White Rock Medical Center

All Charges

Charge

Type

Setting

Price

VALOR 9.0MMX250 STEPPED REAM

Facility

$1,893.18

Hospital Charge Code	993420
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,287.36

VALOR NAIL 3.0MM BEADED K-WIRE

Facility

$1,402.86

Service Code	HCPCS C1769
Hospital Charge Code	993450
Hospital Revenue Code	278
Min. Negotiated Rate	$350.71
Max. Negotiated Rate	$701.43
Rate for Payer: Cash Price	$953.94
Rate for Payer: Cigna Commercial	$350.71
Rate for Payer: Multiplan Auto	$701.43
Rate for Payer: Multiplan Commercial	$701.43
Rate for Payer: Multiplan Workers Comp	$701.43
Rate for Payer: Scott and White EPO/PPO	$701.43

VALOR NAIL 3.0MM BEADED K-WIRE

Facility

$1,402.86

Service Code	HCPCS C1769
Hospital Charge Code	993450
Hospital Revenue Code	278
Min. Negotiated Rate	$126.26
Max. Negotiated Rate	$1,010.06
Rate for Payer: Amerigroup CHIP/Medicaid	$126.26
Rate for Payer: BCBS of TX Blue Advantage	$420.86
Rate for Payer: BCBS of TX Blue Essentials	$505.03
Rate for Payer: BCBS of TX PPO	$561.14
Rate for Payer: Cash Price	$953.94
Rate for Payer: Cigna Medicaid	$1,010.06
Rate for Payer: Molina CHIP/Medicaid	$1,010.06
Rate for Payer: Multiplan Auto	$701.43
Rate for Payer: Multiplan Commercial	$701.43
Rate for Payer: Multiplan Workers Comp	$701.43
Rate for Payer: Parkland Medicaid	$1,010.06
Rate for Payer: Scott and White EPO/PPO	$701.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,010.06
Rate for Payer: Superior Health Plan EPO	$190.79

VALOR NAIL 4.3MM DRILL LONG STERILE

Facility

$1,629.86

Hospital Charge Code	993452
Hospital Revenue Code	272
Min. Negotiated Rate	$146.69
Max. Negotiated Rate	$1,173.50
Rate for Payer: Amerigroup CHIP/Medicaid	$146.69
Rate for Payer: BCBS of TX Blue Advantage	$488.96
Rate for Payer: BCBS of TX Blue Essentials	$586.75
Rate for Payer: BCBS of TX PPO	$651.94
Rate for Payer: Cash Price	$1,108.30
Rate for Payer: Cigna Medicaid	$1,173.50
Rate for Payer: Molina CHIP/Medicaid	$1,173.50
Rate for Payer: Multiplan Auto	$1,059.41
Rate for Payer: Multiplan Commercial	$1,059.41
Rate for Payer: Multiplan Workers Comp	$1,059.41
Rate for Payer: Parkland Medicaid	$1,173.50
Rate for Payer: Scott and White EPO/PPO	$814.93
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,173.50
Rate for Payer: Superior Health Plan EPO	$221.66

VALOR NAIL 4.3MM DRILL LONG STERILE

Facility

$1,629.86

Hospital Charge Code	993452
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,108.30

VALOR NAIL 4.3MM DRILL SHORT STERILE

Facility

$1,629.86

Hospital Charge Code	993451
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,108.30

VALOR NAIL 4.3MM DRILL SHORT STERILE

Facility

$1,629.86

Hospital Charge Code	993451
Hospital Revenue Code	272
Min. Negotiated Rate	$146.69
Max. Negotiated Rate	$1,173.50
Rate for Payer: Amerigroup CHIP/Medicaid	$146.69
Rate for Payer: BCBS of TX Blue Advantage	$488.96
Rate for Payer: BCBS of TX Blue Essentials	$586.75
Rate for Payer: BCBS of TX PPO	$651.94
Rate for Payer: Cash Price	$1,108.30
Rate for Payer: Cigna Medicaid	$1,173.50
Rate for Payer: Molina CHIP/Medicaid	$1,173.50
Rate for Payer: Multiplan Auto	$1,059.41
Rate for Payer: Multiplan Commercial	$1,059.41
Rate for Payer: Multiplan Workers Comp	$1,059.41
Rate for Payer: Parkland Medicaid	$1,173.50
Rate for Payer: Scott and White EPO/PPO	$814.93
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,173.50
Rate for Payer: Superior Health Plan EPO	$221.66

VALOR NAIL FREE HAND DRIVER

Facility

$1,679.80

Hospital Charge Code	993449
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,142.26

VALOR NAIL FREE HAND DRIVER

Facility

$1,679.80

Hospital Charge Code	993449
Hospital Revenue Code	272
Min. Negotiated Rate	$151.18
Max. Negotiated Rate	$1,209.46
Rate for Payer: Amerigroup CHIP/Medicaid	$151.18
Rate for Payer: BCBS of TX Blue Advantage	$503.94
Rate for Payer: BCBS of TX Blue Essentials	$604.73
Rate for Payer: BCBS of TX PPO	$671.92
Rate for Payer: Cash Price	$1,142.26
Rate for Payer: Cigna Medicaid	$1,209.46
Rate for Payer: Molina CHIP/Medicaid	$1,209.46
Rate for Payer: Multiplan Auto	$1,091.87
Rate for Payer: Multiplan Commercial	$1,091.87
Rate for Payer: Multiplan Workers Comp	$1,091.87
Rate for Payer: Parkland Medicaid	$1,209.46
Rate for Payer: Scott and White EPO/PPO	$839.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,209.46
Rate for Payer: Superior Health Plan EPO	$228.45

VALOR NAIL LG LT 10MM X 250MM

Facility

$25,803.61

Service Code	HCPCS C1776
Hospital Charge Code	992401
Hospital Revenue Code	278
Min. Negotiated Rate	$6,450.90
Max. Negotiated Rate	$12,901.81
Rate for Payer: Cash Price	$17,546.45
Rate for Payer: Cigna Commercial	$6,450.90
Rate for Payer: Multiplan Auto	$12,901.81
Rate for Payer: Multiplan Commercial	$12,901.81
Rate for Payer: Multiplan Workers Comp	$12,901.81
Rate for Payer: Scott and White EPO/PPO	$12,901.81

VALOR NAIL LG LT 10MM X 250MM

Facility

$25,803.61

Service Code	HCPCS C1776
Hospital Charge Code	992401
Hospital Revenue Code	278
Min. Negotiated Rate	$2,322.32
Max. Negotiated Rate	$18,578.60
Rate for Payer: Amerigroup CHIP/Medicaid	$2,322.32
Rate for Payer: BCBS of TX Blue Advantage	$7,741.08
Rate for Payer: BCBS of TX Blue Essentials	$9,289.30
Rate for Payer: BCBS of TX PPO	$10,321.44
Rate for Payer: Cash Price	$17,546.45
Rate for Payer: Cigna Medicaid	$18,578.60
Rate for Payer: Molina CHIP/Medicaid	$18,578.60
Rate for Payer: Multiplan Auto	$12,901.81
Rate for Payer: Multiplan Commercial	$12,901.81
Rate for Payer: Multiplan Workers Comp	$12,901.81
Rate for Payer: Parkland Medicaid	$18,578.60
Rate for Payer: Scott and White EPO/PPO	$12,901.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18,578.60
Rate for Payer: Superior Health Plan EPO	$3,509.29

VALOR NAIL LG LT 11.5MM X250MM

Facility

$23,457.83

Service Code	HCPCS C1776
Hospital Charge Code	992281
Hospital Revenue Code	278
Min. Negotiated Rate	$5,864.46
Max. Negotiated Rate	$11,728.92
Rate for Payer: Cash Price	$15,951.32
Rate for Payer: Cigna Commercial	$5,864.46
Rate for Payer: Multiplan Auto	$11,728.92
Rate for Payer: Multiplan Commercial	$11,728.92
Rate for Payer: Multiplan Workers Comp	$11,728.92
Rate for Payer: Scott and White EPO/PPO	$11,728.92

VALOR NAIL LG LT 11.5MM X250MM

Facility

$23,457.83

Service Code	HCPCS C1776
Hospital Charge Code	992281
Hospital Revenue Code	278
Min. Negotiated Rate	$2,111.20
Max. Negotiated Rate	$16,889.64
Rate for Payer: Amerigroup CHIP/Medicaid	$2,111.20
Rate for Payer: BCBS of TX Blue Advantage	$7,037.35
Rate for Payer: BCBS of TX Blue Essentials	$8,444.82
Rate for Payer: BCBS of TX PPO	$9,383.13
Rate for Payer: Cash Price	$15,951.32
Rate for Payer: Cigna Medicaid	$16,889.64
Rate for Payer: Molina CHIP/Medicaid	$16,889.64
Rate for Payer: Multiplan Auto	$11,728.92
Rate for Payer: Multiplan Commercial	$11,728.92
Rate for Payer: Multiplan Workers Comp	$11,728.92
Rate for Payer: Parkland Medicaid	$16,889.64
Rate for Payer: Scott and White EPO/PPO	$11,728.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,889.64
Rate for Payer: Superior Health Plan EPO	$3,190.26

VALOR NAIL MD LT 10MM X 200MM

Facility

$25,803.61

Service Code	HCPCS C1713
Hospital Charge Code	993149
Hospital Revenue Code	278
Min. Negotiated Rate	$2,322.32
Max. Negotiated Rate	$18,578.60
Rate for Payer: Amerigroup CHIP/Medicaid	$2,322.32
Rate for Payer: BCBS of TX Blue Advantage	$7,741.08
Rate for Payer: BCBS of TX Blue Essentials	$9,289.30
Rate for Payer: BCBS of TX PPO	$10,321.44
Rate for Payer: Cash Price	$17,546.45
Rate for Payer: Cigna Medicaid	$18,578.60
Rate for Payer: Molina CHIP/Medicaid	$18,578.60
Rate for Payer: Multiplan Auto	$12,901.81
Rate for Payer: Multiplan Commercial	$12,901.81
Rate for Payer: Multiplan Workers Comp	$12,901.81
Rate for Payer: Parkland Medicaid	$18,578.60
Rate for Payer: Scott and White EPO/PPO	$12,901.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18,578.60
Rate for Payer: Superior Health Plan EPO	$3,509.29

VALOR NAIL MD LT 10MM X 200MM

Facility

$25,803.61

Service Code	HCPCS C1713
Hospital Charge Code	993149
Hospital Revenue Code	278
Min. Negotiated Rate	$6,450.90
Max. Negotiated Rate	$12,901.81
Rate for Payer: Cash Price	$17,546.45
Rate for Payer: Cigna Commercial	$6,450.90
Rate for Payer: Multiplan Auto	$12,901.81
Rate for Payer: Multiplan Commercial	$12,901.81
Rate for Payer: Multiplan Workers Comp	$12,901.81
Rate for Payer: Scott and White EPO/PPO	$12,901.81

VALOR NAIL MD LT 11.5MMX200MM

Facility

$23,457.83

Service Code	HCPCS C1776
Hospital Charge Code	992274
Hospital Revenue Code	278
Min. Negotiated Rate	$5,864.46
Max. Negotiated Rate	$11,728.92
Rate for Payer: Cash Price	$15,951.32
Rate for Payer: Cigna Commercial	$5,864.46
Rate for Payer: Multiplan Auto	$11,728.92
Rate for Payer: Multiplan Commercial	$11,728.92
Rate for Payer: Multiplan Workers Comp	$11,728.92
Rate for Payer: Scott and White EPO/PPO	$11,728.92

VALOR NAIL MD LT 11.5MMX200MM

Facility

$23,457.83

Service Code	HCPCS C1776
Hospital Charge Code	992274
Hospital Revenue Code	278
Min. Negotiated Rate	$2,111.20
Max. Negotiated Rate	$16,889.64
Rate for Payer: Amerigroup CHIP/Medicaid	$2,111.20
Rate for Payer: BCBS of TX Blue Advantage	$7,037.35
Rate for Payer: BCBS of TX Blue Essentials	$8,444.82
Rate for Payer: BCBS of TX PPO	$9,383.13
Rate for Payer: Cash Price	$15,951.32
Rate for Payer: Cigna Medicaid	$16,889.64
Rate for Payer: Molina CHIP/Medicaid	$16,889.64
Rate for Payer: Multiplan Auto	$11,728.92
Rate for Payer: Multiplan Commercial	$11,728.92
Rate for Payer: Multiplan Workers Comp	$11,728.92
Rate for Payer: Parkland Medicaid	$16,889.64
Rate for Payer: Scott and White EPO/PPO	$11,728.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,889.64
Rate for Payer: Superior Health Plan EPO	$3,190.26

VALOR NAIL MD RT 10MM X 200MM

Facility

$23,457.83

Service Code	HCPCS C1776
Hospital Charge Code	992324
Hospital Revenue Code	278
Min. Negotiated Rate	$5,864.46
Max. Negotiated Rate	$11,728.92
Rate for Payer: Cash Price	$15,951.32
Rate for Payer: Cigna Commercial	$5,864.46
Rate for Payer: Multiplan Auto	$11,728.92
Rate for Payer: Multiplan Commercial	$11,728.92
Rate for Payer: Multiplan Workers Comp	$11,728.92
Rate for Payer: Scott and White EPO/PPO	$11,728.92

VALOR NAIL MD RT 10MM X 200MM

Facility

$23,457.83

Service Code	HCPCS C1776
Hospital Charge Code	992324
Hospital Revenue Code	278
Min. Negotiated Rate	$2,111.20
Max. Negotiated Rate	$16,889.64
Rate for Payer: Amerigroup CHIP/Medicaid	$2,111.20
Rate for Payer: BCBS of TX Blue Advantage	$7,037.35
Rate for Payer: BCBS of TX Blue Essentials	$8,444.82
Rate for Payer: BCBS of TX PPO	$9,383.13
Rate for Payer: Cash Price	$15,951.32
Rate for Payer: Cigna Medicaid	$16,889.64
Rate for Payer: Molina CHIP/Medicaid	$16,889.64
Rate for Payer: Multiplan Auto	$11,728.92
Rate for Payer: Multiplan Commercial	$11,728.92
Rate for Payer: Multiplan Workers Comp	$11,728.92
Rate for Payer: Parkland Medicaid	$16,889.64
Rate for Payer: Scott and White EPO/PPO	$11,728.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,889.64
Rate for Payer: Superior Health Plan EPO	$3,190.26

VALOR NAIL MD RT 11.5MMX200MM

Facility

$23,457.83

Service Code	HCPCS C1776
Hospital Charge Code	992284
Hospital Revenue Code	278
Min. Negotiated Rate	$5,864.46
Max. Negotiated Rate	$11,728.92
Rate for Payer: Cash Price	$15,951.32
Rate for Payer: Cigna Commercial	$5,864.46
Rate for Payer: Multiplan Auto	$11,728.92
Rate for Payer: Multiplan Commercial	$11,728.92
Rate for Payer: Multiplan Workers Comp	$11,728.92
Rate for Payer: Scott and White EPO/PPO	$11,728.92

VALOR NAIL MD RT 11.5MMX200MM

Facility

$23,457.83

Service Code	HCPCS C1776
Hospital Charge Code	992284
Hospital Revenue Code	278
Min. Negotiated Rate	$2,111.20
Max. Negotiated Rate	$16,889.64
Rate for Payer: Amerigroup CHIP/Medicaid	$2,111.20
Rate for Payer: BCBS of TX Blue Advantage	$7,037.35
Rate for Payer: BCBS of TX Blue Essentials	$8,444.82
Rate for Payer: BCBS of TX PPO	$9,383.13
Rate for Payer: Cash Price	$15,951.32
Rate for Payer: Cigna Medicaid	$16,889.64
Rate for Payer: Molina CHIP/Medicaid	$16,889.64
Rate for Payer: Multiplan Auto	$11,728.92
Rate for Payer: Multiplan Commercial	$11,728.92
Rate for Payer: Multiplan Workers Comp	$11,728.92
Rate for Payer: Parkland Medicaid	$16,889.64
Rate for Payer: Scott and White EPO/PPO	$11,728.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,889.64
Rate for Payer: Superior Health Plan EPO	$3,190.26

VALOR NAIL SM RT 10MM X 150MM

Facility

$23,457.83

Service Code	HCPCS C1776
Hospital Charge Code	992312
Hospital Revenue Code	278
Min. Negotiated Rate	$5,864.46
Max. Negotiated Rate	$11,728.92
Rate for Payer: Cash Price	$15,951.32
Rate for Payer: Cigna Commercial	$5,864.46
Rate for Payer: Multiplan Auto	$11,728.92
Rate for Payer: Multiplan Commercial	$11,728.92
Rate for Payer: Multiplan Workers Comp	$11,728.92
Rate for Payer: Scott and White EPO/PPO	$11,728.92

VALOR NAIL SM RT 10MM X 150MM

Facility

$23,457.83

Service Code	HCPCS C1776
Hospital Charge Code	992312
Hospital Revenue Code	278
Min. Negotiated Rate	$2,111.20
Max. Negotiated Rate	$16,889.64
Rate for Payer: Amerigroup CHIP/Medicaid	$2,111.20
Rate for Payer: BCBS of TX Blue Advantage	$7,037.35
Rate for Payer: BCBS of TX Blue Essentials	$8,444.82
Rate for Payer: BCBS of TX PPO	$9,383.13
Rate for Payer: Cash Price	$15,951.32
Rate for Payer: Cigna Medicaid	$16,889.64
Rate for Payer: Molina CHIP/Medicaid	$16,889.64
Rate for Payer: Multiplan Auto	$11,728.92
Rate for Payer: Multiplan Commercial	$11,728.92
Rate for Payer: Multiplan Workers Comp	$11,728.92
Rate for Payer: Parkland Medicaid	$16,889.64
Rate for Payer: Scott and White EPO/PPO	$11,728.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,889.64
Rate for Payer: Superior Health Plan EPO	$3,190.26

VALOR NAIL XLG RT 11.5X300MM

Facility

$25,803.61

Service Code	HCPCS C1776
Hospital Charge Code	992400
Hospital Revenue Code	278
Min. Negotiated Rate	$6,450.90
Max. Negotiated Rate	$12,901.81
Rate for Payer: Cash Price	$17,546.45
Rate for Payer: Cigna Commercial	$6,450.90
Rate for Payer: Multiplan Auto	$12,901.81
Rate for Payer: Multiplan Commercial	$12,901.81
Rate for Payer: Multiplan Workers Comp	$12,901.81
Rate for Payer: Scott and White EPO/PPO	$12,901.81

VALOR NAIL XLG RT 11.5X300MM

Facility

$25,803.61

Service Code	HCPCS C1776
Hospital Charge Code	992400
Hospital Revenue Code	278
Min. Negotiated Rate	$2,322.32
Max. Negotiated Rate	$18,578.60
Rate for Payer: Amerigroup CHIP/Medicaid	$2,322.32
Rate for Payer: BCBS of TX Blue Advantage	$7,741.08
Rate for Payer: BCBS of TX Blue Essentials	$9,289.30
Rate for Payer: BCBS of TX PPO	$10,321.44
Rate for Payer: Cash Price	$17,546.45
Rate for Payer: Cigna Medicaid	$18,578.60
Rate for Payer: Molina CHIP/Medicaid	$18,578.60
Rate for Payer: Multiplan Auto	$12,901.81
Rate for Payer: Multiplan Commercial	$12,901.81
Rate for Payer: Multiplan Workers Comp	$12,901.81
Rate for Payer: Parkland Medicaid	$18,578.60
Rate for Payer: Scott and White EPO/PPO	$12,901.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18,578.60
Rate for Payer: Superior Health Plan EPO	$3,509.29

Know your out-of-pocket cost for care.

All Charges