White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SUTURE, SILK BLK BR 0 LABYRINTH 6-18'''' -- DHF

Facility

$106.03

Hospital Charge Code	81941858
Hospital Revenue Code	272
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$68.92
Rate for Payer: Aetna Commercial	$58.32
Rate for Payer: Amerigroup CHIP/Medicaid	$9.54
Rate for Payer: BCBS of TX Blue Advantage	$31.81
Rate for Payer: BCBS of TX Blue Essentials	$38.17
Rate for Payer: BCBS of TX PPO	$42.41
Rate for Payer: Cash Price	$93.31
Rate for Payer: Multiplan Auto	$68.92
Rate for Payer: Multiplan Commercial	$68.92
Rate for Payer: Multiplan Workers Comp	$68.92
Rate for Payer: Scott and White EPO/PPO	$53.02
Rate for Payer: Superior Health Plan EPO	$14.42

SUTURE, SILK BLK BR 0 PLASTIC 18'''' PSL -- DHF

Facility

$106.03

Hospital Charge Code	81941700
Hospital Revenue Code	272
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$68.92
Rate for Payer: Aetna Commercial	$58.32
Rate for Payer: Amerigroup CHIP/Medicaid	$9.54
Rate for Payer: BCBS of TX Blue Advantage	$31.81
Rate for Payer: BCBS of TX Blue Essentials	$38.17
Rate for Payer: BCBS of TX PPO	$42.41
Rate for Payer: Cash Price	$93.31
Rate for Payer: Multiplan Auto	$68.92
Rate for Payer: Multiplan Commercial	$68.92
Rate for Payer: Multiplan Workers Comp	$68.92
Rate for Payer: Scott and White EPO/PPO	$53.02
Rate for Payer: Superior Health Plan EPO	$14.42

SUTURE, SILK BLK BR 2-0 G.I.,CARDIO 30'''' SH -- DHF

Facility

$106.03

Hospital Charge Code	81941700
Hospital Revenue Code	272
Rate for Payer: Cash Price	$93.31

SUTURE, SILK BLK BR 2-0 G.I.,CARDIO 30'''' SH -- DHF

Facility

$106.03

Hospital Charge Code	81941700
Hospital Revenue Code	272
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$68.92
Rate for Payer: Aetna Commercial	$58.32
Rate for Payer: Amerigroup CHIP/Medicaid	$9.54
Rate for Payer: BCBS of TX Blue Advantage	$31.81
Rate for Payer: BCBS of TX Blue Essentials	$38.17
Rate for Payer: BCBS of TX PPO	$42.41
Rate for Payer: Cash Price	$93.31
Rate for Payer: Multiplan Auto	$68.92
Rate for Payer: Multiplan Commercial	$68.92
Rate for Payer: Multiplan Workers Comp	$68.92
Rate for Payer: Scott and White EPO/PPO	$53.02
Rate for Payer: Superior Health Plan EPO	$14.42

SUTURE, SILK BLK BR 2-0 LABYRINTH 12-18'''' -- DHF

Facility

$106.03

Hospital Charge Code	81941858
Hospital Revenue Code	272
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$68.92
Rate for Payer: Aetna Commercial	$58.32
Rate for Payer: Amerigroup CHIP/Medicaid	$9.54
Rate for Payer: BCBS of TX Blue Advantage	$31.81
Rate for Payer: BCBS of TX Blue Essentials	$38.17
Rate for Payer: BCBS of TX PPO	$42.41
Rate for Payer: Cash Price	$93.31
Rate for Payer: Multiplan Auto	$68.92
Rate for Payer: Multiplan Commercial	$68.92
Rate for Payer: Multiplan Workers Comp	$68.92
Rate for Payer: Scott and White EPO/PPO	$53.02
Rate for Payer: Superior Health Plan EPO	$14.42

SUTURE, SILK BLK BR 3-0 LABYRINTH 12-18'''' -- DHF

Facility

$106.03

Hospital Charge Code	81941858
Hospital Revenue Code	272
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$68.92
Rate for Payer: Aetna Commercial	$58.32
Rate for Payer: Amerigroup CHIP/Medicaid	$9.54
Rate for Payer: BCBS of TX Blue Advantage	$31.81
Rate for Payer: BCBS of TX Blue Essentials	$38.17
Rate for Payer: BCBS of TX PPO	$42.41
Rate for Payer: Cash Price	$93.31
Rate for Payer: Multiplan Auto	$68.92
Rate for Payer: Multiplan Commercial	$68.92
Rate for Payer: Multiplan Workers Comp	$68.92
Rate for Payer: Scott and White EPO/PPO	$53.02
Rate for Payer: Superior Health Plan EPO	$14.42

SUTURE, SILK BLK BR 4-0 LABYRINTH 12-18'''' -- DHF

Facility

$106.03

Hospital Charge Code	81941858
Hospital Revenue Code	272
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$68.92
Rate for Payer: Aetna Commercial	$58.32
Rate for Payer: Amerigroup CHIP/Medicaid	$9.54
Rate for Payer: BCBS of TX Blue Advantage	$31.81
Rate for Payer: BCBS of TX Blue Essentials	$38.17
Rate for Payer: BCBS of TX PPO	$42.41
Rate for Payer: Cash Price	$93.31
Rate for Payer: Multiplan Auto	$68.92
Rate for Payer: Multiplan Commercial	$68.92
Rate for Payer: Multiplan Workers Comp	$68.92
Rate for Payer: Scott and White EPO/PPO	$53.02
Rate for Payer: Superior Health Plan EPO	$14.42

SUTURE, SILK BLK BR 4-0 LABYRINTH 12-18'''' -- DHF

Facility

$106.03

Hospital Charge Code	81941858
Hospital Revenue Code	272
Rate for Payer: Cash Price	$93.31

SUTURE STERLING GREAT WHITE

Facility

$989.72

Hospital Charge Code	8414481
Hospital Revenue Code	272
Min. Negotiated Rate	$89.07
Max. Negotiated Rate	$643.32
Rate for Payer: Aetna Commercial	$544.35
Rate for Payer: Amerigroup CHIP/Medicaid	$89.07
Rate for Payer: BCBS of TX Blue Advantage	$296.92
Rate for Payer: BCBS of TX Blue Essentials	$356.30
Rate for Payer: BCBS of TX PPO	$395.89
Rate for Payer: Cash Price	$870.95
Rate for Payer: Multiplan Auto	$643.32
Rate for Payer: Multiplan Commercial	$643.32
Rate for Payer: Multiplan Workers Comp	$643.32
Rate for Payer: Scott and White EPO/PPO	$494.86
Rate for Payer: Superior Health Plan EPO	$134.60

SUTURE STERLING GREAT WHITE

Facility

$989.72

Hospital Charge Code	8414481
Hospital Revenue Code	272
Rate for Payer: Cash Price	$870.95

SUTURE VLOC 180 0-GS22 9" VLOCL2246

Facility

$148.37

Hospital Charge Code	132068
Hospital Revenue Code	272
Rate for Payer: Cash Price	$130.57

SUTURE VLOC 180 0-GS22 9" VLOCL2246

Facility

$148.37

Hospital Charge Code	132068
Hospital Revenue Code	272
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$96.44
Rate for Payer: Aetna Commercial	$81.60
Rate for Payer: Amerigroup CHIP/Medicaid	$13.35
Rate for Payer: BCBS of TX Blue Advantage	$44.51
Rate for Payer: BCBS of TX Blue Essentials	$53.41
Rate for Payer: BCBS of TX PPO	$59.35
Rate for Payer: Cash Price	$130.57
Rate for Payer: Multiplan Auto	$96.44
Rate for Payer: Multiplan Commercial	$96.44
Rate for Payer: Multiplan Workers Comp	$96.44
Rate for Payer: Scott and White EPO/PPO	$74.18
Rate for Payer: Superior Health Plan EPO	$20.18

SUTURE, VLOC 180 2-0 ENDO VLOCA208L

Facility

$393.48

Hospital Charge Code	8570493
Hospital Revenue Code	272
Rate for Payer: Cash Price	$346.26

SUTURE, VLOC 180 2-0 ENDO VLOCA208L

Facility

$393.48

Hospital Charge Code	8570493
Hospital Revenue Code	272
Min. Negotiated Rate	$35.41
Max. Negotiated Rate	$255.76
Rate for Payer: Aetna Commercial	$216.41
Rate for Payer: Amerigroup CHIP/Medicaid	$35.41
Rate for Payer: BCBS of TX Blue Advantage	$118.04
Rate for Payer: BCBS of TX Blue Essentials	$141.65
Rate for Payer: BCBS of TX PPO	$157.39
Rate for Payer: Cash Price	$346.26
Rate for Payer: Multiplan Auto	$255.76
Rate for Payer: Multiplan Commercial	$255.76
Rate for Payer: Multiplan Workers Comp	$255.76
Rate for Payer: Scott and White EPO/PPO	$196.74
Rate for Payer: Superior Health Plan EPO	$53.51

SUTURE VLOC 90 2-0 GS-22 6"VLOCM2145

Facility

$145.19

Hospital Charge Code	81940207
Hospital Revenue Code	272
Min. Negotiated Rate	$13.07
Max. Negotiated Rate	$94.37
Rate for Payer: Aetna Commercial	$79.85
Rate for Payer: Amerigroup CHIP/Medicaid	$13.07
Rate for Payer: BCBS of TX Blue Advantage	$43.56
Rate for Payer: BCBS of TX Blue Essentials	$52.27
Rate for Payer: BCBS of TX PPO	$58.08
Rate for Payer: Cash Price	$127.77
Rate for Payer: Multiplan Auto	$94.37
Rate for Payer: Multiplan Commercial	$94.37
Rate for Payer: Multiplan Workers Comp	$94.37
Rate for Payer: Scott and White EPO/PPO	$72.60
Rate for Payer: Superior Health Plan EPO	$19.75

SUTURE VLOC 90 2-0 GS-22 6"VLOCM2145

Facility

$145.19

Hospital Charge Code	81940207
Hospital Revenue Code	272
Rate for Payer: Cash Price	$127.77

SUTURE V-LOC90 VLOCM2115

Facility

$108.79

Hospital Charge Code	136729
Hospital Revenue Code	272
Min. Negotiated Rate	$9.79
Max. Negotiated Rate	$70.71
Rate for Payer: Aetna Commercial	$59.83
Rate for Payer: Amerigroup CHIP/Medicaid	$9.79
Rate for Payer: BCBS of TX Blue Advantage	$32.64
Rate for Payer: BCBS of TX Blue Essentials	$39.16
Rate for Payer: BCBS of TX PPO	$43.52
Rate for Payer: Cash Price	$95.74
Rate for Payer: Multiplan Auto	$70.71
Rate for Payer: Multiplan Commercial	$70.71
Rate for Payer: Multiplan Workers Comp	$70.71
Rate for Payer: Scott and White EPO/PPO	$54.40
Rate for Payer: Superior Health Plan EPO	$14.80

SUTURE V-LOC90 VLOCM2115

Facility

$108.79

Hospital Charge Code	136729
Hospital Revenue Code	272
Rate for Payer: Cash Price	$95.74

SUTURE VLOC NON ABSORB OGS216 VLOCN0306

Facility

$138.29

Hospital Charge Code	122501
Hospital Revenue Code	272
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$89.89
Rate for Payer: Aetna Commercial	$76.06
Rate for Payer: Amerigroup CHIP/Medicaid	$12.45
Rate for Payer: BCBS of TX Blue Advantage	$41.49
Rate for Payer: BCBS of TX Blue Essentials	$49.78
Rate for Payer: BCBS of TX PPO	$55.32
Rate for Payer: Cash Price	$121.70
Rate for Payer: Multiplan Auto	$89.89
Rate for Payer: Multiplan Commercial	$89.89
Rate for Payer: Multiplan Workers Comp	$89.89
Rate for Payer: Scott and White EPO/PPO	$69.14
Rate for Payer: Superior Health Plan EPO	$18.81

SUTURE VLOC NON ABSORB OGS216 VLOCN0306

Facility

$138.29

Hospital Charge Code	122501
Hospital Revenue Code	272
Rate for Payer: Cash Price	$121.70

SUTURE VLOC NON-ABSORB V-20 6" VLOCNO605

Facility

$136.25

Hospital Charge Code	136341
Hospital Revenue Code	272
Min. Negotiated Rate	$12.26
Max. Negotiated Rate	$88.56
Rate for Payer: Aetna Commercial	$74.94
Rate for Payer: Amerigroup CHIP/Medicaid	$12.26
Rate for Payer: BCBS of TX Blue Advantage	$40.88
Rate for Payer: BCBS of TX Blue Essentials	$49.05
Rate for Payer: BCBS of TX PPO	$54.50
Rate for Payer: Cash Price	$119.90
Rate for Payer: Multiplan Auto	$88.56
Rate for Payer: Multiplan Commercial	$88.56
Rate for Payer: Multiplan Workers Comp	$88.56
Rate for Payer: Scott and White EPO/PPO	$68.12
Rate for Payer: Superior Health Plan EPO	$18.53

SUTURE VLOC NON-ABSORB V-20 6" VLOCNO605

Facility

$136.25

Hospital Charge Code	136341
Hospital Revenue Code	272
Rate for Payer: Cash Price	$119.90

SWEEN CRM -- DHF

Facility

$110.27

Hospital Charge Code	80343551
Hospital Revenue Code	270
Rate for Payer: Cash Price	$97.04

SWEEN CRM -- DHF

Facility

$110.27

Hospital Charge Code	80343551
Hospital Revenue Code	270
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$71.68
Rate for Payer: Aetna Commercial	$60.65
Rate for Payer: Amerigroup CHIP/Medicaid	$9.92
Rate for Payer: BCBS of TX Blue Advantage	$33.08
Rate for Payer: BCBS of TX Blue Essentials	$39.70
Rate for Payer: BCBS of TX PPO	$44.11
Rate for Payer: Cash Price	$97.04
Rate for Payer: Multiplan Auto	$71.68
Rate for Payer: Multiplan Commercial	$71.68
Rate for Payer: Multiplan Workers Comp	$71.68
Rate for Payer: Scott and White EPO/PPO	$55.14
Rate for Payer: Superior Health Plan EPO	$15.00

SWITCHING STICK

Facility

$774.43

Hospital Charge Code	8414480
Hospital Revenue Code	272
Rate for Payer: Cash Price	$681.50

Know your out-of-pocket cost for care.

All Charges