White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 3171: TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES

Facility

$1.55

Service Code	APR-DRG 3171
Hospital Charge Code	APRDRG 3171
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$1.55
Rate for Payer: Amerigroup CHIP/Medicaid	$1.55
Rate for Payer: Cigna Medicaid	$1.55
Rate for Payer: Molina CHIP/Medicaid	$1.55
Rate for Payer: Parkland Medicaid	$1.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.55

INPATIENT APRDRG 3172: TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES

Facility

$1.81

Service Code	APR-DRG 3172
Hospital Charge Code	APRDRG 3172
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$1.81
Rate for Payer: Amerigroup CHIP/Medicaid	$1.81
Rate for Payer: Cigna Medicaid	$1.81
Rate for Payer: Molina CHIP/Medicaid	$1.81
Rate for Payer: Parkland Medicaid	$1.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.81

INPATIENT APRDRG 3173: TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES

Facility

$2.66

Service Code	APR-DRG 3173
Hospital Charge Code	APRDRG 3173
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$2.66
Rate for Payer: Amerigroup CHIP/Medicaid	$2.66
Rate for Payer: Cigna Medicaid	$2.66
Rate for Payer: Molina CHIP/Medicaid	$2.66
Rate for Payer: Parkland Medicaid	$2.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.66

INPATIENT APRDRG 3174: TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES

Facility

$4.14

Service Code	APR-DRG 3174
Hospital Charge Code	APRDRG 3174
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 3201: OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES

Facility

$1.56

Service Code	APR-DRG 3201
Hospital Charge Code	APRDRG 3201
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Amerigroup CHIP/Medicaid	$1.56
Rate for Payer: Cigna Medicaid	$1.56
Rate for Payer: Molina CHIP/Medicaid	$1.56
Rate for Payer: Parkland Medicaid	$1.56
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.56

INPATIENT APRDRG 3202: OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES

Facility

$1.88

Service Code	APR-DRG 3202
Hospital Charge Code	APRDRG 3202
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Amerigroup CHIP/Medicaid	$1.88
Rate for Payer: Cigna Medicaid	$1.88
Rate for Payer: Molina CHIP/Medicaid	$1.88
Rate for Payer: Parkland Medicaid	$1.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.88

INPATIENT APRDRG 3203: OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES

Facility

$2.99

Service Code	APR-DRG 3203
Hospital Charge Code	APRDRG 3203
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$2.99
Rate for Payer: Amerigroup CHIP/Medicaid	$2.99
Rate for Payer: Cigna Medicaid	$2.99
Rate for Payer: Molina CHIP/Medicaid	$2.99
Rate for Payer: Parkland Medicaid	$2.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.99

INPATIENT APRDRG 3204: OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES

Facility

$5.18

Service Code	APR-DRG 3204
Hospital Charge Code	APRDRG 3204
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$5.18
Rate for Payer: Amerigroup CHIP/Medicaid	$5.18
Rate for Payer: Cigna Medicaid	$5.18
Rate for Payer: Molina CHIP/Medicaid	$5.18
Rate for Payer: Parkland Medicaid	$5.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.18

INPATIENT APRDRG 3211: CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP

Facility

$2.40

Service Code	APR-DRG 3211
Hospital Charge Code	APRDRG 3211
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Amerigroup CHIP/Medicaid	$2.40
Rate for Payer: Cigna Medicaid	$2.40
Rate for Payer: Molina CHIP/Medicaid	$2.40
Rate for Payer: Parkland Medicaid	$2.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.40

INPATIENT APRDRG 3212: CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP

Facility

$3.04

Service Code	APR-DRG 3212
Hospital Charge Code	APRDRG 3212
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 3213: CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP

Facility

$3.96

Service Code	APR-DRG 3213
Hospital Charge Code	APRDRG 3213
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$3.96
Rate for Payer: Amerigroup CHIP/Medicaid	$3.96
Rate for Payer: Cigna Medicaid	$3.96
Rate for Payer: Molina CHIP/Medicaid	$3.96
Rate for Payer: Parkland Medicaid	$3.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.96

INPATIENT APRDRG 3214: CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP

Facility

$6.03

Service Code	APR-DRG 3214
Hospital Charge Code	APRDRG 3214
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 3221: SHOULDER & ELBOW JOINT REPLACEMENT

Facility

$2.17

Service Code	APR-DRG 3221
Hospital Charge Code	APRDRG 3221
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 3222: SHOULDER & ELBOW JOINT REPLACEMENT

Facility

$2.61

Service Code	APR-DRG 3222
Hospital Charge Code	APRDRG 3222
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$2.61
Rate for Payer: Amerigroup CHIP/Medicaid	$2.61
Rate for Payer: Cigna Medicaid	$2.61
Rate for Payer: Molina CHIP/Medicaid	$2.61
Rate for Payer: Parkland Medicaid	$2.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.61

INPATIENT APRDRG 3223: SHOULDER & ELBOW JOINT REPLACEMENT

Facility

$3.52

Service Code	APR-DRG 3223
Hospital Charge Code	APRDRG 3223
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$3.52
Rate for Payer: Amerigroup CHIP/Medicaid	$3.52
Rate for Payer: Cigna Medicaid	$3.52
Rate for Payer: Molina CHIP/Medicaid	$3.52
Rate for Payer: Parkland Medicaid	$3.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.52

INPATIENT APRDRG 3224: SHOULDER & ELBOW JOINT REPLACEMENT

Facility

$5.59

Service Code	APR-DRG 3224
Hospital Charge Code	APRDRG 3224
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$5.59
Rate for Payer: Amerigroup CHIP/Medicaid	$5.59
Rate for Payer: Cigna Medicaid	$5.59
Rate for Payer: Molina CHIP/Medicaid	$5.59
Rate for Payer: Parkland Medicaid	$5.59
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.59

INPATIENT APRDRG 3231: NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT

Facility

$2.01

Service Code	APR-DRG 3231
Hospital Charge Code	APRDRG 3231
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.01
Rate for Payer: Amerigroup CHIP/Medicaid	$2.01
Rate for Payer: Cigna Medicaid	$2.01
Rate for Payer: Molina CHIP/Medicaid	$2.01
Rate for Payer: Parkland Medicaid	$2.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.01

INPATIENT APRDRG 3232: NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT

Facility

$2.50

Service Code	APR-DRG 3232
Hospital Charge Code	APRDRG 3232
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Amerigroup CHIP/Medicaid	$2.50
Rate for Payer: Cigna Medicaid	$2.50
Rate for Payer: Molina CHIP/Medicaid	$2.50
Rate for Payer: Parkland Medicaid	$2.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.50

INPATIENT APRDRG 3233: NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT

Facility

$3.17

Service Code	APR-DRG 3233
Hospital Charge Code	APRDRG 3233
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Amerigroup CHIP/Medicaid	$3.17
Rate for Payer: Cigna Medicaid	$3.17
Rate for Payer: Molina CHIP/Medicaid	$3.17
Rate for Payer: Parkland Medicaid	$3.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.17

INPATIENT APRDRG 3234: NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT

Facility

$4.90

Service Code	APR-DRG 3234
Hospital Charge Code	APRDRG 3234
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$4.90
Rate for Payer: Amerigroup CHIP/Medicaid	$4.90
Rate for Payer: Cigna Medicaid	$4.90
Rate for Payer: Molina CHIP/Medicaid	$4.90
Rate for Payer: Parkland Medicaid	$4.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.90

INPATIENT APRDRG 3241: ELECTIVE HIP JOINT REPLACEMENT

Facility

$1.93

Service Code	APR-DRG 3241
Hospital Charge Code	APRDRG 3241
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 3242: ELECTIVE HIP JOINT REPLACEMENT

Facility

$2.03

Service Code	APR-DRG 3242
Hospital Charge Code	APRDRG 3242
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 3243: ELECTIVE HIP JOINT REPLACEMENT

Facility

$3.51

Service Code	APR-DRG 3243
Hospital Charge Code	APRDRG 3243
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$3.51
Rate for Payer: Amerigroup CHIP/Medicaid	$3.51
Rate for Payer: Cigna Medicaid	$3.51
Rate for Payer: Molina CHIP/Medicaid	$3.51
Rate for Payer: Parkland Medicaid	$3.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.51

INPATIENT APRDRG 3244: ELECTIVE HIP JOINT REPLACEMENT

Facility

$5.03

Service Code	APR-DRG 3244
Hospital Charge Code	APRDRG 3244
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$5.03
Rate for Payer: Amerigroup CHIP/Medicaid	$5.03
Rate for Payer: Cigna Medicaid	$5.03
Rate for Payer: Molina CHIP/Medicaid	$5.03
Rate for Payer: Parkland Medicaid	$5.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.03

INPATIENT APRDRG 3251: NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT

Facility

$2.84

Service Code	APR-DRG 3251
Hospital Charge Code	APRDRG 3251
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$2.84
Rate for Payer: Amerigroup CHIP/Medicaid	$2.84
Rate for Payer: Cigna Medicaid	$2.84
Rate for Payer: Molina CHIP/Medicaid	$2.84
Rate for Payer: Parkland Medicaid	$2.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.84

Know your out-of-pocket cost for care.

All Charges