White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 0893: MAJOR CRANIAL/FACIAL BONE PROCEDURES

Facility

$5.27

Service Code	APR-DRG 0893
Hospital Charge Code	APRDRG 0893
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$5.27
Rate for Payer: Amerigroup CHIP/Medicaid	$5.27
Rate for Payer: Cigna Medicaid	$5.27
Rate for Payer: Molina CHIP/Medicaid	$5.27
Rate for Payer: Parkland Medicaid	$5.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.27

INPATIENT APRDRG 0894: MAJOR CRANIAL/FACIAL BONE PROCEDURES

Facility

$9.91

Service Code	APR-DRG 0894
Hospital Charge Code	APRDRG 0894
Min. Negotiated Rate	$9.91
Max. Negotiated Rate	$9.91
Rate for Payer: Amerigroup CHIP/Medicaid	$9.91
Rate for Payer: Cigna Medicaid	$9.91
Rate for Payer: Molina CHIP/Medicaid	$9.91
Rate for Payer: Parkland Medicaid	$9.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.91

INPATIENT APRDRG 0911: OTHER MAJOR HEAD & NECK PROCEDURES

Facility

$1.36

Service Code	APR-DRG 0911
Hospital Charge Code	APRDRG 0911
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$1.36
Rate for Payer: Amerigroup CHIP/Medicaid	$1.36
Rate for Payer: Cigna Medicaid	$1.36
Rate for Payer: Molina CHIP/Medicaid	$1.36
Rate for Payer: Parkland Medicaid	$1.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.36

INPATIENT APRDRG 0912: OTHER MAJOR HEAD & NECK PROCEDURES

Facility

$2.92

Service Code	APR-DRG 0912
Hospital Charge Code	APRDRG 0912
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$2.92
Rate for Payer: Amerigroup CHIP/Medicaid	$2.92
Rate for Payer: Cigna Medicaid	$2.92
Rate for Payer: Molina CHIP/Medicaid	$2.92
Rate for Payer: Parkland Medicaid	$2.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.92

INPATIENT APRDRG 0913: OTHER MAJOR HEAD & NECK PROCEDURES

Facility

$6.46

Service Code	APR-DRG 0913
Hospital Charge Code	APRDRG 0913
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$6.46
Rate for Payer: Amerigroup CHIP/Medicaid	$6.46
Rate for Payer: Cigna Medicaid	$6.46
Rate for Payer: Molina CHIP/Medicaid	$6.46
Rate for Payer: Parkland Medicaid	$6.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.46

INPATIENT APRDRG 0914: OTHER MAJOR HEAD & NECK PROCEDURES

Facility

$9.00

Service Code	APR-DRG 0914
Hospital Charge Code	APRDRG 0914
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Amerigroup CHIP/Medicaid	$9.00
Rate for Payer: Cigna Medicaid	$9.00
Rate for Payer: Molina CHIP/Medicaid	$9.00
Rate for Payer: Parkland Medicaid	$9.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.00

INPATIENT APRDRG 0921: FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES

Facility

$2.03

Service Code	APR-DRG 0921
Hospital Charge Code	APRDRG 0921
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$2.03
Rate for Payer: Amerigroup CHIP/Medicaid	$2.03
Rate for Payer: Cigna Medicaid	$2.03
Rate for Payer: Molina CHIP/Medicaid	$2.03
Rate for Payer: Parkland Medicaid	$2.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.03

INPATIENT APRDRG 0922: FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES

Facility

$2.39

Service Code	APR-DRG 0922
Hospital Charge Code	APRDRG 0922
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$2.39
Rate for Payer: Amerigroup CHIP/Medicaid	$2.39
Rate for Payer: Cigna Medicaid	$2.39
Rate for Payer: Molina CHIP/Medicaid	$2.39
Rate for Payer: Parkland Medicaid	$2.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.39

INPATIENT APRDRG 0923: FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES

Facility

$7.36

Service Code	APR-DRG 0923
Hospital Charge Code	APRDRG 0923
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$7.36
Rate for Payer: Amerigroup CHIP/Medicaid	$7.36
Rate for Payer: Cigna Medicaid	$7.36
Rate for Payer: Molina CHIP/Medicaid	$7.36
Rate for Payer: Parkland Medicaid	$7.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.36

INPATIENT APRDRG 0924: FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES

Facility

$7.63

Service Code	APR-DRG 0924
Hospital Charge Code	APRDRG 0924
Min. Negotiated Rate	$7.63
Max. Negotiated Rate	$7.63
Rate for Payer: Amerigroup CHIP/Medicaid	$7.63
Rate for Payer: Cigna Medicaid	$7.63
Rate for Payer: Molina CHIP/Medicaid	$7.63
Rate for Payer: Parkland Medicaid	$7.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.63

INPATIENT APRDRG 0951: CLEFT LIP & PALATE REPAIR

Facility

$1.16

Service Code	APR-DRG 0951
Hospital Charge Code	APRDRG 0951
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Amerigroup CHIP/Medicaid	$1.16
Rate for Payer: Cigna Medicaid	$1.16
Rate for Payer: Molina CHIP/Medicaid	$1.16
Rate for Payer: Parkland Medicaid	$1.16
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.16

INPATIENT APRDRG 0952: CLEFT LIP & PALATE REPAIR

Facility

$1.69

Service Code	APR-DRG 0952
Hospital Charge Code	APRDRG 0952
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Amerigroup CHIP/Medicaid	$1.69
Rate for Payer: Cigna Medicaid	$1.69
Rate for Payer: Molina CHIP/Medicaid	$1.69
Rate for Payer: Parkland Medicaid	$1.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.69

INPATIENT APRDRG 0953: CLEFT LIP & PALATE REPAIR

Facility

$2.39

Service Code	APR-DRG 0953
Hospital Charge Code	APRDRG 0953
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$2.39
Rate for Payer: Amerigroup CHIP/Medicaid	$2.39
Rate for Payer: Cigna Medicaid	$2.39
Rate for Payer: Molina CHIP/Medicaid	$2.39
Rate for Payer: Parkland Medicaid	$2.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.39

INPATIENT APRDRG 0954: CLEFT LIP & PALATE REPAIR

Facility

$4.73

Service Code	APR-DRG 0954
Hospital Charge Code	APRDRG 0954
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$4.73
Rate for Payer: Amerigroup CHIP/Medicaid	$4.73
Rate for Payer: Cigna Medicaid	$4.73
Rate for Payer: Molina CHIP/Medicaid	$4.73
Rate for Payer: Parkland Medicaid	$4.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.73

INPATIENT APRDRG 0971: TONSIL & ADENOID PROCEDURES

Facility

$0.90

Service Code	APR-DRG 0971
Hospital Charge Code	APRDRG 0971
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Amerigroup CHIP/Medicaid	$0.90
Rate for Payer: Cigna Medicaid	$0.90
Rate for Payer: Molina CHIP/Medicaid	$0.90
Rate for Payer: Parkland Medicaid	$0.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.90

INPATIENT APRDRG 0972: TONSIL & ADENOID PROCEDURES

Facility

$1.27

Service Code	APR-DRG 0972
Hospital Charge Code	APRDRG 0972
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$1.27
Rate for Payer: Amerigroup CHIP/Medicaid	$1.27
Rate for Payer: Cigna Medicaid	$1.27
Rate for Payer: Molina CHIP/Medicaid	$1.27
Rate for Payer: Parkland Medicaid	$1.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.27

INPATIENT APRDRG 0973: TONSIL & ADENOID PROCEDURES

Facility

$1.70

Service Code	APR-DRG 0973
Hospital Charge Code	APRDRG 0973
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.70
Rate for Payer: Amerigroup CHIP/Medicaid	$1.70
Rate for Payer: Cigna Medicaid	$1.70
Rate for Payer: Molina CHIP/Medicaid	$1.70
Rate for Payer: Parkland Medicaid	$1.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.70

INPATIENT APRDRG 0974: TONSIL & ADENOID PROCEDURES

Facility

$3.92

Service Code	APR-DRG 0974
Hospital Charge Code	APRDRG 0974
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$3.92
Rate for Payer: Amerigroup CHIP/Medicaid	$3.92
Rate for Payer: Cigna Medicaid	$3.92
Rate for Payer: Molina CHIP/Medicaid	$3.92
Rate for Payer: Parkland Medicaid	$3.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.92

INPATIENT APRDRG 0981: OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

Facility

$1.42

Service Code	APR-DRG 0981
Hospital Charge Code	APRDRG 0981
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$1.42
Rate for Payer: Amerigroup CHIP/Medicaid	$1.42
Rate for Payer: Cigna Medicaid	$1.42
Rate for Payer: Molina CHIP/Medicaid	$1.42
Rate for Payer: Parkland Medicaid	$1.42
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.42

INPATIENT APRDRG 0982: OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

Facility

$2.00

Service Code	APR-DRG 0982
Hospital Charge Code	APRDRG 0982
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Amerigroup CHIP/Medicaid	$2.00
Rate for Payer: Cigna Medicaid	$2.00
Rate for Payer: Molina CHIP/Medicaid	$2.00
Rate for Payer: Parkland Medicaid	$2.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.00

INPATIENT APRDRG 0983: OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

Facility

$3.46

Service Code	APR-DRG 0983
Hospital Charge Code	APRDRG 0983
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$3.46
Rate for Payer: Amerigroup CHIP/Medicaid	$3.46
Rate for Payer: Cigna Medicaid	$3.46
Rate for Payer: Molina CHIP/Medicaid	$3.46
Rate for Payer: Parkland Medicaid	$3.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.46

INPATIENT APRDRG 0984: OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

Facility

$6.44

Service Code	APR-DRG 0984
Hospital Charge Code	APRDRG 0984
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$6.44
Rate for Payer: Amerigroup CHIP/Medicaid	$6.44
Rate for Payer: Cigna Medicaid	$6.44
Rate for Payer: Molina CHIP/Medicaid	$6.44
Rate for Payer: Parkland Medicaid	$6.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.44

INPATIENT APRDRG 1101: EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES

Facility

$0.86

Service Code	APR-DRG 1101
Hospital Charge Code	APRDRG 1101
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Amerigroup CHIP/Medicaid	$0.86
Rate for Payer: Cigna Medicaid	$0.86
Rate for Payer: Molina CHIP/Medicaid	$0.86
Rate for Payer: Parkland Medicaid	$0.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.86

INPATIENT APRDRG 1102: EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES

Facility

$1.37

Service Code	APR-DRG 1102
Hospital Charge Code	APRDRG 1102
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$1.37
Rate for Payer: Amerigroup CHIP/Medicaid	$1.37
Rate for Payer: Cigna Medicaid	$1.37
Rate for Payer: Molina CHIP/Medicaid	$1.37
Rate for Payer: Parkland Medicaid	$1.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.37

INPATIENT APRDRG 1103: EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES

Facility

$1.48

Service Code	APR-DRG 1103
Hospital Charge Code	APRDRG 1103
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$1.48
Rate for Payer: Amerigroup CHIP/Medicaid	$1.48
Rate for Payer: Cigna Medicaid	$1.48
Rate for Payer: Molina CHIP/Medicaid	$1.48
Rate for Payer: Parkland Medicaid	$1.48
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.48

Know your out-of-pocket cost for care.

All Charges