White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SUTURE, ETHILON,3-0,PS-2,18, BLACK

Facility

$15.69

Hospital Charge Code	992842
Hospital Revenue Code	272
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$11.30
Rate for Payer: Amerigroup CHIP/Medicaid	$1.41
Rate for Payer: BCBS of TX Blue Advantage	$4.71
Rate for Payer: BCBS of TX Blue Essentials	$5.65
Rate for Payer: BCBS of TX PPO	$6.28
Rate for Payer: Cash Price	$10.67
Rate for Payer: Cigna Medicaid	$11.30
Rate for Payer: Molina CHIP/Medicaid	$11.30
Rate for Payer: Multiplan Auto	$10.20
Rate for Payer: Multiplan Commercial	$10.20
Rate for Payer: Multiplan Workers Comp	$10.20
Rate for Payer: Parkland Medicaid	$11.30
Rate for Payer: Scott and White EPO/PPO	$7.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11.30
Rate for Payer: Superior Health Plan EPO	$2.13

SUTURE, ETHILON,3-0,PS-2,18, BLACK

Facility

$15.69

Hospital Charge Code	992842
Hospital Revenue Code	272
Rate for Payer: Cash Price	$10.67

SUTURE, ETHILON,5-0,PS-2,18, BLACK

Facility

$13.30

Hospital Charge Code	992890
Hospital Revenue Code	272
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$9.58
Rate for Payer: Amerigroup CHIP/Medicaid	$1.20
Rate for Payer: BCBS of TX Blue Advantage	$3.99
Rate for Payer: BCBS of TX Blue Essentials	$4.79
Rate for Payer: BCBS of TX PPO	$5.32
Rate for Payer: Cash Price	$9.04
Rate for Payer: Cigna Medicaid	$9.58
Rate for Payer: Molina CHIP/Medicaid	$9.58
Rate for Payer: Multiplan Auto	$8.64
Rate for Payer: Multiplan Commercial	$8.64
Rate for Payer: Multiplan Workers Comp	$8.64
Rate for Payer: Parkland Medicaid	$9.58
Rate for Payer: Scott and White EPO/PPO	$6.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.58
Rate for Payer: Superior Health Plan EPO	$1.81

SUTURE, ETHILON,5-0,PS-2,18, BLACK

Facility

$13.30

Hospital Charge Code	992890
Hospital Revenue Code	272
Rate for Payer: Cash Price	$9.04

SUTURE, ETHILON,6-0,P-3,18, BLACK

Facility

$12.37

Hospital Charge Code	992843
Hospital Revenue Code	272
Rate for Payer: Cash Price	$8.41

SUTURE, ETHILON,6-0,P-3,18, BLACK

Facility

$12.37

Hospital Charge Code	992843
Hospital Revenue Code	272
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$8.91
Rate for Payer: Amerigroup CHIP/Medicaid	$1.11
Rate for Payer: BCBS of TX Blue Advantage	$3.71
Rate for Payer: BCBS of TX Blue Essentials	$4.45
Rate for Payer: BCBS of TX PPO	$4.95
Rate for Payer: Cash Price	$8.41
Rate for Payer: Cigna Medicaid	$8.91
Rate for Payer: Molina CHIP/Medicaid	$8.91
Rate for Payer: Multiplan Auto	$8.04
Rate for Payer: Multiplan Commercial	$8.04
Rate for Payer: Multiplan Workers Comp	$8.04
Rate for Payer: Parkland Medicaid	$8.91
Rate for Payer: Scott and White EPO/PPO	$6.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.91
Rate for Payer: Superior Health Plan EPO	$1.68

SUTURE, ETHILON,6-0,PC-3,18, BLACK

Facility

$14.78

Hospital Charge Code	992844
Hospital Revenue Code	272
Rate for Payer: Cash Price	$10.05

SUTURE, ETHILON,6-0,PC-3,18, BLACK

Facility

$14.78

Hospital Charge Code	992844
Hospital Revenue Code	272
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$10.64
Rate for Payer: Amerigroup CHIP/Medicaid	$1.33
Rate for Payer: BCBS of TX Blue Advantage	$4.43
Rate for Payer: BCBS of TX Blue Essentials	$5.32
Rate for Payer: BCBS of TX PPO	$5.91
Rate for Payer: Cash Price	$10.05
Rate for Payer: Cigna Medicaid	$10.64
Rate for Payer: Molina CHIP/Medicaid	$10.64
Rate for Payer: Multiplan Auto	$9.61
Rate for Payer: Multiplan Commercial	$9.61
Rate for Payer: Multiplan Workers Comp	$9.61
Rate for Payer: Parkland Medicaid	$10.64
Rate for Payer: Scott and White EPO/PPO	$7.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10.64
Rate for Payer: Superior Health Plan EPO	$2.01

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

Facility

$147.62

Hospital Charge Code	81940207
Hospital Revenue Code	272
Rate for Payer: Cash Price	$100.38

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

Facility

$234.19

Hospital Charge Code	81941452
Hospital Revenue Code	272
Rate for Payer: Cash Price	$159.25

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	$168.62
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	$159.25
Rate for Payer: Cigna Medicaid	$168.62
Rate for Payer: Molina CHIP/Medicaid	$168.62
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: Parkland Medicaid	$168.62
Rate for Payer: Scott and White EPO/PPO	$117.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$168.62
Rate for Payer: Superior Health Plan EPO	$31.85

SUTURE FIBERLINK SUTURE TAPE

Facility

$644.68

Hospital Charge Code	145387
Hospital Revenue Code	272
Min. Negotiated Rate	$58.02
Max. Negotiated Rate	$464.17
Rate for Payer: Amerigroup CHIP/Medicaid	$58.02
Rate for Payer: BCBS of TX Blue Advantage	$193.40
Rate for Payer: BCBS of TX Blue Essentials	$232.08
Rate for Payer: BCBS of TX PPO	$257.87
Rate for Payer: Cash Price	$438.38
Rate for Payer: Cigna Medicaid	$464.17
Rate for Payer: Molina CHIP/Medicaid	$464.17
Rate for Payer: Multiplan Auto	$419.04
Rate for Payer: Multiplan Commercial	$419.04
Rate for Payer: Multiplan Workers Comp	$419.04
Rate for Payer: Parkland Medicaid	$464.17
Rate for Payer: Scott and White EPO/PPO	$322.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$464.17
Rate for Payer: Superior Health Plan EPO	$87.68

SUTURE FIBERLINK SUTURE TAPE

Facility

$644.68

Hospital Charge Code	145387
Hospital Revenue Code	272
Rate for Payer: Cash Price	$438.38

SUTURE GRAFT PREP SYSTEM SPEEDTRAP WHITE 30MM

Facility

$562.96

Hospital Charge Code	131970
Hospital Revenue Code	272
Rate for Payer: Cash Price	$382.81

SUTURE GRAFT PREP SYSTEM SPEEDTRAP WHITE 30MM

Facility

$562.96

Hospital Charge Code	131970
Hospital Revenue Code	272
Min. Negotiated Rate	$50.67
Max. Negotiated Rate	$405.33
Rate for Payer: Amerigroup CHIP/Medicaid	$50.67
Rate for Payer: BCBS of TX Blue Advantage	$168.89
Rate for Payer: BCBS of TX Blue Essentials	$202.67
Rate for Payer: BCBS of TX PPO	$225.18
Rate for Payer: Cash Price	$382.81
Rate for Payer: Cigna Medicaid	$405.33
Rate for Payer: Molina CHIP/Medicaid	$405.33
Rate for Payer: Multiplan Auto	$365.92
Rate for Payer: Multiplan Commercial	$365.92
Rate for Payer: Multiplan Workers Comp	$365.92
Rate for Payer: Parkland Medicaid	$405.33
Rate for Payer: Scott and White EPO/PPO	$281.48
Rate for Payer: Superior Health Plan CHIP/Medicaid	$405.33
Rate for Payer: Superior Health Plan EPO	$76.56

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	$92.22
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	$87.09
Rate for Payer: Cigna Medicaid	$92.22
Rate for Payer: Molina CHIP/Medicaid	$92.22
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: Parkland Medicaid	$92.22
Rate for Payer: Scott and White EPO/PPO	$64.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$92.22
Rate for Payer: Superior Health Plan EPO	$17.42

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	$87.09

suture hi-fi

Facility

$304.36

Hospital Charge Code	8640531
Hospital Revenue Code	272
Min. Negotiated Rate	$27.39
Max. Negotiated Rate	$219.14
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	$206.96
Rate for Payer: Cigna Medicaid	$219.14
Rate for Payer: Molina CHIP/Medicaid	$219.14
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: Parkland Medicaid	$219.14
Rate for Payer: Scott and White EPO/PPO	$152.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$219.14
Rate for Payer: Superior Health Plan EPO	$41.39

suture hi-fi

Facility

$304.36

Hospital Charge Code	8640531
Hospital Revenue Code	272
Rate for Payer: Cash Price	$206.96

SUTURE HI FI

Facility

$304.36

Hospital Charge Code	992641
Hospital Revenue Code	272
Min. Negotiated Rate	$27.39
Max. Negotiated Rate	$219.14
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	$206.96
Rate for Payer: Cigna Medicaid	$219.14
Rate for Payer: Molina CHIP/Medicaid	$219.14
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: Parkland Medicaid	$219.14
Rate for Payer: Scott and White EPO/PPO	$152.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$219.14
Rate for Payer: Superior Health Plan EPO	$41.39

SUTURE HI FI

Facility

$304.36

Hospital Charge Code	992641
Hospital Revenue Code	272
Rate for Payer: Cash Price	$206.96

SUTURE, HI FI 2 COLOR 40' W 1/2 CIR TAPRD NEEDLE

Facility

$156.72

Hospital Charge Code	140483
Hospital Revenue Code	272
Min. Negotiated Rate	$14.10
Max. Negotiated Rate	$112.84
Rate for Payer: Amerigroup CHIP/Medicaid	$14.10
Rate for Payer: BCBS of TX Blue Advantage	$47.02
Rate for Payer: BCBS of TX Blue Essentials	$56.42
Rate for Payer: BCBS of TX PPO	$62.69
Rate for Payer: Cash Price	$106.57
Rate for Payer: Cigna Medicaid	$112.84
Rate for Payer: Molina CHIP/Medicaid	$112.84
Rate for Payer: Multiplan Auto	$101.87
Rate for Payer: Multiplan Commercial	$101.87
Rate for Payer: Multiplan Workers Comp	$101.87
Rate for Payer: Parkland Medicaid	$112.84
Rate for Payer: Scott and White EPO/PPO	$78.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$112.84
Rate for Payer: Superior Health Plan EPO	$21.31

SUTURE, HI FI 2 COLOR 40' W 1/2 CIR TAPRD NEEDLE

Facility

$156.72

Hospital Charge Code	140483
Hospital Revenue Code	272
Rate for Payer: Cash Price	$106.57

SUTURE HI-FI SZ 2

Facility

$128.85

Hospital Charge Code	145527
Hospital Revenue Code	272
Rate for Payer: Cash Price	$87.62

Know your out-of-pocket cost for care.

All Charges