White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 1624: CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX

Facility

$18.90

Service Code	APR-DRG 1624
Hospital Charge Code	APRDRG 1624
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Amerigroup CHIP/Medicaid	$18.90
Rate for Payer: Cigna Medicaid	$18.90
Rate for Payer: Molina CHIP/Medicaid	$18.90
Rate for Payer: Parkland Medicaid	$18.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18.90

INPATIENT APRDRG 1631: CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX

Facility

$4.50

Service Code	APR-DRG 1631
Hospital Charge Code	APRDRG 1631
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Amerigroup CHIP/Medicaid	$4.50
Rate for Payer: Cigna Medicaid	$4.50
Rate for Payer: Molina CHIP/Medicaid	$4.50
Rate for Payer: Parkland Medicaid	$4.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.50

INPATIENT APRDRG 1632: CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX

Facility

$5.59

Service Code	APR-DRG 1632
Hospital Charge Code	APRDRG 1632
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$5.59
Rate for Payer: Amerigroup CHIP/Medicaid	$5.59
Rate for Payer: Cigna Medicaid	$5.59
Rate for Payer: Molina CHIP/Medicaid	$5.59
Rate for Payer: Parkland Medicaid	$5.59
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.59

INPATIENT APRDRG 1633: CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX

Facility

$7.54

Service Code	APR-DRG 1633
Hospital Charge Code	APRDRG 1633
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$7.54
Rate for Payer: Amerigroup CHIP/Medicaid	$7.54
Rate for Payer: Cigna Medicaid	$7.54
Rate for Payer: Molina CHIP/Medicaid	$7.54
Rate for Payer: Parkland Medicaid	$7.54
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.54

INPATIENT APRDRG 1634: CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX

Facility

$11.27

Service Code	APR-DRG 1634
Hospital Charge Code	APRDRG 1634
Min. Negotiated Rate	$11.27
Max. Negotiated Rate	$11.27
Rate for Payer: Amerigroup CHIP/Medicaid	$11.27
Rate for Payer: Cigna Medicaid	$11.27
Rate for Payer: Molina CHIP/Medicaid	$11.27
Rate for Payer: Parkland Medicaid	$11.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11.27

INPATIENT APRDRG 1651: CORONARY BYPASS W AMI OR COMPLEX PDX

Facility

$4.51

Service Code	APR-DRG 1651
Hospital Charge Code	APRDRG 1651
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Amerigroup CHIP/Medicaid	$4.51
Rate for Payer: Cigna Medicaid	$4.51
Rate for Payer: Molina CHIP/Medicaid	$4.51
Rate for Payer: Parkland Medicaid	$4.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.51

INPATIENT APRDRG 1652: CORONARY BYPASS W AMI OR COMPLEX PDX

Facility

$5.28

Service Code	APR-DRG 1652
Hospital Charge Code	APRDRG 1652
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$5.28
Rate for Payer: Amerigroup CHIP/Medicaid	$5.28
Rate for Payer: Cigna Medicaid	$5.28
Rate for Payer: Molina CHIP/Medicaid	$5.28
Rate for Payer: Parkland Medicaid	$5.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.28

INPATIENT APRDRG 1653: CORONARY BYPASS W AMI OR COMPLEX PDX

Facility

$6.41

Service Code	APR-DRG 1653
Hospital Charge Code	APRDRG 1653
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$6.41
Rate for Payer: Amerigroup CHIP/Medicaid	$6.41
Rate for Payer: Cigna Medicaid	$6.41
Rate for Payer: Molina CHIP/Medicaid	$6.41
Rate for Payer: Parkland Medicaid	$6.41
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.41

INPATIENT APRDRG 1654: CORONARY BYPASS W AMI OR COMPLEX PDX

Facility

$9.74

Service Code	APR-DRG 1654
Hospital Charge Code	APRDRG 1654
Min. Negotiated Rate	$9.74
Max. Negotiated Rate	$9.74
Rate for Payer: Amerigroup CHIP/Medicaid	$9.74
Rate for Payer: Cigna Medicaid	$9.74
Rate for Payer: Molina CHIP/Medicaid	$9.74
Rate for Payer: Parkland Medicaid	$9.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.74

INPATIENT APRDRG 1661: CORONARY BYPASS W/O AMI OR COMPLEX PDX

Facility

$3.79

Service Code	APR-DRG 1661
Hospital Charge Code	APRDRG 1661
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$3.79
Rate for Payer: Amerigroup CHIP/Medicaid	$3.79
Rate for Payer: Cigna Medicaid	$3.79
Rate for Payer: Molina CHIP/Medicaid	$3.79
Rate for Payer: Parkland Medicaid	$3.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.79

INPATIENT APRDRG 1662: CORONARY BYPASS W/O AMI OR COMPLEX PDX

Facility

$4.18

Service Code	APR-DRG 1662
Hospital Charge Code	APRDRG 1662
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$4.18
Rate for Payer: Amerigroup CHIP/Medicaid	$4.18
Rate for Payer: Cigna Medicaid	$4.18
Rate for Payer: Molina CHIP/Medicaid	$4.18
Rate for Payer: Parkland Medicaid	$4.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.18

INPATIENT APRDRG 1663: CORONARY BYPASS W/O AMI OR COMPLEX PDX

Facility

$5.35

Service Code	APR-DRG 1663
Hospital Charge Code	APRDRG 1663
Min. Negotiated Rate	$5.35
Max. Negotiated Rate	$5.35
Rate for Payer: Amerigroup CHIP/Medicaid	$5.35
Rate for Payer: Cigna Medicaid	$5.35
Rate for Payer: Molina CHIP/Medicaid	$5.35
Rate for Payer: Parkland Medicaid	$5.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.35

INPATIENT APRDRG 1664: CORONARY BYPASS W/O AMI OR COMPLEX PDX

Facility

$7.53

Service Code	APR-DRG 1664
Hospital Charge Code	APRDRG 1664
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$7.53
Rate for Payer: Amerigroup CHIP/Medicaid	$7.53
Rate for Payer: Cigna Medicaid	$7.53
Rate for Payer: Molina CHIP/Medicaid	$7.53
Rate for Payer: Parkland Medicaid	$7.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.53

INPATIENT APRDRG 1671: OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES

Facility

$4.01

Service Code	APR-DRG 1671
Hospital Charge Code	APRDRG 1671
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$4.01
Rate for Payer: Amerigroup CHIP/Medicaid	$4.01
Rate for Payer: Cigna Medicaid	$4.01
Rate for Payer: Molina CHIP/Medicaid	$4.01
Rate for Payer: Parkland Medicaid	$4.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.01

INPATIENT APRDRG 1672: OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES

Facility

$4.88

Service Code	APR-DRG 1672
Hospital Charge Code	APRDRG 1672
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$4.88
Rate for Payer: Amerigroup CHIP/Medicaid	$4.88
Rate for Payer: Cigna Medicaid	$4.88
Rate for Payer: Molina CHIP/Medicaid	$4.88
Rate for Payer: Parkland Medicaid	$4.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.88

INPATIENT APRDRG 1673: OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES

Facility

$6.24

Service Code	APR-DRG 1673
Hospital Charge Code	APRDRG 1673
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$6.24
Rate for Payer: Amerigroup CHIP/Medicaid	$6.24
Rate for Payer: Cigna Medicaid	$6.24
Rate for Payer: Molina CHIP/Medicaid	$6.24
Rate for Payer: Parkland Medicaid	$6.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.24

INPATIENT APRDRG 1674: OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES

Facility

$14.36

Service Code	APR-DRG 1674
Hospital Charge Code	APRDRG 1674
Min. Negotiated Rate	$14.36
Max. Negotiated Rate	$14.36
Rate for Payer: Amerigroup CHIP/Medicaid	$14.36
Rate for Payer: Cigna Medicaid	$14.36
Rate for Payer: Molina CHIP/Medicaid	$14.36
Rate for Payer: Parkland Medicaid	$14.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14.36

INPATIENT APRDRG 1691: MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$3.66

Service Code	APR-DRG 1691
Hospital Charge Code	APRDRG 1691
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$3.66
Rate for Payer: Amerigroup CHIP/Medicaid	$3.66
Rate for Payer: Cigna Medicaid	$3.66
Rate for Payer: Molina CHIP/Medicaid	$3.66
Rate for Payer: Parkland Medicaid	$3.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.66

INPATIENT APRDRG 1692: MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$3.67

Service Code	APR-DRG 1692
Hospital Charge Code	APRDRG 1692
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$3.67
Rate for Payer: Amerigroup CHIP/Medicaid	$3.67
Rate for Payer: Cigna Medicaid	$3.67
Rate for Payer: Molina CHIP/Medicaid	$3.67
Rate for Payer: Parkland Medicaid	$3.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.67

INPATIENT APRDRG 1693: MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$5.20

Service Code	APR-DRG 1693
Hospital Charge Code	APRDRG 1693
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$5.20
Rate for Payer: Amerigroup CHIP/Medicaid	$5.20
Rate for Payer: Cigna Medicaid	$5.20
Rate for Payer: Molina CHIP/Medicaid	$5.20
Rate for Payer: Parkland Medicaid	$5.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.20

INPATIENT APRDRG 1694: MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$10.09

Service Code	APR-DRG 1694
Hospital Charge Code	APRDRG 1694
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$10.09
Rate for Payer: Amerigroup CHIP/Medicaid	$10.09
Rate for Payer: Cigna Medicaid	$10.09
Rate for Payer: Molina CHIP/Medicaid	$10.09
Rate for Payer: Parkland Medicaid	$10.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10.09

INPATIENT APRDRG 1701: PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK

Facility

$2.91

Service Code	APR-DRG 1701
Hospital Charge Code	APRDRG 1701
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$2.91
Rate for Payer: Amerigroup CHIP/Medicaid	$2.91
Rate for Payer: Cigna Medicaid	$2.91
Rate for Payer: Molina CHIP/Medicaid	$2.91
Rate for Payer: Parkland Medicaid	$2.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.91

INPATIENT APRDRG 1702: PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK

Facility

$3.34

Service Code	APR-DRG 1702
Hospital Charge Code	APRDRG 1702
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$3.34
Rate for Payer: Amerigroup CHIP/Medicaid	$3.34
Rate for Payer: Cigna Medicaid	$3.34
Rate for Payer: Molina CHIP/Medicaid	$3.34
Rate for Payer: Parkland Medicaid	$3.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.34

INPATIENT APRDRG 1703: PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK

Facility

$4.09

Service Code	APR-DRG 1703
Hospital Charge Code	APRDRG 1703
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$4.09
Rate for Payer: Amerigroup CHIP/Medicaid	$4.09
Rate for Payer: Cigna Medicaid	$4.09
Rate for Payer: Molina CHIP/Medicaid	$4.09
Rate for Payer: Parkland Medicaid	$4.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.09

INPATIENT APRDRG 1704: PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK

Facility

$6.29

Service Code	APR-DRG 1704
Hospital Charge Code	APRDRG 1704
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$6.29
Rate for Payer: Amerigroup CHIP/Medicaid	$6.29
Rate for Payer: Cigna Medicaid	$6.29
Rate for Payer: Molina CHIP/Medicaid	$6.29
Rate for Payer: Parkland Medicaid	$6.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.29

Know your out-of-pocket cost for care.

All Charges