White Rock Medical Center

All Charges

Charge

Type

Setting

Price

PROS HUMERAL COMPONENT -- DHF

Facility

$21,857.78

Service Code	HCPCS C1776
Hospital Charge Code	81343535
Hospital Revenue Code	278
Min. Negotiated Rate	$5,464.44
Max. Negotiated Rate	$10,928.89
Rate for Payer: Aetna Commercial	$6,557.33
Rate for Payer: Cash Price	$19,234.85
Rate for Payer: Cigna Commercial	$5,464.44
Rate for Payer: Multiplan Auto	$10,928.89
Rate for Payer: Multiplan Commercial	$10,928.89
Rate for Payer: Multiplan Workers Comp	$10,928.89
Rate for Payer: Scott and White EPO/PPO	$10,928.89

PROS HUMERAL COMPONENT -- DHF

Facility

$21,857.78

Service Code	HCPCS C1776
Hospital Charge Code	81343535
Hospital Revenue Code	278
Min. Negotiated Rate	$1,967.20
Max. Negotiated Rate	$10,928.89
Rate for Payer: Aetna Commercial	$6,557.33
Rate for Payer: Amerigroup CHIP/Medicaid	$1,967.20
Rate for Payer: BCBS of TX Blue Advantage	$6,557.33
Rate for Payer: BCBS of TX Blue Essentials	$7,868.80
Rate for Payer: BCBS of TX PPO	$8,743.11
Rate for Payer: Cash Price	$19,234.85
Rate for Payer: Multiplan Auto	$10,928.89
Rate for Payer: Multiplan Commercial	$10,928.89
Rate for Payer: Multiplan Workers Comp	$10,928.89
Rate for Payer: Scott and White EPO/PPO	$10,928.89
Rate for Payer: Superior Health Plan EPO	$2,972.66

PROS RADIAL HEA -- DHF

Facility

$20,103.17

Service Code	HCPCS C1776
Hospital Charge Code	81344350
Hospital Revenue Code	278
Min. Negotiated Rate	$5,025.79
Max. Negotiated Rate	$10,051.58
Rate for Payer: Aetna Commercial	$6,030.95
Rate for Payer: Cash Price	$17,690.79
Rate for Payer: Cigna Commercial	$5,025.79
Rate for Payer: Multiplan Auto	$10,051.58
Rate for Payer: Multiplan Commercial	$10,051.58
Rate for Payer: Multiplan Workers Comp	$10,051.58
Rate for Payer: Scott and White EPO/PPO	$10,051.58

PROS RADIAL HEA -- DHF

Facility

$20,103.17

Service Code	HCPCS C1776
Hospital Charge Code	81344350
Hospital Revenue Code	278
Min. Negotiated Rate	$1,809.29
Max. Negotiated Rate	$10,051.58
Rate for Payer: Aetna Commercial	$6,030.95
Rate for Payer: Amerigroup CHIP/Medicaid	$1,809.29
Rate for Payer: BCBS of TX Blue Advantage	$6,030.95
Rate for Payer: BCBS of TX Blue Essentials	$7,237.14
Rate for Payer: BCBS of TX PPO	$8,041.27
Rate for Payer: Cash Price	$17,690.79
Rate for Payer: Multiplan Auto	$10,051.58
Rate for Payer: Multiplan Commercial	$10,051.58
Rate for Payer: Multiplan Workers Comp	$10,051.58
Rate for Payer: Scott and White EPO/PPO	$10,051.58
Rate for Payer: Superior Health Plan EPO	$2,734.03

PROS SIZER BRST IMP 2 -- DHF

Facility

$1,061.13

Hospital Charge Code	81541872
Hospital Revenue Code	272
Min. Negotiated Rate	$95.50
Max. Negotiated Rate	$689.73
Rate for Payer: Aetna Commercial	$583.62
Rate for Payer: Amerigroup CHIP/Medicaid	$95.50
Rate for Payer: BCBS of TX Blue Advantage	$318.34
Rate for Payer: BCBS of TX Blue Essentials	$382.01
Rate for Payer: BCBS of TX PPO	$424.45
Rate for Payer: Cash Price	$933.79
Rate for Payer: Multiplan Auto	$689.73
Rate for Payer: Multiplan Commercial	$689.73
Rate for Payer: Multiplan Workers Comp	$689.73
Rate for Payer: Scott and White EPO/PPO	$530.56
Rate for Payer: Superior Health Plan EPO	$144.31

PROS SIZER BRST IMP 2 -- DHF

Facility

$1,061.13

Hospital Charge Code	81541872
Hospital Revenue Code	272
Rate for Payer: Cash Price	$933.79

PROSTATECTOMY WITH CC

Facility

$32,630.60

Service Code	MSDRG 666
Min. Negotiated Rate	$15,027.25
Max. Negotiated Rate	$32,630.60
Rate for Payer: Aetna Commercial	$19,320.75
Rate for Payer: Aetna Medicare	$22,665.38
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15,110.25
Rate for Payer: Amerigroup Medicare	$15,110.25
Rate for Payer: BCBS of TX Blue Advantage	$15,121.38
Rate for Payer: BCBS of TX Blue Essentials	$18,358.53
Rate for Payer: BCBS of TX Medicare	$15,110.25
Rate for Payer: BCBS of TX PPO	$20,399.16
Rate for Payer: Cigna Commercial	$22,120.11
Rate for Payer: Cigna Medicare	$15,110.25
Rate for Payer: Employer Direct Commercial	$15,110.25
Rate for Payer: Humana Medicare/TRICARE	$15,110.25
Rate for Payer: Molina Dual Medicare/Medicaid	$15,110.25
Rate for Payer: Molina Medicare	$15,110.25
Rate for Payer: Multiplan Auto	$32,630.60
Rate for Payer: Multiplan Commercial	$32,630.60
Rate for Payer: Multiplan Workers Comp	$32,630.60
Rate for Payer: Scott and White EPO/PPO	$15,027.25
Rate for Payer: Scott and White Medicare	$15,110.25
Rate for Payer: Superior Health Plan EPO	$15,110.25
Rate for Payer: Superior Health Plan Medicare	$15,110.25
Rate for Payer: Universal American Dual Medicare/Medicaid	$15,110.25
Rate for Payer: Universal American Medicare	$15,110.25
Rate for Payer: Wellcare Medicare	$15,110.25
Rate for Payer: Wellmed Medicare	$15,110.25

PROSTATECTOMY WITH MCC

Facility

$58,692.90

Service Code	MSDRG 665
Min. Negotiated Rate	$24,898.78
Max. Negotiated Rate	$58,692.90
Rate for Payer: Aetna Commercial	$34,752.38
Rate for Payer: Aetna Medicare	$37,348.17
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$24,898.78
Rate for Payer: Amerigroup Medicare	$24,898.78
Rate for Payer: BCBS of TX Blue Advantage	$26,351.26
Rate for Payer: BCBS of TX Blue Essentials	$32,802.04
Rate for Payer: BCBS of TX Medicare	$24,898.78
Rate for Payer: BCBS of TX PPO	$36,448.12
Rate for Payer: Cigna Commercial	$39,787.61
Rate for Payer: Cigna Medicare	$24,898.78
Rate for Payer: Employer Direct Commercial	$24,898.78
Rate for Payer: Humana Medicare/TRICARE	$24,898.78
Rate for Payer: Molina Dual Medicare/Medicaid	$24,898.78
Rate for Payer: Molina Medicare	$24,898.78
Rate for Payer: Multiplan Auto	$58,692.90
Rate for Payer: Multiplan Commercial	$58,692.90
Rate for Payer: Multiplan Workers Comp	$58,692.90
Rate for Payer: Scott and White EPO/PPO	$27,029.62
Rate for Payer: Scott and White Medicare	$24,898.78
Rate for Payer: Superior Health Plan EPO	$24,898.78
Rate for Payer: Superior Health Plan Medicare	$24,898.78
Rate for Payer: Universal American Dual Medicare/Medicaid	$24,898.78
Rate for Payer: Universal American Medicare	$24,898.78
Rate for Payer: Wellcare Medicare	$24,898.78
Rate for Payer: Wellmed Medicare	$24,898.78

PROSTATECTOMY WITHOUT CC/MCC

Facility

$19,942.40

Service Code	MSDRG 667
Min. Negotiated Rate	$8,614.62
Max. Negotiated Rate	$19,942.40
Rate for Payer: Aetna Commercial	$11,808.00
Rate for Payer: Aetna Medicare	$15,517.20
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$10,344.80
Rate for Payer: Amerigroup Medicare	$10,344.80
Rate for Payer: BCBS of TX Blue Advantage	$8,614.62
Rate for Payer: BCBS of TX Blue Essentials	$11,148.65
Rate for Payer: BCBS of TX Medicare	$10,344.80
Rate for Payer: BCBS of TX PPO	$12,387.87
Rate for Payer: Cigna Commercial	$13,518.85
Rate for Payer: Cigna Medicare	$10,344.80
Rate for Payer: Employer Direct Commercial	$10,344.80
Rate for Payer: Humana Medicare/TRICARE	$10,344.80
Rate for Payer: Molina Dual Medicare/Medicaid	$10,344.80
Rate for Payer: Molina Medicare	$10,344.80
Rate for Payer: Multiplan Auto	$19,942.40
Rate for Payer: Multiplan Commercial	$19,942.40
Rate for Payer: Multiplan Workers Comp	$19,942.40
Rate for Payer: Scott and White EPO/PPO	$9,184.00
Rate for Payer: Scott and White Medicare	$10,344.80
Rate for Payer: Superior Health Plan EPO	$10,344.80
Rate for Payer: Superior Health Plan Medicare	$10,344.80
Rate for Payer: Universal American Dual Medicare/Medicaid	$10,344.80
Rate for Payer: Universal American Medicare	$10,344.80
Rate for Payer: Wellcare Medicare	$10,344.80
Rate for Payer: Wellmed Medicare	$10,344.80

Prostate-Specific Ag, Serum SO

Facility

$227.00

Service Code	CPT 84153
Hospital Charge Code	1601376
Hospital Revenue Code	301
Rate for Payer: Cash Price	$199.76

Prostate-Specific Ag, Serum SO

Facility

$227.00

Service Code	CPT 84153
Hospital Charge Code	1601376
Hospital Revenue Code	301
Min. Negotiated Rate	$7.17
Max. Negotiated Rate	$147.55
Rate for Payer: Aetna Commercial	$19.30
Rate for Payer: Aetna Medicare	$27.58
Rate for Payer: Amerigroup CHIP/Medicaid	$7.17
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$18.39
Rate for Payer: Amerigroup Medicare	$18.39
Rate for Payer: BCBS of TX Blue Advantage	$30.34
Rate for Payer: BCBS of TX Blue Essentials	$36.41
Rate for Payer: BCBS of TX Medicare	$18.39
Rate for Payer: BCBS of TX PPO	$40.64
Rate for Payer: Cash Price	$199.76
Rate for Payer: Cash Price	$199.76
Rate for Payer: Cigna Medicaid	$18.39
Rate for Payer: Cigna Medicare	$18.39
Rate for Payer: Employer Direct Commercial	$18.39
Rate for Payer: Humana Medicare/TRICARE	$18.39
Rate for Payer: Molina CHIP/Medicaid	$18.39
Rate for Payer: Molina Dual Medicare/Medicaid	$18.39
Rate for Payer: Molina Medicare	$18.39
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	$18.39
Rate for Payer: Scott and White EPO/PPO	$22.99
Rate for Payer: Scott and White Medicare	$18.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18.39
Rate for Payer: Superior Health Plan EPO	$18.39
Rate for Payer: Superior Health Plan Medicare	$18.39
Rate for Payer: Universal American Dual Medicare/Medicaid	$18.39
Rate for Payer: Universal American Medicare	$18.39
Rate for Payer: Wellcare Medicare	$18.39
Rate for Payer: Wellmed Medicare	$18.39

Prostate Specific Antigen

Facility

$227.00

Service Code	CPT 84153
Hospital Charge Code	1601376
Hospital Revenue Code	301
Min. Negotiated Rate	$7.17
Max. Negotiated Rate	$147.55
Rate for Payer: Aetna Commercial	$19.30
Rate for Payer: Aetna Medicare	$27.58
Rate for Payer: Amerigroup CHIP/Medicaid	$7.17
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$18.39
Rate for Payer: Amerigroup Medicare	$18.39
Rate for Payer: BCBS of TX Blue Advantage	$30.34
Rate for Payer: BCBS of TX Blue Essentials	$36.41
Rate for Payer: BCBS of TX Medicare	$18.39
Rate for Payer: BCBS of TX PPO	$40.64
Rate for Payer: Cash Price	$199.76
Rate for Payer: Cash Price	$199.76
Rate for Payer: Cigna Medicaid	$18.39
Rate for Payer: Cigna Medicare	$18.39
Rate for Payer: Employer Direct Commercial	$18.39
Rate for Payer: Humana Medicare/TRICARE	$18.39
Rate for Payer: Molina CHIP/Medicaid	$18.39
Rate for Payer: Molina Dual Medicare/Medicaid	$18.39
Rate for Payer: Molina Medicare	$18.39
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	$18.39
Rate for Payer: Scott and White EPO/PPO	$22.99
Rate for Payer: Scott and White Medicare	$18.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18.39
Rate for Payer: Superior Health Plan EPO	$18.39
Rate for Payer: Superior Health Plan Medicare	$18.39
Rate for Payer: Universal American Dual Medicare/Medicaid	$18.39
Rate for Payer: Universal American Medicare	$18.39
Rate for Payer: Wellcare Medicare	$18.39
Rate for Payer: Wellmed Medicare	$18.39

protamine 10 mg/mL Inj Soln 25 mL

Facility

$128.17

Service Code	HCPCS J2720
Hospital Charge Code	77783316
Hospital Revenue Code	636
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$83.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$1.74
Rate for Payer: BCBS of TX Blue Essentials	$2.09
Rate for Payer: BCBS of TX PPO	$2.32
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cash Price	$87.16
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: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan EPO	$17.43

protamine 10 mg/mL Inj Soln 25 mL

Facility

$128.17

Service Code	HCPCS J2720
Hospital Charge Code	77783316
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

protamine 10 mg/mL Inj Soln 5 mL

Facility

$128.17

Service Code	HCPCS J2720
Hospital Charge Code	77783373
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

protamine 10 mg/mL Inj Soln 5 mL

Facility

$128.17

Service Code	HCPCS J2720
Hospital Charge Code	77783373
Hospital Revenue Code	636
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$83.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$1.74
Rate for Payer: BCBS of TX Blue Essentials	$2.09
Rate for Payer: BCBS of TX PPO	$2.32
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cash Price	$87.16
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: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan EPO	$17.43

Prot+CreatU (Random) SO

Facility

$96.00

Service Code	CPT 82570
Hospital Charge Code	1601152
Hospital Revenue Code	301
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$62.40
Rate for Payer: Aetna Commercial	$5.44
Rate for Payer: Aetna Medicare	$7.77
Rate for Payer: Amerigroup CHIP/Medicaid	$2.02
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.18
Rate for Payer: Amerigroup Medicare	$5.18
Rate for Payer: BCBS of TX Blue Advantage	$8.55
Rate for Payer: BCBS of TX Blue Essentials	$10.26
Rate for Payer: BCBS of TX Medicare	$5.18
Rate for Payer: BCBS of TX PPO	$11.45
Rate for Payer: Cash Price	$84.48
Rate for Payer: Cash Price	$84.48
Rate for Payer: Cigna Medicaid	$5.18
Rate for Payer: Cigna Medicare	$5.18
Rate for Payer: Employer Direct Commercial	$5.18
Rate for Payer: Humana Medicare/TRICARE	$5.18
Rate for Payer: Molina CHIP/Medicaid	$5.18
Rate for Payer: Molina Dual Medicare/Medicaid	$5.18
Rate for Payer: Molina Medicare	$5.18
Rate for Payer: Multiplan Auto	$62.40
Rate for Payer: Multiplan Commercial	$62.40
Rate for Payer: Multiplan Workers Comp	$62.40
Rate for Payer: Parkland Medicaid	$5.18
Rate for Payer: Scott and White EPO/PPO	$6.48
Rate for Payer: Scott and White Medicare	$5.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.18
Rate for Payer: Superior Health Plan EPO	$5.18
Rate for Payer: Superior Health Plan Medicare	$5.18
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.18
Rate for Payer: Universal American Medicare	$5.18
Rate for Payer: Wellcare Medicare	$5.18
Rate for Payer: Wellmed Medicare	$5.18

Prot+CreatU (Random) SO

Facility

$96.00

Service Code	CPT 82570
Hospital Charge Code	1601152
Hospital Revenue Code	301
Rate for Payer: Cash Price	$84.48

Protein 24 Hour Urine

Facility

$160.00

Service Code	CPT 84156
Hospital Charge Code	1605823
Hospital Revenue Code	301
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$104.00
Rate for Payer: Aetna Commercial	$3.85
Rate for Payer: Aetna Medicare	$5.50
Rate for Payer: Amerigroup CHIP/Medicaid	$1.43
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$3.67
Rate for Payer: Amerigroup Medicare	$3.67
Rate for Payer: BCBS of TX Blue Advantage	$6.06
Rate for Payer: BCBS of TX Blue Essentials	$7.27
Rate for Payer: BCBS of TX Medicare	$3.67
Rate for Payer: BCBS of TX PPO	$8.11
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cigna Medicaid	$3.67
Rate for Payer: Cigna Medicare	$3.67
Rate for Payer: Employer Direct Commercial	$3.67
Rate for Payer: Humana Medicare/TRICARE	$3.67
Rate for Payer: Molina CHIP/Medicaid	$3.67
Rate for Payer: Molina Dual Medicare/Medicaid	$3.67
Rate for Payer: Molina Medicare	$3.67
Rate for Payer: Multiplan Auto	$104.00
Rate for Payer: Multiplan Commercial	$104.00
Rate for Payer: Multiplan Workers Comp	$104.00
Rate for Payer: Parkland Medicaid	$3.67
Rate for Payer: Scott and White EPO/PPO	$4.59
Rate for Payer: Scott and White Medicare	$3.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.67
Rate for Payer: Superior Health Plan EPO	$3.67
Rate for Payer: Superior Health Plan Medicare	$3.67
Rate for Payer: Universal American Dual Medicare/Medicaid	$3.67
Rate for Payer: Universal American Medicare	$3.67
Rate for Payer: Wellcare Medicare	$3.67
Rate for Payer: Wellmed Medicare	$3.67

Protein Body Fluid

Facility

$193.00

Service Code	CPT 84157
Hospital Charge Code	4104196
Hospital Revenue Code	301
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$125.45
Rate for Payer: Aetna Commercial	$4.20
Rate for Payer: Aetna Medicare	$6.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1.56
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$4.00
Rate for Payer: Amerigroup Medicare	$4.00
Rate for Payer: BCBS of TX Blue Advantage	$6.60
Rate for Payer: BCBS of TX Blue Essentials	$7.92
Rate for Payer: BCBS of TX Medicare	$4.00
Rate for Payer: BCBS of TX PPO	$8.84
Rate for Payer: Cash Price	$169.84
Rate for Payer: Cash Price	$169.84
Rate for Payer: Cigna Medicaid	$4.00
Rate for Payer: Cigna Medicare	$4.00
Rate for Payer: Employer Direct Commercial	$4.00
Rate for Payer: Humana Medicare/TRICARE	$4.00
Rate for Payer: Molina CHIP/Medicaid	$4.00
Rate for Payer: Molina Dual Medicare/Medicaid	$4.00
Rate for Payer: Molina Medicare	$4.00
Rate for Payer: Multiplan Auto	$125.45
Rate for Payer: Multiplan Commercial	$125.45
Rate for Payer: Multiplan Workers Comp	$125.45
Rate for Payer: Parkland Medicaid	$4.00
Rate for Payer: Scott and White EPO/PPO	$5.00
Rate for Payer: Scott and White Medicare	$4.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.00
Rate for Payer: Superior Health Plan EPO	$4.00
Rate for Payer: Superior Health Plan Medicare	$4.00
Rate for Payer: Universal American Dual Medicare/Medicaid	$4.00
Rate for Payer: Universal American Medicare	$4.00
Rate for Payer: Wellcare Medicare	$4.00
Rate for Payer: Wellmed Medicare	$4.00

Protein Body Fluid

Facility

$193.00

Service Code	CPT 84157
Hospital Charge Code	4104196
Hospital Revenue Code	301
Rate for Payer: Cash Price	$169.84

Protein C Antigen SO

Facility

$83.00

Service Code	CPT 85302
Hospital Charge Code	1708312
Hospital Revenue Code	305
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$53.95
Rate for Payer: Aetna Commercial	$12.62
Rate for Payer: Aetna Medicare	$18.02
Rate for Payer: Amerigroup CHIP/Medicaid	$4.68
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12.01
Rate for Payer: Amerigroup Medicare	$12.01
Rate for Payer: BCBS of TX Blue Advantage	$19.82
Rate for Payer: BCBS of TX Blue Essentials	$23.78
Rate for Payer: BCBS of TX Medicare	$12.01
Rate for Payer: BCBS of TX PPO	$26.54
Rate for Payer: Cash Price	$73.04
Rate for Payer: Cash Price	$73.04
Rate for Payer: Cigna Medicaid	$12.01
Rate for Payer: Cigna Medicare	$12.01
Rate for Payer: Employer Direct Commercial	$12.01
Rate for Payer: Humana Medicare/TRICARE	$12.01
Rate for Payer: Molina CHIP/Medicaid	$12.01
Rate for Payer: Molina Dual Medicare/Medicaid	$12.01
Rate for Payer: Molina Medicare	$12.01
Rate for Payer: Multiplan Auto	$53.95
Rate for Payer: Multiplan Commercial	$53.95
Rate for Payer: Multiplan Workers Comp	$53.95
Rate for Payer: Parkland Medicaid	$12.01
Rate for Payer: Scott and White EPO/PPO	$15.01
Rate for Payer: Scott and White Medicare	$12.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.01
Rate for Payer: Superior Health Plan EPO	$12.01
Rate for Payer: Superior Health Plan Medicare	$12.01
Rate for Payer: Universal American Dual Medicare/Medicaid	$12.01
Rate for Payer: Universal American Medicare	$12.01
Rate for Payer: Wellcare Medicare	$12.01
Rate for Payer: Wellmed Medicare	$12.01

Protein C Antigen SO

Facility

$83.00

Service Code	CPT 85302
Hospital Charge Code	1708312
Hospital Revenue Code	305
Rate for Payer: Cash Price	$73.04

Protein C-Functional SO

Facility

$288.00

Service Code	CPT 85303
Hospital Charge Code	1704915
Hospital Revenue Code	305
Rate for Payer: Cash Price	$253.44

Protein C-Functional SO

Facility

$288.00

Service Code	CPT 85303
Hospital Charge Code	1704915
Hospital Revenue Code	305
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$187.20
Rate for Payer: Aetna Commercial	$14.52
Rate for Payer: Aetna Medicare	$20.76
Rate for Payer: Amerigroup CHIP/Medicaid	$5.40
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13.84
Rate for Payer: Amerigroup Medicare	$13.84
Rate for Payer: BCBS of TX Blue Advantage	$22.84
Rate for Payer: BCBS of TX Blue Essentials	$27.40
Rate for Payer: BCBS of TX Medicare	$13.84
Rate for Payer: BCBS of TX PPO	$30.59
Rate for Payer: Cash Price	$253.44
Rate for Payer: Cash Price	$253.44
Rate for Payer: Cigna Medicaid	$13.84
Rate for Payer: Cigna Medicare	$13.84
Rate for Payer: Employer Direct Commercial	$13.84
Rate for Payer: Humana Medicare/TRICARE	$13.84
Rate for Payer: Molina CHIP/Medicaid	$13.84
Rate for Payer: Molina Dual Medicare/Medicaid	$13.84
Rate for Payer: Molina Medicare	$13.84
Rate for Payer: Multiplan Auto	$187.20
Rate for Payer: Multiplan Commercial	$187.20
Rate for Payer: Multiplan Workers Comp	$187.20
Rate for Payer: Parkland Medicaid	$13.84
Rate for Payer: Scott and White EPO/PPO	$17.30
Rate for Payer: Scott and White Medicare	$13.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.84
Rate for Payer: Superior Health Plan EPO	$13.84
Rate for Payer: Superior Health Plan Medicare	$13.84
Rate for Payer: Universal American Dual Medicare/Medicaid	$13.84
Rate for Payer: Universal American Medicare	$13.84
Rate for Payer: Wellcare Medicare	$13.84
Rate for Payer: Wellmed Medicare	$13.84

Know your out-of-pocket cost for care.

All Charges