White Rock Medical Center

All Charges

Charge

Type

Setting

Price

calcitriol 0.25 mcg Cap

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77431842
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

calcitriol 0.25 mcg Cap

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77431842
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$5.51
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.29
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: Cigna Medicaid	$5.51
Rate for Payer: Molina CHIP/Medicaid	$5.51
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: Parkland Medicaid	$5.51
Rate for Payer: Scott and White EPO/PPO	$3.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.51
Rate for Payer: Superior Health Plan EPO	$1.04

Calcitriol(1,25 di-OH Vit D) SO

Facility

$454.00

Service Code	HCPCS 82652
Hospital Charge Code	1706910
Hospital Revenue Code	301
Rate for Payer: Cash Price	$308.72

Calcitriol(1,25 di-OH Vit D) SO

Facility

$454.00

Service Code	HCPCS 82652
Hospital Charge Code	1706910
Hospital Revenue Code	301
Min. Negotiated Rate	$15.02
Max. Negotiated Rate	$326.88
Rate for Payer: Amerigroup CHIP/Medicaid	$15.02
Rate for Payer: Amerigroup Dual Medicare/Medicaid	$38.50
Rate for Payer: Amerigroup Medicare	$38.50
Rate for Payer: BCBS of TX Blue Advantage	$136.20
Rate for Payer: BCBS of TX Blue Essentials	$163.44
Rate for Payer: BCBS of TX Medicare	$38.50
Rate for Payer: BCBS of TX PPO	$181.60
Rate for Payer: Cash Price	$308.72
Rate for Payer: Cash Price	$308.72
Rate for Payer: Cigna Medicaid	$326.88
Rate for Payer: Cigna Medicare	$38.50
Rate for Payer: Employer Direct Commercial	$38.50
Rate for Payer: Humana Medicare/TRICARE	$38.50
Rate for Payer: Molina CHIP/Medicaid	$326.88
Rate for Payer: Molina Dual Medicare/Medicaid	$38.50
Rate for Payer: Molina Medicare	$38.50
Rate for Payer: Multiplan Auto	$295.10
Rate for Payer: Multiplan Commercial	$295.10
Rate for Payer: Multiplan Workers Comp	$295.10
Rate for Payer: Parkland Medicaid	$326.88
Rate for Payer: Scott and White EPO/PPO	$48.12
Rate for Payer: Scott and White Medicare	$38.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$326.88
Rate for Payer: Superior Health Plan EPO	$38.50
Rate for Payer: Superior Health Plan Medicare	$38.50
Rate for Payer: Universal American Dual Medicare/Medicaid	$38.50
Rate for Payer: Universal American Medicare	$38.50
Rate for Payer: Wellcare Medicare	$38.50
Rate for Payer: Wellmed Medicare	$38.50

calcium acetate 667 mg Cap

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77433217
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

calcium acetate 667 mg Cap

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77433217
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$5.51
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.29
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: Cigna Medicaid	$5.51
Rate for Payer: Molina CHIP/Medicaid	$5.51
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: Parkland Medicaid	$5.51
Rate for Payer: Scott and White EPO/PPO	$3.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.51
Rate for Payer: Superior Health Plan EPO	$1.04

calcium acetate 667 mg Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77433268
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$5.51
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.29
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: Cigna Medicaid	$5.51
Rate for Payer: Molina CHIP/Medicaid	$5.51
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: Parkland Medicaid	$5.51
Rate for Payer: Scott and White EPO/PPO	$3.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.51
Rate for Payer: Superior Health Plan EPO	$1.04

calcium acetate 667 mg Tab

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77433268
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	$5.51
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.29
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: Cigna Medicaid	$5.51
Rate for Payer: Molina CHIP/Medicaid	$5.51
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: Parkland Medicaid	$5.51
Rate for Payer: Scott and White EPO/PPO	$3.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.51
Rate for Payer: Superior Health Plan EPO	$1.04

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 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	$5.51
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.29
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: Cigna Medicaid	$5.51
Rate for Payer: Molina CHIP/Medicaid	$5.51
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: Parkland Medicaid	$5.51
Rate for Payer: Scott and White EPO/PPO	$3.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.51
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

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77433943
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$5.51
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: BCBS of TX Blue Advantage	$2.29
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: Cigna Medicaid	$5.51
Rate for Payer: Molina CHIP/Medicaid	$5.51
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: Parkland Medicaid	$5.51
Rate for Payer: Scott and White EPO/PPO	$3.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.51
Rate for Payer: Superior Health Plan EPO	$1.04

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

Facility

$7.65

Service Code	HCPCS J3490
Hospital Charge Code	77433943
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5.20

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 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	$92.28
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: Cigna Medicaid	$92.28
Rate for Payer: Molina CHIP/Medicaid	$92.28
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: Parkland Medicaid	$92.28
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$92.28
Rate for Payer: Superior Health Plan EPO	$17.43

calcium chloride solution

Facility

$6.23

Hospital Charge Code	993564
Hospital Revenue Code	270
Rate for Payer: Cash Price	$4.24

calcium chloride solution

Facility

$6.23

Hospital Charge Code	993564
Hospital Revenue Code	270
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$4.49
Rate for Payer: Amerigroup CHIP/Medicaid	$0.56
Rate for Payer: BCBS of TX Blue Advantage	$1.87
Rate for Payer: BCBS of TX Blue Essentials	$2.24
Rate for Payer: BCBS of TX PPO	$2.49
Rate for Payer: Cash Price	$4.24
Rate for Payer: Cigna Medicaid	$4.49
Rate for Payer: Molina CHIP/Medicaid	$4.49
Rate for Payer: Multiplan Auto	$4.05
Rate for Payer: Multiplan Commercial	$4.05
Rate for Payer: Multiplan Workers Comp	$4.05
Rate for Payer: Parkland Medicaid	$4.49
Rate for Payer: Scott and White EPO/PPO	$3.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.49
Rate for Payer: Superior Health Plan EPO	$0.85

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

Facility

$128.17

Service Code	HCPCS J0612
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 J0612
Hospital Charge Code	79364704
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$92.28
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$0.07
Rate for Payer: BCBS of TX Blue Essentials	$0.09
Rate for Payer: BCBS of TX PPO	$0.10
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cigna Medicaid	$92.28
Rate for Payer: Molina CHIP/Medicaid	$92.28
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: Parkland Medicaid	$92.28
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$92.28
Rate for Payer: Superior Health Plan EPO	$17.43

calcium gluconate 100 mg/mL Inj Soln 10 mL

Facility

$128.17

Service Code	HCPCS J0612
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 J0612
Hospital Charge Code	7443109
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$92.28
Rate for Payer: Amerigroup CHIP/Medicaid	$11.54
Rate for Payer: BCBS of TX Blue Advantage	$0.07
Rate for Payer: BCBS of TX Blue Essentials	$0.09
Rate for Payer: BCBS of TX PPO	$0.10
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cash Price	$87.16
Rate for Payer: Cigna Medicaid	$92.28
Rate for Payer: Molina CHIP/Medicaid	$92.28
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: Parkland Medicaid	$92.28
Rate for Payer: Scott and White EPO/PPO	$64.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$92.28
Rate for Payer: Superior Health Plan EPO	$17.43

Calcium, Ionized, Serum SO

Facility

$360.00

Service Code	HCPCS 82330
Hospital Charge Code	1701291
Hospital Revenue Code	301
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$259.20
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	$108.00
Rate for Payer: BCBS of TX Blue Essentials	$129.60
Rate for Payer: BCBS of TX Medicare	$13.68
Rate for Payer: BCBS of TX PPO	$144.00
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cigna Medicaid	$259.20
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	$259.20
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	$259.20
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	$259.20
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	HCPCS 82330
Hospital Charge Code	1701291
Hospital Revenue Code	301
Rate for Payer: Cash Price	$244.80

Calcium Level Total

Facility

$234.00

Service Code	HCPCS 82310
Hospital Charge Code	1601673
Hospital Revenue Code	301
Rate for Payer: Cash Price	$159.12

Know your out-of-pocket cost for care.

All Charges