White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SUTURE ORTHOCORD #2 MO-7

Facility

$295.87

Hospital Charge Code	121483
Hospital Revenue Code	272
Rate for Payer: Cash Price	$201.19

SUTURE PASSER SHUTTLE INFINITY

Facility

$236.08

Hospital Charge Code	8406459
Hospital Revenue Code	272
Rate for Payer: Cash Price	$160.53

SUTURE PASSER SHUTTLE INFINITY

Facility

$236.08

Hospital Charge Code	8406459
Hospital Revenue Code	272
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$169.98
Rate for Payer: Amerigroup CHIP/Medicaid	$21.25
Rate for Payer: BCBS of TX Blue Advantage	$70.82
Rate for Payer: BCBS of TX Blue Essentials	$84.99
Rate for Payer: BCBS of TX PPO	$94.43
Rate for Payer: Cash Price	$160.53
Rate for Payer: Cigna Medicaid	$169.98
Rate for Payer: Molina CHIP/Medicaid	$169.98
Rate for Payer: Multiplan Auto	$153.45
Rate for Payer: Multiplan Commercial	$153.45
Rate for Payer: Multiplan Workers Comp	$153.45
Rate for Payer: Parkland Medicaid	$169.98
Rate for Payer: Scott and White EPO/PPO	$118.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$169.98
Rate for Payer: Superior Health Plan EPO	$32.11

SUTURE, PDS II, 2-0, CT-1, 27, UNDYED

Facility

$8.79

Hospital Charge Code	993812
Hospital Revenue Code	272
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$6.33
Rate for Payer: Amerigroup CHIP/Medicaid	$0.79
Rate for Payer: BCBS of TX Blue Advantage	$2.64
Rate for Payer: BCBS of TX Blue Essentials	$3.16
Rate for Payer: BCBS of TX PPO	$3.52
Rate for Payer: Cash Price	$5.98
Rate for Payer: Cigna Medicaid	$6.33
Rate for Payer: Molina CHIP/Medicaid	$6.33
Rate for Payer: Multiplan Auto	$5.71
Rate for Payer: Multiplan Commercial	$5.71
Rate for Payer: Multiplan Workers Comp	$5.71
Rate for Payer: Parkland Medicaid	$6.33
Rate for Payer: Scott and White EPO/PPO	$4.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.33
Rate for Payer: Superior Health Plan EPO	$1.20

SUTURE, PDS II, 2-0, CT-1, 27, UNDYED

Facility

$8.79

Hospital Charge Code	993812
Hospital Revenue Code	272
Rate for Payer: Cash Price	$5.98

SUTURE, PDS II VIL MONO 1 CLOSURE 96' LP TP-1 -- DHF

Facility

$170.09

Hospital Charge Code	81945008
Hospital Revenue Code	272
Min. Negotiated Rate	$15.31
Max. Negotiated Rate	$122.46
Rate for Payer: Amerigroup CHIP/Medicaid	$15.31
Rate for Payer: BCBS of TX Blue Advantage	$51.03
Rate for Payer: BCBS of TX Blue Essentials	$61.23
Rate for Payer: BCBS of TX PPO	$68.04
Rate for Payer: Cash Price	$115.66
Rate for Payer: Cigna Medicaid	$122.46
Rate for Payer: Molina CHIP/Medicaid	$122.46
Rate for Payer: Multiplan Auto	$110.56
Rate for Payer: Multiplan Commercial	$110.56
Rate for Payer: Multiplan Workers Comp	$110.56
Rate for Payer: Parkland Medicaid	$122.46
Rate for Payer: Scott and White EPO/PPO	$85.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$122.46
Rate for Payer: Superior Health Plan EPO	$23.13

SUTURE, PDS II VIL MONO 1 CLOSURE 96' LP TP-1 -- DHF

Facility

$170.09

Hospital Charge Code	81945008
Hospital Revenue Code	272
Rate for Payer: Cash Price	$115.66

SUTURE, PDS II VIOLET MONO ENDOLOOP 0 18' -- DHF

Facility

$287.25

Hospital Charge Code	81942203
Hospital Revenue Code	272
Rate for Payer: Cash Price	$195.33

SUTURE, PDS II VIOLET MONO ENDOLOOP 0 18' -- DHF

Facility

$287.25

Hospital Charge Code	81942203
Hospital Revenue Code	272
Min. Negotiated Rate	$25.85
Max. Negotiated Rate	$206.82
Rate for Payer: Amerigroup CHIP/Medicaid	$25.85
Rate for Payer: BCBS of TX Blue Advantage	$86.17
Rate for Payer: BCBS of TX Blue Essentials	$103.41
Rate for Payer: BCBS of TX PPO	$114.90
Rate for Payer: Cash Price	$195.33
Rate for Payer: Cigna Medicaid	$206.82
Rate for Payer: Molina CHIP/Medicaid	$206.82
Rate for Payer: Multiplan Auto	$186.71
Rate for Payer: Multiplan Commercial	$186.71
Rate for Payer: Multiplan Workers Comp	$186.71
Rate for Payer: Parkland Medicaid	$206.82
Rate for Payer: Scott and White EPO/PPO	$143.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$206.82
Rate for Payer: Superior Health Plan EPO	$39.07

SUTURE, PERMAHAND, 2-0, SH, 24, BLACK

Facility

$23.78

Hospital Charge Code	993798
Hospital Revenue Code	272
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$17.12
Rate for Payer: Amerigroup CHIP/Medicaid	$2.14
Rate for Payer: BCBS of TX Blue Advantage	$7.13
Rate for Payer: BCBS of TX Blue Essentials	$8.56
Rate for Payer: BCBS of TX PPO	$9.51
Rate for Payer: Cash Price	$16.17
Rate for Payer: Cigna Medicaid	$17.12
Rate for Payer: Molina CHIP/Medicaid	$17.12
Rate for Payer: Multiplan Auto	$15.46
Rate for Payer: Multiplan Commercial	$15.46
Rate for Payer: Multiplan Workers Comp	$15.46
Rate for Payer: Parkland Medicaid	$17.12
Rate for Payer: Scott and White EPO/PPO	$11.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.12
Rate for Payer: Superior Health Plan EPO	$3.23

SUTURE, PERMAHAND, 2-0, SH, 24, BLACK

Facility

$23.78

Hospital Charge Code	993798
Hospital Revenue Code	272
Rate for Payer: Cash Price	$16.17

SUTURE, PERMAHAND, 2, NA, 60', BLACK

Facility

$4.52

Hospital Charge Code	992888
Hospital Revenue Code	272
Rate for Payer: Cash Price	$3.07

SUTURE, PERMAHAND, 2, NA, 60', BLACK

Facility

$4.52

Hospital Charge Code	992888
Hospital Revenue Code	272
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$3.25
Rate for Payer: Amerigroup CHIP/Medicaid	$0.41
Rate for Payer: BCBS of TX Blue Advantage	$1.36
Rate for Payer: BCBS of TX Blue Essentials	$1.63
Rate for Payer: BCBS of TX PPO	$1.81
Rate for Payer: Cash Price	$3.07
Rate for Payer: Cigna Medicaid	$3.25
Rate for Payer: Molina CHIP/Medicaid	$3.25
Rate for Payer: Multiplan Auto	$2.94
Rate for Payer: Multiplan Commercial	$2.94
Rate for Payer: Multiplan Workers Comp	$2.94
Rate for Payer: Parkland Medicaid	$3.25
Rate for Payer: Scott and White EPO/PPO	$2.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.25
Rate for Payer: Superior Health Plan EPO	$0.61

SUTURE PLGC VCL 3-0 SH 18IN UND CR

Facility

$12.69

Hospital Charge Code	993745
Hospital Revenue Code	272
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$9.14
Rate for Payer: Amerigroup CHIP/Medicaid	$1.14
Rate for Payer: BCBS of TX Blue Advantage	$3.81
Rate for Payer: BCBS of TX Blue Essentials	$4.57
Rate for Payer: BCBS of TX PPO	$5.08
Rate for Payer: Cash Price	$8.63
Rate for Payer: Cigna Medicaid	$9.14
Rate for Payer: Molina CHIP/Medicaid	$9.14
Rate for Payer: Multiplan Auto	$8.25
Rate for Payer: Multiplan Commercial	$8.25
Rate for Payer: Multiplan Workers Comp	$8.25
Rate for Payer: Parkland Medicaid	$9.14
Rate for Payer: Scott and White EPO/PPO	$6.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.14
Rate for Payer: Superior Health Plan EPO	$1.73

SUTURE PLGC VCL 3-0 SH 18IN UND CR

Facility

$12.69

Hospital Charge Code	993745
Hospital Revenue Code	272
Rate for Payer: Cash Price	$8.63

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	$172.16

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	$182.28
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	$172.16
Rate for Payer: Cigna Medicaid	$182.28
Rate for Payer: Molina CHIP/Medicaid	$182.28
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: Parkland Medicaid	$182.28
Rate for Payer: Scott and White EPO/PPO	$126.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$182.28
Rate for Payer: Superior Health Plan EPO	$34.43

SUTURE, PROLENE, 3-0, PS-2, 18, BLUE

Facility

$18.53

Hospital Charge Code	992845
Hospital Revenue Code	272
Rate for Payer: Cash Price	$12.60

SUTURE, PROLENE, 3-0, PS-2, 18, BLUE

Facility

$18.53

Hospital Charge Code	992845
Hospital Revenue Code	272
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$13.34
Rate for Payer: Amerigroup CHIP/Medicaid	$1.67
Rate for Payer: BCBS of TX Blue Advantage	$5.56
Rate for Payer: BCBS of TX Blue Essentials	$6.67
Rate for Payer: BCBS of TX PPO	$7.41
Rate for Payer: Cash Price	$12.60
Rate for Payer: Cigna Medicaid	$13.34
Rate for Payer: Molina CHIP/Medicaid	$13.34
Rate for Payer: Multiplan Auto	$12.04
Rate for Payer: Multiplan Commercial	$12.04
Rate for Payer: Multiplan Workers Comp	$12.04
Rate for Payer: Parkland Medicaid	$13.34
Rate for Payer: Scott and White EPO/PPO	$9.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.34
Rate for Payer: Superior Health Plan EPO	$2.52

SUTURE,PROLENE,3-0,SH,30,BLUE

Facility

$15.42

Hospital Charge Code	993118
Hospital Revenue Code	270
Rate for Payer: Cash Price	$10.49

SUTURE,PROLENE,3-0,SH,30,BLUE

Facility

$15.42

Hospital Charge Code	993118
Hospital Revenue Code	270
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$11.10
Rate for Payer: Amerigroup CHIP/Medicaid	$1.39
Rate for Payer: BCBS of TX Blue Advantage	$4.63
Rate for Payer: BCBS of TX Blue Essentials	$5.55
Rate for Payer: BCBS of TX PPO	$6.17
Rate for Payer: Cash Price	$10.49
Rate for Payer: Cigna Medicaid	$11.10
Rate for Payer: Molina CHIP/Medicaid	$11.10
Rate for Payer: Multiplan Auto	$10.02
Rate for Payer: Multiplan Commercial	$10.02
Rate for Payer: Multiplan Workers Comp	$10.02
Rate for Payer: Parkland Medicaid	$11.10
Rate for Payer: Scott and White EPO/PPO	$7.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11.10
Rate for Payer: Superior Health Plan EPO	$2.10

SUTURE, PROLENE, 4-0, PC-3,18, BLUE

Facility

$20.50

Hospital Charge Code	992884
Hospital Revenue Code	272
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$14.76
Rate for Payer: Amerigroup CHIP/Medicaid	$1.84
Rate for Payer: BCBS of TX Blue Advantage	$6.15
Rate for Payer: BCBS of TX Blue Essentials	$7.38
Rate for Payer: BCBS of TX PPO	$8.20
Rate for Payer: Cash Price	$13.94
Rate for Payer: Cigna Medicaid	$14.76
Rate for Payer: Molina CHIP/Medicaid	$14.76
Rate for Payer: Multiplan Auto	$13.32
Rate for Payer: Multiplan Commercial	$13.32
Rate for Payer: Multiplan Workers Comp	$13.32
Rate for Payer: Parkland Medicaid	$14.76
Rate for Payer: Scott and White EPO/PPO	$10.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14.76
Rate for Payer: Superior Health Plan EPO	$2.79

SUTURE, PROLENE, 4-0, PC-3,18, BLUE

Facility

$20.50

Hospital Charge Code	992884
Hospital Revenue Code	272
Rate for Payer: Cash Price	$13.94

SUTURE, PROLENE,4-0,PS-1,18, BLUE

Facility

$20.20

Hospital Charge Code	992891
Hospital Revenue Code	272
Rate for Payer: Cash Price	$13.74

SUTURE, PROLENE,4-0,PS-1,18, BLUE

Facility

$20.20

Hospital Charge Code	992891
Hospital Revenue Code	272
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$14.54
Rate for Payer: Amerigroup CHIP/Medicaid	$1.82
Rate for Payer: BCBS of TX Blue Advantage	$6.06
Rate for Payer: BCBS of TX Blue Essentials	$7.27
Rate for Payer: BCBS of TX PPO	$8.08
Rate for Payer: Cash Price	$13.74
Rate for Payer: Cigna Medicaid	$14.54
Rate for Payer: Molina CHIP/Medicaid	$14.54
Rate for Payer: Multiplan Auto	$13.13
Rate for Payer: Multiplan Commercial	$13.13
Rate for Payer: Multiplan Workers Comp	$13.13
Rate for Payer: Parkland Medicaid	$14.54
Rate for Payer: Scott and White EPO/PPO	$10.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14.54
Rate for Payer: Superior Health Plan EPO	$2.75

Know your out-of-pocket cost for care.

All Charges