White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 4822: TRANSURETHRAL PROSTATECTOMY

Facility

$1.26

Service Code	APR-DRG 4822
Hospital Charge Code	APRDRG 4822
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$1.26
Rate for Payer: Amerigroup CHIP/Medicaid	$1.26
Rate for Payer: Cigna Medicaid	$1.26
Rate for Payer: Molina CHIP/Medicaid	$1.26
Rate for Payer: Parkland Medicaid	$1.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.26

INPATIENT APRDRG 4823: TRANSURETHRAL PROSTATECTOMY

Facility

$2.46

Service Code	APR-DRG 4823
Hospital Charge Code	APRDRG 4823
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 4824: TRANSURETHRAL PROSTATECTOMY

Facility

$4.62

Service Code	APR-DRG 4824
Hospital Charge Code	APRDRG 4824
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$4.62
Rate for Payer: Amerigroup CHIP/Medicaid	$4.62
Rate for Payer: Cigna Medicaid	$4.62
Rate for Payer: Molina CHIP/Medicaid	$4.62
Rate for Payer: Parkland Medicaid	$4.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.62

INPATIENT APRDRG 4831: PENIS, TESTES & SCROTAL PROCEDURES

Facility

$1.14

Service Code	APR-DRG 4831
Hospital Charge Code	APRDRG 4831
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 4832: PENIS, TESTES & SCROTAL PROCEDURES

Facility

$1.62

Service Code	APR-DRG 4832
Hospital Charge Code	APRDRG 4832
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$1.62
Rate for Payer: Amerigroup CHIP/Medicaid	$1.62
Rate for Payer: Cigna Medicaid	$1.62
Rate for Payer: Molina CHIP/Medicaid	$1.62
Rate for Payer: Parkland Medicaid	$1.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.62

INPATIENT APRDRG 4833: PENIS, TESTES & SCROTAL PROCEDURES

Facility

$1.88

Service Code	APR-DRG 4833
Hospital Charge Code	APRDRG 4833
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 4834: PENIS, TESTES & SCROTAL PROCEDURES

Facility

$10.01

Service Code	APR-DRG 4834
Hospital Charge Code	APRDRG 4834
Min. Negotiated Rate	$10.01
Max. Negotiated Rate	$10.01
Rate for Payer: Amerigroup CHIP/Medicaid	$10.01
Rate for Payer: Cigna Medicaid	$10.01
Rate for Payer: Molina CHIP/Medicaid	$10.01
Rate for Payer: Parkland Medicaid	$10.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10.01

INPATIENT APRDRG 4841: OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$1.79

Service Code	APR-DRG 4841
Hospital Charge Code	APRDRG 4841
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$1.79
Rate for Payer: Amerigroup CHIP/Medicaid	$1.79
Rate for Payer: Cigna Medicaid	$1.79
Rate for Payer: Molina CHIP/Medicaid	$1.79
Rate for Payer: Parkland Medicaid	$1.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.79

INPATIENT APRDRG 4842: OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$1.99

Service Code	APR-DRG 4842
Hospital Charge Code	APRDRG 4842
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$1.99
Rate for Payer: Amerigroup CHIP/Medicaid	$1.99
Rate for Payer: Cigna Medicaid	$1.99
Rate for Payer: Molina CHIP/Medicaid	$1.99
Rate for Payer: Parkland Medicaid	$1.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.99

INPATIENT APRDRG 4843: OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$2.38

Service Code	APR-DRG 4843
Hospital Charge Code	APRDRG 4843
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$2.38
Rate for Payer: Amerigroup CHIP/Medicaid	$2.38
Rate for Payer: Cigna Medicaid	$2.38
Rate for Payer: Molina CHIP/Medicaid	$2.38
Rate for Payer: Parkland Medicaid	$2.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.38

INPATIENT APRDRG 4844: OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$6.34

Service Code	APR-DRG 4844
Hospital Charge Code	APRDRG 4844
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$6.34
Rate for Payer: Amerigroup CHIP/Medicaid	$6.34
Rate for Payer: Cigna Medicaid	$6.34
Rate for Payer: Molina CHIP/Medicaid	$6.34
Rate for Payer: Parkland Medicaid	$6.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.34

INPATIENT APRDRG 5001: MALIGNANCY, MALE REPRODUCTIVE SYSTEM

Facility

$1.13

Service Code	APR-DRG 5001
Hospital Charge Code	APRDRG 5001
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 5002: MALIGNANCY, MALE REPRODUCTIVE SYSTEM

Facility

$1.38

Service Code	APR-DRG 5002
Hospital Charge Code	APRDRG 5002
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$1.38
Rate for Payer: Amerigroup CHIP/Medicaid	$1.38
Rate for Payer: Cigna Medicaid	$1.38
Rate for Payer: Molina CHIP/Medicaid	$1.38
Rate for Payer: Parkland Medicaid	$1.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.38

INPATIENT APRDRG 5003: MALIGNANCY, MALE REPRODUCTIVE SYSTEM

Facility

$2.10

Service Code	APR-DRG 5003
Hospital Charge Code	APRDRG 5003
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Amerigroup CHIP/Medicaid	$2.10
Rate for Payer: Cigna Medicaid	$2.10
Rate for Payer: Molina CHIP/Medicaid	$2.10
Rate for Payer: Parkland Medicaid	$2.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.10

INPATIENT APRDRG 5004: MALIGNANCY, MALE REPRODUCTIVE SYSTEM

Facility

$2.92

Service Code	APR-DRG 5004
Hospital Charge Code	APRDRG 5004
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$2.92
Rate for Payer: Amerigroup CHIP/Medicaid	$2.92
Rate for Payer: Cigna Medicaid	$2.92
Rate for Payer: Molina CHIP/Medicaid	$2.92
Rate for Payer: Parkland Medicaid	$2.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.92

INPATIENT APRDRG 5011: MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY

Facility

$0.50

Service Code	APR-DRG 5011
Hospital Charge Code	APRDRG 5011
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 5012: MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY

Facility

$0.83

Service Code	APR-DRG 5012
Hospital Charge Code	APRDRG 5012
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 5013: MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY

Facility

$1.23

Service Code	APR-DRG 5013
Hospital Charge Code	APRDRG 5013
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 5014: MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY

Facility

$1.64

Service Code	APR-DRG 5014
Hospital Charge Code	APRDRG 5014
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 5101: PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS

Facility

$1.22

Service Code	APR-DRG 5101
Hospital Charge Code	APRDRG 5101
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 5102: PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS

Facility

$1.53

Service Code	APR-DRG 5102
Hospital Charge Code	APRDRG 5102
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$1.53
Rate for Payer: Amerigroup CHIP/Medicaid	$1.53
Rate for Payer: Cigna Medicaid	$1.53
Rate for Payer: Molina CHIP/Medicaid	$1.53
Rate for Payer: Parkland Medicaid	$1.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.53

INPATIENT APRDRG 5103: PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS

Facility

$3.73

Service Code	APR-DRG 5103
Hospital Charge Code	APRDRG 5103
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Amerigroup CHIP/Medicaid	$3.73
Rate for Payer: Cigna Medicaid	$3.73
Rate for Payer: Molina CHIP/Medicaid	$3.73
Rate for Payer: Parkland Medicaid	$3.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.73

INPATIENT APRDRG 5104: PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS

Facility

$6.97

Service Code	APR-DRG 5104
Hospital Charge Code	APRDRG 5104
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Amerigroup CHIP/Medicaid	$6.97
Rate for Payer: Cigna Medicaid	$6.97
Rate for Payer: Molina CHIP/Medicaid	$6.97
Rate for Payer: Parkland Medicaid	$6.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.97

INPATIENT APRDRG 5111: UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY

Facility

$1.45

Service Code	APR-DRG 5111
Hospital Charge Code	APRDRG 5111
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 5112: UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY

Facility

$1.78

Service Code	APR-DRG 5112
Hospital Charge Code	APRDRG 5112
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

Know your out-of-pocket cost for care.

All Charges