White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 0273: OTHER OPEN CRANIOTOMY

Facility

$5.54

Service Code	APR-DRG 0273
Hospital Charge Code	APRDRG 0273
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$5.54
Rate for Payer: Amerigroup CHIP/Medicaid	$5.54
Rate for Payer: Cigna Medicaid	$5.54
Rate for Payer: Molina CHIP/Medicaid	$5.54
Rate for Payer: Parkland Medicaid	$5.54
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.54

INPATIENT APRDRG 0274: OTHER OPEN CRANIOTOMY

Facility

$6.11

Service Code	APR-DRG 0274
Hospital Charge Code	APRDRG 0274
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$6.11
Rate for Payer: Amerigroup CHIP/Medicaid	$6.11
Rate for Payer: Cigna Medicaid	$6.11
Rate for Payer: Molina CHIP/Medicaid	$6.11
Rate for Payer: Parkland Medicaid	$6.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.11

INPATIENT APRDRG 0291: OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$4.08

Service Code	APR-DRG 0291
Hospital Charge Code	APRDRG 0291
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.08
Rate for Payer: Amerigroup CHIP/Medicaid	$4.08
Rate for Payer: Cigna Medicaid	$4.08
Rate for Payer: Molina CHIP/Medicaid	$4.08
Rate for Payer: Parkland Medicaid	$4.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.08

INPATIENT APRDRG 0292: OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$4.32

Service Code	APR-DRG 0292
Hospital Charge Code	APRDRG 0292
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$4.32
Rate for Payer: Amerigroup CHIP/Medicaid	$4.32
Rate for Payer: Cigna Medicaid	$4.32
Rate for Payer: Molina CHIP/Medicaid	$4.32
Rate for Payer: Parkland Medicaid	$4.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.32

INPATIENT APRDRG 0293: OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$5.85

Service Code	APR-DRG 0293
Hospital Charge Code	APRDRG 0293
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Amerigroup CHIP/Medicaid	$5.85
Rate for Payer: Cigna Medicaid	$5.85
Rate for Payer: Molina CHIP/Medicaid	$5.85
Rate for Payer: Parkland Medicaid	$5.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.85

INPATIENT APRDRG 0294: OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$6.63

Service Code	APR-DRG 0294
Hospital Charge Code	APRDRG 0294
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$6.63
Rate for Payer: Amerigroup CHIP/Medicaid	$6.63
Rate for Payer: Cigna Medicaid	$6.63
Rate for Payer: Molina CHIP/Medicaid	$6.63
Rate for Payer: Parkland Medicaid	$6.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.63

INPATIENT APRDRG 0301: PERCUTANEOUS INTRA & EXTRACRANIAL VASCULAR PROCEDURES

Facility

$2.69

Service Code	APR-DRG 0301
Hospital Charge Code	APRDRG 0301
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Amerigroup CHIP/Medicaid	$2.69
Rate for Payer: Cigna Medicaid	$2.69
Rate for Payer: Molina CHIP/Medicaid	$2.69
Rate for Payer: Parkland Medicaid	$2.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.69

INPATIENT APRDRG 0302: PERCUTANEOUS INTRA & EXTRACRANIAL VASCULAR PROCEDURES

Facility

$3.54

Service Code	APR-DRG 0302
Hospital Charge Code	APRDRG 0302
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$3.54
Rate for Payer: Amerigroup CHIP/Medicaid	$3.54
Rate for Payer: Cigna Medicaid	$3.54
Rate for Payer: Molina CHIP/Medicaid	$3.54
Rate for Payer: Parkland Medicaid	$3.54
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.54

INPATIENT APRDRG 0303: PERCUTANEOUS INTRA & EXTRACRANIAL VASCULAR PROCEDURES

Facility

$4.81

Service Code	APR-DRG 0303
Hospital Charge Code	APRDRG 0303
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$4.81
Rate for Payer: Amerigroup CHIP/Medicaid	$4.81
Rate for Payer: Cigna Medicaid	$4.81
Rate for Payer: Molina CHIP/Medicaid	$4.81
Rate for Payer: Parkland Medicaid	$4.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.81

INPATIENT APRDRG 0304: PERCUTANEOUS INTRA & EXTRACRANIAL VASCULAR PROCEDURES

Facility

$6.74

Service Code	APR-DRG 0304
Hospital Charge Code	APRDRG 0304
Min. Negotiated Rate	$6.74
Max. Negotiated Rate	$6.74
Rate for Payer: Amerigroup CHIP/Medicaid	$6.74
Rate for Payer: Cigna Medicaid	$6.74
Rate for Payer: Molina CHIP/Medicaid	$6.74
Rate for Payer: Parkland Medicaid	$6.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.74

INPATIENT APRDRG 0401: SPINAL DISORDERS & INJURIES

Facility

$1.36

Service Code	APR-DRG 0401
Hospital Charge Code	APRDRG 0401
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$1.36
Rate for Payer: Amerigroup CHIP/Medicaid	$1.36
Rate for Payer: Cigna Medicaid	$1.36
Rate for Payer: Molina CHIP/Medicaid	$1.36
Rate for Payer: Parkland Medicaid	$1.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.36

INPATIENT APRDRG 0402: SPINAL DISORDERS & INJURIES

Facility

$2.94

Service Code	APR-DRG 0402
Hospital Charge Code	APRDRG 0402
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$2.94
Rate for Payer: Amerigroup CHIP/Medicaid	$2.94
Rate for Payer: Cigna Medicaid	$2.94
Rate for Payer: Molina CHIP/Medicaid	$2.94
Rate for Payer: Parkland Medicaid	$2.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.94

INPATIENT APRDRG 0403: SPINAL DISORDERS & INJURIES

Facility

$3.80

Service Code	APR-DRG 0403
Hospital Charge Code	APRDRG 0403
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$3.80
Rate for Payer: Amerigroup CHIP/Medicaid	$3.80
Rate for Payer: Cigna Medicaid	$3.80
Rate for Payer: Molina CHIP/Medicaid	$3.80
Rate for Payer: Parkland Medicaid	$3.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.80

INPATIENT APRDRG 0404: SPINAL DISORDERS & INJURIES

Facility

$5.87

Service Code	APR-DRG 0404
Hospital Charge Code	APRDRG 0404
Min. Negotiated Rate	$5.87
Max. Negotiated Rate	$5.87
Rate for Payer: Amerigroup CHIP/Medicaid	$5.87
Rate for Payer: Cigna Medicaid	$5.87
Rate for Payer: Molina CHIP/Medicaid	$5.87
Rate for Payer: Parkland Medicaid	$5.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.87

INPATIENT APRDRG 0411: NERVOUS SYSTEM MALIGNANCY

Facility

$1.02

Service Code	APR-DRG 0411
Hospital Charge Code	APRDRG 0411
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.02
Rate for Payer: Amerigroup CHIP/Medicaid	$1.02
Rate for Payer: Cigna Medicaid	$1.02
Rate for Payer: Molina CHIP/Medicaid	$1.02
Rate for Payer: Parkland Medicaid	$1.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.02

INPATIENT APRDRG 0412: NERVOUS SYSTEM MALIGNANCY

Facility

$1.09

Service Code	APR-DRG 0412
Hospital Charge Code	APRDRG 0412
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Amerigroup CHIP/Medicaid	$1.09
Rate for Payer: Cigna Medicaid	$1.09
Rate for Payer: Molina CHIP/Medicaid	$1.09
Rate for Payer: Parkland Medicaid	$1.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.09

INPATIENT APRDRG 0413: NERVOUS SYSTEM MALIGNANCY

Facility

$1.50

Service Code	APR-DRG 0413
Hospital Charge Code	APRDRG 0413
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Amerigroup CHIP/Medicaid	$1.50
Rate for Payer: Cigna Medicaid	$1.50
Rate for Payer: Molina CHIP/Medicaid	$1.50
Rate for Payer: Parkland Medicaid	$1.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.50

INPATIENT APRDRG 0414: NERVOUS SYSTEM MALIGNANCY

Facility

$2.58

Service Code	APR-DRG 0414
Hospital Charge Code	APRDRG 0414
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$2.58
Rate for Payer: Amerigroup CHIP/Medicaid	$2.58
Rate for Payer: Cigna Medicaid	$2.58
Rate for Payer: Molina CHIP/Medicaid	$2.58
Rate for Payer: Parkland Medicaid	$2.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.58

INPATIENT APRDRG 0421: DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS

Facility

$0.94

Service Code	APR-DRG 0421
Hospital Charge Code	APRDRG 0421
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$0.94
Rate for Payer: Amerigroup CHIP/Medicaid	$0.94
Rate for Payer: Cigna Medicaid	$0.94
Rate for Payer: Molina CHIP/Medicaid	$0.94
Rate for Payer: Parkland Medicaid	$0.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.94

INPATIENT APRDRG 0422: DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS

Facility

$1.30

Service Code	APR-DRG 0422
Hospital Charge Code	APRDRG 0422
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 0423: DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS

Facility

$2.04

Service Code	APR-DRG 0423
Hospital Charge Code	APRDRG 0423
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$2.04
Rate for Payer: Amerigroup CHIP/Medicaid	$2.04
Rate for Payer: Cigna Medicaid	$2.04
Rate for Payer: Molina CHIP/Medicaid	$2.04
Rate for Payer: Parkland Medicaid	$2.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.04

INPATIENT APRDRG 0424: DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS

Facility

$5.04

Service Code	APR-DRG 0424
Hospital Charge Code	APRDRG 0424
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$5.04
Rate for Payer: Amerigroup CHIP/Medicaid	$5.04
Rate for Payer: Cigna Medicaid	$5.04
Rate for Payer: Molina CHIP/Medicaid	$5.04
Rate for Payer: Parkland Medicaid	$5.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.04

INPATIENT APRDRG 0431: MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES

Facility

$1.24

Service Code	APR-DRG 0431
Hospital Charge Code	APRDRG 0431
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.24
Rate for Payer: Amerigroup CHIP/Medicaid	$1.24
Rate for Payer: Cigna Medicaid	$1.24
Rate for Payer: Molina CHIP/Medicaid	$1.24
Rate for Payer: Parkland Medicaid	$1.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.24

INPATIENT APRDRG 0432: MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES

Facility

$1.85

Service Code	APR-DRG 0432
Hospital Charge Code	APRDRG 0432
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$1.85
Rate for Payer: Amerigroup CHIP/Medicaid	$1.85
Rate for Payer: Cigna Medicaid	$1.85
Rate for Payer: Molina CHIP/Medicaid	$1.85
Rate for Payer: Parkland Medicaid	$1.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.85

INPATIENT APRDRG 0433: MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES

Facility

$5.89

Service Code	APR-DRG 0433
Hospital Charge Code	APRDRG 0433
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$5.89
Rate for Payer: Amerigroup CHIP/Medicaid	$5.89
Rate for Payer: Cigna Medicaid	$5.89
Rate for Payer: Molina CHIP/Medicaid	$5.89
Rate for Payer: Parkland Medicaid	$5.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.89

Know your out-of-pocket cost for care.

All Charges