White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 0562: BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA

Facility

$1.35

Service Code	APR-DRG 0562
Hospital Charge Code	APRDRG 0562
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Amerigroup CHIP/Medicaid	$1.35
Rate for Payer: Cigna Medicaid	$1.35
Rate for Payer: Molina CHIP/Medicaid	$1.35
Rate for Payer: Parkland Medicaid	$1.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.35

INPATIENT APRDRG 0563: BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA

Facility

$2.06

Service Code	APR-DRG 0563
Hospital Charge Code	APRDRG 0563
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$2.06
Rate for Payer: Amerigroup CHIP/Medicaid	$2.06
Rate for Payer: Cigna Medicaid	$2.06
Rate for Payer: Molina CHIP/Medicaid	$2.06
Rate for Payer: Parkland Medicaid	$2.06
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.06

INPATIENT APRDRG 0564: BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA

Facility

$3.96

Service Code	APR-DRG 0564
Hospital Charge Code	APRDRG 0564
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

INPATIENT APRDRG 0571: CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA

Facility

$0.58

Service Code	APR-DRG 0571
Hospital Charge Code	APRDRG 0571
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Amerigroup CHIP/Medicaid	$0.58
Rate for Payer: Cigna Medicaid	$0.58
Rate for Payer: Molina CHIP/Medicaid	$0.58
Rate for Payer: Parkland Medicaid	$0.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.58

INPATIENT APRDRG 0572: CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA

Facility

$1.02

Service Code	APR-DRG 0572
Hospital Charge Code	APRDRG 0572
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 0573: CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA

Facility

$1.95

Service Code	APR-DRG 0573
Hospital Charge Code	APRDRG 0573
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 0574: CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA

Facility

$4.88

Service Code	APR-DRG 0574
Hospital Charge Code	APRDRG 0574
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$4.88
Rate for Payer: Amerigroup CHIP/Medicaid	$4.88
Rate for Payer: Cigna Medicaid	$4.88
Rate for Payer: Molina CHIP/Medicaid	$4.88
Rate for Payer: Parkland Medicaid	$4.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.88

INPATIENT APRDRG 0581: OTHER DISORDERS OF NERVOUS SYSTEM

Facility

$1.06

Service Code	APR-DRG 0581
Hospital Charge Code	APRDRG 0581
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.06
Rate for Payer: Amerigroup CHIP/Medicaid	$1.06
Rate for Payer: Cigna Medicaid	$1.06
Rate for Payer: Molina CHIP/Medicaid	$1.06
Rate for Payer: Parkland Medicaid	$1.06
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.06

INPATIENT APRDRG 0582: OTHER DISORDERS OF NERVOUS SYSTEM

Facility

$1.49

Service Code	APR-DRG 0582
Hospital Charge Code	APRDRG 0582
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$1.49
Rate for Payer: Amerigroup CHIP/Medicaid	$1.49
Rate for Payer: Cigna Medicaid	$1.49
Rate for Payer: Molina CHIP/Medicaid	$1.49
Rate for Payer: Parkland Medicaid	$1.49
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.49

INPATIENT APRDRG 0583: OTHER DISORDERS OF NERVOUS SYSTEM

Facility

$2.39

Service Code	APR-DRG 0583
Hospital Charge Code	APRDRG 0583
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 0584: OTHER DISORDERS OF NERVOUS SYSTEM

Facility

$4.84

Service Code	APR-DRG 0584
Hospital Charge Code	APRDRG 0584
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$4.84
Rate for Payer: Amerigroup CHIP/Medicaid	$4.84
Rate for Payer: Cigna Medicaid	$4.84
Rate for Payer: Molina CHIP/Medicaid	$4.84
Rate for Payer: Parkland Medicaid	$4.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.84

INPATIENT APRDRG 0591: ANOXIC & OTHER SEVERE BRAIN DAMAGE

Facility

$1.72

Service Code	APR-DRG 0591
Hospital Charge Code	APRDRG 0591
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$1.72
Rate for Payer: Amerigroup CHIP/Medicaid	$1.72
Rate for Payer: Cigna Medicaid	$1.72
Rate for Payer: Molina CHIP/Medicaid	$1.72
Rate for Payer: Parkland Medicaid	$1.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.72

INPATIENT APRDRG 0592: ANOXIC & OTHER SEVERE BRAIN DAMAGE

Facility

$2.13

Service Code	APR-DRG 0592
Hospital Charge Code	APRDRG 0592
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$2.13
Rate for Payer: Amerigroup CHIP/Medicaid	$2.13
Rate for Payer: Cigna Medicaid	$2.13
Rate for Payer: Molina CHIP/Medicaid	$2.13
Rate for Payer: Parkland Medicaid	$2.13
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.13

INPATIENT APRDRG 0593: ANOXIC & OTHER SEVERE BRAIN DAMAGE

Facility

$3.20

Service Code	APR-DRG 0593
Hospital Charge Code	APRDRG 0593
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$3.20
Rate for Payer: Amerigroup CHIP/Medicaid	$3.20
Rate for Payer: Cigna Medicaid	$3.20
Rate for Payer: Molina CHIP/Medicaid	$3.20
Rate for Payer: Parkland Medicaid	$3.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.20

INPATIENT APRDRG 0594: ANOXIC & OTHER SEVERE BRAIN DAMAGE

Facility

$5.54

Service Code	APR-DRG 0594
Hospital Charge Code	APRDRG 0594
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 0731: ORBIT AND EYE PROCEDURES

Facility

$1.32

Service Code	APR-DRG 0731
Hospital Charge Code	APRDRG 0731
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.32
Rate for Payer: Amerigroup CHIP/Medicaid	$1.32
Rate for Payer: Cigna Medicaid	$1.32
Rate for Payer: Molina CHIP/Medicaid	$1.32
Rate for Payer: Parkland Medicaid	$1.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.32

INPATIENT APRDRG 0732: ORBIT AND EYE PROCEDURES

Facility

$1.80

Service Code	APR-DRG 0732
Hospital Charge Code	APRDRG 0732
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 0733: ORBIT AND EYE PROCEDURES

Facility

$2.58

Service Code	APR-DRG 0733
Hospital Charge Code	APRDRG 0733
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 0734: ORBIT AND EYE PROCEDURES

Facility

$6.62

Service Code	APR-DRG 0734
Hospital Charge Code	APRDRG 0734
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$6.62
Rate for Payer: Amerigroup CHIP/Medicaid	$6.62
Rate for Payer: Cigna Medicaid	$6.62
Rate for Payer: Molina CHIP/Medicaid	$6.62
Rate for Payer: Parkland Medicaid	$6.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.62

INPATIENT APRDRG 0821: EYE INFECTIONS AND OTHER EYE DISORDERS

Facility

$0.59

Service Code	APR-DRG 0821
Hospital Charge Code	APRDRG 0821
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.59
Rate for Payer: Amerigroup CHIP/Medicaid	$0.59
Rate for Payer: Cigna Medicaid	$0.59
Rate for Payer: Molina CHIP/Medicaid	$0.59
Rate for Payer: Parkland Medicaid	$0.59
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.59

INPATIENT APRDRG 0822: EYE INFECTIONS AND OTHER EYE DISORDERS

Facility

$1.13

Service Code	APR-DRG 0822
Hospital Charge Code	APRDRG 0822
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 0823: EYE INFECTIONS AND OTHER EYE DISORDERS

Facility

$2.02

Service Code	APR-DRG 0823
Hospital Charge Code	APRDRG 0823
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 0824: EYE INFECTIONS AND OTHER EYE DISORDERS

Facility

$3.51

Service Code	APR-DRG 0824
Hospital Charge Code	APRDRG 0824
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$3.51
Rate for Payer: Amerigroup CHIP/Medicaid	$3.51
Rate for Payer: Cigna Medicaid	$3.51
Rate for Payer: Molina CHIP/Medicaid	$3.51
Rate for Payer: Parkland Medicaid	$3.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.51

INPATIENT APRDRG 0891: MAJOR CRANIAL/FACIAL BONE PROCEDURES

Facility

$2.67

Service Code	APR-DRG 0891
Hospital Charge Code	APRDRG 0891
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$2.67
Rate for Payer: Amerigroup CHIP/Medicaid	$2.67
Rate for Payer: Cigna Medicaid	$2.67
Rate for Payer: Molina CHIP/Medicaid	$2.67
Rate for Payer: Parkland Medicaid	$2.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.67

INPATIENT APRDRG 0892: MAJOR CRANIAL/FACIAL BONE PROCEDURES

Facility

$2.89

Service Code	APR-DRG 0892
Hospital Charge Code	APRDRG 0892
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Amerigroup CHIP/Medicaid	$2.89
Rate for Payer: Cigna Medicaid	$2.89
Rate for Payer: Molina CHIP/Medicaid	$2.89
Rate for Payer: Parkland Medicaid	$2.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.89

Know your out-of-pocket cost for care.

All Charges