White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SUTURE, COATED VICRYL UND BR 2-0 SUTUPAK 12-18'''' SS -- DHF

Facility

$257.57

Hospital Charge Code	81944902
Hospital Revenue Code	272
Min. Negotiated Rate	$23.18
Max. Negotiated Rate	$167.42
Rate for Payer: Aetna Commercial	$141.66
Rate for Payer: Amerigroup CHIP/Medicaid	$23.18
Rate for Payer: BCBS of TX Blue Advantage	$77.27
Rate for Payer: BCBS of TX Blue Essentials	$92.73
Rate for Payer: BCBS of TX PPO	$103.03
Rate for Payer: Cash Price	$226.66
Rate for Payer: Multiplan Auto	$167.42
Rate for Payer: Multiplan Commercial	$167.42
Rate for Payer: Multiplan Workers Comp	$167.42
Rate for Payer: Scott and White EPO/PPO	$128.78
Rate for Payer: Superior Health Plan EPO	$35.03

SUTURE, COATED VICRYL UND BR 3-0 CLOSURE 27'''' CT-1 -- DHF

Facility

$257.57

Hospital Charge Code	81945107
Hospital Revenue Code	272
Min. Negotiated Rate	$23.18
Max. Negotiated Rate	$167.42
Rate for Payer: Aetna Commercial	$141.66
Rate for Payer: Amerigroup CHIP/Medicaid	$23.18
Rate for Payer: BCBS of TX Blue Advantage	$77.27
Rate for Payer: BCBS of TX Blue Essentials	$92.73
Rate for Payer: BCBS of TX PPO	$103.03
Rate for Payer: Cash Price	$226.66
Rate for Payer: Multiplan Auto	$167.42
Rate for Payer: Multiplan Commercial	$167.42
Rate for Payer: Multiplan Workers Comp	$167.42
Rate for Payer: Scott and White EPO/PPO	$128.78
Rate for Payer: Superior Health Plan EPO	$35.03

SUTURE, COATED VICRYL UND BR 3-0 G.I. 27'''' SH -- DHF

Facility

$142.72

Hospital Charge Code	81943706
Hospital Revenue Code	272
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$92.77
Rate for Payer: Aetna Commercial	$78.50
Rate for Payer: Amerigroup CHIP/Medicaid	$12.84
Rate for Payer: BCBS of TX Blue Advantage	$42.82
Rate for Payer: BCBS of TX Blue Essentials	$51.38
Rate for Payer: BCBS of TX PPO	$57.09
Rate for Payer: Cash Price	$125.59
Rate for Payer: Multiplan Auto	$92.77
Rate for Payer: Multiplan Commercial	$92.77
Rate for Payer: Multiplan Workers Comp	$92.77
Rate for Payer: Scott and White EPO/PPO	$71.36
Rate for Payer: Superior Health Plan EPO	$19.41

SUTURE, COATED VICRYL UND BR 3-0 LIGAPAK 54'''' -- DHF

Facility

$142.72

Hospital Charge Code	81943706
Hospital Revenue Code	272
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$92.77
Rate for Payer: Aetna Commercial	$78.50
Rate for Payer: Amerigroup CHIP/Medicaid	$12.84
Rate for Payer: BCBS of TX Blue Advantage	$42.82
Rate for Payer: BCBS of TX Blue Essentials	$51.38
Rate for Payer: BCBS of TX PPO	$57.09
Rate for Payer: Cash Price	$125.59
Rate for Payer: Multiplan Auto	$92.77
Rate for Payer: Multiplan Commercial	$92.77
Rate for Payer: Multiplan Workers Comp	$92.77
Rate for Payer: Scott and White EPO/PPO	$71.36
Rate for Payer: Superior Health Plan EPO	$19.41

SUTURE, COATED VICRYL UND BR 3-0 OB GYN 18'''' PS-2 -- DHF

Facility

$147.62

Hospital Charge Code	81944456
Hospital Revenue Code	272
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$95.95
Rate for Payer: Aetna Commercial	$81.19
Rate for Payer: Amerigroup CHIP/Medicaid	$13.29
Rate for Payer: BCBS of TX Blue Advantage	$44.29
Rate for Payer: BCBS of TX Blue Essentials	$53.14
Rate for Payer: BCBS of TX PPO	$59.05
Rate for Payer: Cash Price	$129.91
Rate for Payer: Multiplan Auto	$95.95
Rate for Payer: Multiplan Commercial	$95.95
Rate for Payer: Multiplan Workers Comp	$95.95
Rate for Payer: Scott and White EPO/PPO	$73.81
Rate for Payer: Superior Health Plan EPO	$20.08

SUTURE, COATED VICRYL UND BR 3-0 PLASTIC 18'''' PS-1 -- DHF

Facility

$202.44

Hospital Charge Code	81944704
Hospital Revenue Code	272
Rate for Payer: Cash Price	$178.15

SUTURE, COATED VICRYL UND BR 3-0 PLASTIC 18'''' PS-1 -- DHF

Facility

$202.44

Hospital Charge Code	81944704
Hospital Revenue Code	272
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$131.59
Rate for Payer: Aetna Commercial	$111.34
Rate for Payer: Amerigroup CHIP/Medicaid	$18.22
Rate for Payer: BCBS of TX Blue Advantage	$60.73
Rate for Payer: BCBS of TX Blue Essentials	$72.88
Rate for Payer: BCBS of TX PPO	$80.98
Rate for Payer: Cash Price	$178.15
Rate for Payer: Multiplan Auto	$131.59
Rate for Payer: Multiplan Commercial	$131.59
Rate for Payer: Multiplan Workers Comp	$131.59
Rate for Payer: Scott and White EPO/PPO	$101.22
Rate for Payer: Superior Health Plan EPO	$27.53

SUTURE, COATED VICRYL UND BR 3-0 PLASTIC 18'''' PS-2 -- DHF

Facility

$257.57

Hospital Charge Code	81945107
Hospital Revenue Code	272
Min. Negotiated Rate	$23.18
Max. Negotiated Rate	$167.42
Rate for Payer: Aetna Commercial	$141.66
Rate for Payer: Amerigroup CHIP/Medicaid	$23.18
Rate for Payer: BCBS of TX Blue Advantage	$77.27
Rate for Payer: BCBS of TX Blue Essentials	$92.73
Rate for Payer: BCBS of TX PPO	$103.03
Rate for Payer: Cash Price	$226.66
Rate for Payer: Multiplan Auto	$167.42
Rate for Payer: Multiplan Commercial	$167.42
Rate for Payer: Multiplan Workers Comp	$167.42
Rate for Payer: Scott and White EPO/PPO	$128.78
Rate for Payer: Superior Health Plan EPO	$35.03

SUTURE, COATED VICRYL UND BR 3-0 PLASTIC 18'''' PS-2 -- DHF

Facility

$257.57

Hospital Charge Code	81945107
Hospital Revenue Code	272
Rate for Payer: Cash Price	$226.66

SUTURE, COATED VICRYL UND BR 3-0 SUTUPAK 12-18'''' SS -- DHF

Facility

$257.57

Hospital Charge Code	81944902
Hospital Revenue Code	272
Min. Negotiated Rate	$23.18
Max. Negotiated Rate	$167.42
Rate for Payer: Aetna Commercial	$141.66
Rate for Payer: Amerigroup CHIP/Medicaid	$23.18
Rate for Payer: BCBS of TX Blue Advantage	$77.27
Rate for Payer: BCBS of TX Blue Essentials	$92.73
Rate for Payer: BCBS of TX PPO	$103.03
Rate for Payer: Cash Price	$226.66
Rate for Payer: Multiplan Auto	$167.42
Rate for Payer: Multiplan Commercial	$167.42
Rate for Payer: Multiplan Workers Comp	$167.42
Rate for Payer: Scott and White EPO/PPO	$128.78
Rate for Payer: Superior Health Plan EPO	$35.03

SUTURE, COATED VICRYL UND BR 4-0 G.I. 27'''' SH -- DHF

Facility

$142.72

Hospital Charge Code	81943706
Hospital Revenue Code	272
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$92.77
Rate for Payer: Aetna Commercial	$78.50
Rate for Payer: Amerigroup CHIP/Medicaid	$12.84
Rate for Payer: BCBS of TX Blue Advantage	$42.82
Rate for Payer: BCBS of TX Blue Essentials	$51.38
Rate for Payer: BCBS of TX PPO	$57.09
Rate for Payer: Cash Price	$125.59
Rate for Payer: Multiplan Auto	$92.77
Rate for Payer: Multiplan Commercial	$92.77
Rate for Payer: Multiplan Workers Comp	$92.77
Rate for Payer: Scott and White EPO/PPO	$71.36
Rate for Payer: Superior Health Plan EPO	$19.41

SUTURE, COATED VICRYL UND BR 4-0 PLASTIC 18'''' P-3 -- DHF

Facility

$142.72

Hospital Charge Code	81943706
Hospital Revenue Code	272
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$92.77
Rate for Payer: Aetna Commercial	$78.50
Rate for Payer: Amerigroup CHIP/Medicaid	$12.84
Rate for Payer: BCBS of TX Blue Advantage	$42.82
Rate for Payer: BCBS of TX Blue Essentials	$51.38
Rate for Payer: BCBS of TX PPO	$57.09
Rate for Payer: Cash Price	$125.59
Rate for Payer: Multiplan Auto	$92.77
Rate for Payer: Multiplan Commercial	$92.77
Rate for Payer: Multiplan Workers Comp	$92.77
Rate for Payer: Scott and White EPO/PPO	$71.36
Rate for Payer: Superior Health Plan EPO	$19.41

SUTURE, COATED VICRYL UND BR 4-0 URL. 27'''' RB-1 -- DHF

Facility

$142.72

Hospital Charge Code	81943706
Hospital Revenue Code	272
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$92.77
Rate for Payer: Aetna Commercial	$78.50
Rate for Payer: Amerigroup CHIP/Medicaid	$12.84
Rate for Payer: BCBS of TX Blue Advantage	$42.82
Rate for Payer: BCBS of TX Blue Essentials	$51.38
Rate for Payer: BCBS of TX PPO	$57.09
Rate for Payer: Cash Price	$125.59
Rate for Payer: Multiplan Auto	$92.77
Rate for Payer: Multiplan Commercial	$92.77
Rate for Payer: Multiplan Workers Comp	$92.77
Rate for Payer: Scott and White EPO/PPO	$71.36
Rate for Payer: Superior Health Plan EPO	$19.41

SUTURE, COATED VICRYL UNDYED BR 0 OB-GYN 27'''' CT-1 -- DHF

Facility

$147.62

Hospital Charge Code	81944456
Hospital Revenue Code	272
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$95.95
Rate for Payer: Aetna Commercial	$81.19
Rate for Payer: Amerigroup CHIP/Medicaid	$13.29
Rate for Payer: BCBS of TX Blue Advantage	$44.29
Rate for Payer: BCBS of TX Blue Essentials	$53.14
Rate for Payer: BCBS of TX PPO	$59.05
Rate for Payer: Cash Price	$129.91
Rate for Payer: Multiplan Auto	$95.95
Rate for Payer: Multiplan Commercial	$95.95
Rate for Payer: Multiplan Workers Comp	$95.95
Rate for Payer: Scott and White EPO/PPO	$73.81
Rate for Payer: Superior Health Plan EPO	$20.08

SUTURE, COATED VICRYL VIL BR 0 OB-GYN 36'''' CP-1 -- DHF

Facility

$147.62

Hospital Charge Code	81944456
Hospital Revenue Code	272
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$95.95
Rate for Payer: Aetna Commercial	$81.19
Rate for Payer: Amerigroup CHIP/Medicaid	$13.29
Rate for Payer: BCBS of TX Blue Advantage	$44.29
Rate for Payer: BCBS of TX Blue Essentials	$53.14
Rate for Payer: BCBS of TX PPO	$59.05
Rate for Payer: Cash Price	$129.91
Rate for Payer: Multiplan Auto	$95.95
Rate for Payer: Multiplan Commercial	$95.95
Rate for Payer: Multiplan Workers Comp	$95.95
Rate for Payer: Scott and White EPO/PPO	$73.81
Rate for Payer: Superior Health Plan EPO	$20.08

SUTURE, COATED VICRYL VIL BR 0 OB-GYN 8-18 CR CT-2 -- DHF

Facility

$257.57

Hospital Charge Code	81944902
Hospital Revenue Code	272
Min. Negotiated Rate	$23.18
Max. Negotiated Rate	$167.42
Rate for Payer: Aetna Commercial	$141.66
Rate for Payer: Amerigroup CHIP/Medicaid	$23.18
Rate for Payer: BCBS of TX Blue Advantage	$77.27
Rate for Payer: BCBS of TX Blue Essentials	$92.73
Rate for Payer: BCBS of TX PPO	$103.03
Rate for Payer: Cash Price	$226.66
Rate for Payer: Multiplan Auto	$167.42
Rate for Payer: Multiplan Commercial	$167.42
Rate for Payer: Multiplan Workers Comp	$167.42
Rate for Payer: Scott and White EPO/PPO	$128.78
Rate for Payer: Superior Health Plan EPO	$35.03

SUTURE, COATED VICRYL VIL BR 0 OB-GYN 8-18 CR CT-2 -- DHF

Facility

$257.57

Hospital Charge Code	81944902
Hospital Revenue Code	272
Rate for Payer: Cash Price	$226.66

SUTURE, COATED VICRYL VIL BR 0 URL. 27'''' UR-6 -- DHF

Facility

$142.72

Hospital Charge Code	81943706
Hospital Revenue Code	272
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$92.77
Rate for Payer: Aetna Commercial	$78.50
Rate for Payer: Amerigroup CHIP/Medicaid	$12.84
Rate for Payer: BCBS of TX Blue Advantage	$42.82
Rate for Payer: BCBS of TX Blue Essentials	$51.38
Rate for Payer: BCBS of TX PPO	$57.09
Rate for Payer: Cash Price	$125.59
Rate for Payer: Multiplan Auto	$92.77
Rate for Payer: Multiplan Commercial	$92.77
Rate for Payer: Multiplan Workers Comp	$92.77
Rate for Payer: Scott and White EPO/PPO	$71.36
Rate for Payer: Superior Health Plan EPO	$19.41

SUTURE, COATED VICRYL VIL BR 1 OB-GYN 36'''' CTX -- DHF

Facility

$147.62

Hospital Charge Code	81944456
Hospital Revenue Code	272
Rate for Payer: Cash Price	$129.91

SUTURE, COATED VICRYL VIL BR 1 OB-GYN 36'''' CTX -- DHF

Facility

$147.62

Hospital Charge Code	81944456
Hospital Revenue Code	272
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$95.95
Rate for Payer: Aetna Commercial	$81.19
Rate for Payer: Amerigroup CHIP/Medicaid	$13.29
Rate for Payer: BCBS of TX Blue Advantage	$44.29
Rate for Payer: BCBS of TX Blue Essentials	$53.14
Rate for Payer: BCBS of TX PPO	$59.05
Rate for Payer: Cash Price	$129.91
Rate for Payer: Multiplan Auto	$95.95
Rate for Payer: Multiplan Commercial	$95.95
Rate for Payer: Multiplan Workers Comp	$95.95
Rate for Payer: Scott and White EPO/PPO	$73.81
Rate for Payer: Superior Health Plan EPO	$20.08

SUTURE, COATED VICRYL VIL BR 2-0 CLS 8-18 COMPTMNT -- DHF

Facility

$39.31

Hospital Charge Code	81940058
Hospital Revenue Code	272
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$25.55
Rate for Payer: Aetna Commercial	$21.62
Rate for Payer: Amerigroup CHIP/Medicaid	$3.54
Rate for Payer: BCBS of TX Blue Advantage	$11.79
Rate for Payer: BCBS of TX Blue Essentials	$14.15
Rate for Payer: BCBS of TX PPO	$15.72
Rate for Payer: Cash Price	$34.59
Rate for Payer: Multiplan Auto	$25.55
Rate for Payer: Multiplan Commercial	$25.55
Rate for Payer: Multiplan Workers Comp	$25.55
Rate for Payer: Scott and White EPO/PPO	$19.66
Rate for Payer: Superior Health Plan EPO	$5.35

SUTURE, COATED VICRYL VIL BR 2-0 CLS 8-18 COMPTMNT -- DHF

Facility

$39.31

Hospital Charge Code	81940058
Hospital Revenue Code	272
Rate for Payer: Cash Price	$34.59

SUTURE, COATED VICRYL VIL BR 2-0 G.I. 27'''' MH -- DHF

Facility

$147.62

Hospital Charge Code	81940207
Hospital Revenue Code	272
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$95.95
Rate for Payer: Aetna Commercial	$81.19
Rate for Payer: Amerigroup CHIP/Medicaid	$13.29
Rate for Payer: BCBS of TX Blue Advantage	$44.29
Rate for Payer: BCBS of TX Blue Essentials	$53.14
Rate for Payer: BCBS of TX PPO	$59.05
Rate for Payer: Cash Price	$129.91
Rate for Payer: Multiplan Auto	$95.95
Rate for Payer: Multiplan Commercial	$95.95
Rate for Payer: Multiplan Workers Comp	$95.95
Rate for Payer: Scott and White EPO/PPO	$73.81
Rate for Payer: Superior Health Plan EPO	$20.08

SUTURE, COATED VICRYL VIL BR 2 CARDIO 4-27'''' TP-1 -- DHF

Facility

$642.60

Hospital Charge Code	81941551
Hospital Revenue Code	272
Min. Negotiated Rate	$57.83
Max. Negotiated Rate	$417.69
Rate for Payer: Aetna Commercial	$353.43
Rate for Payer: Amerigroup CHIP/Medicaid	$57.83
Rate for Payer: BCBS of TX Blue Advantage	$192.78
Rate for Payer: BCBS of TX Blue Essentials	$231.34
Rate for Payer: BCBS of TX PPO	$257.04
Rate for Payer: Cash Price	$565.49
Rate for Payer: Multiplan Auto	$417.69
Rate for Payer: Multiplan Commercial	$417.69
Rate for Payer: Multiplan Workers Comp	$417.69
Rate for Payer: Scott and White EPO/PPO	$321.30
Rate for Payer: Superior Health Plan EPO	$87.39

SUTURE, COATED VICRYL VIL BR 3-0 CLOSURE 27'''' CT-1 -- DHF

Facility

$142.72

Hospital Charge Code	81943706
Hospital Revenue Code	272
Rate for Payer: Cash Price	$125.59

Know your out-of-pocket cost for care.

All Charges