White Rock Medical Center

All Charges

Charge

Type

Setting

Price

KT TRACHEOS -- DHF

Facility

$2,023.98

Hospital Charge Code	82050253
Hospital Revenue Code	270
Min. Negotiated Rate	$182.16
Max. Negotiated Rate	$1,315.59
Rate for Payer: Aetna Commercial	$1,113.19
Rate for Payer: Amerigroup CHIP/Medicaid	$182.16
Rate for Payer: BCBS of TX Blue Advantage	$607.19
Rate for Payer: BCBS of TX Blue Essentials	$728.63
Rate for Payer: BCBS of TX PPO	$809.59
Rate for Payer: Cash Price	$1,781.10
Rate for Payer: Multiplan Auto	$1,315.59
Rate for Payer: Multiplan Commercial	$1,315.59
Rate for Payer: Multiplan Workers Comp	$1,315.59
Rate for Payer: Scott and White EPO/PPO	$1,011.99
Rate for Payer: Superior Health Plan EPO	$275.26

KT TRACHEOS -- DHF

Facility

$2,023.98

Hospital Charge Code	82050253
Hospital Revenue Code	270
Rate for Payer: Cash Price	$1,781.10

KT VERTBRL AUGMNT INFLAT -- DHF

Facility

$4,619.45

Hospital Charge Code	81870776
Hospital Revenue Code	272
Min. Negotiated Rate	$415.75
Max. Negotiated Rate	$3,002.64
Rate for Payer: Aetna Commercial	$2,540.70
Rate for Payer: Amerigroup CHIP/Medicaid	$415.75
Rate for Payer: BCBS of TX Blue Advantage	$1,385.84
Rate for Payer: BCBS of TX Blue Essentials	$1,663.00
Rate for Payer: BCBS of TX PPO	$1,847.78
Rate for Payer: Cash Price	$4,065.12
Rate for Payer: Multiplan Auto	$3,002.64
Rate for Payer: Multiplan Commercial	$3,002.64
Rate for Payer: Multiplan Workers Comp	$3,002.64
Rate for Payer: Scott and White EPO/PPO	$2,309.72
Rate for Payer: Superior Health Plan EPO	$628.25

KT VERTBRL AUGMNT INFLAT -- DHF

Facility

$4,619.45

Hospital Charge Code	81870776
Hospital Revenue Code	272
Rate for Payer: Cash Price	$4,065.12

KT WRENCH DISP -- DHF

Facility

$216.01

Hospital Charge Code	80325939
Hospital Revenue Code	272
Rate for Payer: Cash Price	$190.09

KT WRENCH DISP -- DHF

Facility

$216.01

Hospital Charge Code	80325939
Hospital Revenue Code	272
Min. Negotiated Rate	$19.44
Max. Negotiated Rate	$140.41
Rate for Payer: Aetna Commercial	$118.81
Rate for Payer: Amerigroup CHIP/Medicaid	$19.44
Rate for Payer: BCBS of TX Blue Advantage	$64.80
Rate for Payer: BCBS of TX Blue Essentials	$77.76
Rate for Payer: BCBS of TX PPO	$86.40
Rate for Payer: Cash Price	$190.09
Rate for Payer: Multiplan Auto	$140.41
Rate for Payer: Multiplan Commercial	$140.41
Rate for Payer: Multiplan Workers Comp	$140.41
Rate for Payer: Scott and White EPO/PPO	$108.00
Rate for Payer: Superior Health Plan EPO	$29.38

K-WIRE 0.9 MM NON THREAD

Facility

$240.96

Service Code	HCPCS C1713
Hospital Charge Code	145185
Hospital Revenue Code	278
Min. Negotiated Rate	$60.24
Max. Negotiated Rate	$120.48
Rate for Payer: Aetna Commercial	$72.29
Rate for Payer: Cash Price	$212.04
Rate for Payer: Cigna Commercial	$60.24
Rate for Payer: Multiplan Auto	$120.48
Rate for Payer: Multiplan Commercial	$120.48
Rate for Payer: Multiplan Workers Comp	$120.48
Rate for Payer: Scott and White EPO/PPO	$120.48

K-WIRE 0.9 MM NON THREAD

Facility

$240.96

Service Code	HCPCS C1713
Hospital Charge Code	145185
Hospital Revenue Code	278
Min. Negotiated Rate	$21.69
Max. Negotiated Rate	$120.48
Rate for Payer: Aetna Commercial	$72.29
Rate for Payer: Amerigroup CHIP/Medicaid	$21.69
Rate for Payer: BCBS of TX Blue Advantage	$72.29
Rate for Payer: BCBS of TX Blue Essentials	$86.75
Rate for Payer: BCBS of TX PPO	$96.38
Rate for Payer: Cash Price	$212.04
Rate for Payer: Multiplan Auto	$120.48
Rate for Payer: Multiplan Commercial	$120.48
Rate for Payer: Multiplan Workers Comp	$120.48
Rate for Payer: Scott and White EPO/PPO	$120.48
Rate for Payer: Superior Health Plan EPO	$32.77

K WIRE 1.0 MM

Facility

$116.22

Hospital Charge Code	8420461
Hospital Revenue Code	272
Rate for Payer: Cash Price	$102.27

K WIRE 1.0 MM

Facility

$116.22

Hospital Charge Code	8420461
Hospital Revenue Code	272
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$75.54
Rate for Payer: Aetna Commercial	$63.92
Rate for Payer: Amerigroup CHIP/Medicaid	$10.46
Rate for Payer: BCBS of TX Blue Advantage	$34.87
Rate for Payer: BCBS of TX Blue Essentials	$41.84
Rate for Payer: BCBS of TX PPO	$46.49
Rate for Payer: Cash Price	$102.27
Rate for Payer: Multiplan Auto	$75.54
Rate for Payer: Multiplan Commercial	$75.54
Rate for Payer: Multiplan Workers Comp	$75.54
Rate for Payer: Scott and White EPO/PPO	$58.11
Rate for Payer: Superior Health Plan EPO	$15.81

K-WIRE 1.1MM

Facility

$240.96

Service Code	HCPCS C1713
Hospital Charge Code	144642
Hospital Revenue Code	278
Min. Negotiated Rate	$60.24
Max. Negotiated Rate	$120.48
Rate for Payer: Aetna Commercial	$72.29
Rate for Payer: Cash Price	$212.04
Rate for Payer: Cigna Commercial	$60.24
Rate for Payer: Multiplan Auto	$120.48
Rate for Payer: Multiplan Commercial	$120.48
Rate for Payer: Multiplan Workers Comp	$120.48
Rate for Payer: Scott and White EPO/PPO	$120.48

K-WIRE 1.1MM

Facility

$240.96

Service Code	HCPCS C1713
Hospital Charge Code	144642
Hospital Revenue Code	278
Min. Negotiated Rate	$21.69
Max. Negotiated Rate	$120.48
Rate for Payer: Aetna Commercial	$72.29
Rate for Payer: Amerigroup CHIP/Medicaid	$21.69
Rate for Payer: BCBS of TX Blue Advantage	$72.29
Rate for Payer: BCBS of TX Blue Essentials	$86.75
Rate for Payer: BCBS of TX PPO	$96.38
Rate for Payer: Cash Price	$212.04
Rate for Payer: Multiplan Auto	$120.48
Rate for Payer: Multiplan Commercial	$120.48
Rate for Payer: Multiplan Workers Comp	$120.48
Rate for Payer: Scott and White EPO/PPO	$120.48
Rate for Payer: Superior Health Plan EPO	$32.77

K-WIRE 18060050S

Facility

$993.98

Service Code	HCPCS C1713
Hospital Charge Code	122781
Hospital Revenue Code	278
Min. Negotiated Rate	$89.46
Max. Negotiated Rate	$496.99
Rate for Payer: Aetna Commercial	$298.19
Rate for Payer: Amerigroup CHIP/Medicaid	$89.46
Rate for Payer: BCBS of TX Blue Advantage	$298.19
Rate for Payer: BCBS of TX Blue Essentials	$357.83
Rate for Payer: BCBS of TX PPO	$397.59
Rate for Payer: Cash Price	$874.70
Rate for Payer: Multiplan Auto	$496.99
Rate for Payer: Multiplan Commercial	$496.99
Rate for Payer: Multiplan Workers Comp	$496.99
Rate for Payer: Scott and White EPO/PPO	$496.99
Rate for Payer: Superior Health Plan EPO	$135.18

K-WIRE 18060050S

Facility

$993.98

Service Code	HCPCS C1713
Hospital Charge Code	122781
Hospital Revenue Code	278
Min. Negotiated Rate	$248.50
Max. Negotiated Rate	$496.99
Rate for Payer: Aetna Commercial	$298.19
Rate for Payer: Cash Price	$874.70
Rate for Payer: Cigna Commercial	$248.50
Rate for Payer: Multiplan Auto	$496.99
Rate for Payer: Multiplan Commercial	$496.99
Rate for Payer: Multiplan Workers Comp	$496.99
Rate for Payer: Scott and White EPO/PPO	$496.99

K WIRE 3.2MM

Facility

$1,033.73

Service Code	HCPCS C1713
Hospital Charge Code	122780
Hospital Revenue Code	278
Min. Negotiated Rate	$258.43
Max. Negotiated Rate	$516.86
Rate for Payer: Aetna Commercial	$310.12
Rate for Payer: Cash Price	$909.68
Rate for Payer: Cigna Commercial	$258.43
Rate for Payer: Multiplan Auto	$516.86
Rate for Payer: Multiplan Commercial	$516.86
Rate for Payer: Multiplan Workers Comp	$516.86
Rate for Payer: Scott and White EPO/PPO	$516.86

K WIRE 3.2MM

Facility

$1,033.73

Service Code	HCPCS C1713
Hospital Charge Code	122780
Hospital Revenue Code	278
Min. Negotiated Rate	$93.04
Max. Negotiated Rate	$516.86
Rate for Payer: Aetna Commercial	$310.12
Rate for Payer: Amerigroup CHIP/Medicaid	$93.04
Rate for Payer: BCBS of TX Blue Advantage	$310.12
Rate for Payer: BCBS of TX Blue Essentials	$372.14
Rate for Payer: BCBS of TX PPO	$413.49
Rate for Payer: Cash Price	$909.68
Rate for Payer: Multiplan Auto	$516.86
Rate for Payer: Multiplan Commercial	$516.86
Rate for Payer: Multiplan Workers Comp	$516.86
Rate for Payer: Scott and White EPO/PPO	$516.86
Rate for Payer: Superior Health Plan EPO	$140.59

k wire access 3.2x3s 2x350mm

Facility

$848.20

Service Code	HCPCS C1713
Hospital Charge Code	8720596
Hospital Revenue Code	278
Min. Negotiated Rate	$212.05
Max. Negotiated Rate	$424.10
Rate for Payer: Aetna Commercial	$254.46
Rate for Payer: Cash Price	$746.42
Rate for Payer: Cigna Commercial	$212.05
Rate for Payer: Multiplan Auto	$424.10
Rate for Payer: Multiplan Commercial	$424.10
Rate for Payer: Multiplan Workers Comp	$424.10
Rate for Payer: Scott and White EPO/PPO	$424.10

k wire access 3.2x3s 2x350mm

Facility

$848.20

Service Code	HCPCS C1713
Hospital Charge Code	8720596
Hospital Revenue Code	278
Min. Negotiated Rate	$76.34
Max. Negotiated Rate	$424.10
Rate for Payer: Aetna Commercial	$254.46
Rate for Payer: Amerigroup CHIP/Medicaid	$76.34
Rate for Payer: BCBS of TX Blue Advantage	$254.46
Rate for Payer: BCBS of TX Blue Essentials	$305.35
Rate for Payer: BCBS of TX PPO	$339.28
Rate for Payer: Cash Price	$746.42
Rate for Payer: Multiplan Auto	$424.10
Rate for Payer: Multiplan Commercial	$424.10
Rate for Payer: Multiplan Workers Comp	$424.10
Rate for Payer: Scott and White EPO/PPO	$424.10
Rate for Payer: Superior Health Plan EPO	$115.36

K WIRE -- DHF

Facility

$549.36

Service Code	HCPCS C1713
Hospital Charge Code	81329500
Hospital Revenue Code	278
Min. Negotiated Rate	$49.44
Max. Negotiated Rate	$274.68
Rate for Payer: Aetna Commercial	$164.81
Rate for Payer: Amerigroup CHIP/Medicaid	$49.44
Rate for Payer: BCBS of TX Blue Advantage	$164.81
Rate for Payer: BCBS of TX Blue Essentials	$197.77
Rate for Payer: BCBS of TX PPO	$219.74
Rate for Payer: Cash Price	$483.44
Rate for Payer: Multiplan Auto	$274.68
Rate for Payer: Multiplan Commercial	$274.68
Rate for Payer: Multiplan Workers Comp	$274.68
Rate for Payer: Scott and White EPO/PPO	$274.68
Rate for Payer: Superior Health Plan EPO	$74.71

K WIRE -- DHF

Facility

$549.36

Service Code	HCPCS C1713
Hospital Charge Code	81329500
Hospital Revenue Code	278
Min. Negotiated Rate	$137.34
Max. Negotiated Rate	$274.68
Rate for Payer: Aetna Commercial	$164.81
Rate for Payer: Cash Price	$483.44
Rate for Payer: Cigna Commercial	$137.34
Rate for Payer: Multiplan Auto	$274.68
Rate for Payer: Multiplan Commercial	$274.68
Rate for Payer: Multiplan Workers Comp	$274.68
Rate for Payer: Scott and White EPO/PPO	$274.68

k wire lag screw 62s 620mm

Facility

$886.75

Service Code	HCPCS C1713
Hospital Charge Code	8720595
Hospital Revenue Code	278
Min. Negotiated Rate	$79.81
Max. Negotiated Rate	$443.38
Rate for Payer: Aetna Commercial	$266.02
Rate for Payer: Amerigroup CHIP/Medicaid	$79.81
Rate for Payer: BCBS of TX Blue Advantage	$266.02
Rate for Payer: BCBS of TX Blue Essentials	$319.23
Rate for Payer: BCBS of TX PPO	$354.70
Rate for Payer: Cash Price	$780.34
Rate for Payer: Multiplan Auto	$443.38
Rate for Payer: Multiplan Commercial	$443.38
Rate for Payer: Multiplan Workers Comp	$443.38
Rate for Payer: Scott and White EPO/PPO	$443.38
Rate for Payer: Superior Health Plan EPO	$120.60

k wire lag screw 62s 620mm

Facility

$886.75

Service Code	HCPCS C1713
Hospital Charge Code	8720595
Hospital Revenue Code	278
Min. Negotiated Rate	$221.69
Max. Negotiated Rate	$443.38
Rate for Payer: Aetna Commercial	$266.02
Rate for Payer: Cash Price	$780.34
Rate for Payer: Cigna Commercial	$221.69
Rate for Payer: Multiplan Auto	$443.38
Rate for Payer: Multiplan Commercial	$443.38
Rate for Payer: Multiplan Workers Comp	$443.38
Rate for Payer: Scott and White EPO/PPO	$443.38

KYPHON ADDITIONAL FIX KIT

Facility

$8,802.19

Hospital Charge Code	8576624
Hospital Revenue Code	272
Min. Negotiated Rate	$792.20
Max. Negotiated Rate	$5,721.42
Rate for Payer: Aetna Commercial	$4,841.20
Rate for Payer: Amerigroup CHIP/Medicaid	$792.20
Rate for Payer: BCBS of TX Blue Advantage	$2,640.66
Rate for Payer: BCBS of TX Blue Essentials	$3,168.79
Rate for Payer: BCBS of TX PPO	$3,520.88
Rate for Payer: Cash Price	$7,745.93
Rate for Payer: Multiplan Auto	$5,721.42
Rate for Payer: Multiplan Commercial	$5,721.42
Rate for Payer: Multiplan Workers Comp	$5,721.42
Rate for Payer: Scott and White EPO/PPO	$4,401.10
Rate for Payer: Superior Health Plan EPO	$1,197.10

KYPHON ADDITIONAL FIX KIT

Facility

$8,802.19

Hospital Charge Code	8576624
Hospital Revenue Code	272
Rate for Payer: Cash Price	$7,745.93

KYPHON CEMENT WITH MIXER

Facility

$2,222.89

Service Code	HCPCS C1713
Hospital Charge Code	8484501
Hospital Revenue Code	278
Min. Negotiated Rate	$555.72
Max. Negotiated Rate	$1,111.44
Rate for Payer: Aetna Commercial	$666.87
Rate for Payer: Cash Price	$1,956.14
Rate for Payer: Cigna Commercial	$555.72
Rate for Payer: Multiplan Auto	$1,111.44
Rate for Payer: Multiplan Commercial	$1,111.44
Rate for Payer: Multiplan Workers Comp	$1,111.44
Rate for Payer: Scott and White EPO/PPO	$1,111.44

Know your out-of-pocket cost for care.

All Charges