White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 3094: OTHER SIGNIFICANT HIP & FEMUR SURGERY

Facility

$5.06

Service Code	APR-DRG 3094
Hospital Charge Code	APRDRG 3094
Min. Negotiated Rate	$5.06
Max. Negotiated Rate	$5.06
Rate for Payer: Amerigroup CHIP/Medicaid	$5.06
Rate for Payer: Cigna Medicaid	$5.06
Rate for Payer: Molina CHIP/Medicaid	$5.06
Rate for Payer: Parkland Medicaid	$5.06
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.06

INPATIENT APRDRG 3101: INTERVERTEBRAL DISC EXCISION & DECOMPRESSION

Facility

$1.51

Service Code	APR-DRG 3101
Hospital Charge Code	APRDRG 3101
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$1.51
Rate for Payer: Amerigroup CHIP/Medicaid	$1.51
Rate for Payer: Cigna Medicaid	$1.51
Rate for Payer: Molina CHIP/Medicaid	$1.51
Rate for Payer: Parkland Medicaid	$1.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.51

INPATIENT APRDRG 3102: INTERVERTEBRAL DISC EXCISION & DECOMPRESSION

Facility

$2.37

Service Code	APR-DRG 3102
Hospital Charge Code	APRDRG 3102
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 3103: INTERVERTEBRAL DISC EXCISION & DECOMPRESSION

Facility

$3.63

Service Code	APR-DRG 3103
Hospital Charge Code	APRDRG 3103
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$3.63
Rate for Payer: Amerigroup CHIP/Medicaid	$3.63
Rate for Payer: Cigna Medicaid	$3.63
Rate for Payer: Molina CHIP/Medicaid	$3.63
Rate for Payer: Parkland Medicaid	$3.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.63

INPATIENT APRDRG 3104: INTERVERTEBRAL DISC EXCISION & DECOMPRESSION

Facility

$6.86

Service Code	APR-DRG 3104
Hospital Charge Code	APRDRG 3104
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 3121: SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES

Facility

$1.64

Service Code	APR-DRG 3121
Hospital Charge Code	APRDRG 3121
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 3122: SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES

Facility

$2.48

Service Code	APR-DRG 3122
Hospital Charge Code	APRDRG 3122
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$2.48
Rate for Payer: Amerigroup CHIP/Medicaid	$2.48
Rate for Payer: Cigna Medicaid	$2.48
Rate for Payer: Molina CHIP/Medicaid	$2.48
Rate for Payer: Parkland Medicaid	$2.48
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.48

INPATIENT APRDRG 3123: SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES

Facility

$3.84

Service Code	APR-DRG 3123
Hospital Charge Code	APRDRG 3123
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$3.84
Rate for Payer: Amerigroup CHIP/Medicaid	$3.84
Rate for Payer: Cigna Medicaid	$3.84
Rate for Payer: Molina CHIP/Medicaid	$3.84
Rate for Payer: Parkland Medicaid	$3.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.84

INPATIENT APRDRG 3124: SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES

Facility

$7.20

Service Code	APR-DRG 3124
Hospital Charge Code	APRDRG 3124
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Amerigroup CHIP/Medicaid	$7.20
Rate for Payer: Cigna Medicaid	$7.20
Rate for Payer: Molina CHIP/Medicaid	$7.20
Rate for Payer: Parkland Medicaid	$7.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.20

INPATIENT APRDRG 3131: KNEE & LOWER LEG PROCEDURES EXCEPT FOOT

Facility

$1.66

Service Code	APR-DRG 3131
Hospital Charge Code	APRDRG 3131
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$1.66
Rate for Payer: Amerigroup CHIP/Medicaid	$1.66
Rate for Payer: Cigna Medicaid	$1.66
Rate for Payer: Molina CHIP/Medicaid	$1.66
Rate for Payer: Parkland Medicaid	$1.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.66

INPATIENT APRDRG 3132: KNEE & LOWER LEG PROCEDURES EXCEPT FOOT

Facility

$2.28

Service Code	APR-DRG 3132
Hospital Charge Code	APRDRG 3132
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.28
Rate for Payer: Amerigroup CHIP/Medicaid	$2.28
Rate for Payer: Cigna Medicaid	$2.28
Rate for Payer: Molina CHIP/Medicaid	$2.28
Rate for Payer: Parkland Medicaid	$2.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.28

INPATIENT APRDRG 3133: KNEE & LOWER LEG PROCEDURES EXCEPT FOOT

Facility

$3.80

Service Code	APR-DRG 3133
Hospital Charge Code	APRDRG 3133
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$3.80
Rate for Payer: Amerigroup CHIP/Medicaid	$3.80
Rate for Payer: Cigna Medicaid	$3.80
Rate for Payer: Molina CHIP/Medicaid	$3.80
Rate for Payer: Parkland Medicaid	$3.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.80

INPATIENT APRDRG 3134: KNEE & LOWER LEG PROCEDURES EXCEPT FOOT

Facility

$6.57

Service Code	APR-DRG 3134
Hospital Charge Code	APRDRG 3134
Min. Negotiated Rate	$6.57
Max. Negotiated Rate	$6.57
Rate for Payer: Amerigroup CHIP/Medicaid	$6.57
Rate for Payer: Cigna Medicaid	$6.57
Rate for Payer: Molina CHIP/Medicaid	$6.57
Rate for Payer: Parkland Medicaid	$6.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.57

INPATIENT APRDRG 3141: FOOT & TOE PROCEDURES

Facility

$1.34

Service Code	APR-DRG 3141
Hospital Charge Code	APRDRG 3141
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.34
Rate for Payer: Amerigroup CHIP/Medicaid	$1.34
Rate for Payer: Cigna Medicaid	$1.34
Rate for Payer: Molina CHIP/Medicaid	$1.34
Rate for Payer: Parkland Medicaid	$1.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.34

INPATIENT APRDRG 3142: FOOT & TOE PROCEDURES

Facility

$1.63

Service Code	APR-DRG 3142
Hospital Charge Code	APRDRG 3142
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$1.63
Rate for Payer: Amerigroup CHIP/Medicaid	$1.63
Rate for Payer: Cigna Medicaid	$1.63
Rate for Payer: Molina CHIP/Medicaid	$1.63
Rate for Payer: Parkland Medicaid	$1.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.63

INPATIENT APRDRG 3143: FOOT & TOE PROCEDURES

Facility

$2.13

Service Code	APR-DRG 3143
Hospital Charge Code	APRDRG 3143
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$2.13
Rate for Payer: Amerigroup CHIP/Medicaid	$2.13
Rate for Payer: Cigna Medicaid	$2.13
Rate for Payer: Molina CHIP/Medicaid	$2.13
Rate for Payer: Parkland Medicaid	$2.13
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.13

INPATIENT APRDRG 3144: FOOT & TOE PROCEDURES

Facility

$3.81

Service Code	APR-DRG 3144
Hospital Charge Code	APRDRG 3144
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$3.81
Rate for Payer: Amerigroup CHIP/Medicaid	$3.81
Rate for Payer: Cigna Medicaid	$3.81
Rate for Payer: Molina CHIP/Medicaid	$3.81
Rate for Payer: Parkland Medicaid	$3.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.81

INPATIENT APRDRG 3151: SHOULDER, UPPER ARM & FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$1.10

Service Code	APR-DRG 3151
Hospital Charge Code	APRDRG 3151
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.10
Rate for Payer: Amerigroup CHIP/Medicaid	$1.10
Rate for Payer: Cigna Medicaid	$1.10
Rate for Payer: Molina CHIP/Medicaid	$1.10
Rate for Payer: Parkland Medicaid	$1.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.10

INPATIENT APRDRG 3152: SHOULDER, UPPER ARM & FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$1.92

Service Code	APR-DRG 3152
Hospital Charge Code	APRDRG 3152
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 3153: SHOULDER, UPPER ARM & FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$3.02

Service Code	APR-DRG 3153
Hospital Charge Code	APRDRG 3153
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$3.02
Rate for Payer: Amerigroup CHIP/Medicaid	$3.02
Rate for Payer: Cigna Medicaid	$3.02
Rate for Payer: Molina CHIP/Medicaid	$3.02
Rate for Payer: Parkland Medicaid	$3.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.02

INPATIENT APRDRG 3154: SHOULDER, UPPER ARM & FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$10.13

Service Code	APR-DRG 3154
Hospital Charge Code	APRDRG 3154
Min. Negotiated Rate	$10.13
Max. Negotiated Rate	$10.13
Rate for Payer: Amerigroup CHIP/Medicaid	$10.13
Rate for Payer: Cigna Medicaid	$10.13
Rate for Payer: Molina CHIP/Medicaid	$10.13
Rate for Payer: Parkland Medicaid	$10.13
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10.13

INPATIENT APRDRG 3161: HAND & WRIST PROCEDURES

Facility

$1.18

Service Code	APR-DRG 3161
Hospital Charge Code	APRDRG 3161
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$1.18
Rate for Payer: Amerigroup CHIP/Medicaid	$1.18
Rate for Payer: Cigna Medicaid	$1.18
Rate for Payer: Molina CHIP/Medicaid	$1.18
Rate for Payer: Parkland Medicaid	$1.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.18

INPATIENT APRDRG 3162: HAND & WRIST PROCEDURES

Facility

$1.72

Service Code	APR-DRG 3162
Hospital Charge Code	APRDRG 3162
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 3163: HAND & WRIST PROCEDURES

Facility

$1.96

Service Code	APR-DRG 3163
Hospital Charge Code	APRDRG 3163
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 3164: HAND & WRIST PROCEDURES

Facility

$5.33

Service Code	APR-DRG 3164
Hospital Charge Code	APRDRG 3164
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$5.33
Rate for Payer: Amerigroup CHIP/Medicaid	$5.33
Rate for Payer: Cigna Medicaid	$5.33
Rate for Payer: Molina CHIP/Medicaid	$5.33
Rate for Payer: Parkland Medicaid	$5.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.33

Know your out-of-pocket cost for care.

All Charges