White Rock Medical Center

All Charges

Charge

Type

Setting

Price

calcium (as carbonate) 600 mg Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77432319
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

calcium (as carbonate) 600 mg Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77432319
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$4.97
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.30
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: Multiplan Auto	$4.97
Rate for Payer: Multiplan Commercial	$4.97
Rate for Payer: Multiplan Workers Comp	$4.97
Rate for Payer: Scott and White EPO/PPO	$3.82
Rate for Payer: Superior Health Plan EPO	$1.04

calcium (as carbonnate)-vitamin D 250 mg-125 intl units Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	78419911
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$4.97
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.30
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: Multiplan Auto	$4.97
Rate for Payer: Multiplan Commercial	$4.97
Rate for Payer: Multiplan Workers Comp	$4.97
Rate for Payer: Scott and White EPO/PPO	$3.82
Rate for Payer: Superior Health Plan EPO	$1.04

calcium (as carbonnate)-vitamin D 250 mg-125 intl units Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	78419911
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

calcium carbonate 500 mg (200 mg elemental calcium) Chew Tab

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77433943
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.44

calcium carbonate 500 mg (200 mg elemental calcium) Chew Tab

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	77433943
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$5.20
Rate for Payer: Amerigroup CHIP/Medicaid	$0.72
Rate for Payer: BCBS of TX Blue Advantage	$2.40
Rate for Payer: BCBS of TX Blue Essentials	$2.88
Rate for Payer: BCBS of TX PPO	$3.20
Rate for Payer: Cash Price	$5.44
Rate for Payer: Multiplan Auto	$5.20
Rate for Payer: Multiplan Commercial	$5.20
Rate for Payer: Multiplan Workers Comp	$5.20
Rate for Payer: Scott and White EPO/PPO	$4.00
Rate for Payer: Superior Health Plan EPO	$1.09

calcium chloride 100 mg/mL Inj Soln 10 mL

Facility

$128.17

Service Code	HCPCS J3490
Hospital Charge Code	77434912
Hospital Revenue Code	250
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$83.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$38.45
Rate for Payer: BCBS of TX Blue Essentials	$46.14
Rate for Payer: BCBS of TX PPO	$51.27
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

calcium chloride 100 mg/mL Inj Soln 10 mL

Facility

$128.17

Service Code	HCPCS J3490
Hospital Charge Code	77434912
Hospital Revenue Code	250
Rate for Payer: Cash Price	$87.16

calcium gluconate 1000 mg/50 mL-NaCl - IV Soln 50 mL

Facility

$128.17

Service Code	HCPCS J0610
Hospital Charge Code	79364704
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

calcium gluconate 1000 mg/50 mL-NaCl - IV Soln 50 mL

Facility

$128.17

Service Code	HCPCS J0610
Hospital Charge Code	79364704
Hospital Revenue Code	636
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$83.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$38.45
Rate for Payer: BCBS of TX Blue Essentials	$46.14
Rate for Payer: BCBS of TX PPO	$51.27
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

calcium gluconate 100 mg/mL Inj Soln 10 mL

Facility

$128.17

Service Code	HCPCS J0610
Hospital Charge Code	7443109
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

calcium gluconate 100 mg/mL Inj Soln 10 mL

Facility

$128.17

Service Code	HCPCS J0610
Hospital Charge Code	7443109
Hospital Revenue Code	636
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$83.31
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$38.45
Rate for Payer: BCBS of TX Blue Essentials	$46.14
Rate for Payer: BCBS of TX PPO	$51.27
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

Calcium, Ionized, Serum SO

Facility

$360.00

Service Code	CPT 82330
Hospital Charge Code	1701291
Hospital Revenue Code	301
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna Commercial	$14.37
Rate for Payer: Aetna Medicare	$20.52
Rate for Payer: Amerigroup CHIP/Medicaid	$5.34
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13.68
Rate for Payer: Amerigroup Medicare	$13.68
Rate for Payer: BCBS of TX Blue Advantage	$22.57
Rate for Payer: BCBS of TX Blue Essentials	$27.09
Rate for Payer: BCBS of TX Medicare	$13.68
Rate for Payer: BCBS of TX PPO	$30.23
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cigna Medicaid	$13.68
Rate for Payer: Cigna Medicare	$13.68
Rate for Payer: Employer Direct Commercial	$13.68
Rate for Payer: Humana Medicare/TRICARE	$13.68
Rate for Payer: Molina CHIP/Medicaid	$13.68
Rate for Payer: Molina Dual Medicare/Medicaid	$13.68
Rate for Payer: Molina Medicare	$13.68
Rate for Payer: Multiplan Auto	$234.00
Rate for Payer: Multiplan Commercial	$234.00
Rate for Payer: Multiplan Workers Comp	$234.00
Rate for Payer: Parkland Medicaid	$13.68
Rate for Payer: Scott and White EPO/PPO	$17.10
Rate for Payer: Scott and White Medicare	$13.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.68
Rate for Payer: Superior Health Plan EPO	$13.68
Rate for Payer: Superior Health Plan Medicare	$13.68
Rate for Payer: Universal American Dual Medicare/Medicaid	$13.68
Rate for Payer: Universal American Medicare	$13.68
Rate for Payer: Wellcare Medicare	$13.68
Rate for Payer: Wellmed Medicare	$13.68

Calcium, Ionized, Serum SO

Facility

$360.00

Service Code	CPT 82330
Hospital Charge Code	1701291
Hospital Revenue Code	301
Rate for Payer: Cash Price	$316.80

Calcium Level Ionized

Facility

$360.00

Service Code	CPT 82330
Hospital Charge Code	1701291
Hospital Revenue Code	301
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna Commercial	$14.37
Rate for Payer: Aetna Medicare	$20.52
Rate for Payer: Amerigroup CHIP/Medicaid	$5.34
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$13.68
Rate for Payer: Amerigroup Medicare	$13.68
Rate for Payer: BCBS of TX Blue Advantage	$22.57
Rate for Payer: BCBS of TX Blue Essentials	$27.09
Rate for Payer: BCBS of TX Medicare	$13.68
Rate for Payer: BCBS of TX PPO	$30.23
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cigna Medicaid	$13.68
Rate for Payer: Cigna Medicare	$13.68
Rate for Payer: Employer Direct Commercial	$13.68
Rate for Payer: Humana Medicare/TRICARE	$13.68
Rate for Payer: Molina CHIP/Medicaid	$13.68
Rate for Payer: Molina Dual Medicare/Medicaid	$13.68
Rate for Payer: Molina Medicare	$13.68
Rate for Payer: Multiplan Auto	$234.00
Rate for Payer: Multiplan Commercial	$234.00
Rate for Payer: Multiplan Workers Comp	$234.00
Rate for Payer: Parkland Medicaid	$13.68
Rate for Payer: Scott and White EPO/PPO	$17.10
Rate for Payer: Scott and White Medicare	$13.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.68
Rate for Payer: Superior Health Plan EPO	$13.68
Rate for Payer: Superior Health Plan Medicare	$13.68
Rate for Payer: Universal American Dual Medicare/Medicaid	$13.68
Rate for Payer: Universal American Medicare	$13.68
Rate for Payer: Wellcare Medicare	$13.68
Rate for Payer: Wellmed Medicare	$13.68

Calcium Level Total

Facility

$234.00

Service Code	CPT 82310
Hospital Charge Code	1601673
Hospital Revenue Code	301
Rate for Payer: Cash Price	$205.92

Calcium Level Total

Facility

$234.00

Service Code	CPT 82310
Hospital Charge Code	1601673
Hospital Revenue Code	301
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$152.10
Rate for Payer: Aetna Commercial	$5.42
Rate for Payer: Aetna Medicare	$7.74
Rate for Payer: Amerigroup CHIP/Medicaid	$2.01
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$5.16
Rate for Payer: Amerigroup Medicare	$5.16
Rate for Payer: BCBS of TX Blue Advantage	$8.51
Rate for Payer: BCBS of TX Blue Essentials	$10.22
Rate for Payer: BCBS of TX Medicare	$5.16
Rate for Payer: BCBS of TX PPO	$11.40
Rate for Payer: Cash Price	$205.92
Rate for Payer: Cash Price	$205.92
Rate for Payer: Cigna Medicaid	$5.16
Rate for Payer: Cigna Medicare	$5.16
Rate for Payer: Employer Direct Commercial	$5.16
Rate for Payer: Humana Medicare/TRICARE	$5.16
Rate for Payer: Molina CHIP/Medicaid	$5.16
Rate for Payer: Molina Dual Medicare/Medicaid	$5.16
Rate for Payer: Molina Medicare	$5.16
Rate for Payer: Multiplan Auto	$152.10
Rate for Payer: Multiplan Commercial	$152.10
Rate for Payer: Multiplan Workers Comp	$152.10
Rate for Payer: Parkland Medicaid	$5.16
Rate for Payer: Scott and White EPO/PPO	$6.45
Rate for Payer: Scott and White Medicare	$5.16
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.16
Rate for Payer: Superior Health Plan EPO	$5.16
Rate for Payer: Superior Health Plan Medicare	$5.16
Rate for Payer: Universal American Dual Medicare/Medicaid	$5.16
Rate for Payer: Universal American Medicare	$5.16
Rate for Payer: Wellcare Medicare	$5.16
Rate for Payer: Wellmed Medicare	$5.16

Calcium, Random Urine SO

Facility

$213.00

Service Code	CPT 82340
Hospital Charge Code	1601269
Hospital Revenue Code	301
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$138.45
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Aetna Medicare	$9.04
Rate for Payer: Amerigroup CHIP/Medicaid	$2.35
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6.03
Rate for Payer: Amerigroup Medicare	$6.03
Rate for Payer: BCBS of TX Blue Advantage	$9.95
Rate for Payer: BCBS of TX Blue Essentials	$11.94
Rate for Payer: BCBS of TX Medicare	$6.03
Rate for Payer: BCBS of TX PPO	$13.33
Rate for Payer: Cash Price	$187.44
Rate for Payer: Cash Price	$187.44
Rate for Payer: Cigna Medicaid	$6.03
Rate for Payer: Cigna Medicare	$6.03
Rate for Payer: Employer Direct Commercial	$6.03
Rate for Payer: Humana Medicare/TRICARE	$6.03
Rate for Payer: Molina CHIP/Medicaid	$6.03
Rate for Payer: Molina Dual Medicare/Medicaid	$6.03
Rate for Payer: Molina Medicare	$6.03
Rate for Payer: Multiplan Auto	$138.45
Rate for Payer: Multiplan Commercial	$138.45
Rate for Payer: Multiplan Workers Comp	$138.45
Rate for Payer: Parkland Medicaid	$6.03
Rate for Payer: Scott and White EPO/PPO	$7.54
Rate for Payer: Scott and White Medicare	$6.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.03
Rate for Payer: Superior Health Plan EPO	$6.03
Rate for Payer: Superior Health Plan Medicare	$6.03
Rate for Payer: Universal American Dual Medicare/Medicaid	$6.03
Rate for Payer: Universal American Medicare	$6.03
Rate for Payer: Wellcare Medicare	$6.03
Rate for Payer: Wellmed Medicare	$6.03

Calcium, Random Urine SO

Facility

$213.00

Service Code	CPT 82340
Hospital Charge Code	1601269
Hospital Revenue Code	301
Rate for Payer: Cash Price	$187.44

CALCIUM URINE QUANT TIMED SPECIMEN

Facility

$213.00

Service Code	CPT 82340
Hospital Charge Code	1601269
Hospital Revenue Code	301
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$138.45
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Aetna Medicare	$9.04
Rate for Payer: Amerigroup CHIP/Medicaid	$2.35
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$6.03
Rate for Payer: Amerigroup Medicare	$6.03
Rate for Payer: BCBS of TX Blue Advantage	$9.95
Rate for Payer: BCBS of TX Blue Essentials	$11.94
Rate for Payer: BCBS of TX Medicare	$6.03
Rate for Payer: BCBS of TX PPO	$13.33
Rate for Payer: Cash Price	$187.44
Rate for Payer: Cash Price	$187.44
Rate for Payer: Cigna Medicaid	$6.03
Rate for Payer: Cigna Medicare	$6.03
Rate for Payer: Employer Direct Commercial	$6.03
Rate for Payer: Humana Medicare/TRICARE	$6.03
Rate for Payer: Molina CHIP/Medicaid	$6.03
Rate for Payer: Molina Dual Medicare/Medicaid	$6.03
Rate for Payer: Molina Medicare	$6.03
Rate for Payer: Multiplan Auto	$138.45
Rate for Payer: Multiplan Commercial	$138.45
Rate for Payer: Multiplan Workers Comp	$138.45
Rate for Payer: Parkland Medicaid	$6.03
Rate for Payer: Scott and White EPO/PPO	$7.54
Rate for Payer: Scott and White Medicare	$6.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.03
Rate for Payer: Superior Health Plan EPO	$6.03
Rate for Payer: Superior Health Plan Medicare	$6.03
Rate for Payer: Universal American Dual Medicare/Medicaid	$6.03
Rate for Payer: Universal American Medicare	$6.03
Rate for Payer: Wellcare Medicare	$6.03
Rate for Payer: Wellmed Medicare	$6.03

Calculi, Urinary SO

Facility

$96.00

Service Code	CPT 82360
Hospital Charge Code	1630026
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$62.40
Rate for Payer: Aetna Commercial	$13.51
Rate for Payer: Aetna Medicare	$19.30
Rate for Payer: Amerigroup CHIP/Medicaid	$5.02
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$12.87
Rate for Payer: Amerigroup Medicare	$12.87
Rate for Payer: BCBS of TX Blue Advantage	$21.24
Rate for Payer: BCBS of TX Blue Essentials	$25.48
Rate for Payer: BCBS of TX Medicare	$12.87
Rate for Payer: BCBS of TX PPO	$28.44
Rate for Payer: Cash Price	$84.48
Rate for Payer: Cash Price	$84.48
Rate for Payer: Cigna Medicaid	$12.87
Rate for Payer: Cigna Medicare	$12.87
Rate for Payer: Employer Direct Commercial	$12.87
Rate for Payer: Humana Medicare/TRICARE	$12.87
Rate for Payer: Molina CHIP/Medicaid	$12.87
Rate for Payer: Molina Dual Medicare/Medicaid	$12.87
Rate for Payer: Molina Medicare	$12.87
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	$12.87
Rate for Payer: Scott and White EPO/PPO	$16.09
Rate for Payer: Scott and White Medicare	$12.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.87
Rate for Payer: Superior Health Plan EPO	$12.87
Rate for Payer: Superior Health Plan Medicare	$12.87
Rate for Payer: Universal American Dual Medicare/Medicaid	$12.87
Rate for Payer: Universal American Medicare	$12.87
Rate for Payer: Wellcare Medicare	$12.87
Rate for Payer: Wellmed Medicare	$12.87

Calculi, Urinary SO

Facility

$96.00

Service Code	CPT 82360
Hospital Charge Code	1630026
Hospital Revenue Code	301
Rate for Payer: Cash Price	$84.48

Calprotectin, Fecal SO

Facility

$338.00

Service Code	CPT 83993
Hospital Charge Code	1740932
Hospital Revenue Code	301
Rate for Payer: Cash Price	$297.44

Calprotectin, Fecal SO

Facility

$338.00

Service Code	CPT 83993
Hospital Charge Code	1740932
Hospital Revenue Code	301
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$219.70
Rate for Payer: Aetna Commercial	$20.62
Rate for Payer: Aetna Medicare	$29.44
Rate for Payer: Amerigroup CHIP/Medicaid	$7.66
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$19.63
Rate for Payer: Amerigroup Medicare	$19.63
Rate for Payer: BCBS of TX Blue Advantage	$32.39
Rate for Payer: BCBS of TX Blue Essentials	$38.87
Rate for Payer: BCBS of TX Medicare	$19.63
Rate for Payer: BCBS of TX PPO	$43.38
Rate for Payer: Cash Price	$297.44
Rate for Payer: Cash Price	$297.44
Rate for Payer: Cigna Medicaid	$19.63
Rate for Payer: Cigna Medicare	$19.63
Rate for Payer: Employer Direct Commercial	$19.63
Rate for Payer: Humana Medicare/TRICARE	$19.63
Rate for Payer: Molina CHIP/Medicaid	$19.63
Rate for Payer: Molina Dual Medicare/Medicaid	$19.63
Rate for Payer: Molina Medicare	$19.63
Rate for Payer: Multiplan Auto	$219.70
Rate for Payer: Multiplan Commercial	$219.70
Rate for Payer: Multiplan Workers Comp	$219.70
Rate for Payer: Parkland Medicaid	$19.63
Rate for Payer: Scott and White EPO/PPO	$24.54
Rate for Payer: Scott and White Medicare	$19.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$19.63
Rate for Payer: Superior Health Plan EPO	$19.63
Rate for Payer: Superior Health Plan Medicare	$19.63
Rate for Payer: Universal American Dual Medicare/Medicaid	$19.63
Rate for Payer: Universal American Medicare	$19.63
Rate for Payer: Wellcare Medicare	$19.63
Rate for Payer: Wellmed Medicare	$19.63

CANCELLOUS BONE CHIPS 30CC

Facility

$15,060.24

Service Code	HCPCS C1713
Hospital Charge Code	8394473
Hospital Revenue Code	278
Min. Negotiated Rate	$3,765.06
Max. Negotiated Rate	$7,530.12
Rate for Payer: Aetna Commercial	$4,518.07
Rate for Payer: Cash Price	$13,253.01
Rate for Payer: Cigna Commercial	$3,765.06
Rate for Payer: Multiplan Auto	$7,530.12
Rate for Payer: Multiplan Commercial	$7,530.12
Rate for Payer: Multiplan Workers Comp	$7,530.12
Rate for Payer: Scott and White EPO/PPO	$7,530.12

Know your out-of-pocket cost for care.

All Charges