White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 0434: MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES

Facility

$14.15

Service Code	APR-DRG 0434
Hospital Charge Code	APRDRG 0434
Min. Negotiated Rate	$14.15
Max. Negotiated Rate	$14.15
Rate for Payer: Amerigroup CHIP/Medicaid	$14.15
Rate for Payer: Cigna Medicaid	$14.15
Rate for Payer: Molina CHIP/Medicaid	$14.15
Rate for Payer: Parkland Medicaid	$14.15
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14.15

INPATIENT APRDRG 0441: INTRACRANIAL HEMORRHAGE

Facility

$1.09

Service Code	APR-DRG 0441
Hospital Charge Code	APRDRG 0441
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 0442: INTRACRANIAL HEMORRHAGE

Facility

$1.76

Service Code	APR-DRG 0442
Hospital Charge Code	APRDRG 0442
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$1.76
Rate for Payer: Amerigroup CHIP/Medicaid	$1.76
Rate for Payer: Cigna Medicaid	$1.76
Rate for Payer: Molina CHIP/Medicaid	$1.76
Rate for Payer: Parkland Medicaid	$1.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.76

INPATIENT APRDRG 0443: INTRACRANIAL HEMORRHAGE

Facility

$2.17

Service Code	APR-DRG 0443
Hospital Charge Code	APRDRG 0443
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$2.17
Rate for Payer: Amerigroup CHIP/Medicaid	$2.17
Rate for Payer: Cigna Medicaid	$2.17
Rate for Payer: Molina CHIP/Medicaid	$2.17
Rate for Payer: Parkland Medicaid	$2.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.17

INPATIENT APRDRG 0444: INTRACRANIAL HEMORRHAGE

Facility

$3.40

Service Code	APR-DRG 0444
Hospital Charge Code	APRDRG 0444
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.40
Rate for Payer: Amerigroup CHIP/Medicaid	$3.40
Rate for Payer: Cigna Medicaid	$3.40
Rate for Payer: Molina CHIP/Medicaid	$3.40
Rate for Payer: Parkland Medicaid	$3.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.40

INPATIENT APRDRG 0451: CVA & PRECEREBRAL OCCLUSION W INFARCT

Facility

$1.03

Service Code	APR-DRG 0451
Hospital Charge Code	APRDRG 0451
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$1.03
Rate for Payer: Amerigroup CHIP/Medicaid	$1.03
Rate for Payer: Cigna Medicaid	$1.03
Rate for Payer: Molina CHIP/Medicaid	$1.03
Rate for Payer: Parkland Medicaid	$1.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.03

INPATIENT APRDRG 0452: CVA & PRECEREBRAL OCCLUSION W INFARCT

Facility

$1.36

Service Code	APR-DRG 0452
Hospital Charge Code	APRDRG 0452
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 0453: CVA & PRECEREBRAL OCCLUSION W INFARCT

Facility

$2.02

Service Code	APR-DRG 0453
Hospital Charge Code	APRDRG 0453
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.02
Rate for Payer: Amerigroup CHIP/Medicaid	$2.02
Rate for Payer: Cigna Medicaid	$2.02
Rate for Payer: Molina CHIP/Medicaid	$2.02
Rate for Payer: Parkland Medicaid	$2.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.02

INPATIENT APRDRG 0454: CVA & PRECEREBRAL OCCLUSION W INFARCT

Facility

$3.61

Service Code	APR-DRG 0454
Hospital Charge Code	APRDRG 0454
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$3.61
Rate for Payer: Amerigroup CHIP/Medicaid	$3.61
Rate for Payer: Cigna Medicaid	$3.61
Rate for Payer: Molina CHIP/Medicaid	$3.61
Rate for Payer: Parkland Medicaid	$3.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.61

INPATIENT APRDRG 0461: NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT

Facility

$1.12

Service Code	APR-DRG 0461
Hospital Charge Code	APRDRG 0461
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Amerigroup CHIP/Medicaid	$1.12
Rate for Payer: Cigna Medicaid	$1.12
Rate for Payer: Molina CHIP/Medicaid	$1.12
Rate for Payer: Parkland Medicaid	$1.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.12

INPATIENT APRDRG 0462: NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT

Facility

$1.13

Service Code	APR-DRG 0462
Hospital Charge Code	APRDRG 0462
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.13
Rate for Payer: Amerigroup CHIP/Medicaid	$1.13
Rate for Payer: Cigna Medicaid	$1.13
Rate for Payer: Molina CHIP/Medicaid	$1.13
Rate for Payer: Parkland Medicaid	$1.13
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.13

INPATIENT APRDRG 0463: NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT

Facility

$1.80

Service Code	APR-DRG 0463
Hospital Charge Code	APRDRG 0463
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Amerigroup CHIP/Medicaid	$1.80
Rate for Payer: Cigna Medicaid	$1.80
Rate for Payer: Molina CHIP/Medicaid	$1.80
Rate for Payer: Parkland Medicaid	$1.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.80

INPATIENT APRDRG 0464: NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT

Facility

$2.39

Service Code	APR-DRG 0464
Hospital Charge Code	APRDRG 0464
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$2.39
Rate for Payer: Amerigroup CHIP/Medicaid	$2.39
Rate for Payer: Cigna Medicaid	$2.39
Rate for Payer: Molina CHIP/Medicaid	$2.39
Rate for Payer: Parkland Medicaid	$2.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.39

INPATIENT APRDRG 0471: TRANSIENT ISCHEMIA

Facility

$0.82

Service Code	APR-DRG 0471
Hospital Charge Code	APRDRG 0471
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.82
Rate for Payer: Amerigroup CHIP/Medicaid	$0.82
Rate for Payer: Cigna Medicaid	$0.82
Rate for Payer: Molina CHIP/Medicaid	$0.82
Rate for Payer: Parkland Medicaid	$0.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.82

INPATIENT APRDRG 0472: TRANSIENT ISCHEMIA

Facility

$1.03

Service Code	APR-DRG 0472
Hospital Charge Code	APRDRG 0472
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$1.03
Rate for Payer: Amerigroup CHIP/Medicaid	$1.03
Rate for Payer: Cigna Medicaid	$1.03
Rate for Payer: Molina CHIP/Medicaid	$1.03
Rate for Payer: Parkland Medicaid	$1.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.03

INPATIENT APRDRG 0473: TRANSIENT ISCHEMIA

Facility

$1.33

Service Code	APR-DRG 0473
Hospital Charge Code	APRDRG 0473
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$1.33
Rate for Payer: Amerigroup CHIP/Medicaid	$1.33
Rate for Payer: Cigna Medicaid	$1.33
Rate for Payer: Molina CHIP/Medicaid	$1.33
Rate for Payer: Parkland Medicaid	$1.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.33

INPATIENT APRDRG 0474: TRANSIENT ISCHEMIA

Facility

$2.44

Service Code	APR-DRG 0474
Hospital Charge Code	APRDRG 0474
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$2.44
Rate for Payer: Amerigroup CHIP/Medicaid	$2.44
Rate for Payer: Cigna Medicaid	$2.44
Rate for Payer: Molina CHIP/Medicaid	$2.44
Rate for Payer: Parkland Medicaid	$2.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.44

INPATIENT APRDRG 0481: PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS

Facility

$0.79

Service Code	APR-DRG 0481
Hospital Charge Code	APRDRG 0481
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Amerigroup CHIP/Medicaid	$0.79
Rate for Payer: Cigna Medicaid	$0.79
Rate for Payer: Molina CHIP/Medicaid	$0.79
Rate for Payer: Parkland Medicaid	$0.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.79

INPATIENT APRDRG 0482: PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS

Facility

$0.82

Service Code	APR-DRG 0482
Hospital Charge Code	APRDRG 0482
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.82
Rate for Payer: Amerigroup CHIP/Medicaid	$0.82
Rate for Payer: Cigna Medicaid	$0.82
Rate for Payer: Molina CHIP/Medicaid	$0.82
Rate for Payer: Parkland Medicaid	$0.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.82

INPATIENT APRDRG 0483: PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS

Facility

$1.15

Service Code	APR-DRG 0483
Hospital Charge Code	APRDRG 0483
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 0484: PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS

Facility

$4.91

Service Code	APR-DRG 0484
Hospital Charge Code	APRDRG 0484
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$4.91
Rate for Payer: Amerigroup CHIP/Medicaid	$4.91
Rate for Payer: Cigna Medicaid	$4.91
Rate for Payer: Molina CHIP/Medicaid	$4.91
Rate for Payer: Parkland Medicaid	$4.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.91

INPATIENT APRDRG 0491: BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$1.46

Service Code	APR-DRG 0491
Hospital Charge Code	APRDRG 0491
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$1.46
Rate for Payer: Amerigroup CHIP/Medicaid	$1.46
Rate for Payer: Cigna Medicaid	$1.46
Rate for Payer: Molina CHIP/Medicaid	$1.46
Rate for Payer: Parkland Medicaid	$1.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.46

INPATIENT APRDRG 0492: BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$2.93

Service Code	APR-DRG 0492
Hospital Charge Code	APRDRG 0492
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$2.93
Rate for Payer: Amerigroup CHIP/Medicaid	$2.93
Rate for Payer: Cigna Medicaid	$2.93
Rate for Payer: Molina CHIP/Medicaid	$2.93
Rate for Payer: Parkland Medicaid	$2.93
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.93

INPATIENT APRDRG 0493: BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$3.10

Service Code	APR-DRG 0493
Hospital Charge Code	APRDRG 0493
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$3.10
Rate for Payer: Amerigroup CHIP/Medicaid	$3.10
Rate for Payer: Cigna Medicaid	$3.10
Rate for Payer: Molina CHIP/Medicaid	$3.10
Rate for Payer: Parkland Medicaid	$3.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.10

INPATIENT APRDRG 0494: BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$6.33

Service Code	APR-DRG 0494
Hospital Charge Code	APRDRG 0494
Min. Negotiated Rate	$6.33
Max. Negotiated Rate	$6.33
Rate for Payer: Amerigroup CHIP/Medicaid	$6.33
Rate for Payer: Cigna Medicaid	$6.33
Rate for Payer: Molina CHIP/Medicaid	$6.33
Rate for Payer: Parkland Medicaid	$6.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.33

Know your out-of-pocket cost for care.

All Charges