White Rock Medical Center

All Charges

Charge

Type

Setting

Price

ANCHOR PUNCHTAK THREADED

Facility

$2,195.54

Service Code	HCPCS C1713
Hospital Charge Code	8524480
Hospital Revenue Code	278
Min. Negotiated Rate	$197.60
Max. Negotiated Rate	$1,097.77
Rate for Payer: Aetna Commercial	$658.66
Rate for Payer: Amerigroup CHIP/Medicaid	$197.60
Rate for Payer: BCBS of TX Blue Advantage	$658.66
Rate for Payer: BCBS of TX Blue Essentials	$790.39
Rate for Payer: BCBS of TX PPO	$878.22
Rate for Payer: Cash Price	$1,932.08
Rate for Payer: Multiplan Auto	$1,097.77
Rate for Payer: Multiplan Commercial	$1,097.77
Rate for Payer: Multiplan Workers Comp	$1,097.77
Rate for Payer: Scott and White EPO/PPO	$1,097.77
Rate for Payer: Superior Health Plan EPO	$298.59

ANCHOR QUICK ANCHOR PLUS SUPER

Facility

$3,668.67

Service Code	HCPCS C1713
Hospital Charge Code	8512491
Hospital Revenue Code	278
Min. Negotiated Rate	$917.17
Max. Negotiated Rate	$1,834.34
Rate for Payer: Aetna Commercial	$1,100.60
Rate for Payer: Cash Price	$3,228.43
Rate for Payer: Cigna Commercial	$917.17
Rate for Payer: Multiplan Auto	$1,834.34
Rate for Payer: Multiplan Commercial	$1,834.34
Rate for Payer: Multiplan Workers Comp	$1,834.34
Rate for Payer: Scott and White EPO/PPO	$1,834.34

ANCHOR QUICK ANCHOR PLUS SUPER

Facility

$3,668.67

Service Code	HCPCS C1713
Hospital Charge Code	8512491
Hospital Revenue Code	278
Min. Negotiated Rate	$330.18
Max. Negotiated Rate	$1,834.34
Rate for Payer: Aetna Commercial	$1,100.60
Rate for Payer: Amerigroup CHIP/Medicaid	$330.18
Rate for Payer: BCBS of TX Blue Advantage	$1,100.60
Rate for Payer: BCBS of TX Blue Essentials	$1,320.72
Rate for Payer: BCBS of TX PPO	$1,467.47
Rate for Payer: Cash Price	$3,228.43
Rate for Payer: Multiplan Auto	$1,834.34
Rate for Payer: Multiplan Commercial	$1,834.34
Rate for Payer: Multiplan Workers Comp	$1,834.34
Rate for Payer: Scott and White EPO/PPO	$1,834.34
Rate for Payer: Superior Health Plan EPO	$498.94

Anchor/screw for opposing bone-to-bone

Facility

$10,000.00

Service Code	CPT 11012
Hospital Charge Code	36011012
Hospital Revenue Code	360
Min. Negotiated Rate	$57.32
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$1,400.00
Rate for Payer: Aetna Medicare	$3,898.02
Rate for Payer: Amerigroup CHIP/Medicaid	$815.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,598.68
Rate for Payer: Amerigroup Medicare	$2,598.68
Rate for Payer: BCBS of TX Blue Advantage	$3,872.55
Rate for Payer: BCBS of TX Blue Essentials	$4,637.78
Rate for Payer: BCBS of TX Medicare	$2,598.68
Rate for Payer: BCBS of TX PPO	$5,843.60
Rate for Payer: Cigna Commercial	$5,886.75
Rate for Payer: Cigna Medicaid	$815.20
Rate for Payer: Cigna Medicare	$2,598.68
Rate for Payer: Employer Direct Commercial	$2,598.68
Rate for Payer: Humana Medicare/TRICARE	$2,598.68
Rate for Payer: Molina CHIP/Medicaid	$815.20
Rate for Payer: Molina Dual Medicare/Medicaid	$2,598.68
Rate for Payer: Molina Medicare	$2,598.68
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$815.20
Rate for Payer: Scott and White EPO/PPO	$57.32
Rate for Payer: Scott and White Medicare	$2,598.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$815.20
Rate for Payer: Superior Health Plan EPO	$2,598.68
Rate for Payer: Superior Health Plan Medicare	$2,598.68
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,598.68
Rate for Payer: Universal American Medicare	$2,598.68
Rate for Payer: Wellcare Medicare	$2,598.68
Rate for Payer: Wellmed Medicare	$2,598.68

ANCHOR SUTURE 3.5 POPLOK W/ HIFI

Facility

$2,908.61

Service Code	HCPCS C1713
Hospital Charge Code	145480
Hospital Revenue Code	278
Min. Negotiated Rate	$727.15
Max. Negotiated Rate	$1,454.30
Rate for Payer: Aetna Commercial	$872.58
Rate for Payer: Cash Price	$2,559.58
Rate for Payer: Cigna Commercial	$727.15
Rate for Payer: Multiplan Auto	$1,454.30
Rate for Payer: Multiplan Commercial	$1,454.30
Rate for Payer: Multiplan Workers Comp	$1,454.30
Rate for Payer: Scott and White EPO/PPO	$1,454.30

ANCHOR SUTURE 3.5 POPLOK W/ HIFI

Facility

$2,908.61

Service Code	HCPCS C1713
Hospital Charge Code	145480
Hospital Revenue Code	278
Min. Negotiated Rate	$261.77
Max. Negotiated Rate	$1,454.30
Rate for Payer: Aetna Commercial	$872.58
Rate for Payer: Amerigroup CHIP/Medicaid	$261.77
Rate for Payer: BCBS of TX Blue Advantage	$872.58
Rate for Payer: BCBS of TX Blue Essentials	$1,047.10
Rate for Payer: BCBS of TX PPO	$1,163.44
Rate for Payer: Cash Price	$2,559.58
Rate for Payer: Multiplan Auto	$1,454.30
Rate for Payer: Multiplan Commercial	$1,454.30
Rate for Payer: Multiplan Workers Comp	$1,454.30
Rate for Payer: Scott and White EPO/PPO	$1,454.30
Rate for Payer: Superior Health Plan EPO	$395.57

ANCHOR SUTURE GRYPHONE

Facility

$3,650.60

Service Code	HCPCS C1713
Hospital Charge Code	139089
Hospital Revenue Code	278
Min. Negotiated Rate	$912.65
Max. Negotiated Rate	$1,825.30
Rate for Payer: Aetna Commercial	$1,095.18
Rate for Payer: Cash Price	$3,212.53
Rate for Payer: Cigna Commercial	$912.65
Rate for Payer: Multiplan Auto	$1,825.30
Rate for Payer: Multiplan Commercial	$1,825.30
Rate for Payer: Multiplan Workers Comp	$1,825.30
Rate for Payer: Scott and White EPO/PPO	$1,825.30

ANCHOR SUTURE GRYPHONE

Facility

$3,650.60

Service Code	HCPCS C1713
Hospital Charge Code	139089
Hospital Revenue Code	278
Min. Negotiated Rate	$328.55
Max. Negotiated Rate	$1,825.30
Rate for Payer: Aetna Commercial	$1,095.18
Rate for Payer: Amerigroup CHIP/Medicaid	$328.55
Rate for Payer: BCBS of TX Blue Advantage	$1,095.18
Rate for Payer: BCBS of TX Blue Essentials	$1,314.22
Rate for Payer: BCBS of TX PPO	$1,460.24
Rate for Payer: Cash Price	$3,212.53
Rate for Payer: Multiplan Auto	$1,825.30
Rate for Payer: Multiplan Commercial	$1,825.30
Rate for Payer: Multiplan Workers Comp	$1,825.30
Rate for Payer: Scott and White EPO/PPO	$1,825.30
Rate for Payer: Superior Health Plan EPO	$496.48

ANCHOR SUTURE HEALIX TRANSTEND

Facility

$7,765.06

Service Code	HCPCS C1713
Hospital Charge Code	8398515
Hospital Revenue Code	278
Min. Negotiated Rate	$698.86
Max. Negotiated Rate	$3,882.53
Rate for Payer: Aetna Commercial	$2,329.52
Rate for Payer: Amerigroup CHIP/Medicaid	$698.86
Rate for Payer: BCBS of TX Blue Advantage	$2,329.52
Rate for Payer: BCBS of TX Blue Essentials	$2,795.42
Rate for Payer: BCBS of TX PPO	$3,106.02
Rate for Payer: Cash Price	$6,833.25
Rate for Payer: Multiplan Auto	$3,882.53
Rate for Payer: Multiplan Commercial	$3,882.53
Rate for Payer: Multiplan Workers Comp	$3,882.53
Rate for Payer: Scott and White EPO/PPO	$3,882.53
Rate for Payer: Superior Health Plan EPO	$1,056.05

ANCHOR SUTURE HEALIX TRANSTEND

Facility

$7,765.06

Service Code	HCPCS C1713
Hospital Charge Code	8398515
Hospital Revenue Code	278
Min. Negotiated Rate	$1,941.26
Max. Negotiated Rate	$3,882.53
Rate for Payer: Aetna Commercial	$2,329.52
Rate for Payer: Cash Price	$6,833.25
Rate for Payer: Cigna Commercial	$1,941.26
Rate for Payer: Multiplan Auto	$3,882.53
Rate for Payer: Multiplan Commercial	$3,882.53
Rate for Payer: Multiplan Workers Comp	$3,882.53
Rate for Payer: Scott and White EPO/PPO	$3,882.53

ANCHOR SUTURE PRESFIT GENHIP FLEX

Facility

$5,048.19

Service Code	HCPCS C1713
Hospital Charge Code	8406460
Hospital Revenue Code	278
Min. Negotiated Rate	$454.34
Max. Negotiated Rate	$2,524.10
Rate for Payer: Aetna Commercial	$1,514.46
Rate for Payer: Amerigroup CHIP/Medicaid	$454.34
Rate for Payer: BCBS of TX Blue Advantage	$1,514.46
Rate for Payer: BCBS of TX Blue Essentials	$1,817.35
Rate for Payer: BCBS of TX PPO	$2,019.28
Rate for Payer: Cash Price	$4,442.41
Rate for Payer: Multiplan Auto	$2,524.10
Rate for Payer: Multiplan Commercial	$2,524.10
Rate for Payer: Multiplan Workers Comp	$2,524.10
Rate for Payer: Scott and White EPO/PPO	$2,524.10
Rate for Payer: Superior Health Plan EPO	$686.55

ANCHOR SUTURE PRESFIT GENHIP FLEX

Facility

$5,048.19

Service Code	HCPCS C1713
Hospital Charge Code	8406460
Hospital Revenue Code	278
Min. Negotiated Rate	$1,262.05
Max. Negotiated Rate	$2,524.10
Rate for Payer: Aetna Commercial	$1,514.46
Rate for Payer: Cash Price	$4,442.41
Rate for Payer: Cigna Commercial	$1,262.05
Rate for Payer: Multiplan Auto	$2,524.10
Rate for Payer: Multiplan Commercial	$2,524.10
Rate for Payer: Multiplan Workers Comp	$2,524.10
Rate for Payer: Scott and White EPO/PPO	$2,524.10

ANCHOR SUTURE QUICK ANCHOR PLUS

Facility

$5,471.07

Service Code	HCPCS C1713
Hospital Charge Code	8394457
Hospital Revenue Code	278
Min. Negotiated Rate	$1,367.77
Max. Negotiated Rate	$2,735.54
Rate for Payer: Aetna Commercial	$1,641.32
Rate for Payer: Cash Price	$4,814.54
Rate for Payer: Cigna Commercial	$1,367.77
Rate for Payer: Multiplan Auto	$2,735.54
Rate for Payer: Multiplan Commercial	$2,735.54
Rate for Payer: Multiplan Workers Comp	$2,735.54
Rate for Payer: Scott and White EPO/PPO	$2,735.54

ANCHOR SUTURE QUICK ANCHOR PLUS

Facility

$5,471.07

Service Code	HCPCS C1713
Hospital Charge Code	8394457
Hospital Revenue Code	278
Min. Negotiated Rate	$492.40
Max. Negotiated Rate	$2,735.54
Rate for Payer: Aetna Commercial	$1,641.32
Rate for Payer: Amerigroup CHIP/Medicaid	$492.40
Rate for Payer: BCBS of TX Blue Advantage	$1,641.32
Rate for Payer: BCBS of TX Blue Essentials	$1,969.59
Rate for Payer: BCBS of TX PPO	$2,188.43
Rate for Payer: Cash Price	$4,814.54
Rate for Payer: Multiplan Auto	$2,735.54
Rate for Payer: Multiplan Commercial	$2,735.54
Rate for Payer: Multiplan Workers Comp	$2,735.54
Rate for Payer: Scott and White EPO/PPO	$2,735.54
Rate for Payer: Superior Health Plan EPO	$744.07

anchor suture sys y-knot w/ribbon

Facility

$5,888.55

Service Code	HCPCS C1713
Hospital Charge Code	8708541
Hospital Revenue Code	278
Min. Negotiated Rate	$529.97
Max. Negotiated Rate	$2,944.28
Rate for Payer: Aetna Commercial	$1,766.56
Rate for Payer: Amerigroup CHIP/Medicaid	$529.97
Rate for Payer: BCBS of TX Blue Advantage	$1,766.56
Rate for Payer: BCBS of TX Blue Essentials	$2,119.88
Rate for Payer: BCBS of TX PPO	$2,355.42
Rate for Payer: Cash Price	$5,181.92
Rate for Payer: Multiplan Auto	$2,944.28
Rate for Payer: Multiplan Commercial	$2,944.28
Rate for Payer: Multiplan Workers Comp	$2,944.28
Rate for Payer: Scott and White EPO/PPO	$2,944.28
Rate for Payer: Superior Health Plan EPO	$800.84

anchor suture sys y-knot w/ribbon

Facility

$5,888.55

Service Code	HCPCS C1713
Hospital Charge Code	8708541
Hospital Revenue Code	278
Min. Negotiated Rate	$1,472.14
Max. Negotiated Rate	$2,944.28
Rate for Payer: Aetna Commercial	$1,766.56
Rate for Payer: Cash Price	$5,181.92
Rate for Payer: Cigna Commercial	$1,472.14
Rate for Payer: Multiplan Auto	$2,944.28
Rate for Payer: Multiplan Commercial	$2,944.28
Rate for Payer: Multiplan Workers Comp	$2,944.28
Rate for Payer: Scott and White EPO/PPO	$2,944.28

anchor suture toggleloc

Facility

$3,855.42

Service Code	HCPCS C1713
Hospital Charge Code	8720600
Hospital Revenue Code	278
Min. Negotiated Rate	$346.99
Max. Negotiated Rate	$1,927.71
Rate for Payer: Aetna Commercial	$1,156.63
Rate for Payer: Amerigroup CHIP/Medicaid	$346.99
Rate for Payer: BCBS of TX Blue Advantage	$1,156.63
Rate for Payer: BCBS of TX Blue Essentials	$1,387.95
Rate for Payer: BCBS of TX PPO	$1,542.17
Rate for Payer: Cash Price	$3,392.77
Rate for Payer: Multiplan Auto	$1,927.71
Rate for Payer: Multiplan Commercial	$1,927.71
Rate for Payer: Multiplan Workers Comp	$1,927.71
Rate for Payer: Scott and White EPO/PPO	$1,927.71
Rate for Payer: Superior Health Plan EPO	$524.34

anchor suture toggleloc

Facility

$3,855.42

Service Code	HCPCS C1713
Hospital Charge Code	8720600
Hospital Revenue Code	278
Min. Negotiated Rate	$963.86
Max. Negotiated Rate	$1,927.71
Rate for Payer: Aetna Commercial	$1,156.63
Rate for Payer: Cash Price	$3,392.77
Rate for Payer: Cigna Commercial	$963.86
Rate for Payer: Multiplan Auto	$1,927.71
Rate for Payer: Multiplan Commercial	$1,927.71
Rate for Payer: Multiplan Workers Comp	$1,927.71
Rate for Payer: Scott and White EPO/PPO	$1,927.71

anchor suture y knot

Facility

$3,024.10

Service Code	HCPCS C1713
Hospital Charge Code	8688555
Hospital Revenue Code	278
Min. Negotiated Rate	$272.17
Max. Negotiated Rate	$1,512.05
Rate for Payer: Aetna Commercial	$907.23
Rate for Payer: Amerigroup CHIP/Medicaid	$272.17
Rate for Payer: BCBS of TX Blue Advantage	$907.23
Rate for Payer: BCBS of TX Blue Essentials	$1,088.68
Rate for Payer: BCBS of TX PPO	$1,209.64
Rate for Payer: Cash Price	$2,661.21
Rate for Payer: Multiplan Auto	$1,512.05
Rate for Payer: Multiplan Commercial	$1,512.05
Rate for Payer: Multiplan Workers Comp	$1,512.05
Rate for Payer: Scott and White EPO/PPO	$1,512.05
Rate for Payer: Superior Health Plan EPO	$411.28

anchor suture y knot

Facility

$3,024.10

Service Code	HCPCS C1713
Hospital Charge Code	8688555
Hospital Revenue Code	278
Min. Negotiated Rate	$756.02
Max. Negotiated Rate	$1,512.05
Rate for Payer: Aetna Commercial	$907.23
Rate for Payer: Cash Price	$2,661.21
Rate for Payer: Cigna Commercial	$756.02
Rate for Payer: Multiplan Auto	$1,512.05
Rate for Payer: Multiplan Commercial	$1,512.05
Rate for Payer: Multiplan Workers Comp	$1,512.05
Rate for Payer: Scott and White EPO/PPO	$1,512.05

ANCHOR SUTURE Y-KNOT 1.3MM WHT/BLK

Facility

$2,807.23

Service Code	HCPCS C1713
Hospital Charge Code	144881
Hospital Revenue Code	278
Min. Negotiated Rate	$701.81
Max. Negotiated Rate	$1,403.62
Rate for Payer: Aetna Commercial	$842.17
Rate for Payer: Cash Price	$2,470.36
Rate for Payer: Cigna Commercial	$701.81
Rate for Payer: Multiplan Auto	$1,403.62
Rate for Payer: Multiplan Commercial	$1,403.62
Rate for Payer: Multiplan Workers Comp	$1,403.62
Rate for Payer: Scott and White EPO/PPO	$1,403.62

ANCHOR SUTURE Y-KNOT 1.3MM WHT/BLK

Facility

$2,807.23

Service Code	HCPCS C1713
Hospital Charge Code	144881
Hospital Revenue Code	278
Min. Negotiated Rate	$252.65
Max. Negotiated Rate	$1,403.62
Rate for Payer: Aetna Commercial	$842.17
Rate for Payer: Amerigroup CHIP/Medicaid	$252.65
Rate for Payer: BCBS of TX Blue Advantage	$842.17
Rate for Payer: BCBS of TX Blue Essentials	$1,010.60
Rate for Payer: BCBS of TX PPO	$1,122.89
Rate for Payer: Cash Price	$2,470.36
Rate for Payer: Multiplan Auto	$1,403.62
Rate for Payer: Multiplan Commercial	$1,403.62
Rate for Payer: Multiplan Workers Comp	$1,403.62
Rate for Payer: Scott and White EPO/PPO	$1,403.62
Rate for Payer: Superior Health Plan EPO	$381.78

anchor suture y-knot rc

Facility

$2,891.57

Service Code	HCPCS C1713
Hospital Charge Code	8708546
Hospital Revenue Code	278
Min. Negotiated Rate	$260.24
Max. Negotiated Rate	$1,445.78
Rate for Payer: Aetna Commercial	$867.47
Rate for Payer: Amerigroup CHIP/Medicaid	$260.24
Rate for Payer: BCBS of TX Blue Advantage	$867.47
Rate for Payer: BCBS of TX Blue Essentials	$1,040.97
Rate for Payer: BCBS of TX PPO	$1,156.63
Rate for Payer: Cash Price	$2,544.58
Rate for Payer: Multiplan Auto	$1,445.78
Rate for Payer: Multiplan Commercial	$1,445.78
Rate for Payer: Multiplan Workers Comp	$1,445.78
Rate for Payer: Scott and White EPO/PPO	$1,445.78
Rate for Payer: Superior Health Plan EPO	$393.25

anchor suture y-knot rc

Facility

$2,891.57

Service Code	HCPCS C1713
Hospital Charge Code	8708546
Hospital Revenue Code	278
Min. Negotiated Rate	$722.89
Max. Negotiated Rate	$1,445.78
Rate for Payer: Aetna Commercial	$867.47
Rate for Payer: Cash Price	$2,544.58
Rate for Payer: Cigna Commercial	$722.89
Rate for Payer: Multiplan Auto	$1,445.78
Rate for Payer: Multiplan Commercial	$1,445.78
Rate for Payer: Multiplan Workers Comp	$1,445.78
Rate for Payer: Scott and White EPO/PPO	$1,445.78

ANCHOR SUTURE Y-KNOT RC W/NEEDLE ALL

Facility

$2,805.45

Service Code	HCPCS C1713
Hospital Charge Code	145479
Hospital Revenue Code	278
Min. Negotiated Rate	$701.36
Max. Negotiated Rate	$1,402.72
Rate for Payer: Aetna Commercial	$841.64
Rate for Payer: Cash Price	$2,468.80
Rate for Payer: Cigna Commercial	$701.36
Rate for Payer: Multiplan Auto	$1,402.72
Rate for Payer: Multiplan Commercial	$1,402.72
Rate for Payer: Multiplan Workers Comp	$1,402.72
Rate for Payer: Scott and White EPO/PPO	$1,402.72

Know your out-of-pocket cost for care.

All Charges