White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 3252: NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT

Facility

$3.10

Service Code	APR-DRG 3252
Hospital Charge Code	APRDRG 3252
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$3.10
Rate for Payer: Amerigroup CHIP/Medicaid	$3.10
Rate for Payer: Cigna Medicaid	$3.10
Rate for Payer: Molina CHIP/Medicaid	$3.10
Rate for Payer: Parkland Medicaid	$3.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.10

INPATIENT APRDRG 3253: NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT

Facility

$3.61

Service Code	APR-DRG 3253
Hospital Charge Code	APRDRG 3253
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$3.61
Rate for Payer: Amerigroup CHIP/Medicaid	$3.61
Rate for Payer: Cigna Medicaid	$3.61
Rate for Payer: Molina CHIP/Medicaid	$3.61
Rate for Payer: Parkland Medicaid	$3.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.61

INPATIENT APRDRG 3254: NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT

Facility

$6.19

Service Code	APR-DRG 3254
Hospital Charge Code	APRDRG 3254
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$6.19
Rate for Payer: Amerigroup CHIP/Medicaid	$6.19
Rate for Payer: Cigna Medicaid	$6.19
Rate for Payer: Molina CHIP/Medicaid	$6.19
Rate for Payer: Parkland Medicaid	$6.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.19

INPATIENT APRDRG 3261: ELECTIVE KNEE JOINT REPLACEMENT

Facility

$1.77

Service Code	APR-DRG 3261
Hospital Charge Code	APRDRG 3261
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$1.77
Rate for Payer: Amerigroup CHIP/Medicaid	$1.77
Rate for Payer: Cigna Medicaid	$1.77
Rate for Payer: Molina CHIP/Medicaid	$1.77
Rate for Payer: Parkland Medicaid	$1.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.77

INPATIENT APRDRG 3262: ELECTIVE KNEE JOINT REPLACEMENT

Facility

$1.88

Service Code	APR-DRG 3262
Hospital Charge Code	APRDRG 3262
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 3263: ELECTIVE KNEE JOINT REPLACEMENT

Facility

$2.60

Service Code	APR-DRG 3263
Hospital Charge Code	APRDRG 3263
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$2.60
Rate for Payer: Amerigroup CHIP/Medicaid	$2.60
Rate for Payer: Cigna Medicaid	$2.60
Rate for Payer: Molina CHIP/Medicaid	$2.60
Rate for Payer: Parkland Medicaid	$2.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.60

INPATIENT APRDRG 3264: ELECTIVE KNEE JOINT REPLACEMENT

Facility

$4.36

Service Code	APR-DRG 3264
Hospital Charge Code	APRDRG 3264
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 3401: FRACTURE OF FEMUR

Facility

$0.50

Service Code	APR-DRG 3401
Hospital Charge Code	APRDRG 3401
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Amerigroup CHIP/Medicaid	$0.50
Rate for Payer: Cigna Medicaid	$0.50
Rate for Payer: Molina CHIP/Medicaid	$0.50
Rate for Payer: Parkland Medicaid	$0.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.50

INPATIENT APRDRG 3402: FRACTURE OF FEMUR

Facility

$0.81

Service Code	APR-DRG 3402
Hospital Charge Code	APRDRG 3402
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Amerigroup CHIP/Medicaid	$0.81
Rate for Payer: Cigna Medicaid	$0.81
Rate for Payer: Molina CHIP/Medicaid	$0.81
Rate for Payer: Parkland Medicaid	$0.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.81

INPATIENT APRDRG 3403: FRACTURE OF FEMUR

Facility

$1.36

Service Code	APR-DRG 3403
Hospital Charge Code	APRDRG 3403
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$1.36
Rate for Payer: Amerigroup CHIP/Medicaid	$1.36
Rate for Payer: Cigna Medicaid	$1.36
Rate for Payer: Molina CHIP/Medicaid	$1.36
Rate for Payer: Parkland Medicaid	$1.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.36

INPATIENT APRDRG 3404: FRACTURE OF FEMUR

Facility

$3.00

Service Code	APR-DRG 3404
Hospital Charge Code	APRDRG 3404
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Amerigroup CHIP/Medicaid	$3.00
Rate for Payer: Cigna Medicaid	$3.00
Rate for Payer: Molina CHIP/Medicaid	$3.00
Rate for Payer: Parkland Medicaid	$3.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.00

INPATIENT APRDRG 3411: FRACTURE OF PELVIS OR DISLOCATION OF HIP

Facility

$0.68

Service Code	APR-DRG 3411
Hospital Charge Code	APRDRG 3411
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Amerigroup CHIP/Medicaid	$0.68
Rate for Payer: Cigna Medicaid	$0.68
Rate for Payer: Molina CHIP/Medicaid	$0.68
Rate for Payer: Parkland Medicaid	$0.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.68

INPATIENT APRDRG 3412: FRACTURE OF PELVIS OR DISLOCATION OF HIP

Facility

$1.05

Service Code	APR-DRG 3412
Hospital Charge Code	APRDRG 3412
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 3413: FRACTURE OF PELVIS OR DISLOCATION OF HIP

Facility

$1.25

Service Code	APR-DRG 3413
Hospital Charge Code	APRDRG 3413
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.25
Rate for Payer: Amerigroup CHIP/Medicaid	$1.25
Rate for Payer: Cigna Medicaid	$1.25
Rate for Payer: Molina CHIP/Medicaid	$1.25
Rate for Payer: Parkland Medicaid	$1.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.25

INPATIENT APRDRG 3414: FRACTURE OF PELVIS OR DISLOCATION OF HIP

Facility

$2.52

Service Code	APR-DRG 3414
Hospital Charge Code	APRDRG 3414
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$2.52
Rate for Payer: Amerigroup CHIP/Medicaid	$2.52
Rate for Payer: Cigna Medicaid	$2.52
Rate for Payer: Molina CHIP/Medicaid	$2.52
Rate for Payer: Parkland Medicaid	$2.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.52

INPATIENT APRDRG 3421: FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK

Facility

$0.72

Service Code	APR-DRG 3421
Hospital Charge Code	APRDRG 3421
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.72
Rate for Payer: Amerigroup CHIP/Medicaid	$0.72
Rate for Payer: Cigna Medicaid	$0.72
Rate for Payer: Molina CHIP/Medicaid	$0.72
Rate for Payer: Parkland Medicaid	$0.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.72

INPATIENT APRDRG 3422: FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK

Facility

$0.80

Service Code	APR-DRG 3422
Hospital Charge Code	APRDRG 3422
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Amerigroup CHIP/Medicaid	$0.80
Rate for Payer: Cigna Medicaid	$0.80
Rate for Payer: Molina CHIP/Medicaid	$0.80
Rate for Payer: Parkland Medicaid	$0.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.80

INPATIENT APRDRG 3423: FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK

Facility

$1.60

Service Code	APR-DRG 3423
Hospital Charge Code	APRDRG 3423
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 3424: FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK

Facility

$2.19

Service Code	APR-DRG 3424
Hospital Charge Code	APRDRG 3424
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$2.19
Rate for Payer: Amerigroup CHIP/Medicaid	$2.19
Rate for Payer: Cigna Medicaid	$2.19
Rate for Payer: Molina CHIP/Medicaid	$2.19
Rate for Payer: Parkland Medicaid	$2.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.19

INPATIENT APRDRG 3431: MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG

Facility

$1.45

Service Code	APR-DRG 3431
Hospital Charge Code	APRDRG 3431
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Amerigroup CHIP/Medicaid	$1.45
Rate for Payer: Cigna Medicaid	$1.45
Rate for Payer: Molina CHIP/Medicaid	$1.45
Rate for Payer: Parkland Medicaid	$1.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.45

INPATIENT APRDRG 3432: MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG

Facility

$1.77

Service Code	APR-DRG 3432
Hospital Charge Code	APRDRG 3432
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$1.77
Rate for Payer: Amerigroup CHIP/Medicaid	$1.77
Rate for Payer: Cigna Medicaid	$1.77
Rate for Payer: Molina CHIP/Medicaid	$1.77
Rate for Payer: Parkland Medicaid	$1.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.77

INPATIENT APRDRG 3433: MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG

Facility

$2.10

Service Code	APR-DRG 3433
Hospital Charge Code	APRDRG 3433
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Amerigroup CHIP/Medicaid	$2.10
Rate for Payer: Cigna Medicaid	$2.10
Rate for Payer: Molina CHIP/Medicaid	$2.10
Rate for Payer: Parkland Medicaid	$2.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.10

INPATIENT APRDRG 3434: MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG

Facility

$5.18

Service Code	APR-DRG 3434
Hospital Charge Code	APRDRG 3434
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 3441: OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS

Facility

$0.94

Service Code	APR-DRG 3441
Hospital Charge Code	APRDRG 3441
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 3442: OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS

Facility

$1.18

Service Code	APR-DRG 3442
Hospital Charge Code	APRDRG 3442
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

Know your out-of-pocket cost for care.

All Charges