White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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	$185.45
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	$175.15
Rate for Payer: Cigna Medicaid	$185.45
Rate for Payer: Molina CHIP/Medicaid	$185.45
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: Parkland Medicaid	$185.45
Rate for Payer: Scott and White EPO/PPO	$128.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$185.45
Rate for Payer: Superior Health Plan EPO	$35.03

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

Facility

$147.62

Hospital Charge Code	81944456
Hospital Revenue Code	272
Rate for Payer: Cash Price	$100.38

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	$106.29
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	$100.38
Rate for Payer: Cigna Medicaid	$106.29
Rate for Payer: Molina CHIP/Medicaid	$106.29
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: Parkland Medicaid	$106.29
Rate for Payer: Scott and White EPO/PPO	$73.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$106.29
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
Rate for Payer: Cash Price	$26.73

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	$28.30
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	$26.73
Rate for Payer: Cigna Medicaid	$28.30
Rate for Payer: Molina CHIP/Medicaid	$28.30
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: Parkland Medicaid	$28.30
Rate for Payer: Scott and White EPO/PPO	$19.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$28.30
Rate for Payer: Superior Health Plan EPO	$5.35

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

Facility

$142.72

Hospital Charge Code	81943706
Hospital Revenue Code	272
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$102.76
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	$97.05
Rate for Payer: Cigna Medicaid	$102.76
Rate for Payer: Molina CHIP/Medicaid	$102.76
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: Parkland Medicaid	$102.76
Rate for Payer: Scott and White EPO/PPO	$71.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$102.76
Rate for Payer: Superior Health Plan EPO	$19.41

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	$97.05

SUTURE, COAT VCRYL VIL BR 3-0 G I 8-18 CRSH RLY PK -- DHF

Facility

$257.57

Hospital Charge Code	81944902
Hospital Revenue Code	272
Min. Negotiated Rate	$23.18
Max. Negotiated Rate	$185.45
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	$175.15
Rate for Payer: Cigna Medicaid	$185.45
Rate for Payer: Molina CHIP/Medicaid	$185.45
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: Parkland Medicaid	$185.45
Rate for Payer: Scott and White EPO/PPO	$128.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$185.45
Rate for Payer: Superior Health Plan EPO	$35.03

SUTURE, COAT VCRYL VIL BR 3-0 G I 8-18 CRSH RLY PK -- DHF

Facility

$257.57

Hospital Charge Code	81944902
Hospital Revenue Code	272
Rate for Payer: Cash Price	$175.15

SUTURE DYNACORD

Facility

$178.50

Hospital Charge Code	8512490
Hospital Revenue Code	272
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$128.52
Rate for Payer: Amerigroup CHIP/Medicaid	$16.07
Rate for Payer: BCBS of TX Blue Advantage	$53.55
Rate for Payer: BCBS of TX Blue Essentials	$64.26
Rate for Payer: BCBS of TX PPO	$71.40
Rate for Payer: Cash Price	$121.38
Rate for Payer: Cigna Medicaid	$128.52
Rate for Payer: Molina CHIP/Medicaid	$128.52
Rate for Payer: Multiplan Auto	$116.03
Rate for Payer: Multiplan Commercial	$116.03
Rate for Payer: Multiplan Workers Comp	$116.03
Rate for Payer: Parkland Medicaid	$128.52
Rate for Payer: Scott and White EPO/PPO	$89.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$128.52
Rate for Payer: Superior Health Plan EPO	$24.28

SUTURE DYNACORD

Facility

$178.50

Hospital Charge Code	8512490
Hospital Revenue Code	272
Rate for Payer: Cash Price	$121.38

SUTURE DYNACORD SGL BLUE W/MO-7 NDLE 222066

Facility

$509.62

Hospital Charge Code	145427
Hospital Revenue Code	272
Rate for Payer: Cash Price	$346.54

SUTURE DYNACORD SGL BLUE W/MO-7 NDLE 222066

Facility

$509.62

Hospital Charge Code	145427
Hospital Revenue Code	272
Min. Negotiated Rate	$45.87
Max. Negotiated Rate	$366.93
Rate for Payer: Amerigroup CHIP/Medicaid	$45.87
Rate for Payer: BCBS of TX Blue Advantage	$152.89
Rate for Payer: BCBS of TX Blue Essentials	$183.46
Rate for Payer: BCBS of TX PPO	$203.85
Rate for Payer: Cash Price	$346.54
Rate for Payer: Cigna Medicaid	$366.93
Rate for Payer: Molina CHIP/Medicaid	$366.93
Rate for Payer: Multiplan Auto	$331.25
Rate for Payer: Multiplan Commercial	$331.25
Rate for Payer: Multiplan Workers Comp	$331.25
Rate for Payer: Parkland Medicaid	$366.93
Rate for Payer: Scott and White EPO/PPO	$254.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$366.93
Rate for Payer: Superior Health Plan EPO	$69.31

SUTURE, ENDOSCOPIC OVERSTITCH 2-0 POLYPROPYLENE -- DHF

Facility

$331.79

Hospital Charge Code	81999021
Hospital Revenue Code	272
Rate for Payer: Cash Price	$225.62

SUTURE, ENDOSCOPIC OVERSTITCH 2-0 POLYPROPYLENE -- DHF

Facility

$331.79

Hospital Charge Code	81999021
Hospital Revenue Code	272
Min. Negotiated Rate	$29.86
Max. Negotiated Rate	$238.89
Rate for Payer: Amerigroup CHIP/Medicaid	$29.86
Rate for Payer: BCBS of TX Blue Advantage	$99.54
Rate for Payer: BCBS of TX Blue Essentials	$119.44
Rate for Payer: BCBS of TX PPO	$132.72
Rate for Payer: Cash Price	$225.62
Rate for Payer: Cigna Medicaid	$238.89
Rate for Payer: Molina CHIP/Medicaid	$238.89
Rate for Payer: Multiplan Auto	$215.66
Rate for Payer: Multiplan Commercial	$215.66
Rate for Payer: Multiplan Workers Comp	$215.66
Rate for Payer: Parkland Medicaid	$238.89
Rate for Payer: Scott and White EPO/PPO	$165.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$238.89
Rate for Payer: Superior Health Plan EPO	$45.12

SUTURE, ETHIBOND EXCEL, 0, MH, 36, GREN

Facility

$17.62

Hospital Charge Code	992766
Hospital Revenue Code	272
Rate for Payer: Cash Price	$11.98

SUTURE, ETHIBOND EXCEL, 0, MH, 36, GREN

Facility

$17.62

Hospital Charge Code	992766
Hospital Revenue Code	272
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$12.69
Rate for Payer: Amerigroup CHIP/Medicaid	$1.59
Rate for Payer: BCBS of TX Blue Advantage	$5.29
Rate for Payer: BCBS of TX Blue Essentials	$6.34
Rate for Payer: BCBS of TX PPO	$7.05
Rate for Payer: Cash Price	$11.98
Rate for Payer: Cigna Medicaid	$12.69
Rate for Payer: Molina CHIP/Medicaid	$12.69
Rate for Payer: Multiplan Auto	$11.45
Rate for Payer: Multiplan Commercial	$11.45
Rate for Payer: Multiplan Workers Comp	$11.45
Rate for Payer: Parkland Medicaid	$12.69
Rate for Payer: Scott and White EPO/PPO	$8.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.69
Rate for Payer: Superior Health Plan EPO	$2.40

SUTURE, ETHIBOND EXCEL, 2-0, SH, 30, GREN

Facility

$6.73

Hospital Charge Code	992886
Hospital Revenue Code	272
Rate for Payer: Cash Price	$4.58

SUTURE, ETHIBOND EXCEL, 2-0, SH, 30, GREN

Facility

$6.73

Hospital Charge Code	992886
Hospital Revenue Code	272
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$4.85
Rate for Payer: Amerigroup CHIP/Medicaid	$0.61
Rate for Payer: BCBS of TX Blue Advantage	$2.02
Rate for Payer: BCBS of TX Blue Essentials	$2.42
Rate for Payer: BCBS of TX PPO	$2.69
Rate for Payer: Cash Price	$4.58
Rate for Payer: Cigna Medicaid	$4.85
Rate for Payer: Molina CHIP/Medicaid	$4.85
Rate for Payer: Multiplan Auto	$4.37
Rate for Payer: Multiplan Commercial	$4.37
Rate for Payer: Multiplan Workers Comp	$4.37
Rate for Payer: Parkland Medicaid	$4.85
Rate for Payer: Scott and White EPO/PPO	$3.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.85
Rate for Payer: Superior Health Plan EPO	$0.92

SUTURE, ETHIBOND GRN BR 3-0 CARDIO 36' RB-1,RB-1 -- DHF

Facility

$276.09

Hospital Charge Code	81940405
Hospital Revenue Code	272
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$198.78
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	$187.74
Rate for Payer: Cigna Medicaid	$198.78
Rate for Payer: Molina CHIP/Medicaid	$198.78
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: Parkland Medicaid	$198.78
Rate for Payer: Scott and White EPO/PPO	$138.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$198.78
Rate for Payer: Superior Health Plan EPO	$37.55

SUTURE, ETHIBOND GRN BR 3-0 CARDIO 36' RB-1,RB-1 -- DHF

Facility

$276.09

Hospital Charge Code	81940405
Hospital Revenue Code	272
Rate for Payer: Cash Price	$187.74

SUTURE, ETHILON,3-0,PC-5,18, BLACK

Facility

$14.37

Hospital Charge Code	992841
Hospital Revenue Code	272
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$10.35
Rate for Payer: Amerigroup CHIP/Medicaid	$1.29
Rate for Payer: BCBS of TX Blue Advantage	$4.31
Rate for Payer: BCBS of TX Blue Essentials	$5.17
Rate for Payer: BCBS of TX PPO	$5.75
Rate for Payer: Cash Price	$9.77
Rate for Payer: Cigna Medicaid	$10.35
Rate for Payer: Molina CHIP/Medicaid	$10.35
Rate for Payer: Multiplan Auto	$9.34
Rate for Payer: Multiplan Commercial	$9.34
Rate for Payer: Multiplan Workers Comp	$9.34
Rate for Payer: Parkland Medicaid	$10.35
Rate for Payer: Scott and White EPO/PPO	$7.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10.35
Rate for Payer: Superior Health Plan EPO	$1.95

SUTURE, ETHILON,3-0,PC-5,18, BLACK

Facility

$14.37

Hospital Charge Code	992841
Hospital Revenue Code	272
Rate for Payer: Cash Price	$9.77

SUTURE, ETHILON, 3-0, PS-1, 18, BLACK

Facility

$29.66

Hospital Charge Code	993795
Hospital Revenue Code	272
Rate for Payer: Cash Price	$20.17

SUTURE, ETHILON, 3-0, PS-1, 18, BLACK

Facility

$29.66

Hospital Charge Code	993795
Hospital Revenue Code	272
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$21.36
Rate for Payer: Amerigroup CHIP/Medicaid	$2.67
Rate for Payer: BCBS of TX Blue Advantage	$8.90
Rate for Payer: BCBS of TX Blue Essentials	$10.68
Rate for Payer: BCBS of TX PPO	$11.86
Rate for Payer: Cash Price	$20.17
Rate for Payer: Cigna Medicaid	$21.36
Rate for Payer: Molina CHIP/Medicaid	$21.36
Rate for Payer: Multiplan Auto	$19.28
Rate for Payer: Multiplan Commercial	$19.28
Rate for Payer: Multiplan Workers Comp	$19.28
Rate for Payer: Parkland Medicaid	$21.36
Rate for Payer: Scott and White EPO/PPO	$14.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$21.36
Rate for Payer: Superior Health Plan EPO	$4.03

Know your out-of-pocket cost for care.

All Charges