White Rock Medical Center

All Charges

Charge

Type

Setting

Price

ST TUBING REFIL -- DHF

Facility

$82.27

Hospital Charge Code	81853103
Hospital Revenue Code	270
Rate for Payer: Cash Price	$55.94

STYLET INTBT GLD RT RGD GLIDESCOPE

Facility

$174.79

Hospital Charge Code	115522
Hospital Revenue Code	272
Rate for Payer: Cash Price	$118.86

STYLET INTBT GLD RT RGD GLIDESCOPE

Facility

$174.79

Hospital Charge Code	115522
Hospital Revenue Code	272
Min. Negotiated Rate	$15.73
Max. Negotiated Rate	$125.85
Rate for Payer: Amerigroup CHIP/Medicaid	$15.73
Rate for Payer: BCBS of TX Blue Advantage	$52.44
Rate for Payer: BCBS of TX Blue Essentials	$62.92
Rate for Payer: BCBS of TX PPO	$69.92
Rate for Payer: Cash Price	$118.86
Rate for Payer: Cigna Medicaid	$125.85
Rate for Payer: Molina CHIP/Medicaid	$125.85
Rate for Payer: Multiplan Auto	$113.61
Rate for Payer: Multiplan Commercial	$113.61
Rate for Payer: Multiplan Workers Comp	$113.61
Rate for Payer: Parkland Medicaid	$125.85
Rate for Payer: Scott and White EPO/PPO	$87.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$125.85
Rate for Payer: Superior Health Plan EPO	$23.77

STYLET,INTUBATING, 14 FR

Facility

$8.43

Hospital Charge Code	992911
Hospital Revenue Code	272
Rate for Payer: Cash Price	$5.73

STYLET,INTUBATING, 14 FR

Facility

$8.43

Hospital Charge Code	992911
Hospital Revenue Code	272
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$6.07
Rate for Payer: Amerigroup CHIP/Medicaid	$0.76
Rate for Payer: BCBS of TX Blue Advantage	$2.53
Rate for Payer: BCBS of TX Blue Essentials	$3.03
Rate for Payer: BCBS of TX PPO	$3.37
Rate for Payer: Cash Price	$5.73
Rate for Payer: Cigna Medicaid	$6.07
Rate for Payer: Molina CHIP/Medicaid	$6.07
Rate for Payer: Multiplan Auto	$5.48
Rate for Payer: Multiplan Commercial	$5.48
Rate for Payer: Multiplan Workers Comp	$5.48
Rate for Payer: Parkland Medicaid	$6.07
Rate for Payer: Scott and White EPO/PPO	$4.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.07
Rate for Payer: Superior Health Plan EPO	$1.15

STYLET PERITONEAL CATHETER

Facility

$227.00

Hospital Charge Code	8484502
Hospital Revenue Code	272
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$163.44
Rate for Payer: Amerigroup CHIP/Medicaid	$20.43
Rate for Payer: BCBS of TX Blue Advantage	$68.10
Rate for Payer: BCBS of TX Blue Essentials	$81.72
Rate for Payer: BCBS of TX PPO	$90.80
Rate for Payer: Cash Price	$154.36
Rate for Payer: Cigna Medicaid	$163.44
Rate for Payer: Molina CHIP/Medicaid	$163.44
Rate for Payer: Multiplan Auto	$147.55
Rate for Payer: Multiplan Commercial	$147.55
Rate for Payer: Multiplan Workers Comp	$147.55
Rate for Payer: Parkland Medicaid	$163.44
Rate for Payer: Scott and White EPO/PPO	$113.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$163.44
Rate for Payer: Superior Health Plan EPO	$30.87

STYLET PERITONEAL CATHETER

Facility

$227.00

Hospital Charge Code	8484502
Hospital Revenue Code	272
Rate for Payer: Cash Price	$154.36

Submucous resection inferior turbinate, partial or complete, any method

Facility

$10,000.00

Service Code	CPT 30140
Hospital Charge Code	36030140
Hospital Revenue Code	360
Min. Negotiated Rate	$886.62
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$886.62
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,330.57
Rate for Payer: Amerigroup Medicare	$3,330.57
Rate for Payer: BCBS of TX Blue Advantage	$4,374.21
Rate for Payer: BCBS of TX Blue Essentials	$5,238.58
Rate for Payer: BCBS of TX Medicare	$3,330.57
Rate for Payer: BCBS of TX PPO	$6,600.61
Rate for Payer: Cigna Commercial	$7,040.22
Rate for Payer: Cigna Medicare	$3,330.57
Rate for Payer: Employer Direct Commercial	$3,330.57
Rate for Payer: Humana Medicare/TRICARE	$3,330.57
Rate for Payer: Molina Dual Medicare/Medicaid	$3,330.57
Rate for Payer: Molina Medicare	$3,330.57
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	$6,161.55
Rate for Payer: Scott and White Medicare	$3,330.57
Rate for Payer: Superior Health Plan EPO	$3,330.57
Rate for Payer: Superior Health Plan Medicare	$3,330.57
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,330.57
Rate for Payer: Universal American Medicare	$3,330.57
Rate for Payer: Wellcare Medicare	$3,330.57
Rate for Payer: Wellmed Medicare	$3,330.57

Submucous resection inferior turbinate, partial or complete, any method

Facility

$6,840.98

Service Code	HCPCS 30140
Hospital Charge Code	9900595
Hospital Revenue Code	360
Rate for Payer: Cash Price	$4,651.87

Submucous resection inferior turbinate, partial or complete, any method

Facility

$6,840.98

Service Code	HCPCS 30140
Hospital Charge Code	9900595
Hospital Revenue Code	360
Min. Negotiated Rate	$886.62
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$886.62
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,330.57
Rate for Payer: Amerigroup Medicare	$3,330.57
Rate for Payer: BCBS of TX Blue Advantage	$4,374.21
Rate for Payer: BCBS of TX Blue Essentials	$5,238.58
Rate for Payer: BCBS of TX Medicare	$3,330.57
Rate for Payer: BCBS of TX PPO	$6,600.61
Rate for Payer: Cash Price	$4,651.87
Rate for Payer: Cash Price	$4,651.87
Rate for Payer: Cash Price	$4,651.87
Rate for Payer: Cigna Commercial	$7,040.22
Rate for Payer: Cigna Medicaid	$4,925.51
Rate for Payer: Cigna Medicare	$3,330.57
Rate for Payer: Employer Direct Commercial	$3,330.57
Rate for Payer: Humana Medicare/TRICARE	$3,330.57
Rate for Payer: Molina CHIP/Medicaid	$4,925.51
Rate for Payer: Molina Dual Medicare/Medicaid	$3,330.57
Rate for Payer: Molina Medicare	$3,330.57
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	$4,925.51
Rate for Payer: Scott and White EPO/PPO	$6,161.55
Rate for Payer: Scott and White Medicare	$3,330.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,925.51
Rate for Payer: Superior Health Plan EPO	$3,330.57
Rate for Payer: Superior Health Plan Medicare	$3,330.57
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,330.57
Rate for Payer: Universal American Medicare	$3,330.57
Rate for Payer: Wellcare Medicare	$3,330.57
Rate for Payer: Wellmed Medicare	$3,330.57

succinylcholine 20 mg/mL Inj Soln 10 mL

Facility

$128.17

Service Code	HCPCS J0330
Hospital Charge Code	77828712
Hospital Revenue Code	636
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$92.28
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$1.93
Rate for Payer: BCBS of TX Blue Essentials	$2.31
Rate for Payer: BCBS of TX PPO	$2.57
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cigna Medicaid	$92.28
Rate for Payer: Molina CHIP/Medicaid	$92.28
Rate for Payer: Multiplan Auto	$83.31
Rate for Payer: Multiplan Commercial	$83.31
Rate for Payer: Multiplan Workers Comp	$83.31
Rate for Payer: Parkland Medicaid	$92.28
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$92.28
Rate for Payer: Superior Health Plan EPO	$17.43

succinylcholine 20 mg/mL Inj Soln 10 mL

Facility

$128.17

Service Code	HCPCS J0330
Hospital Charge Code	77828712
Hospital Revenue Code	636
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$64.08
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cigna Commercial	$32.04
Rate for Payer: Scott and White EPO/PPO	$64.08

sucralfate 1 g/10 mL Oral Susp 10 mL

Facility

$51.94

Service Code	HCPCS J3490
Hospital Charge Code	77828881
Hospital Revenue Code	250
Min. Negotiated Rate	$4.67
Max. Negotiated Rate	$37.40
Rate for Payer: Amerigroup CHIP/Medicaid	$4.67
Rate for Payer: BCBS of TX Blue Advantage	$15.58
Rate for Payer: BCBS of TX Blue Essentials	$18.70
Rate for Payer: BCBS of TX PPO	$20.78
Rate for Payer: Cash Price	$35.32
Rate for Payer: Cigna Medicaid	$37.40
Rate for Payer: Molina CHIP/Medicaid	$37.40
Rate for Payer: Multiplan Auto	$33.76
Rate for Payer: Multiplan Commercial	$33.76
Rate for Payer: Multiplan Workers Comp	$33.76
Rate for Payer: Parkland Medicaid	$37.40
Rate for Payer: Scott and White EPO/PPO	$25.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$37.40
Rate for Payer: Superior Health Plan EPO	$7.06

sucralfate 1 g/10 mL Oral Susp 10 mL

Facility

$51.94

Service Code	HCPCS J3490
Hospital Charge Code	77828881
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.32

sucralfate 1 g Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77828828
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

sucralfate 1 g Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77828828
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$5.51
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.29
Rate for Payer: BCBS of TX Blue Essentials	$2.75
Rate for Payer: BCBS of TX PPO	$3.06
Rate for Payer: Cash Price	$5.20
Rate for Payer: Cigna Medicaid	$5.51
Rate for Payer: Molina CHIP/Medicaid	$5.51
Rate for Payer: Multiplan Auto	$4.97
Rate for Payer: Multiplan Commercial	$4.97
Rate for Payer: Multiplan Workers Comp	$4.97
Rate for Payer: Parkland Medicaid	$5.51
Rate for Payer: Scott and White EPO/PPO	$3.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.51
Rate for Payer: Superior Health Plan EPO	$1.04

Suction assisted lipectomy head and neck

Facility

$8,162.25

Service Code	HCPCS 15876
Hospital Charge Code	9900147
Hospital Revenue Code	360
Min. Negotiated Rate	$734.60
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$734.60
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,559.87
Rate for Payer: Amerigroup Medicare	$3,559.87
Rate for Payer: BCBS of TX Blue Advantage	$4,972.07
Rate for Payer: BCBS of TX Blue Essentials	$5,954.58
Rate for Payer: BCBS of TX Medicare	$3,559.87
Rate for Payer: BCBS of TX PPO	$7,502.77
Rate for Payer: Cash Price	$5,550.33
Rate for Payer: Cash Price	$5,550.33
Rate for Payer: Cash Price	$5,550.33
Rate for Payer: Cigna Commercial	$7,524.93
Rate for Payer: Cigna Medicaid	$5,876.82
Rate for Payer: Cigna Medicare	$3,559.87
Rate for Payer: Employer Direct Commercial	$3,559.87
Rate for Payer: Humana Medicare/TRICARE	$3,559.87
Rate for Payer: Molina CHIP/Medicaid	$5,876.82
Rate for Payer: Molina Dual Medicare/Medicaid	$3,559.87
Rate for Payer: Molina Medicare	$3,559.87
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	$5,876.82
Rate for Payer: Scott and White EPO/PPO	$6,585.76
Rate for Payer: Scott and White Medicare	$3,559.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,876.82
Rate for Payer: Superior Health Plan EPO	$3,559.87
Rate for Payer: Superior Health Plan Medicare	$3,559.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,559.87
Rate for Payer: Universal American Medicare	$3,559.87
Rate for Payer: Wellcare Medicare	$3,559.87
Rate for Payer: Wellmed Medicare	$3,559.87

Suction assisted lipectomy head and neck

Facility

$8,162.25

Service Code	HCPCS 15876
Hospital Charge Code	9900147
Hospital Revenue Code	360
Rate for Payer: Cash Price	$5,550.33

Suction assisted lipectomy head and neck

Facility

$10,000.00

Service Code	CPT 15876
Hospital Charge Code	36015876
Hospital Revenue Code	360
Min. Negotiated Rate	$3,559.87
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,559.87
Rate for Payer: Amerigroup Medicare	$3,559.87
Rate for Payer: BCBS of TX Blue Advantage	$4,972.07
Rate for Payer: BCBS of TX Blue Essentials	$5,954.58
Rate for Payer: BCBS of TX Medicare	$3,559.87
Rate for Payer: BCBS of TX PPO	$7,502.77
Rate for Payer: Cigna Commercial	$7,524.93
Rate for Payer: Cigna Medicare	$3,559.87
Rate for Payer: Employer Direct Commercial	$3,559.87
Rate for Payer: Humana Medicare/TRICARE	$3,559.87
Rate for Payer: Molina Dual Medicare/Medicaid	$3,559.87
Rate for Payer: Molina Medicare	$3,559.87
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	$6,585.76
Rate for Payer: Scott and White Medicare	$3,559.87
Rate for Payer: Superior Health Plan EPO	$3,559.87
Rate for Payer: Superior Health Plan Medicare	$3,559.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,559.87
Rate for Payer: Universal American Medicare	$3,559.87
Rate for Payer: Wellcare Medicare	$3,559.87
Rate for Payer: Wellmed Medicare	$3,559.87

Suction assisted lipectomy lower extremity

Facility

$1,243.40

Service Code	HCPCS 15879
Hospital Charge Code	9900150
Hospital Revenue Code	360
Rate for Payer: Cash Price	$845.51

Suction assisted lipectomy lower extremity

Facility

$1,243.40

Service Code	HCPCS 15879
Hospital Charge Code	9900150
Hospital Revenue Code	360
Min. Negotiated Rate	$111.91
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$111.91
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,559.87
Rate for Payer: Amerigroup Medicare	$3,559.87
Rate for Payer: BCBS of TX Blue Advantage	$4,972.07
Rate for Payer: BCBS of TX Blue Essentials	$5,954.58
Rate for Payer: BCBS of TX Medicare	$3,559.87
Rate for Payer: BCBS of TX PPO	$7,502.77
Rate for Payer: Cash Price	$845.51
Rate for Payer: Cash Price	$845.51
Rate for Payer: Cash Price	$845.51
Rate for Payer: Cigna Commercial	$7,524.93
Rate for Payer: Cigna Medicaid	$895.25
Rate for Payer: Cigna Medicare	$3,559.87
Rate for Payer: Employer Direct Commercial	$3,559.87
Rate for Payer: Humana Medicare/TRICARE	$3,559.87
Rate for Payer: Molina CHIP/Medicaid	$895.25
Rate for Payer: Molina Dual Medicare/Medicaid	$3,559.87
Rate for Payer: Molina Medicare	$3,559.87
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	$895.25
Rate for Payer: Scott and White EPO/PPO	$6,585.76
Rate for Payer: Scott and White Medicare	$3,559.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$895.25
Rate for Payer: Superior Health Plan EPO	$3,559.87
Rate for Payer: Superior Health Plan Medicare	$3,559.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,559.87
Rate for Payer: Universal American Medicare	$3,559.87
Rate for Payer: Wellcare Medicare	$3,559.87
Rate for Payer: Wellmed Medicare	$3,559.87

Suction assisted lipectomy lower extremity

Facility

$10,000.00

Service Code	CPT 15879
Hospital Charge Code	36015879
Hospital Revenue Code	360
Min. Negotiated Rate	$3,559.87
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,559.87
Rate for Payer: Amerigroup Medicare	$3,559.87
Rate for Payer: BCBS of TX Blue Advantage	$4,972.07
Rate for Payer: BCBS of TX Blue Essentials	$5,954.58
Rate for Payer: BCBS of TX Medicare	$3,559.87
Rate for Payer: BCBS of TX PPO	$7,502.77
Rate for Payer: Cigna Commercial	$7,524.93
Rate for Payer: Cigna Medicare	$3,559.87
Rate for Payer: Employer Direct Commercial	$3,559.87
Rate for Payer: Humana Medicare/TRICARE	$3,559.87
Rate for Payer: Molina Dual Medicare/Medicaid	$3,559.87
Rate for Payer: Molina Medicare	$3,559.87
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	$6,585.76
Rate for Payer: Scott and White Medicare	$3,559.87
Rate for Payer: Superior Health Plan EPO	$3,559.87
Rate for Payer: Superior Health Plan Medicare	$3,559.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,559.87
Rate for Payer: Universal American Medicare	$3,559.87
Rate for Payer: Wellcare Medicare	$3,559.87
Rate for Payer: Wellmed Medicare	$3,559.87

Suction assisted lipectomy trunk

Facility

$10,000.00

Service Code	CPT 15877
Hospital Charge Code	36015877
Hospital Revenue Code	360
Min. Negotiated Rate	$3,559.87
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,559.87
Rate for Payer: Amerigroup Medicare	$3,559.87
Rate for Payer: BCBS of TX Blue Advantage	$4,972.07
Rate for Payer: BCBS of TX Blue Essentials	$5,954.58
Rate for Payer: BCBS of TX Medicare	$3,559.87
Rate for Payer: BCBS of TX PPO	$7,502.77
Rate for Payer: Cigna Commercial	$7,524.93
Rate for Payer: Cigna Medicare	$3,559.87
Rate for Payer: Employer Direct Commercial	$3,559.87
Rate for Payer: Humana Medicare/TRICARE	$3,559.87
Rate for Payer: Molina Dual Medicare/Medicaid	$3,559.87
Rate for Payer: Molina Medicare	$3,559.87
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	$6,585.76
Rate for Payer: Scott and White Medicare	$3,559.87
Rate for Payer: Superior Health Plan EPO	$3,559.87
Rate for Payer: Superior Health Plan Medicare	$3,559.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,559.87
Rate for Payer: Universal American Medicare	$3,559.87
Rate for Payer: Wellcare Medicare	$3,559.87
Rate for Payer: Wellmed Medicare	$3,559.87

Suction assisted lipectomy trunk

Facility

$12,243.40

Service Code	HCPCS 15877
Hospital Charge Code	9900148
Hospital Revenue Code	360
Min. Negotiated Rate	$1,101.91
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1,101.91
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,559.87
Rate for Payer: Amerigroup Medicare	$3,559.87
Rate for Payer: BCBS of TX Blue Advantage	$4,972.07
Rate for Payer: BCBS of TX Blue Essentials	$5,954.58
Rate for Payer: BCBS of TX Medicare	$3,559.87
Rate for Payer: BCBS of TX PPO	$7,502.77
Rate for Payer: Cash Price	$8,325.51
Rate for Payer: Cash Price	$8,325.51
Rate for Payer: Cash Price	$8,325.51
Rate for Payer: Cigna Commercial	$7,524.93
Rate for Payer: Cigna Medicaid	$8,815.25
Rate for Payer: Cigna Medicare	$3,559.87
Rate for Payer: Employer Direct Commercial	$3,559.87
Rate for Payer: Humana Medicare/TRICARE	$3,559.87
Rate for Payer: Molina CHIP/Medicaid	$8,815.25
Rate for Payer: Molina Dual Medicare/Medicaid	$3,559.87
Rate for Payer: Molina Medicare	$3,559.87
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	$8,815.25
Rate for Payer: Scott and White EPO/PPO	$6,585.76
Rate for Payer: Scott and White Medicare	$3,559.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,815.25
Rate for Payer: Superior Health Plan EPO	$3,559.87
Rate for Payer: Superior Health Plan Medicare	$3,559.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,559.87
Rate for Payer: Universal American Medicare	$3,559.87
Rate for Payer: Wellcare Medicare	$3,559.87
Rate for Payer: Wellmed Medicare	$3,559.87

Suction assisted lipectomy trunk

Facility

$12,243.40

Service Code	HCPCS 15877
Hospital Charge Code	9900148
Hospital Revenue Code	360
Rate for Payer: Cash Price	$8,325.51

Know your out-of-pocket cost for care.

All Charges