White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 4651: URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION

Facility

$0.66

Service Code	APR-DRG 4651
Hospital Charge Code	APRDRG 4651
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Amerigroup CHIP/Medicaid	$0.66
Rate for Payer: Cigna Medicaid	$0.66
Rate for Payer: Molina CHIP/Medicaid	$0.66
Rate for Payer: Parkland Medicaid	$0.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.66

INPATIENT APRDRG 4652: URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION

Facility

$0.93

Service Code	APR-DRG 4652
Hospital Charge Code	APRDRG 4652
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 4653: URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION

Facility

$1.59

Service Code	APR-DRG 4653
Hospital Charge Code	APRDRG 4653
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$1.59
Rate for Payer: Amerigroup CHIP/Medicaid	$1.59
Rate for Payer: Cigna Medicaid	$1.59
Rate for Payer: Molina CHIP/Medicaid	$1.59
Rate for Payer: Parkland Medicaid	$1.59
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.59

INPATIENT APRDRG 4654: URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION

Facility

$2.84

Service Code	APR-DRG 4654
Hospital Charge Code	APRDRG 4654
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$2.84
Rate for Payer: Amerigroup CHIP/Medicaid	$2.84
Rate for Payer: Cigna Medicaid	$2.84
Rate for Payer: Molina CHIP/Medicaid	$2.84
Rate for Payer: Parkland Medicaid	$2.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.84

INPATIENT APRDRG 4661: MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC

Facility

$0.69

Service Code	APR-DRG 4661
Hospital Charge Code	APRDRG 4661
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 4662: MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC

Facility

$0.83

Service Code	APR-DRG 4662
Hospital Charge Code	APRDRG 4662
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$0.83
Rate for Payer: Amerigroup CHIP/Medicaid	$0.83
Rate for Payer: Cigna Medicaid	$0.83
Rate for Payer: Molina CHIP/Medicaid	$0.83
Rate for Payer: Parkland Medicaid	$0.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.83

INPATIENT APRDRG 4663: MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC

Facility

$1.33

Service Code	APR-DRG 4663
Hospital Charge Code	APRDRG 4663
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 4664: MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC

Facility

$2.11

Service Code	APR-DRG 4664
Hospital Charge Code	APRDRG 4664
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$2.11
Rate for Payer: Amerigroup CHIP/Medicaid	$2.11
Rate for Payer: Cigna Medicaid	$2.11
Rate for Payer: Molina CHIP/Medicaid	$2.11
Rate for Payer: Parkland Medicaid	$2.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.11

INPATIENT APRDRG 4681: OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS

Facility

$0.76

Service Code	APR-DRG 4681
Hospital Charge Code	APRDRG 4681
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.76
Rate for Payer: Amerigroup CHIP/Medicaid	$0.76
Rate for Payer: Cigna Medicaid	$0.76
Rate for Payer: Molina CHIP/Medicaid	$0.76
Rate for Payer: Parkland Medicaid	$0.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.76

INPATIENT APRDRG 4682: OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS

Facility

$0.85

Service Code	APR-DRG 4682
Hospital Charge Code	APRDRG 4682
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Amerigroup CHIP/Medicaid	$0.85
Rate for Payer: Cigna Medicaid	$0.85
Rate for Payer: Molina CHIP/Medicaid	$0.85
Rate for Payer: Parkland Medicaid	$0.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.85

INPATIENT APRDRG 4683: OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS

Facility

$1.55

Service Code	APR-DRG 4683
Hospital Charge Code	APRDRG 4683
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$1.55
Rate for Payer: Amerigroup CHIP/Medicaid	$1.55
Rate for Payer: Cigna Medicaid	$1.55
Rate for Payer: Molina CHIP/Medicaid	$1.55
Rate for Payer: Parkland Medicaid	$1.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.55

INPATIENT APRDRG 4684: OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS

Facility

$6.59

Service Code	APR-DRG 4684
Hospital Charge Code	APRDRG 4684
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$6.59
Rate for Payer: Amerigroup CHIP/Medicaid	$6.59
Rate for Payer: Cigna Medicaid	$6.59
Rate for Payer: Molina CHIP/Medicaid	$6.59
Rate for Payer: Parkland Medicaid	$6.59
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.59

INPATIENT APRDRG 4691: ACUTE KIDNEY INJURY

Facility

$0.66

Service Code	APR-DRG 4691
Hospital Charge Code	APRDRG 4691
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Amerigroup CHIP/Medicaid	$0.66
Rate for Payer: Cigna Medicaid	$0.66
Rate for Payer: Molina CHIP/Medicaid	$0.66
Rate for Payer: Parkland Medicaid	$0.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.66

INPATIENT APRDRG 4692: ACUTE KIDNEY INJURY

Facility

$0.83

Service Code	APR-DRG 4692
Hospital Charge Code	APRDRG 4692
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$0.83
Rate for Payer: Amerigroup CHIP/Medicaid	$0.83
Rate for Payer: Cigna Medicaid	$0.83
Rate for Payer: Molina CHIP/Medicaid	$0.83
Rate for Payer: Parkland Medicaid	$0.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.83

INPATIENT APRDRG 4693: ACUTE KIDNEY INJURY

Facility

$1.45

Service Code	APR-DRG 4693
Hospital Charge Code	APRDRG 4693
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 4694: ACUTE KIDNEY INJURY

Facility

$3.54

Service Code	APR-DRG 4694
Hospital Charge Code	APRDRG 4694
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$3.54
Rate for Payer: Amerigroup CHIP/Medicaid	$3.54
Rate for Payer: Cigna Medicaid	$3.54
Rate for Payer: Molina CHIP/Medicaid	$3.54
Rate for Payer: Parkland Medicaid	$3.54
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.54

INPATIENT APRDRG 4701: CHRONIC KIDNEY DISEASE

Facility

$0.93

Service Code	APR-DRG 4701
Hospital Charge Code	APRDRG 4701
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 4702: CHRONIC KIDNEY DISEASE

Facility

$1.19

Service Code	APR-DRG 4702
Hospital Charge Code	APRDRG 4702
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 4703: CHRONIC KIDNEY DISEASE

Facility

$1.45

Service Code	APR-DRG 4703
Hospital Charge Code	APRDRG 4703
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 4704: CHRONIC KIDNEY DISEASE

Facility

$2.26

Service Code	APR-DRG 4704
Hospital Charge Code	APRDRG 4704
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$2.26
Rate for Payer: Amerigroup CHIP/Medicaid	$2.26
Rate for Payer: Cigna Medicaid	$2.26
Rate for Payer: Molina CHIP/Medicaid	$2.26
Rate for Payer: Parkland Medicaid	$2.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.26

INPATIENT APRDRG 4801: MAJOR MALE PELVIC PROCEDURES

Facility

$1.71

Service Code	APR-DRG 4801
Hospital Charge Code	APRDRG 4801
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 4802: MAJOR MALE PELVIC PROCEDURES

Facility

$3.13

Service Code	APR-DRG 4802
Hospital Charge Code	APRDRG 4802
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 4803: MAJOR MALE PELVIC PROCEDURES

Facility

$3.16

Service Code	APR-DRG 4803
Hospital Charge Code	APRDRG 4803
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 4804: MAJOR MALE PELVIC PROCEDURES

Facility

$6.79

Service Code	APR-DRG 4804
Hospital Charge Code	APRDRG 4804
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$6.79
Rate for Payer: Amerigroup CHIP/Medicaid	$6.79
Rate for Payer: Cigna Medicaid	$6.79
Rate for Payer: Molina CHIP/Medicaid	$6.79
Rate for Payer: Parkland Medicaid	$6.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.79

INPATIENT APRDRG 4821: TRANSURETHRAL PROSTATECTOMY

Facility

$1.06

Service Code	APR-DRG 4821
Hospital Charge Code	APRDRG 4821
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.06
Rate for Payer: Amerigroup CHIP/Medicaid	$1.06
Rate for Payer: Cigna Medicaid	$1.06
Rate for Payer: Molina CHIP/Medicaid	$1.06
Rate for Payer: Parkland Medicaid	$1.06
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.06

Know your out-of-pocket cost for care.

All Charges