White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 1104: EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES

Facility

$2.72

Service Code	APR-DRG 1104
Hospital Charge Code	APRDRG 1104
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$2.72
Rate for Payer: Amerigroup CHIP/Medicaid	$2.72
Rate for Payer: Cigna Medicaid	$2.72
Rate for Payer: Molina CHIP/Medicaid	$2.72
Rate for Payer: Parkland Medicaid	$2.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.72

INPATIENT APRDRG 1111: VERTIGO & OTHER LABYRINTH DISORDERS

Facility

$0.64

Service Code	APR-DRG 1111
Hospital Charge Code	APRDRG 1111
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.64
Rate for Payer: Amerigroup CHIP/Medicaid	$0.64
Rate for Payer: Cigna Medicaid	$0.64
Rate for Payer: Molina CHIP/Medicaid	$0.64
Rate for Payer: Parkland Medicaid	$0.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.64

INPATIENT APRDRG 1112: VERTIGO & OTHER LABYRINTH DISORDERS

Facility

$0.88

Service Code	APR-DRG 1112
Hospital Charge Code	APRDRG 1112
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Amerigroup CHIP/Medicaid	$0.88
Rate for Payer: Cigna Medicaid	$0.88
Rate for Payer: Molina CHIP/Medicaid	$0.88
Rate for Payer: Parkland Medicaid	$0.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.88

INPATIENT APRDRG 1113: VERTIGO & OTHER LABYRINTH DISORDERS

Facility

$1.04

Service Code	APR-DRG 1113
Hospital Charge Code	APRDRG 1113
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.04
Rate for Payer: Amerigroup CHIP/Medicaid	$1.04
Rate for Payer: Cigna Medicaid	$1.04
Rate for Payer: Molina CHIP/Medicaid	$1.04
Rate for Payer: Parkland Medicaid	$1.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.04

INPATIENT APRDRG 1114: VERTIGO & OTHER LABYRINTH DISORDERS

Facility

$1.71

Service Code	APR-DRG 1114
Hospital Charge Code	APRDRG 1114
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$1.71
Rate for Payer: Amerigroup CHIP/Medicaid	$1.71
Rate for Payer: Cigna Medicaid	$1.71
Rate for Payer: Molina CHIP/Medicaid	$1.71
Rate for Payer: Parkland Medicaid	$1.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.71

INPATIENT APRDRG 1131: INFECTIONS OF UPPER RESPIRATORY TRACT

Facility

$0.38

Service Code	APR-DRG 1131
Hospital Charge Code	APRDRG 1131
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Amerigroup CHIP/Medicaid	$0.38
Rate for Payer: Cigna Medicaid	$0.38
Rate for Payer: Molina CHIP/Medicaid	$0.38
Rate for Payer: Parkland Medicaid	$0.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.38

INPATIENT APRDRG 1132: INFECTIONS OF UPPER RESPIRATORY TRACT

Facility

$0.58

Service Code	APR-DRG 1132
Hospital Charge Code	APRDRG 1132
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 1133: INFECTIONS OF UPPER RESPIRATORY TRACT

Facility

$1.72

Service Code	APR-DRG 1133
Hospital Charge Code	APRDRG 1133
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 1134: INFECTIONS OF UPPER RESPIRATORY TRACT

Facility

$2.78

Service Code	APR-DRG 1134
Hospital Charge Code	APRDRG 1134
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$2.78
Rate for Payer: Amerigroup CHIP/Medicaid	$2.78
Rate for Payer: Cigna Medicaid	$2.78
Rate for Payer: Molina CHIP/Medicaid	$2.78
Rate for Payer: Parkland Medicaid	$2.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.78

INPATIENT APRDRG 1141: DENTAL DISEASES AND DISORDERS

Facility

$0.60

Service Code	APR-DRG 1141
Hospital Charge Code	APRDRG 1141
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Amerigroup CHIP/Medicaid	$0.60
Rate for Payer: Cigna Medicaid	$0.60
Rate for Payer: Molina CHIP/Medicaid	$0.60
Rate for Payer: Parkland Medicaid	$0.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.60

INPATIENT APRDRG 1142: DENTAL DISEASES AND DISORDERS

Facility

$0.73

Service Code	APR-DRG 1142
Hospital Charge Code	APRDRG 1142
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Amerigroup CHIP/Medicaid	$0.73
Rate for Payer: Cigna Medicaid	$0.73
Rate for Payer: Molina CHIP/Medicaid	$0.73
Rate for Payer: Parkland Medicaid	$0.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.73

INPATIENT APRDRG 1143: DENTAL DISEASES AND DISORDERS

Facility

$1.07

Service Code	APR-DRG 1143
Hospital Charge Code	APRDRG 1143
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$1.07
Rate for Payer: Amerigroup CHIP/Medicaid	$1.07
Rate for Payer: Cigna Medicaid	$1.07
Rate for Payer: Molina CHIP/Medicaid	$1.07
Rate for Payer: Parkland Medicaid	$1.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.07

INPATIENT APRDRG 1144: DENTAL DISEASES AND DISORDERS

Facility

$3.51

Service Code	APR-DRG 1144
Hospital Charge Code	APRDRG 1144
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 1151: OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

Facility

$0.59

Service Code	APR-DRG 1151
Hospital Charge Code	APRDRG 1151
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 1152: OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

Facility

$1.05

Service Code	APR-DRG 1152
Hospital Charge Code	APRDRG 1152
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Amerigroup CHIP/Medicaid	$1.05
Rate for Payer: Cigna Medicaid	$1.05
Rate for Payer: Molina CHIP/Medicaid	$1.05
Rate for Payer: Parkland Medicaid	$1.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.05

INPATIENT APRDRG 1153: OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

Facility

$2.05

Service Code	APR-DRG 1153
Hospital Charge Code	APRDRG 1153
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Amerigroup CHIP/Medicaid	$2.05
Rate for Payer: Cigna Medicaid	$2.05
Rate for Payer: Molina CHIP/Medicaid	$2.05
Rate for Payer: Parkland Medicaid	$2.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.05

INPATIENT APRDRG 1154: OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

Facility

$3.77

Service Code	APR-DRG 1154
Hospital Charge Code	APRDRG 1154
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$3.77
Rate for Payer: Amerigroup CHIP/Medicaid	$3.77
Rate for Payer: Cigna Medicaid	$3.77
Rate for Payer: Molina CHIP/Medicaid	$3.77
Rate for Payer: Parkland Medicaid	$3.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.77

INPATIENT APRDRG 1201: MAJOR RESPIRATORY & CHEST PROCEDURES

Facility

$2.36

Service Code	APR-DRG 1201
Hospital Charge Code	APRDRG 1201
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$2.36
Rate for Payer: Amerigroup CHIP/Medicaid	$2.36
Rate for Payer: Cigna Medicaid	$2.36
Rate for Payer: Molina CHIP/Medicaid	$2.36
Rate for Payer: Parkland Medicaid	$2.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.36

INPATIENT APRDRG 1202: MAJOR RESPIRATORY & CHEST PROCEDURES

Facility

$2.42

Service Code	APR-DRG 1202
Hospital Charge Code	APRDRG 1202
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$2.42
Rate for Payer: Amerigroup CHIP/Medicaid	$2.42
Rate for Payer: Cigna Medicaid	$2.42
Rate for Payer: Molina CHIP/Medicaid	$2.42
Rate for Payer: Parkland Medicaid	$2.42
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.42

INPATIENT APRDRG 1203: MAJOR RESPIRATORY & CHEST PROCEDURES

Facility

$3.41

Service Code	APR-DRG 1203
Hospital Charge Code	APRDRG 1203
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$3.41
Rate for Payer: Amerigroup CHIP/Medicaid	$3.41
Rate for Payer: Cigna Medicaid	$3.41
Rate for Payer: Molina CHIP/Medicaid	$3.41
Rate for Payer: Parkland Medicaid	$3.41
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.41

INPATIENT APRDRG 1204: MAJOR RESPIRATORY & CHEST PROCEDURES

Facility

$10.05

Service Code	APR-DRG 1204
Hospital Charge Code	APRDRG 1204
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$10.05
Rate for Payer: Amerigroup CHIP/Medicaid	$10.05
Rate for Payer: Cigna Medicaid	$10.05
Rate for Payer: Molina CHIP/Medicaid	$10.05
Rate for Payer: Parkland Medicaid	$10.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10.05

INPATIENT APRDRG 1211: OTHER RESPIRATORY & CHEST PROCEDURES

Facility

$1.78

Service Code	APR-DRG 1211
Hospital Charge Code	APRDRG 1211
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$1.78
Rate for Payer: Amerigroup CHIP/Medicaid	$1.78
Rate for Payer: Cigna Medicaid	$1.78
Rate for Payer: Molina CHIP/Medicaid	$1.78
Rate for Payer: Parkland Medicaid	$1.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.78

INPATIENT APRDRG 1212: OTHER RESPIRATORY & CHEST PROCEDURES

Facility

$2.47

Service Code	APR-DRG 1212
Hospital Charge Code	APRDRG 1212
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$2.47
Rate for Payer: Amerigroup CHIP/Medicaid	$2.47
Rate for Payer: Cigna Medicaid	$2.47
Rate for Payer: Molina CHIP/Medicaid	$2.47
Rate for Payer: Parkland Medicaid	$2.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.47

INPATIENT APRDRG 1213: OTHER RESPIRATORY & CHEST PROCEDURES

Facility

$5.07

Service Code	APR-DRG 1213
Hospital Charge Code	APRDRG 1213
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$5.07
Rate for Payer: Amerigroup CHIP/Medicaid	$5.07
Rate for Payer: Cigna Medicaid	$5.07
Rate for Payer: Molina CHIP/Medicaid	$5.07
Rate for Payer: Parkland Medicaid	$5.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.07

INPATIENT APRDRG 1214: OTHER RESPIRATORY & CHEST PROCEDURES

Facility

$9.38

Service Code	APR-DRG 1214
Hospital Charge Code	APRDRG 1214
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$9.38
Rate for Payer: Amerigroup CHIP/Medicaid	$9.38
Rate for Payer: Cigna Medicaid	$9.38
Rate for Payer: Molina CHIP/Medicaid	$9.38
Rate for Payer: Parkland Medicaid	$9.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.38

Know your out-of-pocket cost for care.

All Charges