White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 1362: RESPIRATORY MALIGNANCY

Facility

$1.50

Service Code	APR-DRG 1362
Hospital Charge Code	APRDRG 1362
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 1363: RESPIRATORY MALIGNANCY

Facility

$2.13

Service Code	APR-DRG 1363
Hospital Charge Code	APRDRG 1363
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 1364: RESPIRATORY MALIGNANCY

Facility

$3.03

Service Code	APR-DRG 1364
Hospital Charge Code	APRDRG 1364
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$3.03
Rate for Payer: Amerigroup CHIP/Medicaid	$3.03
Rate for Payer: Cigna Medicaid	$3.03
Rate for Payer: Molina CHIP/Medicaid	$3.03
Rate for Payer: Parkland Medicaid	$3.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.03

INPATIENT APRDRG 1371: MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS

Facility

$0.80

Service Code	APR-DRG 1371
Hospital Charge Code	APRDRG 1371
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Amerigroup CHIP/Medicaid	$0.80
Rate for Payer: Cigna Medicaid	$0.80
Rate for Payer: Molina CHIP/Medicaid	$0.80
Rate for Payer: Parkland Medicaid	$0.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.80

INPATIENT APRDRG 1372: MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS

Facility

$1.15

Service Code	APR-DRG 1372
Hospital Charge Code	APRDRG 1372
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 1373: MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS

Facility

$1.68

Service Code	APR-DRG 1373
Hospital Charge Code	APRDRG 1373
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$1.68
Rate for Payer: Amerigroup CHIP/Medicaid	$1.68
Rate for Payer: Cigna Medicaid	$1.68
Rate for Payer: Molina CHIP/Medicaid	$1.68
Rate for Payer: Parkland Medicaid	$1.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.68

INPATIENT APRDRG 1374: MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS

Facility

$3.11

Service Code	APR-DRG 1374
Hospital Charge Code	APRDRG 1374
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$3.11
Rate for Payer: Amerigroup CHIP/Medicaid	$3.11
Rate for Payer: Cigna Medicaid	$3.11
Rate for Payer: Molina CHIP/Medicaid	$3.11
Rate for Payer: Parkland Medicaid	$3.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.11

INPATIENT APRDRG 1381: BRONCHIOLITIS & RSV PNEUMONIA

Facility

$0.41

Service Code	APR-DRG 1381
Hospital Charge Code	APRDRG 1381
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Amerigroup CHIP/Medicaid	$0.41
Rate for Payer: Cigna Medicaid	$0.41
Rate for Payer: Molina CHIP/Medicaid	$0.41
Rate for Payer: Parkland Medicaid	$0.41
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.41

INPATIENT APRDRG 1382: BRONCHIOLITIS & RSV PNEUMONIA

Facility

$0.58

Service Code	APR-DRG 1382
Hospital Charge Code	APRDRG 1382
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 1383: BRONCHIOLITIS & RSV PNEUMONIA

Facility

$0.98

Service Code	APR-DRG 1383
Hospital Charge Code	APRDRG 1383
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Amerigroup CHIP/Medicaid	$0.98
Rate for Payer: Cigna Medicaid	$0.98
Rate for Payer: Molina CHIP/Medicaid	$0.98
Rate for Payer: Parkland Medicaid	$0.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.98

INPATIENT APRDRG 1384: BRONCHIOLITIS & RSV PNEUMONIA

Facility

$2.20

Service Code	APR-DRG 1384
Hospital Charge Code	APRDRG 1384
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$2.20
Rate for Payer: Amerigroup CHIP/Medicaid	$2.20
Rate for Payer: Cigna Medicaid	$2.20
Rate for Payer: Molina CHIP/Medicaid	$2.20
Rate for Payer: Parkland Medicaid	$2.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.20

INPATIENT APRDRG 1391: OTHER PNEUMONIA

Facility

$0.49

Service Code	APR-DRG 1391
Hospital Charge Code	APRDRG 1391
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.49
Rate for Payer: Amerigroup CHIP/Medicaid	$0.49
Rate for Payer: Cigna Medicaid	$0.49
Rate for Payer: Molina CHIP/Medicaid	$0.49
Rate for Payer: Parkland Medicaid	$0.49
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.49

INPATIENT APRDRG 1392: OTHER PNEUMONIA

Facility

$0.77

Service Code	APR-DRG 1392
Hospital Charge Code	APRDRG 1392
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 1393: OTHER PNEUMONIA

Facility

$1.21

Service Code	APR-DRG 1393
Hospital Charge Code	APRDRG 1393
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$1.21
Rate for Payer: Amerigroup CHIP/Medicaid	$1.21
Rate for Payer: Cigna Medicaid	$1.21
Rate for Payer: Molina CHIP/Medicaid	$1.21
Rate for Payer: Parkland Medicaid	$1.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.21

INPATIENT APRDRG 1394: OTHER PNEUMONIA

Facility

$2.08

Service Code	APR-DRG 1394
Hospital Charge Code	APRDRG 1394
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$2.08
Rate for Payer: Amerigroup CHIP/Medicaid	$2.08
Rate for Payer: Cigna Medicaid	$2.08
Rate for Payer: Molina CHIP/Medicaid	$2.08
Rate for Payer: Parkland Medicaid	$2.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.08

INPATIENT APRDRG 1401: CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Facility

$0.76

Service Code	APR-DRG 1401
Hospital Charge Code	APRDRG 1401
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.76
Rate for Payer: Amerigroup CHIP/Medicaid	$0.76
Rate for Payer: Cigna Medicaid	$0.76
Rate for Payer: Molina CHIP/Medicaid	$0.76
Rate for Payer: Parkland Medicaid	$0.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.76

INPATIENT APRDRG 1402: CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Facility

$0.88

Service Code	APR-DRG 1402
Hospital Charge Code	APRDRG 1402
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 1403: CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Facility

$1.03

Service Code	APR-DRG 1403
Hospital Charge Code	APRDRG 1403
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 1404: CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Facility

$1.51

Service Code	APR-DRG 1404
Hospital Charge Code	APRDRG 1404
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$1.51
Rate for Payer: Amerigroup CHIP/Medicaid	$1.51
Rate for Payer: Cigna Medicaid	$1.51
Rate for Payer: Molina CHIP/Medicaid	$1.51
Rate for Payer: Parkland Medicaid	$1.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.51

INPATIENT APRDRG 1411: ASTHMA

Facility

$0.48

Service Code	APR-DRG 1411
Hospital Charge Code	APRDRG 1411
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Amerigroup CHIP/Medicaid	$0.48
Rate for Payer: Cigna Medicaid	$0.48
Rate for Payer: Molina CHIP/Medicaid	$0.48
Rate for Payer: Parkland Medicaid	$0.48
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.48

INPATIENT APRDRG 1412: ASTHMA

Facility

$0.70

Service Code	APR-DRG 1412
Hospital Charge Code	APRDRG 1412
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.70
Rate for Payer: Amerigroup CHIP/Medicaid	$0.70
Rate for Payer: Cigna Medicaid	$0.70
Rate for Payer: Molina CHIP/Medicaid	$0.70
Rate for Payer: Parkland Medicaid	$0.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.70

INPATIENT APRDRG 1413: ASTHMA

Facility

$0.89

Service Code	APR-DRG 1413
Hospital Charge Code	APRDRG 1413
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 1414: ASTHMA

Facility

$1.81

Service Code	APR-DRG 1414
Hospital Charge Code	APRDRG 1414
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$1.81
Rate for Payer: Amerigroup CHIP/Medicaid	$1.81
Rate for Payer: Cigna Medicaid	$1.81
Rate for Payer: Molina CHIP/Medicaid	$1.81
Rate for Payer: Parkland Medicaid	$1.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.81

INPATIENT APRDRG 1421: INTERSTITIAL & ALVEOLAR LUNG DISEASES

Facility

$0.84

Service Code	APR-DRG 1421
Hospital Charge Code	APRDRG 1421
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Amerigroup CHIP/Medicaid	$0.84
Rate for Payer: Cigna Medicaid	$0.84
Rate for Payer: Molina CHIP/Medicaid	$0.84
Rate for Payer: Parkland Medicaid	$0.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.84

INPATIENT APRDRG 1422: INTERSTITIAL & ALVEOLAR LUNG DISEASES

Facility

$1.34

Service Code	APR-DRG 1422
Hospital Charge Code	APRDRG 1422
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.34
Rate for Payer: Amerigroup CHIP/Medicaid	$1.34
Rate for Payer: Cigna Medicaid	$1.34
Rate for Payer: Molina CHIP/Medicaid	$1.34
Rate for Payer: Parkland Medicaid	$1.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.34

Know your out-of-pocket cost for care.

All Charges