White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs)

Facility

$5,747.96

Service Code	HCPCS 20220
Hospital Charge Code	9900167
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,908.61

Biopsy of liver, needle when done for indicated purpose at time of other major procedure (List sepa

Facility

$568.81

Service Code	HCPCS 47001
Hospital Charge Code	9900704
Hospital Revenue Code	360
Min. Negotiated Rate	$51.19
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$51.19
Rate for Payer: BCBS of TX Blue Advantage	$170.64
Rate for Payer: BCBS of TX Blue Essentials	$204.77
Rate for Payer: BCBS of TX PPO	$227.52
Rate for Payer: Cash Price	$386.79
Rate for Payer: Cash Price	$386.79
Rate for Payer: Cigna Medicaid	$409.54
Rate for Payer: Molina CHIP/Medicaid	$409.54
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	$409.54
Rate for Payer: Scott and White EPO/PPO	$284.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$409.54
Rate for Payer: Superior Health Plan EPO	$77.36

Biopsy of liver, needle when done for indicated purpose at time of other major procedure (List sepa

Facility

$10,000.00

Service Code	CPT 47001
Hospital Charge Code	36047001
Hospital Revenue Code	360
Min. Negotiated Rate	$124.35
Max. Negotiated Rate	$10,000.00
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: Scott and White EPO/PPO	$124.35

Biopsy of liver, needle when done for indicated purpose at time of other major procedure (List sepa

Facility

$568.81

Service Code	HCPCS 47001
Hospital Charge Code	9900704
Hospital Revenue Code	360
Rate for Payer: Cash Price	$386.79

Biopsy of tongue posterior one-third

Facility

$13,681.95

Service Code	HCPCS 41105
Hospital Charge Code	9900644
Hospital Revenue Code	360
Rate for Payer: Cash Price	$9,303.73

Biopsy of tongue posterior one-third

Facility

$13,681.95

Service Code	HCPCS 41105
Hospital Charge Code	9900644
Hospital Revenue Code	360
Min. Negotiated Rate	$109.63
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$109.63
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	$204.91
Rate for Payer: BCBS of TX Blue Essentials	$245.40
Rate for Payer: BCBS of TX Medicare	$3,330.57
Rate for Payer: BCBS of TX PPO	$309.20
Rate for Payer: Cash Price	$9,303.73
Rate for Payer: Cash Price	$9,303.73
Rate for Payer: Cash Price	$9,303.73
Rate for Payer: Cigna Commercial	$7,040.22
Rate for Payer: Cigna Medicaid	$9,851.00
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	$9,851.00
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	$9,851.00
Rate for Payer: Scott and White EPO/PPO	$5,447.31
Rate for Payer: Scott and White Medicare	$3,330.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,851.00
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

Biopsy of tongue posterior one-third

Facility

$10,000.00

Service Code	CPT 41105
Hospital Charge Code	36041105
Hospital Revenue Code	360
Min. Negotiated Rate	$109.63
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$109.63
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	$204.91
Rate for Payer: BCBS of TX Blue Essentials	$245.40
Rate for Payer: BCBS of TX Medicare	$3,330.57
Rate for Payer: BCBS of TX PPO	$309.20
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	$5,447.31
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

Biopsy or excision of lymph node(s) open, deep cervical node(s)

Facility

$14,209.83

Service Code	HCPCS 38510
Hospital Charge Code	9900637
Hospital Revenue Code	360
Min. Negotiated Rate	$963.66
Max. Negotiated Rate	$10,231.08
Rate for Payer: Amerigroup CHIP/Medicaid	$963.66
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,933.28
Rate for Payer: Amerigroup Medicare	$3,933.28
Rate for Payer: BCBS of TX Blue Advantage	$5,059.35
Rate for Payer: BCBS of TX Blue Essentials	$6,059.10
Rate for Payer: BCBS of TX Medicare	$3,933.28
Rate for Payer: BCBS of TX PPO	$7,634.47
Rate for Payer: Cash Price	$9,662.68
Rate for Payer: Cash Price	$9,662.68
Rate for Payer: Cash Price	$9,662.68
Rate for Payer: Cigna Commercial	$8,314.23
Rate for Payer: Cigna Medicaid	$10,231.08
Rate for Payer: Cigna Medicare	$3,933.28
Rate for Payer: Employer Direct Commercial	$3,933.28
Rate for Payer: Humana Medicare/TRICARE	$3,933.28
Rate for Payer: Molina CHIP/Medicaid	$10,231.08
Rate for Payer: Molina Dual Medicare/Medicaid	$3,933.28
Rate for Payer: Molina Medicare	$3,933.28
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	$10,231.08
Rate for Payer: Scott and White EPO/PPO	$6,449.12
Rate for Payer: Scott and White Medicare	$3,933.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,231.08
Rate for Payer: Superior Health Plan EPO	$3,933.28
Rate for Payer: Superior Health Plan Medicare	$3,933.28
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,933.28
Rate for Payer: Universal American Medicare	$3,933.28
Rate for Payer: Wellcare Medicare	$3,933.28
Rate for Payer: Wellmed Medicare	$3,933.28

Biopsy or excision of lymph node(s) open, deep cervical node(s)

Facility

$10,000.00

Service Code	CPT 38510
Hospital Charge Code	36038510
Hospital Revenue Code	360
Min. Negotiated Rate	$963.66
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$963.66
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3,933.28
Rate for Payer: Amerigroup Medicare	$3,933.28
Rate for Payer: BCBS of TX Blue Advantage	$5,059.35
Rate for Payer: BCBS of TX Blue Essentials	$6,059.10
Rate for Payer: BCBS of TX Medicare	$3,933.28
Rate for Payer: BCBS of TX PPO	$7,634.47
Rate for Payer: Cigna Commercial	$8,314.23
Rate for Payer: Cigna Medicare	$3,933.28
Rate for Payer: Employer Direct Commercial	$3,933.28
Rate for Payer: Humana Medicare/TRICARE	$3,933.28
Rate for Payer: Molina Dual Medicare/Medicaid	$3,933.28
Rate for Payer: Molina Medicare	$3,933.28
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	$6,449.12
Rate for Payer: Scott and White Medicare	$3,933.28
Rate for Payer: Superior Health Plan EPO	$3,933.28
Rate for Payer: Superior Health Plan Medicare	$3,933.28
Rate for Payer: Universal American Dual Medicare/Medicaid	$3,933.28
Rate for Payer: Universal American Medicare	$3,933.28
Rate for Payer: Wellcare Medicare	$3,933.28
Rate for Payer: Wellmed Medicare	$3,933.28

Biopsy or excision of lymph node(s) open, deep cervical node(s)

Facility

$14,209.83

Service Code	HCPCS 38510
Hospital Charge Code	9900637
Hospital Revenue Code	360
Rate for Payer: Cash Price	$9,662.68

Biopsy oropharynx

Facility

$10,000.00

Service Code	CPT 42800
Hospital Charge Code	36042800
Hospital Revenue Code	360
Min. Negotiated Rate	$85.54
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$85.54
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,558.65
Rate for Payer: Amerigroup Medicare	$1,558.65
Rate for Payer: BCBS of TX Blue Advantage	$172.38
Rate for Payer: BCBS of TX Blue Essentials	$206.44
Rate for Payer: BCBS of TX Medicare	$1,558.65
Rate for Payer: BCBS of TX PPO	$260.11
Rate for Payer: Cigna Commercial	$3,294.71
Rate for Payer: Cigna Medicare	$1,558.65
Rate for Payer: Employer Direct Commercial	$1,558.65
Rate for Payer: Humana Medicare/TRICARE	$1,558.65
Rate for Payer: Molina Dual Medicare/Medicaid	$1,558.65
Rate for Payer: Molina Medicare	$1,558.65
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	$2,580.23
Rate for Payer: Scott and White Medicare	$1,558.65
Rate for Payer: Superior Health Plan EPO	$1,558.65
Rate for Payer: Superior Health Plan Medicare	$1,558.65
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,558.65
Rate for Payer: Universal American Medicare	$1,558.65
Rate for Payer: Wellcare Medicare	$1,558.65
Rate for Payer: Wellmed Medicare	$1,558.65

Biopsy oropharynx

Facility

$6,872.85

Service Code	HCPCS 42800
Hospital Charge Code	9900658
Hospital Revenue Code	360
Min. Negotiated Rate	$85.54
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$85.54
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$1,558.65
Rate for Payer: Amerigroup Medicare	$1,558.65
Rate for Payer: BCBS of TX Blue Advantage	$172.38
Rate for Payer: BCBS of TX Blue Essentials	$206.44
Rate for Payer: BCBS of TX Medicare	$1,558.65
Rate for Payer: BCBS of TX PPO	$260.11
Rate for Payer: Cash Price	$4,673.54
Rate for Payer: Cash Price	$4,673.54
Rate for Payer: Cash Price	$4,673.54
Rate for Payer: Cigna Commercial	$3,294.71
Rate for Payer: Cigna Medicaid	$4,948.45
Rate for Payer: Cigna Medicare	$1,558.65
Rate for Payer: Employer Direct Commercial	$1,558.65
Rate for Payer: Humana Medicare/TRICARE	$1,558.65
Rate for Payer: Molina CHIP/Medicaid	$4,948.45
Rate for Payer: Molina Dual Medicare/Medicaid	$1,558.65
Rate for Payer: Molina Medicare	$1,558.65
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	$4,948.45
Rate for Payer: Scott and White EPO/PPO	$2,580.23
Rate for Payer: Scott and White Medicare	$1,558.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,948.45
Rate for Payer: Superior Health Plan EPO	$1,558.65
Rate for Payer: Superior Health Plan Medicare	$1,558.65
Rate for Payer: Universal American Dual Medicare/Medicaid	$1,558.65
Rate for Payer: Universal American Medicare	$1,558.65
Rate for Payer: Wellcare Medicare	$1,558.65
Rate for Payer: Wellmed Medicare	$1,558.65

Biopsy oropharynx

Facility

$6,872.85

Service Code	HCPCS 42800
Hospital Charge Code	9900658
Hospital Revenue Code	360
Rate for Payer: Cash Price	$4,673.54

Biopsy Skin Each Additional Leasion

Facility

$346.00

Service Code	HCPCS 11105
Hospital Charge Code	8912554
Hospital Revenue Code	361
Rate for Payer: Cash Price	$235.28

Biopsy Skin Each Additional Leasion

Facility

$346.00

Service Code	HCPCS 11105
Hospital Charge Code	8912554
Hospital Revenue Code	361
Min. Negotiated Rate	$31.14
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$31.14
Rate for Payer: BCBS of TX Blue Advantage	$103.80
Rate for Payer: BCBS of TX Blue Essentials	$124.56
Rate for Payer: BCBS of TX PPO	$138.40
Rate for Payer: Cash Price	$235.28
Rate for Payer: Cash Price	$235.28
Rate for Payer: Cigna Medicaid	$249.12
Rate for Payer: Molina CHIP/Medicaid	$249.12
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	$249.12
Rate for Payer: Scott and White EPO/PPO	$173.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$249.12
Rate for Payer: Superior Health Plan EPO	$47.06

Biopsy Skin Single Lesion

Facility

$688.00

Service Code	HCPCS 11104
Hospital Charge Code	7150051
Hospital Revenue Code	361
Min. Negotiated Rate	$79.46
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$79.46
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$408.37
Rate for Payer: Amerigroup Medicare	$408.37
Rate for Payer: BCBS of TX Blue Advantage	$147.44
Rate for Payer: BCBS of TX Blue Essentials	$176.58
Rate for Payer: BCBS of TX Medicare	$408.37
Rate for Payer: BCBS of TX PPO	$222.49
Rate for Payer: Cash Price	$467.84
Rate for Payer: Cash Price	$467.84
Rate for Payer: Cash Price	$467.84
Rate for Payer: Cigna Commercial	$863.21
Rate for Payer: Cigna Medicaid	$495.36
Rate for Payer: Cigna Medicare	$408.37
Rate for Payer: Employer Direct Commercial	$408.37
Rate for Payer: Humana Medicare/TRICARE	$408.37
Rate for Payer: Molina CHIP/Medicaid	$495.36
Rate for Payer: Molina Dual Medicare/Medicaid	$408.37
Rate for Payer: Molina Medicare	$408.37
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	$495.36
Rate for Payer: Scott and White EPO/PPO	$674.64
Rate for Payer: Scott and White Medicare	$408.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$495.36
Rate for Payer: Superior Health Plan EPO	$408.37
Rate for Payer: Superior Health Plan Medicare	$408.37
Rate for Payer: Universal American Dual Medicare/Medicaid	$408.37
Rate for Payer: Universal American Medicare	$408.37
Rate for Payer: Wellcare Medicare	$408.37
Rate for Payer: Wellmed Medicare	$408.37

Biopsy Skin Single Lesion

Facility

$688.00

Service Code	HCPCS 11104
Hospital Charge Code	7150051
Hospital Revenue Code	361
Rate for Payer: Cash Price	$467.84

Biopsy, soft tissue of thigh or knee area; deep (subfascial or intramuscular)

Facility

$10,829.40

Service Code	HCPCS 27324
Hospital Charge Code	9900392
Hospital Revenue Code	360
Min. Negotiated Rate	$815.20
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$815.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,917.95
Rate for Payer: Amerigroup Medicare	$2,917.95
Rate for Payer: BCBS of TX Blue Advantage	$3,872.55
Rate for Payer: BCBS of TX Blue Essentials	$4,637.78
Rate for Payer: BCBS of TX Medicare	$2,917.95
Rate for Payer: BCBS of TX PPO	$5,843.60
Rate for Payer: Cash Price	$7,363.99
Rate for Payer: Cash Price	$7,363.99
Rate for Payer: Cash Price	$7,363.99
Rate for Payer: Cigna Commercial	$6,168.03
Rate for Payer: Cigna Medicaid	$7,797.17
Rate for Payer: Cigna Medicare	$2,917.95
Rate for Payer: Employer Direct Commercial	$2,917.95
Rate for Payer: Humana Medicare/TRICARE	$2,917.95
Rate for Payer: Molina CHIP/Medicaid	$7,797.17
Rate for Payer: Molina Dual Medicare/Medicaid	$2,917.95
Rate for Payer: Molina Medicare	$2,917.95
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	$7,797.17
Rate for Payer: Scott and White EPO/PPO	$4,807.56
Rate for Payer: Scott and White Medicare	$2,917.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,797.17
Rate for Payer: Superior Health Plan EPO	$2,917.95
Rate for Payer: Superior Health Plan Medicare	$2,917.95
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,917.95
Rate for Payer: Universal American Medicare	$2,917.95
Rate for Payer: Wellcare Medicare	$2,917.95
Rate for Payer: Wellmed Medicare	$2,917.95

Biopsy, soft tissue of thigh or knee area; deep (subfascial or intramuscular)

Facility

$10,000.00

Service Code	CPT 27324
Hospital Charge Code	36027324
Hospital Revenue Code	360
Min. Negotiated Rate	$815.20
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$815.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$2,917.95
Rate for Payer: Amerigroup Medicare	$2,917.95
Rate for Payer: BCBS of TX Blue Advantage	$3,872.55
Rate for Payer: BCBS of TX Blue Essentials	$4,637.78
Rate for Payer: BCBS of TX Medicare	$2,917.95
Rate for Payer: BCBS of TX PPO	$5,843.60
Rate for Payer: Cigna Commercial	$6,168.03
Rate for Payer: Cigna Medicare	$2,917.95
Rate for Payer: Employer Direct Commercial	$2,917.95
Rate for Payer: Humana Medicare/TRICARE	$2,917.95
Rate for Payer: Molina Dual Medicare/Medicaid	$2,917.95
Rate for Payer: Molina Medicare	$2,917.95
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	$4,807.56
Rate for Payer: Scott and White Medicare	$2,917.95
Rate for Payer: Superior Health Plan EPO	$2,917.95
Rate for Payer: Superior Health Plan Medicare	$2,917.95
Rate for Payer: Universal American Dual Medicare/Medicaid	$2,917.95
Rate for Payer: Universal American Medicare	$2,917.95
Rate for Payer: Wellcare Medicare	$2,917.95
Rate for Payer: Wellmed Medicare	$2,917.95

Biopsy, soft tissue of thigh or knee area; deep (subfascial or intramuscular)

Facility

$10,829.40

Service Code	HCPCS 27324
Hospital Charge Code	9900392
Hospital Revenue Code	360
Rate for Payer: Cash Price	$7,363.99

Bipolar cautery cord, sterile

Facility

$14.73

Hospital Charge Code	992786
Hospital Revenue Code	272
Rate for Payer: Cash Price	$10.02

Bipolar cautery cord, sterile

Facility

$14.73

Hospital Charge Code	992786
Hospital Revenue Code	272
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$10.61
Rate for Payer: Amerigroup CHIP/Medicaid	$1.33
Rate for Payer: BCBS of TX Blue Advantage	$4.42
Rate for Payer: BCBS of TX Blue Essentials	$5.30
Rate for Payer: BCBS of TX PPO	$5.89
Rate for Payer: Cash Price	$10.02
Rate for Payer: Cigna Medicaid	$10.61
Rate for Payer: Molina CHIP/Medicaid	$10.61
Rate for Payer: Multiplan Auto	$9.57
Rate for Payer: Multiplan Commercial	$9.57
Rate for Payer: Multiplan Workers Comp	$9.57
Rate for Payer: Parkland Medicaid	$10.61
Rate for Payer: Scott and White EPO/PPO	$7.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10.61
Rate for Payer: Superior Health Plan EPO	$2.00

BIPOLAR DISORDERS

Facility

$1,812.39

Service Code	APR-DRG 7531
Min. Negotiated Rate	$1,708.79
Max. Negotiated Rate	$1,812.39
Rate for Payer: Amerigroup CHIP/Medicaid	$1,708.79
Rate for Payer: Cigna Medicaid	$1,708.79
Rate for Payer: Molina CHIP/Medicaid	$1,708.79
Rate for Payer: Parkland Medicaid	$1,708.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,812.39

BIPOLAR DISORDERS

Facility

$10,399.86

Service Code	APR-DRG 7534
Min. Negotiated Rate	$9,805.35
Max. Negotiated Rate	$10,399.86
Rate for Payer: Amerigroup CHIP/Medicaid	$9,805.35
Rate for Payer: Cigna Medicaid	$9,805.35
Rate for Payer: Molina CHIP/Medicaid	$9,805.35
Rate for Payer: Parkland Medicaid	$9,805.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,399.86

BIPOLAR DISORDERS

Facility

$4,516.84

Service Code	APR-DRG 7533
Min. Negotiated Rate	$4,258.63
Max. Negotiated Rate	$4,516.84
Rate for Payer: Amerigroup CHIP/Medicaid	$4,258.63
Rate for Payer: Cigna Medicaid	$4,258.63
Rate for Payer: Molina CHIP/Medicaid	$4,258.63
Rate for Payer: Parkland Medicaid	$4,258.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,516.84

Know your out-of-pocket cost for care.

All Charges