White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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	$299.34
Max. Negotiated Rate	$598.68
Rate for Payer: Aetna Commercial	$359.20
Rate for Payer: Cash Price	$1,053.67
Rate for Payer: Cigna Commercial	$299.34
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

SCREW LOCKING 2.7 X 12

Facility

$1,197.35

Service Code	HCPCS C1713
Hospital Charge Code	132388
Hospital Revenue Code	278
Min. Negotiated Rate	$299.34
Max. Negotiated Rate	$598.68
Rate for Payer: Aetna Commercial	$359.20
Rate for Payer: Cash Price	$1,053.67
Rate for Payer: Cigna Commercial	$299.34
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

SCREW LOCKING 2.7 X 12

Facility

$1,197.35

Service Code	HCPCS C1713
Hospital Charge Code	132388
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

SCREW LOCKING 2.7 X 14

Facility

$1,197.35

Service Code	HCPCS C1713
Hospital Charge Code	132389
Hospital Revenue Code	278
Min. Negotiated Rate	$299.34
Max. Negotiated Rate	$598.68
Rate for Payer: Aetna Commercial	$359.20
Rate for Payer: Cash Price	$1,053.67
Rate for Payer: Cigna Commercial	$299.34
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

SCREW LOCKING 2.7 X 14

Facility

$1,197.35

Service Code	HCPCS C1713
Hospital Charge Code	132389
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

SCREW LOCKING 2.7 X 16

Facility

$1,197.35

Service Code	HCPCS C1713
Hospital Charge Code	132390
Hospital Revenue Code	278
Min. Negotiated Rate	$299.34
Max. Negotiated Rate	$598.68
Rate for Payer: Aetna Commercial	$359.20
Rate for Payer: Cash Price	$1,053.67
Rate for Payer: Cigna Commercial	$299.34
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

SCREW LOCKING 2.7 X 16

Facility

$1,197.35

Service Code	HCPCS C1713
Hospital Charge Code	132390
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

SCREW LOCKING 2.7 X 18

Facility

$1,197.35

Service Code	HCPCS C1713
Hospital Charge Code	132391
Hospital Revenue Code	278
Min. Negotiated Rate	$299.34
Max. Negotiated Rate	$598.68
Rate for Payer: Aetna Commercial	$359.20
Rate for Payer: Cash Price	$1,053.67
Rate for Payer: Cigna Commercial	$299.34
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

SCREW LOCKING 2.7 X 18

Facility

$1,197.35

Service Code	HCPCS C1713
Hospital Charge Code	132391
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

SCREW LOCKING 2.7 X 20

Facility

$1,197.35

Service Code	HCPCS C1713
Hospital Charge Code	132392
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

SCREW LOCKING 2.7 X 20

Facility

$1,197.35

Service Code	HCPCS C1713
Hospital Charge Code	132392
Hospital Revenue Code	278
Min. Negotiated Rate	$299.34
Max. Negotiated Rate	$598.68
Rate for Payer: Aetna Commercial	$359.20
Rate for Payer: Cash Price	$1,053.67
Rate for Payer: Cigna Commercial	$299.34
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

SCREW LOCKING 2.7 X 26

Facility

$1,197.35

Service Code	HCPCS C1713
Hospital Charge Code	145164
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

SCREW LOCKING 2.7 X 26

Facility

$1,197.35

Service Code	HCPCS C1713
Hospital Charge Code	145164
Hospital Revenue Code	278
Min. Negotiated Rate	$299.34
Max. Negotiated Rate	$598.68
Rate for Payer: Aetna Commercial	$359.20
Rate for Payer: Cash Price	$1,053.67
Rate for Payer: Cigna Commercial	$299.34
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

SCREW LOCKING 3.5

Facility

$1,398.43

Service Code	HCPCS C1713
Hospital Charge Code	125930
Hospital Revenue Code	278
Min. Negotiated Rate	$125.86
Max. Negotiated Rate	$699.22
Rate for Payer: Aetna Commercial	$419.53
Rate for Payer: Amerigroup CHIP/Medicaid	$125.86
Rate for Payer: BCBS of TX Blue Advantage	$419.53
Rate for Payer: BCBS of TX Blue Essentials	$503.43
Rate for Payer: BCBS of TX PPO	$559.37
Rate for Payer: Cash Price	$1,230.62
Rate for Payer: Multiplan Auto	$699.22
Rate for Payer: Multiplan Commercial	$699.22
Rate for Payer: Multiplan Workers Comp	$699.22
Rate for Payer: Scott and White EPO/PPO	$699.22
Rate for Payer: Superior Health Plan EPO	$190.19

SCREW LOCKING 3.5

Facility

$1,398.43

Service Code	HCPCS C1713
Hospital Charge Code	125930
Hospital Revenue Code	278
Min. Negotiated Rate	$349.61
Max. Negotiated Rate	$699.22
Rate for Payer: Aetna Commercial	$419.53
Rate for Payer: Cash Price	$1,230.62
Rate for Payer: Cigna Commercial	$349.61
Rate for Payer: Multiplan Auto	$699.22
Rate for Payer: Multiplan Commercial	$699.22
Rate for Payer: Multiplan Workers Comp	$699.22
Rate for Payer: Scott and White EPO/PPO	$699.22

SCREW LOCKING 5.0X 37.5

Facility

$873.49

Service Code	HCPCS C1713
Hospital Charge Code	145473
Hospital Revenue Code	278
Min. Negotiated Rate	$78.61
Max. Negotiated Rate	$436.74
Rate for Payer: Aetna Commercial	$262.05
Rate for Payer: Amerigroup CHIP/Medicaid	$78.61
Rate for Payer: BCBS of TX Blue Advantage	$262.05
Rate for Payer: BCBS of TX Blue Essentials	$314.46
Rate for Payer: BCBS of TX PPO	$349.40
Rate for Payer: Cash Price	$768.67
Rate for Payer: Multiplan Auto	$436.74
Rate for Payer: Multiplan Commercial	$436.74
Rate for Payer: Multiplan Workers Comp	$436.74
Rate for Payer: Scott and White EPO/PPO	$436.74
Rate for Payer: Superior Health Plan EPO	$118.79

SCREW LOCKING 5.0X 37.5

Facility

$873.49

Service Code	HCPCS C1713
Hospital Charge Code	145473
Hospital Revenue Code	278
Min. Negotiated Rate	$218.37
Max. Negotiated Rate	$436.74
Rate for Payer: Aetna Commercial	$262.05
Rate for Payer: Cash Price	$768.67
Rate for Payer: Cigna Commercial	$218.37
Rate for Payer: Multiplan Auto	$436.74
Rate for Payer: Multiplan Commercial	$436.74
Rate for Payer: Multiplan Workers Comp	$436.74
Rate for Payer: Scott and White EPO/PPO	$436.74

SCREW LOCKING 5.0X42

Facility

$1,234.94

Service Code	HCPCS C1713
Hospital Charge Code	145423
Hospital Revenue Code	278
Min. Negotiated Rate	$308.74
Max. Negotiated Rate	$617.47
Rate for Payer: Aetna Commercial	$370.48
Rate for Payer: Cash Price	$1,086.75
Rate for Payer: Cigna Commercial	$308.74
Rate for Payer: Multiplan Auto	$617.47
Rate for Payer: Multiplan Commercial	$617.47
Rate for Payer: Multiplan Workers Comp	$617.47
Rate for Payer: Scott and White EPO/PPO	$617.47

SCREW LOCKING 5.0X42

Facility

$1,234.94

Service Code	HCPCS C1713
Hospital Charge Code	145423
Hospital Revenue Code	278
Min. Negotiated Rate	$111.14
Max. Negotiated Rate	$617.47
Rate for Payer: Aetna Commercial	$370.48
Rate for Payer: Amerigroup CHIP/Medicaid	$111.14
Rate for Payer: BCBS of TX Blue Advantage	$370.48
Rate for Payer: BCBS of TX Blue Essentials	$444.58
Rate for Payer: BCBS of TX PPO	$493.98
Rate for Payer: Cash Price	$1,086.75
Rate for Payer: Multiplan Auto	$617.47
Rate for Payer: Multiplan Commercial	$617.47
Rate for Payer: Multiplan Workers Comp	$617.47
Rate for Payer: Scott and White EPO/PPO	$617.47
Rate for Payer: Superior Health Plan EPO	$167.95

SCREW LOCKING 5MM

Facility

$1,171.02

Service Code	HCPCS C1713
Hospital Charge Code	125723
Hospital Revenue Code	278
Min. Negotiated Rate	$292.76
Max. Negotiated Rate	$585.51
Rate for Payer: Aetna Commercial	$351.31
Rate for Payer: Cash Price	$1,030.50
Rate for Payer: Cigna Commercial	$292.76
Rate for Payer: Multiplan Auto	$585.51
Rate for Payer: Multiplan Commercial	$585.51
Rate for Payer: Multiplan Workers Comp	$585.51
Rate for Payer: Scott and White EPO/PPO	$585.51

SCREW LOCKING 5MM

Facility

$1,171.02

Service Code	HCPCS C1713
Hospital Charge Code	125723
Hospital Revenue Code	278
Min. Negotiated Rate	$105.39
Max. Negotiated Rate	$585.51
Rate for Payer: Aetna Commercial	$351.31
Rate for Payer: Amerigroup CHIP/Medicaid	$105.39
Rate for Payer: BCBS of TX Blue Advantage	$351.31
Rate for Payer: BCBS of TX Blue Essentials	$421.57
Rate for Payer: BCBS of TX PPO	$468.41
Rate for Payer: Cash Price	$1,030.50
Rate for Payer: Multiplan Auto	$585.51
Rate for Payer: Multiplan Commercial	$585.51
Rate for Payer: Multiplan Workers Comp	$585.51
Rate for Payer: Scott and White EPO/PPO	$585.51
Rate for Payer: Superior Health Plan EPO	$159.26

SCREW LOCKING CORTICAL 3.5 X 18

Facility

$897.59

Service Code	HCPCS C1713
Hospital Charge Code	145270
Hospital Revenue Code	278
Min. Negotiated Rate	$80.78
Max. Negotiated Rate	$448.80
Rate for Payer: Aetna Commercial	$269.28
Rate for Payer: Amerigroup CHIP/Medicaid	$80.78
Rate for Payer: BCBS of TX Blue Advantage	$269.28
Rate for Payer: BCBS of TX Blue Essentials	$323.13
Rate for Payer: BCBS of TX PPO	$359.04
Rate for Payer: Cash Price	$789.88
Rate for Payer: Multiplan Auto	$448.80
Rate for Payer: Multiplan Commercial	$448.80
Rate for Payer: Multiplan Workers Comp	$448.80
Rate for Payer: Scott and White EPO/PPO	$448.80
Rate for Payer: Superior Health Plan EPO	$122.07

SCREW LOCKING CORTICAL 3.5 X 18

Facility

$897.59

Service Code	HCPCS C1713
Hospital Charge Code	145270
Hospital Revenue Code	278
Min. Negotiated Rate	$224.40
Max. Negotiated Rate	$448.80
Rate for Payer: Aetna Commercial	$269.28
Rate for Payer: Cash Price	$789.88
Rate for Payer: Cigna Commercial	$224.40
Rate for Payer: Multiplan Auto	$448.80
Rate for Payer: Multiplan Commercial	$448.80
Rate for Payer: Multiplan Workers Comp	$448.80
Rate for Payer: Scott and White EPO/PPO	$448.80

SCREW LOCKING CORTICAL 3.5 X 20

Facility

$897.59

Service Code	HCPCS C1713
Hospital Charge Code	145269
Hospital Revenue Code	278
Min. Negotiated Rate	$80.78
Max. Negotiated Rate	$448.80
Rate for Payer: Aetna Commercial	$269.28
Rate for Payer: Amerigroup CHIP/Medicaid	$80.78
Rate for Payer: BCBS of TX Blue Advantage	$269.28
Rate for Payer: BCBS of TX Blue Essentials	$323.13
Rate for Payer: BCBS of TX PPO	$359.04
Rate for Payer: Cash Price	$789.88
Rate for Payer: Multiplan Auto	$448.80
Rate for Payer: Multiplan Commercial	$448.80
Rate for Payer: Multiplan Workers Comp	$448.80
Rate for Payer: Scott and White EPO/PPO	$448.80
Rate for Payer: Superior Health Plan EPO	$122.07

SCREW LOCKING CORTICAL 3.5 X 20

Facility

$897.59

Service Code	HCPCS C1713
Hospital Charge Code	145269
Hospital Revenue Code	278
Min. Negotiated Rate	$224.40
Max. Negotiated Rate	$448.80
Rate for Payer: Aetna Commercial	$269.28
Rate for Payer: Cash Price	$789.88
Rate for Payer: Cigna Commercial	$224.40
Rate for Payer: Multiplan Auto	$448.80
Rate for Payer: Multiplan Commercial	$448.80
Rate for Payer: Multiplan Workers Comp	$448.80
Rate for Payer: Scott and White EPO/PPO	$448.80

Know your out-of-pocket cost for care.

All Charges