White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 1711: PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK

Facility

$1.71

Service Code	APR-DRG 1711
Hospital Charge Code	APRDRG 1711
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$1.71
Rate for Payer: Amerigroup CHIP/Medicaid	$1.71
Rate for Payer: Cigna Medicaid	$1.71
Rate for Payer: Molina CHIP/Medicaid	$1.71
Rate for Payer: Parkland Medicaid	$1.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.71

INPATIENT APRDRG 1712: PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK

Facility

$2.07

Service Code	APR-DRG 1712
Hospital Charge Code	APRDRG 1712
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$2.07
Rate for Payer: Amerigroup CHIP/Medicaid	$2.07
Rate for Payer: Cigna Medicaid	$2.07
Rate for Payer: Molina CHIP/Medicaid	$2.07
Rate for Payer: Parkland Medicaid	$2.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.07

INPATIENT APRDRG 1713: PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK

Facility

$2.96

Service Code	APR-DRG 1713
Hospital Charge Code	APRDRG 1713
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$2.96
Rate for Payer: Amerigroup CHIP/Medicaid	$2.96
Rate for Payer: Cigna Medicaid	$2.96
Rate for Payer: Molina CHIP/Medicaid	$2.96
Rate for Payer: Parkland Medicaid	$2.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.96

INPATIENT APRDRG 1714: PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK

Facility

$7.12

Service Code	APR-DRG 1714
Hospital Charge Code	APRDRG 1714
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$7.12
Rate for Payer: Amerigroup CHIP/Medicaid	$7.12
Rate for Payer: Cigna Medicaid	$7.12
Rate for Payer: Molina CHIP/Medicaid	$7.12
Rate for Payer: Parkland Medicaid	$7.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.12

INPATIENT APRDRG 1741: PERCUTANEOUS CORONARY INTERVENTION W AMI

Facility

$2.21

Service Code	APR-DRG 1741
Hospital Charge Code	APRDRG 1741
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$2.21
Rate for Payer: Amerigroup CHIP/Medicaid	$2.21
Rate for Payer: Cigna Medicaid	$2.21
Rate for Payer: Molina CHIP/Medicaid	$2.21
Rate for Payer: Parkland Medicaid	$2.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.21

INPATIENT APRDRG 1742: PERCUTANEOUS CORONARY INTERVENTION W AMI

Facility

$2.58

Service Code	APR-DRG 1742
Hospital Charge Code	APRDRG 1742
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$2.58
Rate for Payer: Amerigroup CHIP/Medicaid	$2.58
Rate for Payer: Cigna Medicaid	$2.58
Rate for Payer: Molina CHIP/Medicaid	$2.58
Rate for Payer: Parkland Medicaid	$2.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.58

INPATIENT APRDRG 1743: PERCUTANEOUS CORONARY INTERVENTION W AMI

Facility

$2.99

Service Code	APR-DRG 1743
Hospital Charge Code	APRDRG 1743
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$2.99
Rate for Payer: Amerigroup CHIP/Medicaid	$2.99
Rate for Payer: Cigna Medicaid	$2.99
Rate for Payer: Molina CHIP/Medicaid	$2.99
Rate for Payer: Parkland Medicaid	$2.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.99

INPATIENT APRDRG 1744: PERCUTANEOUS CORONARY INTERVENTION W AMI

Facility

$4.89

Service Code	APR-DRG 1744
Hospital Charge Code	APRDRG 1744
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$4.89
Rate for Payer: Amerigroup CHIP/Medicaid	$4.89
Rate for Payer: Cigna Medicaid	$4.89
Rate for Payer: Molina CHIP/Medicaid	$4.89
Rate for Payer: Parkland Medicaid	$4.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.89

INPATIENT APRDRG 1751: PERCUTANEOUS CORONARY INTERVENTION W/O AMI

Facility

$2.46

Service Code	APR-DRG 1751
Hospital Charge Code	APRDRG 1751
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.46
Rate for Payer: Amerigroup CHIP/Medicaid	$2.46
Rate for Payer: Cigna Medicaid	$2.46
Rate for Payer: Molina CHIP/Medicaid	$2.46
Rate for Payer: Parkland Medicaid	$2.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.46

INPATIENT APRDRG 1752: PERCUTANEOUS CORONARY INTERVENTION W/O AMI

Facility

$2.90

Service Code	APR-DRG 1752
Hospital Charge Code	APRDRG 1752
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Amerigroup CHIP/Medicaid	$2.90
Rate for Payer: Cigna Medicaid	$2.90
Rate for Payer: Molina CHIP/Medicaid	$2.90
Rate for Payer: Parkland Medicaid	$2.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.90

INPATIENT APRDRG 1753: PERCUTANEOUS CORONARY INTERVENTION W/O AMI

Facility

$3.93

Service Code	APR-DRG 1753
Hospital Charge Code	APRDRG 1753
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$3.93
Rate for Payer: Amerigroup CHIP/Medicaid	$3.93
Rate for Payer: Cigna Medicaid	$3.93
Rate for Payer: Molina CHIP/Medicaid	$3.93
Rate for Payer: Parkland Medicaid	$3.93
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.93

INPATIENT APRDRG 1754: PERCUTANEOUS CORONARY INTERVENTION W/O AMI

Facility

$6.45

Service Code	APR-DRG 1754
Hospital Charge Code	APRDRG 1754
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Amerigroup CHIP/Medicaid	$6.45
Rate for Payer: Cigna Medicaid	$6.45
Rate for Payer: Molina CHIP/Medicaid	$6.45
Rate for Payer: Parkland Medicaid	$6.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.45

INPATIENT APRDRG 1761: CARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENT

Facility

$1.48

Service Code	APR-DRG 1761
Hospital Charge Code	APRDRG 1761
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

INPATIENT APRDRG 1762: CARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENT

Facility

$1.80

Service Code	APR-DRG 1762
Hospital Charge Code	APRDRG 1762
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Amerigroup CHIP/Medicaid	$1.80
Rate for Payer: Cigna Medicaid	$1.80
Rate for Payer: Molina CHIP/Medicaid	$1.80
Rate for Payer: Parkland Medicaid	$1.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.80

INPATIENT APRDRG 1763: CARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENT

Facility

$4.08

Service Code	APR-DRG 1763
Hospital Charge Code	APRDRG 1763
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.08
Rate for Payer: Amerigroup CHIP/Medicaid	$4.08
Rate for Payer: Cigna Medicaid	$4.08
Rate for Payer: Molina CHIP/Medicaid	$4.08
Rate for Payer: Parkland Medicaid	$4.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.08

INPATIENT APRDRG 1764: CARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENT

Facility

$7.32

Service Code	APR-DRG 1764
Hospital Charge Code	APRDRG 1764
Min. Negotiated Rate	$7.32
Max. Negotiated Rate	$7.32
Rate for Payer: Amerigroup CHIP/Medicaid	$7.32
Rate for Payer: Cigna Medicaid	$7.32
Rate for Payer: Molina CHIP/Medicaid	$7.32
Rate for Payer: Parkland Medicaid	$7.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.32

INPATIENT APRDRG 1771: CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$1.44

Service Code	APR-DRG 1771
Hospital Charge Code	APRDRG 1771
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.44
Rate for Payer: Amerigroup CHIP/Medicaid	$1.44
Rate for Payer: Cigna Medicaid	$1.44
Rate for Payer: Molina CHIP/Medicaid	$1.44
Rate for Payer: Parkland Medicaid	$1.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.44

INPATIENT APRDRG 1772: CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$2.47

Service Code	APR-DRG 1772
Hospital Charge Code	APRDRG 1772
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$2.47
Rate for Payer: Amerigroup CHIP/Medicaid	$2.47
Rate for Payer: Cigna Medicaid	$2.47
Rate for Payer: Molina CHIP/Medicaid	$2.47
Rate for Payer: Parkland Medicaid	$2.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.47

INPATIENT APRDRG 1773: CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$3.51

Service Code	APR-DRG 1773
Hospital Charge Code	APRDRG 1773
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$3.51
Rate for Payer: Amerigroup CHIP/Medicaid	$3.51
Rate for Payer: Cigna Medicaid	$3.51
Rate for Payer: Molina CHIP/Medicaid	$3.51
Rate for Payer: Parkland Medicaid	$3.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.51

INPATIENT APRDRG 1774: CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$5.01

Service Code	APR-DRG 1774
Hospital Charge Code	APRDRG 1774
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$5.01
Rate for Payer: Amerigroup CHIP/Medicaid	$5.01
Rate for Payer: Cigna Medicaid	$5.01
Rate for Payer: Molina CHIP/Medicaid	$5.01
Rate for Payer: Parkland Medicaid	$5.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.01

INPATIENT APRDRG 1781: EXTERNAL HEART ASSIST SYSTEMS

Facility

$7.38

Service Code	APR-DRG 1781
Hospital Charge Code	APRDRG 1781
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$7.38
Rate for Payer: Amerigroup CHIP/Medicaid	$7.38
Rate for Payer: Cigna Medicaid	$7.38
Rate for Payer: Molina CHIP/Medicaid	$7.38
Rate for Payer: Parkland Medicaid	$7.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.38

INPATIENT APRDRG 1782: EXTERNAL HEART ASSIST SYSTEMS

Facility

$8.06

Service Code	APR-DRG 1782
Hospital Charge Code	APRDRG 1782
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$8.06
Rate for Payer: Amerigroup CHIP/Medicaid	$8.06
Rate for Payer: Cigna Medicaid	$8.06
Rate for Payer: Molina CHIP/Medicaid	$8.06
Rate for Payer: Parkland Medicaid	$8.06
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.06

INPATIENT APRDRG 1783: EXTERNAL HEART ASSIST SYSTEMS

Facility

$9.39

Service Code	APR-DRG 1783
Hospital Charge Code	APRDRG 1783
Min. Negotiated Rate	$9.39
Max. Negotiated Rate	$9.39
Rate for Payer: Amerigroup CHIP/Medicaid	$9.39
Rate for Payer: Cigna Medicaid	$9.39
Rate for Payer: Molina CHIP/Medicaid	$9.39
Rate for Payer: Parkland Medicaid	$9.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.39

INPATIENT APRDRG 1784: EXTERNAL HEART ASSIST SYSTEMS

Facility

$14.67

Service Code	APR-DRG 1784
Hospital Charge Code	APRDRG 1784
Min. Negotiated Rate	$14.67
Max. Negotiated Rate	$14.67
Rate for Payer: Amerigroup CHIP/Medicaid	$14.67
Rate for Payer: Cigna Medicaid	$14.67
Rate for Payer: Molina CHIP/Medicaid	$14.67
Rate for Payer: Parkland Medicaid	$14.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14.67

INPATIENT APRDRG 1791: DEFIBRILLATOR IMPLANTS

Facility

$3.50

Service Code	APR-DRG 1791
Hospital Charge Code	APRDRG 1791
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$3.50
Rate for Payer: Amerigroup CHIP/Medicaid	$3.50
Rate for Payer: Cigna Medicaid	$3.50
Rate for Payer: Molina CHIP/Medicaid	$3.50
Rate for Payer: Parkland Medicaid	$3.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.50

Know your out-of-pocket cost for care.

All Charges