White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 2511: ABDOMINAL PAIN

Facility

$0.57

Service Code	APR-DRG 2511
Hospital Charge Code	APRDRG 2511
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.57
Rate for Payer: Amerigroup CHIP/Medicaid	$0.57
Rate for Payer: Cigna Medicaid	$0.57
Rate for Payer: Molina CHIP/Medicaid	$0.57
Rate for Payer: Parkland Medicaid	$0.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.57

INPATIENT APRDRG 2512: ABDOMINAL PAIN

Facility

$0.82

Service Code	APR-DRG 2512
Hospital Charge Code	APRDRG 2512
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.82
Rate for Payer: Amerigroup CHIP/Medicaid	$0.82
Rate for Payer: Cigna Medicaid	$0.82
Rate for Payer: Molina CHIP/Medicaid	$0.82
Rate for Payer: Parkland Medicaid	$0.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.82

INPATIENT APRDRG 2513: ABDOMINAL PAIN

Facility

$1.11

Service Code	APR-DRG 2513
Hospital Charge Code	APRDRG 2513
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.11
Rate for Payer: Amerigroup CHIP/Medicaid	$1.11
Rate for Payer: Cigna Medicaid	$1.11
Rate for Payer: Molina CHIP/Medicaid	$1.11
Rate for Payer: Parkland Medicaid	$1.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.11

INPATIENT APRDRG 2514: ABDOMINAL PAIN

Facility

$2.32

Service Code	APR-DRG 2514
Hospital Charge Code	APRDRG 2514
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$2.32
Rate for Payer: Amerigroup CHIP/Medicaid	$2.32
Rate for Payer: Cigna Medicaid	$2.32
Rate for Payer: Molina CHIP/Medicaid	$2.32
Rate for Payer: Parkland Medicaid	$2.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.32

INPATIENT APRDRG 2521: MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE

Facility

$0.79

Service Code	APR-DRG 2521
Hospital Charge Code	APRDRG 2521
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Amerigroup CHIP/Medicaid	$0.79
Rate for Payer: Cigna Medicaid	$0.79
Rate for Payer: Molina CHIP/Medicaid	$0.79
Rate for Payer: Parkland Medicaid	$0.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.79

INPATIENT APRDRG 2522: MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE

Facility

$0.93

Service Code	APR-DRG 2522
Hospital Charge Code	APRDRG 2522
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 2523: MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE

Facility

$1.37

Service Code	APR-DRG 2523
Hospital Charge Code	APRDRG 2523
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 2524: MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE

Facility

$4.79

Service Code	APR-DRG 2524
Hospital Charge Code	APRDRG 2524
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$4.79
Rate for Payer: Amerigroup CHIP/Medicaid	$4.79
Rate for Payer: Cigna Medicaid	$4.79
Rate for Payer: Molina CHIP/Medicaid	$4.79
Rate for Payer: Parkland Medicaid	$4.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.79

INPATIENT APRDRG 2531: OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$0.69

Service Code	APR-DRG 2531
Hospital Charge Code	APRDRG 2531
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: Cigna Medicaid	$0.69
Rate for Payer: Molina CHIP/Medicaid	$0.69
Rate for Payer: Parkland Medicaid	$0.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.69

INPATIENT APRDRG 2532: OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$0.94

Service Code	APR-DRG 2532
Hospital Charge Code	APRDRG 2532
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$0.94
Rate for Payer: Amerigroup CHIP/Medicaid	$0.94
Rate for Payer: Cigna Medicaid	$0.94
Rate for Payer: Molina CHIP/Medicaid	$0.94
Rate for Payer: Parkland Medicaid	$0.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.94

INPATIENT APRDRG 2533: OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$1.28

Service Code	APR-DRG 2533
Hospital Charge Code	APRDRG 2533
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$1.28
Rate for Payer: Amerigroup CHIP/Medicaid	$1.28
Rate for Payer: Cigna Medicaid	$1.28
Rate for Payer: Molina CHIP/Medicaid	$1.28
Rate for Payer: Parkland Medicaid	$1.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.28

INPATIENT APRDRG 2534: OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$2.18

Service Code	APR-DRG 2534
Hospital Charge Code	APRDRG 2534
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$2.18
Rate for Payer: Amerigroup CHIP/Medicaid	$2.18
Rate for Payer: Cigna Medicaid	$2.18
Rate for Payer: Molina CHIP/Medicaid	$2.18
Rate for Payer: Parkland Medicaid	$2.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.18

INPATIENT APRDRG 2541: OTHER DIGESTIVE SYSTEM DIAGNOSES

Facility

$0.64

Service Code	APR-DRG 2541
Hospital Charge Code	APRDRG 2541
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.64
Rate for Payer: Amerigroup CHIP/Medicaid	$0.64
Rate for Payer: Cigna Medicaid	$0.64
Rate for Payer: Molina CHIP/Medicaid	$0.64
Rate for Payer: Parkland Medicaid	$0.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.64

INPATIENT APRDRG 2542: OTHER DIGESTIVE SYSTEM DIAGNOSES

Facility

$1.07

Service Code	APR-DRG 2542
Hospital Charge Code	APRDRG 2542
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$1.07
Rate for Payer: Amerigroup CHIP/Medicaid	$1.07
Rate for Payer: Cigna Medicaid	$1.07
Rate for Payer: Molina CHIP/Medicaid	$1.07
Rate for Payer: Parkland Medicaid	$1.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.07

INPATIENT APRDRG 2543: OTHER DIGESTIVE SYSTEM DIAGNOSES

Facility

$1.74

Service Code	APR-DRG 2543
Hospital Charge Code	APRDRG 2543
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$1.74
Rate for Payer: Amerigroup CHIP/Medicaid	$1.74
Rate for Payer: Cigna Medicaid	$1.74
Rate for Payer: Molina CHIP/Medicaid	$1.74
Rate for Payer: Parkland Medicaid	$1.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.74

INPATIENT APRDRG 2544: OTHER DIGESTIVE SYSTEM DIAGNOSES

Facility

$3.85

Service Code	APR-DRG 2544
Hospital Charge Code	APRDRG 2544
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$3.85
Rate for Payer: Amerigroup CHIP/Medicaid	$3.85
Rate for Payer: Cigna Medicaid	$3.85
Rate for Payer: Molina CHIP/Medicaid	$3.85
Rate for Payer: Parkland Medicaid	$3.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.85

INPATIENT APRDRG 2601: MAJOR PANCREAS, LIVER & SHUNT PROCEDURES

Facility

$2.67

Service Code	APR-DRG 2601
Hospital Charge Code	APRDRG 2601
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$2.67
Rate for Payer: Amerigroup CHIP/Medicaid	$2.67
Rate for Payer: Cigna Medicaid	$2.67
Rate for Payer: Molina CHIP/Medicaid	$2.67
Rate for Payer: Parkland Medicaid	$2.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.67

INPATIENT APRDRG 2602: MAJOR PANCREAS, LIVER & SHUNT PROCEDURES

Facility

$2.91

Service Code	APR-DRG 2602
Hospital Charge Code	APRDRG 2602
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 2603: MAJOR PANCREAS, LIVER & SHUNT PROCEDURES

Facility

$4.36

Service Code	APR-DRG 2603
Hospital Charge Code	APRDRG 2603
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$4.36
Rate for Payer: Amerigroup CHIP/Medicaid	$4.36
Rate for Payer: Cigna Medicaid	$4.36
Rate for Payer: Molina CHIP/Medicaid	$4.36
Rate for Payer: Parkland Medicaid	$4.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.36

INPATIENT APRDRG 2604: MAJOR PANCREAS, LIVER & SHUNT PROCEDURES

Facility

$9.50

Service Code	APR-DRG 2604
Hospital Charge Code	APRDRG 2604
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$9.50
Rate for Payer: Amerigroup CHIP/Medicaid	$9.50
Rate for Payer: Cigna Medicaid	$9.50
Rate for Payer: Molina CHIP/Medicaid	$9.50
Rate for Payer: Parkland Medicaid	$9.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.50

INPATIENT APRDRG 2611: MAJOR BILIARY TRACT PROCEDURES

Facility

$1.87

Service Code	APR-DRG 2611
Hospital Charge Code	APRDRG 2611
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1.87
Rate for Payer: Amerigroup CHIP/Medicaid	$1.87
Rate for Payer: Cigna Medicaid	$1.87
Rate for Payer: Molina CHIP/Medicaid	$1.87
Rate for Payer: Parkland Medicaid	$1.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.87

INPATIENT APRDRG 2612: MAJOR BILIARY TRACT PROCEDURES

Facility

$2.73

Service Code	APR-DRG 2612
Hospital Charge Code	APRDRG 2612
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$2.73
Rate for Payer: Amerigroup CHIP/Medicaid	$2.73
Rate for Payer: Cigna Medicaid	$2.73
Rate for Payer: Molina CHIP/Medicaid	$2.73
Rate for Payer: Parkland Medicaid	$2.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.73

INPATIENT APRDRG 2613: MAJOR BILIARY TRACT PROCEDURES

Facility

$5.51

Service Code	APR-DRG 2613
Hospital Charge Code	APRDRG 2613
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$5.51
Rate for Payer: Amerigroup CHIP/Medicaid	$5.51
Rate for Payer: Cigna Medicaid	$5.51
Rate for Payer: Molina CHIP/Medicaid	$5.51
Rate for Payer: Parkland Medicaid	$5.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.51

INPATIENT APRDRG 2614: MAJOR BILIARY TRACT PROCEDURES

Facility

$8.34

Service Code	APR-DRG 2614
Hospital Charge Code	APRDRG 2614
Min. Negotiated Rate	$8.34
Max. Negotiated Rate	$8.34
Rate for Payer: Amerigroup CHIP/Medicaid	$8.34
Rate for Payer: Cigna Medicaid	$8.34
Rate for Payer: Molina CHIP/Medicaid	$8.34
Rate for Payer: Parkland Medicaid	$8.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.34

INPATIENT APRDRG 2631: CHOLECYSTECTOMY

Facility

$1.26

Service Code	APR-DRG 2631
Hospital Charge Code	APRDRG 2631
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$1.26
Rate for Payer: Amerigroup CHIP/Medicaid	$1.26
Rate for Payer: Cigna Medicaid	$1.26
Rate for Payer: Molina CHIP/Medicaid	$1.26
Rate for Payer: Parkland Medicaid	$1.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.26

Know your out-of-pocket cost for care.

All Charges