White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SUTURE, ETHILON BLK MONO3-0 PLAST. 18'''' PS-1 12/BX -- 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, ETHILON BLK MONO 3-0 PLASTIC 18'''' PS-1 -- DHF

Facility

$234.19

Hospital Charge Code	81941452
Hospital Revenue Code	272
Min. Negotiated Rate	$21.08
Max. Negotiated Rate	$152.22
Rate for Payer: Aetna Commercial	$128.80
Rate for Payer: Amerigroup CHIP/Medicaid	$21.08
Rate for Payer: BCBS of TX Blue Advantage	$70.26
Rate for Payer: BCBS of TX Blue Essentials	$84.31
Rate for Payer: BCBS of TX PPO	$93.68
Rate for Payer: Cash Price	$206.09
Rate for Payer: Multiplan Auto	$152.22
Rate for Payer: Multiplan Commercial	$152.22
Rate for Payer: Multiplan Workers Comp	$152.22
Rate for Payer: Scott and White EPO/PPO	$117.10
Rate for Payer: Superior Health Plan EPO	$31.85

SUTURE, ETHILON BLK MONO 4-0 CUTICULAR 18'' FS-2 -- DHF

Facility

$234.19

Hospital Charge Code	81941452
Hospital Revenue Code	272
Min. Negotiated Rate	$21.08
Max. Negotiated Rate	$152.22
Rate for Payer: Aetna Commercial	$128.80
Rate for Payer: Amerigroup CHIP/Medicaid	$21.08
Rate for Payer: BCBS of TX Blue Advantage	$70.26
Rate for Payer: BCBS of TX Blue Essentials	$84.31
Rate for Payer: BCBS of TX PPO	$93.68
Rate for Payer: Cash Price	$206.09
Rate for Payer: Multiplan Auto	$152.22
Rate for Payer: Multiplan Commercial	$152.22
Rate for Payer: Multiplan Workers Comp	$152.22
Rate for Payer: Scott and White EPO/PPO	$117.10
Rate for Payer: Superior Health Plan EPO	$31.85

SUTURE, ETHILON BLK MONO 4-0 CUTICULAR 18'' FS-2 -- DHF

Facility

$234.19

Hospital Charge Code	81941452
Hospital Revenue Code	272
Rate for Payer: Cash Price	$206.09

SUTURE, ETHILON BLK MONO 4-0 PLAST. 18'''' PS-2 36/BX -- DHF

Facility

$234.19

Hospital Charge Code	81941452
Hospital Revenue Code	272
Min. Negotiated Rate	$21.08
Max. Negotiated Rate	$152.22
Rate for Payer: Aetna Commercial	$128.80
Rate for Payer: Amerigroup CHIP/Medicaid	$21.08
Rate for Payer: BCBS of TX Blue Advantage	$70.26
Rate for Payer: BCBS of TX Blue Essentials	$84.31
Rate for Payer: BCBS of TX PPO	$93.68
Rate for Payer: Cash Price	$206.09
Rate for Payer: Multiplan Auto	$152.22
Rate for Payer: Multiplan Commercial	$152.22
Rate for Payer: Multiplan Workers Comp	$152.22
Rate for Payer: Scott and White EPO/PPO	$117.10
Rate for Payer: Superior Health Plan EPO	$31.85

SUTURE, ETHILON BLK MONO 4-0 PLASTIC 18'''' PS-2 -- DHF

Facility

$234.19

Hospital Charge Code	81941452
Hospital Revenue Code	272
Min. Negotiated Rate	$21.08
Max. Negotiated Rate	$152.22
Rate for Payer: Aetna Commercial	$128.80
Rate for Payer: Amerigroup CHIP/Medicaid	$21.08
Rate for Payer: BCBS of TX Blue Advantage	$70.26
Rate for Payer: BCBS of TX Blue Essentials	$84.31
Rate for Payer: BCBS of TX PPO	$93.68
Rate for Payer: Cash Price	$206.09
Rate for Payer: Multiplan Auto	$152.22
Rate for Payer: Multiplan Commercial	$152.22
Rate for Payer: Multiplan Workers Comp	$152.22
Rate for Payer: Scott and White EPO/PPO	$117.10
Rate for Payer: Superior Health Plan EPO	$31.85

SUTURE, ETHILON BLK MONO 5-0 PLASTIC 18'''' PS-2 -- DHF

Facility

$285.37

Hospital Charge Code	81941403
Hospital Revenue Code	272
Min. Negotiated Rate	$25.68
Max. Negotiated Rate	$185.49
Rate for Payer: Aetna Commercial	$156.95
Rate for Payer: Amerigroup CHIP/Medicaid	$25.68
Rate for Payer: BCBS of TX Blue Advantage	$85.61
Rate for Payer: BCBS of TX Blue Essentials	$102.73
Rate for Payer: BCBS of TX PPO	$114.15
Rate for Payer: Cash Price	$251.13
Rate for Payer: Multiplan Auto	$185.49
Rate for Payer: Multiplan Commercial	$185.49
Rate for Payer: Multiplan Workers Comp	$185.49
Rate for Payer: Scott and White EPO/PPO	$142.68
Rate for Payer: Superior Health Plan EPO	$38.81

SUTURE, ETHILON NYL BLK MONO 3-0 PLASTIC 18'''' PS-2 -- DHF

Facility

$234.19

Hospital Charge Code	81941452
Hospital Revenue Code	272
Min. Negotiated Rate	$21.08
Max. Negotiated Rate	$152.22
Rate for Payer: Aetna Commercial	$128.80
Rate for Payer: Amerigroup CHIP/Medicaid	$21.08
Rate for Payer: BCBS of TX Blue Advantage	$70.26
Rate for Payer: BCBS of TX Blue Essentials	$84.31
Rate for Payer: BCBS of TX PPO	$93.68
Rate for Payer: Cash Price	$206.09
Rate for Payer: Multiplan Auto	$152.22
Rate for Payer: Multiplan Commercial	$152.22
Rate for Payer: Multiplan Workers Comp	$152.22
Rate for Payer: Scott and White EPO/PPO	$117.10
Rate for Payer: Superior Health Plan EPO	$31.85

SUTURE, GUT CHR 1 OB-GYN 8-18'''' CR MO-4 -- DHF

Facility

$128.08

Hospital Charge Code	81944357
Hospital Revenue Code	272
Rate for Payer: Cash Price	$112.71

SUTURE, GUT CHR 1 OB-GYN 8-18'''' CR MO-4 -- DHF

Facility

$128.08

Hospital Charge Code	81944357
Hospital Revenue Code	272
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$83.25
Rate for Payer: Aetna Commercial	$70.44
Rate for Payer: Amerigroup CHIP/Medicaid	$11.53
Rate for Payer: BCBS of TX Blue Advantage	$38.42
Rate for Payer: BCBS of TX Blue Essentials	$46.11
Rate for Payer: BCBS of TX PPO	$51.23
Rate for Payer: Cash Price	$112.71
Rate for Payer: Multiplan Auto	$83.25
Rate for Payer: Multiplan Commercial	$83.25
Rate for Payer: Multiplan Workers Comp	$83.25
Rate for Payer: Scott and White EPO/PPO	$64.04
Rate for Payer: Superior Health Plan EPO	$17.42

suture hi-fi

Facility

$304.36

Hospital Charge Code	8640531
Hospital Revenue Code	272
Rate for Payer: Cash Price	$267.84

suture hi-fi

Facility

$304.36

Hospital Charge Code	8640531
Hospital Revenue Code	272
Min. Negotiated Rate	$27.39
Max. Negotiated Rate	$197.83
Rate for Payer: Aetna Commercial	$167.40
Rate for Payer: Amerigroup CHIP/Medicaid	$27.39
Rate for Payer: BCBS of TX Blue Advantage	$91.31
Rate for Payer: BCBS of TX Blue Essentials	$109.57
Rate for Payer: BCBS of TX PPO	$121.74
Rate for Payer: Cash Price	$267.84
Rate for Payer: Multiplan Auto	$197.83
Rate for Payer: Multiplan Commercial	$197.83
Rate for Payer: Multiplan Workers Comp	$197.83
Rate for Payer: Scott and White EPO/PPO	$152.18
Rate for Payer: Superior Health Plan EPO	$41.39

SUTURE HI-FI SZ 2

Facility

$128.85

Hospital Charge Code	145527
Hospital Revenue Code	272
Min. Negotiated Rate	$11.60
Max. Negotiated Rate	$83.75
Rate for Payer: Aetna Commercial	$70.87
Rate for Payer: Amerigroup CHIP/Medicaid	$11.60
Rate for Payer: BCBS of TX Blue Advantage	$38.66
Rate for Payer: BCBS of TX Blue Essentials	$46.39
Rate for Payer: BCBS of TX PPO	$51.54
Rate for Payer: Cash Price	$113.39
Rate for Payer: Multiplan Auto	$83.75
Rate for Payer: Multiplan Commercial	$83.75
Rate for Payer: Multiplan Workers Comp	$83.75
Rate for Payer: Scott and White EPO/PPO	$64.42
Rate for Payer: Superior Health Plan EPO	$17.52

SUTURE HI-FI SZ 2

Facility

$128.85

Hospital Charge Code	145527
Hospital Revenue Code	272
Rate for Payer: Cash Price	$113.39

suture hook

Facility

$280.80

Hospital Charge Code	140683
Hospital Revenue Code	272
Rate for Payer: Cash Price	$247.10

suture hook

Facility

$280.80

Hospital Charge Code	140683
Hospital Revenue Code	272
Min. Negotiated Rate	$25.27
Max. Negotiated Rate	$182.52
Rate for Payer: Aetna Commercial	$154.44
Rate for Payer: Amerigroup CHIP/Medicaid	$25.27
Rate for Payer: BCBS of TX Blue Advantage	$84.24
Rate for Payer: BCBS of TX Blue Essentials	$101.09
Rate for Payer: BCBS of TX PPO	$112.32
Rate for Payer: Cash Price	$247.10
Rate for Payer: Multiplan Auto	$182.52
Rate for Payer: Multiplan Commercial	$182.52
Rate for Payer: Multiplan Workers Comp	$182.52
Rate for Payer: Scott and White EPO/PPO	$140.40
Rate for Payer: Superior Health Plan EPO	$38.19

SUTURE, MONOCRYL UND MONO 2-0 OB-GYN 36'''' CT-1 -- 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 MONOCRYL UND MONO 3-0 PLASTIC 18'''' PS-2 -- DHF

Facility

$285.37

Hospital Charge Code	81941403
Hospital Revenue Code	272
Min. Negotiated Rate	$25.68
Max. Negotiated Rate	$185.49
Rate for Payer: Aetna Commercial	$156.95
Rate for Payer: Amerigroup CHIP/Medicaid	$25.68
Rate for Payer: BCBS of TX Blue Advantage	$85.61
Rate for Payer: BCBS of TX Blue Essentials	$102.73
Rate for Payer: BCBS of TX PPO	$114.15
Rate for Payer: Cash Price	$251.13
Rate for Payer: Multiplan Auto	$185.49
Rate for Payer: Multiplan Commercial	$185.49
Rate for Payer: Multiplan Workers Comp	$185.49
Rate for Payer: Scott and White EPO/PPO	$142.68
Rate for Payer: Superior Health Plan EPO	$38.81

SUTURE, MONOCRYL UND MONO 3-0 PLASTIC 27'''' PS-2 -- 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, MONOCRYL UND MONO 4-0 PLASTIC 18'''' P-3 -- DHF

Facility

$285.37

Hospital Charge Code	81941403
Hospital Revenue Code	272
Rate for Payer: Cash Price	$251.13

SUTURE, MONOCRYL UND MONO 4-0 PLASTIC 18'''' P-3 -- DHF

Facility

$285.37

Hospital Charge Code	81941403
Hospital Revenue Code	272
Min. Negotiated Rate	$25.68
Max. Negotiated Rate	$185.49
Rate for Payer: Aetna Commercial	$156.95
Rate for Payer: Amerigroup CHIP/Medicaid	$25.68
Rate for Payer: BCBS of TX Blue Advantage	$85.61
Rate for Payer: BCBS of TX Blue Essentials	$102.73
Rate for Payer: BCBS of TX PPO	$114.15
Rate for Payer: Cash Price	$251.13
Rate for Payer: Multiplan Auto	$185.49
Rate for Payer: Multiplan Commercial	$185.49
Rate for Payer: Multiplan Workers Comp	$185.49
Rate for Payer: Scott and White EPO/PPO	$142.68
Rate for Payer: Superior Health Plan EPO	$38.81

SUTURE, MONOCRYL UND MONO 4-0 PLASTIC 18'''' PS-2 -- 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, MONOCRYL UND MONO 4-0 PLASTIC 27'''' PS-2 -- 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, MONOCRYL UND MONO 4-0 PLASTIC 27'''' PS-2 -- DHF

Facility

$147.62

Hospital Charge Code	81940207
Hospital Revenue Code	272
Rate for Payer: Cash Price	$129.91

SUTURE, MONODERM CLR 3-0 3.5X3.5CML DE12 NDL ABSRB -- DHF

Facility

$115.36

Hospital Charge Code	81943656
Hospital Revenue Code	272
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$74.98
Rate for Payer: Aetna Commercial	$63.45
Rate for Payer: Amerigroup CHIP/Medicaid	$10.38
Rate for Payer: BCBS of TX Blue Advantage	$34.61
Rate for Payer: BCBS of TX Blue Essentials	$41.53
Rate for Payer: BCBS of TX PPO	$46.14
Rate for Payer: Cash Price	$101.52
Rate for Payer: Multiplan Auto	$74.98
Rate for Payer: Multiplan Commercial	$74.98
Rate for Payer: Multiplan Workers Comp	$74.98
Rate for Payer: Scott and White EPO/PPO	$57.68
Rate for Payer: Superior Health Plan EPO	$15.69

Know your out-of-pocket cost for care.

All Charges