White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 2833: OTHER DISORDERS OF THE LIVER

Facility

$1.19

Service Code	APR-DRG 2833
Hospital Charge Code	APRDRG 2833
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.19
Rate for Payer: Amerigroup CHIP/Medicaid	$1.19
Rate for Payer: Cigna Medicaid	$1.19
Rate for Payer: Molina CHIP/Medicaid	$1.19
Rate for Payer: Parkland Medicaid	$1.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.19

INPATIENT APRDRG 2834: OTHER DISORDERS OF THE LIVER

Facility

$4.89

Service Code	APR-DRG 2834
Hospital Charge Code	APRDRG 2834
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 2841: DISORDERS OF GALLBLADDER & BILIARY TRACT

Facility

$0.85

Service Code	APR-DRG 2841
Hospital Charge Code	APRDRG 2841
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 2842: DISORDERS OF GALLBLADDER & BILIARY TRACT

Facility

$1.13

Service Code	APR-DRG 2842
Hospital Charge Code	APRDRG 2842
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.13
Rate for Payer: Amerigroup CHIP/Medicaid	$1.13
Rate for Payer: Cigna Medicaid	$1.13
Rate for Payer: Molina CHIP/Medicaid	$1.13
Rate for Payer: Parkland Medicaid	$1.13
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.13

INPATIENT APRDRG 2843: DISORDERS OF GALLBLADDER & BILIARY TRACT

Facility

$1.69

Service Code	APR-DRG 2843
Hospital Charge Code	APRDRG 2843
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Amerigroup CHIP/Medicaid	$1.69
Rate for Payer: Cigna Medicaid	$1.69
Rate for Payer: Molina CHIP/Medicaid	$1.69
Rate for Payer: Parkland Medicaid	$1.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.69

INPATIENT APRDRG 2844: DISORDERS OF GALLBLADDER & BILIARY TRACT

Facility

$3.18

Service Code	APR-DRG 2844
Hospital Charge Code	APRDRG 2844
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$3.18
Rate for Payer: Amerigroup CHIP/Medicaid	$3.18
Rate for Payer: Cigna Medicaid	$3.18
Rate for Payer: Molina CHIP/Medicaid	$3.18
Rate for Payer: Parkland Medicaid	$3.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.18

INPATIENT APRDRG 3031: DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK

Facility

$6.03

Service Code	APR-DRG 3031
Hospital Charge Code	APRDRG 3031
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$6.03
Rate for Payer: Amerigroup CHIP/Medicaid	$6.03
Rate for Payer: Cigna Medicaid	$6.03
Rate for Payer: Molina CHIP/Medicaid	$6.03
Rate for Payer: Parkland Medicaid	$6.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.03

INPATIENT APRDRG 3032: DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK

Facility

$8.19

Service Code	APR-DRG 3032
Hospital Charge Code	APRDRG 3032
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$8.19
Rate for Payer: Amerigroup CHIP/Medicaid	$8.19
Rate for Payer: Cigna Medicaid	$8.19
Rate for Payer: Molina CHIP/Medicaid	$8.19
Rate for Payer: Parkland Medicaid	$8.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.19

INPATIENT APRDRG 3033: DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK

Facility

$11.28

Service Code	APR-DRG 3033
Hospital Charge Code	APRDRG 3033
Min. Negotiated Rate	$11.28
Max. Negotiated Rate	$11.28
Rate for Payer: Amerigroup CHIP/Medicaid	$11.28
Rate for Payer: Cigna Medicaid	$11.28
Rate for Payer: Molina CHIP/Medicaid	$11.28
Rate for Payer: Parkland Medicaid	$11.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11.28

INPATIENT APRDRG 3034: DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK

Facility

$13.34

Service Code	APR-DRG 3034
Hospital Charge Code	APRDRG 3034
Min. Negotiated Rate	$13.34
Max. Negotiated Rate	$13.34
Rate for Payer: Amerigroup CHIP/Medicaid	$13.34
Rate for Payer: Cigna Medicaid	$13.34
Rate for Payer: Molina CHIP/Medicaid	$13.34
Rate for Payer: Parkland Medicaid	$13.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.34

INPATIENT APRDRG 3041: DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK

Facility

$3.53

Service Code	APR-DRG 3041
Hospital Charge Code	APRDRG 3041
Min. Negotiated Rate	$3.53
Max. Negotiated Rate	$3.53
Rate for Payer: Amerigroup CHIP/Medicaid	$3.53
Rate for Payer: Cigna Medicaid	$3.53
Rate for Payer: Molina CHIP/Medicaid	$3.53
Rate for Payer: Parkland Medicaid	$3.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.53

INPATIENT APRDRG 3042: DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK

Facility

$4.26

Service Code	APR-DRG 3042
Hospital Charge Code	APRDRG 3042
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$4.26
Rate for Payer: Amerigroup CHIP/Medicaid	$4.26
Rate for Payer: Cigna Medicaid	$4.26
Rate for Payer: Molina CHIP/Medicaid	$4.26
Rate for Payer: Parkland Medicaid	$4.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.26

INPATIENT APRDRG 3043: DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK

Facility

$6.94

Service Code	APR-DRG 3043
Hospital Charge Code	APRDRG 3043
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$6.94
Rate for Payer: Amerigroup CHIP/Medicaid	$6.94
Rate for Payer: Cigna Medicaid	$6.94
Rate for Payer: Molina CHIP/Medicaid	$6.94
Rate for Payer: Parkland Medicaid	$6.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.94

INPATIENT APRDRG 3044: DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK

Facility

$11.08

Service Code	APR-DRG 3044
Hospital Charge Code	APRDRG 3044
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$11.08
Rate for Payer: Amerigroup CHIP/Medicaid	$11.08
Rate for Payer: Cigna Medicaid	$11.08
Rate for Payer: Molina CHIP/Medicaid	$11.08
Rate for Payer: Parkland Medicaid	$11.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11.08

INPATIENT APRDRG 3051: AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$1.50

Service Code	APR-DRG 3051
Hospital Charge Code	APRDRG 3051
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 3052: AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$1.96

Service Code	APR-DRG 3052
Hospital Charge Code	APRDRG 3052
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$1.96
Rate for Payer: Amerigroup CHIP/Medicaid	$1.96
Rate for Payer: Cigna Medicaid	$1.96
Rate for Payer: Molina CHIP/Medicaid	$1.96
Rate for Payer: Parkland Medicaid	$1.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.96

INPATIENT APRDRG 3053: AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$3.04

Service Code	APR-DRG 3053
Hospital Charge Code	APRDRG 3053
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$3.04
Rate for Payer: Amerigroup CHIP/Medicaid	$3.04
Rate for Payer: Cigna Medicaid	$3.04
Rate for Payer: Molina CHIP/Medicaid	$3.04
Rate for Payer: Parkland Medicaid	$3.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.04

INPATIENT APRDRG 3054: AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$5.46

Service Code	APR-DRG 3054
Hospital Charge Code	APRDRG 3054
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 3081: HIP & FEMUR FRACTURE REPAIR

Facility

$1.64

Service Code	APR-DRG 3081
Hospital Charge Code	APRDRG 3081
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Amerigroup CHIP/Medicaid	$1.64
Rate for Payer: Cigna Medicaid	$1.64
Rate for Payer: Molina CHIP/Medicaid	$1.64
Rate for Payer: Parkland Medicaid	$1.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.64

INPATIENT APRDRG 3082: HIP & FEMUR FRACTURE REPAIR

Facility

$2.03

Service Code	APR-DRG 3082
Hospital Charge Code	APRDRG 3082
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$2.03
Rate for Payer: Amerigroup CHIP/Medicaid	$2.03
Rate for Payer: Cigna Medicaid	$2.03
Rate for Payer: Molina CHIP/Medicaid	$2.03
Rate for Payer: Parkland Medicaid	$2.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.03

INPATIENT APRDRG 3083: HIP & FEMUR FRACTURE REPAIR

Facility

$2.87

Service Code	APR-DRG 3083
Hospital Charge Code	APRDRG 3083
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$2.87
Rate for Payer: Amerigroup CHIP/Medicaid	$2.87
Rate for Payer: Cigna Medicaid	$2.87
Rate for Payer: Molina CHIP/Medicaid	$2.87
Rate for Payer: Parkland Medicaid	$2.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.87

INPATIENT APRDRG 3084: HIP & FEMUR FRACTURE REPAIR

Facility

$5.99

Service Code	APR-DRG 3084
Hospital Charge Code	APRDRG 3084
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$5.99
Rate for Payer: Amerigroup CHIP/Medicaid	$5.99
Rate for Payer: Cigna Medicaid	$5.99
Rate for Payer: Molina CHIP/Medicaid	$5.99
Rate for Payer: Parkland Medicaid	$5.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.99

INPATIENT APRDRG 3091: OTHER SIGNIFICANT HIP & FEMUR SURGERY

Facility

$1.93

Service Code	APR-DRG 3091
Hospital Charge Code	APRDRG 3091
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$1.93
Rate for Payer: Amerigroup CHIP/Medicaid	$1.93
Rate for Payer: Cigna Medicaid	$1.93
Rate for Payer: Molina CHIP/Medicaid	$1.93
Rate for Payer: Parkland Medicaid	$1.93
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.93

INPATIENT APRDRG 3092: OTHER SIGNIFICANT HIP & FEMUR SURGERY

Facility

$2.72

Service Code	APR-DRG 3092
Hospital Charge Code	APRDRG 3092
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$2.72
Rate for Payer: Amerigroup CHIP/Medicaid	$2.72
Rate for Payer: Cigna Medicaid	$2.72
Rate for Payer: Molina CHIP/Medicaid	$2.72
Rate for Payer: Parkland Medicaid	$2.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.72

INPATIENT APRDRG 3093: OTHER SIGNIFICANT HIP & FEMUR SURGERY

Facility

$3.83

Service Code	APR-DRG 3093
Hospital Charge Code	APRDRG 3093
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$3.83
Rate for Payer: Amerigroup CHIP/Medicaid	$3.83
Rate for Payer: Cigna Medicaid	$3.83
Rate for Payer: Molina CHIP/Medicaid	$3.83
Rate for Payer: Parkland Medicaid	$3.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.83

Know your out-of-pocket cost for care.

All Charges