White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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	$3,370.72
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	$3,183.46
Rate for Payer: Cigna Medicaid	$3,370.72
Rate for Payer: Molina CHIP/Medicaid	$3,370.72
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: Parkland Medicaid	$3,370.72
Rate for Payer: Scott and White EPO/PPO	$2,340.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,370.72
Rate for Payer: Superior Health Plan EPO	$636.69

EXFX CLAMP LG -- DHF

Facility

$6,740.19

Hospital Charge Code	81320103
Hospital Revenue Code	272
Min. Negotiated Rate	$606.62
Max. Negotiated Rate	$4,852.94
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	$4,583.33
Rate for Payer: Cigna Medicaid	$4,852.94
Rate for Payer: Molina CHIP/Medicaid	$4,852.94
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: Parkland Medicaid	$4,852.94
Rate for Payer: Scott and White EPO/PPO	$3,370.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,852.94
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	$4,583.33

EXFX CLAMP SM -- DHF

Facility

$1,661.55

Hospital Charge Code	81320152
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,129.85

EXFX CLAMP SM -- DHF

Facility

$1,661.55

Hospital Charge Code	81320152
Hospital Revenue Code	272
Min. Negotiated Rate	$149.54
Max. Negotiated Rate	$1,196.32
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	$1,129.85
Rate for Payer: Cigna Medicaid	$1,196.32
Rate for Payer: Molina CHIP/Medicaid	$1,196.32
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: Parkland Medicaid	$1,196.32
Rate for Payer: Scott and White EPO/PPO	$830.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,196.32
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	$84.86
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	$80.14
Rate for Payer: Cigna Medicaid	$84.86
Rate for Payer: Molina CHIP/Medicaid	$84.86
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: Parkland Medicaid	$84.86
Rate for Payer: Scott and White EPO/PPO	$58.93
Rate for Payer: Superior Health Plan CHIP/Medicaid	$84.86
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	$80.14

EXFX COUP CLAMP

Facility

$3,329.90

Hospital Charge Code	8470489
Hospital Revenue Code	272
Rate for Payer: Cash Price	$2,264.33

EXFX COUP CLAMP

Facility

$3,329.90

Hospital Charge Code	8470489
Hospital Revenue Code	272
Min. Negotiated Rate	$299.69
Max. Negotiated Rate	$2,397.53
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	$2,264.33
Rate for Payer: Cigna Medicaid	$2,397.53
Rate for Payer: Molina CHIP/Medicaid	$2,397.53
Rate for Payer: Multiplan Auto	$2,164.43
Rate for Payer: Multiplan Commercial	$2,164.43
Rate for Payer: Multiplan Workers Comp	$2,164.43
Rate for Payer: Parkland Medicaid	$2,397.53
Rate for Payer: Scott and White EPO/PPO	$1,664.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,397.53
Rate for Payer: Superior Health Plan EPO	$452.87

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	$1,856.64
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	$1,753.50
Rate for Payer: Cigna Medicaid	$1,856.64
Rate for Payer: Molina CHIP/Medicaid	$1,856.64
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: Parkland Medicaid	$1,856.64
Rate for Payer: Scott and White EPO/PPO	$1,289.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,856.64
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	$1,753.50

EXFX DOUBLE ROW FOOR PLATE

Facility

$4,494.60

Hospital Charge Code	138537
Hospital Revenue Code	272
Rate for Payer: Cash Price	$3,056.33

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	$3,236.11
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	$3,056.33
Rate for Payer: Cigna Medicaid	$3,236.11
Rate for Payer: Molina CHIP/Medicaid	$3,236.11
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: Parkland Medicaid	$3,236.11
Rate for Payer: Scott and White EPO/PPO	$2,247.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,236.11
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	$129.60

EXFX EXTENDED NUT

Facility

$190.59

Hospital Charge Code	138307
Hospital Revenue Code	272
Min. Negotiated Rate	$17.15
Max. Negotiated Rate	$137.22
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	$129.60
Rate for Payer: Cigna Medicaid	$137.22
Rate for Payer: Molina CHIP/Medicaid	$137.22
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: Parkland Medicaid	$137.22
Rate for Payer: Scott and White EPO/PPO	$95.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$137.22
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	$6,020.67
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	$5,686.19
Rate for Payer: Cigna Medicaid	$6,020.67
Rate for Payer: Molina CHIP/Medicaid	$6,020.67
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: Parkland Medicaid	$6,020.67
Rate for Payer: Scott and White EPO/PPO	$4,181.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,020.67
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	$5,686.19

EXFX FOOT PLATE 160MM

Facility

$2,642.28

Hospital Charge Code	145100
Hospital Revenue Code	272
Min. Negotiated Rate	$237.81
Max. Negotiated Rate	$1,902.44
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	$1,796.75
Rate for Payer: Cigna Medicaid	$1,902.44
Rate for Payer: Molina CHIP/Medicaid	$1,902.44
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: Parkland Medicaid	$1,902.44
Rate for Payer: Scott and White EPO/PPO	$1,321.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,902.44
Rate for Payer: Superior Health Plan EPO	$359.35

EXFX FOOT PLATE 160MM

Facility

$2,642.28

Hospital Charge Code	145100
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,796.75

EXFX FOOT RING

Facility

$6,331.94

Hospital Charge Code	145659
Hospital Revenue Code	272
Rate for Payer: Cash Price	$4,305.72

EXFX FOOT RING

Facility

$6,331.94

Hospital Charge Code	145659
Hospital Revenue Code	272
Min. Negotiated Rate	$569.87
Max. Negotiated Rate	$4,559.00
Rate for Payer: Amerigroup CHIP/Medicaid	$569.87
Rate for Payer: BCBS of TX Blue Advantage	$1,899.58
Rate for Payer: BCBS of TX Blue Essentials	$2,279.50
Rate for Payer: BCBS of TX PPO	$2,532.78
Rate for Payer: Cash Price	$4,305.72
Rate for Payer: Cigna Medicaid	$4,559.00
Rate for Payer: Molina CHIP/Medicaid	$4,559.00
Rate for Payer: Multiplan Auto	$4,115.76
Rate for Payer: Multiplan Commercial	$4,115.76
Rate for Payer: Multiplan Workers Comp	$4,115.76
Rate for Payer: Parkland Medicaid	$4,559.00
Rate for Payer: Scott and White EPO/PPO	$3,165.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,559.00
Rate for Payer: Superior Health Plan EPO	$861.14

EXFX FOOT RING LONG

Facility

$7,319.02

Hospital Charge Code	145604
Hospital Revenue Code	272
Min. Negotiated Rate	$658.71
Max. Negotiated Rate	$5,269.69
Rate for Payer: Amerigroup CHIP/Medicaid	$658.71
Rate for Payer: BCBS of TX Blue Advantage	$2,195.71
Rate for Payer: BCBS of TX Blue Essentials	$2,634.85
Rate for Payer: BCBS of TX PPO	$2,927.61
Rate for Payer: Cash Price	$4,976.93
Rate for Payer: Cigna Medicaid	$5,269.69
Rate for Payer: Molina CHIP/Medicaid	$5,269.69
Rate for Payer: Multiplan Auto	$4,757.36
Rate for Payer: Multiplan Commercial	$4,757.36
Rate for Payer: Multiplan Workers Comp	$4,757.36
Rate for Payer: Parkland Medicaid	$5,269.69
Rate for Payer: Scott and White EPO/PPO	$3,659.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,269.69
Rate for Payer: Superior Health Plan EPO	$995.39

EXFX FOOT RING LONG

Facility

$7,319.02

Hospital Charge Code	145604
Hospital Revenue Code	272
Rate for Payer: Cash Price	$4,976.93

EXFX HALF PIN BOLT

Facility

$589.02

Hospital Charge Code	138893
Hospital Revenue Code	272
Rate for Payer: Cash Price	$400.53

EXFX HALF PIN BOLT

Facility

$589.02

Hospital Charge Code	138893
Hospital Revenue Code	272
Min. Negotiated Rate	$53.01
Max. Negotiated Rate	$424.09
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	$400.53
Rate for Payer: Cigna Medicaid	$424.09
Rate for Payer: Molina CHIP/Medicaid	$424.09
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: Parkland Medicaid	$424.09
Rate for Payer: Scott and White EPO/PPO	$294.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$424.09
Rate for Payer: Superior Health Plan EPO	$80.11

Know your out-of-pocket cost for care.

All Charges