White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SCREW CORTICAL

Facility

$3,058.00

Service Code	HCPCS C1713
Hospital Charge Code	8428497
Hospital Revenue Code	278
Min. Negotiated Rate	$764.50
Max. Negotiated Rate	$1,529.00
Rate for Payer: Cash Price	$2,079.44
Rate for Payer: Cigna Commercial	$764.50
Rate for Payer: Multiplan Auto	$1,529.00
Rate for Payer: Multiplan Commercial	$1,529.00
Rate for Payer: Multiplan Workers Comp	$1,529.00
Rate for Payer: Scott and White EPO/PPO	$1,529.00

SCREW CORTICAL

Facility

$3,058.00

Service Code	HCPCS C1713
Hospital Charge Code	8428497
Hospital Revenue Code	278
Min. Negotiated Rate	$275.22
Max. Negotiated Rate	$2,201.76
Rate for Payer: Amerigroup CHIP/Medicaid	$275.22
Rate for Payer: BCBS of TX Blue Advantage	$917.40
Rate for Payer: BCBS of TX Blue Essentials	$1,100.88
Rate for Payer: BCBS of TX PPO	$1,223.20
Rate for Payer: Cash Price	$2,079.44
Rate for Payer: Cigna Medicaid	$2,201.76
Rate for Payer: Molina CHIP/Medicaid	$2,201.76
Rate for Payer: Multiplan Auto	$1,529.00
Rate for Payer: Multiplan Commercial	$1,529.00
Rate for Payer: Multiplan Workers Comp	$1,529.00
Rate for Payer: Parkland Medicaid	$2,201.76
Rate for Payer: Scott and White EPO/PPO	$1,529.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,201.76
Rate for Payer: Superior Health Plan EPO	$415.89

SCREW CORTICAL 3.5MM X 28

Facility

$416.00

Service Code	HCPCS C1713
Hospital Charge Code	145265
Hospital Revenue Code	278
Min. Negotiated Rate	$104.00
Max. Negotiated Rate	$208.00
Rate for Payer: Cash Price	$282.88
Rate for Payer: Cigna Commercial	$104.00
Rate for Payer: Multiplan Auto	$208.00
Rate for Payer: Multiplan Commercial	$208.00
Rate for Payer: Multiplan Workers Comp	$208.00
Rate for Payer: Scott and White EPO/PPO	$208.00

SCREW CORTICAL 3.5MM X 28

Facility

$416.00

Service Code	HCPCS C1713
Hospital Charge Code	145265
Hospital Revenue Code	278
Min. Negotiated Rate	$37.44
Max. Negotiated Rate	$299.52
Rate for Payer: Amerigroup CHIP/Medicaid	$37.44
Rate for Payer: BCBS of TX Blue Advantage	$124.80
Rate for Payer: BCBS of TX Blue Essentials	$149.76
Rate for Payer: BCBS of TX PPO	$166.40
Rate for Payer: Cash Price	$282.88
Rate for Payer: Cigna Medicaid	$299.52
Rate for Payer: Molina CHIP/Medicaid	$299.52
Rate for Payer: Multiplan Auto	$208.00
Rate for Payer: Multiplan Commercial	$208.00
Rate for Payer: Multiplan Workers Comp	$208.00
Rate for Payer: Parkland Medicaid	$299.52
Rate for Payer: Scott and White EPO/PPO	$208.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$299.52
Rate for Payer: Superior Health Plan EPO	$56.58

SCREW CORTICAL 3.5 X 20

Facility

$355.00

Service Code	HCPCS C1713
Hospital Charge Code	145264
Hospital Revenue Code	278
Min. Negotiated Rate	$88.75
Max. Negotiated Rate	$177.50
Rate for Payer: Cash Price	$241.40
Rate for Payer: Cigna Commercial	$88.75
Rate for Payer: Multiplan Auto	$177.50
Rate for Payer: Multiplan Commercial	$177.50
Rate for Payer: Multiplan Workers Comp	$177.50
Rate for Payer: Scott and White EPO/PPO	$177.50

SCREW CORTICAL 3.5 X 20

Facility

$355.00

Service Code	HCPCS C1713
Hospital Charge Code	145264
Hospital Revenue Code	278
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$255.60
Rate for Payer: Amerigroup CHIP/Medicaid	$31.95
Rate for Payer: BCBS of TX Blue Advantage	$106.50
Rate for Payer: BCBS of TX Blue Essentials	$127.80
Rate for Payer: BCBS of TX PPO	$142.00
Rate for Payer: Cash Price	$241.40
Rate for Payer: Cigna Medicaid	$255.60
Rate for Payer: Molina CHIP/Medicaid	$255.60
Rate for Payer: Multiplan Auto	$177.50
Rate for Payer: Multiplan Commercial	$177.50
Rate for Payer: Multiplan Workers Comp	$177.50
Rate for Payer: Parkland Medicaid	$255.60
Rate for Payer: Scott and White EPO/PPO	$177.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$255.60
Rate for Payer: Superior Health Plan EPO	$48.28

SCREW CORTICAL 3.5 X 22

Facility

$355.00

Service Code	HCPCS C1713
Hospital Charge Code	145266
Hospital Revenue Code	278
Min. Negotiated Rate	$88.75
Max. Negotiated Rate	$177.50
Rate for Payer: Cash Price	$241.40
Rate for Payer: Cigna Commercial	$88.75
Rate for Payer: Multiplan Auto	$177.50
Rate for Payer: Multiplan Commercial	$177.50
Rate for Payer: Multiplan Workers Comp	$177.50
Rate for Payer: Scott and White EPO/PPO	$177.50

SCREW CORTICAL 3.5 X 22

Facility

$355.00

Service Code	HCPCS C1713
Hospital Charge Code	145266
Hospital Revenue Code	278
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$255.60
Rate for Payer: Amerigroup CHIP/Medicaid	$31.95
Rate for Payer: BCBS of TX Blue Advantage	$106.50
Rate for Payer: BCBS of TX Blue Essentials	$127.80
Rate for Payer: BCBS of TX PPO	$142.00
Rate for Payer: Cash Price	$241.40
Rate for Payer: Cigna Medicaid	$255.60
Rate for Payer: Molina CHIP/Medicaid	$255.60
Rate for Payer: Multiplan Auto	$177.50
Rate for Payer: Multiplan Commercial	$177.50
Rate for Payer: Multiplan Workers Comp	$177.50
Rate for Payer: Parkland Medicaid	$255.60
Rate for Payer: Scott and White EPO/PPO	$177.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$255.60
Rate for Payer: Superior Health Plan EPO	$48.28

SCREW CORTICAL 3.5X 24

Facility

$355.00

Service Code	HCPCS C1713
Hospital Charge Code	145267
Hospital Revenue Code	278
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$255.60
Rate for Payer: Amerigroup CHIP/Medicaid	$31.95
Rate for Payer: BCBS of TX Blue Advantage	$106.50
Rate for Payer: BCBS of TX Blue Essentials	$127.80
Rate for Payer: BCBS of TX PPO	$142.00
Rate for Payer: Cash Price	$241.40
Rate for Payer: Cigna Medicaid	$255.60
Rate for Payer: Molina CHIP/Medicaid	$255.60
Rate for Payer: Multiplan Auto	$177.50
Rate for Payer: Multiplan Commercial	$177.50
Rate for Payer: Multiplan Workers Comp	$177.50
Rate for Payer: Parkland Medicaid	$255.60
Rate for Payer: Scott and White EPO/PPO	$177.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$255.60
Rate for Payer: Superior Health Plan EPO	$48.28

SCREW CORTICAL 3.5X 24

Facility

$355.00

Service Code	HCPCS C1713
Hospital Charge Code	145267
Hospital Revenue Code	278
Min. Negotiated Rate	$88.75
Max. Negotiated Rate	$177.50
Rate for Payer: Cash Price	$241.40
Rate for Payer: Cigna Commercial	$88.75
Rate for Payer: Multiplan Auto	$177.50
Rate for Payer: Multiplan Commercial	$177.50
Rate for Payer: Multiplan Workers Comp	$177.50
Rate for Payer: Scott and White EPO/PPO	$177.50

SCREW CORTICAL SELF TAP LARGE HEX 46MM

Facility

$147.00

Service Code	HCPCS C1713
Hospital Charge Code	146536
Hospital Revenue Code	278
Min. Negotiated Rate	$13.23
Max. Negotiated Rate	$105.84
Rate for Payer: Amerigroup CHIP/Medicaid	$13.23
Rate for Payer: BCBS of TX Blue Advantage	$44.10
Rate for Payer: BCBS of TX Blue Essentials	$52.92
Rate for Payer: BCBS of TX PPO	$58.80
Rate for Payer: Cash Price	$99.96
Rate for Payer: Cigna Medicaid	$105.84
Rate for Payer: Molina CHIP/Medicaid	$105.84
Rate for Payer: Multiplan Auto	$73.50
Rate for Payer: Multiplan Commercial	$73.50
Rate for Payer: Multiplan Workers Comp	$73.50
Rate for Payer: Parkland Medicaid	$105.84
Rate for Payer: Scott and White EPO/PPO	$73.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$105.84
Rate for Payer: Superior Health Plan EPO	$19.99

SCREW CORTICAL SELF TAP LARGE HEX 46MM

Facility

$147.00

Service Code	HCPCS C1713
Hospital Charge Code	146536
Hospital Revenue Code	278
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$73.50
Rate for Payer: Cash Price	$99.96
Rate for Payer: Cigna Commercial	$36.75
Rate for Payer: Multiplan Auto	$73.50
Rate for Payer: Multiplan Commercial	$73.50
Rate for Payer: Multiplan Workers Comp	$73.50
Rate for Payer: Scott and White EPO/PPO	$73.50

SCREW CORTICAL SELF TAP LARGE HEX 48MM

Facility

$147.00

Service Code	HCPCS C1713
Hospital Charge Code	146537
Hospital Revenue Code	278
Min. Negotiated Rate	$13.23
Max. Negotiated Rate	$105.84
Rate for Payer: Amerigroup CHIP/Medicaid	$13.23
Rate for Payer: BCBS of TX Blue Advantage	$44.10
Rate for Payer: BCBS of TX Blue Essentials	$52.92
Rate for Payer: BCBS of TX PPO	$58.80
Rate for Payer: Cash Price	$99.96
Rate for Payer: Cigna Medicaid	$105.84
Rate for Payer: Molina CHIP/Medicaid	$105.84
Rate for Payer: Multiplan Auto	$73.50
Rate for Payer: Multiplan Commercial	$73.50
Rate for Payer: Multiplan Workers Comp	$73.50
Rate for Payer: Parkland Medicaid	$105.84
Rate for Payer: Scott and White EPO/PPO	$73.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$105.84
Rate for Payer: Superior Health Plan EPO	$19.99

SCREW CORTICAL SELF TAP LARGE HEX 48MM

Facility

$147.00

Service Code	HCPCS C1713
Hospital Charge Code	146537
Hospital Revenue Code	278
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$73.50
Rate for Payer: Cash Price	$99.96
Rate for Payer: Cigna Commercial	$36.75
Rate for Payer: Multiplan Auto	$73.50
Rate for Payer: Multiplan Commercial	$73.50
Rate for Payer: Multiplan Workers Comp	$73.50
Rate for Payer: Scott and White EPO/PPO	$73.50

SCREW DARTFIRE EDGE

Facility

$9,568.00

Service Code	HCPCS C1713
Hospital Charge Code	146670
Hospital Revenue Code	278
Min. Negotiated Rate	$2,392.00
Max. Negotiated Rate	$4,784.00
Rate for Payer: Cash Price	$6,506.24
Rate for Payer: Cigna Commercial	$2,392.00
Rate for Payer: Multiplan Auto	$4,784.00
Rate for Payer: Multiplan Commercial	$4,784.00
Rate for Payer: Multiplan Workers Comp	$4,784.00
Rate for Payer: Scott and White EPO/PPO	$4,784.00

SCREW DARTFIRE EDGE

Facility

$9,568.00

Service Code	HCPCS C1713
Hospital Charge Code	146670
Hospital Revenue Code	278
Min. Negotiated Rate	$861.12
Max. Negotiated Rate	$6,888.96
Rate for Payer: Amerigroup CHIP/Medicaid	$861.12
Rate for Payer: BCBS of TX Blue Advantage	$2,870.40
Rate for Payer: BCBS of TX Blue Essentials	$3,444.48
Rate for Payer: BCBS of TX PPO	$3,827.20
Rate for Payer: Cash Price	$6,506.24
Rate for Payer: Cigna Medicaid	$6,888.96
Rate for Payer: Molina CHIP/Medicaid	$6,888.96
Rate for Payer: Multiplan Auto	$4,784.00
Rate for Payer: Multiplan Commercial	$4,784.00
Rate for Payer: Multiplan Workers Comp	$4,784.00
Rate for Payer: Parkland Medicaid	$6,888.96
Rate for Payer: Scott and White EPO/PPO	$4,784.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,888.96
Rate for Payer: Superior Health Plan EPO	$1,301.25

SCREWDRIVER

Facility

$2,242.76

Service Code	HCPCS C1713
Hospital Charge Code	993245
Hospital Revenue Code	278
Min. Negotiated Rate	$201.85
Max. Negotiated Rate	$1,614.79
Rate for Payer: Amerigroup CHIP/Medicaid	$201.85
Rate for Payer: BCBS of TX Blue Advantage	$672.83
Rate for Payer: BCBS of TX Blue Essentials	$807.39
Rate for Payer: BCBS of TX PPO	$897.10
Rate for Payer: Cash Price	$1,525.08
Rate for Payer: Cigna Medicaid	$1,614.79
Rate for Payer: Molina CHIP/Medicaid	$1,614.79
Rate for Payer: Multiplan Auto	$1,121.38
Rate for Payer: Multiplan Commercial	$1,121.38
Rate for Payer: Multiplan Workers Comp	$1,121.38
Rate for Payer: Parkland Medicaid	$1,614.79
Rate for Payer: Scott and White EPO/PPO	$1,121.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,614.79
Rate for Payer: Superior Health Plan EPO	$305.02

SCREWDRIVER

Facility

$2,242.76

Service Code	HCPCS C1713
Hospital Charge Code	993245
Hospital Revenue Code	278
Min. Negotiated Rate	$560.69
Max. Negotiated Rate	$1,121.38
Rate for Payer: Cash Price	$1,525.08
Rate for Payer: Cigna Commercial	$560.69
Rate for Payer: Multiplan Auto	$1,121.38
Rate for Payer: Multiplan Commercial	$1,121.38
Rate for Payer: Multiplan Workers Comp	$1,121.38
Rate for Payer: Scott and White EPO/PPO	$1,121.38

SCREWDRIVER BLADE T10 AO SELF RETAINING

Facility

$2,242.76

Hospital Charge Code	146725
Hospital Revenue Code	274
Min. Negotiated Rate	$560.69
Max. Negotiated Rate	$1,121.38
Rate for Payer: Cash Price	$1,525.08
Rate for Payer: Cigna Commercial	$560.69
Rate for Payer: Multiplan Auto	$1,121.38
Rate for Payer: Multiplan Commercial	$1,121.38
Rate for Payer: Multiplan Workers Comp	$1,121.38
Rate for Payer: Scott and White EPO/PPO	$1,121.38

SCREWDRIVER BLADE T10 AO SELF RETAINING

Facility

$2,242.76

Hospital Charge Code	146725
Hospital Revenue Code	274
Min. Negotiated Rate	$201.85
Max. Negotiated Rate	$1,614.79
Rate for Payer: Amerigroup CHIP/Medicaid	$201.85
Rate for Payer: BCBS of TX Blue Advantage	$672.83
Rate for Payer: BCBS of TX Blue Essentials	$807.39
Rate for Payer: BCBS of TX PPO	$897.10
Rate for Payer: Cash Price	$1,525.08
Rate for Payer: Cigna Medicaid	$1,614.79
Rate for Payer: Molina CHIP/Medicaid	$1,614.79
Rate for Payer: Multiplan Auto	$1,121.38
Rate for Payer: Multiplan Commercial	$1,121.38
Rate for Payer: Multiplan Workers Comp	$1,121.38
Rate for Payer: Parkland Medicaid	$1,614.79
Rate for Payer: Scott and White EPO/PPO	$1,121.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,614.79
Rate for Payer: Superior Health Plan EPO	$305.02

SCREW FASTTHREAD BIOCOMPOSITE INTERFERENCE 10MM

Facility

$80.00

Service Code	HCPCS C1713
Hospital Charge Code	145987
Hospital Revenue Code	278
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$40.00
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: Multiplan Auto	$40.00
Rate for Payer: Multiplan Commercial	$40.00
Rate for Payer: Multiplan Workers Comp	$40.00
Rate for Payer: Scott and White EPO/PPO	$40.00

SCREW FASTTHREAD BIOCOMPOSITE INTERFERENCE 10MM

Facility

$80.00

Service Code	HCPCS C1713
Hospital Charge Code	145987
Hospital Revenue Code	278
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$57.60
Rate for Payer: Amerigroup CHIP/Medicaid	$7.20
Rate for Payer: BCBS of TX Blue Advantage	$24.00
Rate for Payer: BCBS of TX Blue Essentials	$28.80
Rate for Payer: BCBS of TX PPO	$32.00
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cigna Medicaid	$57.60
Rate for Payer: Molina CHIP/Medicaid	$57.60
Rate for Payer: Multiplan Auto	$40.00
Rate for Payer: Multiplan Commercial	$40.00
Rate for Payer: Multiplan Workers Comp	$40.00
Rate for Payer: Parkland Medicaid	$57.60
Rate for Payer: Scott and White EPO/PPO	$40.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$57.60
Rate for Payer: Superior Health Plan EPO	$10.88

SCREW FEMALE 2.5 X 25

Facility

$736.00

Service Code	HCPCS C1713
Hospital Charge Code	126090
Hospital Revenue Code	278
Min. Negotiated Rate	$66.24
Max. Negotiated Rate	$529.92
Rate for Payer: Amerigroup CHIP/Medicaid	$66.24
Rate for Payer: BCBS of TX Blue Advantage	$220.80
Rate for Payer: BCBS of TX Blue Essentials	$264.96
Rate for Payer: BCBS of TX PPO	$294.40
Rate for Payer: Cash Price	$500.48
Rate for Payer: Cigna Medicaid	$529.92
Rate for Payer: Molina CHIP/Medicaid	$529.92
Rate for Payer: Multiplan Auto	$368.00
Rate for Payer: Multiplan Commercial	$368.00
Rate for Payer: Multiplan Workers Comp	$368.00
Rate for Payer: Parkland Medicaid	$529.92
Rate for Payer: Scott and White EPO/PPO	$368.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$529.92
Rate for Payer: Superior Health Plan EPO	$100.10

SCREW FEMALE 2.5 X 25

Facility

$736.00

Service Code	HCPCS C1713
Hospital Charge Code	126090
Hospital Revenue Code	278
Min. Negotiated Rate	$184.00
Max. Negotiated Rate	$368.00
Rate for Payer: Cash Price	$500.48
Rate for Payer: Cigna Commercial	$184.00
Rate for Payer: Multiplan Auto	$368.00
Rate for Payer: Multiplan Commercial	$368.00
Rate for Payer: Multiplan Workers Comp	$368.00
Rate for Payer: Scott and White EPO/PPO	$368.00

SCREW FENESTRATED STERILE 85MM

Facility

$10,562.00

Service Code	HCPCS C1713
Hospital Charge Code	146296
Hospital Revenue Code	278
Min. Negotiated Rate	$950.58
Max. Negotiated Rate	$7,604.64
Rate for Payer: Amerigroup CHIP/Medicaid	$950.58
Rate for Payer: BCBS of TX Blue Advantage	$3,168.60
Rate for Payer: BCBS of TX Blue Essentials	$3,802.32
Rate for Payer: BCBS of TX PPO	$4,224.80
Rate for Payer: Cash Price	$7,182.16
Rate for Payer: Cigna Medicaid	$7,604.64
Rate for Payer: Molina CHIP/Medicaid	$7,604.64
Rate for Payer: Multiplan Auto	$5,281.00
Rate for Payer: Multiplan Commercial	$5,281.00
Rate for Payer: Multiplan Workers Comp	$5,281.00
Rate for Payer: Parkland Medicaid	$7,604.64
Rate for Payer: Scott and White EPO/PPO	$5,281.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,604.64
Rate for Payer: Superior Health Plan EPO	$1,436.43

Know your out-of-pocket cost for care.

All Charges