EPO	$1,508.53

EXFX MINIFIX DISTRACTION NUT

Facility

$312.67

Hospital Charge Code	145208
Hospital Revenue Code	272
Rate for Payer: Cash Price	$275.15

EXFX MINIFIX DISTRACTION NUT

Facility

$312.67

Hospital Charge Code	145208
Hospital Revenue Code	272
Min. Negotiated Rate	$28.14
Max. Negotiated Rate	$203.24
Rate for Payer: Aetna Commercial	$171.97
Rate for Payer: Amerigroup CHIP/Medicaid	$28.14
Rate for Payer: BCBS of TX Blue Advantage	$93.80
Rate for Payer: BCBS of TX Blue Essentials	$112.56
Rate for Payer: BCBS of TX PPO	$125.07
Rate for Payer: Cash Price	$275.15
Rate for Payer: Multiplan Auto	$203.24
Rate for Payer: Multiplan Commercial	$203.24
Rate for Payer: Multiplan Workers Comp	$203.24
Rate for Payer: Scott and White EPO/PPO	$156.34
Rate for Payer: Superior Health Plan EPO	$42.52

EXFX MINI LENGHENER NUT

Facility

$484.42

Hospital Charge Code	145207
Hospital Revenue Code	272
Rate for Payer: Cash Price	$426.29

EXFX MINI LENGHENER NUT

Facility

$484.42

Hospital Charge Code	145207
Hospital Revenue Code	272
Min. Negotiated Rate	$43.60
Max. Negotiated Rate	$314.87
Rate for Payer: Aetna Commercial	$266.43
Rate for Payer: Amerigroup CHIP/Medicaid	$43.60
Rate for Payer: BCBS of TX Blue Advantage	$145.33
Rate for Payer: BCBS of TX Blue Essentials	$174.39
Rate for Payer: BCBS of TX PPO	$193.77
Rate for Payer: Cash Price	$426.29
Rate for Payer: Multiplan Auto	$314.87
Rate for Payer: Multiplan Commercial	$314.87
Rate for Payer: Multiplan Workers Comp	$314.87
Rate for Payer: Scott and White EPO/PPO	$242.21
Rate for Payer: Superior Health Plan EPO	$65.88

EXFX MINI LENGTHENER KIT

Facility

$7,605.36

Hospital Charge Code	145205
Hospital Revenue Code	272
Rate for Payer: Cash Price	$6,692.72

EXFX MINI LENGTHENER KIT

Facility

$7,605.36

Hospital Charge Code	145205
Hospital Revenue Code	272
Min. Negotiated Rate	$684.48
Max. Negotiated Rate	$4,943.48
Rate for Payer: Aetna Commercial	$4,182.95
Rate for Payer: Amerigroup CHIP/Medicaid	$684.48
Rate for Payer: BCBS of TX Blue Advantage	$2,281.61
Rate for Payer: BCBS of TX Blue Essentials	$2,737.93
Rate for Payer: BCBS of TX PPO	$3,042.14
Rate for Payer: Cash Price	$6,692.72
Rate for Payer: Multiplan Auto	$4,943.48
Rate for Payer: Multiplan Commercial	$4,943.48
Rate for Payer: Multiplan Workers Comp	$4,943.48
Rate for Payer: Scott and White EPO/PPO	$3,802.68
Rate for Payer: Superior Health Plan EPO	$1,034.33

EXFX NUT SPRING LOAD -- DHF

Facility

$17.48

Hospital Charge Code	81321531
Hospital Revenue Code	272
Rate for Payer: Cash Price	$15.38

Know your out-of-pocket cost for care.

All Charges