White Rock Medical Center

All Charges

Charge

Type

Setting

Price

WIRE KIRCHNER PL -- DHF

Facility

$261.37

Service Code	HCPCS C1713
Hospital Charge Code	81370959
Hospital Revenue Code	278
Min. Negotiated Rate	$65.34
Max. Negotiated Rate	$130.68
Rate for Payer: Aetna Commercial	$78.41
Rate for Payer: Cash Price	$230.01
Rate for Payer: Cigna Commercial	$65.34
Rate for Payer: Multiplan Auto	$130.68
Rate for Payer: Multiplan Commercial	$130.68
Rate for Payer: Multiplan Workers Comp	$130.68
Rate for Payer: Scott and White EPO/PPO	$130.68

WIRE KIRCHNER PL -- DHF

Facility

$261.37

Service Code	HCPCS C1713
Hospital Charge Code	81370959
Hospital Revenue Code	278
Min. Negotiated Rate	$23.52
Max. Negotiated Rate	$130.68
Rate for Payer: Aetna Commercial	$78.41
Rate for Payer: Amerigroup CHIP/Medicaid	$23.52
Rate for Payer: BCBS of TX Blue Advantage	$78.41
Rate for Payer: BCBS of TX Blue Essentials	$94.09
Rate for Payer: BCBS of TX PPO	$104.55
Rate for Payer: Cash Price	$230.01
Rate for Payer: Multiplan Auto	$130.68
Rate for Payer: Multiplan Commercial	$130.68
Rate for Payer: Multiplan Workers Comp	$130.68
Rate for Payer: Scott and White EPO/PPO	$130.68
Rate for Payer: Superior Health Plan EPO	$35.55

WIRE KIRCHNER TH -- DHF

Facility

$137.21

Service Code	HCPCS C1713
Hospital Charge Code	81371007
Hospital Revenue Code	278
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$68.60
Rate for Payer: Aetna Commercial	$41.16
Rate for Payer: Amerigroup CHIP/Medicaid	$12.35
Rate for Payer: BCBS of TX Blue Advantage	$41.16
Rate for Payer: BCBS of TX Blue Essentials	$49.40
Rate for Payer: BCBS of TX PPO	$54.88
Rate for Payer: Cash Price	$120.74
Rate for Payer: Multiplan Auto	$68.60
Rate for Payer: Multiplan Commercial	$68.60
Rate for Payer: Multiplan Workers Comp	$68.60
Rate for Payer: Scott and White EPO/PPO	$68.60
Rate for Payer: Superior Health Plan EPO	$18.66

WIRE KIRCHNER TH -- DHF

Facility

$137.21

Service Code	HCPCS C1713
Hospital Charge Code	81371007
Hospital Revenue Code	278
Min. Negotiated Rate	$34.30
Max. Negotiated Rate	$68.60
Rate for Payer: Aetna Commercial	$41.16
Rate for Payer: Cash Price	$120.74
Rate for Payer: Cigna Commercial	$34.30
Rate for Payer: Multiplan Auto	$68.60
Rate for Payer: Multiplan Commercial	$68.60
Rate for Payer: Multiplan Workers Comp	$68.60
Rate for Payer: Scott and White EPO/PPO	$68.60

WIRE, KIRSCHNER 1.6MM DIA 6" L

Facility

$71.57

Service Code	HCPCS C1769
Hospital Charge Code	140179
Hospital Revenue Code	272
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$46.52
Rate for Payer: Aetna Commercial	$39.36
Rate for Payer: Amerigroup CHIP/Medicaid	$6.44
Rate for Payer: BCBS of TX Blue Advantage	$21.47
Rate for Payer: BCBS of TX Blue Essentials	$25.77
Rate for Payer: BCBS of TX PPO	$28.63
Rate for Payer: Cash Price	$62.98
Rate for Payer: Multiplan Auto	$46.52
Rate for Payer: Multiplan Commercial	$46.52
Rate for Payer: Multiplan Workers Comp	$46.52
Rate for Payer: Scott and White EPO/PPO	$35.78
Rate for Payer: Superior Health Plan EPO	$9.73

WIRE, KIRSCHNER 1.6MM DIA 6" L

Facility

$71.57

Service Code	HCPCS C1769
Hospital Charge Code	140179
Hospital Revenue Code	272
Rate for Payer: Cash Price	$62.98

WIRE, KIRSCHNER DIAMOND POINT 2 END .028 X 4'''' STRL -- DHF

Facility

$26.54

Service Code	HCPCS C1713
Hospital Charge Code	81371023
Hospital Revenue Code	278
Min. Negotiated Rate	$6.64
Max. Negotiated Rate	$13.27
Rate for Payer: Aetna Commercial	$7.96
Rate for Payer: Cash Price	$23.36
Rate for Payer: Cigna Commercial	$6.64
Rate for Payer: Multiplan Auto	$13.27
Rate for Payer: Multiplan Commercial	$13.27
Rate for Payer: Multiplan Workers Comp	$13.27
Rate for Payer: Scott and White EPO/PPO	$13.27

WIRE, KIRSCHNER DIAMOND POINT 2 END .028 X 4'''' STRL -- DHF

Facility

$26.54

Service Code	HCPCS C1713
Hospital Charge Code	81371023
Hospital Revenue Code	278
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$13.27
Rate for Payer: Aetna Commercial	$7.96
Rate for Payer: Amerigroup CHIP/Medicaid	$2.39
Rate for Payer: BCBS of TX Blue Advantage	$7.96
Rate for Payer: BCBS of TX Blue Essentials	$9.55
Rate for Payer: BCBS of TX PPO	$10.62
Rate for Payer: Cash Price	$23.36
Rate for Payer: Multiplan Auto	$13.27
Rate for Payer: Multiplan Commercial	$13.27
Rate for Payer: Multiplan Workers Comp	$13.27
Rate for Payer: Scott and White EPO/PPO	$13.27
Rate for Payer: Superior Health Plan EPO	$3.61

WIRE, KIRSCHNER DIAMOND POINT 2 END .035 X 4'''' STRL -- DHF

Facility

$583.13

Service Code	HCPCS C1713
Hospital Charge Code	81371023
Hospital Revenue Code	278
Min. Negotiated Rate	$145.78
Max. Negotiated Rate	$291.56
Rate for Payer: Aetna Commercial	$174.94
Rate for Payer: Cash Price	$513.15
Rate for Payer: Cigna Commercial	$145.78
Rate for Payer: Multiplan Auto	$291.56
Rate for Payer: Multiplan Commercial	$291.56
Rate for Payer: Multiplan Workers Comp	$291.56
Rate for Payer: Scott and White EPO/PPO	$291.56

WIRE, KIRSCHNER DIAMOND POINT 2 END .035 X 4'''' STRL -- DHF

Facility

$583.13

Service Code	HCPCS C1713
Hospital Charge Code	81371023
Hospital Revenue Code	278
Min. Negotiated Rate	$52.48
Max. Negotiated Rate	$291.56
Rate for Payer: Aetna Commercial	$174.94
Rate for Payer: Amerigroup CHIP/Medicaid	$52.48
Rate for Payer: BCBS of TX Blue Advantage	$174.94
Rate for Payer: BCBS of TX Blue Essentials	$209.93
Rate for Payer: BCBS of TX PPO	$233.25
Rate for Payer: Cash Price	$513.15
Rate for Payer: Multiplan Auto	$291.56
Rate for Payer: Multiplan Commercial	$291.56
Rate for Payer: Multiplan Workers Comp	$291.56
Rate for Payer: Scott and White EPO/PPO	$291.56
Rate for Payer: Superior Health Plan EPO	$79.31

WIRE, KIRSCHNER DIAMOND POINT 2 END .045 X 4'''' STRL -- DHF

Facility

$26.54

Service Code	HCPCS C1713
Hospital Charge Code	81371023
Hospital Revenue Code	278
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$13.27
Rate for Payer: Aetna Commercial	$7.96
Rate for Payer: Amerigroup CHIP/Medicaid	$2.39
Rate for Payer: BCBS of TX Blue Advantage	$7.96
Rate for Payer: BCBS of TX Blue Essentials	$9.55
Rate for Payer: BCBS of TX PPO	$10.62
Rate for Payer: Cash Price	$23.36
Rate for Payer: Multiplan Auto	$13.27
Rate for Payer: Multiplan Commercial	$13.27
Rate for Payer: Multiplan Workers Comp	$13.27
Rate for Payer: Scott and White EPO/PPO	$13.27
Rate for Payer: Superior Health Plan EPO	$3.61

WIRE, KIRSCHNER DIAMOND POINT 2 END .045 X 4'''' STRL -- DHF

Facility

$26.54

Service Code	HCPCS C1713
Hospital Charge Code	81371023
Hospital Revenue Code	278
Min. Negotiated Rate	$6.64
Max. Negotiated Rate	$13.27
Rate for Payer: Aetna Commercial	$7.96
Rate for Payer: Cash Price	$23.36
Rate for Payer: Cigna Commercial	$6.64
Rate for Payer: Multiplan Auto	$13.27
Rate for Payer: Multiplan Commercial	$13.27
Rate for Payer: Multiplan Workers Comp	$13.27
Rate for Payer: Scott and White EPO/PPO	$13.27

WIRE, KIRSCHNER DIAMOND POINT 2 END .062''''X4'''' STRL -- DHF

Facility

$26.54

Service Code	HCPCS C1713
Hospital Charge Code	81371023
Hospital Revenue Code	278
Min. Negotiated Rate	$6.64
Max. Negotiated Rate	$13.27
Rate for Payer: Aetna Commercial	$7.96
Rate for Payer: Cash Price	$23.36
Rate for Payer: Cigna Commercial	$6.64
Rate for Payer: Multiplan Auto	$13.27
Rate for Payer: Multiplan Commercial	$13.27
Rate for Payer: Multiplan Workers Comp	$13.27
Rate for Payer: Scott and White EPO/PPO	$13.27

WIRE, KIRSCHNER DIAMOND POINT 2 END .062''''X4'''' STRL -- DHF

Facility

$26.54

Service Code	HCPCS C1713
Hospital Charge Code	81371023
Hospital Revenue Code	278
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$13.27
Rate for Payer: Aetna Commercial	$7.96
Rate for Payer: Amerigroup CHIP/Medicaid	$2.39
Rate for Payer: BCBS of TX Blue Advantage	$7.96
Rate for Payer: BCBS of TX Blue Essentials	$9.55
Rate for Payer: BCBS of TX PPO	$10.62
Rate for Payer: Cash Price	$23.36
Rate for Payer: Multiplan Auto	$13.27
Rate for Payer: Multiplan Commercial	$13.27
Rate for Payer: Multiplan Workers Comp	$13.27
Rate for Payer: Scott and White EPO/PPO	$13.27
Rate for Payer: Superior Health Plan EPO	$3.61

WIRE, KIRSCHNER DIAMOND POINT 2 END .062'''' X 9'''' -- DHF

Facility

$26.54

Service Code	HCPCS C1713
Hospital Charge Code	81371023
Hospital Revenue Code	278
Min. Negotiated Rate	$6.64
Max. Negotiated Rate	$13.27
Rate for Payer: Aetna Commercial	$7.96
Rate for Payer: Cash Price	$23.36
Rate for Payer: Cigna Commercial	$6.64
Rate for Payer: Multiplan Auto	$13.27
Rate for Payer: Multiplan Commercial	$13.27
Rate for Payer: Multiplan Workers Comp	$13.27
Rate for Payer: Scott and White EPO/PPO	$13.27

WIRE, KIRSCHNER DIAMOND POINT 2 END .062'''' X 9'''' -- DHF

Facility

$26.54

Service Code	HCPCS C1713
Hospital Charge Code	81371023
Hospital Revenue Code	278
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$13.27
Rate for Payer: Aetna Commercial	$7.96
Rate for Payer: Amerigroup CHIP/Medicaid	$2.39
Rate for Payer: BCBS of TX Blue Advantage	$7.96
Rate for Payer: BCBS of TX Blue Essentials	$9.55
Rate for Payer: BCBS of TX PPO	$10.62
Rate for Payer: Cash Price	$23.36
Rate for Payer: Multiplan Auto	$13.27
Rate for Payer: Multiplan Commercial	$13.27
Rate for Payer: Multiplan Workers Comp	$13.27
Rate for Payer: Scott and White EPO/PPO	$13.27
Rate for Payer: Superior Health Plan EPO	$3.61

WIRE KIRSCHNER ZEBRA

Facility

$106.02

Service Code	HCPCS C1713
Hospital Charge Code	8576466
Hospital Revenue Code	278
Min. Negotiated Rate	$26.50
Max. Negotiated Rate	$53.01
Rate for Payer: Aetna Commercial	$31.81
Rate for Payer: Cash Price	$93.30
Rate for Payer: Cigna Commercial	$26.50
Rate for Payer: Multiplan Auto	$53.01
Rate for Payer: Multiplan Commercial	$53.01
Rate for Payer: Multiplan Workers Comp	$53.01
Rate for Payer: Scott and White EPO/PPO	$53.01

WIRE KIRSCHNER ZEBRA

Facility

$106.02

Service Code	HCPCS C1713
Hospital Charge Code	8576466
Hospital Revenue Code	278
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$53.01
Rate for Payer: Aetna Commercial	$31.81
Rate for Payer: Amerigroup CHIP/Medicaid	$9.54
Rate for Payer: BCBS of TX Blue Advantage	$31.81
Rate for Payer: BCBS of TX Blue Essentials	$38.17
Rate for Payer: BCBS of TX PPO	$42.41
Rate for Payer: Cash Price	$93.30
Rate for Payer: Multiplan Auto	$53.01
Rate for Payer: Multiplan Commercial	$53.01
Rate for Payer: Multiplan Workers Comp	$53.01
Rate for Payer: Scott and White EPO/PPO	$53.01
Rate for Payer: Superior Health Plan EPO	$14.42

WIRE SHUTTLE LOOP

Facility

$908.00

Hospital Charge Code	8524479
Hospital Revenue Code	272
Rate for Payer: Cash Price	$799.04

WIRE SHUTTLE LOOP

Facility

$908.00

Hospital Charge Code	8524479
Hospital Revenue Code	272
Min. Negotiated Rate	$81.72
Max. Negotiated Rate	$590.20
Rate for Payer: Aetna Commercial	$499.40
Rate for Payer: Amerigroup CHIP/Medicaid	$81.72
Rate for Payer: BCBS of TX Blue Advantage	$272.40
Rate for Payer: BCBS of TX Blue Essentials	$326.88
Rate for Payer: BCBS of TX PPO	$363.20
Rate for Payer: Cash Price	$799.04
Rate for Payer: Multiplan Auto	$590.20
Rate for Payer: Multiplan Commercial	$590.20
Rate for Payer: Multiplan Workers Comp	$590.20
Rate for Payer: Scott and White EPO/PPO	$454.00
Rate for Payer: Superior Health Plan EPO	$123.49

WIRE SUTURE PASSING

Facility

$340.50

Hospital Charge Code	114787
Hospital Revenue Code	272
Min. Negotiated Rate	$30.64
Max. Negotiated Rate	$221.32
Rate for Payer: Aetna Commercial	$187.28
Rate for Payer: Amerigroup CHIP/Medicaid	$30.64
Rate for Payer: BCBS of TX Blue Advantage	$102.15
Rate for Payer: BCBS of TX Blue Essentials	$122.58
Rate for Payer: BCBS of TX PPO	$136.20
Rate for Payer: Cash Price	$299.64
Rate for Payer: Multiplan Auto	$221.32
Rate for Payer: Multiplan Commercial	$221.32
Rate for Payer: Multiplan Workers Comp	$221.32
Rate for Payer: Scott and White EPO/PPO	$170.25
Rate for Payer: Superior Health Plan EPO	$46.31

WIRE SUTURE PASSING

Facility

$340.50

Hospital Charge Code	114787
Hospital Revenue Code	272
Rate for Payer: Cash Price	$299.64

WOUND CLOSURE

Facility

$10,000.00

Service Code	CPT 13160
Hospital Charge Code	36013160
Hospital Revenue Code	360
Min. Negotiated Rate	$36.79
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$2,200.00
Rate for Payer: Aetna Medicare	$2,501.68
Rate for Payer: Amerigroup CHIP/Medicaid	$709.01
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,667.79
Rate for Payer: Amerigroup Medicare	$1,667.79
Rate for Payer: BCBS of TX Blue Advantage	$2,709.98
Rate for Payer: BCBS of TX Blue Essentials	$3,245.48
Rate for Payer: BCBS of TX Medicare	$1,667.79
Rate for Payer: BCBS of TX PPO	$4,089.30
Rate for Payer: Cigna Commercial	$3,778.02
Rate for Payer: Cigna Medicaid	$709.01
Rate for Payer: Cigna Medicare	$1,667.79
Rate for Payer: Employer Direct Commercial	$1,667.79
Rate for Payer: Humana Medicare/TRICARE	$1,667.79
Rate for Payer: Molina CHIP/Medicaid	$709.01
Rate for Payer: Molina Dual Medicare/Medicaid	$1,667.79
Rate for Payer: Molina Medicare	$1,667.79
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$709.01
Rate for Payer: Scott and White EPO/PPO	$36.79
Rate for Payer: Scott and White Medicare	$1,667.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$709.01
Rate for Payer: Superior Health Plan EPO	$1,667.79
Rate for Payer: Superior Health Plan Medicare	$1,667.79
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,667.79
Rate for Payer: Universal American Medicare	$1,667.79
Rate for Payer: Wellcare Medicare	$1,667.79
Rate for Payer: Wellmed Medicare	$1,667.79

Wound Culture

Facility

$309.00

Service Code	CPT 87070
Hospital Charge Code	4107133
Hospital Revenue Code	306
Rate for Payer: Cash Price	$271.92

Wound Culture

Facility

$309.00

Service Code	CPT 87070
Hospital Charge Code	4107133
Hospital Revenue Code	306
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$200.85
Rate for Payer: Aetna Commercial	$9.05
Rate for Payer: Aetna Medicare	$12.93
Rate for Payer: Amerigroup CHIP/Medicaid	$3.36
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8.62
Rate for Payer: Amerigroup Medicare	$8.62
Rate for Payer: BCBS of TX Blue Advantage	$14.22
Rate for Payer: BCBS of TX Blue Essentials	$17.07
Rate for Payer: BCBS of TX Medicare	$8.62
Rate for Payer: BCBS of TX PPO	$19.05
Rate for Payer: Cash Price	$271.92
Rate for Payer: Cash Price	$271.92
Rate for Payer: Cigna Medicaid	$8.62
Rate for Payer: Cigna Medicare	$8.62
Rate for Payer: Employer Direct Commercial	$8.62
Rate for Payer: Humana Medicare/TRICARE	$8.62
Rate for Payer: Molina CHIP/Medicaid	$8.62
Rate for Payer: Molina Dual Medicare/Medicaid	$8.62
Rate for Payer: Molina Medicare	$8.62
Rate for Payer: Multiplan Auto	$200.85
Rate for Payer: Multiplan Commercial	$200.85
Rate for Payer: Multiplan Workers Comp	$200.85
Rate for Payer: Parkland Medicaid	$8.62
Rate for Payer: Scott and White EPO/PPO	$10.78
Rate for Payer: Scott and White Medicare	$8.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.62
Rate for Payer: Superior Health Plan EPO	$8.62
Rate for Payer: Superior Health Plan Medicare	$8.62
Rate for Payer: Universal American Dual Medicare/Medicaid	$8.62
Rate for Payer: Universal American Medicare	$8.62
Rate for Payer: Wellcare Medicare	$8.62
Rate for Payer: Wellmed Medicare	$8.62

Know your out-of-pocket cost for care.

All Charges