White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 2323: GASTRIC FUNDOPLICATION

Facility

$2.04

Service Code	APR-DRG 2323
Hospital Charge Code	APRDRG 2323
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$2.04
Rate for Payer: Amerigroup CHIP/Medicaid	$2.04
Rate for Payer: Cigna Medicaid	$2.04
Rate for Payer: Molina CHIP/Medicaid	$2.04
Rate for Payer: Parkland Medicaid	$2.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.04

INPATIENT APRDRG 2324: GASTRIC FUNDOPLICATION

Facility

$4.14

Service Code	APR-DRG 2324
Hospital Charge Code	APRDRG 2324
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$4.14
Rate for Payer: Amerigroup CHIP/Medicaid	$4.14
Rate for Payer: Cigna Medicaid	$4.14
Rate for Payer: Molina CHIP/Medicaid	$4.14
Rate for Payer: Parkland Medicaid	$4.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.14

INPATIENT APRDRG 2331: APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$1.37

Service Code	APR-DRG 2331
Hospital Charge Code	APRDRG 2331
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 2332: APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$1.89

Service Code	APR-DRG 2332
Hospital Charge Code	APRDRG 2332
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$1.89
Rate for Payer: Amerigroup CHIP/Medicaid	$1.89
Rate for Payer: Cigna Medicaid	$1.89
Rate for Payer: Molina CHIP/Medicaid	$1.89
Rate for Payer: Parkland Medicaid	$1.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.89

INPATIENT APRDRG 2333: APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$2.43

Service Code	APR-DRG 2333
Hospital Charge Code	APRDRG 2333
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$2.43
Rate for Payer: Amerigroup CHIP/Medicaid	$2.43
Rate for Payer: Cigna Medicaid	$2.43
Rate for Payer: Molina CHIP/Medicaid	$2.43
Rate for Payer: Parkland Medicaid	$2.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.43

INPATIENT APRDRG 2334: APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$6.86

Service Code	APR-DRG 2334
Hospital Charge Code	APRDRG 2334
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$6.86
Rate for Payer: Amerigroup CHIP/Medicaid	$6.86
Rate for Payer: Cigna Medicaid	$6.86
Rate for Payer: Molina CHIP/Medicaid	$6.86
Rate for Payer: Parkland Medicaid	$6.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.86

INPATIENT APRDRG 2341: APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$0.98

Service Code	APR-DRG 2341
Hospital Charge Code	APRDRG 2341
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Amerigroup CHIP/Medicaid	$0.98
Rate for Payer: Cigna Medicaid	$0.98
Rate for Payer: Molina CHIP/Medicaid	$0.98
Rate for Payer: Parkland Medicaid	$0.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.98

INPATIENT APRDRG 2342: APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$1.29

Service Code	APR-DRG 2342
Hospital Charge Code	APRDRG 2342
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.29
Rate for Payer: Amerigroup CHIP/Medicaid	$1.29
Rate for Payer: Cigna Medicaid	$1.29
Rate for Payer: Molina CHIP/Medicaid	$1.29
Rate for Payer: Parkland Medicaid	$1.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.29

INPATIENT APRDRG 2343: APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$1.60

Service Code	APR-DRG 2343
Hospital Charge Code	APRDRG 2343
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$1.60
Rate for Payer: Amerigroup CHIP/Medicaid	$1.60
Rate for Payer: Cigna Medicaid	$1.60
Rate for Payer: Molina CHIP/Medicaid	$1.60
Rate for Payer: Parkland Medicaid	$1.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.60

INPATIENT APRDRG 2344: APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$4.28

Service Code	APR-DRG 2344
Hospital Charge Code	APRDRG 2344
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$4.28
Rate for Payer: Amerigroup CHIP/Medicaid	$4.28
Rate for Payer: Cigna Medicaid	$4.28
Rate for Payer: Molina CHIP/Medicaid	$4.28
Rate for Payer: Parkland Medicaid	$4.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.28

INPATIENT APRDRG 2401: DIGESTIVE MALIGNANCY

Facility

$1.05

Service Code	APR-DRG 2401
Hospital Charge Code	APRDRG 2401
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Amerigroup CHIP/Medicaid	$1.05
Rate for Payer: Cigna Medicaid	$1.05
Rate for Payer: Molina CHIP/Medicaid	$1.05
Rate for Payer: Parkland Medicaid	$1.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.05

INPATIENT APRDRG 2402: DIGESTIVE MALIGNANCY

Facility

$1.20

Service Code	APR-DRG 2402
Hospital Charge Code	APRDRG 2402
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Amerigroup CHIP/Medicaid	$1.20
Rate for Payer: Cigna Medicaid	$1.20
Rate for Payer: Molina CHIP/Medicaid	$1.20
Rate for Payer: Parkland Medicaid	$1.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.20

INPATIENT APRDRG 2403: DIGESTIVE MALIGNANCY

Facility

$1.68

Service Code	APR-DRG 2403
Hospital Charge Code	APRDRG 2403
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$1.68
Rate for Payer: Amerigroup CHIP/Medicaid	$1.68
Rate for Payer: Cigna Medicaid	$1.68
Rate for Payer: Molina CHIP/Medicaid	$1.68
Rate for Payer: Parkland Medicaid	$1.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.68

INPATIENT APRDRG 2404: DIGESTIVE MALIGNANCY

Facility

$2.83

Service Code	APR-DRG 2404
Hospital Charge Code	APRDRG 2404
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$2.83
Rate for Payer: Amerigroup CHIP/Medicaid	$2.83
Rate for Payer: Cigna Medicaid	$2.83
Rate for Payer: Molina CHIP/Medicaid	$2.83
Rate for Payer: Parkland Medicaid	$2.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.83

INPATIENT APRDRG 2411: PEPTIC ULCER & GASTRITIS

Facility

$0.85

Service Code	APR-DRG 2411
Hospital Charge Code	APRDRG 2411
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Amerigroup CHIP/Medicaid	$0.85
Rate for Payer: Cigna Medicaid	$0.85
Rate for Payer: Molina CHIP/Medicaid	$0.85
Rate for Payer: Parkland Medicaid	$0.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.85

INPATIENT APRDRG 2412: PEPTIC ULCER & GASTRITIS

Facility

$0.99

Service Code	APR-DRG 2412
Hospital Charge Code	APRDRG 2412
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$0.99
Rate for Payer: Amerigroup CHIP/Medicaid	$0.99
Rate for Payer: Cigna Medicaid	$0.99
Rate for Payer: Molina CHIP/Medicaid	$0.99
Rate for Payer: Parkland Medicaid	$0.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.99

INPATIENT APRDRG 2413: PEPTIC ULCER & GASTRITIS

Facility

$1.62

Service Code	APR-DRG 2413
Hospital Charge Code	APRDRG 2413
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$1.62
Rate for Payer: Amerigroup CHIP/Medicaid	$1.62
Rate for Payer: Cigna Medicaid	$1.62
Rate for Payer: Molina CHIP/Medicaid	$1.62
Rate for Payer: Parkland Medicaid	$1.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.62

INPATIENT APRDRG 2414: PEPTIC ULCER & GASTRITIS

Facility

$3.94

Service Code	APR-DRG 2414
Hospital Charge Code	APRDRG 2414
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$3.94
Rate for Payer: Amerigroup CHIP/Medicaid	$3.94
Rate for Payer: Cigna Medicaid	$3.94
Rate for Payer: Molina CHIP/Medicaid	$3.94
Rate for Payer: Parkland Medicaid	$3.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.94

INPATIENT APRDRG 2421: MAJOR ESOPHAGEAL DISORDERS

Facility

$0.87

Service Code	APR-DRG 2421
Hospital Charge Code	APRDRG 2421
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Amerigroup CHIP/Medicaid	$0.87
Rate for Payer: Cigna Medicaid	$0.87
Rate for Payer: Molina CHIP/Medicaid	$0.87
Rate for Payer: Parkland Medicaid	$0.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.87

INPATIENT APRDRG 2422: MAJOR ESOPHAGEAL DISORDERS

Facility

$0.93

Service Code	APR-DRG 2422
Hospital Charge Code	APRDRG 2422
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$0.93
Rate for Payer: Amerigroup CHIP/Medicaid	$0.93
Rate for Payer: Cigna Medicaid	$0.93
Rate for Payer: Molina CHIP/Medicaid	$0.93
Rate for Payer: Parkland Medicaid	$0.93
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.93

INPATIENT APRDRG 2423: MAJOR ESOPHAGEAL DISORDERS

Facility

$1.50

Service Code	APR-DRG 2423
Hospital Charge Code	APRDRG 2423
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 2424: MAJOR ESOPHAGEAL DISORDERS

Facility

$3.45

Service Code	APR-DRG 2424
Hospital Charge Code	APRDRG 2424
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Amerigroup CHIP/Medicaid	$3.45
Rate for Payer: Cigna Medicaid	$3.45
Rate for Payer: Molina CHIP/Medicaid	$3.45
Rate for Payer: Parkland Medicaid	$3.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.45

INPATIENT APRDRG 2431: OTHER ESOPHAGEAL DISORDERS

Facility

$0.60

Service Code	APR-DRG 2431
Hospital Charge Code	APRDRG 2431
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Amerigroup CHIP/Medicaid	$0.60
Rate for Payer: Cigna Medicaid	$0.60
Rate for Payer: Molina CHIP/Medicaid	$0.60
Rate for Payer: Parkland Medicaid	$0.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.60

INPATIENT APRDRG 2432: OTHER ESOPHAGEAL DISORDERS

Facility

$0.91

Service Code	APR-DRG 2432
Hospital Charge Code	APRDRG 2432
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$0.91
Rate for Payer: Amerigroup CHIP/Medicaid	$0.91
Rate for Payer: Cigna Medicaid	$0.91
Rate for Payer: Molina CHIP/Medicaid	$0.91
Rate for Payer: Parkland Medicaid	$0.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.91

INPATIENT APRDRG 2433: OTHER ESOPHAGEAL DISORDERS

Facility

$1.42

Service Code	APR-DRG 2433
Hospital Charge Code	APRDRG 2433
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

Know your out-of-pocket cost for care.

All Charges