White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SCREW 3.5MM HEX HEAD

Facility

$936.14

Service Code	HCPCS C1713
Hospital Charge Code	144886
Hospital Revenue Code	278
Min. Negotiated Rate	$84.25
Max. Negotiated Rate	$468.07
Rate for Payer: Aetna Commercial	$280.84
Rate for Payer: Amerigroup CHIP/Medicaid	$84.25
Rate for Payer: BCBS of TX Blue Advantage	$280.84
Rate for Payer: BCBS of TX Blue Essentials	$337.01
Rate for Payer: BCBS of TX PPO	$374.46
Rate for Payer: Cash Price	$823.80
Rate for Payer: Multiplan Auto	$468.07
Rate for Payer: Multiplan Commercial	$468.07
Rate for Payer: Multiplan Workers Comp	$468.07
Rate for Payer: Scott and White EPO/PPO	$468.07
Rate for Payer: Superior Health Plan EPO	$127.32

SCREW 3.5MM HEX HEAD

Facility

$936.14

Service Code	HCPCS C1713
Hospital Charge Code	144886
Hospital Revenue Code	278
Min. Negotiated Rate	$234.04
Max. Negotiated Rate	$468.07
Rate for Payer: Aetna Commercial	$280.84
Rate for Payer: Cash Price	$823.80
Rate for Payer: Cigna Commercial	$234.04
Rate for Payer: Multiplan Auto	$468.07
Rate for Payer: Multiplan Commercial	$468.07
Rate for Payer: Multiplan Workers Comp	$468.07
Rate for Payer: Scott and White EPO/PPO	$468.07

SCREW ACF 4.0 SELF DRILLING SDV40

Facility

$1,506.02

Service Code	HCPCS C1713
Hospital Charge Code	8420463
Hospital Revenue Code	278
Min. Negotiated Rate	$135.54
Max. Negotiated Rate	$753.01
Rate for Payer: Aetna Commercial	$451.81
Rate for Payer: Amerigroup CHIP/Medicaid	$135.54
Rate for Payer: BCBS of TX Blue Advantage	$451.81
Rate for Payer: BCBS of TX Blue Essentials	$542.17
Rate for Payer: BCBS of TX PPO	$602.41
Rate for Payer: Cash Price	$1,325.30
Rate for Payer: Multiplan Auto	$753.01
Rate for Payer: Multiplan Commercial	$753.01
Rate for Payer: Multiplan Workers Comp	$753.01
Rate for Payer: Scott and White EPO/PPO	$753.01
Rate for Payer: Superior Health Plan EPO	$204.82

SCREW ACF 4.0 SELF DRILLING SDV40

Facility

$1,506.02

Service Code	HCPCS C1713
Hospital Charge Code	8420463
Hospital Revenue Code	278
Min. Negotiated Rate	$376.50
Max. Negotiated Rate	$753.01
Rate for Payer: Aetna Commercial	$451.81
Rate for Payer: Cash Price	$1,325.30
Rate for Payer: Cigna Commercial	$376.50
Rate for Payer: Multiplan Auto	$753.01
Rate for Payer: Multiplan Commercial	$753.01
Rate for Payer: Multiplan Workers Comp	$753.01
Rate for Payer: Scott and White EPO/PPO	$753.01

SCREW ACIFSLF DRL FXD 4.0X16

Facility

$1,506.02

Service Code	HCPCS C1713
Hospital Charge Code	8568969
Hospital Revenue Code	278
Min. Negotiated Rate	$135.54
Max. Negotiated Rate	$753.01
Rate for Payer: Aetna Commercial	$451.81
Rate for Payer: Amerigroup CHIP/Medicaid	$135.54
Rate for Payer: BCBS of TX Blue Advantage	$451.81
Rate for Payer: BCBS of TX Blue Essentials	$542.17
Rate for Payer: BCBS of TX PPO	$602.41
Rate for Payer: Cash Price	$1,325.30
Rate for Payer: Multiplan Auto	$753.01
Rate for Payer: Multiplan Commercial	$753.01
Rate for Payer: Multiplan Workers Comp	$753.01
Rate for Payer: Scott and White EPO/PPO	$753.01
Rate for Payer: Superior Health Plan EPO	$204.82

SCREW ACIFSLF DRL FXD 4.0X16

Facility

$1,506.02

Service Code	HCPCS C1713
Hospital Charge Code	8568969
Hospital Revenue Code	278
Min. Negotiated Rate	$376.50
Max. Negotiated Rate	$753.01
Rate for Payer: Aetna Commercial	$451.81
Rate for Payer: Cash Price	$1,325.30
Rate for Payer: Cigna Commercial	$376.50
Rate for Payer: Multiplan Auto	$753.01
Rate for Payer: Multiplan Commercial	$753.01
Rate for Payer: Multiplan Workers Comp	$753.01
Rate for Payer: Scott and White EPO/PPO	$753.01

SCREW ACIF SLF DRL FXD 4X12

Facility

$1,506.02

Service Code	HCPCS C1713
Hospital Charge Code	8568968
Hospital Revenue Code	278
Min. Negotiated Rate	$376.50
Max. Negotiated Rate	$753.01
Rate for Payer: Aetna Commercial	$451.81
Rate for Payer: Cash Price	$1,325.30
Rate for Payer: Cigna Commercial	$376.50
Rate for Payer: Multiplan Auto	$753.01
Rate for Payer: Multiplan Commercial	$753.01
Rate for Payer: Multiplan Workers Comp	$753.01
Rate for Payer: Scott and White EPO/PPO	$753.01

SCREW ACIF SLF DRL FXD 4X12

Facility

$1,506.02

Service Code	HCPCS C1713
Hospital Charge Code	8568968
Hospital Revenue Code	278
Min. Negotiated Rate	$135.54
Max. Negotiated Rate	$753.01
Rate for Payer: Aetna Commercial	$451.81
Rate for Payer: Amerigroup CHIP/Medicaid	$135.54
Rate for Payer: BCBS of TX Blue Advantage	$451.81
Rate for Payer: BCBS of TX Blue Essentials	$542.17
Rate for Payer: BCBS of TX PPO	$602.41
Rate for Payer: Cash Price	$1,325.30
Rate for Payer: Multiplan Auto	$753.01
Rate for Payer: Multiplan Commercial	$753.01
Rate for Payer: Multiplan Workers Comp	$753.01
Rate for Payer: Scott and White EPO/PPO	$753.01
Rate for Payer: Superior Health Plan EPO	$204.82

SCREW ALIF 4.0MM

Facility

$1,204.82

Service Code	HCPCS C1713
Hospital Charge Code	81360075
Hospital Revenue Code	278
Min. Negotiated Rate	$108.43
Max. Negotiated Rate	$602.41
Rate for Payer: Aetna Commercial	$361.45
Rate for Payer: Amerigroup CHIP/Medicaid	$108.43
Rate for Payer: BCBS of TX Blue Advantage	$361.45
Rate for Payer: BCBS of TX Blue Essentials	$433.74
Rate for Payer: BCBS of TX PPO	$481.93
Rate for Payer: Cash Price	$1,060.24
Rate for Payer: Multiplan Auto	$602.41
Rate for Payer: Multiplan Commercial	$602.41
Rate for Payer: Multiplan Workers Comp	$602.41
Rate for Payer: Scott and White EPO/PPO	$602.41
Rate for Payer: Superior Health Plan EPO	$163.86

SCREW ALIF 4.0MM

Facility

$1,204.82

Service Code	HCPCS C1713
Hospital Charge Code	81360075
Hospital Revenue Code	278
Min. Negotiated Rate	$301.20
Max. Negotiated Rate	$602.41
Rate for Payer: Aetna Commercial	$361.45
Rate for Payer: Cash Price	$1,060.24
Rate for Payer: Cigna Commercial	$301.20
Rate for Payer: Multiplan Auto	$602.41
Rate for Payer: Multiplan Commercial	$602.41
Rate for Payer: Multiplan Workers Comp	$602.41
Rate for Payer: Scott and White EPO/PPO	$602.41

SCREW BN TAP CORTICAL 4.5X48NL 661748

Facility

$275.72

Service Code	HCPCS C1713
Hospital Charge Code	145155
Hospital Revenue Code	278
Min. Negotiated Rate	$68.93
Max. Negotiated Rate	$137.86
Rate for Payer: Aetna Commercial	$82.72
Rate for Payer: Cash Price	$242.63
Rate for Payer: Cigna Commercial	$68.93
Rate for Payer: Multiplan Auto	$137.86
Rate for Payer: Multiplan Commercial	$137.86
Rate for Payer: Multiplan Workers Comp	$137.86
Rate for Payer: Scott and White EPO/PPO	$137.86

SCREW BN TAP CORTICAL 4.5X48NL 661748

Facility

$275.72

Service Code	HCPCS C1713
Hospital Charge Code	145155
Hospital Revenue Code	278
Min. Negotiated Rate	$24.81
Max. Negotiated Rate	$137.86
Rate for Payer: Aetna Commercial	$82.72
Rate for Payer: Amerigroup CHIP/Medicaid	$24.81
Rate for Payer: BCBS of TX Blue Advantage	$82.72
Rate for Payer: BCBS of TX Blue Essentials	$99.26
Rate for Payer: BCBS of TX PPO	$110.29
Rate for Payer: Cash Price	$242.63
Rate for Payer: Multiplan Auto	$137.86
Rate for Payer: Multiplan Commercial	$137.86
Rate for Payer: Multiplan Workers Comp	$137.86
Rate for Payer: Scott and White EPO/PPO	$137.86
Rate for Payer: Superior Health Plan EPO	$37.50

screw bone full thread

Facility

$517.59

Service Code	HCPCS C1713
Hospital Charge Code	8702510
Hospital Revenue Code	278
Min. Negotiated Rate	$46.58
Max. Negotiated Rate	$258.80
Rate for Payer: Aetna Commercial	$155.28
Rate for Payer: Amerigroup CHIP/Medicaid	$46.58
Rate for Payer: BCBS of TX Blue Advantage	$155.28
Rate for Payer: BCBS of TX Blue Essentials	$186.33
Rate for Payer: BCBS of TX PPO	$207.04
Rate for Payer: Cash Price	$455.48
Rate for Payer: Multiplan Auto	$258.80
Rate for Payer: Multiplan Commercial	$258.80
Rate for Payer: Multiplan Workers Comp	$258.80
Rate for Payer: Scott and White EPO/PPO	$258.80
Rate for Payer: Superior Health Plan EPO	$70.39

screw bone full thread

Facility

$517.59

Service Code	HCPCS C1713
Hospital Charge Code	8702510
Hospital Revenue Code	278
Min. Negotiated Rate	$129.40
Max. Negotiated Rate	$258.80
Rate for Payer: Aetna Commercial	$155.28
Rate for Payer: Cash Price	$455.48
Rate for Payer: Cigna Commercial	$129.40
Rate for Payer: Multiplan Auto	$258.80
Rate for Payer: Multiplan Commercial	$258.80
Rate for Payer: Multiplan Workers Comp	$258.80
Rate for Payer: Scott and White EPO/PPO	$258.80

SCREW BONE LOCKING

Facility

$1,845.12

Service Code	HCPCS C1713
Hospital Charge Code	8428501
Hospital Revenue Code	278
Min. Negotiated Rate	$166.06
Max. Negotiated Rate	$922.56
Rate for Payer: Aetna Commercial	$553.54
Rate for Payer: Amerigroup CHIP/Medicaid	$166.06
Rate for Payer: BCBS of TX Blue Advantage	$553.54
Rate for Payer: BCBS of TX Blue Essentials	$664.24
Rate for Payer: BCBS of TX PPO	$738.05
Rate for Payer: Cash Price	$1,623.71
Rate for Payer: Multiplan Auto	$922.56
Rate for Payer: Multiplan Commercial	$922.56
Rate for Payer: Multiplan Workers Comp	$922.56
Rate for Payer: Scott and White EPO/PPO	$922.56
Rate for Payer: Superior Health Plan EPO	$250.94

SCREW BONE LOCKING

Facility

$1,845.12

Service Code	HCPCS C1713
Hospital Charge Code	8428501
Hospital Revenue Code	278
Min. Negotiated Rate	$461.28
Max. Negotiated Rate	$922.56
Rate for Payer: Aetna Commercial	$553.54
Rate for Payer: Cash Price	$1,623.71
Rate for Payer: Cigna Commercial	$461.28
Rate for Payer: Multiplan Auto	$922.56
Rate for Payer: Multiplan Commercial	$922.56
Rate for Payer: Multiplan Workers Comp	$922.56
Rate for Payer: Scott and White EPO/PPO	$922.56

SCREW BONE T8 FULL THREAD 2.7X12

Facility

$698.80

Service Code	HCPCS C1713
Hospital Charge Code	145594
Hospital Revenue Code	278
Min. Negotiated Rate	$174.70
Max. Negotiated Rate	$349.40
Rate for Payer: Aetna Commercial	$209.64
Rate for Payer: Cash Price	$614.94
Rate for Payer: Cigna Commercial	$174.70
Rate for Payer: Multiplan Auto	$349.40
Rate for Payer: Multiplan Commercial	$349.40
Rate for Payer: Multiplan Workers Comp	$349.40
Rate for Payer: Scott and White EPO/PPO	$349.40

SCREW BONE T8 FULL THREAD 2.7X12

Facility

$698.80

Service Code	HCPCS C1713
Hospital Charge Code	145594
Hospital Revenue Code	278
Min. Negotiated Rate	$62.89
Max. Negotiated Rate	$349.40
Rate for Payer: Aetna Commercial	$209.64
Rate for Payer: Amerigroup CHIP/Medicaid	$62.89
Rate for Payer: BCBS of TX Blue Advantage	$209.64
Rate for Payer: BCBS of TX Blue Essentials	$251.57
Rate for Payer: BCBS of TX PPO	$279.52
Rate for Payer: Cash Price	$614.94
Rate for Payer: Multiplan Auto	$349.40
Rate for Payer: Multiplan Commercial	$349.40
Rate for Payer: Multiplan Workers Comp	$349.40
Rate for Payer: Scott and White EPO/PPO	$349.40
Rate for Payer: Superior Health Plan EPO	$95.04

SCREW CANCELLOUS6.0X80 608080

Facility

$249.46

Service Code	HCPCS C1713
Hospital Charge Code	145153
Hospital Revenue Code	278
Min. Negotiated Rate	$62.36
Max. Negotiated Rate	$124.73
Rate for Payer: Aetna Commercial	$74.84
Rate for Payer: Cash Price	$219.52
Rate for Payer: Cigna Commercial	$62.36
Rate for Payer: Multiplan Auto	$124.73
Rate for Payer: Multiplan Commercial	$124.73
Rate for Payer: Multiplan Workers Comp	$124.73
Rate for Payer: Scott and White EPO/PPO	$124.73

SCREW CANCELLOUS6.0X80 608080

Facility

$249.46

Service Code	HCPCS C1713
Hospital Charge Code	145153
Hospital Revenue Code	278
Min. Negotiated Rate	$22.45
Max. Negotiated Rate	$124.73
Rate for Payer: Aetna Commercial	$74.84
Rate for Payer: Amerigroup CHIP/Medicaid	$22.45
Rate for Payer: BCBS of TX Blue Advantage	$74.84
Rate for Payer: BCBS of TX Blue Essentials	$89.81
Rate for Payer: BCBS of TX PPO	$99.78
Rate for Payer: Cash Price	$219.52
Rate for Payer: Multiplan Auto	$124.73
Rate for Payer: Multiplan Commercial	$124.73
Rate for Payer: Multiplan Workers Comp	$124.73
Rate for Payer: Scott and White EPO/PPO	$124.73
Rate for Payer: Superior Health Plan EPO	$33.93

SCREW CANCELLOUS 6MM F/T

Facility

$309.70

Service Code	HCPCS C1713
Hospital Charge Code	145596
Hospital Revenue Code	278
Min. Negotiated Rate	$77.42
Max. Negotiated Rate	$154.85
Rate for Payer: Aetna Commercial	$92.91
Rate for Payer: Cash Price	$272.54
Rate for Payer: Cigna Commercial	$77.42
Rate for Payer: Multiplan Auto	$154.85
Rate for Payer: Multiplan Commercial	$154.85
Rate for Payer: Multiplan Workers Comp	$154.85
Rate for Payer: Scott and White EPO/PPO	$154.85

SCREW CANCELLOUS 6MM F/T

Facility

$309.70

Service Code	HCPCS C1713
Hospital Charge Code	145596
Hospital Revenue Code	278
Min. Negotiated Rate	$27.87
Max. Negotiated Rate	$154.85
Rate for Payer: Aetna Commercial	$92.91
Rate for Payer: Amerigroup CHIP/Medicaid	$27.87
Rate for Payer: BCBS of TX Blue Advantage	$92.91
Rate for Payer: BCBS of TX Blue Essentials	$111.49
Rate for Payer: BCBS of TX PPO	$123.88
Rate for Payer: Cash Price	$272.54
Rate for Payer: Multiplan Auto	$154.85
Rate for Payer: Multiplan Commercial	$154.85
Rate for Payer: Multiplan Workers Comp	$154.85
Rate for Payer: Scott and White EPO/PPO	$154.85
Rate for Payer: Superior Health Plan EPO	$42.12

SCREW CANN ASNIS III

Facility

$1,424.34

Service Code	HCPCS C1713
Hospital Charge Code	144885
Hospital Revenue Code	278
Min. Negotiated Rate	$356.08
Max. Negotiated Rate	$712.17
Rate for Payer: Aetna Commercial	$427.30
Rate for Payer: Cash Price	$1,253.42
Rate for Payer: Cigna Commercial	$356.08
Rate for Payer: Multiplan Auto	$712.17
Rate for Payer: Multiplan Commercial	$712.17
Rate for Payer: Multiplan Workers Comp	$712.17
Rate for Payer: Scott and White EPO/PPO	$712.17

SCREW CANN ASNIS III

Facility

$1,424.34

Service Code	HCPCS C1713
Hospital Charge Code	144885
Hospital Revenue Code	278
Min. Negotiated Rate	$128.19
Max. Negotiated Rate	$712.17
Rate for Payer: Aetna Commercial	$427.30
Rate for Payer: Amerigroup CHIP/Medicaid	$128.19
Rate for Payer: BCBS of TX Blue Advantage	$427.30
Rate for Payer: BCBS of TX Blue Essentials	$512.76
Rate for Payer: BCBS of TX PPO	$569.74
Rate for Payer: Cash Price	$1,253.42
Rate for Payer: Multiplan Auto	$712.17
Rate for Payer: Multiplan Commercial	$712.17
Rate for Payer: Multiplan Workers Comp	$712.17
Rate for Payer: Scott and White EPO/PPO	$712.17
Rate for Payer: Superior Health Plan EPO	$193.71

SCREW CANN -- DHF

Facility

$1,224.73

Service Code	HCPCS C1713
Hospital Charge Code	81360315
Hospital Revenue Code	278
Min. Negotiated Rate	$110.23
Max. Negotiated Rate	$612.36
Rate for Payer: Aetna Commercial	$367.42
Rate for Payer: Amerigroup CHIP/Medicaid	$110.23
Rate for Payer: BCBS of TX Blue Advantage	$367.42
Rate for Payer: BCBS of TX Blue Essentials	$440.90
Rate for Payer: BCBS of TX PPO	$489.89
Rate for Payer: Cash Price	$1,077.76
Rate for Payer: Multiplan Auto	$612.36
Rate for Payer: Multiplan Commercial	$612.36
Rate for Payer: Multiplan Workers Comp	$612.36
Rate for Payer: Scott and White EPO/PPO	$612.36
Rate for Payer: Superior Health Plan EPO	$166.56

Know your out-of-pocket cost for care.

All Charges