White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 0202: CRANIOTOMY FOR TRAUMA

Facility

$3.14

Service Code	APR-DRG 0202
Hospital Charge Code	APRDRG 0202
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$3.14
Rate for Payer: Amerigroup CHIP/Medicaid	$3.14
Rate for Payer: Cigna Medicaid	$3.14
Rate for Payer: Molina CHIP/Medicaid	$3.14
Rate for Payer: Parkland Medicaid	$3.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.14

INPATIENT APRDRG 0203: CRANIOTOMY FOR TRAUMA

Facility

$5.60

Service Code	APR-DRG 0203
Hospital Charge Code	APRDRG 0203
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$5.60
Rate for Payer: Amerigroup CHIP/Medicaid	$5.60
Rate for Payer: Cigna Medicaid	$5.60
Rate for Payer: Molina CHIP/Medicaid	$5.60
Rate for Payer: Parkland Medicaid	$5.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.60

INPATIENT APRDRG 0204: CRANIOTOMY FOR TRAUMA

Facility

$8.91

Service Code	APR-DRG 0204
Hospital Charge Code	APRDRG 0204
Min. Negotiated Rate	$8.91
Max. Negotiated Rate	$8.91
Rate for Payer: Amerigroup CHIP/Medicaid	$8.91
Rate for Payer: Cigna Medicaid	$8.91
Rate for Payer: Molina CHIP/Medicaid	$8.91
Rate for Payer: Parkland Medicaid	$8.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.91

INPATIENT APRDRG 0211: CRANIOTOMY EXCEPT FOR TRAUMA

Facility

$2.84

Service Code	APR-DRG 0211
Hospital Charge Code	APRDRG 0211
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$2.84
Rate for Payer: Amerigroup CHIP/Medicaid	$2.84
Rate for Payer: Cigna Medicaid	$2.84
Rate for Payer: Molina CHIP/Medicaid	$2.84
Rate for Payer: Parkland Medicaid	$2.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.84

INPATIENT APRDRG 0212: CRANIOTOMY EXCEPT FOR TRAUMA

Facility

$3.86

Service Code	APR-DRG 0212
Hospital Charge Code	APRDRG 0212
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$3.86
Rate for Payer: Amerigroup CHIP/Medicaid	$3.86
Rate for Payer: Cigna Medicaid	$3.86
Rate for Payer: Molina CHIP/Medicaid	$3.86
Rate for Payer: Parkland Medicaid	$3.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.86

INPATIENT APRDRG 0213: CRANIOTOMY EXCEPT FOR TRAUMA

Facility

$6.07

Service Code	APR-DRG 0213
Hospital Charge Code	APRDRG 0213
Min. Negotiated Rate	$6.07
Max. Negotiated Rate	$6.07
Rate for Payer: Amerigroup CHIP/Medicaid	$6.07
Rate for Payer: Cigna Medicaid	$6.07
Rate for Payer: Molina CHIP/Medicaid	$6.07
Rate for Payer: Parkland Medicaid	$6.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.07

INPATIENT APRDRG 0214: CRANIOTOMY EXCEPT FOR TRAUMA

Facility

$10.61

Service Code	APR-DRG 0214
Hospital Charge Code	APRDRG 0214
Min. Negotiated Rate	$10.61
Max. Negotiated Rate	$10.61
Rate for Payer: Amerigroup CHIP/Medicaid	$10.61
Rate for Payer: Cigna Medicaid	$10.61
Rate for Payer: Molina CHIP/Medicaid	$10.61
Rate for Payer: Parkland Medicaid	$10.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10.61

INPATIENT APRDRG 0221: VENTRICULAR SHUNT PROCEDURES

Facility

$1.59

Service Code	APR-DRG 0221
Hospital Charge Code	APRDRG 0221
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$1.59
Rate for Payer: Amerigroup CHIP/Medicaid	$1.59
Rate for Payer: Cigna Medicaid	$1.59
Rate for Payer: Molina CHIP/Medicaid	$1.59
Rate for Payer: Parkland Medicaid	$1.59
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.59

INPATIENT APRDRG 0222: VENTRICULAR SHUNT PROCEDURES

Facility

$1.95

Service Code	APR-DRG 0222
Hospital Charge Code	APRDRG 0222
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Amerigroup CHIP/Medicaid	$1.95
Rate for Payer: Cigna Medicaid	$1.95
Rate for Payer: Molina CHIP/Medicaid	$1.95
Rate for Payer: Parkland Medicaid	$1.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.95

INPATIENT APRDRG 0223: VENTRICULAR SHUNT PROCEDURES

Facility

$2.91

Service Code	APR-DRG 0223
Hospital Charge Code	APRDRG 0223
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 0224: VENTRICULAR SHUNT PROCEDURES

Facility

$10.53

Service Code	APR-DRG 0224
Hospital Charge Code	APRDRG 0224
Min. Negotiated Rate	$10.53
Max. Negotiated Rate	$10.53
Rate for Payer: Amerigroup CHIP/Medicaid	$10.53
Rate for Payer: Cigna Medicaid	$10.53
Rate for Payer: Molina CHIP/Medicaid	$10.53
Rate for Payer: Parkland Medicaid	$10.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10.53

INPATIENT APRDRG 0231: SPINAL PROCEDURES

Facility

$2.01

Service Code	APR-DRG 0231
Hospital Charge Code	APRDRG 0231
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.01
Rate for Payer: Amerigroup CHIP/Medicaid	$2.01
Rate for Payer: Cigna Medicaid	$2.01
Rate for Payer: Molina CHIP/Medicaid	$2.01
Rate for Payer: Parkland Medicaid	$2.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.01

INPATIENT APRDRG 0232: SPINAL PROCEDURES

Facility

$2.92

Service Code	APR-DRG 0232
Hospital Charge Code	APRDRG 0232
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 0233: SPINAL PROCEDURES

Facility

$5.95

Service Code	APR-DRG 0233
Hospital Charge Code	APRDRG 0233
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 0234: SPINAL PROCEDURES

Facility

$12.22

Service Code	APR-DRG 0234
Hospital Charge Code	APRDRG 0234
Min. Negotiated Rate	$12.22
Max. Negotiated Rate	$12.22
Rate for Payer: Amerigroup CHIP/Medicaid	$12.22
Rate for Payer: Cigna Medicaid	$12.22
Rate for Payer: Molina CHIP/Medicaid	$12.22
Rate for Payer: Parkland Medicaid	$12.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.22

INPATIENT APRDRG 0241: EXTRACRANIAL VASCULAR PROCEDURES

Facility

$1.15

Service Code	APR-DRG 0241
Hospital Charge Code	APRDRG 0241
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$1.15
Rate for Payer: Amerigroup CHIP/Medicaid	$1.15
Rate for Payer: Cigna Medicaid	$1.15
Rate for Payer: Molina CHIP/Medicaid	$1.15
Rate for Payer: Parkland Medicaid	$1.15
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.15

INPATIENT APRDRG 0242: EXTRACRANIAL VASCULAR PROCEDURES

Facility

$1.75

Service Code	APR-DRG 0242
Hospital Charge Code	APRDRG 0242
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$1.75
Rate for Payer: Amerigroup CHIP/Medicaid	$1.75
Rate for Payer: Cigna Medicaid	$1.75
Rate for Payer: Molina CHIP/Medicaid	$1.75
Rate for Payer: Parkland Medicaid	$1.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.75

INPATIENT APRDRG 0243: EXTRACRANIAL VASCULAR PROCEDURES

Facility

$3.13

Service Code	APR-DRG 0243
Hospital Charge Code	APRDRG 0243
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$3.13
Rate for Payer: Amerigroup CHIP/Medicaid	$3.13
Rate for Payer: Cigna Medicaid	$3.13
Rate for Payer: Molina CHIP/Medicaid	$3.13
Rate for Payer: Parkland Medicaid	$3.13
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.13

INPATIENT APRDRG 0244: EXTRACRANIAL VASCULAR PROCEDURES

Facility

$6.02

Service Code	APR-DRG 0244
Hospital Charge Code	APRDRG 0244
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$6.02
Rate for Payer: Amerigroup CHIP/Medicaid	$6.02
Rate for Payer: Cigna Medicaid	$6.02
Rate for Payer: Molina CHIP/Medicaid	$6.02
Rate for Payer: Parkland Medicaid	$6.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.02

INPATIENT APRDRG 0261: OTHER NERVOUS SYSTEM & RELATED PROCEDURES

Facility

$1.75

Service Code	APR-DRG 0261
Hospital Charge Code	APRDRG 0261
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$1.75
Rate for Payer: Amerigroup CHIP/Medicaid	$1.75
Rate for Payer: Cigna Medicaid	$1.75
Rate for Payer: Molina CHIP/Medicaid	$1.75
Rate for Payer: Parkland Medicaid	$1.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.75

INPATIENT APRDRG 0262: OTHER NERVOUS SYSTEM & RELATED PROCEDURES

Facility

$2.83

Service Code	APR-DRG 0262
Hospital Charge Code	APRDRG 0262
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$2.83
Rate for Payer: Amerigroup CHIP/Medicaid	$2.83
Rate for Payer: Cigna Medicaid	$2.83
Rate for Payer: Molina CHIP/Medicaid	$2.83
Rate for Payer: Parkland Medicaid	$2.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.83

INPATIENT APRDRG 0263: OTHER NERVOUS SYSTEM & RELATED PROCEDURES

Facility

$4.28

Service Code	APR-DRG 0263
Hospital Charge Code	APRDRG 0263
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$4.28
Rate for Payer: Amerigroup CHIP/Medicaid	$4.28
Rate for Payer: Cigna Medicaid	$4.28
Rate for Payer: Molina CHIP/Medicaid	$4.28
Rate for Payer: Parkland Medicaid	$4.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.28

INPATIENT APRDRG 0264: OTHER NERVOUS SYSTEM & RELATED PROCEDURES

Facility

$11.40

Service Code	APR-DRG 0264
Hospital Charge Code	APRDRG 0264
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$11.40
Rate for Payer: Amerigroup CHIP/Medicaid	$11.40
Rate for Payer: Cigna Medicaid	$11.40
Rate for Payer: Molina CHIP/Medicaid	$11.40
Rate for Payer: Parkland Medicaid	$11.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11.40

INPATIENT APRDRG 0271: OTHER OPEN CRANIOTOMY

Facility

$2.38

Service Code	APR-DRG 0271
Hospital Charge Code	APRDRG 0271
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 0272: OTHER OPEN CRANIOTOMY

Facility

$3.96

Service Code	APR-DRG 0272
Hospital Charge Code	APRDRG 0272
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$3.96
Rate for Payer: Amerigroup CHIP/Medicaid	$3.96
Rate for Payer: Cigna Medicaid	$3.96
Rate for Payer: Molina CHIP/Medicaid	$3.96
Rate for Payer: Parkland Medicaid	$3.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.96

Know your out-of-pocket cost for care.

All Charges