White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 2061: MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE

Facility

$0.89

Service Code	APR-DRG 2061
Hospital Charge Code	APRDRG 2061
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Amerigroup CHIP/Medicaid	$0.89
Rate for Payer: Cigna Medicaid	$0.89
Rate for Payer: Molina CHIP/Medicaid	$0.89
Rate for Payer: Parkland Medicaid	$0.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.89

INPATIENT APRDRG 2062: MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE

Facility

$1.04

Service Code	APR-DRG 2062
Hospital Charge Code	APRDRG 2062
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.04
Rate for Payer: Amerigroup CHIP/Medicaid	$1.04
Rate for Payer: Cigna Medicaid	$1.04
Rate for Payer: Molina CHIP/Medicaid	$1.04
Rate for Payer: Parkland Medicaid	$1.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.04

INPATIENT APRDRG 2063: MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE

Facility

$2.17

Service Code	APR-DRG 2063
Hospital Charge Code	APRDRG 2063
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$2.17
Rate for Payer: Amerigroup CHIP/Medicaid	$2.17
Rate for Payer: Cigna Medicaid	$2.17
Rate for Payer: Molina CHIP/Medicaid	$2.17
Rate for Payer: Parkland Medicaid	$2.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.17

INPATIENT APRDRG 2064: MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE

Facility

$4.80

Service Code	APR-DRG 2064
Hospital Charge Code	APRDRG 2064
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Amerigroup CHIP/Medicaid	$4.80
Rate for Payer: Cigna Medicaid	$4.80
Rate for Payer: Molina CHIP/Medicaid	$4.80
Rate for Payer: Parkland Medicaid	$4.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.80

INPATIENT APRDRG 2071: OTHER CIRCULATORY SYSTEM DIAGNOSES

Facility

$0.80

Service Code	APR-DRG 2071
Hospital Charge Code	APRDRG 2071
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Amerigroup CHIP/Medicaid	$0.80
Rate for Payer: Cigna Medicaid	$0.80
Rate for Payer: Molina CHIP/Medicaid	$0.80
Rate for Payer: Parkland Medicaid	$0.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.80

INPATIENT APRDRG 2072: OTHER CIRCULATORY SYSTEM DIAGNOSES

Facility

$1.04

Service Code	APR-DRG 2072
Hospital Charge Code	APRDRG 2072
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.04
Rate for Payer: Amerigroup CHIP/Medicaid	$1.04
Rate for Payer: Cigna Medicaid	$1.04
Rate for Payer: Molina CHIP/Medicaid	$1.04
Rate for Payer: Parkland Medicaid	$1.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.04

INPATIENT APRDRG 2073: OTHER CIRCULATORY SYSTEM DIAGNOSES

Facility

$1.48

Service Code	APR-DRG 2073
Hospital Charge Code	APRDRG 2073
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 2074: OTHER CIRCULATORY SYSTEM DIAGNOSES

Facility

$5.46

Service Code	APR-DRG 2074
Hospital Charge Code	APRDRG 2074
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$5.46
Rate for Payer: Amerigroup CHIP/Medicaid	$5.46
Rate for Payer: Cigna Medicaid	$5.46
Rate for Payer: Molina CHIP/Medicaid	$5.46
Rate for Payer: Parkland Medicaid	$5.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.46

INPATIENT APRDRG 2201: MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$1.92

Service Code	APR-DRG 2201
Hospital Charge Code	APRDRG 2201
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$1.92
Rate for Payer: Amerigroup CHIP/Medicaid	$1.92
Rate for Payer: Cigna Medicaid	$1.92
Rate for Payer: Molina CHIP/Medicaid	$1.92
Rate for Payer: Parkland Medicaid	$1.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.92

INPATIENT APRDRG 2202: MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$2.34

Service Code	APR-DRG 2202
Hospital Charge Code	APRDRG 2202
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$2.34
Rate for Payer: Amerigroup CHIP/Medicaid	$2.34
Rate for Payer: Cigna Medicaid	$2.34
Rate for Payer: Molina CHIP/Medicaid	$2.34
Rate for Payer: Parkland Medicaid	$2.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.34

INPATIENT APRDRG 2203: MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$4.60

Service Code	APR-DRG 2203
Hospital Charge Code	APRDRG 2203
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$4.60
Rate for Payer: Amerigroup CHIP/Medicaid	$4.60
Rate for Payer: Cigna Medicaid	$4.60
Rate for Payer: Molina CHIP/Medicaid	$4.60
Rate for Payer: Parkland Medicaid	$4.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.60

INPATIENT APRDRG 2204: MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$12.50

Service Code	APR-DRG 2204
Hospital Charge Code	APRDRG 2204
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$12.50
Rate for Payer: Amerigroup CHIP/Medicaid	$12.50
Rate for Payer: Cigna Medicaid	$12.50
Rate for Payer: Molina CHIP/Medicaid	$12.50
Rate for Payer: Parkland Medicaid	$12.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.50

INPATIENT APRDRG 2221: OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$0.96

Service Code	APR-DRG 2221
Hospital Charge Code	APRDRG 2221
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$0.96
Rate for Payer: Amerigroup CHIP/Medicaid	$0.96
Rate for Payer: Cigna Medicaid	$0.96
Rate for Payer: Molina CHIP/Medicaid	$0.96
Rate for Payer: Parkland Medicaid	$0.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.96

INPATIENT APRDRG 2222: OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$1.91

Service Code	APR-DRG 2222
Hospital Charge Code	APRDRG 2222
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$1.91
Rate for Payer: Amerigroup CHIP/Medicaid	$1.91
Rate for Payer: Cigna Medicaid	$1.91
Rate for Payer: Molina CHIP/Medicaid	$1.91
Rate for Payer: Parkland Medicaid	$1.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.91

INPATIENT APRDRG 2223: OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$4.19

Service Code	APR-DRG 2223
Hospital Charge Code	APRDRG 2223
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$4.19
Rate for Payer: Amerigroup CHIP/Medicaid	$4.19
Rate for Payer: Cigna Medicaid	$4.19
Rate for Payer: Molina CHIP/Medicaid	$4.19
Rate for Payer: Parkland Medicaid	$4.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.19

INPATIENT APRDRG 2224: OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES

Facility

$5.94

Service Code	APR-DRG 2224
Hospital Charge Code	APRDRG 2224
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$5.94
Rate for Payer: Amerigroup CHIP/Medicaid	$5.94
Rate for Payer: Cigna Medicaid	$5.94
Rate for Payer: Molina CHIP/Medicaid	$5.94
Rate for Payer: Parkland Medicaid	$5.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.94

INPATIENT APRDRG 2231: OTHER SMALL & LARGE BOWEL PROCEDURES

Facility

$1.36

Service Code	APR-DRG 2231
Hospital Charge Code	APRDRG 2231
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 2232: OTHER SMALL & LARGE BOWEL PROCEDURES

Facility

$1.72

Service Code	APR-DRG 2232
Hospital Charge Code	APRDRG 2232
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$1.72
Rate for Payer: Amerigroup CHIP/Medicaid	$1.72
Rate for Payer: Cigna Medicaid	$1.72
Rate for Payer: Molina CHIP/Medicaid	$1.72
Rate for Payer: Parkland Medicaid	$1.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.72

INPATIENT APRDRG 2233: OTHER SMALL & LARGE BOWEL PROCEDURES

Facility

$2.37

Service Code	APR-DRG 2233
Hospital Charge Code	APRDRG 2233
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$2.37
Rate for Payer: Amerigroup CHIP/Medicaid	$2.37
Rate for Payer: Cigna Medicaid	$2.37
Rate for Payer: Molina CHIP/Medicaid	$2.37
Rate for Payer: Parkland Medicaid	$2.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.37

INPATIENT APRDRG 2234: OTHER SMALL & LARGE BOWEL PROCEDURES

Facility

$7.85

Service Code	APR-DRG 2234
Hospital Charge Code	APRDRG 2234
Min. Negotiated Rate	$7.85
Max. Negotiated Rate	$7.85
Rate for Payer: Amerigroup CHIP/Medicaid	$7.85
Rate for Payer: Cigna Medicaid	$7.85
Rate for Payer: Molina CHIP/Medicaid	$7.85
Rate for Payer: Parkland Medicaid	$7.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.85

INPATIENT APRDRG 2241: PERITONEAL ADHESIOLYSIS

Facility

$1.50

Service Code	APR-DRG 2241
Hospital Charge Code	APRDRG 2241
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Amerigroup CHIP/Medicaid	$1.50
Rate for Payer: Cigna Medicaid	$1.50
Rate for Payer: Molina CHIP/Medicaid	$1.50
Rate for Payer: Parkland Medicaid	$1.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.50

INPATIENT APRDRG 2242: PERITONEAL ADHESIOLYSIS

Facility

$2.19

Service Code	APR-DRG 2242
Hospital Charge Code	APRDRG 2242
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$2.19
Rate for Payer: Amerigroup CHIP/Medicaid	$2.19
Rate for Payer: Cigna Medicaid	$2.19
Rate for Payer: Molina CHIP/Medicaid	$2.19
Rate for Payer: Parkland Medicaid	$2.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.19

INPATIENT APRDRG 2243: PERITONEAL ADHESIOLYSIS

Facility

$3.33

Service Code	APR-DRG 2243
Hospital Charge Code	APRDRG 2243
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$3.33
Rate for Payer: Amerigroup CHIP/Medicaid	$3.33
Rate for Payer: Cigna Medicaid	$3.33
Rate for Payer: Molina CHIP/Medicaid	$3.33
Rate for Payer: Parkland Medicaid	$3.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.33

INPATIENT APRDRG 2244: PERITONEAL ADHESIOLYSIS

Facility

$9.14

Service Code	APR-DRG 2244
Hospital Charge Code	APRDRG 2244
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$9.14
Rate for Payer: Amerigroup CHIP/Medicaid	$9.14
Rate for Payer: Cigna Medicaid	$9.14
Rate for Payer: Molina CHIP/Medicaid	$9.14
Rate for Payer: Parkland Medicaid	$9.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.14

INPATIENT APRDRG 2261: ANAL PROCEDURES

Facility

$1.14

Service Code	APR-DRG 2261
Hospital Charge Code	APRDRG 2261
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.14
Rate for Payer: Amerigroup CHIP/Medicaid	$1.14
Rate for Payer: Cigna Medicaid	$1.14
Rate for Payer: Molina CHIP/Medicaid	$1.14
Rate for Payer: Parkland Medicaid	$1.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.14

Know your out-of-pocket cost for care.

All Charges