White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 5113: UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY

Facility

$3.31

Service Code	APR-DRG 5113
Hospital Charge Code	APRDRG 5113
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$3.31
Rate for Payer: Amerigroup CHIP/Medicaid	$3.31
Rate for Payer: Cigna Medicaid	$3.31
Rate for Payer: Molina CHIP/Medicaid	$3.31
Rate for Payer: Parkland Medicaid	$3.31
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.31

INPATIENT APRDRG 5114: UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY

Facility

$6.85

Service Code	APR-DRG 5114
Hospital Charge Code	APRDRG 5114
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$6.85
Rate for Payer: Amerigroup CHIP/Medicaid	$6.85
Rate for Payer: Cigna Medicaid	$6.85
Rate for Payer: Molina CHIP/Medicaid	$6.85
Rate for Payer: Parkland Medicaid	$6.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.85

INPATIENT APRDRG 5121: UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG

Facility

$1.70

Service Code	APR-DRG 5121
Hospital Charge Code	APRDRG 5121
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.70
Rate for Payer: Amerigroup CHIP/Medicaid	$1.70
Rate for Payer: Cigna Medicaid	$1.70
Rate for Payer: Molina CHIP/Medicaid	$1.70
Rate for Payer: Parkland Medicaid	$1.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.70

INPATIENT APRDRG 5122: UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG

Facility

$1.91

Service Code	APR-DRG 5122
Hospital Charge Code	APRDRG 5122
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$1.91
Rate for Payer: Amerigroup CHIP/Medicaid	$1.91
Rate for Payer: Cigna Medicaid	$1.91
Rate for Payer: Molina CHIP/Medicaid	$1.91
Rate for Payer: Parkland Medicaid	$1.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.91

INPATIENT APRDRG 5123: UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG

Facility

$3.43

Service Code	APR-DRG 5123
Hospital Charge Code	APRDRG 5123
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

INPATIENT APRDRG 5124: UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG

Facility

$5.94

Service Code	APR-DRG 5124
Hospital Charge Code	APRDRG 5124
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$5.94
Rate for Payer: Amerigroup CHIP/Medicaid	$5.94
Rate for Payer: Cigna Medicaid	$5.94
Rate for Payer: Molina CHIP/Medicaid	$5.94
Rate for Payer: Parkland Medicaid	$5.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.94

INPATIENT APRDRG 5131: UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$1.07

Service Code	APR-DRG 5131
Hospital Charge Code	APRDRG 5131
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$1.07
Rate for Payer: Amerigroup CHIP/Medicaid	$1.07
Rate for Payer: Cigna Medicaid	$1.07
Rate for Payer: Molina CHIP/Medicaid	$1.07
Rate for Payer: Parkland Medicaid	$1.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.07

INPATIENT APRDRG 5132: UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$1.25

Service Code	APR-DRG 5132
Hospital Charge Code	APRDRG 5132
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 5133: UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$2.30

Service Code	APR-DRG 5133
Hospital Charge Code	APRDRG 5133
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$2.30
Rate for Payer: Amerigroup CHIP/Medicaid	$2.30
Rate for Payer: Cigna Medicaid	$2.30
Rate for Payer: Molina CHIP/Medicaid	$2.30
Rate for Payer: Parkland Medicaid	$2.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.30

INPATIENT APRDRG 5134: UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$7.21

Service Code	APR-DRG 5134
Hospital Charge Code	APRDRG 5134
Min. Negotiated Rate	$7.21
Max. Negotiated Rate	$7.21
Rate for Payer: Amerigroup CHIP/Medicaid	$7.21
Rate for Payer: Cigna Medicaid	$7.21
Rate for Payer: Molina CHIP/Medicaid	$7.21
Rate for Payer: Parkland Medicaid	$7.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.21

INPATIENT APRDRG 5141: FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

$1.43

Service Code	APR-DRG 5141
Hospital Charge Code	APRDRG 5141
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Amerigroup CHIP/Medicaid	$1.43
Rate for Payer: Cigna Medicaid	$1.43
Rate for Payer: Molina CHIP/Medicaid	$1.43
Rate for Payer: Parkland Medicaid	$1.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.43

INPATIENT APRDRG 5142: FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

$1.94

Service Code	APR-DRG 5142
Hospital Charge Code	APRDRG 5142
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$1.94
Rate for Payer: Amerigroup CHIP/Medicaid	$1.94
Rate for Payer: Cigna Medicaid	$1.94
Rate for Payer: Molina CHIP/Medicaid	$1.94
Rate for Payer: Parkland Medicaid	$1.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.94

INPATIENT APRDRG 5143: FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

$3.32

Service Code	APR-DRG 5143
Hospital Charge Code	APRDRG 5143
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$3.32
Rate for Payer: Amerigroup CHIP/Medicaid	$3.32
Rate for Payer: Cigna Medicaid	$3.32
Rate for Payer: Molina CHIP/Medicaid	$3.32
Rate for Payer: Parkland Medicaid	$3.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.32

INPATIENT APRDRG 5144: FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

$5.95

Service Code	APR-DRG 5144
Hospital Charge Code	APRDRG 5144
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$5.95
Rate for Payer: Amerigroup CHIP/Medicaid	$5.95
Rate for Payer: Cigna Medicaid	$5.95
Rate for Payer: Molina CHIP/Medicaid	$5.95
Rate for Payer: Parkland Medicaid	$5.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.95

INPATIENT APRDRG 5171: DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$0.81

Service Code	APR-DRG 5171
Hospital Charge Code	APRDRG 5171
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Amerigroup CHIP/Medicaid	$0.81
Rate for Payer: Cigna Medicaid	$0.81
Rate for Payer: Molina CHIP/Medicaid	$0.81
Rate for Payer: Parkland Medicaid	$0.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.81

INPATIENT APRDRG 5172: DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$1.21

Service Code	APR-DRG 5172
Hospital Charge Code	APRDRG 5172
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$1.21
Rate for Payer: Amerigroup CHIP/Medicaid	$1.21
Rate for Payer: Cigna Medicaid	$1.21
Rate for Payer: Molina CHIP/Medicaid	$1.21
Rate for Payer: Parkland Medicaid	$1.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.21

INPATIENT APRDRG 5173: DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$1.86

Service Code	APR-DRG 5173
Hospital Charge Code	APRDRG 5173
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$1.86
Rate for Payer: Amerigroup CHIP/Medicaid	$1.86
Rate for Payer: Cigna Medicaid	$1.86
Rate for Payer: Molina CHIP/Medicaid	$1.86
Rate for Payer: Parkland Medicaid	$1.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.86

INPATIENT APRDRG 5174: DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$5.08

Service Code	APR-DRG 5174
Hospital Charge Code	APRDRG 5174
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$5.08
Rate for Payer: Amerigroup CHIP/Medicaid	$5.08
Rate for Payer: Cigna Medicaid	$5.08
Rate for Payer: Molina CHIP/Medicaid	$5.08
Rate for Payer: Parkland Medicaid	$5.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.08

INPATIENT APRDRG 5181: OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$0.99

Service Code	APR-DRG 5181
Hospital Charge Code	APRDRG 5181
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$0.99
Rate for Payer: Amerigroup CHIP/Medicaid	$0.99
Rate for Payer: Cigna Medicaid	$0.99
Rate for Payer: Molina CHIP/Medicaid	$0.99
Rate for Payer: Parkland Medicaid	$0.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.99

INPATIENT APRDRG 5182: OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$1.45

Service Code	APR-DRG 5182
Hospital Charge Code	APRDRG 5182
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 5183: OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$2.96

Service Code	APR-DRG 5183
Hospital Charge Code	APRDRG 5183
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$2.96
Rate for Payer: Amerigroup CHIP/Medicaid	$2.96
Rate for Payer: Cigna Medicaid	$2.96
Rate for Payer: Molina CHIP/Medicaid	$2.96
Rate for Payer: Parkland Medicaid	$2.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.96

INPATIENT APRDRG 5184: OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES

Facility

$5.26

Service Code	APR-DRG 5184
Hospital Charge Code	APRDRG 5184
Min. Negotiated Rate	$5.26
Max. Negotiated Rate	$5.26
Rate for Payer: Amerigroup CHIP/Medicaid	$5.26
Rate for Payer: Cigna Medicaid	$5.26
Rate for Payer: Molina CHIP/Medicaid	$5.26
Rate for Payer: Parkland Medicaid	$5.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.26

INPATIENT APRDRG 5191: UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$1.06

Service Code	APR-DRG 5191
Hospital Charge Code	APRDRG 5191
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

INPATIENT APRDRG 5192: UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$1.29

Service Code	APR-DRG 5192
Hospital Charge Code	APRDRG 5192
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 5193: UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$2.22

Service Code	APR-DRG 5193
Hospital Charge Code	APRDRG 5193
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$2.22
Rate for Payer: Amerigroup CHIP/Medicaid	$2.22
Rate for Payer: Cigna Medicaid	$2.22
Rate for Payer: Molina CHIP/Medicaid	$2.22
Rate for Payer: Parkland Medicaid	$2.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.22

Know your out-of-pocket cost for care.

All Charges