White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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
Rate for Payer: Cash Price	$4,976.93

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 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

EXFX HALF PIN BOLT

Facility

$589.02

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

EXFX HALF RING

Facility

$2,529.42

Hospital Charge Code	138506
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,720.01

EXFX HALF RING

Facility

$2,529.42

Hospital Charge Code	138506
Hospital Revenue Code	272
Min. Negotiated Rate	$227.65
Max. Negotiated Rate	$1,821.18
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	$1,720.01
Rate for Payer: Cigna Medicaid	$1,821.18
Rate for Payer: Molina CHIP/Medicaid	$1,821.18
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: Parkland Medicaid	$1,821.18
Rate for Payer: Scott and White EPO/PPO	$1,264.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,821.18
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	$594.29

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	$629.24
Rate for Payer: Amerigroup CHIP/Medicaid	$78.66
Rate for Payer: BCBS of TX Blue Advantage	$262.19
Rate for Payer: BCBS of TX Blue Essentials	$314.62
Rate for Payer: BCBS of TX PPO	$349.58
Rate for Payer: Cash Price	$594.29
Rate for Payer: Cigna Medicaid	$629.24
Rate for Payer: Molina CHIP/Medicaid	$629.24
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: Parkland Medicaid	$629.24
Rate for Payer: Scott and White EPO/PPO	$436.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$629.24
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
Min. Negotiated Rate	$998.29
Max. Negotiated Rate	$7,986.33
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	$7,542.65
Rate for Payer: Cigna Medicaid	$7,986.33
Rate for Payer: Molina CHIP/Medicaid	$7,986.33
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: Parkland Medicaid	$7,986.33
Rate for Payer: Scott and White EPO/PPO	$5,546.06
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,986.33
Rate for Payer: Superior Health Plan EPO	$1,508.53

exfx micro lenthener assembly stryker

Facility

$11,092.13

Hospital Charge Code	8628565
Hospital Revenue Code	272
Rate for Payer: Cash Price	$7,542.65

EXFX MINIFIX DISTRACTION NUT

Facility

$312.67

Hospital Charge Code	145208
Hospital Revenue Code	272
Min. Negotiated Rate	$28.14
Max. Negotiated Rate	$225.12
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	$212.62
Rate for Payer: Cigna Medicaid	$225.12
Rate for Payer: Molina CHIP/Medicaid	$225.12
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: Parkland Medicaid	$225.12
Rate for Payer: Scott and White EPO/PPO	$156.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$225.12
Rate for Payer: Superior Health Plan EPO	$42.52

EXFX MINIFIX DISTRACTION NUT

Facility

$312.67

Hospital Charge Code	145208
Hospital Revenue Code	272
Rate for Payer: Cash Price	$212.62

EXFX MINI LENGHENER NUT

Facility

$484.42

Hospital Charge Code	145207
Hospital Revenue Code	272
Rate for Payer: Cash Price	$329.41

EXFX MINI LENGHENER NUT

Facility

$484.42

Hospital Charge Code	145207
Hospital Revenue Code	272
Min. Negotiated Rate	$43.60
Max. Negotiated Rate	$348.78
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	$329.41
Rate for Payer: Cigna Medicaid	$348.78
Rate for Payer: Molina CHIP/Medicaid	$348.78
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: Parkland Medicaid	$348.78
Rate for Payer: Scott and White EPO/PPO	$242.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$348.78
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
Min. Negotiated Rate	$684.48
Max. Negotiated Rate	$5,475.86
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	$5,171.64
Rate for Payer: Cigna Medicaid	$5,475.86
Rate for Payer: Molina CHIP/Medicaid	$5,475.86
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: Parkland Medicaid	$5,475.86
Rate for Payer: Scott and White EPO/PPO	$3,802.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,475.86
Rate for Payer: Superior Health Plan EPO	$1,034.33

EXFX MINI LENGTHENER KIT

Facility

$7,605.36

Hospital Charge Code	145205
Hospital Revenue Code	272
Rate for Payer: Cash Price	$5,171.64

EXFX NUT SPRING LOAD -- DHF

Facility

$17.48

Hospital Charge Code	81321531
Hospital Revenue Code	272
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$12.59
Rate for Payer: Amerigroup CHIP/Medicaid	$1.57
Rate for Payer: BCBS of TX Blue Advantage	$5.24
Rate for Payer: BCBS of TX Blue Essentials	$6.29
Rate for Payer: BCBS of TX PPO	$6.99
Rate for Payer: Cash Price	$11.89
Rate for Payer: Cigna Medicaid	$12.59
Rate for Payer: Molina CHIP/Medicaid	$12.59
Rate for Payer: Multiplan Auto	$11.36
Rate for Payer: Multiplan Commercial	$11.36
Rate for Payer: Multiplan Workers Comp	$11.36
Rate for Payer: Parkland Medicaid	$12.59
Rate for Payer: Scott and White EPO/PPO	$8.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.59
Rate for Payer: Superior Health Plan EPO	$2.38

EXFX NUT SPRING LOAD -- DHF

Facility

$17.48

Hospital Charge Code	81321531
Hospital Revenue Code	272
Rate for Payer: Cash Price	$11.89

EXFX OLIVE WIRE 1.8MM

Facility

$489.09

Hospital Charge Code	126424
Hospital Revenue Code	272
Rate for Payer: Cash Price	$332.58

EXFX OLIVE WIRE 1.8MM

Facility

$489.09

Hospital Charge Code	126424
Hospital Revenue Code	272
Min. Negotiated Rate	$44.02
Max. Negotiated Rate	$352.14
Rate for Payer: Amerigroup CHIP/Medicaid	$44.02
Rate for Payer: BCBS of TX Blue Advantage	$146.73
Rate for Payer: BCBS of TX Blue Essentials	$176.07
Rate for Payer: BCBS of TX PPO	$195.64
Rate for Payer: Cash Price	$332.58
Rate for Payer: Cigna Medicaid	$352.14
Rate for Payer: Molina CHIP/Medicaid	$352.14
Rate for Payer: Multiplan Auto	$317.91
Rate for Payer: Multiplan Commercial	$317.91
Rate for Payer: Multiplan Workers Comp	$317.91
Rate for Payer: Parkland Medicaid	$352.14
Rate for Payer: Scott and White EPO/PPO	$244.54
Rate for Payer: Superior Health Plan CHIP/Medicaid	$352.14
Rate for Payer: Superior Health Plan EPO	$66.52

exfx pin 2.0x20m-stryker

Facility

$312.35

Hospital Charge Code	8628564
Hospital Revenue Code	272
Min. Negotiated Rate	$28.11
Max. Negotiated Rate	$224.89
Rate for Payer: Amerigroup CHIP/Medicaid	$28.11
Rate for Payer: BCBS of TX Blue Advantage	$93.70
Rate for Payer: BCBS of TX Blue Essentials	$112.45
Rate for Payer: BCBS of TX PPO	$124.94
Rate for Payer: Cash Price	$212.40
Rate for Payer: Cigna Medicaid	$224.89
Rate for Payer: Molina CHIP/Medicaid	$224.89
Rate for Payer: Multiplan Auto	$203.03
Rate for Payer: Multiplan Commercial	$203.03
Rate for Payer: Multiplan Workers Comp	$203.03
Rate for Payer: Parkland Medicaid	$224.89
Rate for Payer: Scott and White EPO/PPO	$156.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$224.89
Rate for Payer: Superior Health Plan EPO	$42.48

exfx pin 2.0x20m-stryker

Facility

$312.35

Hospital Charge Code	8628564
Hospital Revenue Code	272
Rate for Payer: Cash Price	$212.40

Know your out-of-pocket cost for care.

All Charges