White Rock Medical Center

All Charges

Charge

Type

Setting

Price

PLATE ACP

Facility

$12,048.19

Service Code	HCPCS C1713
Hospital Charge Code	8452479
Hospital Revenue Code	278
Min. Negotiated Rate	$3,012.05
Max. Negotiated Rate	$6,024.10
Rate for Payer: Aetna Commercial	$3,614.46
Rate for Payer: Cash Price	$10,602.41
Rate for Payer: Cigna Commercial	$3,012.05
Rate for Payer: Multiplan Auto	$6,024.10
Rate for Payer: Multiplan Commercial	$6,024.10
Rate for Payer: Multiplan Workers Comp	$6,024.10
Rate for Payer: Scott and White EPO/PPO	$6,024.10

PLATE ALIF PEEK 32MMX08MMX13MM

Facility

$18,072.29

Service Code	HCPCS C1713
Hospital Charge Code	145336
Hospital Revenue Code	278
Min. Negotiated Rate	$4,518.07
Max. Negotiated Rate	$9,036.14
Rate for Payer: Aetna Commercial	$5,421.69
Rate for Payer: Cash Price	$15,903.62
Rate for Payer: Cigna Commercial	$4,518.07
Rate for Payer: Multiplan Auto	$9,036.14
Rate for Payer: Multiplan Commercial	$9,036.14
Rate for Payer: Multiplan Workers Comp	$9,036.14
Rate for Payer: Scott and White EPO/PPO	$9,036.14

PLATE ALIF PEEK 32MMX08MMX13MM

Facility

$18,072.29

Service Code	HCPCS C1713
Hospital Charge Code	145336
Hospital Revenue Code	278
Min. Negotiated Rate	$1,626.51
Max. Negotiated Rate	$9,036.14
Rate for Payer: Aetna Commercial	$5,421.69
Rate for Payer: Amerigroup CHIP/Medicaid	$1,626.51
Rate for Payer: BCBS of TX Blue Advantage	$5,421.69
Rate for Payer: BCBS of TX Blue Essentials	$6,506.02
Rate for Payer: BCBS of TX PPO	$7,228.92
Rate for Payer: Cash Price	$15,903.62
Rate for Payer: Multiplan Auto	$9,036.14
Rate for Payer: Multiplan Commercial	$9,036.14
Rate for Payer: Multiplan Workers Comp	$9,036.14
Rate for Payer: Scott and White EPO/PPO	$9,036.14
Rate for Payer: Superior Health Plan EPO	$2,457.83

plate alif peek 39x15x15

Facility

$18,072.29

Service Code	HCPCS C1713
Hospital Charge Code	8618509
Hospital Revenue Code	278
Min. Negotiated Rate	$1,626.51
Max. Negotiated Rate	$9,036.14
Rate for Payer: Aetna Commercial	$5,421.69
Rate for Payer: Amerigroup CHIP/Medicaid	$1,626.51
Rate for Payer: BCBS of TX Blue Advantage	$5,421.69
Rate for Payer: BCBS of TX Blue Essentials	$6,506.02
Rate for Payer: BCBS of TX PPO	$7,228.92
Rate for Payer: Cash Price	$15,903.62
Rate for Payer: Multiplan Auto	$9,036.14
Rate for Payer: Multiplan Commercial	$9,036.14
Rate for Payer: Multiplan Workers Comp	$9,036.14
Rate for Payer: Scott and White EPO/PPO	$9,036.14
Rate for Payer: Superior Health Plan EPO	$2,457.83

plate alif peek 39x15x15

Facility

$18,072.29

Service Code	HCPCS C1713
Hospital Charge Code	8618509
Hospital Revenue Code	278
Min. Negotiated Rate	$4,518.07
Max. Negotiated Rate	$9,036.14
Rate for Payer: Aetna Commercial	$5,421.69
Rate for Payer: Cash Price	$15,903.62
Rate for Payer: Cigna Commercial	$4,518.07
Rate for Payer: Multiplan Auto	$9,036.14
Rate for Payer: Multiplan Commercial	$9,036.14
Rate for Payer: Multiplan Workers Comp	$9,036.14
Rate for Payer: Scott and White EPO/PPO	$9,036.14

PLATE CERVICAL ACP 34MM

Facility

$19,834.71

Service Code	HCPCS C1713
Hospital Charge Code	8428488
Hospital Revenue Code	278
Min. Negotiated Rate	$4,958.68
Max. Negotiated Rate	$9,917.36
Rate for Payer: Aetna Commercial	$5,950.41
Rate for Payer: Cash Price	$17,454.54
Rate for Payer: Cigna Commercial	$4,958.68
Rate for Payer: Multiplan Auto	$9,917.36
Rate for Payer: Multiplan Commercial	$9,917.36
Rate for Payer: Multiplan Workers Comp	$9,917.36
Rate for Payer: Scott and White EPO/PPO	$9,917.36

PLATE CERVICAL ACP 34MM

Facility

$19,834.71

Service Code	HCPCS C1713
Hospital Charge Code	8428488
Hospital Revenue Code	278
Min. Negotiated Rate	$1,785.12
Max. Negotiated Rate	$9,917.36
Rate for Payer: Aetna Commercial	$5,950.41
Rate for Payer: Amerigroup CHIP/Medicaid	$1,785.12
Rate for Payer: BCBS of TX Blue Advantage	$5,950.41
Rate for Payer: BCBS of TX Blue Essentials	$7,140.50
Rate for Payer: BCBS of TX PPO	$7,933.88
Rate for Payer: Cash Price	$17,454.54
Rate for Payer: Multiplan Auto	$9,917.36
Rate for Payer: Multiplan Commercial	$9,917.36
Rate for Payer: Multiplan Workers Comp	$9,917.36
Rate for Payer: Scott and White EPO/PPO	$9,917.36
Rate for Payer: Superior Health Plan EPO	$2,697.52

PLATE CERVICAL LVL 3

Facility

$23,140.49

Service Code	HCPCS C1713
Hospital Charge Code	8404459
Hospital Revenue Code	278
Min. Negotiated Rate	$5,785.12
Max. Negotiated Rate	$11,570.24
Rate for Payer: Aetna Commercial	$6,942.15
Rate for Payer: Cash Price	$20,363.63
Rate for Payer: Cigna Commercial	$5,785.12
Rate for Payer: Multiplan Auto	$11,570.24
Rate for Payer: Multiplan Commercial	$11,570.24
Rate for Payer: Multiplan Workers Comp	$11,570.24
Rate for Payer: Scott and White EPO/PPO	$11,570.24

PLATE CERVICAL LVL 3

Facility

$23,140.49

Service Code	HCPCS C1713
Hospital Charge Code	8404459
Hospital Revenue Code	278
Min. Negotiated Rate	$2,082.64
Max. Negotiated Rate	$11,570.24
Rate for Payer: Aetna Commercial	$6,942.15
Rate for Payer: Amerigroup CHIP/Medicaid	$2,082.64
Rate for Payer: BCBS of TX Blue Advantage	$6,942.15
Rate for Payer: BCBS of TX Blue Essentials	$8,330.58
Rate for Payer: BCBS of TX PPO	$9,256.20
Rate for Payer: Cash Price	$20,363.63
Rate for Payer: Multiplan Auto	$11,570.24
Rate for Payer: Multiplan Commercial	$11,570.24
Rate for Payer: Multiplan Workers Comp	$11,570.24
Rate for Payer: Scott and White EPO/PPO	$11,570.24
Rate for Payer: Superior Health Plan EPO	$3,147.11

PLATE DISTAL LATERAL FEMUR 8 HOLE

Facility

$14,176.39

Service Code	HCPCS C1713
Hospital Charge Code	144884
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.88
Max. Negotiated Rate	$7,088.20
Rate for Payer: Aetna Commercial	$4,252.92
Rate for Payer: Amerigroup CHIP/Medicaid	$1,275.88
Rate for Payer: BCBS of TX Blue Advantage	$4,252.92
Rate for Payer: BCBS of TX Blue Essentials	$5,103.50
Rate for Payer: BCBS of TX PPO	$5,670.56
Rate for Payer: Cash Price	$12,475.22
Rate for Payer: Multiplan Auto	$7,088.20
Rate for Payer: Multiplan Commercial	$7,088.20
Rate for Payer: Multiplan Workers Comp	$7,088.20
Rate for Payer: Scott and White EPO/PPO	$7,088.20
Rate for Payer: Superior Health Plan EPO	$1,927.99

PLATE DISTAL LATERAL FEMUR 8 HOLE

Facility

$14,176.39

Service Code	HCPCS C1713
Hospital Charge Code	144884
Hospital Revenue Code	278
Min. Negotiated Rate	$3,544.10
Max. Negotiated Rate	$7,088.20
Rate for Payer: Aetna Commercial	$4,252.92
Rate for Payer: Cash Price	$12,475.22
Rate for Payer: Cigna Commercial	$3,544.10
Rate for Payer: Multiplan Auto	$7,088.20
Rate for Payer: Multiplan Commercial	$7,088.20
Rate for Payer: Multiplan Workers Comp	$7,088.20
Rate for Payer: Scott and White EPO/PPO	$7,088.20

PLATE DISTAL RIGHT 6 HOLE

Facility

$14,870.48

Service Code	HCPCS C1713
Hospital Charge Code	141515
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.34
Max. Negotiated Rate	$7,435.24
Rate for Payer: Aetna Commercial	$4,461.14
Rate for Payer: Amerigroup CHIP/Medicaid	$1,338.34
Rate for Payer: BCBS of TX Blue Advantage	$4,461.14
Rate for Payer: BCBS of TX Blue Essentials	$5,353.37
Rate for Payer: BCBS of TX PPO	$5,948.19
Rate for Payer: Cash Price	$13,086.02
Rate for Payer: Multiplan Auto	$7,435.24
Rate for Payer: Multiplan Commercial	$7,435.24
Rate for Payer: Multiplan Workers Comp	$7,435.24
Rate for Payer: Scott and White EPO/PPO	$7,435.24
Rate for Payer: Superior Health Plan EPO	$2,022.39

PLATE DISTAL RIGHT 6 HOLE

Facility

$14,870.48

Service Code	HCPCS C1713
Hospital Charge Code	141515
Hospital Revenue Code	278
Min. Negotiated Rate	$3,717.62
Max. Negotiated Rate	$7,435.24
Rate for Payer: Aetna Commercial	$4,461.14
Rate for Payer: Cash Price	$13,086.02
Rate for Payer: Cigna Commercial	$3,717.62
Rate for Payer: Multiplan Auto	$7,435.24
Rate for Payer: Multiplan Commercial	$7,435.24
Rate for Payer: Multiplan Workers Comp	$7,435.24
Rate for Payer: Scott and White EPO/PPO	$7,435.24

PLATE DISTAL VOLAR RADIAL

Facility

$5,019.75

Service Code	HCPCS C1713
Hospital Charge Code	8568966
Hospital Revenue Code	278
Min. Negotiated Rate	$451.78
Max. Negotiated Rate	$2,509.88
Rate for Payer: Aetna Commercial	$1,505.92
Rate for Payer: Amerigroup CHIP/Medicaid	$451.78
Rate for Payer: BCBS of TX Blue Advantage	$1,505.92
Rate for Payer: BCBS of TX Blue Essentials	$1,807.11
Rate for Payer: BCBS of TX PPO	$2,007.90
Rate for Payer: Cash Price	$4,417.38
Rate for Payer: Multiplan Auto	$2,509.88
Rate for Payer: Multiplan Commercial	$2,509.88
Rate for Payer: Multiplan Workers Comp	$2,509.88
Rate for Payer: Scott and White EPO/PPO	$2,509.88
Rate for Payer: Superior Health Plan EPO	$682.69

PLATE DISTAL VOLAR RADIAL

Facility

$5,019.75

Service Code	HCPCS C1713
Hospital Charge Code	8568966
Hospital Revenue Code	278
Min. Negotiated Rate	$1,254.94
Max. Negotiated Rate	$2,509.88
Rate for Payer: Aetna Commercial	$1,505.92
Rate for Payer: Cash Price	$4,417.38
Rate for Payer: Cigna Commercial	$1,254.94
Rate for Payer: Multiplan Auto	$2,509.88
Rate for Payer: Multiplan Commercial	$2,509.88
Rate for Payer: Multiplan Workers Comp	$2,509.88
Rate for Payer: Scott and White EPO/PPO	$2,509.88

plate fibula distal

Facility

$3,305.06

Service Code	HCPCS C1713
Hospital Charge Code	8702512
Hospital Revenue Code	278
Min. Negotiated Rate	$297.46
Max. Negotiated Rate	$1,652.53
Rate for Payer: Aetna Commercial	$991.52
Rate for Payer: Amerigroup CHIP/Medicaid	$297.46
Rate for Payer: BCBS of TX Blue Advantage	$991.52
Rate for Payer: BCBS of TX Blue Essentials	$1,189.82
Rate for Payer: BCBS of TX PPO	$1,322.02
Rate for Payer: Cash Price	$2,908.45
Rate for Payer: Multiplan Auto	$1,652.53
Rate for Payer: Multiplan Commercial	$1,652.53
Rate for Payer: Multiplan Workers Comp	$1,652.53
Rate for Payer: Scott and White EPO/PPO	$1,652.53
Rate for Payer: Superior Health Plan EPO	$449.49

plate fibula distal

Facility

$3,305.06

Service Code	HCPCS C1713
Hospital Charge Code	8702512
Hospital Revenue Code	278
Min. Negotiated Rate	$826.26
Max. Negotiated Rate	$1,652.53
Rate for Payer: Aetna Commercial	$991.52
Rate for Payer: Cash Price	$2,908.45
Rate for Payer: Cigna Commercial	$826.26
Rate for Payer: Multiplan Auto	$1,652.53
Rate for Payer: Multiplan Commercial	$1,652.53
Rate for Payer: Multiplan Workers Comp	$1,652.53
Rate for Payer: Scott and White EPO/PPO	$1,652.53

PLATE FOREARM 11 HOLE

Facility

$6,957.83

Service Code	HCPCS C1713
Hospital Charge Code	145263
Hospital Revenue Code	278
Min. Negotiated Rate	$626.20
Max. Negotiated Rate	$3,478.92
Rate for Payer: Aetna Commercial	$2,087.35
Rate for Payer: Amerigroup CHIP/Medicaid	$626.20
Rate for Payer: BCBS of TX Blue Advantage	$2,087.35
Rate for Payer: BCBS of TX Blue Essentials	$2,504.82
Rate for Payer: BCBS of TX PPO	$2,783.13
Rate for Payer: Cash Price	$6,122.89
Rate for Payer: Multiplan Auto	$3,478.92
Rate for Payer: Multiplan Commercial	$3,478.92
Rate for Payer: Multiplan Workers Comp	$3,478.92
Rate for Payer: Scott and White EPO/PPO	$3,478.92
Rate for Payer: Superior Health Plan EPO	$946.26

PLATE FOREARM 11 HOLE

Facility

$6,957.83

Service Code	HCPCS C1713
Hospital Charge Code	145263
Hospital Revenue Code	278
Min. Negotiated Rate	$1,739.46
Max. Negotiated Rate	$3,478.92
Rate for Payer: Aetna Commercial	$2,087.35
Rate for Payer: Cash Price	$6,122.89
Rate for Payer: Cigna Commercial	$1,739.46
Rate for Payer: Multiplan Auto	$3,478.92
Rate for Payer: Multiplan Commercial	$3,478.92
Rate for Payer: Multiplan Workers Comp	$3,478.92
Rate for Payer: Scott and White EPO/PPO	$3,478.92

PLATE HUMERUS

Facility

$11,624.09

Service Code	HCPCS C1713
Hospital Charge Code	8514468
Hospital Revenue Code	278
Min. Negotiated Rate	$1,046.17
Max. Negotiated Rate	$5,812.04
Rate for Payer: Aetna Commercial	$3,487.23
Rate for Payer: Amerigroup CHIP/Medicaid	$1,046.17
Rate for Payer: BCBS of TX Blue Advantage	$3,487.23
Rate for Payer: BCBS of TX Blue Essentials	$4,184.67
Rate for Payer: BCBS of TX PPO	$4,649.64
Rate for Payer: Cash Price	$10,229.20
Rate for Payer: Multiplan Auto	$5,812.04
Rate for Payer: Multiplan Commercial	$5,812.04
Rate for Payer: Multiplan Workers Comp	$5,812.04
Rate for Payer: Scott and White EPO/PPO	$5,812.04
Rate for Payer: Superior Health Plan EPO	$1,580.88

PLATE HUMERUS

Facility

$11,624.09

Service Code	HCPCS C1713
Hospital Charge Code	8514468
Hospital Revenue Code	278
Min. Negotiated Rate	$2,906.02
Max. Negotiated Rate	$5,812.04
Rate for Payer: Aetna Commercial	$3,487.23
Rate for Payer: Cash Price	$10,229.20
Rate for Payer: Cigna Commercial	$2,906.02
Rate for Payer: Multiplan Auto	$5,812.04
Rate for Payer: Multiplan Commercial	$5,812.04
Rate for Payer: Multiplan Workers Comp	$5,812.04
Rate for Payer: Scott and White EPO/PPO	$5,812.04

PLATE HUMERUS DISTAL MEDIA

Facility

$4,901.20

Service Code	HCPCS C1713
Hospital Charge Code	144824
Hospital Revenue Code	278
Min. Negotiated Rate	$441.11
Max. Negotiated Rate	$2,450.60
Rate for Payer: Aetna Commercial	$1,470.36
Rate for Payer: Amerigroup CHIP/Medicaid	$441.11
Rate for Payer: BCBS of TX Blue Advantage	$1,470.36
Rate for Payer: BCBS of TX Blue Essentials	$1,764.43
Rate for Payer: BCBS of TX PPO	$1,960.48
Rate for Payer: Cash Price	$4,313.06
Rate for Payer: Multiplan Auto	$2,450.60
Rate for Payer: Multiplan Commercial	$2,450.60
Rate for Payer: Multiplan Workers Comp	$2,450.60
Rate for Payer: Scott and White EPO/PPO	$2,450.60
Rate for Payer: Superior Health Plan EPO	$666.56

PLATE HUMERUS DISTAL MEDIA

Facility

$4,901.20

Service Code	HCPCS C1713
Hospital Charge Code	144824
Hospital Revenue Code	278
Min. Negotiated Rate	$1,225.30
Max. Negotiated Rate	$2,450.60
Rate for Payer: Aetna Commercial	$1,470.36
Rate for Payer: Cash Price	$4,313.06
Rate for Payer: Cigna Commercial	$1,225.30
Rate for Payer: Multiplan Auto	$2,450.60
Rate for Payer: Multiplan Commercial	$2,450.60
Rate for Payer: Multiplan Workers Comp	$2,450.60
Rate for Payer: Scott and White EPO/PPO	$2,450.60

PLATE HUMERUS PROX

Facility

$13,413.01

Service Code	HCPCS C1713
Hospital Charge Code	8528469
Hospital Revenue Code	278
Min. Negotiated Rate	$3,353.25
Max. Negotiated Rate	$6,706.50
Rate for Payer: Aetna Commercial	$4,023.90
Rate for Payer: Cash Price	$11,803.45
Rate for Payer: Cigna Commercial	$3,353.25
Rate for Payer: Multiplan Auto	$6,706.50
Rate for Payer: Multiplan Commercial	$6,706.50
Rate for Payer: Multiplan Workers Comp	$6,706.50
Rate for Payer: Scott and White EPO/PPO	$6,706.50

PLATE HUMERUS PROX

Facility

$13,413.01

Service Code	HCPCS C1713
Hospital Charge Code	8528469
Hospital Revenue Code	278
Min. Negotiated Rate	$1,207.17
Max. Negotiated Rate	$6,706.50
Rate for Payer: Aetna Commercial	$4,023.90
Rate for Payer: Amerigroup CHIP/Medicaid	$1,207.17
Rate for Payer: BCBS of TX Blue Advantage	$4,023.90
Rate for Payer: BCBS of TX Blue Essentials	$4,828.68
Rate for Payer: BCBS of TX PPO	$5,365.20
Rate for Payer: Cash Price	$11,803.45
Rate for Payer: Multiplan Auto	$6,706.50
Rate for Payer: Multiplan Commercial	$6,706.50
Rate for Payer: Multiplan Workers Comp	$6,706.50
Rate for Payer: Scott and White EPO/PPO	$6,706.50
Rate for Payer: Superior Health Plan EPO	$1,824.17

Know your out-of-pocket cost for care.

All Charges