White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SPPRT WRIST -- DHF

Facility

$360.44

Hospital Charge Code	80341506
Hospital Revenue Code	270
Min. Negotiated Rate	$32.44
Max. Negotiated Rate	$259.52
Rate for Payer: Amerigroup CHIP/Medicaid	$32.44
Rate for Payer: BCBS of TX Blue Advantage	$108.13
Rate for Payer: BCBS of TX Blue Essentials	$129.76
Rate for Payer: BCBS of TX PPO	$144.18
Rate for Payer: Cash Price	$245.10
Rate for Payer: Cigna Medicaid	$259.52
Rate for Payer: Molina CHIP/Medicaid	$259.52
Rate for Payer: Multiplan Auto	$234.29
Rate for Payer: Multiplan Commercial	$234.29
Rate for Payer: Multiplan Workers Comp	$234.29
Rate for Payer: Parkland Medicaid	$259.52
Rate for Payer: Scott and White EPO/PPO	$180.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$259.52
Rate for Payer: Superior Health Plan EPO	$49.02

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC

Facility

$18,131.70

Service Code	MSDRG 537
Min. Negotiated Rate	$7,830.30
Max. Negotiated Rate	$18,131.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,754.18
Rate for Payer: Amerigroup Medicare	$11,754.18
Rate for Payer: BCBS of TX Medicare	$11,754.18
Rate for Payer: Cigna Commercial	$12,291.38
Rate for Payer: Cigna Medicare	$11,754.18
Rate for Payer: Employer Direct Commercial	$11,754.18
Rate for Payer: Humana Medicare/TRICARE	$11,754.18
Rate for Payer: Molina Dual Medicare/Medicaid	$11,754.18
Rate for Payer: Molina Medicare	$11,754.18
Rate for Payer: Multiplan Auto	$18,131.70
Rate for Payer: Multiplan Commercial	$18,131.70
Rate for Payer: Multiplan Workers Comp	$18,131.70
Rate for Payer: Scott and White EPO/PPO	$8,350.12
Rate for Payer: Scott and White Medicare	$11,754.18
Rate for Payer: Superior Health Plan EPO	$11,754.18
Rate for Payer: Superior Health Plan Medicare	$11,754.18
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,754.18
Rate for Payer: Universal American Medicare	$11,754.18
Rate for Payer: Wellcare Medicare	$11,754.18
Rate for Payer: Wellmed Medicare	$11,754.18

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC

Facility

$13,685.70

Service Code	MSDRG 538
Min. Negotiated Rate	$6,252.20
Max. Negotiated Rate	$13,685.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,039.18
Rate for Payer: Amerigroup Medicare	$10,039.18
Rate for Payer: BCBS of TX Medicare	$10,039.18
Rate for Payer: Cigna Commercial	$9,277.46
Rate for Payer: Cigna Medicare	$10,039.18
Rate for Payer: Employer Direct Commercial	$10,039.18
Rate for Payer: Humana Medicare/TRICARE	$10,039.18
Rate for Payer: Molina Dual Medicare/Medicaid	$10,039.18
Rate for Payer: Molina Medicare	$10,039.18
Rate for Payer: Multiplan Auto	$13,685.70
Rate for Payer: Multiplan Commercial	$13,685.70
Rate for Payer: Multiplan Workers Comp	$13,685.70
Rate for Payer: Scott and White EPO/PPO	$6,302.62
Rate for Payer: Scott and White Medicare	$10,039.18
Rate for Payer: Superior Health Plan EPO	$10,039.18
Rate for Payer: Superior Health Plan Medicare	$10,039.18
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,039.18
Rate for Payer: Universal American Medicare	$10,039.18
Rate for Payer: Wellcare Medicare	$10,039.18
Rate for Payer: Wellmed Medicare	$10,039.18

SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH W CC/MCC

Facility

$18,131.70

Service Code	MSDRG 537
Min. Negotiated Rate	$7,830.30
Max. Negotiated Rate	$18,131.70
Rate for Payer: BCBS of TX Blue Advantage	$7,830.30
Rate for Payer: BCBS of TX Blue Essentials	$9,395.45
Rate for Payer: BCBS of TX PPO	$10,439.79

SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH W/O CC/MCC

Facility

$13,685.70

Service Code	MSDRG 538
Min. Negotiated Rate	$6,252.20
Max. Negotiated Rate	$13,685.70
Rate for Payer: BCBS of TX Blue Advantage	$6,252.20
Rate for Payer: BCBS of TX Blue Essentials	$7,501.91
Rate for Payer: BCBS of TX PPO	$8,335.78

SPY RENTAL

Facility

$15,054.27

Hospital Charge Code	991151
Hospital Revenue Code	272
Rate for Payer: Cash Price	$10,236.90

SPY RENTAL

Facility

$15,054.27

Hospital Charge Code	991151
Hospital Revenue Code	272
Min. Negotiated Rate	$1,354.88
Max. Negotiated Rate	$10,839.07
Rate for Payer: Amerigroup CHIP/Medicaid	$1,354.88
Rate for Payer: BCBS of TX Blue Advantage	$4,516.28
Rate for Payer: BCBS of TX Blue Essentials	$5,419.54
Rate for Payer: BCBS of TX PPO	$6,021.71
Rate for Payer: Cash Price	$10,236.90
Rate for Payer: Cigna Medicaid	$10,839.07
Rate for Payer: Molina CHIP/Medicaid	$10,839.07
Rate for Payer: Multiplan Auto	$9,785.28
Rate for Payer: Multiplan Commercial	$9,785.28
Rate for Payer: Multiplan Workers Comp	$9,785.28
Rate for Payer: Parkland Medicaid	$10,839.07
Rate for Payer: Scott and White EPO/PPO	$7,527.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,839.07
Rate for Payer: Superior Health Plan EPO	$2,047.38

Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions

Facility

$14,618.15

Service Code	HCPCS 37765
Hospital Charge Code	9900633
Hospital Revenue Code	360
Min. Negotiated Rate	$194.90
Max. Negotiated Rate	$10,525.07
Rate for Payer: Amerigroup CHIP/Medicaid	$194.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Amerigroup Medicare	$3,171.87
Rate for Payer: BCBS of TX Blue Advantage	$414.06
Rate for Payer: BCBS of TX Blue Essentials	$495.88
Rate for Payer: BCBS of TX Medicare	$3,171.87
Rate for Payer: BCBS of TX PPO	$624.81
Rate for Payer: Cash Price	$9,940.34
Rate for Payer: Cash Price	$9,940.34
Rate for Payer: Cash Price	$9,940.34
Rate for Payer: Cigna Commercial	$6,704.76
Rate for Payer: Cigna Medicaid	$10,525.07
Rate for Payer: Cigna Medicare	$3,171.87
Rate for Payer: Employer Direct Commercial	$3,171.87
Rate for Payer: Humana Medicare/TRICARE	$3,171.87
Rate for Payer: Molina CHIP/Medicaid	$10,525.07
Rate for Payer: Molina Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Molina Medicare	$3,171.87
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	$10,525.07
Rate for Payer: Scott and White EPO/PPO	$5,867.96
Rate for Payer: Scott and White Medicare	$3,171.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,525.07
Rate for Payer: Superior Health Plan EPO	$3,171.87
Rate for Payer: Superior Health Plan Medicare	$3,171.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Universal American Medicare	$3,171.87
Rate for Payer: Wellcare Medicare	$3,171.87
Rate for Payer: Wellmed Medicare	$3,171.87

Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions

Facility

$10,000.00

Service Code	CPT 37765
Hospital Charge Code	36037765
Hospital Revenue Code	360
Min. Negotiated Rate	$194.90
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$194.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Amerigroup Medicare	$3,171.87
Rate for Payer: BCBS of TX Blue Advantage	$414.06
Rate for Payer: BCBS of TX Blue Essentials	$495.88
Rate for Payer: BCBS of TX Medicare	$3,171.87
Rate for Payer: BCBS of TX PPO	$624.81
Rate for Payer: Cigna Commercial	$6,704.76
Rate for Payer: Cigna Medicare	$3,171.87
Rate for Payer: Employer Direct Commercial	$3,171.87
Rate for Payer: Humana Medicare/TRICARE	$3,171.87
Rate for Payer: Molina Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Molina Medicare	$3,171.87
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	$5,867.96
Rate for Payer: Scott and White Medicare	$3,171.87
Rate for Payer: Superior Health Plan EPO	$3,171.87
Rate for Payer: Superior Health Plan Medicare	$3,171.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Universal American Medicare	$3,171.87
Rate for Payer: Wellcare Medicare	$3,171.87
Rate for Payer: Wellmed Medicare	$3,171.87

Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions

Facility

$14,618.15

Service Code	HCPCS 36475
Hospital Charge Code	9900627
Hospital Revenue Code	360
Rate for Payer: Cash Price	$9,940.34

Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions

Facility

$14,618.15

Service Code	HCPCS 36475
Hospital Charge Code	9900627
Hospital Revenue Code	360
Min. Negotiated Rate	$1,118.22
Max. Negotiated Rate	$10,525.07
Rate for Payer: Amerigroup CHIP/Medicaid	$1,118.22
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Amerigroup Medicare	$3,171.87
Rate for Payer: BCBS of TX Blue Advantage	$4,628.04
Rate for Payer: BCBS of TX Blue Essentials	$5,542.56
Rate for Payer: BCBS of TX Medicare	$3,171.87
Rate for Payer: BCBS of TX PPO	$6,983.63
Rate for Payer: Cash Price	$9,940.34
Rate for Payer: Cash Price	$9,940.34
Rate for Payer: Cash Price	$9,940.34
Rate for Payer: Cigna Commercial	$6,704.76
Rate for Payer: Cigna Medicaid	$10,525.07
Rate for Payer: Cigna Medicare	$3,171.87
Rate for Payer: Employer Direct Commercial	$3,171.87
Rate for Payer: Humana Medicare/TRICARE	$3,171.87
Rate for Payer: Molina CHIP/Medicaid	$10,525.07
Rate for Payer: Molina Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Molina Medicare	$3,171.87
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	$10,525.07
Rate for Payer: Scott and White EPO/PPO	$5,867.96
Rate for Payer: Scott and White Medicare	$3,171.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,525.07
Rate for Payer: Superior Health Plan EPO	$3,171.87
Rate for Payer: Superior Health Plan Medicare	$3,171.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Universal American Medicare	$3,171.87
Rate for Payer: Wellcare Medicare	$3,171.87
Rate for Payer: Wellmed Medicare	$3,171.87

Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions

Facility

$10,000.00

Service Code	CPT 36475
Hospital Charge Code	36036475
Hospital Revenue Code	360
Min. Negotiated Rate	$1,118.22
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,118.22
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Amerigroup Medicare	$3,171.87
Rate for Payer: BCBS of TX Blue Advantage	$4,628.04
Rate for Payer: BCBS of TX Blue Essentials	$5,542.56
Rate for Payer: BCBS of TX Medicare	$3,171.87
Rate for Payer: BCBS of TX PPO	$6,983.63
Rate for Payer: Cigna Commercial	$6,704.76
Rate for Payer: Cigna Medicare	$3,171.87
Rate for Payer: Employer Direct Commercial	$3,171.87
Rate for Payer: Humana Medicare/TRICARE	$3,171.87
Rate for Payer: Molina Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Molina Medicare	$3,171.87
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	$5,867.96
Rate for Payer: Scott and White Medicare	$3,171.87
Rate for Payer: Superior Health Plan EPO	$3,171.87
Rate for Payer: Superior Health Plan Medicare	$3,171.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Universal American Medicare	$3,171.87
Rate for Payer: Wellcare Medicare	$3,171.87
Rate for Payer: Wellmed Medicare	$3,171.87

Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions

Facility

$14,618.15

Service Code	HCPCS 37765
Hospital Charge Code	9900633
Hospital Revenue Code	360
Rate for Payer: Cash Price	$9,940.34

Stab phlebectomy of varicose veins, 1 extremity; more than 20 incisions

Facility

$11,915.88

Service Code	HCPCS 37766
Hospital Charge Code	9900634
Hospital Revenue Code	360
Rate for Payer: Cash Price	$8,102.80

Stab phlebectomy of varicose veins, 1 extremity; more than 20 incisions

Facility

$11,915.88

Service Code	HCPCS 37766
Hospital Charge Code	9900634
Hospital Revenue Code	360
Min. Negotiated Rate	$212.90
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$212.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Amerigroup Medicare	$3,171.87
Rate for Payer: BCBS of TX Blue Advantage	$456.24
Rate for Payer: BCBS of TX Blue Essentials	$546.40
Rate for Payer: BCBS of TX Medicare	$3,171.87
Rate for Payer: BCBS of TX PPO	$688.46
Rate for Payer: Cash Price	$8,102.80
Rate for Payer: Cash Price	$8,102.80
Rate for Payer: Cash Price	$8,102.80
Rate for Payer: Cigna Commercial	$6,704.76
Rate for Payer: Cigna Medicaid	$8,579.43
Rate for Payer: Cigna Medicare	$3,171.87
Rate for Payer: Employer Direct Commercial	$3,171.87
Rate for Payer: Humana Medicare/TRICARE	$3,171.87
Rate for Payer: Molina CHIP/Medicaid	$8,579.43
Rate for Payer: Molina Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Molina Medicare	$3,171.87
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	$8,579.43
Rate for Payer: Scott and White EPO/PPO	$5,867.96
Rate for Payer: Scott and White Medicare	$3,171.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,579.43
Rate for Payer: Superior Health Plan EPO	$3,171.87
Rate for Payer: Superior Health Plan Medicare	$3,171.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Universal American Medicare	$3,171.87
Rate for Payer: Wellcare Medicare	$3,171.87
Rate for Payer: Wellmed Medicare	$3,171.87

Stab phlebectomy of varicose veins, 1 extremity; more than 20 incisions

Facility

$10,000.00

Service Code	CPT 37766
Hospital Charge Code	36037766
Hospital Revenue Code	360
Min. Negotiated Rate	$212.90
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$212.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Amerigroup Medicare	$3,171.87
Rate for Payer: BCBS of TX Blue Advantage	$456.24
Rate for Payer: BCBS of TX Blue Essentials	$546.40
Rate for Payer: BCBS of TX Medicare	$3,171.87
Rate for Payer: BCBS of TX PPO	$688.46
Rate for Payer: Cigna Commercial	$6,704.76
Rate for Payer: Cigna Medicare	$3,171.87
Rate for Payer: Employer Direct Commercial	$3,171.87
Rate for Payer: Humana Medicare/TRICARE	$3,171.87
Rate for Payer: Molina Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Molina Medicare	$3,171.87
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	$5,867.96
Rate for Payer: Scott and White Medicare	$3,171.87
Rate for Payer: Superior Health Plan EPO	$3,171.87
Rate for Payer: Superior Health Plan Medicare	$3,171.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,171.87
Rate for Payer: Universal American Medicare	$3,171.87
Rate for Payer: Wellcare Medicare	$3,171.87
Rate for Payer: Wellmed Medicare	$3,171.87

ST ADM BLOOD/PMP -- DHF

Facility

$152.70

Hospital Charge Code	54200365
Hospital Revenue Code	270
Rate for Payer: Cash Price	$103.84

ST ADM BLOOD/PMP -- DHF

Facility

$152.70

Hospital Charge Code	54200365
Hospital Revenue Code	270
Min. Negotiated Rate	$13.74
Max. Negotiated Rate	$109.94
Rate for Payer: Amerigroup CHIP/Medicaid	$13.74
Rate for Payer: BCBS of TX Blue Advantage	$45.81
Rate for Payer: BCBS of TX Blue Essentials	$54.97
Rate for Payer: BCBS of TX PPO	$61.08
Rate for Payer: Cash Price	$103.84
Rate for Payer: Cigna Medicaid	$109.94
Rate for Payer: Molina CHIP/Medicaid	$109.94
Rate for Payer: Multiplan Auto	$99.25
Rate for Payer: Multiplan Commercial	$99.25
Rate for Payer: Multiplan Workers Comp	$99.25
Rate for Payer: Parkland Medicaid	$109.94
Rate for Payer: Scott and White EPO/PPO	$76.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$109.94
Rate for Payer: Superior Health Plan EPO	$20.77

ST AMBU -- DHF

Facility

$85.35

Hospital Charge Code	82070004
Hospital Revenue Code	270
Rate for Payer: Cash Price	$58.04

ST AMBU -- DHF

Facility

$85.35

Hospital Charge Code	82070004
Hospital Revenue Code	270
Min. Negotiated Rate	$7.68
Max. Negotiated Rate	$61.45
Rate for Payer: Amerigroup CHIP/Medicaid	$7.68
Rate for Payer: BCBS of TX Blue Advantage	$25.61
Rate for Payer: BCBS of TX Blue Essentials	$30.73
Rate for Payer: BCBS of TX PPO	$34.14
Rate for Payer: Cash Price	$58.04
Rate for Payer: Cigna Medicaid	$61.45
Rate for Payer: Molina CHIP/Medicaid	$61.45
Rate for Payer: Multiplan Auto	$55.48
Rate for Payer: Multiplan Commercial	$55.48
Rate for Payer: Multiplan Workers Comp	$55.48
Rate for Payer: Parkland Medicaid	$61.45
Rate for Payer: Scott and White EPO/PPO	$42.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$61.45
Rate for Payer: Superior Health Plan EPO	$11.61

Standard bore iv extension set with removable sure-lok needle free connector

Facility

$8.56

Hospital Charge Code	993454
Hospital Revenue Code	272
Rate for Payer: Cash Price	$5.82

Standard bore iv extension set with removable sure-lok needle free connector

Facility

$8.56

Hospital Charge Code	993454
Hospital Revenue Code	272
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$6.16
Rate for Payer: Amerigroup CHIP/Medicaid	$0.77
Rate for Payer: BCBS of TX Blue Advantage	$2.57
Rate for Payer: BCBS of TX Blue Essentials	$3.08
Rate for Payer: BCBS of TX PPO	$3.42
Rate for Payer: Cash Price	$5.82
Rate for Payer: Cigna Medicaid	$6.16
Rate for Payer: Molina CHIP/Medicaid	$6.16
Rate for Payer: Multiplan Auto	$5.56
Rate for Payer: Multiplan Commercial	$5.56
Rate for Payer: Multiplan Workers Comp	$5.56
Rate for Payer: Parkland Medicaid	$6.16
Rate for Payer: Scott and White EPO/PPO	$4.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.16
Rate for Payer: Superior Health Plan EPO	$1.16

Standard instant cold pack, 6'x 9'

Facility

$2.94

Hospital Charge Code	993720
Hospital Revenue Code	271
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$2.12
Rate for Payer: Amerigroup CHIP/Medicaid	$0.26
Rate for Payer: BCBS of TX Blue Advantage	$0.88
Rate for Payer: BCBS of TX Blue Essentials	$1.06
Rate for Payer: BCBS of TX PPO	$1.18
Rate for Payer: Cash Price	$2.00
Rate for Payer: Cigna Medicaid	$2.12
Rate for Payer: Molina CHIP/Medicaid	$2.12
Rate for Payer: Multiplan Auto	$1.91
Rate for Payer: Multiplan Commercial	$1.91
Rate for Payer: Multiplan Workers Comp	$1.91
Rate for Payer: Parkland Medicaid	$2.12
Rate for Payer: Scott and White EPO/PPO	$1.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.12
Rate for Payer: Superior Health Plan EPO	$0.40

Standard instant cold pack, 6'x 9'

Facility

$2.94

Hospital Charge Code	993720
Hospital Revenue Code	271
Rate for Payer: Cash Price	$2.00

Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or without use of for

Facility

$13,986.64

Service Code	HCPCS 69660
Hospital Charge Code	9900893
Hospital Revenue Code	360
Rate for Payer: Cash Price	$9,510.92

Know your out-of-pocket cost for care.

All Charges