White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 4444: RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR

Facility

$5.72

Service Code	APR-DRG 4444
Hospital Charge Code	APRDRG 4444
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$5.72
Rate for Payer: Amerigroup CHIP/Medicaid	$5.72
Rate for Payer: Cigna Medicaid	$5.72
Rate for Payer: Molina CHIP/Medicaid	$5.72
Rate for Payer: Parkland Medicaid	$5.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.72

INPATIENT APRDRG 4451: OTHER BLADDER PROCEDURES

Facility

$1.12

Service Code	APR-DRG 4451
Hospital Charge Code	APRDRG 4451
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Amerigroup CHIP/Medicaid	$1.12
Rate for Payer: Cigna Medicaid	$1.12
Rate for Payer: Molina CHIP/Medicaid	$1.12
Rate for Payer: Parkland Medicaid	$1.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.12

INPATIENT APRDRG 4452: OTHER BLADDER PROCEDURES

Facility

$1.72

Service Code	APR-DRG 4452
Hospital Charge Code	APRDRG 4452
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$1.72
Rate for Payer: Amerigroup CHIP/Medicaid	$1.72
Rate for Payer: Cigna Medicaid	$1.72
Rate for Payer: Molina CHIP/Medicaid	$1.72
Rate for Payer: Parkland Medicaid	$1.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.72

INPATIENT APRDRG 4453: OTHER BLADDER PROCEDURES

Facility

$2.64

Service Code	APR-DRG 4453
Hospital Charge Code	APRDRG 4453
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$2.64
Rate for Payer: Amerigroup CHIP/Medicaid	$2.64
Rate for Payer: Cigna Medicaid	$2.64
Rate for Payer: Molina CHIP/Medicaid	$2.64
Rate for Payer: Parkland Medicaid	$2.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.64

INPATIENT APRDRG 4454: OTHER BLADDER PROCEDURES

Facility

$5.40

Service Code	APR-DRG 4454
Hospital Charge Code	APRDRG 4454
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Amerigroup CHIP/Medicaid	$5.40
Rate for Payer: Cigna Medicaid	$5.40
Rate for Payer: Molina CHIP/Medicaid	$5.40
Rate for Payer: Parkland Medicaid	$5.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.40

INPATIENT APRDRG 4461: URETHRAL & TRANSURETHRAL PROCEDURES

Facility

$1.14

Service Code	APR-DRG 4461
Hospital Charge Code	APRDRG 4461
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 4462: URETHRAL & TRANSURETHRAL PROCEDURES

Facility

$1.34

Service Code	APR-DRG 4462
Hospital Charge Code	APRDRG 4462
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.34
Rate for Payer: Amerigroup CHIP/Medicaid	$1.34
Rate for Payer: Cigna Medicaid	$1.34
Rate for Payer: Molina CHIP/Medicaid	$1.34
Rate for Payer: Parkland Medicaid	$1.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.34

INPATIENT APRDRG 4463: URETHRAL & TRANSURETHRAL PROCEDURES

Facility

$2.45

Service Code	APR-DRG 4463
Hospital Charge Code	APRDRG 4463
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$2.45
Rate for Payer: Amerigroup CHIP/Medicaid	$2.45
Rate for Payer: Cigna Medicaid	$2.45
Rate for Payer: Molina CHIP/Medicaid	$2.45
Rate for Payer: Parkland Medicaid	$2.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.45

INPATIENT APRDRG 4464: URETHRAL & TRANSURETHRAL PROCEDURES

Facility

$4.40

Service Code	APR-DRG 4464
Hospital Charge Code	APRDRG 4464
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$4.40
Rate for Payer: Amerigroup CHIP/Medicaid	$4.40
Rate for Payer: Cigna Medicaid	$4.40
Rate for Payer: Molina CHIP/Medicaid	$4.40
Rate for Payer: Parkland Medicaid	$4.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.40

INPATIENT APRDRG 4471: OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES

Facility

$1.09

Service Code	APR-DRG 4471
Hospital Charge Code	APRDRG 4471
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 4472: OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES

Facility

$1.71

Service Code	APR-DRG 4472
Hospital Charge Code	APRDRG 4472
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$1.71
Rate for Payer: Amerigroup CHIP/Medicaid	$1.71
Rate for Payer: Cigna Medicaid	$1.71
Rate for Payer: Molina CHIP/Medicaid	$1.71
Rate for Payer: Parkland Medicaid	$1.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.71

INPATIENT APRDRG 4473: OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES

Facility

$2.77

Service Code	APR-DRG 4473
Hospital Charge Code	APRDRG 4473
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Amerigroup CHIP/Medicaid	$2.77
Rate for Payer: Cigna Medicaid	$2.77
Rate for Payer: Molina CHIP/Medicaid	$2.77
Rate for Payer: Parkland Medicaid	$2.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.77

INPATIENT APRDRG 4474: OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES

Facility

$12.40

Service Code	APR-DRG 4474
Hospital Charge Code	APRDRG 4474
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$12.40
Rate for Payer: Amerigroup CHIP/Medicaid	$12.40
Rate for Payer: Cigna Medicaid	$12.40
Rate for Payer: Molina CHIP/Medicaid	$12.40
Rate for Payer: Parkland Medicaid	$12.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.40

INPATIENT APRDRG 4611: KIDNEY & URINARY TRACT MALIGNANCY

Facility

$1.11

Service Code	APR-DRG 4611
Hospital Charge Code	APRDRG 4611
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 4612: KIDNEY & URINARY TRACT MALIGNANCY

Facility

$1.25

Service Code	APR-DRG 4612
Hospital Charge Code	APRDRG 4612
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 4613: KIDNEY & URINARY TRACT MALIGNANCY

Facility

$2.41

Service Code	APR-DRG 4613
Hospital Charge Code	APRDRG 4613
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$2.41
Rate for Payer: Amerigroup CHIP/Medicaid	$2.41
Rate for Payer: Cigna Medicaid	$2.41
Rate for Payer: Molina CHIP/Medicaid	$2.41
Rate for Payer: Parkland Medicaid	$2.41
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.41

INPATIENT APRDRG 4614: KIDNEY & URINARY TRACT MALIGNANCY

Facility

$5.19

Service Code	APR-DRG 4614
Hospital Charge Code	APRDRG 4614
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Amerigroup CHIP/Medicaid	$5.19
Rate for Payer: Cigna Medicaid	$5.19
Rate for Payer: Molina CHIP/Medicaid	$5.19
Rate for Payer: Parkland Medicaid	$5.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.19

INPATIENT APRDRG 4621: NEPHRITIS & NEPHROSIS

Facility

$0.77

Service Code	APR-DRG 4621
Hospital Charge Code	APRDRG 4621
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.77
Rate for Payer: Amerigroup CHIP/Medicaid	$0.77
Rate for Payer: Cigna Medicaid	$0.77
Rate for Payer: Molina CHIP/Medicaid	$0.77
Rate for Payer: Parkland Medicaid	$0.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.77

INPATIENT APRDRG 4622: NEPHRITIS & NEPHROSIS

Facility

$1.10

Service Code	APR-DRG 4622
Hospital Charge Code	APRDRG 4622
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.10
Rate for Payer: Amerigroup CHIP/Medicaid	$1.10
Rate for Payer: Cigna Medicaid	$1.10
Rate for Payer: Molina CHIP/Medicaid	$1.10
Rate for Payer: Parkland Medicaid	$1.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.10

INPATIENT APRDRG 4623: NEPHRITIS & NEPHROSIS

Facility

$2.50

Service Code	APR-DRG 4623
Hospital Charge Code	APRDRG 4623
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 4624: NEPHRITIS & NEPHROSIS

Facility

$5.54

Service Code	APR-DRG 4624
Hospital Charge Code	APRDRG 4624
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$5.54
Rate for Payer: Amerigroup CHIP/Medicaid	$5.54
Rate for Payer: Cigna Medicaid	$5.54
Rate for Payer: Molina CHIP/Medicaid	$5.54
Rate for Payer: Parkland Medicaid	$5.54
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.54

INPATIENT APRDRG 4631: KIDNEY & URINARY TRACT INFECTIONS

Facility

$0.52

Service Code	APR-DRG 4631
Hospital Charge Code	APRDRG 4631
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.52
Rate for Payer: Amerigroup CHIP/Medicaid	$0.52
Rate for Payer: Cigna Medicaid	$0.52
Rate for Payer: Molina CHIP/Medicaid	$0.52
Rate for Payer: Parkland Medicaid	$0.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.52

INPATIENT APRDRG 4632: KIDNEY & URINARY TRACT INFECTIONS

Facility

$0.74

Service Code	APR-DRG 4632
Hospital Charge Code	APRDRG 4632
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$0.74
Rate for Payer: Amerigroup CHIP/Medicaid	$0.74
Rate for Payer: Cigna Medicaid	$0.74
Rate for Payer: Molina CHIP/Medicaid	$0.74
Rate for Payer: Parkland Medicaid	$0.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.74

INPATIENT APRDRG 4633: KIDNEY & URINARY TRACT INFECTIONS

Facility

$1.13

Service Code	APR-DRG 4633
Hospital Charge Code	APRDRG 4633
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.13
Rate for Payer: Amerigroup CHIP/Medicaid	$1.13
Rate for Payer: Cigna Medicaid	$1.13
Rate for Payer: Molina CHIP/Medicaid	$1.13
Rate for Payer: Parkland Medicaid	$1.13
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.13

INPATIENT APRDRG 4634: KIDNEY & URINARY TRACT INFECTIONS

Facility

$2.15

Service Code	APR-DRG 4634
Hospital Charge Code	APRDRG 4634
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$2.15
Rate for Payer: Amerigroup CHIP/Medicaid	$2.15
Rate for Payer: Cigna Medicaid	$2.15
Rate for Payer: Molina CHIP/Medicaid	$2.15
Rate for Payer: Parkland Medicaid	$2.15
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.15

Know your out-of-pocket cost for care.

All Charges