White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 3443: OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS

Facility

$1.65

Service Code	APR-DRG 3443
Hospital Charge Code	APRDRG 3443
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$1.65
Rate for Payer: Amerigroup CHIP/Medicaid	$1.65
Rate for Payer: Cigna Medicaid	$1.65
Rate for Payer: Molina CHIP/Medicaid	$1.65
Rate for Payer: Parkland Medicaid	$1.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.65

INPATIENT APRDRG 3444: OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS

Facility

$3.16

Service Code	APR-DRG 3444
Hospital Charge Code	APRDRG 3444
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$3.16
Rate for Payer: Amerigroup CHIP/Medicaid	$3.16
Rate for Payer: Cigna Medicaid	$3.16
Rate for Payer: Molina CHIP/Medicaid	$3.16
Rate for Payer: Parkland Medicaid	$3.16
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.16

INPATIENT APRDRG 3461: CONNECTIVE TISSUE DISORDERS

Facility

$1.11

Service Code	APR-DRG 3461
Hospital Charge Code	APRDRG 3461
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 3462: CONNECTIVE TISSUE DISORDERS

Facility

$1.46

Service Code	APR-DRG 3462
Hospital Charge Code	APRDRG 3462
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$1.46
Rate for Payer: Amerigroup CHIP/Medicaid	$1.46
Rate for Payer: Cigna Medicaid	$1.46
Rate for Payer: Molina CHIP/Medicaid	$1.46
Rate for Payer: Parkland Medicaid	$1.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.46

INPATIENT APRDRG 3463: CONNECTIVE TISSUE DISORDERS

Facility

$2.87

Service Code	APR-DRG 3463
Hospital Charge Code	APRDRG 3463
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 3464: CONNECTIVE TISSUE DISORDERS

Facility

$6.71

Service Code	APR-DRG 3464
Hospital Charge Code	APRDRG 3464
Min. Negotiated Rate	$6.71
Max. Negotiated Rate	$6.71
Rate for Payer: Amerigroup CHIP/Medicaid	$6.71
Rate for Payer: Cigna Medicaid	$6.71
Rate for Payer: Molina CHIP/Medicaid	$6.71
Rate for Payer: Parkland Medicaid	$6.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.71

INPATIENT APRDRG 3471: OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES

Facility

$0.89

Service Code	APR-DRG 3471
Hospital Charge Code	APRDRG 3471
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Amerigroup CHIP/Medicaid	$0.89
Rate for Payer: Cigna Medicaid	$0.89
Rate for Payer: Molina CHIP/Medicaid	$0.89
Rate for Payer: Parkland Medicaid	$0.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.89

INPATIENT APRDRG 3472: OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES

Facility

$1.29

Service Code	APR-DRG 3472
Hospital Charge Code	APRDRG 3472
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.29
Rate for Payer: Amerigroup CHIP/Medicaid	$1.29
Rate for Payer: Cigna Medicaid	$1.29
Rate for Payer: Molina CHIP/Medicaid	$1.29
Rate for Payer: Parkland Medicaid	$1.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.29

INPATIENT APRDRG 3473: OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES

Facility

$1.64

Service Code	APR-DRG 3473
Hospital Charge Code	APRDRG 3473
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 3474: OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES

Facility

$3.82

Service Code	APR-DRG 3474
Hospital Charge Code	APRDRG 3474
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$3.82
Rate for Payer: Amerigroup CHIP/Medicaid	$3.82
Rate for Payer: Cigna Medicaid	$3.82
Rate for Payer: Molina CHIP/Medicaid	$3.82
Rate for Payer: Parkland Medicaid	$3.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.82

INPATIENT APRDRG 3491: MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$0.61

Service Code	APR-DRG 3491
Hospital Charge Code	APRDRG 3491
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Amerigroup CHIP/Medicaid	$0.61
Rate for Payer: Cigna Medicaid	$0.61
Rate for Payer: Molina CHIP/Medicaid	$0.61
Rate for Payer: Parkland Medicaid	$0.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.61

INPATIENT APRDRG 3492: MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$1.09

Service Code	APR-DRG 3492
Hospital Charge Code	APRDRG 3492
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Amerigroup CHIP/Medicaid	$1.09
Rate for Payer: Cigna Medicaid	$1.09
Rate for Payer: Molina CHIP/Medicaid	$1.09
Rate for Payer: Parkland Medicaid	$1.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.09

INPATIENT APRDRG 3493: MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$1.43

Service Code	APR-DRG 3493
Hospital Charge Code	APRDRG 3493
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Amerigroup CHIP/Medicaid	$1.43
Rate for Payer: Cigna Medicaid	$1.43
Rate for Payer: Molina CHIP/Medicaid	$1.43
Rate for Payer: Parkland Medicaid	$1.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.43

INPATIENT APRDRG 3494: MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$3.00

Service Code	APR-DRG 3494
Hospital Charge Code	APRDRG 3494
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 3511: OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES

Facility

$0.80

Service Code	APR-DRG 3511
Hospital Charge Code	APRDRG 3511
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 3512: OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES

Facility

$0.93

Service Code	APR-DRG 3512
Hospital Charge Code	APRDRG 3512
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 3513: OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES

Facility

$1.66

Service Code	APR-DRG 3513
Hospital Charge Code	APRDRG 3513
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 3514: OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES

Facility

$4.82

Service Code	APR-DRG 3514
Hospital Charge Code	APRDRG 3514
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$4.82
Rate for Payer: Amerigroup CHIP/Medicaid	$4.82
Rate for Payer: Cigna Medicaid	$4.82
Rate for Payer: Molina CHIP/Medicaid	$4.82
Rate for Payer: Parkland Medicaid	$4.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.82

INPATIENT APRDRG 3611: SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$1.88

Service Code	APR-DRG 3611
Hospital Charge Code	APRDRG 3611
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 3612: SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$3.52

Service Code	APR-DRG 3612
Hospital Charge Code	APRDRG 3612
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 3613: SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$3.92

Service Code	APR-DRG 3613
Hospital Charge Code	APRDRG 3613
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$3.92
Rate for Payer: Amerigroup CHIP/Medicaid	$3.92
Rate for Payer: Cigna Medicaid	$3.92
Rate for Payer: Molina CHIP/Medicaid	$3.92
Rate for Payer: Parkland Medicaid	$3.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.92

INPATIENT APRDRG 3614: SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$9.05

Service Code	APR-DRG 3614
Hospital Charge Code	APRDRG 3614
Min. Negotiated Rate	$9.05
Max. Negotiated Rate	$9.05
Rate for Payer: Amerigroup CHIP/Medicaid	$9.05
Rate for Payer: Cigna Medicaid	$9.05
Rate for Payer: Molina CHIP/Medicaid	$9.05
Rate for Payer: Parkland Medicaid	$9.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.05

INPATIENT APRDRG 3621: MASTECTOMY PROCEDURES

Facility

$1.78

Service Code	APR-DRG 3621
Hospital Charge Code	APRDRG 3621
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$1.78
Rate for Payer: Amerigroup CHIP/Medicaid	$1.78
Rate for Payer: Cigna Medicaid	$1.78
Rate for Payer: Molina CHIP/Medicaid	$1.78
Rate for Payer: Parkland Medicaid	$1.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.78

INPATIENT APRDRG 3622: MASTECTOMY PROCEDURES

Facility

$2.89

Service Code	APR-DRG 3622
Hospital Charge Code	APRDRG 3622
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Amerigroup CHIP/Medicaid	$2.89
Rate for Payer: Cigna Medicaid	$2.89
Rate for Payer: Molina CHIP/Medicaid	$2.89
Rate for Payer: Parkland Medicaid	$2.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.89

INPATIENT APRDRG 3623: MASTECTOMY PROCEDURES

Facility

$2.94

Service Code	APR-DRG 3623
Hospital Charge Code	APRDRG 3623
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$2.94
Rate for Payer: Amerigroup CHIP/Medicaid	$2.94
Rate for Payer: Cigna Medicaid	$2.94
Rate for Payer: Molina CHIP/Medicaid	$2.94
Rate for Payer: Parkland Medicaid	$2.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.94

Know your out-of-pocket cost for care.

All Charges