White Rock Medical Center

All Charges

Charge

Type

Setting

Price

Transferrin SO

Facility

$308.00

Service Code	HCPCS 84466
Hospital Charge Code	1600998
Hospital Revenue Code	301
Min. Negotiated Rate	$4.98
Max. Negotiated Rate	$221.76
Rate for Payer: Amerigroup CHIP/Medicaid	$4.98
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12.76
Rate for Payer: Amerigroup Medicare	$12.76
Rate for Payer: BCBS of TX Blue Advantage	$92.40
Rate for Payer: BCBS of TX Blue Essentials	$110.88
Rate for Payer: BCBS of TX Medicare	$12.76
Rate for Payer: BCBS of TX PPO	$123.20
Rate for Payer: Cash Price	$209.44
Rate for Payer: Cash Price	$209.44
Rate for Payer: Cigna Medicaid	$221.76
Rate for Payer: Cigna Medicare	$12.76
Rate for Payer: Employer Direct Commercial	$12.76
Rate for Payer: Humana Medicare/TRICARE	$12.76
Rate for Payer: Molina CHIP/Medicaid	$221.76
Rate for Payer: Molina Dual Medicare/Medicaid	$12.76
Rate for Payer: Molina Medicare	$12.76
Rate for Payer: Multiplan Auto	$200.20
Rate for Payer: Multiplan Commercial	$200.20
Rate for Payer: Multiplan Workers Comp	$200.20
Rate for Payer: Parkland Medicaid	$221.76
Rate for Payer: Scott and White EPO/PPO	$15.95
Rate for Payer: Scott and White Medicare	$12.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$221.76
Rate for Payer: Superior Health Plan EPO	$12.76
Rate for Payer: Superior Health Plan Medicare	$12.76
Rate for Payer: Universal American Dual Medicare/Medicaid	$12.76
Rate for Payer: Universal American Medicare	$12.76
Rate for Payer: Wellcare Medicare	$12.76
Rate for Payer: Wellmed Medicare	$12.76

Transferrin SO

Facility

$308.00

Service Code	HCPCS 84466
Hospital Charge Code	1600998
Hospital Revenue Code	301
Rate for Payer: Cash Price	$209.44

TRANSIENT ISCHEMIA

Facility

$5,011.71

Service Code	APR-DRG 0473
Min. Negotiated Rate	$4,725.22
Max. Negotiated Rate	$5,011.71
Rate for Payer: Amerigroup CHIP/Medicaid	$4,725.22
Rate for Payer: Cigna Medicaid	$4,725.22
Rate for Payer: Molina CHIP/Medicaid	$4,725.22
Rate for Payer: Parkland Medicaid	$4,725.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,011.71

TRANSIENT ISCHEMIA

Facility

$3,874.86

Service Code	APR-DRG 0472
Min. Negotiated Rate	$3,653.36
Max. Negotiated Rate	$3,874.86
Rate for Payer: Amerigroup CHIP/Medicaid	$3,653.36
Rate for Payer: Cigna Medicaid	$3,653.36
Rate for Payer: Molina CHIP/Medicaid	$3,653.36
Rate for Payer: Parkland Medicaid	$3,653.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,874.86

TRANSIENT ISCHEMIA

Facility

$3,081.26

Service Code	APR-DRG 0471
Min. Negotiated Rate	$2,905.12
Max. Negotiated Rate	$3,081.26
Rate for Payer: Amerigroup CHIP/Medicaid	$2,905.12
Rate for Payer: Cigna Medicaid	$2,905.12
Rate for Payer: Molina CHIP/Medicaid	$2,905.12
Rate for Payer: Parkland Medicaid	$2,905.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,081.26

TRANSIENT ISCHEMIA

Facility

$9,187.19

Service Code	APR-DRG 0474
Min. Negotiated Rate	$8,662.01
Max. Negotiated Rate	$9,187.19
Rate for Payer: Amerigroup CHIP/Medicaid	$8,662.01
Rate for Payer: Cigna Medicaid	$8,662.01
Rate for Payer: Molina CHIP/Medicaid	$8,662.01
Rate for Payer: Parkland Medicaid	$8,662.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,187.19

TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC

Facility

$15,160.10

Service Code	MSDRG 069
Min. Negotiated Rate	$6,583.30
Max. Negotiated Rate	$15,160.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,614.51
Rate for Payer: Amerigroup Medicare	$10,614.51
Rate for Payer: BCBS of TX Medicare	$10,614.51
Rate for Payer: Cigna Commercial	$10,288.54
Rate for Payer: Cigna Medicare	$10,614.51
Rate for Payer: Employer Direct Commercial	$10,614.51
Rate for Payer: Humana Medicare/TRICARE	$10,614.51
Rate for Payer: Molina Dual Medicare/Medicaid	$10,614.51
Rate for Payer: Molina Medicare	$10,614.51
Rate for Payer: Multiplan Auto	$15,160.10
Rate for Payer: Multiplan Commercial	$15,160.10
Rate for Payer: Multiplan Workers Comp	$15,160.10
Rate for Payer: Scott and White EPO/PPO	$6,981.62
Rate for Payer: Scott and White Medicare	$10,614.51
Rate for Payer: Superior Health Plan EPO	$10,614.51
Rate for Payer: Superior Health Plan Medicare	$10,614.51
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,614.51
Rate for Payer: Universal American Medicare	$10,614.51
Rate for Payer: Wellcare Medicare	$10,614.51
Rate for Payer: Wellmed Medicare	$10,614.51

TRANSIENT ISCHEMIA W/O THROMBOLYTIC

Facility

$15,160.10

Service Code	MSDRG 069
Min. Negotiated Rate	$6,583.30
Max. Negotiated Rate	$15,160.10
Rate for Payer: BCBS of TX Blue Advantage	$6,583.30
Rate for Payer: BCBS of TX Blue Essentials	$7,899.19
Rate for Payer: BCBS of TX PPO	$8,777.22

TRANSLUMBAR RENAL CYST

Facility

$1,145.00

Service Code	HCPCS 74470
Hospital Charge Code	4614470
Hospital Revenue Code	320
Min. Negotiated Rate	$81.35
Max. Negotiated Rate	$1,160.29
Rate for Payer: Amerigroup CHIP/Medicaid	$81.35
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$548.90
Rate for Payer: Amerigroup Medicare	$548.90
Rate for Payer: BCBS of TX Blue Advantage	$794.61
Rate for Payer: BCBS of TX Blue Essentials	$953.53
Rate for Payer: BCBS of TX Medicare	$548.90
Rate for Payer: BCBS of TX PPO	$1,064.29
Rate for Payer: Cash Price	$778.60
Rate for Payer: Cash Price	$778.60
Rate for Payer: Cash Price	$778.60
Rate for Payer: Cigna Commercial	$1,160.29
Rate for Payer: Cigna Medicaid	$824.40
Rate for Payer: Cigna Medicare	$548.90
Rate for Payer: Employer Direct Commercial	$548.90
Rate for Payer: Humana Medicare/TRICARE	$548.90
Rate for Payer: Molina CHIP/Medicaid	$824.40
Rate for Payer: Molina Dual Medicare/Medicaid	$548.90
Rate for Payer: Molina Medicare	$548.90
Rate for Payer: Multiplan Auto	$744.25
Rate for Payer: Multiplan Commercial	$744.25
Rate for Payer: Multiplan Workers Comp	$744.25
Rate for Payer: Parkland Medicaid	$824.40
Rate for Payer: Scott and White EPO/PPO	$572.50
Rate for Payer: Scott and White Medicare	$548.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$824.40
Rate for Payer: Superior Health Plan EPO	$548.90
Rate for Payer: Superior Health Plan Medicare	$548.90
Rate for Payer: Universal American Dual Medicare/Medicaid	$548.90
Rate for Payer: Universal American Medicare	$548.90
Rate for Payer: Wellcare Medicare	$548.90
Rate for Payer: Wellmed Medicare	$548.90

TRANSLUMBAR RENAL CYST

Facility

$1,145.00

Service Code	HCPCS 74470
Hospital Charge Code	4614470
Hospital Revenue Code	320
Rate for Payer: Cash Price	$778.60

Transluminal dilation of aqueous outflow canal (eg, canaloplasty); without retention of device or st

Facility

$15,982.32

Service Code	HCPCS 66174
Hospital Charge Code	9900862
Hospital Revenue Code	360
Rate for Payer: Cash Price	$10,867.98

Transluminal dilation of aqueous outflow canal (eg, canaloplasty); without retention of device or st

Facility

$15,982.32

Service Code	HCPCS 66174
Hospital Charge Code	9900862
Hospital Revenue Code	360
Min. Negotiated Rate	$1,438.41
Max. Negotiated Rate	$11,507.27
Rate for Payer: Amerigroup CHIP/Medicaid	$1,438.41
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$4,152.26
Rate for Payer: Amerigroup Medicare	$4,152.26
Rate for Payer: BCBS of TX Blue Advantage	$6,376.61
Rate for Payer: BCBS of TX Blue Essentials	$7,636.66
Rate for Payer: BCBS of TX Medicare	$4,152.26
Rate for Payer: BCBS of TX PPO	$9,622.19
Rate for Payer: Cash Price	$10,867.98
Rate for Payer: Cash Price	$10,867.98
Rate for Payer: Cash Price	$10,867.98
Rate for Payer: Cigna Commercial	$8,777.13
Rate for Payer: Cigna Medicaid	$11,507.27
Rate for Payer: Cigna Medicare	$4,152.26
Rate for Payer: Employer Direct Commercial	$4,152.26
Rate for Payer: Humana Medicare/TRICARE	$4,152.26
Rate for Payer: Molina CHIP/Medicaid	$11,507.27
Rate for Payer: Molina Dual Medicare/Medicaid	$4,152.26
Rate for Payer: Molina Medicare	$4,152.26
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	$11,507.27
Rate for Payer: Scott and White EPO/PPO	$6,879.04
Rate for Payer: Scott and White Medicare	$4,152.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,507.27
Rate for Payer: Superior Health Plan EPO	$4,152.26
Rate for Payer: Superior Health Plan Medicare	$4,152.26
Rate for Payer: Universal American Dual Medicare/Medicaid	$4,152.26
Rate for Payer: Universal American Medicare	$4,152.26
Rate for Payer: Wellcare Medicare	$4,152.26
Rate for Payer: Wellmed Medicare	$4,152.26

Transluminal dilation of aqueous outflow canal (eg, canaloplasty); without retention of device or st

Facility

$10,000.00

Service Code	CPT 66174
Hospital Charge Code	36066174
Hospital Revenue Code	360
Min. Negotiated Rate	$4,152.26
Max. Negotiated Rate	$10,000.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$4,152.26
Rate for Payer: Amerigroup Medicare	$4,152.26
Rate for Payer: BCBS of TX Blue Advantage	$6,376.61
Rate for Payer: BCBS of TX Blue Essentials	$7,636.66
Rate for Payer: BCBS of TX Medicare	$4,152.26
Rate for Payer: BCBS of TX PPO	$9,622.19
Rate for Payer: Cigna Commercial	$8,777.13
Rate for Payer: Cigna Medicare	$4,152.26
Rate for Payer: Employer Direct Commercial	$4,152.26
Rate for Payer: Humana Medicare/TRICARE	$4,152.26
Rate for Payer: Molina Dual Medicare/Medicaid	$4,152.26
Rate for Payer: Molina Medicare	$4,152.26
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	$6,879.04
Rate for Payer: Scott and White Medicare	$4,152.26
Rate for Payer: Superior Health Plan EPO	$4,152.26
Rate for Payer: Superior Health Plan Medicare	$4,152.26
Rate for Payer: Universal American Dual Medicare/Medicaid	$4,152.26
Rate for Payer: Universal American Medicare	$4,152.26
Rate for Payer: Wellcare Medicare	$4,152.26
Rate for Payer: Wellmed Medicare	$4,152.26

Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniate

Facility

$28,192.28

Service Code	HCPCS 63056
Hospital Charge Code	9900766
Hospital Revenue Code	360
Min. Negotiated Rate	$2,398.52
Max. Negotiated Rate	$20,298.44
Rate for Payer: Amerigroup CHIP/Medicaid	$2,398.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Amerigroup Medicare	$7,289.28
Rate for Payer: BCBS of TX Blue Advantage	$9,989.86
Rate for Payer: BCBS of TX Blue Essentials	$11,963.90
Rate for Payer: BCBS of TX Medicare	$7,289.28
Rate for Payer: BCBS of TX PPO	$15,074.51
Rate for Payer: Cash Price	$19,170.75
Rate for Payer: Cash Price	$19,170.75
Rate for Payer: Cash Price	$19,170.75
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicaid	$20,298.44
Rate for Payer: Cigna Medicare	$7,289.28
Rate for Payer: Employer Direct Commercial	$7,289.28
Rate for Payer: Humana Medicare/TRICARE	$7,289.28
Rate for Payer: Molina CHIP/Medicaid	$20,298.44
Rate for Payer: Molina Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Molina Medicare	$7,289.28
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	$20,298.44
Rate for Payer: Scott and White EPO/PPO	$12,104.03
Rate for Payer: Scott and White Medicare	$7,289.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$20,298.44
Rate for Payer: Superior Health Plan EPO	$7,289.28
Rate for Payer: Superior Health Plan Medicare	$7,289.28
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Universal American Medicare	$7,289.28
Rate for Payer: Wellcare Medicare	$7,289.28
Rate for Payer: Wellmed Medicare	$7,289.28

Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniate

Facility

$28,192.28

Service Code	HCPCS 63056
Hospital Charge Code	9900766
Hospital Revenue Code	360
Rate for Payer: Cash Price	$19,170.75

Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniate

Facility

$15,408.22

Service Code	CPT 63056
Hospital Charge Code	36063056
Hospital Revenue Code	360
Min. Negotiated Rate	$2,398.52
Max. Negotiated Rate	$15,408.22
Rate for Payer: Amerigroup CHIP/Medicaid	$2,398.52
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Amerigroup Medicare	$7,289.28
Rate for Payer: BCBS of TX Blue Advantage	$9,989.86
Rate for Payer: BCBS of TX Blue Essentials	$11,963.90
Rate for Payer: BCBS of TX Medicare	$7,289.28
Rate for Payer: BCBS of TX PPO	$15,074.51
Rate for Payer: Cigna Commercial	$15,408.22
Rate for Payer: Cigna Medicare	$7,289.28
Rate for Payer: Employer Direct Commercial	$7,289.28
Rate for Payer: Humana Medicare/TRICARE	$7,289.28
Rate for Payer: Molina Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Molina Medicare	$7,289.28
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	$12,104.03
Rate for Payer: Scott and White Medicare	$7,289.28
Rate for Payer: Superior Health Plan EPO	$7,289.28
Rate for Payer: Superior Health Plan Medicare	$7,289.28
Rate for Payer: Universal American Dual Medicare/Medicaid	$7,289.28
Rate for Payer: Universal American Medicare	$7,289.28
Rate for Payer: Wellcare Medicare	$7,289.28
Rate for Payer: Wellmed Medicare	$7,289.28

TRANSURETHRAL PROCEDURES W CC

Facility

$29,909.80

Service Code	MSDRG 669
Min. Negotiated Rate	$13,609.50
Max. Negotiated Rate	$29,909.80
Rate for Payer: BCBS of TX Blue Advantage	$13,609.50
Rate for Payer: BCBS of TX Blue Essentials	$16,329.82
Rate for Payer: BCBS of TX PPO	$18,144.94

TRANSURETHRAL PROCEDURES WITH CC

Facility

$29,909.80

Service Code	MSDRG 669
Min. Negotiated Rate	$13,609.50
Max. Negotiated Rate	$29,909.80
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$16,134.73
Rate for Payer: Amerigroup Medicare	$16,134.73
Rate for Payer: BCBS of TX Medicare	$16,134.73
Rate for Payer: Cigna Commercial	$19,989.76
Rate for Payer: Cigna Medicare	$16,134.73
Rate for Payer: Employer Direct Commercial	$16,134.73
Rate for Payer: Humana Medicare/TRICARE	$16,134.73
Rate for Payer: Molina Dual Medicare/Medicaid	$16,134.73
Rate for Payer: Molina Medicare	$16,134.73
Rate for Payer: Multiplan Auto	$29,909.80
Rate for Payer: Multiplan Commercial	$29,909.80
Rate for Payer: Multiplan Workers Comp	$29,909.80
Rate for Payer: Scott and White EPO/PPO	$13,774.25
Rate for Payer: Scott and White Medicare	$16,134.73
Rate for Payer: Superior Health Plan EPO	$16,134.73
Rate for Payer: Superior Health Plan Medicare	$16,134.73
Rate for Payer: Universal American Dual Medicare/Medicaid	$16,134.73
Rate for Payer: Universal American Medicare	$16,134.73
Rate for Payer: Wellcare Medicare	$16,134.73
Rate for Payer: Wellmed Medicare	$16,134.73

TRANSURETHRAL PROCEDURES WITH MCC

Facility

$53,635.10

Service Code	MSDRG 668
Min. Negotiated Rate	$24,205.56
Max. Negotiated Rate	$53,635.10
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$26,160.83
Rate for Payer: Amerigroup Medicare	$26,160.83
Rate for Payer: BCBS of TX Medicare	$26,160.83
Rate for Payer: Cigna Commercial	$37,609.60
Rate for Payer: Cigna Medicare	$26,160.83
Rate for Payer: Employer Direct Commercial	$26,160.83
Rate for Payer: Humana Medicare/TRICARE	$26,160.83
Rate for Payer: Molina Dual Medicare/Medicaid	$26,160.83
Rate for Payer: Molina Medicare	$26,160.83
Rate for Payer: Multiplan Auto	$53,635.10
Rate for Payer: Multiplan Commercial	$53,635.10
Rate for Payer: Multiplan Workers Comp	$53,635.10
Rate for Payer: Scott and White EPO/PPO	$24,700.38
Rate for Payer: Scott and White Medicare	$26,160.83
Rate for Payer: Superior Health Plan EPO	$26,160.83
Rate for Payer: Superior Health Plan Medicare	$26,160.83
Rate for Payer: Universal American Dual Medicare/Medicaid	$26,160.83
Rate for Payer: Universal American Medicare	$26,160.83
Rate for Payer: Wellcare Medicare	$26,160.83
Rate for Payer: Wellmed Medicare	$26,160.83

TRANSURETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$18,762.50

Service Code	MSDRG 670
Min. Negotiated Rate	$8,286.10
Max. Negotiated Rate	$18,762.50
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$11,922.74
Rate for Payer: Amerigroup Medicare	$11,922.74
Rate for Payer: BCBS of TX Medicare	$11,922.74
Rate for Payer: Cigna Commercial	$12,587.62
Rate for Payer: Cigna Medicare	$11,922.74
Rate for Payer: Employer Direct Commercial	$11,922.74
Rate for Payer: Humana Medicare/TRICARE	$11,922.74
Rate for Payer: Molina Dual Medicare/Medicaid	$11,922.74
Rate for Payer: Molina Medicare	$11,922.74
Rate for Payer: Multiplan Auto	$18,762.50
Rate for Payer: Multiplan Commercial	$18,762.50
Rate for Payer: Multiplan Workers Comp	$18,762.50
Rate for Payer: Scott and White EPO/PPO	$8,640.62
Rate for Payer: Scott and White Medicare	$11,922.74
Rate for Payer: Superior Health Plan EPO	$11,922.74
Rate for Payer: Superior Health Plan Medicare	$11,922.74
Rate for Payer: Universal American Dual Medicare/Medicaid	$11,922.74
Rate for Payer: Universal American Medicare	$11,922.74
Rate for Payer: Wellcare Medicare	$11,922.74
Rate for Payer: Wellmed Medicare	$11,922.74

TRANSURETHRAL PROCEDURES W MCC

Facility

$53,635.10

Service Code	MSDRG 668
Min. Negotiated Rate	$24,205.56
Max. Negotiated Rate	$53,635.10
Rate for Payer: BCBS of TX Blue Advantage	$24,205.56
Rate for Payer: BCBS of TX Blue Essentials	$29,043.86
Rate for Payer: BCBS of TX PPO	$32,272.20

TRANSURETHRAL PROCEDURES W/O CC/MCC

Facility

$18,762.50

Service Code	MSDRG 670
Min. Negotiated Rate	$8,286.10
Max. Negotiated Rate	$18,762.50
Rate for Payer: BCBS of TX Blue Advantage	$8,286.10
Rate for Payer: BCBS of TX Blue Essentials	$9,942.36
Rate for Payer: BCBS of TX PPO	$11,047.49

TRANSURETHRAL PROSTATECTOMY

Facility

$4,749.19

Service Code	APR-DRG 4822
Min. Negotiated Rate	$4,477.70
Max. Negotiated Rate	$4,749.19
Rate for Payer: Amerigroup CHIP/Medicaid	$4,477.70
Rate for Payer: Cigna Medicaid	$4,477.70
Rate for Payer: Molina CHIP/Medicaid	$4,477.70
Rate for Payer: Parkland Medicaid	$4,477.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,749.19

TRANSURETHRAL PROSTATECTOMY

Facility

$17,414.06

Service Code	APR-DRG 4824
Min. Negotiated Rate	$16,418.59
Max. Negotiated Rate	$17,414.06
Rate for Payer: Amerigroup CHIP/Medicaid	$16,418.59
Rate for Payer: Cigna Medicaid	$16,418.59
Rate for Payer: Molina CHIP/Medicaid	$16,418.59
Rate for Payer: Parkland Medicaid	$16,418.59
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17,414.06

TRANSURETHRAL PROSTATECTOMY

Facility

$9,261.50

Service Code	APR-DRG 4823
Min. Negotiated Rate	$8,732.07
Max. Negotiated Rate	$9,261.50
Rate for Payer: Amerigroup CHIP/Medicaid	$8,732.07
Rate for Payer: Cigna Medicaid	$8,732.07
Rate for Payer: Molina CHIP/Medicaid	$8,732.07
Rate for Payer: Parkland Medicaid	$8,732.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,261.50

Know your out-of-pocket cost for care.

All Charges