White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 1301: RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

Facility

$5.03

Service Code	APR-DRG 1301
Hospital Charge Code	APRDRG 1301
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$5.03
Rate for Payer: Amerigroup CHIP/Medicaid	$5.03
Rate for Payer: Cigna Medicaid	$5.03
Rate for Payer: Molina CHIP/Medicaid	$5.03
Rate for Payer: Parkland Medicaid	$5.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.03

INPATIENT APRDRG 1302: RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

Facility

$5.87

Service Code	APR-DRG 1302
Hospital Charge Code	APRDRG 1302
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 1303: RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

Facility

$6.72

Service Code	APR-DRG 1303
Hospital Charge Code	APRDRG 1303
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$6.72
Rate for Payer: Amerigroup CHIP/Medicaid	$6.72
Rate for Payer: Cigna Medicaid	$6.72
Rate for Payer: Molina CHIP/Medicaid	$6.72
Rate for Payer: Parkland Medicaid	$6.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.72

INPATIENT APRDRG 1304: RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

Facility

$9.89

Service Code	APR-DRG 1304
Hospital Charge Code	APRDRG 1304
Min. Negotiated Rate	$9.89
Max. Negotiated Rate	$9.89
Rate for Payer: Amerigroup CHIP/Medicaid	$9.89
Rate for Payer: Cigna Medicaid	$9.89
Rate for Payer: Molina CHIP/Medicaid	$9.89
Rate for Payer: Parkland Medicaid	$9.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.89

INPATIENT APRDRG 1311: CYSTIC FIBROSIS - PULMONARY DISEASE

Facility

$1.64

Service Code	APR-DRG 1311
Hospital Charge Code	APRDRG 1311
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Amerigroup CHIP/Medicaid	$1.64
Rate for Payer: Cigna Medicaid	$1.64
Rate for Payer: Molina CHIP/Medicaid	$1.64
Rate for Payer: Parkland Medicaid	$1.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.64

INPATIENT APRDRG 1312: CYSTIC FIBROSIS - PULMONARY DISEASE

Facility

$2.88

Service Code	APR-DRG 1312
Hospital Charge Code	APRDRG 1312
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$2.88
Rate for Payer: Amerigroup CHIP/Medicaid	$2.88
Rate for Payer: Cigna Medicaid	$2.88
Rate for Payer: Molina CHIP/Medicaid	$2.88
Rate for Payer: Parkland Medicaid	$2.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.88

INPATIENT APRDRG 1313: CYSTIC FIBROSIS - PULMONARY DISEASE

Facility

$3.89

Service Code	APR-DRG 1313
Hospital Charge Code	APRDRG 1313
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$3.89
Rate for Payer: Amerigroup CHIP/Medicaid	$3.89
Rate for Payer: Cigna Medicaid	$3.89
Rate for Payer: Molina CHIP/Medicaid	$3.89
Rate for Payer: Parkland Medicaid	$3.89
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.89

INPATIENT APRDRG 1314: CYSTIC FIBROSIS - PULMONARY DISEASE

Facility

$5.23

Service Code	APR-DRG 1314
Hospital Charge Code	APRDRG 1314
Min. Negotiated Rate	$5.23
Max. Negotiated Rate	$5.23
Rate for Payer: Amerigroup CHIP/Medicaid	$5.23
Rate for Payer: Cigna Medicaid	$5.23
Rate for Payer: Molina CHIP/Medicaid	$5.23
Rate for Payer: Parkland Medicaid	$5.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.23

INPATIENT APRDRG 1321: BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD

Facility

$0.60

Service Code	APR-DRG 1321
Hospital Charge Code	APRDRG 1321
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 1322: BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD

Facility

$1.12

Service Code	APR-DRG 1322
Hospital Charge Code	APRDRG 1322
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 1323: BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD

Facility

$1.90

Service Code	APR-DRG 1323
Hospital Charge Code	APRDRG 1323
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$1.90
Rate for Payer: Amerigroup CHIP/Medicaid	$1.90
Rate for Payer: Cigna Medicaid	$1.90
Rate for Payer: Molina CHIP/Medicaid	$1.90
Rate for Payer: Parkland Medicaid	$1.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.90

INPATIENT APRDRG 1324: BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD

Facility

$3.18

Service Code	APR-DRG 1324
Hospital Charge Code	APRDRG 1324
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$3.18
Rate for Payer: Amerigroup CHIP/Medicaid	$3.18
Rate for Payer: Cigna Medicaid	$3.18
Rate for Payer: Molina CHIP/Medicaid	$3.18
Rate for Payer: Parkland Medicaid	$3.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.18

INPATIENT APRDRG 1331: RESPIRATORY FAILURE

Facility

$0.66

Service Code	APR-DRG 1331
Hospital Charge Code	APRDRG 1331
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Amerigroup CHIP/Medicaid	$0.66
Rate for Payer: Cigna Medicaid	$0.66
Rate for Payer: Molina CHIP/Medicaid	$0.66
Rate for Payer: Parkland Medicaid	$0.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.66

INPATIENT APRDRG 1332: RESPIRATORY FAILURE

Facility

$1.03

Service Code	APR-DRG 1332
Hospital Charge Code	APRDRG 1332
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 1333: RESPIRATORY FAILURE

Facility

$1.94

Service Code	APR-DRG 1333
Hospital Charge Code	APRDRG 1333
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$1.94
Rate for Payer: Amerigroup CHIP/Medicaid	$1.94
Rate for Payer: Cigna Medicaid	$1.94
Rate for Payer: Molina CHIP/Medicaid	$1.94
Rate for Payer: Parkland Medicaid	$1.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.94

INPATIENT APRDRG 1334: RESPIRATORY FAILURE

Facility

$2.82

Service Code	APR-DRG 1334
Hospital Charge Code	APRDRG 1334
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$2.82
Rate for Payer: Amerigroup CHIP/Medicaid	$2.82
Rate for Payer: Cigna Medicaid	$2.82
Rate for Payer: Molina CHIP/Medicaid	$2.82
Rate for Payer: Parkland Medicaid	$2.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.82

INPATIENT APRDRG 1341: PULMONARY EMBOLISM

Facility

$0.88

Service Code	APR-DRG 1341
Hospital Charge Code	APRDRG 1341
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 1342: PULMONARY EMBOLISM

Facility

$1.02

Service Code	APR-DRG 1342
Hospital Charge Code	APRDRG 1342
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 1343: PULMONARY EMBOLISM

Facility

$1.52

Service Code	APR-DRG 1343
Hospital Charge Code	APRDRG 1343
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$1.52
Rate for Payer: Amerigroup CHIP/Medicaid	$1.52
Rate for Payer: Cigna Medicaid	$1.52
Rate for Payer: Molina CHIP/Medicaid	$1.52
Rate for Payer: Parkland Medicaid	$1.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.52

INPATIENT APRDRG 1344: PULMONARY EMBOLISM

Facility

$3.02

Service Code	APR-DRG 1344
Hospital Charge Code	APRDRG 1344
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$3.02
Rate for Payer: Amerigroup CHIP/Medicaid	$3.02
Rate for Payer: Cigna Medicaid	$3.02
Rate for Payer: Molina CHIP/Medicaid	$3.02
Rate for Payer: Parkland Medicaid	$3.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.02

INPATIENT APRDRG 1351: MAJOR CHEST & RESPIRAZORY TRAUMA

Facility

$0.95

Service Code	APR-DRG 1351
Hospital Charge Code	APRDRG 1351
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$0.95
Rate for Payer: Amerigroup CHIP/Medicaid	$0.95
Rate for Payer: Cigna Medicaid	$0.95
Rate for Payer: Molina CHIP/Medicaid	$0.95
Rate for Payer: Parkland Medicaid	$0.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.95

INPATIENT APRDRG 1352: MAJOR CHEST & RESPIRATORY TRAUMA

Facility

$1.26

Service Code	APR-DRG 1352
Hospital Charge Code	APRDRG 1352
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 1353: MAJOR CHEST & RESPIRATORY TRAUMA

Facility

$1.50

Service Code	APR-DRG 1353
Hospital Charge Code	APRDRG 1353
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 1354: MAJOR CHEST & RESPIRATORY TRAUMA

Facility

$2.47

Service Code	APR-DRG 1354
Hospital Charge Code	APRDRG 1354
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 1361: RESPIRATORY MALIGNANCY

Facility

$1.13

Service Code	APR-DRG 1361
Hospital Charge Code	APRDRG 1361
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

Know your out-of-pocket cost for care.

All Charges