White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 5194: UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$4.99

Service Code	APR-DRG 5194
Hospital Charge Code	APRDRG 5194
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$4.99
Rate for Payer: Amerigroup CHIP/Medicaid	$4.99
Rate for Payer: Cigna Medicaid	$4.99
Rate for Payer: Molina CHIP/Medicaid	$4.99
Rate for Payer: Parkland Medicaid	$4.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.99

INPATIENT APRDRG 5301: FEMALE REPRODUCTIVE SYSTEM MALIGNANCY

Facility

$0.84

Service Code	APR-DRG 5301
Hospital Charge Code	APRDRG 5301
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Amerigroup CHIP/Medicaid	$0.84
Rate for Payer: Cigna Medicaid	$0.84
Rate for Payer: Molina CHIP/Medicaid	$0.84
Rate for Payer: Parkland Medicaid	$0.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.84

INPATIENT APRDRG 5302: FEMALE REPRODUCTIVE SYSTEM MALIGNANCY

Facility

$1.07

Service Code	APR-DRG 5302
Hospital Charge Code	APRDRG 5302
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 5303: FEMALE REPRODUCTIVE SYSTEM MALIGNANCY

Facility

$1.73

Service Code	APR-DRG 5303
Hospital Charge Code	APRDRG 5303
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$1.73
Rate for Payer: Amerigroup CHIP/Medicaid	$1.73
Rate for Payer: Cigna Medicaid	$1.73
Rate for Payer: Molina CHIP/Medicaid	$1.73
Rate for Payer: Parkland Medicaid	$1.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.73

INPATIENT APRDRG 5304: FEMALE REPRODUCTIVE SYSTEM MALIGNANCY

Facility

$2.59

Service Code	APR-DRG 5304
Hospital Charge Code	APRDRG 5304
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$2.59
Rate for Payer: Amerigroup CHIP/Medicaid	$2.59
Rate for Payer: Cigna Medicaid	$2.59
Rate for Payer: Molina CHIP/Medicaid	$2.59
Rate for Payer: Parkland Medicaid	$2.59
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.59

INPATIENT APRDRG 5311: FEMALE REPRODUCTIVE SYSTEM INFECTIONS

Facility

$0.60

Service Code	APR-DRG 5311
Hospital Charge Code	APRDRG 5311
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Amerigroup CHIP/Medicaid	$0.60
Rate for Payer: Cigna Medicaid	$0.60
Rate for Payer: Molina CHIP/Medicaid	$0.60
Rate for Payer: Parkland Medicaid	$0.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.60

INPATIENT APRDRG 5312: FEMALE REPRODUCTIVE SYSTEM INFECTIONS

Facility

$0.88

Service Code	APR-DRG 5312
Hospital Charge Code	APRDRG 5312
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Amerigroup CHIP/Medicaid	$0.88
Rate for Payer: Cigna Medicaid	$0.88
Rate for Payer: Molina CHIP/Medicaid	$0.88
Rate for Payer: Parkland Medicaid	$0.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.88

INPATIENT APRDRG 5313: FEMALE REPRODUCTIVE SYSTEM INFECTIONS

Facility

$1.34

Service Code	APR-DRG 5313
Hospital Charge Code	APRDRG 5313
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 5314: FEMALE REPRODUCTIVE SYSTEM INFECTIONS

Facility

$2.54

Service Code	APR-DRG 5314
Hospital Charge Code	APRDRG 5314
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$2.54
Rate for Payer: Amerigroup CHIP/Medicaid	$2.54
Rate for Payer: Cigna Medicaid	$2.54
Rate for Payer: Molina CHIP/Medicaid	$2.54
Rate for Payer: Parkland Medicaid	$2.54
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.54

INPATIENT APRDRG 5321: MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS

Facility

$0.54

Service Code	APR-DRG 5321
Hospital Charge Code	APRDRG 5321
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.54
Rate for Payer: Amerigroup CHIP/Medicaid	$0.54
Rate for Payer: Cigna Medicaid	$0.54
Rate for Payer: Molina CHIP/Medicaid	$0.54
Rate for Payer: Parkland Medicaid	$0.54
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.54

INPATIENT APRDRG 5322: MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS

Facility

$0.62

Service Code	APR-DRG 5322
Hospital Charge Code	APRDRG 5322
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.62
Rate for Payer: Amerigroup CHIP/Medicaid	$0.62
Rate for Payer: Cigna Medicaid	$0.62
Rate for Payer: Molina CHIP/Medicaid	$0.62
Rate for Payer: Parkland Medicaid	$0.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.62

INPATIENT APRDRG 5323: MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS

Facility

$1.77

Service Code	APR-DRG 5323
Hospital Charge Code	APRDRG 5323
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$1.77
Rate for Payer: Amerigroup CHIP/Medicaid	$1.77
Rate for Payer: Cigna Medicaid	$1.77
Rate for Payer: Molina CHIP/Medicaid	$1.77
Rate for Payer: Parkland Medicaid	$1.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.77

INPATIENT APRDRG 5324: MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS

Facility

$2.81

Service Code	APR-DRG 5324
Hospital Charge Code	APRDRG 5324
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$2.81
Rate for Payer: Amerigroup CHIP/Medicaid	$2.81
Rate for Payer: Cigna Medicaid	$2.81
Rate for Payer: Molina CHIP/Medicaid	$2.81
Rate for Payer: Parkland Medicaid	$2.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.81

INPATIENT APRDRG 5391: CESAREAN SECTION W STERILIZATION

Facility

$0.61

Service Code	APR-DRG 5391
Hospital Charge Code	APRDRG 5391
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Amerigroup CHIP/Medicaid	$0.61
Rate for Payer: Cigna Medicaid	$0.61
Rate for Payer: Molina CHIP/Medicaid	$0.61
Rate for Payer: Parkland Medicaid	$0.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.61

INPATIENT APRDRG 5392: CESAREAN SECTION W STERILIZATION

Facility

$0.74

Service Code	APR-DRG 5392
Hospital Charge Code	APRDRG 5392
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 5393: CESAREAN SECTION W STERILIZATION

Facility

$1.16

Service Code	APR-DRG 5393
Hospital Charge Code	APRDRG 5393
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Amerigroup CHIP/Medicaid	$1.16
Rate for Payer: Cigna Medicaid	$1.16
Rate for Payer: Molina CHIP/Medicaid	$1.16
Rate for Payer: Parkland Medicaid	$1.16
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.16

INPATIENT APRDRG 5394: CESAREAN SECTION W STERILIZATION

Facility

$2.91

Service Code	APR-DRG 5394
Hospital Charge Code	APRDRG 5394
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$2.91
Rate for Payer: Amerigroup CHIP/Medicaid	$2.91
Rate for Payer: Cigna Medicaid	$2.91
Rate for Payer: Molina CHIP/Medicaid	$2.91
Rate for Payer: Parkland Medicaid	$2.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.91

INPATIENT APRDRG 5401: CESAREAN SECTION W/O STERILIZATION

Facility

$0.58

Service Code	APR-DRG 5401
Hospital Charge Code	APRDRG 5401
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Amerigroup CHIP/Medicaid	$0.58
Rate for Payer: Cigna Medicaid	$0.58
Rate for Payer: Molina CHIP/Medicaid	$0.58
Rate for Payer: Parkland Medicaid	$0.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.58

INPATIENT APRDRG 5402: CESAREAN SECTION W/O STERILIZATION

Facility

$0.72

Service Code	APR-DRG 5402
Hospital Charge Code	APRDRG 5402
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.72
Rate for Payer: Amerigroup CHIP/Medicaid	$0.72
Rate for Payer: Cigna Medicaid	$0.72
Rate for Payer: Molina CHIP/Medicaid	$0.72
Rate for Payer: Parkland Medicaid	$0.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.72

INPATIENT APRDRG 5403: CESAREAN SECTION W/O STERILIZATION

Facility

$0.99

Service Code	APR-DRG 5403
Hospital Charge Code	APRDRG 5403
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 5404: CESAREAN SECTION W/O STERILIZATION

Facility

$1.94

Service Code	APR-DRG 5404
Hospital Charge Code	APRDRG 5404
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 5411: VAGINAL DELIVERY W STERILIZATION &/OR D&C

Facility

$0.61

Service Code	APR-DRG 5411
Hospital Charge Code	APRDRG 5411
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Amerigroup CHIP/Medicaid	$0.61
Rate for Payer: Cigna Medicaid	$0.61
Rate for Payer: Molina CHIP/Medicaid	$0.61
Rate for Payer: Parkland Medicaid	$0.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.61

INPATIENT APRDRG 5412: VAGINAL DELIVERY W STERILIZATION &/OR D&C

Facility

$0.68

Service Code	APR-DRG 5412
Hospital Charge Code	APRDRG 5412
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Amerigroup CHIP/Medicaid	$0.68
Rate for Payer: Cigna Medicaid	$0.68
Rate for Payer: Molina CHIP/Medicaid	$0.68
Rate for Payer: Parkland Medicaid	$0.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.68

INPATIENT APRDRG 5413: VAGINAL DELIVERY W STERILIZATION &/OR D&C

Facility

$0.76

Service Code	APR-DRG 5413
Hospital Charge Code	APRDRG 5413
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 5414: VAGINAL DELIVERY W STERILIZATION &/OR D&C

Facility

$2.09

Service Code	APR-DRG 5414
Hospital Charge Code	APRDRG 5414
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.09
Rate for Payer: Amerigroup CHIP/Medicaid	$2.09
Rate for Payer: Cigna Medicaid	$2.09
Rate for Payer: Molina CHIP/Medicaid	$2.09
Rate for Payer: Parkland Medicaid	$2.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.09

Know your out-of-pocket cost for care.

All Charges