White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 2434: OTHER ESOPHAGEAL DISORDERS

Facility

$2.87

Service Code	APR-DRG 2434
Hospital Charge Code	APRDRG 2434
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$2.87
Rate for Payer: Amerigroup CHIP/Medicaid	$2.87
Rate for Payer: Cigna Medicaid	$2.87
Rate for Payer: Molina CHIP/Medicaid	$2.87
Rate for Payer: Parkland Medicaid	$2.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.87

INPATIENT APRDRG 2441: DIVERTICULITIS & DIVERTICULOSIS

Facility

$0.71

Service Code	APR-DRG 2441
Hospital Charge Code	APRDRG 2441
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$0.71
Rate for Payer: Amerigroup CHIP/Medicaid	$0.71
Rate for Payer: Cigna Medicaid	$0.71
Rate for Payer: Molina CHIP/Medicaid	$0.71
Rate for Payer: Parkland Medicaid	$0.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.71

INPATIENT APRDRG 2442: DIVERTICULITIS & DIVERTICULOSIS

Facility

$0.90

Service Code	APR-DRG 2442
Hospital Charge Code	APRDRG 2442
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Amerigroup CHIP/Medicaid	$0.90
Rate for Payer: Cigna Medicaid	$0.90
Rate for Payer: Molina CHIP/Medicaid	$0.90
Rate for Payer: Parkland Medicaid	$0.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.90

INPATIENT APRDRG 2443: DIVERTICULITIS & DIVERTICULOSIS

Facility

$1.20

Service Code	APR-DRG 2443
Hospital Charge Code	APRDRG 2443
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Amerigroup CHIP/Medicaid	$1.20
Rate for Payer: Cigna Medicaid	$1.20
Rate for Payer: Molina CHIP/Medicaid	$1.20
Rate for Payer: Parkland Medicaid	$1.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.20

INPATIENT APRDRG 2444: DIVERTICULITIS & DIVERTICULOSIS

Facility

$3.99

Service Code	APR-DRG 2444
Hospital Charge Code	APRDRG 2444
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$3.99
Rate for Payer: Amerigroup CHIP/Medicaid	$3.99
Rate for Payer: Cigna Medicaid	$3.99
Rate for Payer: Molina CHIP/Medicaid	$3.99
Rate for Payer: Parkland Medicaid	$3.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.99

INPATIENT APRDRG 2451: INFLAMMATORY BOWEL DISEASE

Facility

$0.88

Service Code	APR-DRG 2451
Hospital Charge Code	APRDRG 2451
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 2452: INFLAMMATORY BOWEL DISEASE

Facility

$1.25

Service Code	APR-DRG 2452
Hospital Charge Code	APRDRG 2452
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 2453: INFLAMMATORY BOWEL DISEASE

Facility

$1.73

Service Code	APR-DRG 2453
Hospital Charge Code	APRDRG 2453
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$1.73
Rate for Payer: Amerigroup CHIP/Medicaid	$1.73
Rate for Payer: Cigna Medicaid	$1.73
Rate for Payer: Molina CHIP/Medicaid	$1.73
Rate for Payer: Parkland Medicaid	$1.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.73

INPATIENT APRDRG 2454: INFLAMMATORY BOWEL DISEASE

Facility

$5.71

Service Code	APR-DRG 2454
Hospital Charge Code	APRDRG 2454
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$5.71
Rate for Payer: Amerigroup CHIP/Medicaid	$5.71
Rate for Payer: Cigna Medicaid	$5.71
Rate for Payer: Molina CHIP/Medicaid	$5.71
Rate for Payer: Parkland Medicaid	$5.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.71

INPATIENT APRDRG 2461: GASTROINTESTINAL VASCULAR INSUFFICIENCY

Facility

$1.56

Service Code	APR-DRG 2461
Hospital Charge Code	APRDRG 2461
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Amerigroup CHIP/Medicaid	$1.56
Rate for Payer: Cigna Medicaid	$1.56
Rate for Payer: Molina CHIP/Medicaid	$1.56
Rate for Payer: Parkland Medicaid	$1.56
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.56

INPATIENT APRDRG 2462: GASTROINTESTINAL VASCULAR INSUFFICIENCY

Facility

$1.75

Service Code	APR-DRG 2462
Hospital Charge Code	APRDRG 2462
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$1.75
Rate for Payer: Amerigroup CHIP/Medicaid	$1.75
Rate for Payer: Cigna Medicaid	$1.75
Rate for Payer: Molina CHIP/Medicaid	$1.75
Rate for Payer: Parkland Medicaid	$1.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.75

INPATIENT APRDRG 2463: GASTROINTESTINAL VASCULAR INSUFFICIENCY

Facility

$1.94

Service Code	APR-DRG 2463
Hospital Charge Code	APRDRG 2463
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 2464: GASTROINTESTINAL VASCULAR INSUFFICIENCY

Facility

$21.01

Service Code	APR-DRG 2464
Hospital Charge Code	APRDRG 2464
Min. Negotiated Rate	$21.01
Max. Negotiated Rate	$21.01
Rate for Payer: Amerigroup CHIP/Medicaid	$21.01
Rate for Payer: Cigna Medicaid	$21.01
Rate for Payer: Molina CHIP/Medicaid	$21.01
Rate for Payer: Parkland Medicaid	$21.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$21.01

INPATIENT APRDRG 2471: INTESTINAL OBSTRUCTION

Facility

$0.55

Service Code	APR-DRG 2471
Hospital Charge Code	APRDRG 2471
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.55
Rate for Payer: Amerigroup CHIP/Medicaid	$0.55
Rate for Payer: Cigna Medicaid	$0.55
Rate for Payer: Molina CHIP/Medicaid	$0.55
Rate for Payer: Parkland Medicaid	$0.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.55

INPATIENT APRDRG 2472: INTESTINAL OBSTRUCTION

Facility

$0.78

Service Code	APR-DRG 2472
Hospital Charge Code	APRDRG 2472
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$0.78
Rate for Payer: Amerigroup CHIP/Medicaid	$0.78
Rate for Payer: Cigna Medicaid	$0.78
Rate for Payer: Molina CHIP/Medicaid	$0.78
Rate for Payer: Parkland Medicaid	$0.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.78

INPATIENT APRDRG 2473: INTESTINAL OBSTRUCTION

Facility

$1.26

Service Code	APR-DRG 2473
Hospital Charge Code	APRDRG 2473
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 2474: INTESTINAL OBSTRUCTION

Facility

$2.71

Service Code	APR-DRG 2474
Hospital Charge Code	APRDRG 2474
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$2.71
Rate for Payer: Amerigroup CHIP/Medicaid	$2.71
Rate for Payer: Cigna Medicaid	$2.71
Rate for Payer: Molina CHIP/Medicaid	$2.71
Rate for Payer: Parkland Medicaid	$2.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.71

INPATIENT APRDRG 2481: MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS

Facility

$0.45

Service Code	APR-DRG 2481
Hospital Charge Code	APRDRG 2481
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Amerigroup CHIP/Medicaid	$0.45
Rate for Payer: Cigna Medicaid	$0.45
Rate for Payer: Molina CHIP/Medicaid	$0.45
Rate for Payer: Parkland Medicaid	$0.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.45

INPATIENT APRDRG 2482: MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS

Facility

$0.97

Service Code	APR-DRG 2482
Hospital Charge Code	APRDRG 2482
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$0.97
Rate for Payer: Amerigroup CHIP/Medicaid	$0.97
Rate for Payer: Cigna Medicaid	$0.97
Rate for Payer: Molina CHIP/Medicaid	$0.97
Rate for Payer: Parkland Medicaid	$0.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.97

INPATIENT APRDRG 2483: MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS

Facility

$1.37

Service Code	APR-DRG 2483
Hospital Charge Code	APRDRG 2483
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$1.37
Rate for Payer: Amerigroup CHIP/Medicaid	$1.37
Rate for Payer: Cigna Medicaid	$1.37
Rate for Payer: Molina CHIP/Medicaid	$1.37
Rate for Payer: Parkland Medicaid	$1.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.37

INPATIENT APRDRG 2484: MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS

Facility

$4.58

Service Code	APR-DRG 2484
Hospital Charge Code	APRDRG 2484
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$4.58
Rate for Payer: Amerigroup CHIP/Medicaid	$4.58
Rate for Payer: Cigna Medicaid	$4.58
Rate for Payer: Molina CHIP/Medicaid	$4.58
Rate for Payer: Parkland Medicaid	$4.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.58

INPATIENT APRDRG 2491: OTHER GASTROENTERITIS, NAUSEA & VOMITING

Facility

$0.41

Service Code	APR-DRG 2491
Hospital Charge Code	APRDRG 2491
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 2492: OTHER GASTROENTERITIS, NAUSEA & VOMITING

Facility

$0.65

Service Code	APR-DRG 2492
Hospital Charge Code	APRDRG 2492
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.65
Rate for Payer: Amerigroup CHIP/Medicaid	$0.65
Rate for Payer: Cigna Medicaid	$0.65
Rate for Payer: Molina CHIP/Medicaid	$0.65
Rate for Payer: Parkland Medicaid	$0.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.65

INPATIENT APRDRG 2493: OTHER GASTROENTERITIS, NAUSEA & VOMITING

Facility

$1.12

Service Code	APR-DRG 2493
Hospital Charge Code	APRDRG 2493
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 2494: OTHER GASTROENTERITIS, NAUSEA & VOMITING

Facility

$3.34

Service Code	APR-DRG 2494
Hospital Charge Code	APRDRG 2494
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$3.34
Rate for Payer: Amerigroup CHIP/Medicaid	$3.34
Rate for Payer: Cigna Medicaid	$3.34
Rate for Payer: Molina CHIP/Medicaid	$3.34
Rate for Payer: Parkland Medicaid	$3.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.34

Know your out-of-pocket cost for care.

All Charges