White Rock Medical Center

All Charges

Charge

Type

Setting

Price

REM&RPL ICD GEN/MULTI SYSTEM

Facility

$41,664.00

Service Code	HCPCS 33264
Hospital Charge Code	2350079
Hospital Revenue Code	481
Min. Negotiated Rate	$3,749.76
Max. Negotiated Rate	$81,352.25
Rate for Payer: Amerigroup CHIP/Medicaid	$3,749.76
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$31,531.90
Rate for Payer: Amerigroup Medicare	$31,531.90
Rate for Payer: BCBS of TX Blue Advantage	$53,912.01
Rate for Payer: BCBS of TX Blue Essentials	$64,565.28
Rate for Payer: BCBS of TX Medicare	$31,531.90
Rate for Payer: BCBS of TX PPO	$81,352.25
Rate for Payer: Cash Price	$28,331.52
Rate for Payer: Cash Price	$28,331.52
Rate for Payer: Cash Price	$28,331.52
Rate for Payer: Cigna Commercial	$66,652.72
Rate for Payer: Cigna Medicaid	$29,998.08
Rate for Payer: Cigna Medicare	$31,531.90
Rate for Payer: Employer Direct Commercial	$31,531.90
Rate for Payer: Humana Medicare/TRICARE	$31,531.90
Rate for Payer: Molina CHIP/Medicaid	$29,998.08
Rate for Payer: Molina Dual Medicare/Medicaid	$31,531.90
Rate for Payer: Molina Medicare	$31,531.90
Rate for Payer: Multiplan Auto	$27,081.60
Rate for Payer: Multiplan Commercial	$27,081.60
Rate for Payer: Multiplan Workers Comp	$27,081.60
Rate for Payer: Parkland Medicaid	$29,998.08
Rate for Payer: Scott and White EPO/PPO	$20,832.00
Rate for Payer: Scott and White Medicare	$31,531.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$29,998.08
Rate for Payer: Superior Health Plan EPO	$31,531.90
Rate for Payer: Superior Health Plan Medicare	$31,531.90
Rate for Payer: Universal American Dual Medicare/Medicaid	$31,531.90
Rate for Payer: Universal American Medicare	$31,531.90
Rate for Payer: Wellcare Medicare	$31,531.90
Rate for Payer: Wellmed Medicare	$31,531.90

REM&RPL ICD GEN/MULTI SYSTEM

Facility

$41,664.00

Service Code	HCPCS 33264
Hospital Charge Code	2350079
Hospital Revenue Code	481
Rate for Payer: Cash Price	$28,331.52

REMV TUNL CVC WO PMP/PRT

Facility

$1,849.00

Service Code	HCPCS 36589
Hospital Charge Code	4616589
Hospital Revenue Code	361
Min. Negotiated Rate	$223.75
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$223.75
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$630.16
Rate for Payer: Amerigroup Medicare	$630.16
Rate for Payer: BCBS of TX Blue Advantage	$1,052.95
Rate for Payer: BCBS of TX Blue Essentials	$1,261.02
Rate for Payer: BCBS of TX Medicare	$630.16
Rate for Payer: BCBS of TX PPO	$1,588.89
Rate for Payer: Cash Price	$1,257.32
Rate for Payer: Cash Price	$1,257.32
Rate for Payer: Cash Price	$1,257.32
Rate for Payer: Cigna Commercial	$1,332.05
Rate for Payer: Cigna Medicaid	$1,331.28
Rate for Payer: Cigna Medicare	$630.16
Rate for Payer: Employer Direct Commercial	$630.16
Rate for Payer: Humana Medicare/TRICARE	$630.16
Rate for Payer: Molina CHIP/Medicaid	$1,331.28
Rate for Payer: Molina Dual Medicare/Medicaid	$630.16
Rate for Payer: Molina Medicare	$630.16
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$1,331.28
Rate for Payer: Scott and White EPO/PPO	$1,165.80
Rate for Payer: Scott and White Medicare	$630.16
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,331.28
Rate for Payer: Superior Health Plan EPO	$630.16
Rate for Payer: Superior Health Plan Medicare	$630.16
Rate for Payer: Universal American Dual Medicare/Medicaid	$630.16
Rate for Payer: Universal American Medicare	$630.16
Rate for Payer: Wellcare Medicare	$630.16
Rate for Payer: Wellmed Medicare	$630.16

REMV TUNL CVC WO PMP/PRT

Facility

$1,849.00

Service Code	HCPCS 36589
Hospital Charge Code	4616589
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,257.32

RENAL DIALYSIS ACCESS DEVICE PROCEDURES

Facility

$21,560.88

Service Code	APR-DRG 4444
Min. Negotiated Rate	$20,328.35
Max. Negotiated Rate	$21,560.88
Rate for Payer: Amerigroup CHIP/Medicaid	$20,328.35
Rate for Payer: Cigna Medicaid	$20,328.35
Rate for Payer: Molina CHIP/Medicaid	$20,328.35
Rate for Payer: Parkland Medicaid	$20,328.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$21,560.88

RENAL DIALYSIS ACCESS DEVICE PROCEDURES

Facility

$6,212.30

Service Code	APR-DRG 4442
Min. Negotiated Rate	$5,857.18
Max. Negotiated Rate	$6,212.30
Rate for Payer: Amerigroup CHIP/Medicaid	$5,857.18
Rate for Payer: Cigna Medicaid	$5,857.18
Rate for Payer: Molina CHIP/Medicaid	$5,857.18
Rate for Payer: Parkland Medicaid	$5,857.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,212.30

RENAL DIALYSIS ACCESS DEVICE PROCEDURES

Facility

$10,949.80

Service Code	APR-DRG 4443
Min. Negotiated Rate	$10,323.85
Max. Negotiated Rate	$10,949.80
Rate for Payer: Amerigroup CHIP/Medicaid	$10,323.85
Rate for Payer: Cigna Medicaid	$10,323.85
Rate for Payer: Molina CHIP/Medicaid	$10,323.85
Rate for Payer: Parkland Medicaid	$10,323.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,949.80

RENAL DIALYSIS ACCESS DEVICE PROCEDURES

Facility

$4,301.09

Service Code	APR-DRG 4441
Min. Negotiated Rate	$4,055.21
Max. Negotiated Rate	$4,301.09
Rate for Payer: Amerigroup CHIP/Medicaid	$4,055.21
Rate for Payer: Cigna Medicaid	$4,055.21
Rate for Payer: Molina CHIP/Medicaid	$4,055.21
Rate for Payer: Parkland Medicaid	$4,055.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,301.09

RENAL FAILURE W CC

Facility

$16,640.20

Service Code	MSDRG 683
Min. Negotiated Rate	$7,663.25
Max. Negotiated Rate	$16,640.20
Rate for Payer: BCBS of TX Blue Advantage	$7,903.40
Rate for Payer: BCBS of TX Blue Essentials	$9,483.16
Rate for Payer: BCBS of TX PPO	$10,537.25

RENAL FAILURE WITH CC

Facility

$16,640.20

Service Code	MSDRG 683
Min. Negotiated Rate	$7,663.25
Max. Negotiated Rate	$16,640.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,178.85
Rate for Payer: Amerigroup Medicare	$11,178.85
Rate for Payer: BCBS of TX Medicare	$11,178.85
Rate for Payer: Cigna Commercial	$11,280.30
Rate for Payer: Cigna Medicare	$11,178.85
Rate for Payer: Employer Direct Commercial	$11,178.85
Rate for Payer: Humana Medicare/TRICARE	$11,178.85
Rate for Payer: Molina Dual Medicare/Medicaid	$11,178.85
Rate for Payer: Molina Medicare	$11,178.85
Rate for Payer: Multiplan Auto	$16,640.20
Rate for Payer: Multiplan Commercial	$16,640.20
Rate for Payer: Multiplan Workers Comp	$16,640.20
Rate for Payer: Scott and White EPO/PPO	$7,663.25
Rate for Payer: Scott and White Medicare	$11,178.85
Rate for Payer: Superior Health Plan EPO	$11,178.85
Rate for Payer: Superior Health Plan Medicare	$11,178.85
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,178.85
Rate for Payer: Universal American Medicare	$11,178.85
Rate for Payer: Wellcare Medicare	$11,178.85
Rate for Payer: Wellmed Medicare	$11,178.85

RENAL FAILURE WITH MCC

Facility

$28,139.00

Service Code	MSDRG 682
Min. Negotiated Rate	$12,958.75
Max. Negotiated Rate	$28,139.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15,614.37
Rate for Payer: Amerigroup Medicare	$15,614.37
Rate for Payer: BCBS of TX Medicare	$15,614.37
Rate for Payer: Cigna Commercial	$19,075.28
Rate for Payer: Cigna Medicare	$15,614.37
Rate for Payer: Employer Direct Commercial	$15,614.37
Rate for Payer: Humana Medicare/TRICARE	$15,614.37
Rate for Payer: Molina Dual Medicare/Medicaid	$15,614.37
Rate for Payer: Molina Medicare	$15,614.37
Rate for Payer: Multiplan Auto	$28,139.00
Rate for Payer: Multiplan Commercial	$28,139.00
Rate for Payer: Multiplan Workers Comp	$28,139.00
Rate for Payer: Scott and White EPO/PPO	$12,958.75
Rate for Payer: Scott and White Medicare	$15,614.37
Rate for Payer: Superior Health Plan EPO	$15,614.37
Rate for Payer: Superior Health Plan Medicare	$15,614.37
Rate for Payer: Universal American Dual Medicare/Medicaid	$15,614.37
Rate for Payer: Universal American Medicare	$15,614.37
Rate for Payer: Wellcare Medicare	$15,614.37
Rate for Payer: Wellmed Medicare	$15,614.37

RENAL FAILURE WITHOUT CC/MCC

Facility

$11,405.70

Service Code	MSDRG 684
Min. Negotiated Rate	$5,252.62
Max. Negotiated Rate	$11,405.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$9,159.70
Rate for Payer: Amerigroup Medicare	$9,159.70
Rate for Payer: BCBS of TX Medicare	$9,159.70
Rate for Payer: Cigna Commercial	$7,731.86
Rate for Payer: Cigna Medicare	$9,159.70
Rate for Payer: Employer Direct Commercial	$9,159.70
Rate for Payer: Humana Medicare/TRICARE	$9,159.70
Rate for Payer: Molina Dual Medicare/Medicaid	$9,159.70
Rate for Payer: Molina Medicare	$9,159.70
Rate for Payer: Multiplan Auto	$11,405.70
Rate for Payer: Multiplan Commercial	$11,405.70
Rate for Payer: Multiplan Workers Comp	$11,405.70
Rate for Payer: Scott and White EPO/PPO	$5,252.62
Rate for Payer: Scott and White Medicare	$9,159.70
Rate for Payer: Superior Health Plan EPO	$9,159.70
Rate for Payer: Superior Health Plan Medicare	$9,159.70
Rate for Payer: Universal American Dual Medicare/Medicaid	$9,159.70
Rate for Payer: Universal American Medicare	$9,159.70
Rate for Payer: Wellcare Medicare	$9,159.70
Rate for Payer: Wellmed Medicare	$9,159.70

RENAL FAILURE W MCC

Facility

$28,139.00

Service Code	MSDRG 682
Min. Negotiated Rate	$12,958.75
Max. Negotiated Rate	$28,139.00
Rate for Payer: BCBS of TX Blue Advantage	$13,175.20
Rate for Payer: BCBS of TX Blue Essentials	$15,808.71
Rate for Payer: BCBS of TX PPO	$17,565.91

RENAL FAILURE W/O CC/MCC

Facility

$11,405.70

Service Code	MSDRG 684
Min. Negotiated Rate	$5,252.62
Max. Negotiated Rate	$11,405.70
Rate for Payer: BCBS of TX Blue Advantage	$5,330.28
Rate for Payer: BCBS of TX Blue Essentials	$6,395.72
Rate for Payer: BCBS of TX PPO	$7,106.63

Renal Function Panel

Facility

$484.00

Service Code	HCPCS 80069
Hospital Charge Code	1603539
Hospital Revenue Code	301
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$348.48
Rate for Payer: Amerigroup CHIP/Medicaid	$3.39
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$8.68
Rate for Payer: Amerigroup Medicare	$8.68
Rate for Payer: BCBS of TX Blue Advantage	$145.20
Rate for Payer: BCBS of TX Blue Essentials	$174.24
Rate for Payer: BCBS of TX Medicare	$8.68
Rate for Payer: BCBS of TX PPO	$193.60
Rate for Payer: Cash Price	$329.12
Rate for Payer: Cash Price	$329.12
Rate for Payer: Cigna Medicaid	$348.48
Rate for Payer: Cigna Medicare	$8.68
Rate for Payer: Employer Direct Commercial	$8.68
Rate for Payer: Humana Medicare/TRICARE	$8.68
Rate for Payer: Molina CHIP/Medicaid	$348.48
Rate for Payer: Molina Dual Medicare/Medicaid	$8.68
Rate for Payer: Molina Medicare	$8.68
Rate for Payer: Multiplan Auto	$314.60
Rate for Payer: Multiplan Commercial	$314.60
Rate for Payer: Multiplan Workers Comp	$314.60
Rate for Payer: Parkland Medicaid	$348.48
Rate for Payer: Scott and White EPO/PPO	$10.85
Rate for Payer: Scott and White Medicare	$8.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$348.48
Rate for Payer: Superior Health Plan EPO	$8.68
Rate for Payer: Superior Health Plan Medicare	$8.68
Rate for Payer: Universal American Dual Medicare/Medicaid	$8.68
Rate for Payer: Universal American Medicare	$8.68
Rate for Payer: Wellcare Medicare	$8.68
Rate for Payer: Wellmed Medicare	$8.68

Renal Function Panel

Facility

$484.00

Service Code	HCPCS 80069
Hospital Charge Code	1603539
Hospital Revenue Code	301
Rate for Payer: Cash Price	$329.12

Renin Activity, Plasma SO

Facility

$469.00

Service Code	HCPCS 84244
Hospital Charge Code	1701523
Hospital Revenue Code	301
Rate for Payer: Cash Price	$318.92

Renin Activity, Plasma SO

Facility

$469.00

Service Code	HCPCS 84244
Hospital Charge Code	1701523
Hospital Revenue Code	301
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$337.68
Rate for Payer: Amerigroup CHIP/Medicaid	$8.58
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$21.99
Rate for Payer: Amerigroup Medicare	$21.99
Rate for Payer: BCBS of TX Blue Advantage	$140.70
Rate for Payer: BCBS of TX Blue Essentials	$168.84
Rate for Payer: BCBS of TX Medicare	$21.99
Rate for Payer: BCBS of TX PPO	$187.60
Rate for Payer: Cash Price	$318.92
Rate for Payer: Cash Price	$318.92
Rate for Payer: Cigna Medicaid	$337.68
Rate for Payer: Cigna Medicare	$21.99
Rate for Payer: Employer Direct Commercial	$21.99
Rate for Payer: Humana Medicare/TRICARE	$21.99
Rate for Payer: Molina CHIP/Medicaid	$337.68
Rate for Payer: Molina Dual Medicare/Medicaid	$21.99
Rate for Payer: Molina Medicare	$21.99
Rate for Payer: Multiplan Auto	$304.85
Rate for Payer: Multiplan Commercial	$304.85
Rate for Payer: Multiplan Workers Comp	$304.85
Rate for Payer: Parkland Medicaid	$337.68
Rate for Payer: Scott and White EPO/PPO	$27.49
Rate for Payer: Scott and White Medicare	$21.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$337.68
Rate for Payer: Superior Health Plan EPO	$21.99
Rate for Payer: Superior Health Plan Medicare	$21.99
Rate for Payer: Universal American Dual Medicare/Medicaid	$21.99
Rate for Payer: Universal American Medicare	$21.99
Rate for Payer: Wellcare Medicare	$21.99
Rate for Payer: Wellmed Medicare	$21.99

Reopening of recent laparotomy

Facility

$64,200.00

Service Code	HCPCS 49002
Hospital Charge Code	991129
Hospital Revenue Code	360
Rate for Payer: Cash Price	$43,656.00

Reopening of recent laparotomy

Facility

$64,200.00

Service Code	HCPCS 49002
Hospital Charge Code	991129
Hospital Revenue Code	360
Min. Negotiated Rate	$1,826.03
Max. Negotiated Rate	$46,224.00
Rate for Payer: Amerigroup CHIP/Medicaid	$5,778.00
Rate for Payer: BCBS of TX Blue Advantage	$1,826.03
Rate for Payer: BCBS of TX Blue Essentials	$2,186.86
Rate for Payer: BCBS of TX PPO	$2,755.44
Rate for Payer: Cash Price	$43,656.00
Rate for Payer: Cash Price	$43,656.00
Rate for Payer: Cash Price	$43,656.00
Rate for Payer: Cigna Medicaid	$46,224.00
Rate for Payer: Molina CHIP/Medicaid	$46,224.00
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$46,224.00
Rate for Payer: Scott and White EPO/PPO	$32,100.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$46,224.00
Rate for Payer: Superior Health Plan EPO	$8,731.20

Reoperation, femoral-popliteal or femoral (popliteal)-anterior tibial, posterior tibial, peroneal artery, or other distal vessels, more than 1 month after original operation

Facility

$4,620.00

Service Code	HCPCS 35700
Hospital Charge Code	991017
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,141.60

Reoperation, femoral-popliteal or femoral (popliteal)-anterior tibial, posterior tibial, peroneal artery, or other distal vessels, more than 1 month after original operation

Facility

$4,620.00

Service Code	HCPCS 35700
Hospital Charge Code	991017
Hospital Revenue Code	360
Min. Negotiated Rate	$266.01
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$415.80
Rate for Payer: BCBS of TX Blue Advantage	$266.01
Rate for Payer: BCBS of TX Blue Essentials	$318.58
Rate for Payer: BCBS of TX PPO	$401.41
Rate for Payer: Cash Price	$3,141.60
Rate for Payer: Cash Price	$3,141.60
Rate for Payer: Cash Price	$3,141.60
Rate for Payer: Cigna Medicaid	$3,326.40
Rate for Payer: Molina CHIP/Medicaid	$3,326.40
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$3,326.40
Rate for Payer: Scott and White EPO/PPO	$2,310.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,326.40
Rate for Payer: Superior Health Plan EPO	$628.32

Repair and reconstruction, finger, volar plate, interphalangeal joint

Facility

$10,000.00

Service Code	CPT 26548
Hospital Charge Code	36026548
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
Rate for Payer: BCBS of TX Blue Advantage	$4,571.54
Rate for Payer: BCBS of TX Blue Essentials	$5,474.90
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Scott and White EPO/PPO	$6,080.78
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Repair and reconstruction, finger, volar plate, interphalangeal joint

Facility

$12,736.80

Service Code	HCPCS 26548
Hospital Charge Code	9900358
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.27
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,088.27
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Amerigroup Medicare	$3,286.91
Rate for Payer: BCBS of TX Blue Advantage	$4,571.54
Rate for Payer: BCBS of TX Blue Essentials	$5,474.90
Rate for Payer: BCBS of TX Medicare	$3,286.91
Rate for Payer: BCBS of TX PPO	$6,898.37
Rate for Payer: Cash Price	$8,661.02
Rate for Payer: Cash Price	$8,661.02
Rate for Payer: Cash Price	$8,661.02
Rate for Payer: Cigna Commercial	$6,947.94
Rate for Payer: Cigna Medicaid	$9,170.50
Rate for Payer: Cigna Medicare	$3,286.91
Rate for Payer: Employer Direct Commercial	$3,286.91
Rate for Payer: Humana Medicare/TRICARE	$3,286.91
Rate for Payer: Molina CHIP/Medicaid	$9,170.50
Rate for Payer: Molina Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Molina Medicare	$3,286.91
Rate for Payer: Multiplan Auto	$10,000.00
Rate for Payer: Multiplan Commercial	$10,000.00
Rate for Payer: Multiplan Workers Comp	$10,000.00
Rate for Payer: Parkland Medicaid	$9,170.50
Rate for Payer: Scott and White EPO/PPO	$6,080.78
Rate for Payer: Scott and White Medicare	$3,286.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,170.50
Rate for Payer: Superior Health Plan EPO	$3,286.91
Rate for Payer: Superior Health Plan Medicare	$3,286.91
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,286.91
Rate for Payer: Universal American Medicare	$3,286.91
Rate for Payer: Wellcare Medicare	$3,286.91
Rate for Payer: Wellmed Medicare	$3,286.91

Repair and reconstruction, finger, volar plate, interphalangeal joint

Facility

$12,736.80

Service Code	HCPCS 26548
Hospital Charge Code	9900358
Hospital Revenue Code	360
Rate for Payer: Cash Price	$8,661.02

Know your out-of-pocket cost for care.

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