White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SUTURE, PGA-PCL DBL-ARM 4-0 3/8 CIR TAPER 7X7CM -- DHF

Facility

$124.04

Hospital Charge Code	81943557
Hospital Revenue Code	272
Min. Negotiated Rate	$11.16
Max. Negotiated Rate	$80.63
Rate for Payer: Aetna Commercial	$68.22
Rate for Payer: Amerigroup CHIP/Medicaid	$11.16
Rate for Payer: BCBS of TX Blue Advantage	$37.21
Rate for Payer: BCBS of TX Blue Essentials	$44.65
Rate for Payer: BCBS of TX PPO	$49.62
Rate for Payer: Cash Price	$109.16
Rate for Payer: Multiplan Auto	$80.63
Rate for Payer: Multiplan Commercial	$80.63
Rate for Payer: Multiplan Workers Comp	$80.63
Rate for Payer: Scott and White EPO/PPO	$62.02
Rate for Payer: Superior Health Plan EPO	$16.87

SUTURE, PGA-PCL DBL-ARM 4-0 3/8 CIR TAPER 7X7CM -- DHF

Facility

$124.04

Hospital Charge Code	81943557
Hospital Revenue Code	272
Rate for Payer: Cash Price	$109.16

SUTURE, POLYBLEND BLUE BR 2 TAPERD NDL 1/2 CIR 38'''' -- DHF

Facility

$253.17

Hospital Charge Code	81941502
Hospital Revenue Code	272
Min. Negotiated Rate	$22.79
Max. Negotiated Rate	$164.56
Rate for Payer: Aetna Commercial	$139.24
Rate for Payer: Amerigroup CHIP/Medicaid	$22.79
Rate for Payer: BCBS of TX Blue Advantage	$75.95
Rate for Payer: BCBS of TX Blue Essentials	$91.14
Rate for Payer: BCBS of TX PPO	$101.27
Rate for Payer: Cash Price	$222.79
Rate for Payer: Multiplan Auto	$164.56
Rate for Payer: Multiplan Commercial	$164.56
Rate for Payer: Multiplan Workers Comp	$164.56
Rate for Payer: Scott and White EPO/PPO	$126.58
Rate for Payer: Superior Health Plan EPO	$34.43

SUTURE, POLYBLEND BLUE BR 2 TAPERD NDL 1/2 CIR 38'''' -- DHF

Facility

$253.17

Hospital Charge Code	81941502
Hospital Revenue Code	272
Rate for Payer: Cash Price	$222.79

SUTURE, PROLENE BL MONO 1 CLOSURE 30'''' CT-1 -- DHF

Facility

$276.09

Hospital Charge Code	81941601
Hospital Revenue Code	272
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$179.46
Rate for Payer: Aetna Commercial	$151.85
Rate for Payer: Amerigroup CHIP/Medicaid	$24.85
Rate for Payer: BCBS of TX Blue Advantage	$82.83
Rate for Payer: BCBS of TX Blue Essentials	$99.39
Rate for Payer: BCBS of TX PPO	$110.44
Rate for Payer: Cash Price	$242.96
Rate for Payer: Multiplan Auto	$179.46
Rate for Payer: Multiplan Commercial	$179.46
Rate for Payer: Multiplan Workers Comp	$179.46
Rate for Payer: Scott and White EPO/PPO	$138.04
Rate for Payer: Superior Health Plan EPO	$37.55

SUTURE, PROLENE BL MONO 2-0 CARDIO 30'''' SH -- DHF

Facility

$276.09

Hospital Charge Code	81941601
Hospital Revenue Code	272
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$179.46
Rate for Payer: Aetna Commercial	$151.85
Rate for Payer: Amerigroup CHIP/Medicaid	$24.85
Rate for Payer: BCBS of TX Blue Advantage	$82.83
Rate for Payer: BCBS of TX Blue Essentials	$99.39
Rate for Payer: BCBS of TX PPO	$110.44
Rate for Payer: Cash Price	$242.96
Rate for Payer: Multiplan Auto	$179.46
Rate for Payer: Multiplan Commercial	$179.46
Rate for Payer: Multiplan Workers Comp	$179.46
Rate for Payer: Scott and White EPO/PPO	$138.04
Rate for Payer: Superior Health Plan EPO	$37.55

SUTURE, PROLENE BL MONO 2-0 CARDIO 36'''' MH,MH -- DHF

Facility

$308.30

Hospital Charge Code	81940454
Hospital Revenue Code	272
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$200.40
Rate for Payer: Aetna Commercial	$169.56
Rate for Payer: Amerigroup CHIP/Medicaid	$27.75
Rate for Payer: BCBS of TX Blue Advantage	$92.49
Rate for Payer: BCBS of TX Blue Essentials	$110.99
Rate for Payer: BCBS of TX PPO	$123.32
Rate for Payer: Cash Price	$271.30
Rate for Payer: Multiplan Auto	$200.40
Rate for Payer: Multiplan Commercial	$200.40
Rate for Payer: Multiplan Workers Comp	$200.40
Rate for Payer: Scott and White EPO/PPO	$154.15
Rate for Payer: Superior Health Plan EPO	$41.93

SUTURE, PROLENE BL MONO 3-0 PLASTIC 18'''' PS-2 -- DHF

Facility

$276.09

Hospital Charge Code	81941601
Hospital Revenue Code	272
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$179.46
Rate for Payer: Aetna Commercial	$151.85
Rate for Payer: Amerigroup CHIP/Medicaid	$24.85
Rate for Payer: BCBS of TX Blue Advantage	$82.83
Rate for Payer: BCBS of TX Blue Essentials	$99.39
Rate for Payer: BCBS of TX PPO	$110.44
Rate for Payer: Cash Price	$242.96
Rate for Payer: Multiplan Auto	$179.46
Rate for Payer: Multiplan Commercial	$179.46
Rate for Payer: Multiplan Workers Comp	$179.46
Rate for Payer: Scott and White EPO/PPO	$138.04
Rate for Payer: Superior Health Plan EPO	$37.55

SUTURE, PROLENE BL MONO 5-0 CARDIO 30'''' RB-2,RB-2 -- DHF

Facility

$308.30

Hospital Charge Code	81940454
Hospital Revenue Code	272
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$200.40
Rate for Payer: Aetna Commercial	$169.56
Rate for Payer: Amerigroup CHIP/Medicaid	$27.75
Rate for Payer: BCBS of TX Blue Advantage	$92.49
Rate for Payer: BCBS of TX Blue Essentials	$110.99
Rate for Payer: BCBS of TX PPO	$123.32
Rate for Payer: Cash Price	$271.30
Rate for Payer: Multiplan Auto	$200.40
Rate for Payer: Multiplan Commercial	$200.40
Rate for Payer: Multiplan Workers Comp	$200.40
Rate for Payer: Scott and White EPO/PPO	$154.15
Rate for Payer: Superior Health Plan EPO	$41.93

SUTURE, PROLENE BL MONO 5-0 PLASTIC 18'''' PS-2 12/BX -- DHF

Facility

$276.09

Hospital Charge Code	81941601
Hospital Revenue Code	272
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$179.46
Rate for Payer: Aetna Commercial	$151.85
Rate for Payer: Amerigroup CHIP/Medicaid	$24.85
Rate for Payer: BCBS of TX Blue Advantage	$82.83
Rate for Payer: BCBS of TX Blue Essentials	$99.39
Rate for Payer: BCBS of TX PPO	$110.44
Rate for Payer: Cash Price	$242.96
Rate for Payer: Multiplan Auto	$179.46
Rate for Payer: Multiplan Commercial	$179.46
Rate for Payer: Multiplan Workers Comp	$179.46
Rate for Payer: Scott and White EPO/PPO	$138.04
Rate for Payer: Superior Health Plan EPO	$37.55

SUTURE, PROLENE BL MONO 5-0 PLASTIC 18'''' PS-2 12/BX -- DHF

Facility

$276.09

Hospital Charge Code	81941601
Hospital Revenue Code	272
Rate for Payer: Cash Price	$242.96

SUTURE, PROLENE BL MONO 6-0 CARDIO 24'''' BV-1,BV-1 -- DHF

Facility

$308.30

Hospital Charge Code	81940454
Hospital Revenue Code	272
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$200.40
Rate for Payer: Aetna Commercial	$169.56
Rate for Payer: Amerigroup CHIP/Medicaid	$27.75
Rate for Payer: BCBS of TX Blue Advantage	$92.49
Rate for Payer: BCBS of TX Blue Essentials	$110.99
Rate for Payer: BCBS of TX PPO	$123.32
Rate for Payer: Cash Price	$271.30
Rate for Payer: Multiplan Auto	$200.40
Rate for Payer: Multiplan Commercial	$200.40
Rate for Payer: Multiplan Workers Comp	$200.40
Rate for Payer: Scott and White EPO/PPO	$154.15
Rate for Payer: Superior Health Plan EPO	$41.93

SUTURE, PROLENE BL MONO 6-0 CARDIO 30'''' C-1,C-1 -- DHF

Facility

$308.30

Hospital Charge Code	81940454
Hospital Revenue Code	272
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$200.40
Rate for Payer: Aetna Commercial	$169.56
Rate for Payer: Amerigroup CHIP/Medicaid	$27.75
Rate for Payer: BCBS of TX Blue Advantage	$92.49
Rate for Payer: BCBS of TX Blue Essentials	$110.99
Rate for Payer: BCBS of TX PPO	$123.32
Rate for Payer: Cash Price	$271.30
Rate for Payer: Multiplan Auto	$200.40
Rate for Payer: Multiplan Commercial	$200.40
Rate for Payer: Multiplan Workers Comp	$200.40
Rate for Payer: Scott and White EPO/PPO	$154.15
Rate for Payer: Superior Health Plan EPO	$41.93

SUTURE, PROLENE BL MONO 7-0 CARDIO 2-30'''' BV175-6 -- 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, PROLENE BL MONO 7-0 CARDIO 2-30'''' BV175-6 -- DHF

Facility

$642.60

Hospital Charge Code	81941551
Hospital Revenue Code	272
Rate for Payer: Cash Price	$565.49

SUTURE, PROLENE BL MONO 7-0 CARDIO 24'''' BV-1,BV-1 -- DHF

Facility

$308.30

Hospital Charge Code	81940454
Hospital Revenue Code	272
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$200.40
Rate for Payer: Aetna Commercial	$169.56
Rate for Payer: Amerigroup CHIP/Medicaid	$27.75
Rate for Payer: BCBS of TX Blue Advantage	$92.49
Rate for Payer: BCBS of TX Blue Essentials	$110.99
Rate for Payer: BCBS of TX PPO	$123.32
Rate for Payer: Cash Price	$271.30
Rate for Payer: Multiplan Auto	$200.40
Rate for Payer: Multiplan Commercial	$200.40
Rate for Payer: Multiplan Workers Comp	$200.40
Rate for Payer: Scott and White EPO/PPO	$154.15
Rate for Payer: Superior Health Plan EPO	$41.93

SUTURE, PROLENE BL MONO 7-0 CARDIO 24'''' BV-1,BV-1 -- DHF

Facility

$308.30

Hospital Charge Code	81940454
Hospital Revenue Code	272
Rate for Payer: Cash Price	$271.30

suture quill 3-0monoderm 3.5x3.5 ya1019q

Facility

$42.40

Hospital Charge Code	8626512
Hospital Revenue Code	272
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$27.56
Rate for Payer: Aetna Commercial	$23.32
Rate for Payer: Amerigroup CHIP/Medicaid	$3.82
Rate for Payer: BCBS of TX Blue Advantage	$12.72
Rate for Payer: BCBS of TX Blue Essentials	$15.26
Rate for Payer: BCBS of TX PPO	$16.96
Rate for Payer: Cash Price	$37.31
Rate for Payer: Multiplan Auto	$27.56
Rate for Payer: Multiplan Commercial	$27.56
Rate for Payer: Multiplan Workers Comp	$27.56
Rate for Payer: Scott and White EPO/PPO	$21.20
Rate for Payer: Superior Health Plan EPO	$5.77

suture quill 3-0monoderm 3.5x3.5 ya1019q

Facility

$42.40

Hospital Charge Code	8626512
Hospital Revenue Code	272
Rate for Payer: Cash Price	$37.31

SUTURE QUILL MONDERM 14X14 YA-1016Q-0

Facility

$73.87

Hospital Charge Code	145345
Hospital Revenue Code	272
Rate for Payer: Cash Price	$65.01

SUTURE QUILL MONDERM 14X14 YA-1016Q-0

Facility

$73.87

Hospital Charge Code	145345
Hospital Revenue Code	272
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$48.02
Rate for Payer: Aetna Commercial	$40.63
Rate for Payer: Amerigroup CHIP/Medicaid	$6.65
Rate for Payer: BCBS of TX Blue Advantage	$22.16
Rate for Payer: BCBS of TX Blue Essentials	$26.59
Rate for Payer: BCBS of TX PPO	$29.55
Rate for Payer: Cash Price	$65.01
Rate for Payer: Multiplan Auto	$48.02
Rate for Payer: Multiplan Commercial	$48.02
Rate for Payer: Multiplan Workers Comp	$48.02
Rate for Payer: Scott and White EPO/PPO	$36.94
Rate for Payer: Superior Health Plan EPO	$10.05

SUTURE QUILL MONODERM 3-0 7X7 YA-1001Q-0

Facility

$56.61

Hospital Charge Code	145344
Hospital Revenue Code	272
Min. Negotiated Rate	$5.09
Max. Negotiated Rate	$36.80
Rate for Payer: Aetna Commercial	$31.14
Rate for Payer: Amerigroup CHIP/Medicaid	$5.09
Rate for Payer: BCBS of TX Blue Advantage	$16.98
Rate for Payer: BCBS of TX Blue Essentials	$20.38
Rate for Payer: BCBS of TX PPO	$22.64
Rate for Payer: Cash Price	$49.82
Rate for Payer: Multiplan Auto	$36.80
Rate for Payer: Multiplan Commercial	$36.80
Rate for Payer: Multiplan Workers Comp	$36.80
Rate for Payer: Scott and White EPO/PPO	$28.30
Rate for Payer: Superior Health Plan EPO	$7.70

SUTURE QUILL MONODERM 3-0 7X7 YA-1001Q-0

Facility

$56.61

Hospital Charge Code	145344
Hospital Revenue Code	272
Rate for Payer: Cash Price	$49.82

SUTURE, SILK BLK BR 0 G.I.,CARDIO 30'''' SH -- 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

SUTURE, SILK BLK BR 0 G.I.,CARDIO 30'''' SH -- DHF

Facility

$115.36

Hospital Charge Code	81943656
Hospital Revenue Code	272
Rate for Payer: Cash Price	$101.52

Know your out-of-pocket cost for care.

All Charges