White Rock Medical Center

All Charges

Charge

Type

Setting

Price

VALOR SCREW 5.0MM X 30MM LEN

Facility

$2,180.72

Service Code	HCPCS C1713
Hospital Charge Code	992276
Hospital Revenue Code	278
Min. Negotiated Rate	$196.26
Max. Negotiated Rate	$1,570.12
Rate for Payer: Amerigroup CHIP/Medicaid	$196.26
Rate for Payer: BCBS of TX Blue Advantage	$654.22
Rate for Payer: BCBS of TX Blue Essentials	$785.06
Rate for Payer: BCBS of TX PPO	$872.29
Rate for Payer: Cash Price	$1,482.89
Rate for Payer: Cigna Medicaid	$1,570.12
Rate for Payer: Molina CHIP/Medicaid	$1,570.12
Rate for Payer: Multiplan Auto	$1,090.36
Rate for Payer: Multiplan Commercial	$1,090.36
Rate for Payer: Multiplan Workers Comp	$1,090.36
Rate for Payer: Parkland Medicaid	$1,570.12
Rate for Payer: Scott and White EPO/PPO	$1,090.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,570.12
Rate for Payer: Superior Health Plan EPO	$296.58

VALOR SCREW 5.0MM X 30MM LEN

Facility

$2,180.72

Service Code	HCPCS C1713
Hospital Charge Code	992276
Hospital Revenue Code	278
Min. Negotiated Rate	$545.18
Max. Negotiated Rate	$1,090.36
Rate for Payer: Cash Price	$1,482.89
Rate for Payer: Cigna Commercial	$545.18
Rate for Payer: Multiplan Auto	$1,090.36
Rate for Payer: Multiplan Commercial	$1,090.36
Rate for Payer: Multiplan Workers Comp	$1,090.36
Rate for Payer: Scott and White EPO/PPO	$1,090.36

VALOR SCREW 5.0MM X 35MM LEN

Facility

$2,180.72

Service Code	HCPCS C1713
Hospital Charge Code	992282
Hospital Revenue Code	278
Min. Negotiated Rate	$545.18
Max. Negotiated Rate	$1,090.36
Rate for Payer: Cash Price	$1,482.89
Rate for Payer: Cigna Commercial	$545.18
Rate for Payer: Multiplan Auto	$1,090.36
Rate for Payer: Multiplan Commercial	$1,090.36
Rate for Payer: Multiplan Workers Comp	$1,090.36
Rate for Payer: Scott and White EPO/PPO	$1,090.36

VALOR SCREW 5.0MM X 35MM LEN

Facility

$2,180.72

Service Code	HCPCS C1713
Hospital Charge Code	992282
Hospital Revenue Code	278
Min. Negotiated Rate	$196.26
Max. Negotiated Rate	$1,570.12
Rate for Payer: Amerigroup CHIP/Medicaid	$196.26
Rate for Payer: BCBS of TX Blue Advantage	$654.22
Rate for Payer: BCBS of TX Blue Essentials	$785.06
Rate for Payer: BCBS of TX PPO	$872.29
Rate for Payer: Cash Price	$1,482.89
Rate for Payer: Cigna Medicaid	$1,570.12
Rate for Payer: Molina CHIP/Medicaid	$1,570.12
Rate for Payer: Multiplan Auto	$1,090.36
Rate for Payer: Multiplan Commercial	$1,090.36
Rate for Payer: Multiplan Workers Comp	$1,090.36
Rate for Payer: Parkland Medicaid	$1,570.12
Rate for Payer: Scott and White EPO/PPO	$1,090.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,570.12
Rate for Payer: Superior Health Plan EPO	$296.58

VALOR SCREW 5.0MM X 40MM LEN

Facility

$2,180.72

Service Code	HCPCS C1713
Hospital Charge Code	992313
Hospital Revenue Code	278
Min. Negotiated Rate	$545.18
Max. Negotiated Rate	$1,090.36
Rate for Payer: Cash Price	$1,482.89
Rate for Payer: Cigna Commercial	$545.18
Rate for Payer: Multiplan Auto	$1,090.36
Rate for Payer: Multiplan Commercial	$1,090.36
Rate for Payer: Multiplan Workers Comp	$1,090.36
Rate for Payer: Scott and White EPO/PPO	$1,090.36

VALOR SCREW 5.0MM X 40MM LEN

Facility

$2,180.72

Service Code	HCPCS C1713
Hospital Charge Code	992313
Hospital Revenue Code	278
Min. Negotiated Rate	$196.26
Max. Negotiated Rate	$1,570.12
Rate for Payer: Amerigroup CHIP/Medicaid	$196.26
Rate for Payer: BCBS of TX Blue Advantage	$654.22
Rate for Payer: BCBS of TX Blue Essentials	$785.06
Rate for Payer: BCBS of TX PPO	$872.29
Rate for Payer: Cash Price	$1,482.89
Rate for Payer: Cigna Medicaid	$1,570.12
Rate for Payer: Molina CHIP/Medicaid	$1,570.12
Rate for Payer: Multiplan Auto	$1,090.36
Rate for Payer: Multiplan Commercial	$1,090.36
Rate for Payer: Multiplan Workers Comp	$1,090.36
Rate for Payer: Parkland Medicaid	$1,570.12
Rate for Payer: Scott and White EPO/PPO	$1,090.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,570.12
Rate for Payer: Superior Health Plan EPO	$296.58

VALOR SCREW 5.0MM X 45MM LEN

Facility

$2,180.72

Service Code	HCPCS C1713
Hospital Charge Code	992277
Hospital Revenue Code	278
Min. Negotiated Rate	$545.18
Max. Negotiated Rate	$1,090.36
Rate for Payer: Cash Price	$1,482.89
Rate for Payer: Cigna Commercial	$545.18
Rate for Payer: Multiplan Auto	$1,090.36
Rate for Payer: Multiplan Commercial	$1,090.36
Rate for Payer: Multiplan Workers Comp	$1,090.36
Rate for Payer: Scott and White EPO/PPO	$1,090.36

VALOR SCREW 5.0MM X 45MM LEN

Facility

$2,180.72

Service Code	HCPCS C1713
Hospital Charge Code	992277
Hospital Revenue Code	278
Min. Negotiated Rate	$196.26
Max. Negotiated Rate	$1,570.12
Rate for Payer: Amerigroup CHIP/Medicaid	$196.26
Rate for Payer: BCBS of TX Blue Advantage	$654.22
Rate for Payer: BCBS of TX Blue Essentials	$785.06
Rate for Payer: BCBS of TX PPO	$872.29
Rate for Payer: Cash Price	$1,482.89
Rate for Payer: Cigna Medicaid	$1,570.12
Rate for Payer: Molina CHIP/Medicaid	$1,570.12
Rate for Payer: Multiplan Auto	$1,090.36
Rate for Payer: Multiplan Commercial	$1,090.36
Rate for Payer: Multiplan Workers Comp	$1,090.36
Rate for Payer: Parkland Medicaid	$1,570.12
Rate for Payer: Scott and White EPO/PPO	$1,090.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,570.12
Rate for Payer: Superior Health Plan EPO	$296.58

VALOR SCREW 5.0MM X 65MM LEN

Facility

$2,180.72

Service Code	HCPCS C1713
Hospital Charge Code	992278
Hospital Revenue Code	278
Min. Negotiated Rate	$545.18
Max. Negotiated Rate	$1,090.36
Rate for Payer: Cash Price	$1,482.89
Rate for Payer: Cigna Commercial	$545.18
Rate for Payer: Multiplan Auto	$1,090.36
Rate for Payer: Multiplan Commercial	$1,090.36
Rate for Payer: Multiplan Workers Comp	$1,090.36
Rate for Payer: Scott and White EPO/PPO	$1,090.36

VALOR SCREW 5.0MM X 65MM LEN

Facility

$2,180.72

Service Code	HCPCS C1713
Hospital Charge Code	992278
Hospital Revenue Code	278
Min. Negotiated Rate	$196.26
Max. Negotiated Rate	$1,570.12
Rate for Payer: Amerigroup CHIP/Medicaid	$196.26
Rate for Payer: BCBS of TX Blue Advantage	$654.22
Rate for Payer: BCBS of TX Blue Essentials	$785.06
Rate for Payer: BCBS of TX PPO	$872.29
Rate for Payer: Cash Price	$1,482.89
Rate for Payer: Cigna Medicaid	$1,570.12
Rate for Payer: Molina CHIP/Medicaid	$1,570.12
Rate for Payer: Multiplan Auto	$1,090.36
Rate for Payer: Multiplan Commercial	$1,090.36
Rate for Payer: Multiplan Workers Comp	$1,090.36
Rate for Payer: Parkland Medicaid	$1,570.12
Rate for Payer: Scott and White EPO/PPO	$1,090.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,570.12
Rate for Payer: Superior Health Plan EPO	$296.58

VALOR SCREW 5.0MM X 70MM LEN

Facility

$2,180.72

Service Code	HCPCS C1713
Hospital Charge Code	992323
Hospital Revenue Code	278
Min. Negotiated Rate	$196.26
Max. Negotiated Rate	$1,570.12
Rate for Payer: Amerigroup CHIP/Medicaid	$196.26
Rate for Payer: BCBS of TX Blue Advantage	$654.22
Rate for Payer: BCBS of TX Blue Essentials	$785.06
Rate for Payer: BCBS of TX PPO	$872.29
Rate for Payer: Cash Price	$1,482.89
Rate for Payer: Cigna Medicaid	$1,570.12
Rate for Payer: Molina CHIP/Medicaid	$1,570.12
Rate for Payer: Multiplan Auto	$1,090.36
Rate for Payer: Multiplan Commercial	$1,090.36
Rate for Payer: Multiplan Workers Comp	$1,090.36
Rate for Payer: Parkland Medicaid	$1,570.12
Rate for Payer: Scott and White EPO/PPO	$1,090.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,570.12
Rate for Payer: Superior Health Plan EPO	$296.58

VALOR SCREW 5.0MM X 70MM LEN

Facility

$2,180.72

Service Code	HCPCS C1713
Hospital Charge Code	992323
Hospital Revenue Code	278
Min. Negotiated Rate	$545.18
Max. Negotiated Rate	$1,090.36
Rate for Payer: Cash Price	$1,482.89
Rate for Payer: Cigna Commercial	$545.18
Rate for Payer: Multiplan Auto	$1,090.36
Rate for Payer: Multiplan Commercial	$1,090.36
Rate for Payer: Multiplan Workers Comp	$1,090.36
Rate for Payer: Scott and White EPO/PPO	$1,090.36

VALOR SCREW 5.0MM X 75MM LEN

Facility

$2,180.72

Service Code	HCPCS C1713
Hospital Charge Code	992285
Hospital Revenue Code	278
Min. Negotiated Rate	$196.26
Max. Negotiated Rate	$1,570.12
Rate for Payer: Amerigroup CHIP/Medicaid	$196.26
Rate for Payer: BCBS of TX Blue Advantage	$654.22
Rate for Payer: BCBS of TX Blue Essentials	$785.06
Rate for Payer: BCBS of TX PPO	$872.29
Rate for Payer: Cash Price	$1,482.89
Rate for Payer: Cigna Medicaid	$1,570.12
Rate for Payer: Molina CHIP/Medicaid	$1,570.12
Rate for Payer: Multiplan Auto	$1,090.36
Rate for Payer: Multiplan Commercial	$1,090.36
Rate for Payer: Multiplan Workers Comp	$1,090.36
Rate for Payer: Parkland Medicaid	$1,570.12
Rate for Payer: Scott and White EPO/PPO	$1,090.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,570.12
Rate for Payer: Superior Health Plan EPO	$296.58

VALOR SCREW 5.0MM X 75MM LEN

Facility

$2,180.72

Service Code	HCPCS C1713
Hospital Charge Code	992285
Hospital Revenue Code	278
Min. Negotiated Rate	$545.18
Max. Negotiated Rate	$1,090.36
Rate for Payer: Cash Price	$1,482.89
Rate for Payer: Cigna Commercial	$545.18
Rate for Payer: Multiplan Auto	$1,090.36
Rate for Payer: Multiplan Commercial	$1,090.36
Rate for Payer: Multiplan Workers Comp	$1,090.36
Rate for Payer: Scott and White EPO/PPO	$1,090.36

VALOR SCREW 5.0MM X 85MM LEN

Facility

$1,643.48

Service Code	HCPCS C1713
Hospital Charge Code	993453
Hospital Revenue Code	278
Min. Negotiated Rate	$147.91
Max. Negotiated Rate	$1,183.31
Rate for Payer: Amerigroup CHIP/Medicaid	$147.91
Rate for Payer: BCBS of TX Blue Advantage	$493.04
Rate for Payer: BCBS of TX Blue Essentials	$591.65
Rate for Payer: BCBS of TX PPO	$657.39
Rate for Payer: Cash Price	$1,117.57
Rate for Payer: Cigna Medicaid	$1,183.31
Rate for Payer: Molina CHIP/Medicaid	$1,183.31
Rate for Payer: Multiplan Auto	$821.74
Rate for Payer: Multiplan Commercial	$821.74
Rate for Payer: Multiplan Workers Comp	$821.74
Rate for Payer: Parkland Medicaid	$1,183.31
Rate for Payer: Scott and White EPO/PPO	$821.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,183.31
Rate for Payer: Superior Health Plan EPO	$223.51

VALOR SCREW 5.0MM X 85MM LEN

Facility

$1,643.48

Service Code	HCPCS C1713
Hospital Charge Code	993453
Hospital Revenue Code	278
Min. Negotiated Rate	$410.87
Max. Negotiated Rate	$821.74
Rate for Payer: Cash Price	$1,117.57
Rate for Payer: Cigna Commercial	$410.87
Rate for Payer: Multiplan Auto	$821.74
Rate for Payer: Multiplan Commercial	$821.74
Rate for Payer: Multiplan Workers Comp	$821.74
Rate for Payer: Scott and White EPO/PPO	$821.74

VALOR SCREW 5.0MM X 90MM LEN

Facility

$2,180.72

Service Code	HCPCS C1713
Hospital Charge Code	992286
Hospital Revenue Code	278
Min. Negotiated Rate	$545.18
Max. Negotiated Rate	$1,090.36
Rate for Payer: Cash Price	$1,482.89
Rate for Payer: Cigna Commercial	$545.18
Rate for Payer: Multiplan Auto	$1,090.36
Rate for Payer: Multiplan Commercial	$1,090.36
Rate for Payer: Multiplan Workers Comp	$1,090.36
Rate for Payer: Scott and White EPO/PPO	$1,090.36

VALOR SCREW 5.0MM X 90MM LEN

Facility

$2,180.72

Service Code	HCPCS C1713
Hospital Charge Code	992286
Hospital Revenue Code	278
Min. Negotiated Rate	$196.26
Max. Negotiated Rate	$1,570.12
Rate for Payer: Amerigroup CHIP/Medicaid	$196.26
Rate for Payer: BCBS of TX Blue Advantage	$654.22
Rate for Payer: BCBS of TX Blue Essentials	$785.06
Rate for Payer: BCBS of TX PPO	$872.29
Rate for Payer: Cash Price	$1,482.89
Rate for Payer: Cigna Medicaid	$1,570.12
Rate for Payer: Molina CHIP/Medicaid	$1,570.12
Rate for Payer: Multiplan Auto	$1,090.36
Rate for Payer: Multiplan Commercial	$1,090.36
Rate for Payer: Multiplan Workers Comp	$1,090.36
Rate for Payer: Parkland Medicaid	$1,570.12
Rate for Payer: Scott and White EPO/PPO	$1,090.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,570.12
Rate for Payer: Superior Health Plan EPO	$296.58

VALOR SCREW 5.0MM X 95MM LEN

Facility

$2,398.80

Service Code	HCPCS C1713
Hospital Charge Code	992402
Hospital Revenue Code	278
Min. Negotiated Rate	$599.70
Max. Negotiated Rate	$1,199.40
Rate for Payer: Cash Price	$1,631.18
Rate for Payer: Cigna Commercial	$599.70
Rate for Payer: Multiplan Auto	$1,199.40
Rate for Payer: Multiplan Commercial	$1,199.40
Rate for Payer: Multiplan Workers Comp	$1,199.40
Rate for Payer: Scott and White EPO/PPO	$1,199.40

VALOR SCREW 5.0MM X 95MM LEN

Facility

$2,398.80

Service Code	HCPCS C1713
Hospital Charge Code	992402
Hospital Revenue Code	278
Min. Negotiated Rate	$215.89
Max. Negotiated Rate	$1,727.14
Rate for Payer: Amerigroup CHIP/Medicaid	$215.89
Rate for Payer: BCBS of TX Blue Advantage	$719.64
Rate for Payer: BCBS of TX Blue Essentials	$863.57
Rate for Payer: BCBS of TX PPO	$959.52
Rate for Payer: Cash Price	$1,631.18
Rate for Payer: Cigna Medicaid	$1,727.14
Rate for Payer: Molina CHIP/Medicaid	$1,727.14
Rate for Payer: Multiplan Auto	$1,199.40
Rate for Payer: Multiplan Commercial	$1,199.40
Rate for Payer: Multiplan Workers Comp	$1,199.40
Rate for Payer: Parkland Medicaid	$1,727.14
Rate for Payer: Scott and White EPO/PPO	$1,199.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,727.14
Rate for Payer: Superior Health Plan EPO	$326.24

valproic acid 250 mg/5 mL Oral Syrup 5 mL

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77868930
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$5.76
Rate for Payer: Amerigroup CHIP/Medicaid	$0.72
Rate for Payer: BCBS of TX Blue Advantage	$2.40
Rate for Payer: BCBS of TX Blue Essentials	$2.88
Rate for Payer: BCBS of TX PPO	$3.20
Rate for Payer: Cash Price	$5.44
Rate for Payer: Cigna Medicaid	$5.76
Rate for Payer: Molina CHIP/Medicaid	$5.76
Rate for Payer: Multiplan Auto	$5.20
Rate for Payer: Multiplan Commercial	$5.20
Rate for Payer: Multiplan Workers Comp	$5.20
Rate for Payer: Parkland Medicaid	$5.76
Rate for Payer: Scott and White EPO/PPO	$4.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.76
Rate for Payer: Superior Health Plan EPO	$1.09

valproic acid 250 mg/5 mL Oral Syrup 5 mL

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77868930
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.44

valproic acid (as valproate sodium) 100 mg/mL IV Soln 5 mL

Facility

$128.00

Service Code	HCPCS J3490
Hospital Charge Code	77868616
Hospital Revenue Code	250
Rate for Payer: Cash Price	$87.04

valproic acid (as valproate sodium) 100 mg/mL IV Soln 5 mL

Facility

$128.00

Service Code	HCPCS J3490
Hospital Charge Code	77868616
Hospital Revenue Code	250
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$92.16
Rate for Payer: Amerigroup CHIP/Medicaid	$11.52
Rate for Payer: BCBS of TX Blue Advantage	$38.40
Rate for Payer: BCBS of TX Blue Essentials	$46.08
Rate for Payer: BCBS of TX PPO	$51.20
Rate for Payer: Cash Price	$87.04
Rate for Payer: Cigna Medicaid	$92.16
Rate for Payer: Molina CHIP/Medicaid	$92.16
Rate for Payer: Multiplan Auto	$83.20
Rate for Payer: Multiplan Commercial	$83.20
Rate for Payer: Multiplan Workers Comp	$83.20
Rate for Payer: Parkland Medicaid	$92.16
Rate for Payer: Scott and White EPO/PPO	$64.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$92.16
Rate for Payer: Superior Health Plan EPO	$17.41

Valproic Acid Level

Facility

$373.00

Service Code	HCPCS 80164
Hospital Charge Code	1602960
Hospital Revenue Code	300
Rate for Payer: Cash Price	$253.64

Know your out-of-pocket cost for care.

All Charges