White Rock Medical Center

All Charges

Charge

Type

Setting

Price

NAIL INTRAMEDULLARY TYP5 -- DHF

Facility

$13,362.00

Service Code	HCPCS C1776
Hospital Charge Code	81330060
Hospital Revenue Code	278
Min. Negotiated Rate	$1,202.58
Max. Negotiated Rate	$9,620.64
Rate for Payer: Amerigroup CHIP/Medicaid	$1,202.58
Rate for Payer: BCBS of TX Blue Advantage	$4,008.60
Rate for Payer: BCBS of TX Blue Essentials	$4,810.32
Rate for Payer: BCBS of TX PPO	$5,344.80
Rate for Payer: Cash Price	$9,086.16
Rate for Payer: Cigna Medicaid	$9,620.64
Rate for Payer: Molina CHIP/Medicaid	$9,620.64
Rate for Payer: Multiplan Auto	$6,681.00
Rate for Payer: Multiplan Commercial	$6,681.00
Rate for Payer: Multiplan Workers Comp	$6,681.00
Rate for Payer: Parkland Medicaid	$9,620.64
Rate for Payer: Scott and White EPO/PPO	$6,681.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,620.64
Rate for Payer: Superior Health Plan EPO	$1,817.23

NAIL LEFT ES LONG

Facility

$26,506.00

Service Code	HCPCS C1776
Hospital Charge Code	8502478
Hospital Revenue Code	278
Min. Negotiated Rate	$6,626.50
Max. Negotiated Rate	$13,253.00
Rate for Payer: Cash Price	$18,024.08
Rate for Payer: Cigna Commercial	$6,626.50
Rate for Payer: Multiplan Auto	$13,253.00
Rate for Payer: Multiplan Commercial	$13,253.00
Rate for Payer: Multiplan Workers Comp	$13,253.00
Rate for Payer: Scott and White EPO/PPO	$13,253.00

NAIL LEFT ES LONG

Facility

$26,506.00

Service Code	HCPCS C1776
Hospital Charge Code	8502478
Hospital Revenue Code	278
Min. Negotiated Rate	$2,385.54
Max. Negotiated Rate	$19,084.32
Rate for Payer: Amerigroup CHIP/Medicaid	$2,385.54
Rate for Payer: BCBS of TX Blue Advantage	$7,951.80
Rate for Payer: BCBS of TX Blue Essentials	$9,542.16
Rate for Payer: BCBS of TX PPO	$10,602.40
Rate for Payer: Cash Price	$18,024.08
Rate for Payer: Cigna Medicaid	$19,084.32
Rate for Payer: Molina CHIP/Medicaid	$19,084.32
Rate for Payer: Multiplan Auto	$13,253.00
Rate for Payer: Multiplan Commercial	$13,253.00
Rate for Payer: Multiplan Workers Comp	$13,253.00
Rate for Payer: Parkland Medicaid	$19,084.32
Rate for Payer: Scott and White EPO/PPO	$13,253.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$19,084.32
Rate for Payer: Superior Health Plan EPO	$3,604.82

NAIL LONG

Facility

$21,240.96

Service Code	HCPCS C1776
Hospital Charge Code	992141
Hospital Revenue Code	278
Min. Negotiated Rate	$5,310.24
Max. Negotiated Rate	$10,620.48
Rate for Payer: Cash Price	$14,443.85
Rate for Payer: Cigna Commercial	$5,310.24
Rate for Payer: Multiplan Auto	$10,620.48
Rate for Payer: Multiplan Commercial	$10,620.48
Rate for Payer: Multiplan Workers Comp	$10,620.48
Rate for Payer: Scott and White EPO/PPO	$10,620.48

NAIL LONG

Facility

$21,240.96

Service Code	HCPCS C1776
Hospital Charge Code	992141
Hospital Revenue Code	278
Min. Negotiated Rate	$1,911.69
Max. Negotiated Rate	$15,293.49
Rate for Payer: Amerigroup CHIP/Medicaid	$1,911.69
Rate for Payer: BCBS of TX Blue Advantage	$6,372.29
Rate for Payer: BCBS of TX Blue Essentials	$7,646.75
Rate for Payer: BCBS of TX PPO	$8,496.38
Rate for Payer: Cash Price	$14,443.85
Rate for Payer: Cigna Medicaid	$15,293.49
Rate for Payer: Molina CHIP/Medicaid	$15,293.49
Rate for Payer: Multiplan Auto	$10,620.48
Rate for Payer: Multiplan Commercial	$10,620.48
Rate for Payer: Multiplan Workers Comp	$10,620.48
Rate for Payer: Parkland Medicaid	$15,293.49
Rate for Payer: Scott and White EPO/PPO	$10,620.48
Rate for Payer: Superior Health Plan CHIP/Medicaid	$15,293.49
Rate for Payer: Superior Health Plan EPO	$2,888.77

NAIL SCHND11&12M -- DHF

Facility

$11,989.00

Service Code	HCPCS C1776
Hospital Charge Code	81330607
Hospital Revenue Code	278
Min. Negotiated Rate	$2,997.25
Max. Negotiated Rate	$5,994.50
Rate for Payer: Cash Price	$8,152.52
Rate for Payer: Cigna Commercial	$2,997.25
Rate for Payer: Multiplan Auto	$5,994.50
Rate for Payer: Multiplan Commercial	$5,994.50
Rate for Payer: Multiplan Workers Comp	$5,994.50
Rate for Payer: Scott and White EPO/PPO	$5,994.50

NAIL SCHND11&12M -- DHF

Facility

$11,989.00

Service Code	HCPCS C1776
Hospital Charge Code	81330607
Hospital Revenue Code	278
Min. Negotiated Rate	$1,079.01
Max. Negotiated Rate	$8,632.08
Rate for Payer: Amerigroup CHIP/Medicaid	$1,079.01
Rate for Payer: BCBS of TX Blue Advantage	$3,596.70
Rate for Payer: BCBS of TX Blue Essentials	$4,316.04
Rate for Payer: BCBS of TX PPO	$4,795.60
Rate for Payer: Cash Price	$8,152.52
Rate for Payer: Cigna Medicaid	$8,632.08
Rate for Payer: Molina CHIP/Medicaid	$8,632.08
Rate for Payer: Multiplan Auto	$5,994.50
Rate for Payer: Multiplan Commercial	$5,994.50
Rate for Payer: Multiplan Workers Comp	$5,994.50
Rate for Payer: Parkland Medicaid	$8,632.08
Rate for Payer: Scott and White EPO/PPO	$5,994.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,632.08
Rate for Payer: Superior Health Plan EPO	$1,630.50

nail talon distal fix

Facility

$16,867.00

Service Code	HCPCS C1776
Hospital Charge Code	8720590
Hospital Revenue Code	278
Min. Negotiated Rate	$4,216.75
Max. Negotiated Rate	$8,433.50
Rate for Payer: Cash Price	$11,469.56
Rate for Payer: Cigna Commercial	$4,216.75
Rate for Payer: Multiplan Auto	$8,433.50
Rate for Payer: Multiplan Commercial	$8,433.50
Rate for Payer: Multiplan Workers Comp	$8,433.50
Rate for Payer: Scott and White EPO/PPO	$8,433.50

nail talon distal fix

Facility

$16,867.00

Service Code	HCPCS C1776
Hospital Charge Code	8720590
Hospital Revenue Code	278
Min. Negotiated Rate	$1,518.03
Max. Negotiated Rate	$12,144.24
Rate for Payer: Amerigroup CHIP/Medicaid	$1,518.03
Rate for Payer: BCBS of TX Blue Advantage	$5,060.10
Rate for Payer: BCBS of TX Blue Essentials	$6,072.12
Rate for Payer: BCBS of TX PPO	$6,746.80
Rate for Payer: Cash Price	$11,469.56
Rate for Payer: Cigna Medicaid	$12,144.24
Rate for Payer: Molina CHIP/Medicaid	$12,144.24
Rate for Payer: Multiplan Auto	$8,433.50
Rate for Payer: Multiplan Commercial	$8,433.50
Rate for Payer: Multiplan Workers Comp	$8,433.50
Rate for Payer: Parkland Medicaid	$12,144.24
Rate for Payer: Scott and White EPO/PPO	$8,433.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,144.24
Rate for Payer: Superior Health Plan EPO	$2,293.91

NAIL TALON DISTAL FIX

Facility

$16,867.00

Service Code	HCPCS C1776
Hospital Charge Code	145159
Hospital Revenue Code	278
Min. Negotiated Rate	$1,518.03
Max. Negotiated Rate	$12,144.24
Rate for Payer: Amerigroup CHIP/Medicaid	$1,518.03
Rate for Payer: BCBS of TX Blue Advantage	$5,060.10
Rate for Payer: BCBS of TX Blue Essentials	$6,072.12
Rate for Payer: BCBS of TX PPO	$6,746.80
Rate for Payer: Cash Price	$11,469.56
Rate for Payer: Cigna Medicaid	$12,144.24
Rate for Payer: Molina CHIP/Medicaid	$12,144.24
Rate for Payer: Multiplan Auto	$8,433.50
Rate for Payer: Multiplan Commercial	$8,433.50
Rate for Payer: Multiplan Workers Comp	$8,433.50
Rate for Payer: Parkland Medicaid	$12,144.24
Rate for Payer: Scott and White EPO/PPO	$8,433.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,144.24
Rate for Payer: Superior Health Plan EPO	$2,293.91

NAIL TALON DISTAL FIX

Facility

$16,867.00

Service Code	HCPCS C1776
Hospital Charge Code	145159
Hospital Revenue Code	278
Min. Negotiated Rate	$4,216.75
Max. Negotiated Rate	$8,433.50
Rate for Payer: Cash Price	$11,469.56
Rate for Payer: Cigna Commercial	$4,216.75
Rate for Payer: Multiplan Auto	$8,433.50
Rate for Payer: Multiplan Commercial	$8,433.50
Rate for Payer: Multiplan Workers Comp	$8,433.50
Rate for Payer: Scott and White EPO/PPO	$8,433.50

NAIL TALON DISTAL FX

Facility

$16,867.00

Service Code	HCPCS C1776
Hospital Charge Code	145225
Hospital Revenue Code	278
Min. Negotiated Rate	$1,518.03
Max. Negotiated Rate	$12,144.24
Rate for Payer: Amerigroup CHIP/Medicaid	$1,518.03
Rate for Payer: BCBS of TX Blue Advantage	$5,060.10
Rate for Payer: BCBS of TX Blue Essentials	$6,072.12
Rate for Payer: BCBS of TX PPO	$6,746.80
Rate for Payer: Cash Price	$11,469.56
Rate for Payer: Cigna Medicaid	$12,144.24
Rate for Payer: Molina CHIP/Medicaid	$12,144.24
Rate for Payer: Multiplan Auto	$8,433.50
Rate for Payer: Multiplan Commercial	$8,433.50
Rate for Payer: Multiplan Workers Comp	$8,433.50
Rate for Payer: Parkland Medicaid	$12,144.24
Rate for Payer: Scott and White EPO/PPO	$8,433.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,144.24
Rate for Payer: Superior Health Plan EPO	$2,293.91

NAIL TALON DISTAL FX

Facility

$16,867.00

Service Code	HCPCS C1776
Hospital Charge Code	145225
Hospital Revenue Code	278
Min. Negotiated Rate	$4,216.75
Max. Negotiated Rate	$8,433.50
Rate for Payer: Cash Price	$11,469.56
Rate for Payer: Cigna Commercial	$4,216.75
Rate for Payer: Multiplan Auto	$8,433.50
Rate for Payer: Multiplan Commercial	$8,433.50
Rate for Payer: Multiplan Workers Comp	$8,433.50
Rate for Payer: Scott and White EPO/PPO	$8,433.50

Nail Talon Distl Fx

Facility

$16,867.00

Service Code	HCPCS C1776
Hospital Charge Code	145813
Hospital Revenue Code	278
Min. Negotiated Rate	$1,518.03
Max. Negotiated Rate	$12,144.24
Rate for Payer: Amerigroup CHIP/Medicaid	$1,518.03
Rate for Payer: BCBS of TX Blue Advantage	$5,060.10
Rate for Payer: BCBS of TX Blue Essentials	$6,072.12
Rate for Payer: BCBS of TX PPO	$6,746.80
Rate for Payer: Cash Price	$11,469.56
Rate for Payer: Cigna Medicaid	$12,144.24
Rate for Payer: Molina CHIP/Medicaid	$12,144.24
Rate for Payer: Multiplan Auto	$8,433.50
Rate for Payer: Multiplan Commercial	$8,433.50
Rate for Payer: Multiplan Workers Comp	$8,433.50
Rate for Payer: Parkland Medicaid	$12,144.24
Rate for Payer: Scott and White EPO/PPO	$8,433.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,144.24
Rate for Payer: Superior Health Plan EPO	$2,293.91

Nail Talon Distl Fx

Facility

$16,867.00

Service Code	HCPCS C1776
Hospital Charge Code	145813
Hospital Revenue Code	278
Min. Negotiated Rate	$4,216.75
Max. Negotiated Rate	$8,433.50
Rate for Payer: Cash Price	$11,469.56
Rate for Payer: Cigna Commercial	$4,216.75
Rate for Payer: Multiplan Auto	$8,433.50
Rate for Payer: Multiplan Commercial	$8,433.50
Rate for Payer: Multiplan Workers Comp	$8,433.50
Rate for Payer: Scott and White EPO/PPO	$8,433.50

NAIL TIBIAL 10.0MM X 320MM

Facility

$16,270.00

Service Code	HCPCS C1776
Hospital Charge Code	145337
Hospital Revenue Code	278
Min. Negotiated Rate	$1,464.30
Max. Negotiated Rate	$11,714.40
Rate for Payer: Amerigroup CHIP/Medicaid	$1,464.30
Rate for Payer: BCBS of TX Blue Advantage	$4,881.00
Rate for Payer: BCBS of TX Blue Essentials	$5,857.20
Rate for Payer: BCBS of TX PPO	$6,508.00
Rate for Payer: Cash Price	$11,063.60
Rate for Payer: Cigna Medicaid	$11,714.40
Rate for Payer: Molina CHIP/Medicaid	$11,714.40
Rate for Payer: Multiplan Auto	$8,135.00
Rate for Payer: Multiplan Commercial	$8,135.00
Rate for Payer: Multiplan Workers Comp	$8,135.00
Rate for Payer: Parkland Medicaid	$11,714.40
Rate for Payer: Scott and White EPO/PPO	$8,135.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,714.40
Rate for Payer: Superior Health Plan EPO	$2,212.72

NAIL TIBIAL 10.0MM X 320MM

Facility

$16,270.00

Service Code	HCPCS C1776
Hospital Charge Code	145337
Hospital Revenue Code	278
Min. Negotiated Rate	$4,067.50
Max. Negotiated Rate	$8,135.00
Rate for Payer: Cash Price	$11,063.60
Rate for Payer: Cigna Commercial	$4,067.50
Rate for Payer: Multiplan Auto	$8,135.00
Rate for Payer: Multiplan Commercial	$8,135.00
Rate for Payer: Multiplan Workers Comp	$8,135.00
Rate for Payer: Scott and White EPO/PPO	$8,135.00

NAIL TIBIAL T2 LOCK 12MM 360MM

Facility

$9,722.00

Service Code	HCPCS C1776
Hospital Charge Code	8394456
Hospital Revenue Code	278
Min. Negotiated Rate	$2,430.50
Max. Negotiated Rate	$4,861.00
Rate for Payer: Cash Price	$6,610.96
Rate for Payer: Cigna Commercial	$2,430.50
Rate for Payer: Multiplan Auto	$4,861.00
Rate for Payer: Multiplan Commercial	$4,861.00
Rate for Payer: Multiplan Workers Comp	$4,861.00
Rate for Payer: Scott and White EPO/PPO	$4,861.00

NAIL TIBIAL T2 LOCK 12MM 360MM

Facility

$9,722.00

Service Code	HCPCS C1776
Hospital Charge Code	8394456
Hospital Revenue Code	278
Min. Negotiated Rate	$874.98
Max. Negotiated Rate	$6,999.84
Rate for Payer: Amerigroup CHIP/Medicaid	$874.98
Rate for Payer: BCBS of TX Blue Advantage	$2,916.60
Rate for Payer: BCBS of TX Blue Essentials	$3,499.92
Rate for Payer: BCBS of TX PPO	$3,888.80
Rate for Payer: Cash Price	$6,610.96
Rate for Payer: Cigna Medicaid	$6,999.84
Rate for Payer: Molina CHIP/Medicaid	$6,999.84
Rate for Payer: Multiplan Auto	$4,861.00
Rate for Payer: Multiplan Commercial	$4,861.00
Rate for Payer: Multiplan Workers Comp	$4,861.00
Rate for Payer: Parkland Medicaid	$6,999.84
Rate for Payer: Scott and White EPO/PPO	$4,861.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,999.84
Rate for Payer: Superior Health Plan EPO	$1,322.19

NAIL TIB T2

Facility

$1,176.00

Service Code	HCPCS C1776
Hospital Charge Code	8470491
Hospital Revenue Code	278
Min. Negotiated Rate	$294.00
Max. Negotiated Rate	$588.00
Rate for Payer: Cash Price	$799.68
Rate for Payer: Cigna Commercial	$294.00
Rate for Payer: Multiplan Auto	$588.00
Rate for Payer: Multiplan Commercial	$588.00
Rate for Payer: Multiplan Workers Comp	$588.00
Rate for Payer: Scott and White EPO/PPO	$588.00

NAIL TIB T2

Facility

$1,176.00

Service Code	HCPCS C1776
Hospital Charge Code	8470491
Hospital Revenue Code	278
Min. Negotiated Rate	$105.84
Max. Negotiated Rate	$846.72
Rate for Payer: Amerigroup CHIP/Medicaid	$105.84
Rate for Payer: BCBS of TX Blue Advantage	$352.80
Rate for Payer: BCBS of TX Blue Essentials	$423.36
Rate for Payer: BCBS of TX PPO	$470.40
Rate for Payer: Cash Price	$799.68
Rate for Payer: Cigna Medicaid	$846.72
Rate for Payer: Molina CHIP/Medicaid	$846.72
Rate for Payer: Multiplan Auto	$588.00
Rate for Payer: Multiplan Commercial	$588.00
Rate for Payer: Multiplan Workers Comp	$588.00
Rate for Payer: Parkland Medicaid	$846.72
Rate for Payer: Scott and White EPO/PPO	$588.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$846.72
Rate for Payer: Superior Health Plan EPO	$159.94

NAIL TROCHANTERIC 125X12X200

Facility

$10,843.00

Service Code	HCPCS C1776
Hospital Charge Code	145474
Hospital Revenue Code	278
Min. Negotiated Rate	$975.87
Max. Negotiated Rate	$7,806.96
Rate for Payer: Amerigroup CHIP/Medicaid	$975.87
Rate for Payer: BCBS of TX Blue Advantage	$3,252.90
Rate for Payer: BCBS of TX Blue Essentials	$3,903.48
Rate for Payer: BCBS of TX PPO	$4,337.20
Rate for Payer: Cash Price	$7,373.24
Rate for Payer: Cigna Medicaid	$7,806.96
Rate for Payer: Molina CHIP/Medicaid	$7,806.96
Rate for Payer: Multiplan Auto	$5,421.50
Rate for Payer: Multiplan Commercial	$5,421.50
Rate for Payer: Multiplan Workers Comp	$5,421.50
Rate for Payer: Parkland Medicaid	$7,806.96
Rate for Payer: Scott and White EPO/PPO	$5,421.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,806.96
Rate for Payer: Superior Health Plan EPO	$1,474.65

NAIL TROCHANTERIC 125X12X200

Facility

$10,843.00

Service Code	HCPCS C1776
Hospital Charge Code	145474
Hospital Revenue Code	278
Min. Negotiated Rate	$2,710.75
Max. Negotiated Rate	$5,421.50
Rate for Payer: Cash Price	$7,373.24
Rate for Payer: Cigna Commercial	$2,710.75
Rate for Payer: Multiplan Auto	$5,421.50
Rate for Payer: Multiplan Commercial	$5,421.50
Rate for Payer: Multiplan Workers Comp	$5,421.50
Rate for Payer: Scott and White EPO/PPO	$5,421.50

NAIL TROCH GAMMA3 IM KIT TI STRL 11 X 180MM

Facility

$9,284.00

Service Code	HCPCS C1776
Hospital Charge Code	123426
Hospital Revenue Code	278
Min. Negotiated Rate	$835.56
Max. Negotiated Rate	$6,684.48
Rate for Payer: Amerigroup CHIP/Medicaid	$835.56
Rate for Payer: BCBS of TX Blue Advantage	$2,785.20
Rate for Payer: BCBS of TX Blue Essentials	$3,342.24
Rate for Payer: BCBS of TX PPO	$3,713.60
Rate for Payer: Cash Price	$6,313.12
Rate for Payer: Cigna Medicaid	$6,684.48
Rate for Payer: Molina CHIP/Medicaid	$6,684.48
Rate for Payer: Multiplan Auto	$4,642.00
Rate for Payer: Multiplan Commercial	$4,642.00
Rate for Payer: Multiplan Workers Comp	$4,642.00
Rate for Payer: Parkland Medicaid	$6,684.48
Rate for Payer: Scott and White EPO/PPO	$4,642.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,684.48
Rate for Payer: Superior Health Plan EPO	$1,262.62

NAIL TROCH GAMMA3 IM KIT TI STRL 11 X 180MM

Facility

$9,284.00

Service Code	HCPCS C1776
Hospital Charge Code	123426
Hospital Revenue Code	278
Min. Negotiated Rate	$2,321.00
Max. Negotiated Rate	$4,642.00
Rate for Payer: Cash Price	$6,313.12
Rate for Payer: Cigna Commercial	$2,321.00
Rate for Payer: Multiplan Auto	$4,642.00
Rate for Payer: Multiplan Commercial	$4,642.00
Rate for Payer: Multiplan Workers Comp	$4,642.00
Rate for Payer: Scott and White EPO/PPO	$4,642.00

Know your out-of-pocket cost for care.

All Charges