White Rock Medical Center

All Charges

Charge

Type

Setting

Price

NAIL HUMERAL 8V22.5

Facility

$22,018.07

Service Code	HCPCS C1713
Hospital Charge Code	8428490
Hospital Revenue Code	278
Min. Negotiated Rate	$1,981.63
Max. Negotiated Rate	$11,009.04
Rate for Payer: Aetna Commercial	$6,605.42
Rate for Payer: Amerigroup CHIP/Medicaid	$1,981.63
Rate for Payer: BCBS of TX Blue Advantage	$6,605.42
Rate for Payer: BCBS of TX Blue Essentials	$7,926.51
Rate for Payer: BCBS of TX PPO	$8,807.23
Rate for Payer: Cash Price	$19,375.90
Rate for Payer: Multiplan Auto	$11,009.04
Rate for Payer: Multiplan Commercial	$11,009.04
Rate for Payer: Multiplan Workers Comp	$11,009.04
Rate for Payer: Scott and White EPO/PPO	$11,009.04
Rate for Payer: Superior Health Plan EPO	$2,994.46

NAIL INTRAMEDULLARY TYP1 -- DHF

Facility

$11,220.85

Service Code	HCPCS C1713
Hospital Charge Code	81330011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,805.21
Max. Negotiated Rate	$5,610.42
Rate for Payer: Aetna Commercial	$3,366.26
Rate for Payer: Cash Price	$9,874.35
Rate for Payer: Cigna Commercial	$2,805.21
Rate for Payer: Multiplan Auto	$5,610.42
Rate for Payer: Multiplan Commercial	$5,610.42
Rate for Payer: Multiplan Workers Comp	$5,610.42
Rate for Payer: Scott and White EPO/PPO	$5,610.42

NAIL INTRAMEDULLARY TYP1 -- DHF

Facility

$11,220.85

Service Code	HCPCS C1713
Hospital Charge Code	81330011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,009.88
Max. Negotiated Rate	$5,610.42
Rate for Payer: Aetna Commercial	$3,366.26
Rate for Payer: Amerigroup CHIP/Medicaid	$1,009.88
Rate for Payer: BCBS of TX Blue Advantage	$3,366.26
Rate for Payer: BCBS of TX Blue Essentials	$4,039.51
Rate for Payer: BCBS of TX PPO	$4,488.34
Rate for Payer: Cash Price	$9,874.35
Rate for Payer: Multiplan Auto	$5,610.42
Rate for Payer: Multiplan Commercial	$5,610.42
Rate for Payer: Multiplan Workers Comp	$5,610.42
Rate for Payer: Scott and White EPO/PPO	$5,610.42
Rate for Payer: Superior Health Plan EPO	$1,526.04

NAIL INTRAMEDULLARY TYP4 -- DHF

Facility

$15,528.23

Service Code	HCPCS C1713
Hospital Charge Code	81330045
Hospital Revenue Code	278
Min. Negotiated Rate	$3,882.06
Max. Negotiated Rate	$7,764.12
Rate for Payer: Aetna Commercial	$4,658.47
Rate for Payer: Cash Price	$13,664.84
Rate for Payer: Cigna Commercial	$3,882.06
Rate for Payer: Multiplan Auto	$7,764.12
Rate for Payer: Multiplan Commercial	$7,764.12
Rate for Payer: Multiplan Workers Comp	$7,764.12
Rate for Payer: Scott and White EPO/PPO	$7,764.12

NAIL INTRAMEDULLARY TYP4 -- DHF

Facility

$15,528.23

Service Code	HCPCS C1713
Hospital Charge Code	81330045
Hospital Revenue Code	278
Min. Negotiated Rate	$1,397.54
Max. Negotiated Rate	$7,764.12
Rate for Payer: Aetna Commercial	$4,658.47
Rate for Payer: Amerigroup CHIP/Medicaid	$1,397.54
Rate for Payer: BCBS of TX Blue Advantage	$4,658.47
Rate for Payer: BCBS of TX Blue Essentials	$5,590.16
Rate for Payer: BCBS of TX PPO	$6,211.29
Rate for Payer: Cash Price	$13,664.84
Rate for Payer: Multiplan Auto	$7,764.12
Rate for Payer: Multiplan Commercial	$7,764.12
Rate for Payer: Multiplan Workers Comp	$7,764.12
Rate for Payer: Scott and White EPO/PPO	$7,764.12
Rate for Payer: Superior Health Plan EPO	$2,111.84

NAIL INTRAMEDULLARY TYP5 -- DHF

Facility

$13,362.06

Service Code	HCPCS C1713
Hospital Charge Code	81330060
Hospital Revenue Code	278
Min. Negotiated Rate	$1,202.59
Max. Negotiated Rate	$6,681.03
Rate for Payer: Aetna Commercial	$4,008.62
Rate for Payer: Amerigroup CHIP/Medicaid	$1,202.59
Rate for Payer: BCBS of TX Blue Advantage	$4,008.62
Rate for Payer: BCBS of TX Blue Essentials	$4,810.34
Rate for Payer: BCBS of TX PPO	$5,344.82
Rate for Payer: Cash Price	$11,758.61
Rate for Payer: Multiplan Auto	$6,681.03
Rate for Payer: Multiplan Commercial	$6,681.03
Rate for Payer: Multiplan Workers Comp	$6,681.03
Rate for Payer: Scott and White EPO/PPO	$6,681.03
Rate for Payer: Superior Health Plan EPO	$1,817.24

NAIL INTRAMEDULLARY TYP5 -- DHF

Facility

$13,362.06

Service Code	HCPCS C1713
Hospital Charge Code	81330060
Hospital Revenue Code	278
Min. Negotiated Rate	$3,340.52
Max. Negotiated Rate	$6,681.03
Rate for Payer: Aetna Commercial	$4,008.62
Rate for Payer: Cash Price	$11,758.61
Rate for Payer: Cigna Commercial	$3,340.52
Rate for Payer: Multiplan Auto	$6,681.03
Rate for Payer: Multiplan Commercial	$6,681.03
Rate for Payer: Multiplan Workers Comp	$6,681.03
Rate for Payer: Scott and White EPO/PPO	$6,681.03

NAIL LEFT ES LONG

Facility

$26,506.02

Service Code	HCPCS C1713
Hospital Charge Code	8502478
Hospital Revenue Code	278
Min. Negotiated Rate	$6,626.50
Max. Negotiated Rate	$13,253.01
Rate for Payer: Aetna Commercial	$7,951.81
Rate for Payer: Cash Price	$23,325.30
Rate for Payer: Cigna Commercial	$6,626.50
Rate for Payer: Multiplan Auto	$13,253.01
Rate for Payer: Multiplan Commercial	$13,253.01
Rate for Payer: Multiplan Workers Comp	$13,253.01
Rate for Payer: Scott and White EPO/PPO	$13,253.01

NAIL LEFT ES LONG

Facility

$26,506.02

Service Code	HCPCS C1713
Hospital Charge Code	8502478
Hospital Revenue Code	278
Min. Negotiated Rate	$2,385.54
Max. Negotiated Rate	$13,253.01
Rate for Payer: Aetna Commercial	$7,951.81
Rate for Payer: Amerigroup CHIP/Medicaid	$2,385.54
Rate for Payer: BCBS of TX Blue Advantage	$7,951.81
Rate for Payer: BCBS of TX Blue Essentials	$9,542.17
Rate for Payer: BCBS of TX PPO	$10,602.41
Rate for Payer: Cash Price	$23,325.30
Rate for Payer: Multiplan Auto	$13,253.01
Rate for Payer: Multiplan Commercial	$13,253.01
Rate for Payer: Multiplan Workers Comp	$13,253.01
Rate for Payer: Scott and White EPO/PPO	$13,253.01
Rate for Payer: Superior Health Plan EPO	$3,604.82

NAIL SCHND11&12M -- DHF

Facility

$11,989.33

Service Code	HCPCS C1713
Hospital Charge Code	81330607
Hospital Revenue Code	278
Min. Negotiated Rate	$2,997.33
Max. Negotiated Rate	$5,994.66
Rate for Payer: Aetna Commercial	$3,596.80
Rate for Payer: Cash Price	$10,550.61
Rate for Payer: Cigna Commercial	$2,997.33
Rate for Payer: Multiplan Auto	$5,994.66
Rate for Payer: Multiplan Commercial	$5,994.66
Rate for Payer: Multiplan Workers Comp	$5,994.66
Rate for Payer: Scott and White EPO/PPO	$5,994.66

NAIL SCHND11&12M -- DHF

Facility

$11,989.33

Service Code	HCPCS C1713
Hospital Charge Code	81330607
Hospital Revenue Code	278
Min. Negotiated Rate	$1,079.04
Max. Negotiated Rate	$5,994.66
Rate for Payer: Aetna Commercial	$3,596.80
Rate for Payer: Amerigroup CHIP/Medicaid	$1,079.04
Rate for Payer: BCBS of TX Blue Advantage	$3,596.80
Rate for Payer: BCBS of TX Blue Essentials	$4,316.16
Rate for Payer: BCBS of TX PPO	$4,795.73
Rate for Payer: Cash Price	$10,550.61
Rate for Payer: Multiplan Auto	$5,994.66
Rate for Payer: Multiplan Commercial	$5,994.66
Rate for Payer: Multiplan Workers Comp	$5,994.66
Rate for Payer: Scott and White EPO/PPO	$5,994.66
Rate for Payer: Superior Health Plan EPO	$1,630.55

nail talon distal fix

Facility

$16,867.47

Service Code	HCPCS C1713
Hospital Charge Code	8720590
Hospital Revenue Code	278
Min. Negotiated Rate	$1,518.07
Max. Negotiated Rate	$8,433.74
Rate for Payer: Aetna Commercial	$5,060.24
Rate for Payer: Amerigroup CHIP/Medicaid	$1,518.07
Rate for Payer: BCBS of TX Blue Advantage	$5,060.24
Rate for Payer: BCBS of TX Blue Essentials	$6,072.29
Rate for Payer: BCBS of TX PPO	$6,746.99
Rate for Payer: Cash Price	$14,843.37
Rate for Payer: Multiplan Auto	$8,433.74
Rate for Payer: Multiplan Commercial	$8,433.74
Rate for Payer: Multiplan Workers Comp	$8,433.74
Rate for Payer: Scott and White EPO/PPO	$8,433.74
Rate for Payer: Superior Health Plan EPO	$2,293.98

nail talon distal fix

Facility

$16,867.47

Service Code	HCPCS C1713
Hospital Charge Code	8720590
Hospital Revenue Code	278
Min. Negotiated Rate	$4,216.87
Max. Negotiated Rate	$8,433.74
Rate for Payer: Aetna Commercial	$5,060.24
Rate for Payer: Cash Price	$14,843.37
Rate for Payer: Cigna Commercial	$4,216.87
Rate for Payer: Multiplan Auto	$8,433.74
Rate for Payer: Multiplan Commercial	$8,433.74
Rate for Payer: Multiplan Workers Comp	$8,433.74
Rate for Payer: Scott and White EPO/PPO	$8,433.74

NAIL TALON DISTAL FIX

Facility

$16,867.47

Service Code	HCPCS C1713
Hospital Charge Code	145159
Hospital Revenue Code	278
Min. Negotiated Rate	$4,216.87
Max. Negotiated Rate	$8,433.74
Rate for Payer: Aetna Commercial	$5,060.24
Rate for Payer: Cash Price	$14,843.37
Rate for Payer: Cigna Commercial	$4,216.87
Rate for Payer: Multiplan Auto	$8,433.74
Rate for Payer: Multiplan Commercial	$8,433.74
Rate for Payer: Multiplan Workers Comp	$8,433.74
Rate for Payer: Scott and White EPO/PPO	$8,433.74

NAIL TALON DISTAL FIX

Facility

$16,867.47

Service Code	HCPCS C1713
Hospital Charge Code	145159
Hospital Revenue Code	278
Min. Negotiated Rate	$1,518.07
Max. Negotiated Rate	$8,433.74
Rate for Payer: Aetna Commercial	$5,060.24
Rate for Payer: Amerigroup CHIP/Medicaid	$1,518.07
Rate for Payer: BCBS of TX Blue Advantage	$5,060.24
Rate for Payer: BCBS of TX Blue Essentials	$6,072.29
Rate for Payer: BCBS of TX PPO	$6,746.99
Rate for Payer: Cash Price	$14,843.37
Rate for Payer: Multiplan Auto	$8,433.74
Rate for Payer: Multiplan Commercial	$8,433.74
Rate for Payer: Multiplan Workers Comp	$8,433.74
Rate for Payer: Scott and White EPO/PPO	$8,433.74
Rate for Payer: Superior Health Plan EPO	$2,293.98

NAIL TIBIAL 10.0MM X 320MM

Facility

$16,269.88

Service Code	HCPCS C1713
Hospital Charge Code	145337
Hospital Revenue Code	278
Min. Negotiated Rate	$1,464.29
Max. Negotiated Rate	$8,134.94
Rate for Payer: Aetna Commercial	$4,880.96
Rate for Payer: Amerigroup CHIP/Medicaid	$1,464.29
Rate for Payer: BCBS of TX Blue Advantage	$4,880.96
Rate for Payer: BCBS of TX Blue Essentials	$5,857.16
Rate for Payer: BCBS of TX PPO	$6,507.95
Rate for Payer: Cash Price	$14,317.49
Rate for Payer: Multiplan Auto	$8,134.94
Rate for Payer: Multiplan Commercial	$8,134.94
Rate for Payer: Multiplan Workers Comp	$8,134.94
Rate for Payer: Scott and White EPO/PPO	$8,134.94
Rate for Payer: Superior Health Plan EPO	$2,212.70

NAIL TIBIAL 10.0MM X 320MM

Facility

$16,269.88

Service Code	HCPCS C1713
Hospital Charge Code	145337
Hospital Revenue Code	278
Min. Negotiated Rate	$4,067.47
Max. Negotiated Rate	$8,134.94
Rate for Payer: Aetna Commercial	$4,880.96
Rate for Payer: Cash Price	$14,317.49
Rate for Payer: Cigna Commercial	$4,067.47
Rate for Payer: Multiplan Auto	$8,134.94
Rate for Payer: Multiplan Commercial	$8,134.94
Rate for Payer: Multiplan Workers Comp	$8,134.94
Rate for Payer: Scott and White EPO/PPO	$8,134.94

NAIL TIBIAL T2 LOCK 12MM 360MM

Facility

$9,722.47

Service Code	HCPCS C1713
Hospital Charge Code	8394456
Hospital Revenue Code	278
Min. Negotiated Rate	$2,430.62
Max. Negotiated Rate	$4,861.24
Rate for Payer: Aetna Commercial	$2,916.74
Rate for Payer: Cash Price	$8,555.77
Rate for Payer: Cigna Commercial	$2,430.62
Rate for Payer: Multiplan Auto	$4,861.24
Rate for Payer: Multiplan Commercial	$4,861.24
Rate for Payer: Multiplan Workers Comp	$4,861.24
Rate for Payer: Scott and White EPO/PPO	$4,861.24

NAIL TIBIAL T2 LOCK 12MM 360MM

Facility

$9,722.47

Service Code	HCPCS C1713
Hospital Charge Code	8394456
Hospital Revenue Code	278
Min. Negotiated Rate	$875.02
Max. Negotiated Rate	$4,861.24
Rate for Payer: Aetna Commercial	$2,916.74
Rate for Payer: Amerigroup CHIP/Medicaid	$875.02
Rate for Payer: BCBS of TX Blue Advantage	$2,916.74
Rate for Payer: BCBS of TX Blue Essentials	$3,500.09
Rate for Payer: BCBS of TX PPO	$3,888.99
Rate for Payer: Cash Price	$8,555.77
Rate for Payer: Multiplan Auto	$4,861.24
Rate for Payer: Multiplan Commercial	$4,861.24
Rate for Payer: Multiplan Workers Comp	$4,861.24
Rate for Payer: Scott and White EPO/PPO	$4,861.24
Rate for Payer: Superior Health Plan EPO	$1,322.26

NAIL TIB T2

Facility

$1,176.42

Service Code	HCPCS C1713
Hospital Charge Code	8470491
Hospital Revenue Code	278
Min. Negotiated Rate	$105.88
Max. Negotiated Rate	$588.21
Rate for Payer: Aetna Commercial	$352.93
Rate for Payer: Amerigroup CHIP/Medicaid	$105.88
Rate for Payer: BCBS of TX Blue Advantage	$352.93
Rate for Payer: BCBS of TX Blue Essentials	$423.51
Rate for Payer: BCBS of TX PPO	$470.57
Rate for Payer: Cash Price	$1,035.25
Rate for Payer: Multiplan Auto	$588.21
Rate for Payer: Multiplan Commercial	$588.21
Rate for Payer: Multiplan Workers Comp	$588.21
Rate for Payer: Scott and White EPO/PPO	$588.21
Rate for Payer: Superior Health Plan EPO	$159.99

NAIL TIB T2

Facility

$1,176.42

Service Code	HCPCS C1713
Hospital Charge Code	8470491
Hospital Revenue Code	278
Min. Negotiated Rate	$294.10
Max. Negotiated Rate	$588.21
Rate for Payer: Aetna Commercial	$352.93
Rate for Payer: Cash Price	$1,035.25
Rate for Payer: Cigna Commercial	$294.10
Rate for Payer: Multiplan Auto	$588.21
Rate for Payer: Multiplan Commercial	$588.21
Rate for Payer: Multiplan Workers Comp	$588.21
Rate for Payer: Scott and White EPO/PPO	$588.21

NAIL TROCHANTERIC 125X12X200

Facility

$10,843.37

Service Code	HCPCS C1713
Hospital Charge Code	145474
Hospital Revenue Code	278
Min. Negotiated Rate	$2,710.84
Max. Negotiated Rate	$5,421.68
Rate for Payer: Aetna Commercial	$3,253.01
Rate for Payer: Cash Price	$9,542.17
Rate for Payer: Cigna Commercial	$2,710.84
Rate for Payer: Multiplan Auto	$5,421.68
Rate for Payer: Multiplan Commercial	$5,421.68
Rate for Payer: Multiplan Workers Comp	$5,421.68
Rate for Payer: Scott and White EPO/PPO	$5,421.68

NAIL TROCHANTERIC 125X12X200

Facility

$10,843.37

Service Code	HCPCS C1713
Hospital Charge Code	145474
Hospital Revenue Code	278
Min. Negotiated Rate	$975.90
Max. Negotiated Rate	$5,421.68
Rate for Payer: Aetna Commercial	$3,253.01
Rate for Payer: Amerigroup CHIP/Medicaid	$975.90
Rate for Payer: BCBS of TX Blue Advantage	$3,253.01
Rate for Payer: BCBS of TX Blue Essentials	$3,903.61
Rate for Payer: BCBS of TX PPO	$4,337.35
Rate for Payer: Cash Price	$9,542.17
Rate for Payer: Multiplan Auto	$5,421.68
Rate for Payer: Multiplan Commercial	$5,421.68
Rate for Payer: Multiplan Workers Comp	$5,421.68
Rate for Payer: Scott and White EPO/PPO	$5,421.68
Rate for Payer: Superior Health Plan EPO	$1,474.70

NAIL TROCH /GAMMA NAIL 3

Facility

$10,667.05

Service Code	HCPCS C1713
Hospital Charge Code	8692522
Hospital Revenue Code	278
Min. Negotiated Rate	$2,666.76
Max. Negotiated Rate	$5,333.52
Rate for Payer: Aetna Commercial	$3,200.12
Rate for Payer: Cash Price	$9,387.00
Rate for Payer: Cigna Commercial	$2,666.76
Rate for Payer: Multiplan Auto	$5,333.52
Rate for Payer: Multiplan Commercial	$5,333.52
Rate for Payer: Multiplan Workers Comp	$5,333.52
Rate for Payer: Scott and White EPO/PPO	$5,333.52

NAIL TROCH /GAMMA NAIL 3

Facility

$10,667.05

Service Code	HCPCS C1713
Hospital Charge Code	8692522
Hospital Revenue Code	278
Min. Negotiated Rate	$960.03
Max. Negotiated Rate	$5,333.52
Rate for Payer: Aetna Commercial	$3,200.12
Rate for Payer: Amerigroup CHIP/Medicaid	$960.03
Rate for Payer: BCBS of TX Blue Advantage	$3,200.12
Rate for Payer: BCBS of TX Blue Essentials	$3,840.14
Rate for Payer: BCBS of TX PPO	$4,266.82
Rate for Payer: Cash Price	$9,387.00
Rate for Payer: Multiplan Auto	$5,333.52
Rate for Payer: Multiplan Commercial	$5,333.52
Rate for Payer: Multiplan Workers Comp	$5,333.52
Rate for Payer: Scott and White EPO/PPO	$5,333.52
Rate for Payer: Superior Health Plan EPO	$1,450.72

Know your out-of-pocket cost for care.

All Charges