White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 0501: NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS

Facility

$0.78

Service Code	APR-DRG 0501
Hospital Charge Code	APRDRG 0501
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 0502: NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS

Facility

$2.66

Service Code	APR-DRG 0502
Hospital Charge Code	APRDRG 0502
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$2.66
Rate for Payer: Amerigroup CHIP/Medicaid	$2.66
Rate for Payer: Cigna Medicaid	$2.66
Rate for Payer: Molina CHIP/Medicaid	$2.66
Rate for Payer: Parkland Medicaid	$2.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.66

INPATIENT APRDRG 0503: NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS

Facility

$4.12

Service Code	APR-DRG 0503
Hospital Charge Code	APRDRG 0503
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$4.12
Rate for Payer: Amerigroup CHIP/Medicaid	$4.12
Rate for Payer: Cigna Medicaid	$4.12
Rate for Payer: Molina CHIP/Medicaid	$4.12
Rate for Payer: Parkland Medicaid	$4.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.12

INPATIENT APRDRG 0504: NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS

Facility

$8.10

Service Code	APR-DRG 0504
Hospital Charge Code	APRDRG 0504
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Amerigroup CHIP/Medicaid	$8.10
Rate for Payer: Cigna Medicaid	$8.10
Rate for Payer: Molina CHIP/Medicaid	$8.10
Rate for Payer: Parkland Medicaid	$8.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.10

INPATIENT APRDRG 0511: VIRAL MENINGITIS

Facility

$0.54

Service Code	APR-DRG 0511
Hospital Charge Code	APRDRG 0511
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 0512: VIRAL MENINGITIS

Facility

$0.87

Service Code	APR-DRG 0512
Hospital Charge Code	APRDRG 0512
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Amerigroup CHIP/Medicaid	$0.87
Rate for Payer: Cigna Medicaid	$0.87
Rate for Payer: Molina CHIP/Medicaid	$0.87
Rate for Payer: Parkland Medicaid	$0.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.87

INPATIENT APRDRG 0513: VIRAL MENINGITIS

Facility

$1.26

Service Code	APR-DRG 0513
Hospital Charge Code	APRDRG 0513
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$1.26
Rate for Payer: Amerigroup CHIP/Medicaid	$1.26
Rate for Payer: Cigna Medicaid	$1.26
Rate for Payer: Molina CHIP/Medicaid	$1.26
Rate for Payer: Parkland Medicaid	$1.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.26

INPATIENT APRDRG 0514: VIRAL MENINGITIS

Facility

$3.75

Service Code	APR-DRG 0514
Hospital Charge Code	APRDRG 0514
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Amerigroup CHIP/Medicaid	$3.75
Rate for Payer: Cigna Medicaid	$3.75
Rate for Payer: Molina CHIP/Medicaid	$3.75
Rate for Payer: Parkland Medicaid	$3.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.75

INPATIENT APRDRG 0521: ALTERATION IN CONSCIOUSNESS

Facility

$0.75

Service Code	APR-DRG 0521
Hospital Charge Code	APRDRG 0521
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Amerigroup CHIP/Medicaid	$0.75
Rate for Payer: Cigna Medicaid	$0.75
Rate for Payer: Molina CHIP/Medicaid	$0.75
Rate for Payer: Parkland Medicaid	$0.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.75

INPATIENT APRDRG 0522: ALTERATION IN CONSCIOUSNESS

Facility

$0.97

Service Code	APR-DRG 0522
Hospital Charge Code	APRDRG 0522
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$0.97
Rate for Payer: Amerigroup CHIP/Medicaid	$0.97
Rate for Payer: Cigna Medicaid	$0.97
Rate for Payer: Molina CHIP/Medicaid	$0.97
Rate for Payer: Parkland Medicaid	$0.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.97

INPATIENT APRDRG 0523: ALTERATION IN CONSCIOUSNESS

Facility

$1.23

Service Code	APR-DRG 0523
Hospital Charge Code	APRDRG 0523
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.23
Rate for Payer: Amerigroup CHIP/Medicaid	$1.23
Rate for Payer: Cigna Medicaid	$1.23
Rate for Payer: Molina CHIP/Medicaid	$1.23
Rate for Payer: Parkland Medicaid	$1.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.23

INPATIENT APRDRG 0524: ALTERATION IN CONSCIOUSNESS

Facility

$3.33

Service Code	APR-DRG 0524
Hospital Charge Code	APRDRG 0524
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$3.33
Rate for Payer: Amerigroup CHIP/Medicaid	$3.33
Rate for Payer: Cigna Medicaid	$3.33
Rate for Payer: Molina CHIP/Medicaid	$3.33
Rate for Payer: Parkland Medicaid	$3.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.33

INPATIENT APRDRG 0531: SEIZURE

Facility

$0.63

Service Code	APR-DRG 0531
Hospital Charge Code	APRDRG 0531
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Amerigroup CHIP/Medicaid	$0.63
Rate for Payer: Cigna Medicaid	$0.63
Rate for Payer: Molina CHIP/Medicaid	$0.63
Rate for Payer: Parkland Medicaid	$0.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.63

INPATIENT APRDRG 0532: SEIZURE

Facility

$0.85

Service Code	APR-DRG 0532
Hospital Charge Code	APRDRG 0532
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 0533: SEIZURE

Facility

$1.22

Service Code	APR-DRG 0533
Hospital Charge Code	APRDRG 0533
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$1.22
Rate for Payer: Amerigroup CHIP/Medicaid	$1.22
Rate for Payer: Cigna Medicaid	$1.22
Rate for Payer: Molina CHIP/Medicaid	$1.22
Rate for Payer: Parkland Medicaid	$1.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.22

INPATIENT APRDRG 0534: SEIZURE

Facility

$2.85

Service Code	APR-DRG 0534
Hospital Charge Code	APRDRG 0534
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Amerigroup CHIP/Medicaid	$2.85
Rate for Payer: Cigna Medicaid	$2.85
Rate for Payer: Molina CHIP/Medicaid	$2.85
Rate for Payer: Parkland Medicaid	$2.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.85

INPATIENT APRDRG 0541: MIGRAINE & OTHER HEADACHES

Facility

$0.72

Service Code	APR-DRG 0541
Hospital Charge Code	APRDRG 0541
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.72
Rate for Payer: Amerigroup CHIP/Medicaid	$0.72
Rate for Payer: Cigna Medicaid	$0.72
Rate for Payer: Molina CHIP/Medicaid	$0.72
Rate for Payer: Parkland Medicaid	$0.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.72

INPATIENT APRDRG 0542: MIGRAINE & OTHER HEADACHES

Facility

$0.89

Service Code	APR-DRG 0542
Hospital Charge Code	APRDRG 0542
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Amerigroup CHIP/Medicaid	$0.89
Rate for Payer: Cigna Medicaid	$0.89
Rate for Payer: Molina CHIP/Medicaid	$0.89
Rate for Payer: Parkland Medicaid	$0.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.89

INPATIENT APRDRG 0543: MIGRAINE & OTHER HEADACHES

Facility

$1.14

Service Code	APR-DRG 0543
Hospital Charge Code	APRDRG 0543
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.14
Rate for Payer: Amerigroup CHIP/Medicaid	$1.14
Rate for Payer: Cigna Medicaid	$1.14
Rate for Payer: Molina CHIP/Medicaid	$1.14
Rate for Payer: Parkland Medicaid	$1.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.14

INPATIENT APRDRG 0544: MIGRAINE & OTHER HEADACHES

Facility

$2.54

Service Code	APR-DRG 0544
Hospital Charge Code	APRDRG 0544
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$2.54
Rate for Payer: Amerigroup CHIP/Medicaid	$2.54
Rate for Payer: Cigna Medicaid	$2.54
Rate for Payer: Molina CHIP/Medicaid	$2.54
Rate for Payer: Parkland Medicaid	$2.54
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.54

INPATIENT APRDRG 0551: HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE

Facility

$0.77

Service Code	APR-DRG 0551
Hospital Charge Code	APRDRG 0551
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.77
Rate for Payer: Amerigroup CHIP/Medicaid	$0.77
Rate for Payer: Cigna Medicaid	$0.77
Rate for Payer: Molina CHIP/Medicaid	$0.77
Rate for Payer: Parkland Medicaid	$0.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.77

INPATIENT APRDRG 0552: HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE

Facility

$1.30

Service Code	APR-DRG 0552
Hospital Charge Code	APRDRG 0552
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 0553: HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE

Facility

$1.96

Service Code	APR-DRG 0553
Hospital Charge Code	APRDRG 0553
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$1.96
Rate for Payer: Amerigroup CHIP/Medicaid	$1.96
Rate for Payer: Cigna Medicaid	$1.96
Rate for Payer: Molina CHIP/Medicaid	$1.96
Rate for Payer: Parkland Medicaid	$1.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.96

INPATIENT APRDRG 0554: HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE

Facility

$3.55

Service Code	APR-DRG 0554
Hospital Charge Code	APRDRG 0554
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$3.55
Rate for Payer: Amerigroup CHIP/Medicaid	$3.55
Rate for Payer: Cigna Medicaid	$3.55
Rate for Payer: Molina CHIP/Medicaid	$3.55
Rate for Payer: Parkland Medicaid	$3.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.55

INPATIENT APRDRG 0561: BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA

Facility

$0.96

Service Code	APR-DRG 0561
Hospital Charge Code	APRDRG 0561
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$0.96
Rate for Payer: Amerigroup CHIP/Medicaid	$0.96
Rate for Payer: Cigna Medicaid	$0.96
Rate for Payer: Molina CHIP/Medicaid	$0.96
Rate for Payer: Parkland Medicaid	$0.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.96

Know your out-of-pocket cost for care.

All Charges