White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 3624: MASTECTOMY PROCEDURES

Facility

$4.60

Service Code	APR-DRG 3624
Hospital Charge Code	APRDRG 3624
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$4.60
Rate for Payer: Amerigroup CHIP/Medicaid	$4.60
Rate for Payer: Cigna Medicaid	$4.60
Rate for Payer: Molina CHIP/Medicaid	$4.60
Rate for Payer: Parkland Medicaid	$4.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.60

INPATIENT APRDRG 3631: BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$1.19

Service Code	APR-DRG 3631
Hospital Charge Code	APRDRG 3631
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 3632: BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$2.33

Service Code	APR-DRG 3632
Hospital Charge Code	APRDRG 3632
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$2.33
Rate for Payer: Amerigroup CHIP/Medicaid	$2.33
Rate for Payer: Cigna Medicaid	$2.33
Rate for Payer: Molina CHIP/Medicaid	$2.33
Rate for Payer: Parkland Medicaid	$2.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.33

INPATIENT APRDRG 3633: BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$3.38

Service Code	APR-DRG 3633
Hospital Charge Code	APRDRG 3633
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Amerigroup CHIP/Medicaid	$3.38
Rate for Payer: Cigna Medicaid	$3.38
Rate for Payer: Molina CHIP/Medicaid	$3.38
Rate for Payer: Parkland Medicaid	$3.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.38

INPATIENT APRDRG 3634: BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$4.57

Service Code	APR-DRG 3634
Hospital Charge Code	APRDRG 3634
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$4.57
Rate for Payer: Amerigroup CHIP/Medicaid	$4.57
Rate for Payer: Cigna Medicaid	$4.57
Rate for Payer: Molina CHIP/Medicaid	$4.57
Rate for Payer: Parkland Medicaid	$4.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.57

INPATIENT APRDRG 3641: OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES

Facility

$0.86

Service Code	APR-DRG 3641
Hospital Charge Code	APRDRG 3641
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Amerigroup CHIP/Medicaid	$0.86
Rate for Payer: Cigna Medicaid	$0.86
Rate for Payer: Molina CHIP/Medicaid	$0.86
Rate for Payer: Parkland Medicaid	$0.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.86

INPATIENT APRDRG 3642: OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES

Facility

$1.33

Service Code	APR-DRG 3642
Hospital Charge Code	APRDRG 3642
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$1.33
Rate for Payer: Amerigroup CHIP/Medicaid	$1.33
Rate for Payer: Cigna Medicaid	$1.33
Rate for Payer: Molina CHIP/Medicaid	$1.33
Rate for Payer: Parkland Medicaid	$1.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.33

INPATIENT APRDRG 3643: OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES

Facility

$2.46

Service Code	APR-DRG 3643
Hospital Charge Code	APRDRG 3643
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.46
Rate for Payer: Amerigroup CHIP/Medicaid	$2.46
Rate for Payer: Cigna Medicaid	$2.46
Rate for Payer: Molina CHIP/Medicaid	$2.46
Rate for Payer: Parkland Medicaid	$2.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.46

INPATIENT APRDRG 3644: OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES

Facility

$4.93

Service Code	APR-DRG 3644
Hospital Charge Code	APRDRG 3644
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$4.93
Rate for Payer: Amerigroup CHIP/Medicaid	$4.93
Rate for Payer: Cigna Medicaid	$4.93
Rate for Payer: Molina CHIP/Medicaid	$4.93
Rate for Payer: Parkland Medicaid	$4.93
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.93

INPATIENT APRDRG 3801: SKIN ULCERS

Facility

$0.69

Service Code	APR-DRG 3801
Hospital Charge Code	APRDRG 3801
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: Cigna Medicaid	$0.69
Rate for Payer: Molina CHIP/Medicaid	$0.69
Rate for Payer: Parkland Medicaid	$0.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.69

INPATIENT APRDRG 3802: SKIN ULCERS

Facility

$0.90

Service Code	APR-DRG 3802
Hospital Charge Code	APRDRG 3802
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Amerigroup CHIP/Medicaid	$0.90
Rate for Payer: Cigna Medicaid	$0.90
Rate for Payer: Molina CHIP/Medicaid	$0.90
Rate for Payer: Parkland Medicaid	$0.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.90

INPATIENT APRDRG 3803: SKIN ULCERS

Facility

$1.29

Service Code	APR-DRG 3803
Hospital Charge Code	APRDRG 3803
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 3804: SKIN ULCERS

Facility

$3.87

Service Code	APR-DRG 3804
Hospital Charge Code	APRDRG 3804
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$3.87
Rate for Payer: Amerigroup CHIP/Medicaid	$3.87
Rate for Payer: Cigna Medicaid	$3.87
Rate for Payer: Molina CHIP/Medicaid	$3.87
Rate for Payer: Parkland Medicaid	$3.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.87

INPATIENT APRDRG 3811: MAJOR SKIN DISORDERS

Facility

$0.44

Service Code	APR-DRG 3811
Hospital Charge Code	APRDRG 3811
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.44
Rate for Payer: Amerigroup CHIP/Medicaid	$0.44
Rate for Payer: Cigna Medicaid	$0.44
Rate for Payer: Molina CHIP/Medicaid	$0.44
Rate for Payer: Parkland Medicaid	$0.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.44

INPATIENT APRDRG 3812: MAJOR SKIN DISORDERS

Facility

$0.79

Service Code	APR-DRG 3812
Hospital Charge Code	APRDRG 3812
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Amerigroup CHIP/Medicaid	$0.79
Rate for Payer: Cigna Medicaid	$0.79
Rate for Payer: Molina CHIP/Medicaid	$0.79
Rate for Payer: Parkland Medicaid	$0.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.79

INPATIENT APRDRG 3813: MAJOR SKIN DISORDERS

Facility

$1.42

Service Code	APR-DRG 3813
Hospital Charge Code	APRDRG 3813
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$1.42
Rate for Payer: Amerigroup CHIP/Medicaid	$1.42
Rate for Payer: Cigna Medicaid	$1.42
Rate for Payer: Molina CHIP/Medicaid	$1.42
Rate for Payer: Parkland Medicaid	$1.42
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.42

INPATIENT APRDRG 3814: MAJOR SKIN DISORDERS

Facility

$5.34

Service Code	APR-DRG 3814
Hospital Charge Code	APRDRG 3814
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$5.34
Rate for Payer: Amerigroup CHIP/Medicaid	$5.34
Rate for Payer: Cigna Medicaid	$5.34
Rate for Payer: Molina CHIP/Medicaid	$5.34
Rate for Payer: Parkland Medicaid	$5.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.34

INPATIENT APRDRG 3821: MALIGNANT BREAST DISORDERS

Facility

$0.82

Service Code	APR-DRG 3821
Hospital Charge Code	APRDRG 3821
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.82
Rate for Payer: Amerigroup CHIP/Medicaid	$0.82
Rate for Payer: Cigna Medicaid	$0.82
Rate for Payer: Molina CHIP/Medicaid	$0.82
Rate for Payer: Parkland Medicaid	$0.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.82

INPATIENT APRDRG 3822: MALIGNANT BREAST DISORDERS

Facility

$1.08

Service Code	APR-DRG 3822
Hospital Charge Code	APRDRG 3822
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.08
Rate for Payer: Amerigroup CHIP/Medicaid	$1.08
Rate for Payer: Cigna Medicaid	$1.08
Rate for Payer: Molina CHIP/Medicaid	$1.08
Rate for Payer: Parkland Medicaid	$1.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.08

INPATIENT APRDRG 3823: MALIGNANT BREAST DISORDERS

Facility

$1.66

Service Code	APR-DRG 3823
Hospital Charge Code	APRDRG 3823
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 3824: MALIGNANT BREAST DISORDERS

Facility

$3.14

Service Code	APR-DRG 3824
Hospital Charge Code	APRDRG 3824
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$3.14
Rate for Payer: Amerigroup CHIP/Medicaid	$3.14
Rate for Payer: Cigna Medicaid	$3.14
Rate for Payer: Molina CHIP/Medicaid	$3.14
Rate for Payer: Parkland Medicaid	$3.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.14

INPATIENT APRDRG 3831: CELLULITIS & OTHER SKIN INFECTIONS

Facility

$0.51

Service Code	APR-DRG 3831
Hospital Charge Code	APRDRG 3831
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.51
Rate for Payer: Amerigroup CHIP/Medicaid	$0.51
Rate for Payer: Cigna Medicaid	$0.51
Rate for Payer: Molina CHIP/Medicaid	$0.51
Rate for Payer: Parkland Medicaid	$0.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.51

INPATIENT APRDRG 3832: CELLULITIS & OTHER SKIN INFECTIONS

Facility

$0.78

Service Code	APR-DRG 3832
Hospital Charge Code	APRDRG 3832
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$0.78
Rate for Payer: Amerigroup CHIP/Medicaid	$0.78
Rate for Payer: Cigna Medicaid	$0.78
Rate for Payer: Molina CHIP/Medicaid	$0.78
Rate for Payer: Parkland Medicaid	$0.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.78

INPATIENT APRDRG 3833: CELLULITIS & OTHER SKIN INFECTIONS

Facility

$1.23

Service Code	APR-DRG 3833
Hospital Charge Code	APRDRG 3833
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.23
Rate for Payer: Amerigroup CHIP/Medicaid	$1.23
Rate for Payer: Cigna Medicaid	$1.23
Rate for Payer: Molina CHIP/Medicaid	$1.23
Rate for Payer: Parkland Medicaid	$1.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.23

INPATIENT APRDRG 3834: CELLULITIS & OTHER SKIN INFECTIONS

Facility

$3.43

Service Code	APR-DRG 3834
Hospital Charge Code	APRDRG 3834
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$3.43
Rate for Payer: Amerigroup CHIP/Medicaid	$3.43
Rate for Payer: Cigna Medicaid	$3.43
Rate for Payer: Molina CHIP/Medicaid	$3.43
Rate for Payer: Parkland Medicaid	$3.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.43

Know your out-of-pocket cost for care.

All Charges