White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SCREW LAG TI 10.5 X 85MM

Facility

$3,432.00

Service Code	HCPCS C1713
Hospital Charge Code	8694515
Hospital Revenue Code	278
Min. Negotiated Rate	$858.00
Max. Negotiated Rate	$1,716.00
Rate for Payer: Cash Price	$2,333.76
Rate for Payer: Cigna Commercial	$858.00
Rate for Payer: Multiplan Auto	$1,716.00
Rate for Payer: Multiplan Commercial	$1,716.00
Rate for Payer: Multiplan Workers Comp	$1,716.00
Rate for Payer: Scott and White EPO/PPO	$1,716.00

SCREW LAG TI 10.5 X 85MM

Facility

$3,432.00

Service Code	HCPCS C1713
Hospital Charge Code	8694515
Hospital Revenue Code	278
Min. Negotiated Rate	$308.88
Max. Negotiated Rate	$2,471.04
Rate for Payer: Amerigroup CHIP/Medicaid	$308.88
Rate for Payer: BCBS of TX Blue Advantage	$1,029.60
Rate for Payer: BCBS of TX Blue Essentials	$1,235.52
Rate for Payer: BCBS of TX PPO	$1,372.80
Rate for Payer: Cash Price	$2,333.76
Rate for Payer: Cigna Medicaid	$2,471.04
Rate for Payer: Molina CHIP/Medicaid	$2,471.04
Rate for Payer: Multiplan Auto	$1,716.00
Rate for Payer: Multiplan Commercial	$1,716.00
Rate for Payer: Multiplan Workers Comp	$1,716.00
Rate for Payer: Parkland Medicaid	$2,471.04
Rate for Payer: Scott and White EPO/PPO	$1,716.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,471.04
Rate for Payer: Superior Health Plan EPO	$466.75

SCREW LAG TI TROCH IM NAIL 10.5 X 95MM STERILE

Facility

$3,517.00

Service Code	HCPCS C1713
Hospital Charge Code	125737
Hospital Revenue Code	278
Min. Negotiated Rate	$879.25
Max. Negotiated Rate	$1,758.50
Rate for Payer: Cash Price	$2,391.56
Rate for Payer: Cigna Commercial	$879.25
Rate for Payer: Multiplan Auto	$1,758.50
Rate for Payer: Multiplan Commercial	$1,758.50
Rate for Payer: Multiplan Workers Comp	$1,758.50
Rate for Payer: Scott and White EPO/PPO	$1,758.50

SCREW LAG TI TROCH IM NAIL 10.5 X 95MM STERILE

Facility

$3,517.00

Service Code	HCPCS C1713
Hospital Charge Code	125737
Hospital Revenue Code	278
Min. Negotiated Rate	$316.53
Max. Negotiated Rate	$2,532.24
Rate for Payer: Amerigroup CHIP/Medicaid	$316.53
Rate for Payer: BCBS of TX Blue Advantage	$1,055.10
Rate for Payer: BCBS of TX Blue Essentials	$1,266.12
Rate for Payer: BCBS of TX PPO	$1,406.80
Rate for Payer: Cash Price	$2,391.56
Rate for Payer: Cigna Medicaid	$2,532.24
Rate for Payer: Molina CHIP/Medicaid	$2,532.24
Rate for Payer: Multiplan Auto	$1,758.50
Rate for Payer: Multiplan Commercial	$1,758.50
Rate for Payer: Multiplan Workers Comp	$1,758.50
Rate for Payer: Parkland Medicaid	$2,532.24
Rate for Payer: Scott and White EPO/PPO	$1,758.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,532.24
Rate for Payer: Superior Health Plan EPO	$478.31

SCREW LAG TI TROCH IM NL STRL10.5 X 90MM

Facility

$3,516.85

Hospital Charge Code	125736
Hospital Revenue Code	273
Rate for Payer: Cash Price	$2,391.46

SCREW LAG TI TROCH IM NL STRL10.5 X 90MM

Facility

$3,516.85

Hospital Charge Code	125736
Hospital Revenue Code	273
Min. Negotiated Rate	$316.52
Max. Negotiated Rate	$2,532.13
Rate for Payer: Amerigroup CHIP/Medicaid	$316.52
Rate for Payer: BCBS of TX Blue Advantage	$1,055.06
Rate for Payer: BCBS of TX Blue Essentials	$1,266.07
Rate for Payer: BCBS of TX PPO	$1,406.74
Rate for Payer: Cash Price	$2,391.46
Rate for Payer: Cigna Medicaid	$2,532.13
Rate for Payer: Molina CHIP/Medicaid	$2,532.13
Rate for Payer: Multiplan Auto	$2,285.95
Rate for Payer: Multiplan Commercial	$2,285.95
Rate for Payer: Multiplan Workers Comp	$2,285.95
Rate for Payer: Parkland Medicaid	$2,532.13
Rate for Payer: Scott and White EPO/PPO	$1,758.42
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,532.13
Rate for Payer: Superior Health Plan EPO	$478.29

SCREW LAG VERSAFIX 12.7MM

Facility

$2,037.00

Service Code	HCPCS C1713
Hospital Charge Code	142601
Hospital Revenue Code	278
Min. Negotiated Rate	$183.33
Max. Negotiated Rate	$1,466.64
Rate for Payer: Amerigroup CHIP/Medicaid	$183.33
Rate for Payer: BCBS of TX Blue Advantage	$611.10
Rate for Payer: BCBS of TX Blue Essentials	$733.32
Rate for Payer: BCBS of TX PPO	$814.80
Rate for Payer: Cash Price	$1,385.16
Rate for Payer: Cigna Medicaid	$1,466.64
Rate for Payer: Molina CHIP/Medicaid	$1,466.64
Rate for Payer: Multiplan Auto	$1,018.50
Rate for Payer: Multiplan Commercial	$1,018.50
Rate for Payer: Multiplan Workers Comp	$1,018.50
Rate for Payer: Parkland Medicaid	$1,466.64
Rate for Payer: Scott and White EPO/PPO	$1,018.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,466.64
Rate for Payer: Superior Health Plan EPO	$277.03

SCREW LAG VERSAFIX 12.7MM

Facility

$2,037.00

Service Code	HCPCS C1713
Hospital Charge Code	142601
Hospital Revenue Code	278
Min. Negotiated Rate	$509.25
Max. Negotiated Rate	$1,018.50
Rate for Payer: Cash Price	$1,385.16
Rate for Payer: Cigna Commercial	$509.25
Rate for Payer: Multiplan Auto	$1,018.50
Rate for Payer: Multiplan Commercial	$1,018.50
Rate for Payer: Multiplan Workers Comp	$1,018.50
Rate for Payer: Scott and White EPO/PPO	$1,018.50

SCREW LAG ZIMMER NATURAL NAIL 10.5 X 95

Facility

$3,571.00

Service Code	HCPCS C1713
Hospital Charge Code	146542
Hospital Revenue Code	278
Min. Negotiated Rate	$321.39
Max. Negotiated Rate	$2,571.12
Rate for Payer: Amerigroup CHIP/Medicaid	$321.39
Rate for Payer: BCBS of TX Blue Advantage	$1,071.30
Rate for Payer: BCBS of TX Blue Essentials	$1,285.56
Rate for Payer: BCBS of TX PPO	$1,428.40
Rate for Payer: Cash Price	$2,428.28
Rate for Payer: Cigna Medicaid	$2,571.12
Rate for Payer: Molina CHIP/Medicaid	$2,571.12
Rate for Payer: Multiplan Auto	$1,785.50
Rate for Payer: Multiplan Commercial	$1,785.50
Rate for Payer: Multiplan Workers Comp	$1,785.50
Rate for Payer: Parkland Medicaid	$2,571.12
Rate for Payer: Scott and White EPO/PPO	$1,785.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,571.12
Rate for Payer: Superior Health Plan EPO	$485.66

SCREW LAG ZIMMER NATURAL NAIL 10.5 X 95

Facility

$3,571.00

Service Code	HCPCS C1713
Hospital Charge Code	146542
Hospital Revenue Code	278
Min. Negotiated Rate	$892.75
Max. Negotiated Rate	$1,785.50
Rate for Payer: Cash Price	$2,428.28
Rate for Payer: Cigna Commercial	$892.75
Rate for Payer: Multiplan Auto	$1,785.50
Rate for Payer: Multiplan Commercial	$1,785.50
Rate for Payer: Multiplan Workers Comp	$1,785.50
Rate for Payer: Scott and White EPO/PPO	$1,785.50

SCREW LCK 3.5X14MM

Facility

$1,398.00

Service Code	HCPCS C1713
Hospital Charge Code	125930
Hospital Revenue Code	278
Min. Negotiated Rate	$125.82
Max. Negotiated Rate	$1,006.56
Rate for Payer: Amerigroup CHIP/Medicaid	$125.82
Rate for Payer: BCBS of TX Blue Advantage	$419.40
Rate for Payer: BCBS of TX Blue Essentials	$503.28
Rate for Payer: BCBS of TX PPO	$559.20
Rate for Payer: Cash Price	$950.64
Rate for Payer: Cigna Medicaid	$1,006.56
Rate for Payer: Molina CHIP/Medicaid	$1,006.56
Rate for Payer: Multiplan Auto	$699.00
Rate for Payer: Multiplan Commercial	$699.00
Rate for Payer: Multiplan Workers Comp	$699.00
Rate for Payer: Parkland Medicaid	$1,006.56
Rate for Payer: Scott and White EPO/PPO	$699.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,006.56
Rate for Payer: Superior Health Plan EPO	$190.13

SCREW LCK 3.5X14MM

Facility

$1,398.00

Service Code	HCPCS C1713
Hospital Charge Code	125930
Hospital Revenue Code	278
Min. Negotiated Rate	$349.50
Max. Negotiated Rate	$699.00
Rate for Payer: Cash Price	$950.64
Rate for Payer: Cigna Commercial	$349.50
Rate for Payer: Multiplan Auto	$699.00
Rate for Payer: Multiplan Commercial	$699.00
Rate for Payer: Multiplan Workers Comp	$699.00
Rate for Payer: Scott and White EPO/PPO	$699.00

SCREW LCK 5X34MM TI TIB T25 STRDRV STRL

Facility

$3,562.00

Service Code	HCPCS C1713
Hospital Charge Code	124841
Hospital Revenue Code	278
Min. Negotiated Rate	$890.50
Max. Negotiated Rate	$1,781.00
Rate for Payer: Cash Price	$2,422.16
Rate for Payer: Cigna Commercial	$890.50
Rate for Payer: Multiplan Auto	$1,781.00
Rate for Payer: Multiplan Commercial	$1,781.00
Rate for Payer: Multiplan Workers Comp	$1,781.00
Rate for Payer: Scott and White EPO/PPO	$1,781.00

SCREW LCK 5X34MM TI TIB T25 STRDRV STRL

Facility

$3,562.00

Service Code	HCPCS C1713
Hospital Charge Code	124841
Hospital Revenue Code	278
Min. Negotiated Rate	$320.58
Max. Negotiated Rate	$2,564.64
Rate for Payer: Amerigroup CHIP/Medicaid	$320.58
Rate for Payer: BCBS of TX Blue Advantage	$1,068.60
Rate for Payer: BCBS of TX Blue Essentials	$1,282.32
Rate for Payer: BCBS of TX PPO	$1,424.80
Rate for Payer: Cash Price	$2,422.16
Rate for Payer: Cigna Medicaid	$2,564.64
Rate for Payer: Molina CHIP/Medicaid	$2,564.64
Rate for Payer: Multiplan Auto	$1,781.00
Rate for Payer: Multiplan Commercial	$1,781.00
Rate for Payer: Multiplan Workers Comp	$1,781.00
Rate for Payer: Parkland Medicaid	$2,564.64
Rate for Payer: Scott and White EPO/PPO	$1,781.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,564.64
Rate for Payer: Superior Health Plan EPO	$484.43

SCREW LCK 5X35MM T2 TI PROX HUM F-T

Facility

$1,171.00

Service Code	HCPCS C1713
Hospital Charge Code	125723
Hospital Revenue Code	278
Min. Negotiated Rate	$292.75
Max. Negotiated Rate	$585.50
Rate for Payer: Cash Price	$796.28
Rate for Payer: Cigna Commercial	$292.75
Rate for Payer: Multiplan Auto	$585.50
Rate for Payer: Multiplan Commercial	$585.50
Rate for Payer: Multiplan Workers Comp	$585.50
Rate for Payer: Scott and White EPO/PPO	$585.50

SCREW LCK 5X35MM T2 TI PROX HUM F-T

Facility

$1,171.00

Service Code	HCPCS C1713
Hospital Charge Code	125723
Hospital Revenue Code	278
Min. Negotiated Rate	$105.39
Max. Negotiated Rate	$843.12
Rate for Payer: Amerigroup CHIP/Medicaid	$105.39
Rate for Payer: BCBS of TX Blue Advantage	$351.30
Rate for Payer: BCBS of TX Blue Essentials	$421.56
Rate for Payer: BCBS of TX PPO	$468.40
Rate for Payer: Cash Price	$796.28
Rate for Payer: Cigna Medicaid	$843.12
Rate for Payer: Molina CHIP/Medicaid	$843.12
Rate for Payer: Multiplan Auto	$585.50
Rate for Payer: Multiplan Commercial	$585.50
Rate for Payer: Multiplan Workers Comp	$585.50
Rate for Payer: Parkland Medicaid	$843.12
Rate for Payer: Scott and White EPO/PPO	$585.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$843.12
Rate for Payer: Superior Health Plan EPO	$159.26

SCREW LCK 5X50MM T2 TI PROX HUM F-T

Facility

$1,765.06

Service Code	HCPCS C1713
Hospital Charge Code	992151
Hospital Revenue Code	278
Min. Negotiated Rate	$441.26
Max. Negotiated Rate	$882.53
Rate for Payer: Cash Price	$1,200.24
Rate for Payer: Cigna Commercial	$441.26
Rate for Payer: Multiplan Auto	$882.53
Rate for Payer: Multiplan Commercial	$882.53
Rate for Payer: Multiplan Workers Comp	$882.53
Rate for Payer: Scott and White EPO/PPO	$882.53

SCREW LCK 5X50MM T2 TI PROX HUM F-T

Facility

$1,765.06

Service Code	HCPCS C1713
Hospital Charge Code	992151
Hospital Revenue Code	278
Min. Negotiated Rate	$158.86
Max. Negotiated Rate	$1,270.84
Rate for Payer: Amerigroup CHIP/Medicaid	$158.86
Rate for Payer: BCBS of TX Blue Advantage	$529.52
Rate for Payer: BCBS of TX Blue Essentials	$635.42
Rate for Payer: BCBS of TX PPO	$706.02
Rate for Payer: Cash Price	$1,200.24
Rate for Payer: Cigna Medicaid	$1,270.84
Rate for Payer: Molina CHIP/Medicaid	$1,270.84
Rate for Payer: Multiplan Auto	$882.53
Rate for Payer: Multiplan Commercial	$882.53
Rate for Payer: Multiplan Workers Comp	$882.53
Rate for Payer: Parkland Medicaid	$1,270.84
Rate for Payer: Scott and White EPO/PPO	$882.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,270.84
Rate for Payer: Superior Health Plan EPO	$240.05

SCREW LCKG T8 FULL THD 2.7MM/22MM

Facility

$1,054.22

Service Code	HCPCS C1713
Hospital Charge Code	992102
Hospital Revenue Code	278
Min. Negotiated Rate	$263.56
Max. Negotiated Rate	$527.11
Rate for Payer: Cash Price	$716.87
Rate for Payer: Cigna Commercial	$263.56
Rate for Payer: Multiplan Auto	$527.11
Rate for Payer: Multiplan Commercial	$527.11
Rate for Payer: Multiplan Workers Comp	$527.11
Rate for Payer: Scott and White EPO/PPO	$527.11

SCREW LCKG T8 FULL THD 2.7MM/22MM

Facility

$1,054.22

Service Code	HCPCS C1713
Hospital Charge Code	992102
Hospital Revenue Code	278
Min. Negotiated Rate	$94.88
Max. Negotiated Rate	$759.04
Rate for Payer: Amerigroup CHIP/Medicaid	$94.88
Rate for Payer: BCBS of TX Blue Advantage	$316.27
Rate for Payer: BCBS of TX Blue Essentials	$379.52
Rate for Payer: BCBS of TX PPO	$421.69
Rate for Payer: Cash Price	$716.87
Rate for Payer: Cigna Medicaid	$759.04
Rate for Payer: Molina CHIP/Medicaid	$759.04
Rate for Payer: Multiplan Auto	$527.11
Rate for Payer: Multiplan Commercial	$527.11
Rate for Payer: Multiplan Workers Comp	$527.11
Rate for Payer: Parkland Medicaid	$759.04
Rate for Payer: Scott and White EPO/PPO	$527.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$759.04
Rate for Payer: Superior Health Plan EPO	$143.37

SCREW LOCKING 2.7 X 10

Facility

$1,197.00

Service Code	HCPCS C1713
Hospital Charge Code	141469
Hospital Revenue Code	278
Min. Negotiated Rate	$107.73
Max. Negotiated Rate	$861.84
Rate for Payer: Amerigroup CHIP/Medicaid	$107.73
Rate for Payer: BCBS of TX Blue Advantage	$359.10
Rate for Payer: BCBS of TX Blue Essentials	$430.92
Rate for Payer: BCBS of TX PPO	$478.80
Rate for Payer: Cash Price	$813.96
Rate for Payer: Cigna Medicaid	$861.84
Rate for Payer: Molina CHIP/Medicaid	$861.84
Rate for Payer: Multiplan Auto	$598.50
Rate for Payer: Multiplan Commercial	$598.50
Rate for Payer: Multiplan Workers Comp	$598.50
Rate for Payer: Parkland Medicaid	$861.84
Rate for Payer: Scott and White EPO/PPO	$598.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$861.84
Rate for Payer: Superior Health Plan EPO	$162.79

SCREW LOCKING 2.7 X 10

Facility

$1,197.00

Service Code	HCPCS C1713
Hospital Charge Code	141469
Hospital Revenue Code	278
Min. Negotiated Rate	$299.25
Max. Negotiated Rate	$598.50
Rate for Payer: Cash Price	$813.96
Rate for Payer: Cigna Commercial	$299.25
Rate for Payer: Multiplan Auto	$598.50
Rate for Payer: Multiplan Commercial	$598.50
Rate for Payer: Multiplan Workers Comp	$598.50
Rate for Payer: Scott and White EPO/PPO	$598.50

SCREW LOCKING 2.7 X 12

Facility

$1,197.00

Service Code	HCPCS C1713
Hospital Charge Code	132388
Hospital Revenue Code	278
Min. Negotiated Rate	$107.73
Max. Negotiated Rate	$861.84
Rate for Payer: Amerigroup CHIP/Medicaid	$107.73
Rate for Payer: BCBS of TX Blue Advantage	$359.10
Rate for Payer: BCBS of TX Blue Essentials	$430.92
Rate for Payer: BCBS of TX PPO	$478.80
Rate for Payer: Cash Price	$813.96
Rate for Payer: Cigna Medicaid	$861.84
Rate for Payer: Molina CHIP/Medicaid	$861.84
Rate for Payer: Multiplan Auto	$598.50
Rate for Payer: Multiplan Commercial	$598.50
Rate for Payer: Multiplan Workers Comp	$598.50
Rate for Payer: Parkland Medicaid	$861.84
Rate for Payer: Scott and White EPO/PPO	$598.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$861.84
Rate for Payer: Superior Health Plan EPO	$162.79

SCREW LOCKING 2.7 X 12

Facility

$1,197.00

Service Code	HCPCS C1713
Hospital Charge Code	132388
Hospital Revenue Code	278
Min. Negotiated Rate	$299.25
Max. Negotiated Rate	$598.50
Rate for Payer: Cash Price	$813.96
Rate for Payer: Cigna Commercial	$299.25
Rate for Payer: Multiplan Auto	$598.50
Rate for Payer: Multiplan Commercial	$598.50
Rate for Payer: Multiplan Workers Comp	$598.50
Rate for Payer: Scott and White EPO/PPO	$598.50

SCREW LOCKING 2.7 X 26

Facility

$1,197.00

Service Code	HCPCS C1713
Hospital Charge Code	145164
Hospital Revenue Code	278
Min. Negotiated Rate	$107.73
Max. Negotiated Rate	$861.84
Rate for Payer: Amerigroup CHIP/Medicaid	$107.73
Rate for Payer: BCBS of TX Blue Advantage	$359.10
Rate for Payer: BCBS of TX Blue Essentials	$430.92
Rate for Payer: BCBS of TX PPO	$478.80
Rate for Payer: Cash Price	$813.96
Rate for Payer: Cigna Medicaid	$861.84
Rate for Payer: Molina CHIP/Medicaid	$861.84
Rate for Payer: Multiplan Auto	$598.50
Rate for Payer: Multiplan Commercial	$598.50
Rate for Payer: Multiplan Workers Comp	$598.50
Rate for Payer: Parkland Medicaid	$861.84
Rate for Payer: Scott and White EPO/PPO	$598.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$861.84
Rate for Payer: Superior Health Plan EPO	$162.79

Know your out-of-pocket cost for care.

All Charges