White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 5421: VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &/OR D&C

Facility

$0.47

Service Code	APR-DRG 5421
Hospital Charge Code	APRDRG 5421
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.47
Rate for Payer: Amerigroup CHIP/Medicaid	$0.47
Rate for Payer: Cigna Medicaid	$0.47
Rate for Payer: Molina CHIP/Medicaid	$0.47
Rate for Payer: Parkland Medicaid	$0.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.47

INPATIENT APRDRG 5422: VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &/OR D&C

Facility

$0.54

Service Code	APR-DRG 5422
Hospital Charge Code	APRDRG 5422
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 5423: VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &/OR D&C

Facility

$0.85

Service Code	APR-DRG 5423
Hospital Charge Code	APRDRG 5423
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 5424: VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &/OR D&C

Facility

$2.03

Service Code	APR-DRG 5424
Hospital Charge Code	APRDRG 5424
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$2.03
Rate for Payer: Amerigroup CHIP/Medicaid	$2.03
Rate for Payer: Cigna Medicaid	$2.03
Rate for Payer: Molina CHIP/Medicaid	$2.03
Rate for Payer: Parkland Medicaid	$2.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.03

INPATIENT APRDRG 5431: ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$0.57

Service Code	APR-DRG 5431
Hospital Charge Code	APRDRG 5431
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.57
Rate for Payer: Amerigroup CHIP/Medicaid	$0.57
Rate for Payer: Cigna Medicaid	$0.57
Rate for Payer: Molina CHIP/Medicaid	$0.57
Rate for Payer: Parkland Medicaid	$0.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.57

INPATIENT APRDRG 5432: ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$0.74

Service Code	APR-DRG 5432
Hospital Charge Code	APRDRG 5432
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 5433: ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$1.16

Service Code	APR-DRG 5433
Hospital Charge Code	APRDRG 5433
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 5434: ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$3.23

Service Code	APR-DRG 5434
Hospital Charge Code	APRDRG 5434
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$3.23
Rate for Payer: Amerigroup CHIP/Medicaid	$3.23
Rate for Payer: Cigna Medicaid	$3.23
Rate for Payer: Molina CHIP/Medicaid	$3.23
Rate for Payer: Parkland Medicaid	$3.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.23

INPATIENT APRDRG 5471: ANTEPARTUM W O.R. PROCEDURE

Facility

$0.78

Service Code	APR-DRG 5471
Hospital Charge Code	APRDRG 5471
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$0.78
Rate for Payer: Amerigroup CHIP/Medicaid	$0.78
Rate for Payer: Cigna Medicaid	$0.78
Rate for Payer: Molina CHIP/Medicaid	$0.78
Rate for Payer: Parkland Medicaid	$0.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.78

INPATIENT APRDRG 5472: ANTEPARTUM W O.R. PROCEDURE

Facility

$1.08

Service Code	APR-DRG 5472
Hospital Charge Code	APRDRG 5472
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.08
Rate for Payer: Amerigroup CHIP/Medicaid	$1.08
Rate for Payer: Cigna Medicaid	$1.08
Rate for Payer: Molina CHIP/Medicaid	$1.08
Rate for Payer: Parkland Medicaid	$1.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.08

INPATIENT APRDRG 5473: ANTEPARTUM W O.R. PROCEDURE

Facility

$1.90

Service Code	APR-DRG 5473
Hospital Charge Code	APRDRG 5473
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$1.90
Rate for Payer: Amerigroup CHIP/Medicaid	$1.90
Rate for Payer: Cigna Medicaid	$1.90
Rate for Payer: Molina CHIP/Medicaid	$1.90
Rate for Payer: Parkland Medicaid	$1.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.90

INPATIENT APRDRG 5474: ANTEPARTUM W O.R. PROCEDURE

Facility

$4.21

Service Code	APR-DRG 5474
Hospital Charge Code	APRDRG 5474
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$4.21
Rate for Payer: Amerigroup CHIP/Medicaid	$4.21
Rate for Payer: Cigna Medicaid	$4.21
Rate for Payer: Molina CHIP/Medicaid	$4.21
Rate for Payer: Parkland Medicaid	$4.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.21

INPATIENT APRDRG 5481: POSTPARTUM & POST ABORTION DIAGNOSIS W O.R. PROCEDURE

Facility

$0.69

Service Code	APR-DRG 5481
Hospital Charge Code	APRDRG 5481
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 5482: POSTPARTUM & POST ABORTION DIAGNOSIS W O.R. PROCEDURE

Facility

$1.30

Service Code	APR-DRG 5482
Hospital Charge Code	APRDRG 5482
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.30
Rate for Payer: Amerigroup CHIP/Medicaid	$1.30
Rate for Payer: Cigna Medicaid	$1.30
Rate for Payer: Molina CHIP/Medicaid	$1.30
Rate for Payer: Parkland Medicaid	$1.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.30

INPATIENT APRDRG 5483: POSTPARTUM & POST ABORTION DIAGNOSIS W O.R. PROCEDURE

Facility

$1.88

Service Code	APR-DRG 5483
Hospital Charge Code	APRDRG 5483
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 5484: POSTPARTUM & POST ABORTION DIAGNOSIS W O.R. PROCEDURE

Facility

$4.87

Service Code	APR-DRG 5484
Hospital Charge Code	APRDRG 5484
Min. Negotiated Rate	$4.87
Max. Negotiated Rate	$4.87
Rate for Payer: Amerigroup CHIP/Medicaid	$4.87
Rate for Payer: Cigna Medicaid	$4.87
Rate for Payer: Molina CHIP/Medicaid	$4.87
Rate for Payer: Parkland Medicaid	$4.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.87

INPATIENT APRDRG 5601: VAGINAL DELIVERY

Facility

$0.37

Service Code	APR-DRG 5601
Hospital Charge Code	APRDRG 5601
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Amerigroup CHIP/Medicaid	$0.37
Rate for Payer: Cigna Medicaid	$0.37
Rate for Payer: Molina CHIP/Medicaid	$0.37
Rate for Payer: Parkland Medicaid	$0.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.37

INPATIENT APRDRG 5602: VAGINAL DELIVERY

Facility

$0.43

Service Code	APR-DRG 5602
Hospital Charge Code	APRDRG 5602
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.43
Rate for Payer: Amerigroup CHIP/Medicaid	$0.43
Rate for Payer: Cigna Medicaid	$0.43
Rate for Payer: Molina CHIP/Medicaid	$0.43
Rate for Payer: Parkland Medicaid	$0.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.43

INPATIENT APRDRG 5603: VAGINAL DELIVERY

Facility

$0.59

Service Code	APR-DRG 5603
Hospital Charge Code	APRDRG 5603
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.59
Rate for Payer: Amerigroup CHIP/Medicaid	$0.59
Rate for Payer: Cigna Medicaid	$0.59
Rate for Payer: Molina CHIP/Medicaid	$0.59
Rate for Payer: Parkland Medicaid	$0.59
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.59

INPATIENT APRDRG 5604: VAGINAL DELIVERY

Facility

$1.00

Service Code	APR-DRG 5604
Hospital Charge Code	APRDRG 5604
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Amerigroup CHIP/Medicaid	$1.00
Rate for Payer: Cigna Medicaid	$1.00
Rate for Payer: Molina CHIP/Medicaid	$1.00
Rate for Payer: Parkland Medicaid	$1.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.00

INPATIENT APRDRG 5611: POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE

Facility

$0.33

Service Code	APR-DRG 5611
Hospital Charge Code	APRDRG 5611
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Amerigroup CHIP/Medicaid	$0.33
Rate for Payer: Cigna Medicaid	$0.33
Rate for Payer: Molina CHIP/Medicaid	$0.33
Rate for Payer: Parkland Medicaid	$0.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.33

INPATIENT APRDRG 5612: POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE

Facility

$0.54

Service Code	APR-DRG 5612
Hospital Charge Code	APRDRG 5612
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 5613: POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE

Facility

$0.90

Service Code	APR-DRG 5613
Hospital Charge Code	APRDRG 5613
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Amerigroup CHIP/Medicaid	$0.90
Rate for Payer: Cigna Medicaid	$0.90
Rate for Payer: Molina CHIP/Medicaid	$0.90
Rate for Payer: Parkland Medicaid	$0.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.90

INPATIENT APRDRG 5614: POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE

Facility

$1.77

Service Code	APR-DRG 5614
Hospital Charge Code	APRDRG 5614
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 5641: ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$0.37

Service Code	APR-DRG 5641
Hospital Charge Code	APRDRG 5641
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Amerigroup CHIP/Medicaid	$0.37
Rate for Payer: Cigna Medicaid	$0.37
Rate for Payer: Molina CHIP/Medicaid	$0.37
Rate for Payer: Parkland Medicaid	$0.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.37

Know your out-of-pocket cost for care.

All Charges