White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CANN -- DHF

Facility

$1,224.73

Service Code	HCPCS C1713
Hospital Charge Code	81360315
Hospital Revenue Code	278
Min. Negotiated Rate	$306.18
Max. Negotiated Rate	$612.36
Rate for Payer: Aetna Commercial	$367.42
Rate for Payer: Cash Price	$1,077.76
Rate for Payer: Cigna Commercial	$306.18
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

screw cannulated 4.0

Facility

$895.06

Service Code	HCPCS C1713
Hospital Charge Code	8654506
Hospital Revenue Code	278
Min. Negotiated Rate	$223.76
Max. Negotiated Rate	$447.53
Rate for Payer: Aetna Commercial	$268.52
Rate for Payer: Cash Price	$787.65
Rate for Payer: Cigna Commercial	$223.76
Rate for Payer: Multiplan Auto	$447.53
Rate for Payer: Multiplan Commercial	$447.53
Rate for Payer: Multiplan Workers Comp	$447.53
Rate for Payer: Scott and White EPO/PPO	$447.53

screw cannulated 4.0

Facility

$895.06

Service Code	HCPCS C1713
Hospital Charge Code	8654506
Hospital Revenue Code	278
Min. Negotiated Rate	$80.56
Max. Negotiated Rate	$447.53
Rate for Payer: Aetna Commercial	$268.52
Rate for Payer: Amerigroup CHIP/Medicaid	$80.56
Rate for Payer: BCBS of TX Blue Advantage	$268.52
Rate for Payer: BCBS of TX Blue Essentials	$322.22
Rate for Payer: BCBS of TX PPO	$358.02
Rate for Payer: Cash Price	$787.65
Rate for Payer: Multiplan Auto	$447.53
Rate for Payer: Multiplan Commercial	$447.53
Rate for Payer: Multiplan Workers Comp	$447.53
Rate for Payer: Scott and White EPO/PPO	$447.53
Rate for Payer: Superior Health Plan EPO	$121.73

SCREW CANNULATED 6.5X100

Facility

$1,396.62

Service Code	HCPCS C1713
Hospital Charge Code	8562501
Hospital Revenue Code	278
Min. Negotiated Rate	$125.70
Max. Negotiated Rate	$698.31
Rate for Payer: Aetna Commercial	$418.99
Rate for Payer: Amerigroup CHIP/Medicaid	$125.70
Rate for Payer: BCBS of TX Blue Advantage	$418.99
Rate for Payer: BCBS of TX Blue Essentials	$502.78
Rate for Payer: BCBS of TX PPO	$558.65
Rate for Payer: Cash Price	$1,229.03
Rate for Payer: Multiplan Auto	$698.31
Rate for Payer: Multiplan Commercial	$698.31
Rate for Payer: Multiplan Workers Comp	$698.31
Rate for Payer: Scott and White EPO/PPO	$698.31
Rate for Payer: Superior Health Plan EPO	$189.94

SCREW CANNULATED 6.5X100

Facility

$1,396.62

Service Code	HCPCS C1713
Hospital Charge Code	8562501
Hospital Revenue Code	278
Min. Negotiated Rate	$349.16
Max. Negotiated Rate	$698.31
Rate for Payer: Aetna Commercial	$418.99
Rate for Payer: Cash Price	$1,229.03
Rate for Payer: Cigna Commercial	$349.16
Rate for Payer: Multiplan Auto	$698.31
Rate for Payer: Multiplan Commercial	$698.31
Rate for Payer: Multiplan Workers Comp	$698.31
Rate for Payer: Scott and White EPO/PPO	$698.31

SCREW CANNULATED 6.5X90

Facility

$1,410.48

Service Code	HCPCS C1713
Hospital Charge Code	8562502
Hospital Revenue Code	278
Min. Negotiated Rate	$126.94
Max. Negotiated Rate	$705.24
Rate for Payer: Aetna Commercial	$423.14
Rate for Payer: Amerigroup CHIP/Medicaid	$126.94
Rate for Payer: BCBS of TX Blue Advantage	$423.14
Rate for Payer: BCBS of TX Blue Essentials	$507.77
Rate for Payer: BCBS of TX PPO	$564.19
Rate for Payer: Cash Price	$1,241.22
Rate for Payer: Multiplan Auto	$705.24
Rate for Payer: Multiplan Commercial	$705.24
Rate for Payer: Multiplan Workers Comp	$705.24
Rate for Payer: Scott and White EPO/PPO	$705.24
Rate for Payer: Superior Health Plan EPO	$191.83

SCREW CANNULATED 6.5X90

Facility

$1,410.48

Service Code	HCPCS C1713
Hospital Charge Code	8562502
Hospital Revenue Code	278
Min. Negotiated Rate	$352.62
Max. Negotiated Rate	$705.24
Rate for Payer: Aetna Commercial	$423.14
Rate for Payer: Cash Price	$1,241.22
Rate for Payer: Cigna Commercial	$352.62
Rate for Payer: Multiplan Auto	$705.24
Rate for Payer: Multiplan Commercial	$705.24
Rate for Payer: Multiplan Workers Comp	$705.24
Rate for Payer: Scott and White EPO/PPO	$705.24

SCREW CANNULATED 6.5 X 95

Facility

$1,828.31

Service Code	HCPCS C1713
Hospital Charge Code	140603
Hospital Revenue Code	278
Min. Negotiated Rate	$164.55
Max. Negotiated Rate	$914.16
Rate for Payer: Aetna Commercial	$548.49
Rate for Payer: Amerigroup CHIP/Medicaid	$164.55
Rate for Payer: BCBS of TX Blue Advantage	$548.49
Rate for Payer: BCBS of TX Blue Essentials	$658.19
Rate for Payer: BCBS of TX PPO	$731.32
Rate for Payer: Cash Price	$1,608.91
Rate for Payer: Multiplan Auto	$914.16
Rate for Payer: Multiplan Commercial	$914.16
Rate for Payer: Multiplan Workers Comp	$914.16
Rate for Payer: Scott and White EPO/PPO	$914.16
Rate for Payer: Superior Health Plan EPO	$248.65

SCREW CANNULATED 6.5 X 95

Facility

$1,828.31

Service Code	HCPCS C1713
Hospital Charge Code	140603
Hospital Revenue Code	278
Min. Negotiated Rate	$457.08
Max. Negotiated Rate	$914.16
Rate for Payer: Aetna Commercial	$548.49
Rate for Payer: Cash Price	$1,608.91
Rate for Payer: Cigna Commercial	$457.08
Rate for Payer: Multiplan Auto	$914.16
Rate for Payer: Multiplan Commercial	$914.16
Rate for Payer: Multiplan Workers Comp	$914.16
Rate for Payer: Scott and White EPO/PPO	$914.16

SCREW CANNULATED COMP HEADLESS

Facility

$2,416.51

Service Code	HCPCS C1713
Hospital Charge Code	8612540
Hospital Revenue Code	278
Min. Negotiated Rate	$604.13
Max. Negotiated Rate	$1,208.26
Rate for Payer: Aetna Commercial	$724.95
Rate for Payer: Cash Price	$2,126.53
Rate for Payer: Cigna Commercial	$604.13
Rate for Payer: Multiplan Auto	$1,208.26
Rate for Payer: Multiplan Commercial	$1,208.26
Rate for Payer: Multiplan Workers Comp	$1,208.26
Rate for Payer: Scott and White EPO/PPO	$1,208.26

SCREW CANNULATED COMP HEADLESS

Facility

$2,416.51

Service Code	HCPCS C1713
Hospital Charge Code	8612540
Hospital Revenue Code	278
Min. Negotiated Rate	$217.49
Max. Negotiated Rate	$1,208.26
Rate for Payer: Aetna Commercial	$724.95
Rate for Payer: Amerigroup CHIP/Medicaid	$217.49
Rate for Payer: BCBS of TX Blue Advantage	$724.95
Rate for Payer: BCBS of TX Blue Essentials	$869.94
Rate for Payer: BCBS of TX PPO	$966.60
Rate for Payer: Cash Price	$2,126.53
Rate for Payer: Multiplan Auto	$1,208.26
Rate for Payer: Multiplan Commercial	$1,208.26
Rate for Payer: Multiplan Workers Comp	$1,208.26
Rate for Payer: Scott and White EPO/PPO	$1,208.26
Rate for Payer: Superior Health Plan EPO	$328.65

SCREW CANNULATED HEADED 2.0

Facility

$1,957.83

Service Code	HCPCS C1713
Hospital Charge Code	145184
Hospital Revenue Code	278
Min. Negotiated Rate	$176.20
Max. Negotiated Rate	$978.92
Rate for Payer: Aetna Commercial	$587.35
Rate for Payer: Amerigroup CHIP/Medicaid	$176.20
Rate for Payer: BCBS of TX Blue Advantage	$587.35
Rate for Payer: BCBS of TX Blue Essentials	$704.82
Rate for Payer: BCBS of TX PPO	$783.13
Rate for Payer: Cash Price	$1,722.89
Rate for Payer: Multiplan Auto	$978.92
Rate for Payer: Multiplan Commercial	$978.92
Rate for Payer: Multiplan Workers Comp	$978.92
Rate for Payer: Scott and White EPO/PPO	$978.92
Rate for Payer: Superior Health Plan EPO	$266.26

SCREW CANNULATED HEADED 2.0

Facility

$1,957.83

Service Code	HCPCS C1713
Hospital Charge Code	145184
Hospital Revenue Code	278
Min. Negotiated Rate	$489.46
Max. Negotiated Rate	$978.92
Rate for Payer: Aetna Commercial	$587.35
Rate for Payer: Cash Price	$1,722.89
Rate for Payer: Cigna Commercial	$489.46
Rate for Payer: Multiplan Auto	$978.92
Rate for Payer: Multiplan Commercial	$978.92
Rate for Payer: Multiplan Workers Comp	$978.92
Rate for Payer: Scott and White EPO/PPO	$978.92

SCREW CANNULATED II

Facility

$6,924.57

Service Code	HCPCS C1713
Hospital Charge Code	8510471
Hospital Revenue Code	278
Min. Negotiated Rate	$1,731.14
Max. Negotiated Rate	$3,462.28
Rate for Payer: Aetna Commercial	$2,077.37
Rate for Payer: Cash Price	$6,093.62
Rate for Payer: Cigna Commercial	$1,731.14
Rate for Payer: Multiplan Auto	$3,462.28
Rate for Payer: Multiplan Commercial	$3,462.28
Rate for Payer: Multiplan Workers Comp	$3,462.28
Rate for Payer: Scott and White EPO/PPO	$3,462.28

SCREW CANNULATED II

Facility

$6,924.57

Service Code	HCPCS C1713
Hospital Charge Code	8510471
Hospital Revenue Code	278
Min. Negotiated Rate	$623.21
Max. Negotiated Rate	$3,462.28
Rate for Payer: Aetna Commercial	$2,077.37
Rate for Payer: Amerigroup CHIP/Medicaid	$623.21
Rate for Payer: BCBS of TX Blue Advantage	$2,077.37
Rate for Payer: BCBS of TX Blue Essentials	$2,492.85
Rate for Payer: BCBS of TX PPO	$2,769.83
Rate for Payer: Cash Price	$6,093.62
Rate for Payer: Multiplan Auto	$3,462.28
Rate for Payer: Multiplan Commercial	$3,462.28
Rate for Payer: Multiplan Workers Comp	$3,462.28
Rate for Payer: Scott and White EPO/PPO	$3,462.28
Rate for Payer: Superior Health Plan EPO	$941.74

SCREW CANNULATED III

Facility

$2,416.50

Service Code	HCPCS C1713
Hospital Charge Code	8512489
Hospital Revenue Code	278
Min. Negotiated Rate	$604.12
Max. Negotiated Rate	$1,208.25
Rate for Payer: Aetna Commercial	$724.95
Rate for Payer: Cash Price	$2,126.52
Rate for Payer: Cigna Commercial	$604.12
Rate for Payer: Multiplan Auto	$1,208.25
Rate for Payer: Multiplan Commercial	$1,208.25
Rate for Payer: Multiplan Workers Comp	$1,208.25
Rate for Payer: Scott and White EPO/PPO	$1,208.25

SCREW CANNULATED III

Facility

$2,416.50

Service Code	HCPCS C1713
Hospital Charge Code	8512489
Hospital Revenue Code	278
Min. Negotiated Rate	$217.48
Max. Negotiated Rate	$1,208.25
Rate for Payer: Aetna Commercial	$724.95
Rate for Payer: Amerigroup CHIP/Medicaid	$217.48
Rate for Payer: BCBS of TX Blue Advantage	$724.95
Rate for Payer: BCBS of TX Blue Essentials	$869.94
Rate for Payer: BCBS of TX PPO	$966.60
Rate for Payer: Cash Price	$2,126.52
Rate for Payer: Multiplan Auto	$1,208.25
Rate for Payer: Multiplan Commercial	$1,208.25
Rate for Payer: Multiplan Workers Comp	$1,208.25
Rate for Payer: Scott and White EPO/PPO	$1,208.25
Rate for Payer: Superior Health Plan EPO	$328.64

SCREW COMPRESSION 1818-0001

Facility

$1,208.43

Service Code	HCPCS C1713
Hospital Charge Code	145504
Hospital Revenue Code	278
Min. Negotiated Rate	$302.11
Max. Negotiated Rate	$604.22
Rate for Payer: Aetna Commercial	$362.53
Rate for Payer: Cash Price	$1,063.42
Rate for Payer: Cigna Commercial	$302.11
Rate for Payer: Multiplan Auto	$604.22
Rate for Payer: Multiplan Commercial	$604.22
Rate for Payer: Multiplan Workers Comp	$604.22
Rate for Payer: Scott and White EPO/PPO	$604.22

SCREW COMPRESSION 1818-0001

Facility

$1,208.43

Service Code	HCPCS C1713
Hospital Charge Code	145504
Hospital Revenue Code	278
Min. Negotiated Rate	$108.76
Max. Negotiated Rate	$604.22
Rate for Payer: Aetna Commercial	$362.53
Rate for Payer: Amerigroup CHIP/Medicaid	$108.76
Rate for Payer: BCBS of TX Blue Advantage	$362.53
Rate for Payer: BCBS of TX Blue Essentials	$435.03
Rate for Payer: BCBS of TX PPO	$483.37
Rate for Payer: Cash Price	$1,063.42
Rate for Payer: Multiplan Auto	$604.22
Rate for Payer: Multiplan Commercial	$604.22
Rate for Payer: Multiplan Workers Comp	$604.22
Rate for Payer: Scott and White EPO/PPO	$604.22
Rate for Payer: Superior Health Plan EPO	$164.35

SCREW COMPRESSION CANN HEADLESS 5.0 X 36

Facility

$2,416.50

Service Code	HCPCS C1713
Hospital Charge Code	8504488
Hospital Revenue Code	278
Min. Negotiated Rate	$217.48
Max. Negotiated Rate	$1,208.25
Rate for Payer: Aetna Commercial	$724.95
Rate for Payer: Amerigroup CHIP/Medicaid	$217.48
Rate for Payer: BCBS of TX Blue Advantage	$724.95
Rate for Payer: BCBS of TX Blue Essentials	$869.94
Rate for Payer: BCBS of TX PPO	$966.60
Rate for Payer: Cash Price	$2,126.52
Rate for Payer: Multiplan Auto	$1,208.25
Rate for Payer: Multiplan Commercial	$1,208.25
Rate for Payer: Multiplan Workers Comp	$1,208.25
Rate for Payer: Scott and White EPO/PPO	$1,208.25
Rate for Payer: Superior Health Plan EPO	$328.64

SCREW COMPRESSION CANN HEADLESS 5.0 X 36

Facility

$2,416.50

Service Code	HCPCS C1713
Hospital Charge Code	8504488
Hospital Revenue Code	278
Min. Negotiated Rate	$604.12
Max. Negotiated Rate	$1,208.25
Rate for Payer: Aetna Commercial	$724.95
Rate for Payer: Cash Price	$2,126.52
Rate for Payer: Cigna Commercial	$604.12
Rate for Payer: Multiplan Auto	$1,208.25
Rate for Payer: Multiplan Commercial	$1,208.25
Rate for Payer: Multiplan Workers Comp	$1,208.25
Rate for Payer: Scott and White EPO/PPO	$1,208.25

SCREW CORTEX 5.00 MM

Facility

$1,235.12

Service Code	HCPCS C1713
Hospital Charge Code	125837
Hospital Revenue Code	278
Min. Negotiated Rate	$111.16
Max. Negotiated Rate	$617.56
Rate for Payer: Aetna Commercial	$370.54
Rate for Payer: Amerigroup CHIP/Medicaid	$111.16
Rate for Payer: BCBS of TX Blue Advantage	$370.54
Rate for Payer: BCBS of TX Blue Essentials	$444.64
Rate for Payer: BCBS of TX PPO	$494.05
Rate for Payer: Cash Price	$1,086.91
Rate for Payer: Multiplan Auto	$617.56
Rate for Payer: Multiplan Commercial	$617.56
Rate for Payer: Multiplan Workers Comp	$617.56
Rate for Payer: Scott and White EPO/PPO	$617.56
Rate for Payer: Superior Health Plan EPO	$167.98

SCREW CORTEX 5.00 MM

Facility

$1,235.12

Service Code	HCPCS C1713
Hospital Charge Code	125837
Hospital Revenue Code	278
Min. Negotiated Rate	$308.78
Max. Negotiated Rate	$617.56
Rate for Payer: Aetna Commercial	$370.54
Rate for Payer: Cash Price	$1,086.91
Rate for Payer: Cigna Commercial	$308.78
Rate for Payer: Multiplan Auto	$617.56
Rate for Payer: Multiplan Commercial	$617.56
Rate for Payer: Multiplan Workers Comp	$617.56
Rate for Payer: Scott and White EPO/PPO	$617.56

SCREW CORTICAL

Facility

$3,057.85

Service Code	HCPCS C1713
Hospital Charge Code	8428497
Hospital Revenue Code	278
Min. Negotiated Rate	$275.21
Max. Negotiated Rate	$1,528.92
Rate for Payer: Aetna Commercial	$917.36
Rate for Payer: Amerigroup CHIP/Medicaid	$275.21
Rate for Payer: BCBS of TX Blue Advantage	$917.36
Rate for Payer: BCBS of TX Blue Essentials	$1,100.83
Rate for Payer: BCBS of TX PPO	$1,223.14
Rate for Payer: Cash Price	$2,690.91
Rate for Payer: Multiplan Auto	$1,528.92
Rate for Payer: Multiplan Commercial	$1,528.92
Rate for Payer: Multiplan Workers Comp	$1,528.92
Rate for Payer: Scott and White EPO/PPO	$1,528.92
Rate for Payer: Superior Health Plan EPO	$415.87

SCREW CORTICAL

Facility

$3,057.85

Service Code	HCPCS C1713
Hospital Charge Code	8428497
Hospital Revenue Code	278
Min. Negotiated Rate	$764.46
Max. Negotiated Rate	$1,528.92
Rate for Payer: Aetna Commercial	$917.36
Rate for Payer: Cash Price	$2,690.91
Rate for Payer: Cigna Commercial	$764.46
Rate for Payer: Multiplan Auto	$1,528.92
Rate for Payer: Multiplan Commercial	$1,528.92
Rate for Payer: Multiplan Workers Comp	$1,528.92
Rate for Payer: Scott and White EPO/PPO	$1,528.92

Know your out-of-pocket cost for care.

All Charges