White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CORTICAL 3.5MM X 28

Facility

$415.67

Service Code	HCPCS C1713
Hospital Charge Code	145265
Hospital Revenue Code	278
Min. Negotiated Rate	$37.41
Max. Negotiated Rate	$207.84
Rate for Payer: Aetna Commercial	$124.70
Rate for Payer: Amerigroup CHIP/Medicaid	$37.41
Rate for Payer: BCBS of TX Blue Advantage	$124.70
Rate for Payer: BCBS of TX Blue Essentials	$149.64
Rate for Payer: BCBS of TX PPO	$166.27
Rate for Payer: Cash Price	$365.79
Rate for Payer: Multiplan Auto	$207.84
Rate for Payer: Multiplan Commercial	$207.84
Rate for Payer: Multiplan Workers Comp	$207.84
Rate for Payer: Scott and White EPO/PPO	$207.84
Rate for Payer: Superior Health Plan EPO	$56.53

SCREW CORTICAL 3.5MM X 28

Facility

$415.67

Service Code	HCPCS C1713
Hospital Charge Code	145265
Hospital Revenue Code	278
Min. Negotiated Rate	$103.92
Max. Negotiated Rate	$207.84
Rate for Payer: Aetna Commercial	$124.70
Rate for Payer: Cash Price	$365.79
Rate for Payer: Cigna Commercial	$103.92
Rate for Payer: Multiplan Auto	$207.84
Rate for Payer: Multiplan Commercial	$207.84
Rate for Payer: Multiplan Workers Comp	$207.84
Rate for Payer: Scott and White EPO/PPO	$207.84

SCREW CORTICAL 3.5 X 20

Facility

$355.42

Service Code	HCPCS C1713
Hospital Charge Code	145264
Hospital Revenue Code	278
Min. Negotiated Rate	$31.99
Max. Negotiated Rate	$177.71
Rate for Payer: Aetna Commercial	$106.63
Rate for Payer: Amerigroup CHIP/Medicaid	$31.99
Rate for Payer: BCBS of TX Blue Advantage	$106.63
Rate for Payer: BCBS of TX Blue Essentials	$127.95
Rate for Payer: BCBS of TX PPO	$142.17
Rate for Payer: Cash Price	$312.77
Rate for Payer: Multiplan Auto	$177.71
Rate for Payer: Multiplan Commercial	$177.71
Rate for Payer: Multiplan Workers Comp	$177.71
Rate for Payer: Scott and White EPO/PPO	$177.71
Rate for Payer: Superior Health Plan EPO	$48.34

SCREW CORTICAL 3.5 X 20

Facility

$355.42

Service Code	HCPCS C1713
Hospital Charge Code	145264
Hospital Revenue Code	278
Min. Negotiated Rate	$88.86
Max. Negotiated Rate	$177.71
Rate for Payer: Aetna Commercial	$106.63
Rate for Payer: Cash Price	$312.77
Rate for Payer: Cigna Commercial	$88.86
Rate for Payer: Multiplan Auto	$177.71
Rate for Payer: Multiplan Commercial	$177.71
Rate for Payer: Multiplan Workers Comp	$177.71
Rate for Payer: Scott and White EPO/PPO	$177.71

SCREW CORTICAL 3.5 X 22

Facility

$355.42

Service Code	HCPCS C1713
Hospital Charge Code	145266
Hospital Revenue Code	278
Min. Negotiated Rate	$31.99
Max. Negotiated Rate	$177.71
Rate for Payer: Aetna Commercial	$106.63
Rate for Payer: Amerigroup CHIP/Medicaid	$31.99
Rate for Payer: BCBS of TX Blue Advantage	$106.63
Rate for Payer: BCBS of TX Blue Essentials	$127.95
Rate for Payer: BCBS of TX PPO	$142.17
Rate for Payer: Cash Price	$312.77
Rate for Payer: Multiplan Auto	$177.71
Rate for Payer: Multiplan Commercial	$177.71
Rate for Payer: Multiplan Workers Comp	$177.71
Rate for Payer: Scott and White EPO/PPO	$177.71
Rate for Payer: Superior Health Plan EPO	$48.34

SCREW CORTICAL 3.5 X 22

Facility

$355.42

Service Code	HCPCS C1713
Hospital Charge Code	145266
Hospital Revenue Code	278
Min. Negotiated Rate	$88.86
Max. Negotiated Rate	$177.71
Rate for Payer: Aetna Commercial	$106.63
Rate for Payer: Cash Price	$312.77
Rate for Payer: Cigna Commercial	$88.86
Rate for Payer: Multiplan Auto	$177.71
Rate for Payer: Multiplan Commercial	$177.71
Rate for Payer: Multiplan Workers Comp	$177.71
Rate for Payer: Scott and White EPO/PPO	$177.71

SCREW CORTICAL 3.5X 24

Facility

$355.42

Service Code	HCPCS C1713
Hospital Charge Code	145267
Hospital Revenue Code	278
Min. Negotiated Rate	$31.99
Max. Negotiated Rate	$177.71
Rate for Payer: Aetna Commercial	$106.63
Rate for Payer: Amerigroup CHIP/Medicaid	$31.99
Rate for Payer: BCBS of TX Blue Advantage	$106.63
Rate for Payer: BCBS of TX Blue Essentials	$127.95
Rate for Payer: BCBS of TX PPO	$142.17
Rate for Payer: Cash Price	$312.77
Rate for Payer: Multiplan Auto	$177.71
Rate for Payer: Multiplan Commercial	$177.71
Rate for Payer: Multiplan Workers Comp	$177.71
Rate for Payer: Scott and White EPO/PPO	$177.71
Rate for Payer: Superior Health Plan EPO	$48.34

SCREW CORTICAL 3.5X 24

Facility

$355.42

Service Code	HCPCS C1713
Hospital Charge Code	145267
Hospital Revenue Code	278
Min. Negotiated Rate	$88.86
Max. Negotiated Rate	$177.71
Rate for Payer: Aetna Commercial	$106.63
Rate for Payer: Cash Price	$312.77
Rate for Payer: Cigna Commercial	$88.86
Rate for Payer: Multiplan Auto	$177.71
Rate for Payer: Multiplan Commercial	$177.71
Rate for Payer: Multiplan Workers Comp	$177.71
Rate for Payer: Scott and White EPO/PPO	$177.71

SCREW HEADLESS 3.00MM X 26MM

Facility

$2,409.64

Service Code	HCPCS C1713
Hospital Charge Code	145140
Hospital Revenue Code	278
Min. Negotiated Rate	$602.41
Max. Negotiated Rate	$1,204.82
Rate for Payer: Aetna Commercial	$722.89
Rate for Payer: Cash Price	$2,120.48
Rate for Payer: Cigna Commercial	$602.41
Rate for Payer: Multiplan Auto	$1,204.82
Rate for Payer: Multiplan Commercial	$1,204.82
Rate for Payer: Multiplan Workers Comp	$1,204.82
Rate for Payer: Scott and White EPO/PPO	$1,204.82

SCREW HEADLESS 3.00MM X 26MM

Facility

$2,409.64

Service Code	HCPCS C1713
Hospital Charge Code	145140
Hospital Revenue Code	278
Min. Negotiated Rate	$216.87
Max. Negotiated Rate	$1,204.82
Rate for Payer: Aetna Commercial	$722.89
Rate for Payer: Amerigroup CHIP/Medicaid	$216.87
Rate for Payer: BCBS of TX Blue Advantage	$722.89
Rate for Payer: BCBS of TX Blue Essentials	$867.47
Rate for Payer: BCBS of TX PPO	$963.86
Rate for Payer: Cash Price	$2,120.48
Rate for Payer: Multiplan Auto	$1,204.82
Rate for Payer: Multiplan Commercial	$1,204.82
Rate for Payer: Multiplan Workers Comp	$1,204.82
Rate for Payer: Scott and White EPO/PPO	$1,204.82
Rate for Payer: Superior Health Plan EPO	$327.71

screw interference

Facility

$2,825.30

Service Code	HCPCS C1713
Hospital Charge Code	145056
Hospital Revenue Code	278
Min. Negotiated Rate	$706.32
Max. Negotiated Rate	$1,412.65
Rate for Payer: Aetna Commercial	$847.59
Rate for Payer: Cash Price	$2,486.26
Rate for Payer: Cigna Commercial	$706.32
Rate for Payer: Multiplan Auto	$1,412.65
Rate for Payer: Multiplan Commercial	$1,412.65
Rate for Payer: Multiplan Workers Comp	$1,412.65
Rate for Payer: Scott and White EPO/PPO	$1,412.65

screw interference

Facility

$2,825.30

Service Code	HCPCS C1713
Hospital Charge Code	145056
Hospital Revenue Code	278
Min. Negotiated Rate	$254.28
Max. Negotiated Rate	$1,412.65
Rate for Payer: Aetna Commercial	$847.59
Rate for Payer: Amerigroup CHIP/Medicaid	$254.28
Rate for Payer: BCBS of TX Blue Advantage	$847.59
Rate for Payer: BCBS of TX Blue Essentials	$1,017.11
Rate for Payer: BCBS of TX PPO	$1,130.12
Rate for Payer: Cash Price	$2,486.26
Rate for Payer: Multiplan Auto	$1,412.65
Rate for Payer: Multiplan Commercial	$1,412.65
Rate for Payer: Multiplan Workers Comp	$1,412.65
Rate for Payer: Scott and White EPO/PPO	$1,412.65
Rate for Payer: Superior Health Plan EPO	$384.24

SCREW INTERFERENCE GENEYSIS

Facility

$1,815.54

Service Code	HCPCS C1713
Hospital Charge Code	144152
Hospital Revenue Code	278
Min. Negotiated Rate	$453.88
Max. Negotiated Rate	$907.77
Rate for Payer: Aetna Commercial	$544.66
Rate for Payer: Cash Price	$1,597.68
Rate for Payer: Cigna Commercial	$453.88
Rate for Payer: Multiplan Auto	$907.77
Rate for Payer: Multiplan Commercial	$907.77
Rate for Payer: Multiplan Workers Comp	$907.77
Rate for Payer: Scott and White EPO/PPO	$907.77

SCREW INTERFERENCE GENEYSIS

Facility

$1,815.54

Service Code	HCPCS C1713
Hospital Charge Code	144152
Hospital Revenue Code	278
Min. Negotiated Rate	$163.40
Max. Negotiated Rate	$907.77
Rate for Payer: Aetna Commercial	$544.66
Rate for Payer: Amerigroup CHIP/Medicaid	$163.40
Rate for Payer: BCBS of TX Blue Advantage	$544.66
Rate for Payer: BCBS of TX Blue Essentials	$653.59
Rate for Payer: BCBS of TX PPO	$726.22
Rate for Payer: Cash Price	$1,597.68
Rate for Payer: Multiplan Auto	$907.77
Rate for Payer: Multiplan Commercial	$907.77
Rate for Payer: Multiplan Workers Comp	$907.77
Rate for Payer: Scott and White EPO/PPO	$907.77
Rate for Payer: Superior Health Plan EPO	$246.91

screw intfr compositcp 30

Facility

$1,679.52

Service Code	HCPCS C1713
Hospital Charge Code	126020
Hospital Revenue Code	278
Min. Negotiated Rate	$151.16
Max. Negotiated Rate	$839.76
Rate for Payer: Aetna Commercial	$503.86
Rate for Payer: Amerigroup CHIP/Medicaid	$151.16
Rate for Payer: BCBS of TX Blue Advantage	$503.86
Rate for Payer: BCBS of TX Blue Essentials	$604.63
Rate for Payer: BCBS of TX PPO	$671.81
Rate for Payer: Cash Price	$1,477.98
Rate for Payer: Multiplan Auto	$839.76
Rate for Payer: Multiplan Commercial	$839.76
Rate for Payer: Multiplan Workers Comp	$839.76
Rate for Payer: Scott and White EPO/PPO	$839.76
Rate for Payer: Superior Health Plan EPO	$228.41

screw intfr compositcp 30

Facility

$1,679.52

Service Code	HCPCS C1713
Hospital Charge Code	126020
Hospital Revenue Code	278
Min. Negotiated Rate	$419.88
Max. Negotiated Rate	$839.76
Rate for Payer: Aetna Commercial	$503.86
Rate for Payer: Cash Price	$1,477.98
Rate for Payer: Cigna Commercial	$419.88
Rate for Payer: Multiplan Auto	$839.76
Rate for Payer: Multiplan Commercial	$839.76
Rate for Payer: Multiplan Workers Comp	$839.76
Rate for Payer: Scott and White EPO/PPO	$839.76

screw lag proxfemur 90mm

Facility

$4,718.07

Service Code	HCPCS C1713
Hospital Charge Code	8720604
Hospital Revenue Code	278
Min. Negotiated Rate	$1,179.52
Max. Negotiated Rate	$2,359.04
Rate for Payer: Aetna Commercial	$1,415.42
Rate for Payer: Cash Price	$4,151.90
Rate for Payer: Cigna Commercial	$1,179.52
Rate for Payer: Multiplan Auto	$2,359.04
Rate for Payer: Multiplan Commercial	$2,359.04
Rate for Payer: Multiplan Workers Comp	$2,359.04
Rate for Payer: Scott and White EPO/PPO	$2,359.04

screw lag proxfemur 90mm

Facility

$4,718.07

Service Code	HCPCS C1713
Hospital Charge Code	8720604
Hospital Revenue Code	278
Min. Negotiated Rate	$424.63
Max. Negotiated Rate	$2,359.04
Rate for Payer: Aetna Commercial	$1,415.42
Rate for Payer: Amerigroup CHIP/Medicaid	$424.63
Rate for Payer: BCBS of TX Blue Advantage	$1,415.42
Rate for Payer: BCBS of TX Blue Essentials	$1,698.51
Rate for Payer: BCBS of TX PPO	$1,887.23
Rate for Payer: Cash Price	$4,151.90
Rate for Payer: Multiplan Auto	$2,359.04
Rate for Payer: Multiplan Commercial	$2,359.04
Rate for Payer: Multiplan Workers Comp	$2,359.04
Rate for Payer: Scott and White EPO/PPO	$2,359.04
Rate for Payer: Superior Health Plan EPO	$641.66

SCREW LAG TALON DISTAL FIX

Facility

$1,195.56

Service Code	HCPCS C1713
Hospital Charge Code	145158
Hospital Revenue Code	278
Min. Negotiated Rate	$107.60
Max. Negotiated Rate	$597.78
Rate for Payer: Aetna Commercial	$358.67
Rate for Payer: Amerigroup CHIP/Medicaid	$107.60
Rate for Payer: BCBS of TX Blue Advantage	$358.67
Rate for Payer: BCBS of TX Blue Essentials	$430.40
Rate for Payer: BCBS of TX PPO	$478.22
Rate for Payer: Cash Price	$1,052.09
Rate for Payer: Multiplan Auto	$597.78
Rate for Payer: Multiplan Commercial	$597.78
Rate for Payer: Multiplan Workers Comp	$597.78
Rate for Payer: Scott and White EPO/PPO	$597.78
Rate for Payer: Superior Health Plan EPO	$162.60

SCREW LAG TALON DISTAL FIX

Facility

$1,195.56

Service Code	HCPCS C1713
Hospital Charge Code	145158
Hospital Revenue Code	278
Min. Negotiated Rate	$298.89
Max. Negotiated Rate	$597.78
Rate for Payer: Aetna Commercial	$358.67
Rate for Payer: Cash Price	$1,052.09
Rate for Payer: Cigna Commercial	$298.89
Rate for Payer: Multiplan Auto	$597.78
Rate for Payer: Multiplan Commercial	$597.78
Rate for Payer: Multiplan Workers Comp	$597.78
Rate for Payer: Scott and White EPO/PPO	$597.78

SCREW LAG TALON DISTAL FX

Facility

$4,819.28

Service Code	HCPCS C1713
Hospital Charge Code	145226
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.82
Max. Negotiated Rate	$2,409.64
Rate for Payer: Aetna Commercial	$1,445.78
Rate for Payer: Cash Price	$4,240.97
Rate for Payer: Cigna Commercial	$1,204.82
Rate for Payer: Multiplan Auto	$2,409.64
Rate for Payer: Multiplan Commercial	$2,409.64
Rate for Payer: Multiplan Workers Comp	$2,409.64
Rate for Payer: Scott and White EPO/PPO	$2,409.64

SCREW LAG TALON DISTAL FX

Facility

$4,819.28

Service Code	HCPCS C1713
Hospital Charge Code	145226
Hospital Revenue Code	278
Min. Negotiated Rate	$433.74
Max. Negotiated Rate	$2,409.64
Rate for Payer: Aetna Commercial	$1,445.78
Rate for Payer: Amerigroup CHIP/Medicaid	$433.74
Rate for Payer: BCBS of TX Blue Advantage	$1,445.78
Rate for Payer: BCBS of TX Blue Essentials	$1,734.94
Rate for Payer: BCBS of TX PPO	$1,927.71
Rate for Payer: Cash Price	$4,240.97
Rate for Payer: Multiplan Auto	$2,409.64
Rate for Payer: Multiplan Commercial	$2,409.64
Rate for Payer: Multiplan Workers Comp	$2,409.64
Rate for Payer: Scott and White EPO/PPO	$2,409.64
Rate for Payer: Superior Health Plan EPO	$655.42

SCREW LAG TI 10.5 X 85MM

Facility

$3,432.11

Service Code	HCPCS C1713
Hospital Charge Code	8694515
Hospital Revenue Code	278
Min. Negotiated Rate	$308.89
Max. Negotiated Rate	$1,716.06
Rate for Payer: Aetna Commercial	$1,029.63
Rate for Payer: Amerigroup CHIP/Medicaid	$308.89
Rate for Payer: BCBS of TX Blue Advantage	$1,029.63
Rate for Payer: BCBS of TX Blue Essentials	$1,235.56
Rate for Payer: BCBS of TX PPO	$1,372.84
Rate for Payer: Cash Price	$3,020.26
Rate for Payer: Multiplan Auto	$1,716.06
Rate for Payer: Multiplan Commercial	$1,716.06
Rate for Payer: Multiplan Workers Comp	$1,716.06
Rate for Payer: Scott and White EPO/PPO	$1,716.06
Rate for Payer: Superior Health Plan EPO	$466.77

SCREW LAG TI 10.5 X 85MM

Facility

$3,432.11

Service Code	HCPCS C1713
Hospital Charge Code	8694515
Hospital Revenue Code	278
Min. Negotiated Rate	$858.03
Max. Negotiated Rate	$1,716.06
Rate for Payer: Aetna Commercial	$1,029.63
Rate for Payer: Cash Price	$3,020.26
Rate for Payer: Cigna Commercial	$858.03
Rate for Payer: Multiplan Auto	$1,716.06
Rate for Payer: Multiplan Commercial	$1,716.06
Rate for Payer: Multiplan Workers Comp	$1,716.06
Rate for Payer: Scott and White EPO/PPO	$1,716.06

SCREW LOCKING 2.7 X 10

Facility

$1,197.35

Service Code	HCPCS C1713
Hospital Charge Code	141469
Hospital Revenue Code	278
Min. Negotiated Rate	$107.76
Max. Negotiated Rate	$598.68
Rate for Payer: Aetna Commercial	$359.20
Rate for Payer: Amerigroup CHIP/Medicaid	$107.76
Rate for Payer: BCBS of TX Blue Advantage	$359.20
Rate for Payer: BCBS of TX Blue Essentials	$431.05
Rate for Payer: BCBS of TX PPO	$478.94
Rate for Payer: Cash Price	$1,053.67
Rate for Payer: Multiplan Auto	$598.68
Rate for Payer: Multiplan Commercial	$598.68
Rate for Payer: Multiplan Workers Comp	$598.68
Rate for Payer: Scott and White EPO/PPO	$598.68
Rate for Payer: Superior Health Plan EPO	$162.84

Know your out-of-pocket cost for care.

All Charges