White Rock Medical Center

All Charges

Charge

Type

Setting

Price

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$16,294.56

Service Code	APR-DRG 0292
Min. Negotiated Rate	$15,363.09
Max. Negotiated Rate	$16,294.56
Rate for Payer: Amerigroup CHIP/Medicaid	$15,363.09
Rate for Payer: Cigna Medicaid	$15,363.09
Rate for Payer: Molina CHIP/Medicaid	$15,363.09
Rate for Payer: Parkland Medicaid	$15,363.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,294.56

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$15,391.57

Service Code	APR-DRG 0291
Min. Negotiated Rate	$14,511.72
Max. Negotiated Rate	$15,391.57
Rate for Payer: Amerigroup CHIP/Medicaid	$14,511.72
Rate for Payer: Cigna Medicaid	$14,511.72
Rate for Payer: Molina CHIP/Medicaid	$14,511.72
Rate for Payer: Parkland Medicaid	$14,511.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$15,391.57

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$25,024.23

Service Code	APR-DRG 0294
Min. Negotiated Rate	$23,593.72
Max. Negotiated Rate	$25,024.23
Rate for Payer: Amerigroup CHIP/Medicaid	$23,593.72
Rate for Payer: Cigna Medicaid	$23,593.72
Rate for Payer: Molina CHIP/Medicaid	$23,593.72
Rate for Payer: Parkland Medicaid	$23,593.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$25,024.23

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$22,053.11

Service Code	APR-DRG 0293
Min. Negotiated Rate	$20,792.44
Max. Negotiated Rate	$22,053.11
Rate for Payer: Amerigroup CHIP/Medicaid	$20,792.44
Rate for Payer: Cigna Medicaid	$20,792.44
Rate for Payer: Molina CHIP/Medicaid	$20,792.44
Rate for Payer: Parkland Medicaid	$20,792.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$22,053.11

OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$42,517.88

Service Code	APR-DRG 1824
Min. Negotiated Rate	$40,087.34
Max. Negotiated Rate	$42,517.88
Rate for Payer: Amerigroup CHIP/Medicaid	$40,087.34
Rate for Payer: Cigna Medicaid	$40,087.34
Rate for Payer: Molina CHIP/Medicaid	$40,087.34
Rate for Payer: Parkland Medicaid	$40,087.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$42,517.88

OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$14,425.59

Service Code	APR-DRG 1823
Min. Negotiated Rate	$13,600.95
Max. Negotiated Rate	$14,425.59
Rate for Payer: Amerigroup CHIP/Medicaid	$13,600.95
Rate for Payer: Cigna Medicaid	$13,600.95
Rate for Payer: Molina CHIP/Medicaid	$13,600.95
Rate for Payer: Parkland Medicaid	$13,600.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14,425.59

OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$10,887.94

Service Code	APR-DRG 1822
Min. Negotiated Rate	$10,265.53
Max. Negotiated Rate	$10,887.94
Rate for Payer: Amerigroup CHIP/Medicaid	$10,265.53
Rate for Payer: Cigna Medicaid	$10,265.53
Rate for Payer: Molina CHIP/Medicaid	$10,265.53
Rate for Payer: Parkland Medicaid	$10,265.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,887.94

OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$7,780.65

Service Code	APR-DRG 1821
Min. Negotiated Rate	$7,335.87
Max. Negotiated Rate	$7,780.65
Rate for Payer: Amerigroup CHIP/Medicaid	$7,335.87
Rate for Payer: Cigna Medicaid	$7,335.87
Rate for Payer: Molina CHIP/Medicaid	$7,335.87
Rate for Payer: Parkland Medicaid	$7,335.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,780.65

OTHER PNEUMONIA

Facility

$7,849.68

Service Code	APR-DRG 1394
Min. Negotiated Rate	$7,400.95
Max. Negotiated Rate	$7,849.68
Rate for Payer: Amerigroup CHIP/Medicaid	$7,400.95
Rate for Payer: Cigna Medicaid	$7,400.95
Rate for Payer: Molina CHIP/Medicaid	$7,400.95
Rate for Payer: Parkland Medicaid	$7,400.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,849.68

OTHER PNEUMONIA

Facility

$2,892.29

Service Code	APR-DRG 1392
Min. Negotiated Rate	$2,726.95
Max. Negotiated Rate	$2,892.29
Rate for Payer: Amerigroup CHIP/Medicaid	$2,726.95
Rate for Payer: Cigna Medicaid	$2,726.95
Rate for Payer: Molina CHIP/Medicaid	$2,726.95
Rate for Payer: Parkland Medicaid	$2,726.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,892.29

OTHER PNEUMONIA

Facility

$1,861.43

Service Code	APR-DRG 1391
Min. Negotiated Rate	$1,755.02
Max. Negotiated Rate	$1,861.43
Rate for Payer: Amerigroup CHIP/Medicaid	$1,755.02
Rate for Payer: Cigna Medicaid	$1,755.02
Rate for Payer: Molina CHIP/Medicaid	$1,755.02
Rate for Payer: Parkland Medicaid	$1,755.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,861.43

OTHER PNEUMONIA

Facility

$4,573.04

Service Code	APR-DRG 1393
Min. Negotiated Rate	$4,311.62
Max. Negotiated Rate	$4,573.04
Rate for Payer: Amerigroup CHIP/Medicaid	$4,311.62
Rate for Payer: Cigna Medicaid	$4,311.62
Rate for Payer: Molina CHIP/Medicaid	$4,311.62
Rate for Payer: Parkland Medicaid	$4,311.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,573.04

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS

Facility

$11,154.61

Service Code	APR-DRG 4052
Min. Negotiated Rate	$10,516.96
Max. Negotiated Rate	$11,154.61
Rate for Payer: Amerigroup CHIP/Medicaid	$10,516.96
Rate for Payer: Cigna Medicaid	$10,516.96
Rate for Payer: Molina CHIP/Medicaid	$10,516.96
Rate for Payer: Parkland Medicaid	$10,516.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,154.61

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS

Facility

$9,485.17

Service Code	APR-DRG 4051
Min. Negotiated Rate	$8,942.95
Max. Negotiated Rate	$9,485.17
Rate for Payer: Amerigroup CHIP/Medicaid	$8,942.95
Rate for Payer: Cigna Medicaid	$8,942.95
Rate for Payer: Molina CHIP/Medicaid	$8,942.95
Rate for Payer: Parkland Medicaid	$8,942.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,485.17

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS

Facility

$12,824.05

Service Code	APR-DRG 4053
Min. Negotiated Rate	$12,090.96
Max. Negotiated Rate	$12,824.05
Rate for Payer: Amerigroup CHIP/Medicaid	$12,090.96
Rate for Payer: Cigna Medicaid	$12,090.96
Rate for Payer: Molina CHIP/Medicaid	$12,090.96
Rate for Payer: Parkland Medicaid	$12,090.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,824.05

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS

Facility

$23,484.92

Service Code	APR-DRG 4054
Min. Negotiated Rate	$22,142.40
Max. Negotiated Rate	$23,484.92
Rate for Payer: Amerigroup CHIP/Medicaid	$22,142.40
Rate for Payer: Cigna Medicaid	$22,142.40
Rate for Payer: Molina CHIP/Medicaid	$22,142.40
Rate for Payer: Parkland Medicaid	$22,142.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$23,484.92

OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$5,316.10

Service Code	APR-DRG 6511
Min. Negotiated Rate	$5,012.21
Max. Negotiated Rate	$5,316.10
Rate for Payer: Amerigroup CHIP/Medicaid	$5,012.21
Rate for Payer: Cigna Medicaid	$5,012.21
Rate for Payer: Molina CHIP/Medicaid	$5,012.21
Rate for Payer: Parkland Medicaid	$5,012.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,316.10

OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$7,326.52

Service Code	APR-DRG 6512
Min. Negotiated Rate	$6,907.70
Max. Negotiated Rate	$7,326.52
Rate for Payer: Amerigroup CHIP/Medicaid	$6,907.70
Rate for Payer: Cigna Medicaid	$6,907.70
Rate for Payer: Molina CHIP/Medicaid	$6,907.70
Rate for Payer: Parkland Medicaid	$6,907.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,326.52

OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$8,829.62

Service Code	APR-DRG 6513
Min. Negotiated Rate	$8,324.87
Max. Negotiated Rate	$8,829.62
Rate for Payer: Amerigroup CHIP/Medicaid	$8,324.87
Rate for Payer: Cigna Medicaid	$8,324.87
Rate for Payer: Molina CHIP/Medicaid	$8,324.87
Rate for Payer: Parkland Medicaid	$8,324.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,829.62

OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$40,737.17

Service Code	APR-DRG 6514
Min. Negotiated Rate	$38,408.43
Max. Negotiated Rate	$40,737.17
Rate for Payer: Amerigroup CHIP/Medicaid	$38,408.43
Rate for Payer: Cigna Medicaid	$38,408.43
Rate for Payer: Molina CHIP/Medicaid	$38,408.43
Rate for Payer: Parkland Medicaid	$38,408.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$40,737.17

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$9,328.64

Service Code	APR-DRG 1212
Min. Negotiated Rate	$8,795.37
Max. Negotiated Rate	$9,328.64
Rate for Payer: Amerigroup CHIP/Medicaid	$8,795.37
Rate for Payer: Cigna Medicaid	$8,795.37
Rate for Payer: Molina CHIP/Medicaid	$8,795.37
Rate for Payer: Parkland Medicaid	$8,795.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,328.64

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$19,137.06

Service Code	APR-DRG 1213
Min. Negotiated Rate	$18,043.09
Max. Negotiated Rate	$19,137.06
Rate for Payer: Amerigroup CHIP/Medicaid	$18,043.09
Rate for Payer: Cigna Medicaid	$18,043.09
Rate for Payer: Molina CHIP/Medicaid	$18,043.09
Rate for Payer: Parkland Medicaid	$18,043.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$19,137.06

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$35,384.85

Service Code	APR-DRG 1214
Min. Negotiated Rate	$33,362.08
Max. Negotiated Rate	$35,384.85
Rate for Payer: Amerigroup CHIP/Medicaid	$33,362.08
Rate for Payer: Cigna Medicaid	$33,362.08
Rate for Payer: Molina CHIP/Medicaid	$33,362.08
Rate for Payer: Parkland Medicaid	$33,362.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$35,384.85

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$6,695.48

Service Code	APR-DRG 1211
Min. Negotiated Rate	$6,312.73
Max. Negotiated Rate	$6,695.48
Rate for Payer: Amerigroup CHIP/Medicaid	$6,312.73
Rate for Payer: Cigna Medicaid	$6,312.73
Rate for Payer: Molina CHIP/Medicaid	$6,312.73
Rate for Payer: Parkland Medicaid	$6,312.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,695.48

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$2,380.82

Service Code	APR-DRG 1431
Min. Negotiated Rate	$2,244.72
Max. Negotiated Rate	$2,380.82
Rate for Payer: Amerigroup CHIP/Medicaid	$2,244.72
Rate for Payer: Cigna Medicaid	$2,244.72
Rate for Payer: Molina CHIP/Medicaid	$2,244.72
Rate for Payer: Parkland Medicaid	$2,244.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,380.82

Know your out-of-pocket cost for care.

All Charges