White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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 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 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	$2,640.50
Max. Negotiated Rate	$5,281.00
Rate for Payer: Cash Price	$7,182.16
Rate for Payer: Cigna Commercial	$2,640.50
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: Scott and White EPO/PPO	$5,281.00

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

SCREW HEADLESS 3.0 MM X 26MM

Facility

$2,410.00

Service Code	HCPCS C1713
Hospital Charge Code	145140
Hospital Revenue Code	278
Min. Negotiated Rate	$216.90
Max. Negotiated Rate	$1,735.20
Rate for Payer: Amerigroup CHIP/Medicaid	$216.90
Rate for Payer: BCBS of TX Blue Advantage	$723.00
Rate for Payer: BCBS of TX Blue Essentials	$867.60
Rate for Payer: BCBS of TX PPO	$964.00
Rate for Payer: Cash Price	$1,638.80
Rate for Payer: Cigna Medicaid	$1,735.20
Rate for Payer: Molina CHIP/Medicaid	$1,735.20
Rate for Payer: Multiplan Auto	$1,205.00
Rate for Payer: Multiplan Commercial	$1,205.00
Rate for Payer: Multiplan Workers Comp	$1,205.00
Rate for Payer: Parkland Medicaid	$1,735.20
Rate for Payer: Scott and White EPO/PPO	$1,205.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,735.20
Rate for Payer: Superior Health Plan EPO	$327.76

SCREW HEADLESS 3.0 MM X 26MM

Facility

$2,410.00

Service Code	HCPCS C1713
Hospital Charge Code	145140
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$1,205.00
Rate for Payer: Cash Price	$1,638.80
Rate for Payer: Cigna Commercial	$602.50
Rate for Payer: Multiplan Auto	$1,205.00
Rate for Payer: Multiplan Commercial	$1,205.00
Rate for Payer: Multiplan Workers Comp	$1,205.00
Rate for Payer: Scott and White EPO/PPO	$1,205.00

screw interference

Facility

$2,825.00

Service Code	HCPCS C1713
Hospital Charge Code	145056
Hospital Revenue Code	278
Min. Negotiated Rate	$706.25
Max. Negotiated Rate	$1,412.50
Rate for Payer: Cash Price	$1,921.00
Rate for Payer: Cigna Commercial	$706.25
Rate for Payer: Multiplan Auto	$1,412.50
Rate for Payer: Multiplan Commercial	$1,412.50
Rate for Payer: Multiplan Workers Comp	$1,412.50
Rate for Payer: Scott and White EPO/PPO	$1,412.50

screw interference

Facility

$2,825.00

Service Code	HCPCS C1713
Hospital Charge Code	145056
Hospital Revenue Code	278
Min. Negotiated Rate	$254.25
Max. Negotiated Rate	$2,034.00
Rate for Payer: Amerigroup CHIP/Medicaid	$254.25
Rate for Payer: BCBS of TX Blue Advantage	$847.50
Rate for Payer: BCBS of TX Blue Essentials	$1,017.00
Rate for Payer: BCBS of TX PPO	$1,130.00
Rate for Payer: Cash Price	$1,921.00
Rate for Payer: Cigna Medicaid	$2,034.00
Rate for Payer: Molina CHIP/Medicaid	$2,034.00
Rate for Payer: Multiplan Auto	$1,412.50
Rate for Payer: Multiplan Commercial	$1,412.50
Rate for Payer: Multiplan Workers Comp	$1,412.50
Rate for Payer: Parkland Medicaid	$2,034.00
Rate for Payer: Scott and White EPO/PPO	$1,412.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,034.00
Rate for Payer: Superior Health Plan EPO	$384.20

SCREW INTERFERENCE GENESYS MATRYX

Facility

$1,475.00

Service Code	HCPCS C1713
Hospital Charge Code	146151
Hospital Revenue Code	278
Min. Negotiated Rate	$132.75
Max. Negotiated Rate	$1,062.00
Rate for Payer: Amerigroup CHIP/Medicaid	$132.75
Rate for Payer: BCBS of TX Blue Advantage	$442.50
Rate for Payer: BCBS of TX Blue Essentials	$531.00
Rate for Payer: BCBS of TX PPO	$590.00
Rate for Payer: Cash Price	$1,003.00
Rate for Payer: Cigna Medicaid	$1,062.00
Rate for Payer: Molina CHIP/Medicaid	$1,062.00
Rate for Payer: Multiplan Auto	$737.50
Rate for Payer: Multiplan Commercial	$737.50
Rate for Payer: Multiplan Workers Comp	$737.50
Rate for Payer: Parkland Medicaid	$1,062.00
Rate for Payer: Scott and White EPO/PPO	$737.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,062.00
Rate for Payer: Superior Health Plan EPO	$200.60

SCREW INTERFERENCE GENESYS MATRYX

Facility

$1,475.00

Service Code	HCPCS C1713
Hospital Charge Code	146151
Hospital Revenue Code	278
Min. Negotiated Rate	$368.75
Max. Negotiated Rate	$737.50
Rate for Payer: Cash Price	$1,003.00
Rate for Payer: Cigna Commercial	$368.75
Rate for Payer: Multiplan Auto	$737.50
Rate for Payer: Multiplan Commercial	$737.50
Rate for Payer: Multiplan Workers Comp	$737.50
Rate for Payer: Scott and White EPO/PPO	$737.50

SCREW INTERFERENCE GENESYS MATRYX 8.0 X 25

Facility

$2,605.30

Service Code	HCPCS C1713
Hospital Charge Code	992122
Hospital Revenue Code	278
Min. Negotiated Rate	$234.48
Max. Negotiated Rate	$1,875.82
Rate for Payer: Amerigroup CHIP/Medicaid	$234.48
Rate for Payer: BCBS of TX Blue Advantage	$781.59
Rate for Payer: BCBS of TX Blue Essentials	$937.91
Rate for Payer: BCBS of TX PPO	$1,042.12
Rate for Payer: Cash Price	$1,771.60
Rate for Payer: Cigna Medicaid	$1,875.82
Rate for Payer: Molina CHIP/Medicaid	$1,875.82
Rate for Payer: Multiplan Auto	$1,302.65
Rate for Payer: Multiplan Commercial	$1,302.65
Rate for Payer: Multiplan Workers Comp	$1,302.65
Rate for Payer: Parkland Medicaid	$1,875.82
Rate for Payer: Scott and White EPO/PPO	$1,302.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,875.82
Rate for Payer: Superior Health Plan EPO	$354.32

SCREW INTERFERENCE GENESYS MATRYX 8.0 X 25

Facility

$2,605.30

Service Code	HCPCS C1713
Hospital Charge Code	992122
Hospital Revenue Code	278
Min. Negotiated Rate	$651.33
Max. Negotiated Rate	$1,302.65
Rate for Payer: Cash Price	$1,771.60
Rate for Payer: Cigna Commercial	$651.33
Rate for Payer: Multiplan Auto	$1,302.65
Rate for Payer: Multiplan Commercial	$1,302.65
Rate for Payer: Multiplan Workers Comp	$1,302.65
Rate for Payer: Scott and White EPO/PPO	$1,302.65

screw intfr compositcp 30

Facility

$1,680.00

Service Code	HCPCS C1713
Hospital Charge Code	126020
Hospital Revenue Code	278
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$840.00
Rate for Payer: Cash Price	$1,142.40
Rate for Payer: Cigna Commercial	$420.00
Rate for Payer: Multiplan Auto	$840.00
Rate for Payer: Multiplan Commercial	$840.00
Rate for Payer: Multiplan Workers Comp	$840.00
Rate for Payer: Scott and White EPO/PPO	$840.00

Know your out-of-pocket cost for care.

All Charges