White Rock Medical Center

All Charges

Charge

Type

Setting

Price

EXFX POST 2 HOLE

Facility

$1,195.56

Hospital Charge Code	130820
Hospital Revenue Code	272
Min. Negotiated Rate	$107.60
Max. Negotiated Rate	$860.80
Rate for Payer: Amerigroup CHIP/Medicaid	$107.60
Rate for Payer: BCBS of TX Blue Advantage	$358.67
Rate for Payer: BCBS of TX Blue Essentials	$430.40
Rate for Payer: BCBS of TX PPO	$478.22
Rate for Payer: Cash Price	$812.98
Rate for Payer: Cigna Medicaid	$860.80
Rate for Payer: Molina CHIP/Medicaid	$860.80
Rate for Payer: Multiplan Auto	$777.11
Rate for Payer: Multiplan Commercial	$777.11
Rate for Payer: Multiplan Workers Comp	$777.11
Rate for Payer: Parkland Medicaid	$860.80
Rate for Payer: Scott and White EPO/PPO	$597.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$860.80
Rate for Payer: Superior Health Plan EPO	$162.60

EXFX POST HF -- DHF

Facility

$528.91

Hospital Charge Code	81321622
Hospital Revenue Code	272
Rate for Payer: Cash Price	$359.66

EXFX POST HF -- DHF

Facility

$528.91

Hospital Charge Code	81321622
Hospital Revenue Code	272
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$380.82
Rate for Payer: Amerigroup CHIP/Medicaid	$47.60
Rate for Payer: BCBS of TX Blue Advantage	$158.67
Rate for Payer: BCBS of TX Blue Essentials	$190.41
Rate for Payer: BCBS of TX PPO	$211.56
Rate for Payer: Cash Price	$359.66
Rate for Payer: Cigna Medicaid	$380.82
Rate for Payer: Molina CHIP/Medicaid	$380.82
Rate for Payer: Multiplan Auto	$343.79
Rate for Payer: Multiplan Commercial	$343.79
Rate for Payer: Multiplan Workers Comp	$343.79
Rate for Payer: Parkland Medicaid	$380.82
Rate for Payer: Scott and White EPO/PPO	$264.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$380.82
Rate for Payer: Superior Health Plan EPO	$71.93

EXFX RD LG -- DHF

Facility

$207.89

Hospital Charge Code	81321655
Hospital Revenue Code	272
Rate for Payer: Cash Price	$141.37

EXFX RD LG -- DHF

Facility

$207.89

Hospital Charge Code	81321655
Hospital Revenue Code	272
Min. Negotiated Rate	$18.71
Max. Negotiated Rate	$149.68
Rate for Payer: Amerigroup CHIP/Medicaid	$18.71
Rate for Payer: BCBS of TX Blue Advantage	$62.37
Rate for Payer: BCBS of TX Blue Essentials	$74.84
Rate for Payer: BCBS of TX PPO	$83.16
Rate for Payer: Cash Price	$141.37
Rate for Payer: Cigna Medicaid	$149.68
Rate for Payer: Molina CHIP/Medicaid	$149.68
Rate for Payer: Multiplan Auto	$135.13
Rate for Payer: Multiplan Commercial	$135.13
Rate for Payer: Multiplan Workers Comp	$135.13
Rate for Payer: Parkland Medicaid	$149.68
Rate for Payer: Scott and White EPO/PPO	$103.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$149.68
Rate for Payer: Superior Health Plan EPO	$28.27

EXFX RINGE CONNECTION BOLT

Facility

$147.50

Hospital Charge Code	145609
Hospital Revenue Code	272
Rate for Payer: Cash Price	$100.30

EXFX RINGE CONNECTION BOLT

Facility

$147.50

Hospital Charge Code	145609
Hospital Revenue Code	272
Min. Negotiated Rate	$13.28
Max. Negotiated Rate	$106.20
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	$100.30
Rate for Payer: Cigna Medicaid	$106.20
Rate for Payer: Molina CHIP/Medicaid	$106.20
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: Parkland Medicaid	$106.20
Rate for Payer: Scott and White EPO/PPO	$73.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$106.20
Rate for Payer: Superior Health Plan EPO	$20.06

EXFX ROCKR BOTTOM SHOE

Facility

$7,607.77

Hospital Charge Code	145603
Hospital Revenue Code	270
Rate for Payer: Cash Price	$5,173.28

EXFX ROCKR BOTTOM SHOE

Facility

$7,607.77

Hospital Charge Code	145603
Hospital Revenue Code	270
Min. Negotiated Rate	$684.70
Max. Negotiated Rate	$5,477.59
Rate for Payer: Amerigroup CHIP/Medicaid	$684.70
Rate for Payer: BCBS of TX Blue Advantage	$2,282.33
Rate for Payer: BCBS of TX Blue Essentials	$2,738.80
Rate for Payer: BCBS of TX PPO	$3,043.11
Rate for Payer: Cash Price	$5,173.28
Rate for Payer: Cigna Medicaid	$5,477.59
Rate for Payer: Molina CHIP/Medicaid	$5,477.59
Rate for Payer: Multiplan Auto	$4,945.05
Rate for Payer: Multiplan Commercial	$4,945.05
Rate for Payer: Multiplan Workers Comp	$4,945.05
Rate for Payer: Parkland Medicaid	$5,477.59
Rate for Payer: Scott and White EPO/PPO	$3,803.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,477.59
Rate for Payer: Superior Health Plan EPO	$1,034.66

EXFX ROD CARBON

Facility

$1,739.54

Hospital Charge Code	8470492
Hospital Revenue Code	272
Min. Negotiated Rate	$156.56
Max. Negotiated Rate	$1,252.47
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	$1,182.89
Rate for Payer: Cigna Medicaid	$1,252.47
Rate for Payer: Molina CHIP/Medicaid	$1,252.47
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: Parkland Medicaid	$1,252.47
Rate for Payer: Scott and White EPO/PPO	$869.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,252.47
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	$1,182.89

EXFX ROD SEMI CIRCULAR HOFFMAN

Facility

$2,210.00

Service Code	HCPCS C1776
Hospital Charge Code	8612536
Hospital Revenue Code	278
Min. Negotiated Rate	$198.90
Max. Negotiated Rate	$1,591.20
Rate for Payer: Amerigroup CHIP/Medicaid	$198.90
Rate for Payer: BCBS of TX Blue Advantage	$663.00
Rate for Payer: BCBS of TX Blue Essentials	$795.60
Rate for Payer: BCBS of TX PPO	$884.00
Rate for Payer: Cash Price	$1,502.80
Rate for Payer: Cigna Medicaid	$1,591.20
Rate for Payer: Molina CHIP/Medicaid	$1,591.20
Rate for Payer: Multiplan Auto	$1,105.00
Rate for Payer: Multiplan Commercial	$1,105.00
Rate for Payer: Multiplan Workers Comp	$1,105.00
Rate for Payer: Parkland Medicaid	$1,591.20
Rate for Payer: Scott and White EPO/PPO	$1,105.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,591.20
Rate for Payer: Superior Health Plan EPO	$300.56

EXFX ROD SEMI CIRCULAR HOFFMAN

Facility

$2,210.00

Service Code	HCPCS C1776
Hospital Charge Code	8612536
Hospital Revenue Code	278
Min. Negotiated Rate	$552.50
Max. Negotiated Rate	$1,105.00
Rate for Payer: Cash Price	$1,502.80
Rate for Payer: Cigna Commercial	$552.50
Rate for Payer: Multiplan Auto	$1,105.00
Rate for Payer: Multiplan Commercial	$1,105.00
Rate for Payer: Multiplan Workers Comp	$1,105.00
Rate for Payer: Scott and White EPO/PPO	$1,105.00

EXFX ROD THREADED 150MM

Facility

$1,238.00

Service Code	HCPCS C1776
Hospital Charge Code	145602
Hospital Revenue Code	278
Min. Negotiated Rate	$111.42
Max. Negotiated Rate	$891.36
Rate for Payer: Amerigroup CHIP/Medicaid	$111.42
Rate for Payer: BCBS of TX Blue Advantage	$371.40
Rate for Payer: BCBS of TX Blue Essentials	$445.68
Rate for Payer: BCBS of TX PPO	$495.20
Rate for Payer: Cash Price	$841.84
Rate for Payer: Cigna Medicaid	$891.36
Rate for Payer: Molina CHIP/Medicaid	$891.36
Rate for Payer: Multiplan Auto	$619.00
Rate for Payer: Multiplan Commercial	$619.00
Rate for Payer: Multiplan Workers Comp	$619.00
Rate for Payer: Parkland Medicaid	$891.36
Rate for Payer: Scott and White EPO/PPO	$619.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$891.36
Rate for Payer: Superior Health Plan EPO	$168.37

EXFX ROD THREADED 150MM

Facility

$1,238.00

Service Code	HCPCS C1776
Hospital Charge Code	145602
Hospital Revenue Code	278
Min. Negotiated Rate	$309.50
Max. Negotiated Rate	$619.00
Rate for Payer: Cash Price	$841.84
Rate for Payer: Cigna Commercial	$309.50
Rate for Payer: Multiplan Auto	$619.00
Rate for Payer: Multiplan Commercial	$619.00
Rate for Payer: Multiplan Workers Comp	$619.00
Rate for Payer: Scott and White EPO/PPO	$619.00

EXFX ROD THREADED -- DHF

Facility

$239.66

Hospital Charge Code	81373193
Hospital Revenue Code	272
Min. Negotiated Rate	$21.57
Max. Negotiated Rate	$172.56
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	$162.97
Rate for Payer: Cigna Medicaid	$172.56
Rate for Payer: Molina CHIP/Medicaid	$172.56
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: Parkland Medicaid	$172.56
Rate for Payer: Scott and White EPO/PPO	$119.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$172.56
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	$162.97

EXFX SLOTTED PLATE 60MM

Facility

$648.22

Hospital Charge Code	145606
Hospital Revenue Code	272
Rate for Payer: Cash Price	$440.79

EXFX SLOTTED PLATE 60MM

Facility

$648.22

Hospital Charge Code	145606
Hospital Revenue Code	272
Min. Negotiated Rate	$58.34
Max. Negotiated Rate	$466.72
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	$440.79
Rate for Payer: Cigna Medicaid	$466.72
Rate for Payer: Molina CHIP/Medicaid	$466.72
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: Parkland Medicaid	$466.72
Rate for Payer: Scott and White EPO/PPO	$324.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$466.72
Rate for Payer: Superior Health Plan EPO	$88.16

EXFX SMOOTH WIRE 1.8MM

Facility

$400.70

Hospital Charge Code	126423
Hospital Revenue Code	272
Rate for Payer: Cash Price	$272.48

EXFX SMOOTH WIRE 1.8MM

Facility

$400.70

Hospital Charge Code	126423
Hospital Revenue Code	272
Min. Negotiated Rate	$36.06
Max. Negotiated Rate	$288.50
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	$272.48
Rate for Payer: Cigna Medicaid	$288.50
Rate for Payer: Molina CHIP/Medicaid	$288.50
Rate for Payer: Multiplan Auto	$260.45
Rate for Payer: Multiplan Commercial	$260.45
Rate for Payer: Multiplan Workers Comp	$260.45
Rate for Payer: Parkland Medicaid	$288.50
Rate for Payer: Scott and White EPO/PPO	$200.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$288.50
Rate for Payer: Superior Health Plan EPO	$54.50

EXFX STATIC STRUT

Facility

$374.19

Hospital Charge Code	145607
Hospital Revenue Code	272
Min. Negotiated Rate	$33.68
Max. Negotiated Rate	$269.42
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	$254.45
Rate for Payer: Cigna Medicaid	$269.42
Rate for Payer: Molina CHIP/Medicaid	$269.42
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: Parkland Medicaid	$269.42
Rate for Payer: Scott and White EPO/PPO	$187.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$269.42
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	$254.45

EXFX STOPPER WIRE RUBBER -- DHF

Facility

$36.00

Hospital Charge Code	81321804
Hospital Revenue Code	272
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$25.92
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	$24.48
Rate for Payer: Cigna Medicaid	$25.92
Rate for Payer: Molina CHIP/Medicaid	$25.92
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: Parkland Medicaid	$25.92
Rate for Payer: Scott and White EPO/PPO	$18.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$25.92
Rate for Payer: Superior Health Plan EPO	$4.90

EXFX STOPPER WIRE RUBBER -- DHF

Facility

$36.00

Hospital Charge Code	81321804
Hospital Revenue Code	272
Rate for Payer: Cash Price	$24.48

Know your out-of-pocket cost for care.

All Charges