White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 1423: INTERSTITIAL & ALVEOLAR LUNG DISEASES

Facility

$1.36

Service Code	APR-DRG 1423
Hospital Charge Code	APRDRG 1423
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$1.36
Rate for Payer: Amerigroup CHIP/Medicaid	$1.36
Rate for Payer: Cigna Medicaid	$1.36
Rate for Payer: Molina CHIP/Medicaid	$1.36
Rate for Payer: Parkland Medicaid	$1.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.36

INPATIENT APRDRG 1424: INTERSTITIAL & ALVEOLAR LUNG DISEASES

Facility

$1.70

Service Code	APR-DRG 1424
Hospital Charge Code	APRDRG 1424
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.70
Rate for Payer: Amerigroup CHIP/Medicaid	$1.70
Rate for Payer: Cigna Medicaid	$1.70
Rate for Payer: Molina CHIP/Medicaid	$1.70
Rate for Payer: Parkland Medicaid	$1.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.70

INPATIENT APRDRG 1431: OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$0.63

Service Code	APR-DRG 1431
Hospital Charge Code	APRDRG 1431
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 1432: OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$0.91

Service Code	APR-DRG 1432
Hospital Charge Code	APRDRG 1432
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$0.91
Rate for Payer: Amerigroup CHIP/Medicaid	$0.91
Rate for Payer: Cigna Medicaid	$0.91
Rate for Payer: Molina CHIP/Medicaid	$0.91
Rate for Payer: Parkland Medicaid	$0.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.91

INPATIENT APRDRG 1433: OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$1.41

Service Code	APR-DRG 1433
Hospital Charge Code	APRDRG 1433
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.41
Rate for Payer: Amerigroup CHIP/Medicaid	$1.41
Rate for Payer: Cigna Medicaid	$1.41
Rate for Payer: Molina CHIP/Medicaid	$1.41
Rate for Payer: Parkland Medicaid	$1.41
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.41

INPATIENT APRDRG 1434: OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$2.24

Service Code	APR-DRG 1434
Hospital Charge Code	APRDRG 1434
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$2.24
Rate for Payer: Amerigroup CHIP/Medicaid	$2.24
Rate for Payer: Cigna Medicaid	$2.24
Rate for Payer: Molina CHIP/Medicaid	$2.24
Rate for Payer: Parkland Medicaid	$2.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.24

INPATIENT APRDRG 1441: RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$0.56

Service Code	APR-DRG 1441
Hospital Charge Code	APRDRG 1441
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Amerigroup CHIP/Medicaid	$0.56
Rate for Payer: Cigna Medicaid	$0.56
Rate for Payer: Molina CHIP/Medicaid	$0.56
Rate for Payer: Parkland Medicaid	$0.56
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.56

INPATIENT APRDRG 1442: RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$0.89

Service Code	APR-DRG 1442
Hospital Charge Code	APRDRG 1442
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 1443: RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$1.77

Service Code	APR-DRG 1443
Hospital Charge Code	APRDRG 1443
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$1.77
Rate for Payer: Amerigroup CHIP/Medicaid	$1.77
Rate for Payer: Cigna Medicaid	$1.77
Rate for Payer: Molina CHIP/Medicaid	$1.77
Rate for Payer: Parkland Medicaid	$1.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.77

INPATIENT APRDRG 1444: RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

Facility

$2.23

Service Code	APR-DRG 1444
Hospital Charge Code	APRDRG 1444
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$2.23
Rate for Payer: Amerigroup CHIP/Medicaid	$2.23
Rate for Payer: Cigna Medicaid	$2.23
Rate for Payer: Molina CHIP/Medicaid	$2.23
Rate for Payer: Parkland Medicaid	$2.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.23

INPATIENT APRDRG 1451: ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$0.40

Service Code	APR-DRG 1451
Hospital Charge Code	APRDRG 1451
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.40
Rate for Payer: Amerigroup CHIP/Medicaid	$0.40
Rate for Payer: Cigna Medicaid	$0.40
Rate for Payer: Molina CHIP/Medicaid	$0.40
Rate for Payer: Parkland Medicaid	$0.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.40

INPATIENT APRDRG 1452: ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$0.75

Service Code	APR-DRG 1452
Hospital Charge Code	APRDRG 1452
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 1453: ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$1.25

Service Code	APR-DRG 1453
Hospital Charge Code	APRDRG 1453
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.25
Rate for Payer: Amerigroup CHIP/Medicaid	$1.25
Rate for Payer: Cigna Medicaid	$1.25
Rate for Payer: Molina CHIP/Medicaid	$1.25
Rate for Payer: Parkland Medicaid	$1.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.25

INPATIENT APRDRG 1454: ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$1.87

Service Code	APR-DRG 1454
Hospital Charge Code	APRDRG 1454
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1.87
Rate for Payer: Amerigroup CHIP/Medicaid	$1.87
Rate for Payer: Cigna Medicaid	$1.87
Rate for Payer: Molina CHIP/Medicaid	$1.87
Rate for Payer: Parkland Medicaid	$1.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.87

INPATIENT APRDRG 1601: MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$4.99

Service Code	APR-DRG 1601
Hospital Charge Code	APRDRG 1601
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$4.99
Rate for Payer: Amerigroup CHIP/Medicaid	$4.99
Rate for Payer: Cigna Medicaid	$4.99
Rate for Payer: Molina CHIP/Medicaid	$4.99
Rate for Payer: Parkland Medicaid	$4.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.99

INPATIENT APRDRG 1602: MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$6.36

Service Code	APR-DRG 1602
Hospital Charge Code	APRDRG 1602
Min. Negotiated Rate	$6.36
Max. Negotiated Rate	$6.36
Rate for Payer: Amerigroup CHIP/Medicaid	$6.36
Rate for Payer: Cigna Medicaid	$6.36
Rate for Payer: Molina CHIP/Medicaid	$6.36
Rate for Payer: Parkland Medicaid	$6.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.36

INPATIENT APRDRG 1603: MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$9.16

Service Code	APR-DRG 1603
Hospital Charge Code	APRDRG 1603
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$9.16
Rate for Payer: Amerigroup CHIP/Medicaid	$9.16
Rate for Payer: Cigna Medicaid	$9.16
Rate for Payer: Molina CHIP/Medicaid	$9.16
Rate for Payer: Parkland Medicaid	$9.16
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.16

INPATIENT APRDRG 1604: MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$21.67

Service Code	APR-DRG 1604
Hospital Charge Code	APRDRG 1604
Min. Negotiated Rate	$21.67
Max. Negotiated Rate	$21.67
Rate for Payer: Amerigroup CHIP/Medicaid	$21.67
Rate for Payer: Cigna Medicaid	$21.67
Rate for Payer: Molina CHIP/Medicaid	$21.67
Rate for Payer: Parkland Medicaid	$21.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$21.67

INPATIENT APRDRG 1611: CARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANT

Facility

$16.59

Service Code	APR-DRG 1611
Hospital Charge Code	APRDRG 1611
Min. Negotiated Rate	$16.59
Max. Negotiated Rate	$16.59
Rate for Payer: Amerigroup CHIP/Medicaid	$16.59
Rate for Payer: Cigna Medicaid	$16.59
Rate for Payer: Molina CHIP/Medicaid	$16.59
Rate for Payer: Parkland Medicaid	$16.59
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16.59

INPATIENT APRDRG 1612: CARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANT

Facility

$17.49

Service Code	APR-DRG 1612
Hospital Charge Code	APRDRG 1612
Min. Negotiated Rate	$17.49
Max. Negotiated Rate	$17.49
Rate for Payer: Amerigroup CHIP/Medicaid	$17.49
Rate for Payer: Cigna Medicaid	$17.49
Rate for Payer: Molina CHIP/Medicaid	$17.49
Rate for Payer: Parkland Medicaid	$17.49
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.49

INPATIENT APRDRG 1613: CARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANT

Facility

$24.33

Service Code	APR-DRG 1613
Hospital Charge Code	APRDRG 1613
Min. Negotiated Rate	$24.33
Max. Negotiated Rate	$24.33
Rate for Payer: Amerigroup CHIP/Medicaid	$24.33
Rate for Payer: Cigna Medicaid	$24.33
Rate for Payer: Molina CHIP/Medicaid	$24.33
Rate for Payer: Parkland Medicaid	$24.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$24.33

INPATIENT APRDRG 1614: CARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANT

Facility

$46.68

Service Code	APR-DRG 1614
Hospital Charge Code	APRDRG 1614
Min. Negotiated Rate	$46.68
Max. Negotiated Rate	$46.68
Rate for Payer: Amerigroup CHIP/Medicaid	$46.68
Rate for Payer: Cigna Medicaid	$46.68
Rate for Payer: Molina CHIP/Medicaid	$46.68
Rate for Payer: Parkland Medicaid	$46.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$46.68

INPATIENT APRDRG 1621: CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX

Facility

$7.05

Service Code	APR-DRG 1621
Hospital Charge Code	APRDRG 1621
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$7.05
Rate for Payer: Amerigroup CHIP/Medicaid	$7.05
Rate for Payer: Cigna Medicaid	$7.05
Rate for Payer: Molina CHIP/Medicaid	$7.05
Rate for Payer: Parkland Medicaid	$7.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.05

INPATIENT APRDRG 1622: CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX

Facility

$7.94

Service Code	APR-DRG 1622
Hospital Charge Code	APRDRG 1622
Min. Negotiated Rate	$7.94
Max. Negotiated Rate	$7.94
Rate for Payer: Amerigroup CHIP/Medicaid	$7.94
Rate for Payer: Cigna Medicaid	$7.94
Rate for Payer: Molina CHIP/Medicaid	$7.94
Rate for Payer: Parkland Medicaid	$7.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.94

INPATIENT APRDRG 1623: CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX

Facility

$10.64

Service Code	APR-DRG 1623
Hospital Charge Code	APRDRG 1623
Min. Negotiated Rate	$10.64
Max. Negotiated Rate	$10.64
Rate for Payer: Amerigroup CHIP/Medicaid	$10.64
Rate for Payer: Cigna Medicaid	$10.64
Rate for Payer: Molina CHIP/Medicaid	$10.64
Rate for Payer: Parkland Medicaid	$10.64
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10.64

Know your out-of-pocket cost for care.

All Charges