White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 4263: NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$1.22

Service Code	APR-DRG 4263
Hospital Charge Code	APRDRG 4263
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$1.22
Rate for Payer: Amerigroup CHIP/Medicaid	$1.22
Rate for Payer: Cigna Medicaid	$1.22
Rate for Payer: Molina CHIP/Medicaid	$1.22
Rate for Payer: Parkland Medicaid	$1.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.22

INPATIENT APRDRG 4264: NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$2.94

Service Code	APR-DRG 4264
Hospital Charge Code	APRDRG 4264
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

INPATIENT APRDRG 4271: THYROID DISORDERS

Facility

$0.50

Service Code	APR-DRG 4271
Hospital Charge Code	APRDRG 4271
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 4272: THYROID DISORDERS

Facility

$0.80

Service Code	APR-DRG 4272
Hospital Charge Code	APRDRG 4272
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 4273: THYROID DISORDERS

Facility

$0.93

Service Code	APR-DRG 4273
Hospital Charge Code	APRDRG 4273
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 4274: THYROID DISORDERS

Facility

$3.13

Service Code	APR-DRG 4274
Hospital Charge Code	APRDRG 4274
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$3.13
Rate for Payer: Amerigroup CHIP/Medicaid	$3.13
Rate for Payer: Cigna Medicaid	$3.13
Rate for Payer: Molina CHIP/Medicaid	$3.13
Rate for Payer: Parkland Medicaid	$3.13
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.13

INPATIENT APRDRG 4401: KIDNEY TRANSPLANT

Facility

$6.11

Service Code	APR-DRG 4401
Hospital Charge Code	APRDRG 4401
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$6.11
Rate for Payer: Amerigroup CHIP/Medicaid	$6.11
Rate for Payer: Cigna Medicaid	$6.11
Rate for Payer: Molina CHIP/Medicaid	$6.11
Rate for Payer: Parkland Medicaid	$6.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.11

INPATIENT APRDRG 4402: KIDNEY TRANSPLANT

Facility

$6.51

Service Code	APR-DRG 4402
Hospital Charge Code	APRDRG 4402
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$6.51
Rate for Payer: Amerigroup CHIP/Medicaid	$6.51
Rate for Payer: Cigna Medicaid	$6.51
Rate for Payer: Molina CHIP/Medicaid	$6.51
Rate for Payer: Parkland Medicaid	$6.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.51

INPATIENT APRDRG 4403: KIDNEY TRANSPLANT

Facility

$10.13

Service Code	APR-DRG 4403
Hospital Charge Code	APRDRG 4403
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 4404: KIDNEY TRANSPLANT

Facility

$16.55

Service Code	APR-DRG 4404
Hospital Charge Code	APRDRG 4404
Min. Negotiated Rate	$16.55
Max. Negotiated Rate	$16.55
Rate for Payer: Amerigroup CHIP/Medicaid	$16.55
Rate for Payer: Cigna Medicaid	$16.55
Rate for Payer: Molina CHIP/Medicaid	$16.55
Rate for Payer: Parkland Medicaid	$16.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16.55

INPATIENT APRDRG 4411: MAJOR BLADDER PROCEDURES

Facility

$1.92

Service Code	APR-DRG 4411
Hospital Charge Code	APRDRG 4411
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 4412: MAJOR BLADDER PROCEDURES

Facility

$2.99

Service Code	APR-DRG 4412
Hospital Charge Code	APRDRG 4412
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 4413: MAJOR BLADDER PROCEDURES

Facility

$3.79

Service Code	APR-DRG 4413
Hospital Charge Code	APRDRG 4413
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$3.79
Rate for Payer: Amerigroup CHIP/Medicaid	$3.79
Rate for Payer: Cigna Medicaid	$3.79
Rate for Payer: Molina CHIP/Medicaid	$3.79
Rate for Payer: Parkland Medicaid	$3.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.79

INPATIENT APRDRG 4414: MAJOR BLADDER PROCEDURES

Facility

$15.66

Service Code	APR-DRG 4414
Hospital Charge Code	APRDRG 4414
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$15.66
Rate for Payer: Amerigroup CHIP/Medicaid	$15.66
Rate for Payer: Cigna Medicaid	$15.66
Rate for Payer: Molina CHIP/Medicaid	$15.66
Rate for Payer: Parkland Medicaid	$15.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$15.66

INPATIENT APRDRG 4421: KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY

Facility

$1.87

Service Code	APR-DRG 4421
Hospital Charge Code	APRDRG 4421
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1.87
Rate for Payer: Amerigroup CHIP/Medicaid	$1.87
Rate for Payer: Cigna Medicaid	$1.87
Rate for Payer: Molina CHIP/Medicaid	$1.87
Rate for Payer: Parkland Medicaid	$1.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.87

INPATIENT APRDRG 4422: KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY

Facility

$2.20

Service Code	APR-DRG 4422
Hospital Charge Code	APRDRG 4422
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$2.20
Rate for Payer: Amerigroup CHIP/Medicaid	$2.20
Rate for Payer: Cigna Medicaid	$2.20
Rate for Payer: Molina CHIP/Medicaid	$2.20
Rate for Payer: Parkland Medicaid	$2.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.20

INPATIENT APRDRG 4423: KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY

Facility

$3.52

Service Code	APR-DRG 4423
Hospital Charge Code	APRDRG 4423
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 4424: KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY

Facility

$10.47

Service Code	APR-DRG 4424
Hospital Charge Code	APRDRG 4424
Min. Negotiated Rate	$10.47
Max. Negotiated Rate	$10.47
Rate for Payer: Amerigroup CHIP/Medicaid	$10.47
Rate for Payer: Cigna Medicaid	$10.47
Rate for Payer: Molina CHIP/Medicaid	$10.47
Rate for Payer: Parkland Medicaid	$10.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10.47

INPATIENT APRDRG 4431: KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY

Facility

$1.33

Service Code	APR-DRG 4431
Hospital Charge Code	APRDRG 4431
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 4432: KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY

Facility

$1.84

Service Code	APR-DRG 4432
Hospital Charge Code	APRDRG 4432
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$1.84
Rate for Payer: Amerigroup CHIP/Medicaid	$1.84
Rate for Payer: Cigna Medicaid	$1.84
Rate for Payer: Molina CHIP/Medicaid	$1.84
Rate for Payer: Parkland Medicaid	$1.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.84

INPATIENT APRDRG 4433: KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY

Facility

$2.89

Service Code	APR-DRG 4433
Hospital Charge Code	APRDRG 4433
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 4434: KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY

Facility

$6.64

Service Code	APR-DRG 4434
Hospital Charge Code	APRDRG 4434
Min. Negotiated Rate	$6.64
Max. Negotiated Rate	$6.64
Rate for Payer: Amerigroup CHIP/Medicaid	$6.64
Rate for Payer: Cigna Medicaid	$6.64
Rate for Payer: Molina CHIP/Medicaid	$6.64
Rate for Payer: Parkland Medicaid	$6.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.64

INPATIENT APRDRG 4441: RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR

Facility

$1.14

Service Code	APR-DRG 4441
Hospital Charge Code	APRDRG 4441
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.14
Rate for Payer: Amerigroup CHIP/Medicaid	$1.14
Rate for Payer: Cigna Medicaid	$1.14
Rate for Payer: Molina CHIP/Medicaid	$1.14
Rate for Payer: Parkland Medicaid	$1.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.14

INPATIENT APRDRG 4442: RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR

Facility

$1.65

Service Code	APR-DRG 4442
Hospital Charge Code	APRDRG 4442
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 4443: RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR

Facility

$2.90

Service Code	APR-DRG 4443
Hospital Charge Code	APRDRG 4443
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Amerigroup CHIP/Medicaid	$2.90
Rate for Payer: Cigna Medicaid	$2.90
Rate for Payer: Molina CHIP/Medicaid	$2.90
Rate for Payer: Parkland Medicaid	$2.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.90

Know your out-of-pocket cost for care.

All Charges