White Rock Medical Center

All Charges

Charge

Type

Setting

Price

EXFX RING -- DHF

Facility

$4,698.90

Hospital Charge Code	81321663
Hospital Revenue Code	272
Min. Negotiated Rate	$422.90
Max. Negotiated Rate	$3,054.28
Rate for Payer: Aetna Commercial	$2,584.40
Rate for Payer: Amerigroup CHIP/Medicaid	$422.90
Rate for Payer: BCBS of TX Blue Advantage	$1,409.67
Rate for Payer: BCBS of TX Blue Essentials	$1,691.60
Rate for Payer: BCBS of TX PPO	$1,879.56
Rate for Payer: Cash Price	$4,135.03
Rate for Payer: Multiplan Auto	$3,054.28
Rate for Payer: Multiplan Commercial	$3,054.28
Rate for Payer: Multiplan Workers Comp	$3,054.28
Rate for Payer: Scott and White EPO/PPO	$2,349.45
Rate for Payer: Superior Health Plan EPO	$639.05

EXFX RING -- DHF

Facility

$4,698.90

Hospital Charge Code	81321663
Hospital Revenue Code	272
Rate for Payer: Cash Price	$4,135.03

EXFX RINGE CONNECTION BOLT

Facility

$147.50

Hospital Charge Code	145609
Hospital Revenue Code	272
Rate for Payer: Cash Price	$129.80

EXFX RINGE CONNECTION BOLT

Facility

$147.50

Hospital Charge Code	145609
Hospital Revenue Code	272
Min. Negotiated Rate	$13.28
Max. Negotiated Rate	$95.88
Rate for Payer: Aetna Commercial	$81.12
Rate for Payer: Amerigroup CHIP/Medicaid	$13.28
Rate for Payer: BCBS of TX Blue Advantage	$44.25
Rate for Payer: BCBS of TX Blue Essentials	$53.10
Rate for Payer: BCBS of TX PPO	$59.00
Rate for Payer: Cash Price	$129.80
Rate for Payer: Multiplan Auto	$95.88
Rate for Payer: Multiplan Commercial	$95.88
Rate for Payer: Multiplan Workers Comp	$95.88
Rate for Payer: Scott and White EPO/PPO	$73.75
Rate for Payer: Superior Health Plan EPO	$20.06

EXFX ROD CARBON

Facility

$1,739.54

Hospital Charge Code	8470492
Hospital Revenue Code	272
Min. Negotiated Rate	$156.56
Max. Negotiated Rate	$1,130.70
Rate for Payer: Aetna Commercial	$956.75
Rate for Payer: Amerigroup CHIP/Medicaid	$156.56
Rate for Payer: BCBS of TX Blue Advantage	$521.86
Rate for Payer: BCBS of TX Blue Essentials	$626.23
Rate for Payer: BCBS of TX PPO	$695.82
Rate for Payer: Cash Price	$1,530.80
Rate for Payer: Multiplan Auto	$1,130.70
Rate for Payer: Multiplan Commercial	$1,130.70
Rate for Payer: Multiplan Workers Comp	$1,130.70
Rate for Payer: Scott and White EPO/PPO	$869.77
Rate for Payer: Superior Health Plan EPO	$236.58

EXFX ROD CARBON

Facility

$1,739.54

Hospital Charge Code	8470492
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,530.80

EXFX ROD SEMI CIRCULAR HOFFMAN

Facility

$2,209.62

Service Code	HCPCS C1713
Hospital Charge Code	8612536
Hospital Revenue Code	278
Min. Negotiated Rate	$198.87
Max. Negotiated Rate	$1,104.81
Rate for Payer: Aetna Commercial	$662.89
Rate for Payer: Amerigroup CHIP/Medicaid	$198.87
Rate for Payer: BCBS of TX Blue Advantage	$662.89
Rate for Payer: BCBS of TX Blue Essentials	$795.46
Rate for Payer: BCBS of TX PPO	$883.85
Rate for Payer: Cash Price	$1,944.47
Rate for Payer: Multiplan Auto	$1,104.81
Rate for Payer: Multiplan Commercial	$1,104.81
Rate for Payer: Multiplan Workers Comp	$1,104.81
Rate for Payer: Scott and White EPO/PPO	$1,104.81
Rate for Payer: Superior Health Plan EPO	$300.51

EXFX ROD SEMI CIRCULAR HOFFMAN

Facility

$2,209.62

Service Code	HCPCS C1713
Hospital Charge Code	8612536
Hospital Revenue Code	278
Min. Negotiated Rate	$552.40
Max. Negotiated Rate	$1,104.81
Rate for Payer: Aetna Commercial	$662.89
Rate for Payer: Cash Price	$1,944.47
Rate for Payer: Cigna Commercial	$552.40
Rate for Payer: Multiplan Auto	$1,104.81
Rate for Payer: Multiplan Commercial	$1,104.81
Rate for Payer: Multiplan Workers Comp	$1,104.81
Rate for Payer: Scott and White EPO/PPO	$1,104.81

EXFX ROD THREADED -- DHF

Facility

$239.66

Hospital Charge Code	81373193
Hospital Revenue Code	272
Min. Negotiated Rate	$21.57
Max. Negotiated Rate	$155.78
Rate for Payer: Aetna Commercial	$131.81
Rate for Payer: Amerigroup CHIP/Medicaid	$21.57
Rate for Payer: BCBS of TX Blue Advantage	$71.90
Rate for Payer: BCBS of TX Blue Essentials	$86.28
Rate for Payer: BCBS of TX PPO	$95.86
Rate for Payer: Cash Price	$210.90
Rate for Payer: Multiplan Auto	$155.78
Rate for Payer: Multiplan Commercial	$155.78
Rate for Payer: Multiplan Workers Comp	$155.78
Rate for Payer: Scott and White EPO/PPO	$119.83
Rate for Payer: Superior Health Plan EPO	$32.59

EXFX ROD THREADED -- DHF

Facility

$239.66

Hospital Charge Code	81373193
Hospital Revenue Code	272
Rate for Payer: Cash Price	$210.90

EXFX SLOTTED PLATE 60MM

Facility

$648.22

Hospital Charge Code	145606
Hospital Revenue Code	272
Min. Negotiated Rate	$58.34
Max. Negotiated Rate	$421.34
Rate for Payer: Aetna Commercial	$356.52
Rate for Payer: Amerigroup CHIP/Medicaid	$58.34
Rate for Payer: BCBS of TX Blue Advantage	$194.47
Rate for Payer: BCBS of TX Blue Essentials	$233.36
Rate for Payer: BCBS of TX PPO	$259.29
Rate for Payer: Cash Price	$570.43
Rate for Payer: Multiplan Auto	$421.34
Rate for Payer: Multiplan Commercial	$421.34
Rate for Payer: Multiplan Workers Comp	$421.34
Rate for Payer: Scott and White EPO/PPO	$324.11
Rate for Payer: Superior Health Plan EPO	$88.16

EXFX SLOTTED PLATE 60MM

Facility

$648.22

Hospital Charge Code	145606
Hospital Revenue Code	272
Rate for Payer: Cash Price	$570.43

EXFX SMOOTH WIRE 1.8MM

Facility

$400.70

Hospital Charge Code	126423
Hospital Revenue Code	272
Min. Negotiated Rate	$36.06
Max. Negotiated Rate	$260.46
Rate for Payer: Aetna Commercial	$220.38
Rate for Payer: Amerigroup CHIP/Medicaid	$36.06
Rate for Payer: BCBS of TX Blue Advantage	$120.21
Rate for Payer: BCBS of TX Blue Essentials	$144.25
Rate for Payer: BCBS of TX PPO	$160.28
Rate for Payer: Cash Price	$352.62
Rate for Payer: Multiplan Auto	$260.46
Rate for Payer: Multiplan Commercial	$260.46
Rate for Payer: Multiplan Workers Comp	$260.46
Rate for Payer: Scott and White EPO/PPO	$200.35
Rate for Payer: Superior Health Plan EPO	$54.50

EXFX SMOOTH WIRE 1.8MM

Facility

$400.70

Hospital Charge Code	126423
Hospital Revenue Code	272
Rate for Payer: Cash Price	$352.62

EXFX STATIC STRUT

Facility

$374.19

Hospital Charge Code	145607
Hospital Revenue Code	272
Min. Negotiated Rate	$33.68
Max. Negotiated Rate	$243.22
Rate for Payer: Aetna Commercial	$205.80
Rate for Payer: Amerigroup CHIP/Medicaid	$33.68
Rate for Payer: BCBS of TX Blue Advantage	$112.26
Rate for Payer: BCBS of TX Blue Essentials	$134.71
Rate for Payer: BCBS of TX PPO	$149.68
Rate for Payer: Cash Price	$329.29
Rate for Payer: Multiplan Auto	$243.22
Rate for Payer: Multiplan Commercial	$243.22
Rate for Payer: Multiplan Workers Comp	$243.22
Rate for Payer: Scott and White EPO/PPO	$187.10
Rate for Payer: Superior Health Plan EPO	$50.89

EXFX STATIC STRUT

Facility

$374.19

Hospital Charge Code	145607
Hospital Revenue Code	272
Rate for Payer: Cash Price	$329.29

EXFX STOPPER WIRE RUBBER -- DHF

Facility

$36.00

Hospital Charge Code	81321804
Hospital Revenue Code	272
Rate for Payer: Cash Price	$31.68

EXFX STOPPER WIRE RUBBER -- DHF

Facility

$36.00

Hospital Charge Code	81321804
Hospital Revenue Code	272
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna Commercial	$19.80
Rate for Payer: Amerigroup CHIP/Medicaid	$3.24
Rate for Payer: BCBS of TX Blue Advantage	$10.80
Rate for Payer: BCBS of TX Blue Essentials	$12.96
Rate for Payer: BCBS of TX PPO	$14.40
Rate for Payer: Cash Price	$31.68
Rate for Payer: Multiplan Auto	$23.40
Rate for Payer: Multiplan Commercial	$23.40
Rate for Payer: Multiplan Workers Comp	$23.40
Rate for Payer: Scott and White EPO/PPO	$18.00
Rate for Payer: Superior Health Plan EPO	$4.90

EXFX STRUT -- DHF

Facility

$4,409.11

Hospital Charge Code	81321770
Hospital Revenue Code	272
Min. Negotiated Rate	$396.82
Max. Negotiated Rate	$2,865.92
Rate for Payer: Aetna Commercial	$2,425.01
Rate for Payer: Amerigroup CHIP/Medicaid	$396.82
Rate for Payer: BCBS of TX Blue Advantage	$1,322.73
Rate for Payer: BCBS of TX Blue Essentials	$1,587.28
Rate for Payer: BCBS of TX PPO	$1,763.64
Rate for Payer: Cash Price	$3,880.02
Rate for Payer: Multiplan Auto	$2,865.92
Rate for Payer: Multiplan Commercial	$2,865.92
Rate for Payer: Multiplan Workers Comp	$2,865.92
Rate for Payer: Scott and White EPO/PPO	$2,204.56
Rate for Payer: Superior Health Plan EPO	$599.64

EXFX STRUT -- DHF

Facility

$4,409.11

Hospital Charge Code	81321770
Hospital Revenue Code	272
Rate for Payer: Cash Price	$3,880.02

EXFX STRUT MEDIUM

Facility

$4,409.11

Hospital Charge Code	138507
Hospital Revenue Code	272
Rate for Payer: Cash Price	$3,880.02

EXFX STRUT MEDIUM

Facility

$4,409.11

Hospital Charge Code	138507
Hospital Revenue Code	272
Min. Negotiated Rate	$396.82
Max. Negotiated Rate	$2,865.92
Rate for Payer: Aetna Commercial	$2,425.01
Rate for Payer: Amerigroup CHIP/Medicaid	$396.82
Rate for Payer: BCBS of TX Blue Advantage	$1,322.73
Rate for Payer: BCBS of TX Blue Essentials	$1,587.28
Rate for Payer: BCBS of TX PPO	$1,763.64
Rate for Payer: Cash Price	$3,880.02
Rate for Payer: Multiplan Auto	$2,865.92
Rate for Payer: Multiplan Commercial	$2,865.92
Rate for Payer: Multiplan Workers Comp	$2,865.92
Rate for Payer: Scott and White EPO/PPO	$2,204.56
Rate for Payer: Superior Health Plan EPO	$599.64

EXFX STRUT QUICK ADJUST

Facility

$4,409.11

Hospital Charge Code	145133
Hospital Revenue Code	272
Rate for Payer: Cash Price	$3,880.02

EXFX STRUT QUICK ADJUST

Facility

$4,409.11

Hospital Charge Code	145133
Hospital Revenue Code	272
Min. Negotiated Rate	$396.82
Max. Negotiated Rate	$2,865.92
Rate for Payer: Aetna Commercial	$2,425.01
Rate for Payer: Amerigroup CHIP/Medicaid	$396.82
Rate for Payer: BCBS of TX Blue Advantage	$1,322.73
Rate for Payer: BCBS of TX Blue Essentials	$1,587.28
Rate for Payer: BCBS of TX PPO	$1,763.64
Rate for Payer: Cash Price	$3,880.02
Rate for Payer: Multiplan Auto	$2,865.92
Rate for Payer: Multiplan Commercial	$2,865.92
Rate for Payer: Multiplan Workers Comp	$2,865.92
Rate for Payer: Scott and White EPO/PPO	$2,204.56
Rate for Payer: Superior Health Plan EPO	$599.64

EXFX TL ROCKER RAIL KIT

Facility

$6,106.94

Hospital Charge Code	139392
Hospital Revenue Code	272
Rate for Payer: Cash Price	$5,374.11

Know your out-of-pocket cost for care.

All Charges