White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 0051: TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE

Facility

$8.85

Service Code	APR-DRG 0051
Hospital Charge Code	APRDRG 0051
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Amerigroup CHIP/Medicaid	$8.85
Rate for Payer: Cigna Medicaid	$8.85
Rate for Payer: Molina CHIP/Medicaid	$8.85
Rate for Payer: Parkland Medicaid	$8.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.85

INPATIENT APRDRG 0052: TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE

Facility

$10.84

Service Code	APR-DRG 0052
Hospital Charge Code	APRDRG 0052
Min. Negotiated Rate	$10.84
Max. Negotiated Rate	$10.84
Rate for Payer: Amerigroup CHIP/Medicaid	$10.84
Rate for Payer: Cigna Medicaid	$10.84
Rate for Payer: Molina CHIP/Medicaid	$10.84
Rate for Payer: Parkland Medicaid	$10.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10.84

INPATIENT APRDRG 0053: TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE

Facility

$11.87

Service Code	APR-DRG 0053
Hospital Charge Code	APRDRG 0053
Min. Negotiated Rate	$11.87
Max. Negotiated Rate	$11.87
Rate for Payer: Amerigroup CHIP/Medicaid	$11.87
Rate for Payer: Cigna Medicaid	$11.87
Rate for Payer: Molina CHIP/Medicaid	$11.87
Rate for Payer: Parkland Medicaid	$11.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11.87

INPATIENT APRDRG 0054: TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE

Facility

$16.47

Service Code	APR-DRG 0054
Hospital Charge Code	APRDRG 0054
Min. Negotiated Rate	$16.47
Max. Negotiated Rate	$16.47
Rate for Payer: Amerigroup CHIP/Medicaid	$16.47
Rate for Payer: Cigna Medicaid	$16.47
Rate for Payer: Molina CHIP/Medicaid	$16.47
Rate for Payer: Parkland Medicaid	$16.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16.47

INPATIENT APRDRG 0061: PANCREAS TRANSPLANT

Facility

$11.70

Service Code	APR-DRG 0061
Hospital Charge Code	APRDRG 0061
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Amerigroup CHIP/Medicaid	$11.70
Rate for Payer: Cigna Medicaid	$11.70
Rate for Payer: Molina CHIP/Medicaid	$11.70
Rate for Payer: Parkland Medicaid	$11.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11.70

INPATIENT APRDRG 0062: PANCREAS TRANSPLANT

Facility

$11.86

Service Code	APR-DRG 0062
Hospital Charge Code	APRDRG 0062
Min. Negotiated Rate	$11.86
Max. Negotiated Rate	$11.86
Rate for Payer: Amerigroup CHIP/Medicaid	$11.86
Rate for Payer: Cigna Medicaid	$11.86
Rate for Payer: Molina CHIP/Medicaid	$11.86
Rate for Payer: Parkland Medicaid	$11.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11.86

INPATIENT APRDRG 0063: PANCREAS TRANSPLANT

Facility

$13.11

Service Code	APR-DRG 0063
Hospital Charge Code	APRDRG 0063
Min. Negotiated Rate	$13.11
Max. Negotiated Rate	$13.11
Rate for Payer: Amerigroup CHIP/Medicaid	$13.11
Rate for Payer: Cigna Medicaid	$13.11
Rate for Payer: Molina CHIP/Medicaid	$13.11
Rate for Payer: Parkland Medicaid	$13.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.11

INPATIENT APRDRG 0064: PANCREAS TRANSPLANT

Facility

$20.29

Service Code	APR-DRG 0064
Hospital Charge Code	APRDRG 0064
Min. Negotiated Rate	$20.29
Max. Negotiated Rate	$20.29
Rate for Payer: Amerigroup CHIP/Medicaid	$20.29
Rate for Payer: Cigna Medicaid	$20.29
Rate for Payer: Molina CHIP/Medicaid	$20.29
Rate for Payer: Parkland Medicaid	$20.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$20.29

INPATIENT APRDRG 0071: ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$11.50

Service Code	APR-DRG 0071
Hospital Charge Code	APRDRG 0071
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$11.50
Rate for Payer: Amerigroup CHIP/Medicaid	$11.50
Rate for Payer: Cigna Medicaid	$11.50
Rate for Payer: Molina CHIP/Medicaid	$11.50
Rate for Payer: Parkland Medicaid	$11.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11.50

INPATIENT APRDRG 0072: ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$17.52

Service Code	APR-DRG 0072
Hospital Charge Code	APRDRG 0072
Min. Negotiated Rate	$17.52
Max. Negotiated Rate	$17.52
Rate for Payer: Amerigroup CHIP/Medicaid	$17.52
Rate for Payer: Cigna Medicaid	$17.52
Rate for Payer: Molina CHIP/Medicaid	$17.52
Rate for Payer: Parkland Medicaid	$17.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.52

INPATIENT APRDRG 0073: ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$26.07

Service Code	APR-DRG 0073
Hospital Charge Code	APRDRG 0073
Min. Negotiated Rate	$26.07
Max. Negotiated Rate	$26.07
Rate for Payer: Amerigroup CHIP/Medicaid	$26.07
Rate for Payer: Cigna Medicaid	$26.07
Rate for Payer: Molina CHIP/Medicaid	$26.07
Rate for Payer: Parkland Medicaid	$26.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$26.07

INPATIENT APRDRG 0074: ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$73.89

Service Code	APR-DRG 0074
Hospital Charge Code	APRDRG 0074
Min. Negotiated Rate	$73.89
Max. Negotiated Rate	$73.89
Rate for Payer: Amerigroup CHIP/Medicaid	$73.89
Rate for Payer: Cigna Medicaid	$73.89
Rate for Payer: Molina CHIP/Medicaid	$73.89
Rate for Payer: Parkland Medicaid	$73.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$73.89

INPATIENT APRDRG 0081: AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$6.50

Service Code	APR-DRG 0081
Hospital Charge Code	APRDRG 0081
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$6.50
Rate for Payer: Amerigroup CHIP/Medicaid	$6.50
Rate for Payer: Cigna Medicaid	$6.50
Rate for Payer: Molina CHIP/Medicaid	$6.50
Rate for Payer: Parkland Medicaid	$6.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.50

INPATIENT APRDRG 0082: AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$7.77

Service Code	APR-DRG 0082
Hospital Charge Code	APRDRG 0082
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$7.77
Rate for Payer: Amerigroup CHIP/Medicaid	$7.77
Rate for Payer: Cigna Medicaid	$7.77
Rate for Payer: Molina CHIP/Medicaid	$7.77
Rate for Payer: Parkland Medicaid	$7.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.77

INPATIENT APRDRG 0083: AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$14.92

Service Code	APR-DRG 0083
Hospital Charge Code	APRDRG 0083
Min. Negotiated Rate	$14.92
Max. Negotiated Rate	$14.92
Rate for Payer: Amerigroup CHIP/Medicaid	$14.92
Rate for Payer: Cigna Medicaid	$14.92
Rate for Payer: Molina CHIP/Medicaid	$14.92
Rate for Payer: Parkland Medicaid	$14.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14.92

INPATIENT APRDRG 0084: AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$22.07

Service Code	APR-DRG 0084
Hospital Charge Code	APRDRG 0084
Min. Negotiated Rate	$22.07
Max. Negotiated Rate	$22.07
Rate for Payer: Amerigroup CHIP/Medicaid	$22.07
Rate for Payer: Cigna Medicaid	$22.07
Rate for Payer: Molina CHIP/Medicaid	$22.07
Rate for Payer: Parkland Medicaid	$22.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$22.07

INPATIENT APRDRG 0091: EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$13.71

Service Code	APR-DRG 0091
Hospital Charge Code	APRDRG 0091
Min. Negotiated Rate	$13.71
Max. Negotiated Rate	$13.71
Rate for Payer: Amerigroup CHIP/Medicaid	$13.71
Rate for Payer: Cigna Medicaid	$13.71
Rate for Payer: Molina CHIP/Medicaid	$13.71
Rate for Payer: Parkland Medicaid	$13.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.71

INPATIENT APRDRG 0092: EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$14.13

Service Code	APR-DRG 0092
Hospital Charge Code	APRDRG 0092
Min. Negotiated Rate	$14.13
Max. Negotiated Rate	$14.13
Rate for Payer: Amerigroup CHIP/Medicaid	$14.13
Rate for Payer: Cigna Medicaid	$14.13
Rate for Payer: Molina CHIP/Medicaid	$14.13
Rate for Payer: Parkland Medicaid	$14.13
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14.13

INPATIENT APRDRG 0093: EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$21.49

Service Code	APR-DRG 0093
Hospital Charge Code	APRDRG 0093
Min. Negotiated Rate	$21.49
Max. Negotiated Rate	$21.49
Rate for Payer: Amerigroup CHIP/Medicaid	$21.49
Rate for Payer: Cigna Medicaid	$21.49
Rate for Payer: Molina CHIP/Medicaid	$21.49
Rate for Payer: Parkland Medicaid	$21.49
Rate for Payer: Superior Health Plan CHIP/Medicaid	$21.49

INPATIENT APRDRG 0094: EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$43.74

Service Code	APR-DRG 0094
Hospital Charge Code	APRDRG 0094
Min. Negotiated Rate	$43.74
Max. Negotiated Rate	$43.74
Rate for Payer: Amerigroup CHIP/Medicaid	$43.74
Rate for Payer: Cigna Medicaid	$43.74
Rate for Payer: Molina CHIP/Medicaid	$43.74
Rate for Payer: Parkland Medicaid	$43.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$43.74

INPATIENT APRDRG 0111: CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES

Facility

$6.83

Service Code	APR-DRG 0111
Hospital Charge Code	APRDRG 0111
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$6.83
Rate for Payer: Amerigroup CHIP/Medicaid	$6.83
Rate for Payer: Cigna Medicaid	$6.83
Rate for Payer: Molina CHIP/Medicaid	$6.83
Rate for Payer: Parkland Medicaid	$6.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.83

INPATIENT APRDRG 0112: CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES

Facility

$12.02

Service Code	APR-DRG 0112
Hospital Charge Code	APRDRG 0112
Min. Negotiated Rate	$12.02
Max. Negotiated Rate	$12.02
Rate for Payer: Amerigroup CHIP/Medicaid	$12.02
Rate for Payer: Cigna Medicaid	$12.02
Rate for Payer: Molina CHIP/Medicaid	$12.02
Rate for Payer: Parkland Medicaid	$12.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.02

INPATIENT APRDRG 0113: CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES

Facility

$17.29

Service Code	APR-DRG 0113
Hospital Charge Code	APRDRG 0113
Min. Negotiated Rate	$17.29
Max. Negotiated Rate	$17.29
Rate for Payer: Amerigroup CHIP/Medicaid	$17.29
Rate for Payer: Cigna Medicaid	$17.29
Rate for Payer: Molina CHIP/Medicaid	$17.29
Rate for Payer: Parkland Medicaid	$17.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.29

INPATIENT APRDRG 0114: CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES

Facility

$30.43

Service Code	APR-DRG 0114
Hospital Charge Code	APRDRG 0114
Min. Negotiated Rate	$30.43
Max. Negotiated Rate	$30.43
Rate for Payer: Amerigroup CHIP/Medicaid	$30.43
Rate for Payer: Cigna Medicaid	$30.43
Rate for Payer: Molina CHIP/Medicaid	$30.43
Rate for Payer: Parkland Medicaid	$30.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$30.43

INPATIENT APRDRG 0201: CRANIOTOMY FOR TRAUMA

Facility

$2.63

Service Code	APR-DRG 0201
Hospital Charge Code	APRDRG 0201
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$2.63
Rate for Payer: Amerigroup CHIP/Medicaid	$2.63
Rate for Payer: Cigna Medicaid	$2.63
Rate for Payer: Molina CHIP/Medicaid	$2.63
Rate for Payer: Parkland Medicaid	$2.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.63

Know your out-of-pocket cost for care.

All Charges