White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SCREW LOCKING CORTICAL 3.5 X22

Facility

$897.59

Service Code	HCPCS C1713
Hospital Charge Code	145268
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 X22

Facility

$897.59

Service Code	HCPCS C1713
Hospital Charge Code	145268
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 24

Facility

$897.59

Service Code	HCPCS C1713
Hospital Charge Code	145271
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 24

Facility

$897.59

Service Code	HCPCS C1713
Hospital Charge Code	145271
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 f/t t2 5x37mm

Facility

$885.54

Service Code	HCPCS C1713
Hospital Charge Code	8694514
Hospital Revenue Code	278
Min. Negotiated Rate	$221.38
Max. Negotiated Rate	$442.77
Rate for Payer: Aetna Commercial	$265.66
Rate for Payer: Cash Price	$779.28
Rate for Payer: Cigna Commercial	$221.38
Rate for Payer: Multiplan Auto	$442.77
Rate for Payer: Multiplan Commercial	$442.77
Rate for Payer: Multiplan Workers Comp	$442.77
Rate for Payer: Scott and White EPO/PPO	$442.77

screw locking f/t t2 5x37mm

Facility

$885.54

Service Code	HCPCS C1713
Hospital Charge Code	8694514
Hospital Revenue Code	278
Min. Negotiated Rate	$79.70
Max. Negotiated Rate	$442.77
Rate for Payer: Aetna Commercial	$265.66
Rate for Payer: Amerigroup CHIP/Medicaid	$79.70
Rate for Payer: BCBS of TX Blue Advantage	$265.66
Rate for Payer: BCBS of TX Blue Essentials	$318.79
Rate for Payer: BCBS of TX PPO	$354.22
Rate for Payer: Cash Price	$779.28
Rate for Payer: Multiplan Auto	$442.77
Rate for Payer: Multiplan Commercial	$442.77
Rate for Payer: Multiplan Workers Comp	$442.77
Rate for Payer: Scott and White EPO/PPO	$442.77
Rate for Payer: Superior Health Plan EPO	$120.43

screw locking vault

Facility

$4,518.07

Service Code	HCPCS C1713
Hospital Charge Code	8394469
Hospital Revenue Code	278
Min. Negotiated Rate	$1,129.52
Max. Negotiated Rate	$2,259.04
Rate for Payer: Aetna Commercial	$1,355.42
Rate for Payer: Cash Price	$3,975.90
Rate for Payer: Cigna Commercial	$1,129.52
Rate for Payer: Multiplan Auto	$2,259.04
Rate for Payer: Multiplan Commercial	$2,259.04
Rate for Payer: Multiplan Workers Comp	$2,259.04
Rate for Payer: Scott and White EPO/PPO	$2,259.04

screw locking vault

Facility

$4,518.07

Service Code	HCPCS C1713
Hospital Charge Code	8394469
Hospital Revenue Code	278
Min. Negotiated Rate	$406.63
Max. Negotiated Rate	$2,259.04
Rate for Payer: Aetna Commercial	$1,355.42
Rate for Payer: Amerigroup CHIP/Medicaid	$406.63
Rate for Payer: BCBS of TX Blue Advantage	$1,355.42
Rate for Payer: BCBS of TX Blue Essentials	$1,626.51
Rate for Payer: BCBS of TX PPO	$1,807.23
Rate for Payer: Cash Price	$3,975.90
Rate for Payer: Multiplan Auto	$2,259.04
Rate for Payer: Multiplan Commercial	$2,259.04
Rate for Payer: Multiplan Workers Comp	$2,259.04
Rate for Payer: Scott and White EPO/PPO	$2,259.04
Rate for Payer: Superior Health Plan EPO	$614.46

SCREW LO PRO 2.7X16

Facility

$388.55

Service Code	HCPCS C1713
Hospital Charge Code	145498
Hospital Revenue Code	278
Min. Negotiated Rate	$97.14
Max. Negotiated Rate	$194.28
Rate for Payer: Aetna Commercial	$116.56
Rate for Payer: Cash Price	$341.92
Rate for Payer: Cigna Commercial	$97.14
Rate for Payer: Multiplan Auto	$194.28
Rate for Payer: Multiplan Commercial	$194.28
Rate for Payer: Multiplan Workers Comp	$194.28
Rate for Payer: Scott and White EPO/PPO	$194.28

SCREW LO PRO 2.7X16

Facility

$388.55

Service Code	HCPCS C1713
Hospital Charge Code	145498
Hospital Revenue Code	278
Min. Negotiated Rate	$34.97
Max. Negotiated Rate	$194.28
Rate for Payer: Aetna Commercial	$116.56
Rate for Payer: Amerigroup CHIP/Medicaid	$34.97
Rate for Payer: BCBS of TX Blue Advantage	$116.56
Rate for Payer: BCBS of TX Blue Essentials	$139.88
Rate for Payer: BCBS of TX PPO	$155.42
Rate for Payer: Cash Price	$341.92
Rate for Payer: Multiplan Auto	$194.28
Rate for Payer: Multiplan Commercial	$194.28
Rate for Payer: Multiplan Workers Comp	$194.28
Rate for Payer: Scott and White EPO/PPO	$194.28
Rate for Payer: Superior Health Plan EPO	$52.84

screw milagro interference

Facility

$2,692.77

Service Code	HCPCS C1713
Hospital Charge Code	8612544
Hospital Revenue Code	278
Min. Negotiated Rate	$673.19
Max. Negotiated Rate	$1,346.38
Rate for Payer: Aetna Commercial	$807.83
Rate for Payer: Cash Price	$2,369.64
Rate for Payer: Cigna Commercial	$673.19
Rate for Payer: Multiplan Auto	$1,346.38
Rate for Payer: Multiplan Commercial	$1,346.38
Rate for Payer: Multiplan Workers Comp	$1,346.38
Rate for Payer: Scott and White EPO/PPO	$1,346.38

screw milagro interference

Facility

$2,692.77

Service Code	HCPCS C1713
Hospital Charge Code	8612544
Hospital Revenue Code	278
Min. Negotiated Rate	$242.35
Max. Negotiated Rate	$1,346.38
Rate for Payer: Aetna Commercial	$807.83
Rate for Payer: Amerigroup CHIP/Medicaid	$242.35
Rate for Payer: BCBS of TX Blue Advantage	$807.83
Rate for Payer: BCBS of TX Blue Essentials	$969.40
Rate for Payer: BCBS of TX PPO	$1,077.11
Rate for Payer: Cash Price	$2,369.64
Rate for Payer: Multiplan Auto	$1,346.38
Rate for Payer: Multiplan Commercial	$1,346.38
Rate for Payer: Multiplan Workers Comp	$1,346.38
Rate for Payer: Scott and White EPO/PPO	$1,346.38
Rate for Payer: Superior Health Plan EPO	$366.22

SCREW NON LOCKING 2.7MM X 14

Facility

$497.34

Service Code	HCPCS C1713
Hospital Charge Code	8576468
Hospital Revenue Code	278
Min. Negotiated Rate	$124.34
Max. Negotiated Rate	$248.67
Rate for Payer: Aetna Commercial	$149.20
Rate for Payer: Cash Price	$437.66
Rate for Payer: Cigna Commercial	$124.34
Rate for Payer: Multiplan Auto	$248.67
Rate for Payer: Multiplan Commercial	$248.67
Rate for Payer: Multiplan Workers Comp	$248.67
Rate for Payer: Scott and White EPO/PPO	$248.67

SCREW NON LOCKING 2.7MM X 14

Facility

$497.34

Service Code	HCPCS C1713
Hospital Charge Code	8576468
Hospital Revenue Code	278
Min. Negotiated Rate	$44.76
Max. Negotiated Rate	$248.67
Rate for Payer: Aetna Commercial	$149.20
Rate for Payer: Amerigroup CHIP/Medicaid	$44.76
Rate for Payer: BCBS of TX Blue Advantage	$149.20
Rate for Payer: BCBS of TX Blue Essentials	$179.04
Rate for Payer: BCBS of TX PPO	$198.94
Rate for Payer: Cash Price	$437.66
Rate for Payer: Multiplan Auto	$248.67
Rate for Payer: Multiplan Commercial	$248.67
Rate for Payer: Multiplan Workers Comp	$248.67
Rate for Payer: Scott and White EPO/PPO	$248.67
Rate for Payer: Superior Health Plan EPO	$67.64

SCREW NON LOCKING 2.7MM X 16

Facility

$497.34

Service Code	HCPCS C1713
Hospital Charge Code	8576469
Hospital Revenue Code	278
Min. Negotiated Rate	$124.34
Max. Negotiated Rate	$248.67
Rate for Payer: Aetna Commercial	$149.20
Rate for Payer: Cash Price	$437.66
Rate for Payer: Cigna Commercial	$124.34
Rate for Payer: Multiplan Auto	$248.67
Rate for Payer: Multiplan Commercial	$248.67
Rate for Payer: Multiplan Workers Comp	$248.67
Rate for Payer: Scott and White EPO/PPO	$248.67

SCREW NON LOCKING 2.7MM X 16

Facility

$497.34

Service Code	HCPCS C1713
Hospital Charge Code	8576469
Hospital Revenue Code	278
Min. Negotiated Rate	$44.76
Max. Negotiated Rate	$248.67
Rate for Payer: Aetna Commercial	$149.20
Rate for Payer: Amerigroup CHIP/Medicaid	$44.76
Rate for Payer: BCBS of TX Blue Advantage	$149.20
Rate for Payer: BCBS of TX Blue Essentials	$179.04
Rate for Payer: BCBS of TX PPO	$198.94
Rate for Payer: Cash Price	$437.66
Rate for Payer: Multiplan Auto	$248.67
Rate for Payer: Multiplan Commercial	$248.67
Rate for Payer: Multiplan Workers Comp	$248.67
Rate for Payer: Scott and White EPO/PPO	$248.67
Rate for Payer: Superior Health Plan EPO	$67.64

SCREW NON LOCKING 2.7MM X 18

Facility

$497.34

Service Code	HCPCS C1713
Hospital Charge Code	8576475
Hospital Revenue Code	278
Min. Negotiated Rate	$124.34
Max. Negotiated Rate	$248.67
Rate for Payer: Aetna Commercial	$149.20
Rate for Payer: Cash Price	$437.66
Rate for Payer: Cigna Commercial	$124.34
Rate for Payer: Multiplan Auto	$248.67
Rate for Payer: Multiplan Commercial	$248.67
Rate for Payer: Multiplan Workers Comp	$248.67
Rate for Payer: Scott and White EPO/PPO	$248.67

SCREW NON LOCKING 2.7MM X 18

Facility

$497.34

Service Code	HCPCS C1713
Hospital Charge Code	8576475
Hospital Revenue Code	278
Min. Negotiated Rate	$44.76
Max. Negotiated Rate	$248.67
Rate for Payer: Aetna Commercial	$149.20
Rate for Payer: Amerigroup CHIP/Medicaid	$44.76
Rate for Payer: BCBS of TX Blue Advantage	$149.20
Rate for Payer: BCBS of TX Blue Essentials	$179.04
Rate for Payer: BCBS of TX PPO	$198.94
Rate for Payer: Cash Price	$437.66
Rate for Payer: Multiplan Auto	$248.67
Rate for Payer: Multiplan Commercial	$248.67
Rate for Payer: Multiplan Workers Comp	$248.67
Rate for Payer: Scott and White EPO/PPO	$248.67
Rate for Payer: Superior Health Plan EPO	$67.64

SCREW NON LOCKING 3.5 X48MM

Facility

$7,895.84

Service Code	HCPCS C1713
Hospital Charge Code	145070
Hospital Revenue Code	278
Min. Negotiated Rate	$710.63
Max. Negotiated Rate	$3,947.92
Rate for Payer: Aetna Commercial	$2,368.75
Rate for Payer: Amerigroup CHIP/Medicaid	$710.63
Rate for Payer: BCBS of TX Blue Advantage	$2,368.75
Rate for Payer: BCBS of TX Blue Essentials	$2,842.50
Rate for Payer: BCBS of TX PPO	$3,158.34
Rate for Payer: Cash Price	$6,948.34
Rate for Payer: Multiplan Auto	$3,947.92
Rate for Payer: Multiplan Commercial	$3,947.92
Rate for Payer: Multiplan Workers Comp	$3,947.92
Rate for Payer: Scott and White EPO/PPO	$3,947.92
Rate for Payer: Superior Health Plan EPO	$1,073.83

SCREW NON LOCKING 3.5 X48MM

Facility

$7,895.84

Service Code	HCPCS C1713
Hospital Charge Code	145070
Hospital Revenue Code	278
Min. Negotiated Rate	$1,973.96
Max. Negotiated Rate	$3,947.92
Rate for Payer: Aetna Commercial	$2,368.75
Rate for Payer: Cash Price	$6,948.34
Rate for Payer: Cigna Commercial	$1,973.96
Rate for Payer: Multiplan Auto	$3,947.92
Rate for Payer: Multiplan Commercial	$3,947.92
Rate for Payer: Multiplan Workers Comp	$3,947.92
Rate for Payer: Scott and White EPO/PPO	$3,947.92

screw pedicle 5.5 x 45

Facility

$6,024.10

Service Code	HCPCS C1713
Hospital Charge Code	8666511
Hospital Revenue Code	278
Min. Negotiated Rate	$542.17
Max. Negotiated Rate	$3,012.05
Rate for Payer: Aetna Commercial	$1,807.23
Rate for Payer: Amerigroup CHIP/Medicaid	$542.17
Rate for Payer: BCBS of TX Blue Advantage	$1,807.23
Rate for Payer: BCBS of TX Blue Essentials	$2,168.68
Rate for Payer: BCBS of TX PPO	$2,409.64
Rate for Payer: Cash Price	$5,301.21
Rate for Payer: Multiplan Auto	$3,012.05
Rate for Payer: Multiplan Commercial	$3,012.05
Rate for Payer: Multiplan Workers Comp	$3,012.05
Rate for Payer: Scott and White EPO/PPO	$3,012.05
Rate for Payer: Superior Health Plan EPO	$819.28

screw pedicle 5.5 x 45

Facility

$6,024.10

Service Code	HCPCS C1713
Hospital Charge Code	8666511
Hospital Revenue Code	278
Min. Negotiated Rate	$1,506.02
Max. Negotiated Rate	$3,012.05
Rate for Payer: Aetna Commercial	$1,807.23
Rate for Payer: Cash Price	$5,301.21
Rate for Payer: Cigna Commercial	$1,506.02
Rate for Payer: Multiplan Auto	$3,012.05
Rate for Payer: Multiplan Commercial	$3,012.05
Rate for Payer: Multiplan Workers Comp	$3,012.05
Rate for Payer: Scott and White EPO/PPO	$3,012.05

screw pedicle 6.5 x 40

Facility

$6,024.10

Service Code	HCPCS C1713
Hospital Charge Code	8666518
Hospital Revenue Code	278
Min. Negotiated Rate	$542.17
Max. Negotiated Rate	$3,012.05
Rate for Payer: Aetna Commercial	$1,807.23
Rate for Payer: Amerigroup CHIP/Medicaid	$542.17
Rate for Payer: BCBS of TX Blue Advantage	$1,807.23
Rate for Payer: BCBS of TX Blue Essentials	$2,168.68
Rate for Payer: BCBS of TX PPO	$2,409.64
Rate for Payer: Cash Price	$5,301.21
Rate for Payer: Multiplan Auto	$3,012.05
Rate for Payer: Multiplan Commercial	$3,012.05
Rate for Payer: Multiplan Workers Comp	$3,012.05
Rate for Payer: Scott and White EPO/PPO	$3,012.05
Rate for Payer: Superior Health Plan EPO	$819.28

screw pedicle 6.5 x 40

Facility

$6,024.10

Service Code	HCPCS C1713
Hospital Charge Code	8666518
Hospital Revenue Code	278
Min. Negotiated Rate	$1,506.02
Max. Negotiated Rate	$3,012.05
Rate for Payer: Aetna Commercial	$1,807.23
Rate for Payer: Cash Price	$5,301.21
Rate for Payer: Cigna Commercial	$1,506.02
Rate for Payer: Multiplan Auto	$3,012.05
Rate for Payer: Multiplan Commercial	$3,012.05
Rate for Payer: Multiplan Workers Comp	$3,012.05
Rate for Payer: Scott and White EPO/PPO	$3,012.05

screw poly avant

Facility

$4,819.28

Service Code	HCPCS C1713
Hospital Charge Code	8708540
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

Know your out-of-pocket cost for care.

All Charges