White Rock Medical Center

All Charges

Charge

Type

Setting

Price

THYROID DISORDERS

Facility

$1,889.72

Service Code	APR-DRG 4271
Min. Negotiated Rate	$1,781.69
Max. Negotiated Rate	$1,889.72
Rate for Payer: Amerigroup CHIP/Medicaid	$1,781.69
Rate for Payer: Cigna Medicaid	$1,781.69
Rate for Payer: Molina CHIP/Medicaid	$1,781.69
Rate for Payer: Parkland Medicaid	$1,781.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,889.72

THYROID DISORDERS

Facility

$11,818.84

Service Code	APR-DRG 4274
Min. Negotiated Rate	$11,143.22
Max. Negotiated Rate	$11,818.84
Rate for Payer: Amerigroup CHIP/Medicaid	$11,143.22
Rate for Payer: Cigna Medicaid	$11,143.22
Rate for Payer: Molina CHIP/Medicaid	$11,143.22
Rate for Payer: Parkland Medicaid	$11,143.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,818.84

THYROID DISORDERS

Facility

$3,009.59

Service Code	APR-DRG 4272
Min. Negotiated Rate	$2,837.55
Max. Negotiated Rate	$3,009.59
Rate for Payer: Amerigroup CHIP/Medicaid	$2,837.55
Rate for Payer: Cigna Medicaid	$2,837.55
Rate for Payer: Molina CHIP/Medicaid	$2,837.55
Rate for Payer: Parkland Medicaid	$2,837.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,009.59

THYROID DISORDERS

Facility

$3,517.29

Service Code	APR-DRG 4273
Min. Negotiated Rate	$3,316.22
Max. Negotiated Rate	$3,517.29
Rate for Payer: Amerigroup CHIP/Medicaid	$3,316.22
Rate for Payer: Cigna Medicaid	$3,316.22
Rate for Payer: Molina CHIP/Medicaid	$3,316.22
Rate for Payer: Parkland Medicaid	$3,316.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,517.29

Thyroidectomy, including substernal thyroid; cervical approach

Facility

$31,165.62

Service Code	HCPCS 60271
Hospital Charge Code	9900736
Hospital Revenue Code	360
Min. Negotiated Rate	$2,804.91
Max. Negotiated Rate	$22,439.25
Rate for Payer: Amerigroup CHIP/Medicaid	$2,804.91
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Amerigroup Medicare	$5,946.81
Rate for Payer: BCBS of TX Blue Advantage	$8,100.39
Rate for Payer: BCBS of TX Blue Essentials	$9,701.06
Rate for Payer: BCBS of TX Medicare	$5,946.81
Rate for Payer: BCBS of TX PPO	$12,223.34
Rate for Payer: Cash Price	$21,192.62
Rate for Payer: Cash Price	$21,192.62
Rate for Payer: Cash Price	$21,192.62
Rate for Payer: Cigna Commercial	$12,570.48
Rate for Payer: Cigna Medicaid	$22,439.25
Rate for Payer: Cigna Medicare	$5,946.81
Rate for Payer: Employer Direct Commercial	$5,946.81
Rate for Payer: Humana Medicare/TRICARE	$5,946.81
Rate for Payer: Molina CHIP/Medicaid	$22,439.25
Rate for Payer: Molina Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Molina Medicare	$5,946.81
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	$22,439.25
Rate for Payer: Scott and White EPO/PPO	$11,001.60
Rate for Payer: Scott and White Medicare	$5,946.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$22,439.25
Rate for Payer: Superior Health Plan EPO	$5,946.81
Rate for Payer: Superior Health Plan Medicare	$5,946.81
Rate for Payer: Universal American Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Universal American Medicare	$5,946.81
Rate for Payer: Wellcare Medicare	$5,946.81
Rate for Payer: Wellmed Medicare	$5,946.81

Thyroidectomy, including substernal thyroid; cervical approach

Facility

$12,570.48

Service Code	CPT 60271
Hospital Charge Code	36060271
Hospital Revenue Code	360
Min. Negotiated Rate	$5,946.81
Max. Negotiated Rate	$12,570.48
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Amerigroup Medicare	$5,946.81
Rate for Payer: BCBS of TX Blue Advantage	$8,100.39
Rate for Payer: BCBS of TX Blue Essentials	$9,701.06
Rate for Payer: BCBS of TX Medicare	$5,946.81
Rate for Payer: BCBS of TX PPO	$12,223.34
Rate for Payer: Cigna Commercial	$12,570.48
Rate for Payer: Cigna Medicare	$5,946.81
Rate for Payer: Employer Direct Commercial	$5,946.81
Rate for Payer: Humana Medicare/TRICARE	$5,946.81
Rate for Payer: Molina Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Molina Medicare	$5,946.81
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	$11,001.60
Rate for Payer: Scott and White Medicare	$5,946.81
Rate for Payer: Superior Health Plan EPO	$5,946.81
Rate for Payer: Superior Health Plan Medicare	$5,946.81
Rate for Payer: Universal American Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Universal American Medicare	$5,946.81
Rate for Payer: Wellcare Medicare	$5,946.81
Rate for Payer: Wellmed Medicare	$5,946.81

Thyroidectomy, including substernal thyroid; cervical approach

Facility

$31,165.62

Service Code	HCPCS 60271
Hospital Charge Code	9900736
Hospital Revenue Code	360
Rate for Payer: Cash Price	$21,192.62

Thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of th

Facility

$50,000.00

Service Code	HCPCS 60260
Hospital Charge Code	9900735
Hospital Revenue Code	360
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$36,000.00
Rate for Payer: Amerigroup CHIP/Medicaid	$4,500.00
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Amerigroup Medicare	$5,946.81
Rate for Payer: BCBS of TX Blue Advantage	$8,100.39
Rate for Payer: BCBS of TX Blue Essentials	$9,701.06
Rate for Payer: BCBS of TX Medicare	$5,946.81
Rate for Payer: BCBS of TX PPO	$12,223.34
Rate for Payer: Cash Price	$34,000.00
Rate for Payer: Cash Price	$34,000.00
Rate for Payer: Cash Price	$34,000.00
Rate for Payer: Cigna Commercial	$12,570.48
Rate for Payer: Cigna Medicaid	$36,000.00
Rate for Payer: Cigna Medicare	$5,946.81
Rate for Payer: Employer Direct Commercial	$5,946.81
Rate for Payer: Humana Medicare/TRICARE	$5,946.81
Rate for Payer: Molina CHIP/Medicaid	$36,000.00
Rate for Payer: Molina Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Molina Medicare	$5,946.81
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	$36,000.00
Rate for Payer: Scott and White EPO/PPO	$11,001.60
Rate for Payer: Scott and White Medicare	$5,946.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$36,000.00
Rate for Payer: Superior Health Plan EPO	$5,946.81
Rate for Payer: Superior Health Plan Medicare	$5,946.81
Rate for Payer: Universal American Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Universal American Medicare	$5,946.81
Rate for Payer: Wellcare Medicare	$5,946.81
Rate for Payer: Wellmed Medicare	$5,946.81

Thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of th

Facility

$50,000.00

Service Code	HCPCS 60260
Hospital Charge Code	9900735
Hospital Revenue Code	360
Rate for Payer: Cash Price	$34,000.00

Thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of th

Facility

$12,570.48

Service Code	CPT 60260
Hospital Charge Code	36060260
Hospital Revenue Code	360
Min. Negotiated Rate	$5,946.81
Max. Negotiated Rate	$12,570.48
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Amerigroup Medicare	$5,946.81
Rate for Payer: BCBS of TX Blue Advantage	$8,100.39
Rate for Payer: BCBS of TX Blue Essentials	$9,701.06
Rate for Payer: BCBS of TX Medicare	$5,946.81
Rate for Payer: BCBS of TX PPO	$12,223.34
Rate for Payer: Cigna Commercial	$12,570.48
Rate for Payer: Cigna Medicare	$5,946.81
Rate for Payer: Employer Direct Commercial	$5,946.81
Rate for Payer: Humana Medicare/TRICARE	$5,946.81
Rate for Payer: Molina Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Molina Medicare	$5,946.81
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	$11,001.60
Rate for Payer: Scott and White Medicare	$5,946.81
Rate for Payer: Superior Health Plan EPO	$5,946.81
Rate for Payer: Superior Health Plan Medicare	$5,946.81
Rate for Payer: Universal American Dual Medicare/Medicaid	$5,946.81
Rate for Payer: Universal American Medicare	$5,946.81
Rate for Payer: Wellcare Medicare	$5,946.81
Rate for Payer: Wellmed Medicare	$5,946.81

Thyroidectomy, total or complete

Facility

$40,483.52

Service Code	HCPCS 60240
Hospital Charge Code	9900733
Hospital Revenue Code	360
Min. Negotiated Rate	$1,888.85
Max. Negotiated Rate	$29,148.13
Rate for Payer: Amerigroup CHIP/Medicaid	$1,888.85
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Amerigroup Medicare	$6,073.08
Rate for Payer: BCBS of TX Blue Advantage	$8,072.30
Rate for Payer: BCBS of TX Blue Essentials	$9,667.42
Rate for Payer: BCBS of TX Medicare	$6,073.08
Rate for Payer: BCBS of TX PPO	$12,180.95
Rate for Payer: Cash Price	$27,528.79
Rate for Payer: Cash Price	$27,528.79
Rate for Payer: Cash Price	$27,528.79
Rate for Payer: Cigna Commercial	$12,837.39
Rate for Payer: Cigna Medicaid	$29,148.13
Rate for Payer: Cigna Medicare	$6,073.08
Rate for Payer: Employer Direct Commercial	$6,073.08
Rate for Payer: Humana Medicare/TRICARE	$6,073.08
Rate for Payer: Molina CHIP/Medicaid	$29,148.13
Rate for Payer: Molina Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Molina Medicare	$6,073.08
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	$29,148.13
Rate for Payer: Scott and White EPO/PPO	$11,235.20
Rate for Payer: Scott and White Medicare	$6,073.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$29,148.13
Rate for Payer: Superior Health Plan EPO	$6,073.08
Rate for Payer: Superior Health Plan Medicare	$6,073.08
Rate for Payer: Universal American Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Universal American Medicare	$6,073.08
Rate for Payer: Wellcare Medicare	$6,073.08
Rate for Payer: Wellmed Medicare	$6,073.08

Thyroidectomy, total or complete

Facility

$12,837.39

Service Code	CPT 60240
Hospital Charge Code	36060240
Hospital Revenue Code	360
Min. Negotiated Rate	$1,888.85
Max. Negotiated Rate	$12,837.39
Rate for Payer: Amerigroup CHIP/Medicaid	$1,888.85
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Amerigroup Medicare	$6,073.08
Rate for Payer: BCBS of TX Blue Advantage	$8,072.30
Rate for Payer: BCBS of TX Blue Essentials	$9,667.42
Rate for Payer: BCBS of TX Medicare	$6,073.08
Rate for Payer: BCBS of TX PPO	$12,180.95
Rate for Payer: Cigna Commercial	$12,837.39
Rate for Payer: Cigna Medicare	$6,073.08
Rate for Payer: Employer Direct Commercial	$6,073.08
Rate for Payer: Humana Medicare/TRICARE	$6,073.08
Rate for Payer: Molina Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Molina Medicare	$6,073.08
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	$11,235.20
Rate for Payer: Scott and White Medicare	$6,073.08
Rate for Payer: Superior Health Plan EPO	$6,073.08
Rate for Payer: Superior Health Plan Medicare	$6,073.08
Rate for Payer: Universal American Dual Medicare/Medicaid	$6,073.08
Rate for Payer: Universal American Medicare	$6,073.08
Rate for Payer: Wellcare Medicare	$6,073.08
Rate for Payer: Wellmed Medicare	$6,073.08

Thyroidectomy, total or complete

Facility

$40,483.52

Service Code	HCPCS 60240
Hospital Charge Code	9900733
Hospital Revenue Code	360
Rate for Payer: Cash Price	$27,528.79

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES

Facility

$19,190.62

Service Code	APR-DRG 4043
Min. Negotiated Rate	$18,093.59
Max. Negotiated Rate	$19,190.62
Rate for Payer: Amerigroup CHIP/Medicaid	$18,093.59
Rate for Payer: Cigna Medicaid	$18,093.59
Rate for Payer: Molina CHIP/Medicaid	$18,093.59
Rate for Payer: Parkland Medicaid	$18,093.59
Rate for Payer: Superior Health Plan CHIP/Medicaid	$19,190.62

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES

Facility

$8,239.32

Service Code	APR-DRG 4042
Min. Negotiated Rate	$7,768.32
Max. Negotiated Rate	$8,239.32
Rate for Payer: Amerigroup CHIP/Medicaid	$7,768.32
Rate for Payer: Cigna Medicaid	$7,768.32
Rate for Payer: Molina CHIP/Medicaid	$7,768.32
Rate for Payer: Parkland Medicaid	$7,768.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,239.32

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES

Facility

$25,246.39

Service Code	APR-DRG 4044
Min. Negotiated Rate	$23,803.18
Max. Negotiated Rate	$25,246.39
Rate for Payer: Amerigroup CHIP/Medicaid	$23,803.18
Rate for Payer: Cigna Medicaid	$23,803.18
Rate for Payer: Molina CHIP/Medicaid	$23,803.18
Rate for Payer: Parkland Medicaid	$23,803.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$25,246.39

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES

Facility

$6,022.58

Service Code	APR-DRG 4041
Min. Negotiated Rate	$5,678.30
Max. Negotiated Rate	$6,022.58
Rate for Payer: Amerigroup CHIP/Medicaid	$5,678.30
Rate for Payer: Cigna Medicaid	$5,678.30
Rate for Payer: Molina CHIP/Medicaid	$5,678.30
Rate for Payer: Parkland Medicaid	$5,678.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,022.58

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC

Facility

$28,488.60

Service Code	MSDRG 626
Min. Negotiated Rate	$13,119.75
Max. Negotiated Rate	$28,488.60
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$15,749.24
Rate for Payer: Amerigroup Medicare	$15,749.24
Rate for Payer: BCBS of TX Medicare	$15,749.24
Rate for Payer: Cigna Commercial	$19,312.27
Rate for Payer: Cigna Medicare	$15,749.24
Rate for Payer: Employer Direct Commercial	$15,749.24
Rate for Payer: Humana Medicare/TRICARE	$15,749.24
Rate for Payer: Molina Dual Medicare/Medicaid	$15,749.24
Rate for Payer: Molina Medicare	$15,749.24
Rate for Payer: Multiplan Auto	$28,488.60
Rate for Payer: Multiplan Commercial	$28,488.60
Rate for Payer: Multiplan Workers Comp	$28,488.60
Rate for Payer: Scott and White EPO/PPO	$13,119.75
Rate for Payer: Scott and White Medicare	$15,749.24
Rate for Payer: Superior Health Plan EPO	$15,749.24
Rate for Payer: Superior Health Plan Medicare	$15,749.24
Rate for Payer: Universal American Dual Medicare/Medicaid	$15,749.24
Rate for Payer: Universal American Medicare	$15,749.24
Rate for Payer: Wellcare Medicare	$15,749.24
Rate for Payer: Wellmed Medicare	$15,749.24

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC

Facility

$57,381.90

Service Code	MSDRG 625
Min. Negotiated Rate	$23,936.38
Max. Negotiated Rate	$57,381.90
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$26,894.47
Rate for Payer: Amerigroup Medicare	$26,894.47
Rate for Payer: BCBS of TX Medicare	$26,894.47
Rate for Payer: Cigna Commercial	$38,898.89
Rate for Payer: Cigna Medicare	$26,894.47
Rate for Payer: Employer Direct Commercial	$26,894.47
Rate for Payer: Humana Medicare/TRICARE	$26,894.47
Rate for Payer: Molina Dual Medicare/Medicaid	$26,894.47
Rate for Payer: Molina Medicare	$26,894.47
Rate for Payer: Multiplan Auto	$57,381.90
Rate for Payer: Multiplan Commercial	$57,381.90
Rate for Payer: Multiplan Workers Comp	$57,381.90
Rate for Payer: Scott and White EPO/PPO	$26,425.88
Rate for Payer: Scott and White Medicare	$26,894.47
Rate for Payer: Superior Health Plan EPO	$26,894.47
Rate for Payer: Superior Health Plan Medicare	$26,894.47
Rate for Payer: Universal American Dual Medicare/Medicaid	$26,894.47
Rate for Payer: Universal American Medicare	$26,894.47
Rate for Payer: Wellcare Medicare	$26,894.47
Rate for Payer: Wellmed Medicare	$26,894.47

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC

Facility

$25,237.70

Service Code	MSDRG 627
Min. Negotiated Rate	$9,331.00
Max. Negotiated Rate	$25,237.70
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14,495.23
Rate for Payer: Amerigroup Medicare	$14,495.23
Rate for Payer: BCBS of TX Medicare	$14,495.23
Rate for Payer: Cigna Commercial	$17,108.50
Rate for Payer: Cigna Medicare	$14,495.23
Rate for Payer: Employer Direct Commercial	$14,495.23
Rate for Payer: Humana Medicare/TRICARE	$14,495.23
Rate for Payer: Molina Dual Medicare/Medicaid	$14,495.23
Rate for Payer: Molina Medicare	$14,495.23
Rate for Payer: Multiplan Auto	$25,237.70
Rate for Payer: Multiplan Commercial	$25,237.70
Rate for Payer: Multiplan Workers Comp	$25,237.70
Rate for Payer: Scott and White EPO/PPO	$11,622.62
Rate for Payer: Scott and White Medicare	$14,495.23
Rate for Payer: Superior Health Plan EPO	$14,495.23
Rate for Payer: Superior Health Plan Medicare	$14,495.23
Rate for Payer: Universal American Dual Medicare/Medicaid	$14,495.23
Rate for Payer: Universal American Medicare	$14,495.23
Rate for Payer: Wellcare Medicare	$14,495.23
Rate for Payer: Wellmed Medicare	$14,495.23

THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W CC

Facility

$28,488.60

Service Code	MSDRG 626
Min. Negotiated Rate	$13,119.75
Max. Negotiated Rate	$28,488.60
Rate for Payer: BCBS of TX Blue Advantage	$13,851.16
Rate for Payer: BCBS of TX Blue Essentials	$16,619.78
Rate for Payer: BCBS of TX PPO	$18,467.14

THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W MCC

Facility

$57,381.90

Service Code	MSDRG 625
Min. Negotiated Rate	$23,936.38
Max. Negotiated Rate	$57,381.90
Rate for Payer: BCBS of TX Blue Advantage	$23,936.38
Rate for Payer: BCBS of TX Blue Essentials	$28,720.87
Rate for Payer: BCBS of TX PPO	$31,913.32

THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W/O CC/MCC

Facility

$25,237.70

Service Code	MSDRG 627
Min. Negotiated Rate	$9,331.00
Max. Negotiated Rate	$25,237.70
Rate for Payer: BCBS of TX Blue Advantage	$9,331.00
Rate for Payer: BCBS of TX Blue Essentials	$11,196.11
Rate for Payer: BCBS of TX PPO	$12,440.61

Thyroid Peroxidase (TPO) Ab SO

Facility

$173.00

Service Code	HCPCS 86376
Hospital Charge Code	1703644
Hospital Revenue Code	302
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$124.56
Rate for Payer: Amerigroup CHIP/Medicaid	$5.67
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$14.55
Rate for Payer: Amerigroup Medicare	$14.55
Rate for Payer: BCBS of TX Blue Advantage	$51.90
Rate for Payer: BCBS of TX Blue Essentials	$62.28
Rate for Payer: BCBS of TX Medicare	$14.55
Rate for Payer: BCBS of TX PPO	$69.20
Rate for Payer: Cash Price	$117.64
Rate for Payer: Cash Price	$117.64
Rate for Payer: Cigna Medicaid	$124.56
Rate for Payer: Cigna Medicare	$14.55
Rate for Payer: Employer Direct Commercial	$14.55
Rate for Payer: Humana Medicare/TRICARE	$14.55
Rate for Payer: Molina CHIP/Medicaid	$124.56
Rate for Payer: Molina Dual Medicare/Medicaid	$14.55
Rate for Payer: Molina Medicare	$14.55
Rate for Payer: Multiplan Auto	$112.45
Rate for Payer: Multiplan Commercial	$112.45
Rate for Payer: Multiplan Workers Comp	$112.45
Rate for Payer: Parkland Medicaid	$124.56
Rate for Payer: Scott and White EPO/PPO	$18.19
Rate for Payer: Scott and White Medicare	$14.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$124.56
Rate for Payer: Superior Health Plan EPO	$14.55
Rate for Payer: Superior Health Plan Medicare	$14.55
Rate for Payer: Universal American Dual Medicare/Medicaid	$14.55
Rate for Payer: Universal American Medicare	$14.55
Rate for Payer: Wellcare Medicare	$14.55
Rate for Payer: Wellmed Medicare	$14.55

Thyroid Peroxidase (TPO) Ab SO

Facility

$173.00

Service Code	HCPCS 86376
Hospital Charge Code	1703644
Hospital Revenue Code	302
Rate for Payer: Cash Price	$117.64

Know your out-of-pocket cost for care.

All Charges