White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SUTURETAPE FIBERLOOP W/ NDL WH/BL

Facility

$344.50

Hospital Charge Code	146505
Hospital Revenue Code	272
Rate for Payer: Cash Price	$234.26

SUTURETAPE FIBERLOOP W/ NDL WH/BL

Facility

$344.50

Hospital Charge Code	146505
Hospital Revenue Code	272
Min. Negotiated Rate	$31.00
Max. Negotiated Rate	$248.04
Rate for Payer: Amerigroup CHIP/Medicaid	$31.00
Rate for Payer: BCBS of TX Blue Advantage	$103.35
Rate for Payer: BCBS of TX Blue Essentials	$124.02
Rate for Payer: BCBS of TX PPO	$137.80
Rate for Payer: Cash Price	$234.26
Rate for Payer: Cigna Medicaid	$248.04
Rate for Payer: Molina CHIP/Medicaid	$248.04
Rate for Payer: Multiplan Auto	$223.93
Rate for Payer: Multiplan Commercial	$223.93
Rate for Payer: Multiplan Workers Comp	$223.93
Rate for Payer: Parkland Medicaid	$248.04
Rate for Payer: Scott and White EPO/PPO	$172.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$248.04
Rate for Payer: Superior Health Plan EPO	$46.85

SUTURE VLOC 180 0-GS22 9' VLOCL2246

Facility

$148.37

Hospital Charge Code	132068
Hospital Revenue Code	272
Rate for Payer: Cash Price	$100.89

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	$106.83
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	$100.89
Rate for Payer: Cigna Medicaid	$106.83
Rate for Payer: Molina CHIP/Medicaid	$106.83
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: Parkland Medicaid	$106.83
Rate for Payer: Scott and White EPO/PPO	$74.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$106.83
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	$267.57

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	$283.31
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	$267.57
Rate for Payer: Cigna Medicaid	$283.31
Rate for Payer: Molina CHIP/Medicaid	$283.31
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: Parkland Medicaid	$283.31
Rate for Payer: Scott and White EPO/PPO	$196.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$283.31
Rate for Payer: Superior Health Plan EPO	$53.51

SUTURE VLOC 180 3-0 V-20 6' VLOCL0604

Facility

$145.19

Hospital Charge Code	122494
Hospital Revenue Code	272
Rate for Payer: Cash Price	$98.73

SUTURE VLOC 180 3-0 V-20 6' VLOCL0604

Facility

$145.19

Hospital Charge Code	122494
Hospital Revenue Code	272
Min. Negotiated Rate	$13.07
Max. Negotiated Rate	$104.54
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	$98.73
Rate for Payer: Cigna Medicaid	$104.54
Rate for Payer: Molina CHIP/Medicaid	$104.54
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: Parkland Medicaid	$104.54
Rate for Payer: Scott and White EPO/PPO	$72.59
Rate for Payer: Superior Health Plan CHIP/Medicaid	$104.54
Rate for Payer: Superior Health Plan EPO	$19.75

SUTURE, VLOC 180 ABS 3-0 GR 9 V-20

Facility

$220.52

Hospital Charge Code	993829
Hospital Revenue Code	272
Min. Negotiated Rate	$19.85
Max. Negotiated Rate	$158.77
Rate for Payer: Amerigroup CHIP/Medicaid	$19.85
Rate for Payer: BCBS of TX Blue Advantage	$66.16
Rate for Payer: BCBS of TX Blue Essentials	$79.39
Rate for Payer: BCBS of TX PPO	$88.21
Rate for Payer: Cash Price	$149.95
Rate for Payer: Cigna Medicaid	$158.77
Rate for Payer: Molina CHIP/Medicaid	$158.77
Rate for Payer: Multiplan Auto	$143.34
Rate for Payer: Multiplan Commercial	$143.34
Rate for Payer: Multiplan Workers Comp	$143.34
Rate for Payer: Parkland Medicaid	$158.77
Rate for Payer: Scott and White EPO/PPO	$110.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$158.77
Rate for Payer: Superior Health Plan EPO	$29.99

SUTURE, VLOC 180 ABS 3-0 GR 9 V-20

Facility

$220.52

Hospital Charge Code	993829
Hospital Revenue Code	272
Rate for Payer: Cash Price	$149.95

SUTURE VLOC NONABSORB 3-0 V-20 9'

Facility

$145.18

Hospital Charge Code	135759
Hospital Revenue Code	272
Min. Negotiated Rate	$13.07
Max. Negotiated Rate	$104.53
Rate for Payer: Amerigroup CHIP/Medicaid	$13.07
Rate for Payer: BCBS of TX Blue Advantage	$43.55
Rate for Payer: BCBS of TX Blue Essentials	$52.26
Rate for Payer: BCBS of TX PPO	$58.07
Rate for Payer: Cash Price	$98.72
Rate for Payer: Cigna Medicaid	$104.53
Rate for Payer: Molina CHIP/Medicaid	$104.53
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: Parkland Medicaid	$104.53
Rate for Payer: Scott and White EPO/PPO	$72.59
Rate for Payer: Superior Health Plan CHIP/Medicaid	$104.53
Rate for Payer: Superior Health Plan EPO	$19.74

SUTURE VLOC NONABSORB 3-0 V-20 9'

Facility

$145.18

Hospital Charge Code	135759
Hospital Revenue Code	272
Rate for Payer: Cash Price	$98.72

SUTURE V-LOC PBT V-20 6IN BLU SZ 0

Facility

$138.29

Hospital Charge Code	122501
Hospital Revenue Code	272
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$99.57
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	$94.04
Rate for Payer: Cigna Medicaid	$99.57
Rate for Payer: Molina CHIP/Medicaid	$99.57
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: Parkland Medicaid	$99.57
Rate for Payer: Scott and White EPO/PPO	$69.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$99.57
Rate for Payer: Superior Health Plan EPO	$18.81

SUTURE V-LOC PBT V-20 6IN BLU SZ 0

Facility

$138.29

Hospital Charge Code	122501
Hospital Revenue Code	272
Rate for Payer: Cash Price	$94.04

SUTURE, WND CLOS, 3-0GR6 V-20, VLOC 180

Facility

$441.04

Hospital Charge Code	993826
Hospital Revenue Code	272
Rate for Payer: Cash Price	$299.91

SUTURE, WND CLOS, 3-0GR6 V-20, VLOC 180

Facility

$441.04

Hospital Charge Code	993826
Hospital Revenue Code	272
Min. Negotiated Rate	$39.69
Max. Negotiated Rate	$317.55
Rate for Payer: Amerigroup CHIP/Medicaid	$39.69
Rate for Payer: BCBS of TX Blue Advantage	$132.31
Rate for Payer: BCBS of TX Blue Essentials	$158.77
Rate for Payer: BCBS of TX PPO	$176.42
Rate for Payer: Cash Price	$299.91
Rate for Payer: Cigna Medicaid	$317.55
Rate for Payer: Molina CHIP/Medicaid	$317.55
Rate for Payer: Multiplan Auto	$286.68
Rate for Payer: Multiplan Commercial	$286.68
Rate for Payer: Multiplan Workers Comp	$286.68
Rate for Payer: Parkland Medicaid	$317.55
Rate for Payer: Scott and White EPO/PPO	$220.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$317.55
Rate for Payer: Superior Health Plan EPO	$59.98

SWAB, CULTURE, DOUBLE, AMIES GEL, N

Facility

$2.36

Hospital Charge Code	993241
Hospital Revenue Code	270
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$1.70
Rate for Payer: Amerigroup CHIP/Medicaid	$0.21
Rate for Payer: BCBS of TX Blue Advantage	$0.71
Rate for Payer: BCBS of TX Blue Essentials	$0.85
Rate for Payer: BCBS of TX PPO	$0.94
Rate for Payer: Cash Price	$1.60
Rate for Payer: Cigna Medicaid	$1.70
Rate for Payer: Molina CHIP/Medicaid	$1.70
Rate for Payer: Multiplan Auto	$1.53
Rate for Payer: Multiplan Commercial	$1.53
Rate for Payer: Multiplan Workers Comp	$1.53
Rate for Payer: Parkland Medicaid	$1.70
Rate for Payer: Scott and White EPO/PPO	$1.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.70
Rate for Payer: Superior Health Plan EPO	$0.32

SWAB, CULTURE, DOUBLE, AMIES GEL, N

Facility

$2.36

Hospital Charge Code	993241
Hospital Revenue Code	270
Rate for Payer: Cash Price	$1.60

SWABSTICK, PVP-1,3/PK

Facility

$0.27

Hospital Charge Code	992919
Hospital Revenue Code	270
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.19
Rate for Payer: Amerigroup CHIP/Medicaid	$0.02
Rate for Payer: BCBS of TX Blue Advantage	$0.08
Rate for Payer: BCBS of TX Blue Essentials	$0.10
Rate for Payer: BCBS of TX PPO	$0.11
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna Medicaid	$0.19
Rate for Payer: Molina CHIP/Medicaid	$0.19
Rate for Payer: Multiplan Auto	$0.18
Rate for Payer: Multiplan Commercial	$0.18
Rate for Payer: Multiplan Workers Comp	$0.18
Rate for Payer: Parkland Medicaid	$0.19
Rate for Payer: Scott and White EPO/PPO	$0.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.19
Rate for Payer: Superior Health Plan EPO	$0.04

SWABSTICK, PVP-1,3/PK

Facility

$0.27

Hospital Charge Code	992919
Hospital Revenue Code	270
Rate for Payer: Cash Price	$0.18

SWAB TINCTURE BENZOIN STERILE

Facility

$9.41

Hospital Charge Code	993597
Hospital Revenue Code	270
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$6.78
Rate for Payer: Amerigroup CHIP/Medicaid	$0.85
Rate for Payer: BCBS of TX Blue Advantage	$2.82
Rate for Payer: BCBS of TX Blue Essentials	$3.39
Rate for Payer: BCBS of TX PPO	$3.76
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cigna Medicaid	$6.78
Rate for Payer: Molina CHIP/Medicaid	$6.78
Rate for Payer: Multiplan Auto	$6.12
Rate for Payer: Multiplan Commercial	$6.12
Rate for Payer: Multiplan Workers Comp	$6.12
Rate for Payer: Parkland Medicaid	$6.78
Rate for Payer: Scott and White EPO/PPO	$4.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.78
Rate for Payer: Superior Health Plan EPO	$1.28

SWAB TINCTURE BENZOIN STERILE

Facility

$9.41

Hospital Charge Code	993597
Hospital Revenue Code	270
Rate for Payer: Cash Price	$6.40

SWEEN CRM -- DHF

Facility

$110.27

Hospital Charge Code	80343551
Hospital Revenue Code	270
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$79.39
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	$74.98
Rate for Payer: Cigna Medicaid	$79.39
Rate for Payer: Molina CHIP/Medicaid	$79.39
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: Parkland Medicaid	$79.39
Rate for Payer: Scott and White EPO/PPO	$55.13
Rate for Payer: Superior Health Plan CHIP/Medicaid	$79.39
Rate for Payer: Superior Health Plan EPO	$15.00

SWEEN CRM -- DHF

Facility

$110.27

Hospital Charge Code	80343551
Hospital Revenue Code	270
Rate for Payer: Cash Price	$74.98

SWITCHING STICK

Facility

$774.43

Hospital Charge Code	8414480
Hospital Revenue Code	272
Rate for Payer: Cash Price	$526.61

Know your out-of-pocket cost for care.

All Charges