White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 4202: DIABETES

Facility

$0.72

Service Code	APR-DRG 4202
Hospital Charge Code	APRDRG 4202
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.72
Rate for Payer: Amerigroup CHIP/Medicaid	$0.72
Rate for Payer: Cigna Medicaid	$0.72
Rate for Payer: Molina CHIP/Medicaid	$0.72
Rate for Payer: Parkland Medicaid	$0.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.72

INPATIENT APRDRG 4203: DIABETES

Facility

$1.12

Service Code	APR-DRG 4203
Hospital Charge Code	APRDRG 4203
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 4204: DIABETES

Facility

$2.33

Service Code	APR-DRG 4204
Hospital Charge Code	APRDRG 4204
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$2.33
Rate for Payer: Amerigroup CHIP/Medicaid	$2.33
Rate for Payer: Cigna Medicaid	$2.33
Rate for Payer: Molina CHIP/Medicaid	$2.33
Rate for Payer: Parkland Medicaid	$2.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.33

INPATIENT APRDRG 4211: MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS

Facility

$0.78

Service Code	APR-DRG 4211
Hospital Charge Code	APRDRG 4211
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 4212: MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS

Facility

$1.39

Service Code	APR-DRG 4212
Hospital Charge Code	APRDRG 4212
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$1.39
Rate for Payer: Amerigroup CHIP/Medicaid	$1.39
Rate for Payer: Cigna Medicaid	$1.39
Rate for Payer: Molina CHIP/Medicaid	$1.39
Rate for Payer: Parkland Medicaid	$1.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.39

INPATIENT APRDRG 4213: MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS

Facility

$2.01

Service Code	APR-DRG 4213
Hospital Charge Code	APRDRG 4213
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.01
Rate for Payer: Amerigroup CHIP/Medicaid	$2.01
Rate for Payer: Cigna Medicaid	$2.01
Rate for Payer: Molina CHIP/Medicaid	$2.01
Rate for Payer: Parkland Medicaid	$2.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.01

INPATIENT APRDRG 4214: MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS

Facility

$5.06

Service Code	APR-DRG 4214
Hospital Charge Code	APRDRG 4214
Min. Negotiated Rate	$5.06
Max. Negotiated Rate	$5.06
Rate for Payer: Amerigroup CHIP/Medicaid	$5.06
Rate for Payer: Cigna Medicaid	$5.06
Rate for Payer: Molina CHIP/Medicaid	$5.06
Rate for Payer: Parkland Medicaid	$5.06
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.06

INPATIENT APRDRG 4221: HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS

Facility

$0.32

Service Code	APR-DRG 4221
Hospital Charge Code	APRDRG 4221
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.32
Rate for Payer: Amerigroup CHIP/Medicaid	$0.32
Rate for Payer: Cigna Medicaid	$0.32
Rate for Payer: Molina CHIP/Medicaid	$0.32
Rate for Payer: Parkland Medicaid	$0.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.32

INPATIENT APRDRG 4222: HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS

Facility

$0.54

Service Code	APR-DRG 4222
Hospital Charge Code	APRDRG 4222
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.54
Rate for Payer: Amerigroup CHIP/Medicaid	$0.54
Rate for Payer: Cigna Medicaid	$0.54
Rate for Payer: Molina CHIP/Medicaid	$0.54
Rate for Payer: Parkland Medicaid	$0.54
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.54

INPATIENT APRDRG 4223: HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS

Facility

$0.96

Service Code	APR-DRG 4223
Hospital Charge Code	APRDRG 4223
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$0.96
Rate for Payer: Amerigroup CHIP/Medicaid	$0.96
Rate for Payer: Cigna Medicaid	$0.96
Rate for Payer: Molina CHIP/Medicaid	$0.96
Rate for Payer: Parkland Medicaid	$0.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.96

INPATIENT APRDRG 4224: HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS

Facility

$2.39

Service Code	APR-DRG 4224
Hospital Charge Code	APRDRG 4224
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$2.39
Rate for Payer: Amerigroup CHIP/Medicaid	$2.39
Rate for Payer: Cigna Medicaid	$2.39
Rate for Payer: Molina CHIP/Medicaid	$2.39
Rate for Payer: Parkland Medicaid	$2.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.39

INPATIENT APRDRG 4231: INBORN ERRORS OF METABOLISM

Facility

$2.03

Service Code	APR-DRG 4231
Hospital Charge Code	APRDRG 4231
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$2.03
Rate for Payer: Amerigroup CHIP/Medicaid	$2.03
Rate for Payer: Cigna Medicaid	$2.03
Rate for Payer: Molina CHIP/Medicaid	$2.03
Rate for Payer: Parkland Medicaid	$2.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.03

INPATIENT APRDRG 4232: INBORN ERRORS OF METABOLISM

Facility

$2.72

Service Code	APR-DRG 4232
Hospital Charge Code	APRDRG 4232
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 4233: INBORN ERRORS OF METABOLISM

Facility

$3.42

Service Code	APR-DRG 4233
Hospital Charge Code	APRDRG 4233
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$3.42
Rate for Payer: Amerigroup CHIP/Medicaid	$3.42
Rate for Payer: Cigna Medicaid	$3.42
Rate for Payer: Molina CHIP/Medicaid	$3.42
Rate for Payer: Parkland Medicaid	$3.42
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.42

INPATIENT APRDRG 4234: INBORN ERRORS OF METABOLISM

Facility

$4.23

Service Code	APR-DRG 4234
Hospital Charge Code	APRDRG 4234
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$4.23
Rate for Payer: Amerigroup CHIP/Medicaid	$4.23
Rate for Payer: Cigna Medicaid	$4.23
Rate for Payer: Molina CHIP/Medicaid	$4.23
Rate for Payer: Parkland Medicaid	$4.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.23

INPATIENT APRDRG 4241: OTHER ENDOCRINE DISORDERS

Facility

$0.86

Service Code	APR-DRG 4241
Hospital Charge Code	APRDRG 4241
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Amerigroup CHIP/Medicaid	$0.86
Rate for Payer: Cigna Medicaid	$0.86
Rate for Payer: Molina CHIP/Medicaid	$0.86
Rate for Payer: Parkland Medicaid	$0.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.86

INPATIENT APRDRG 4242: OTHER ENDOCRINE DISORDERS

Facility

$1.09

Service Code	APR-DRG 4242
Hospital Charge Code	APRDRG 4242
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Amerigroup CHIP/Medicaid	$1.09
Rate for Payer: Cigna Medicaid	$1.09
Rate for Payer: Molina CHIP/Medicaid	$1.09
Rate for Payer: Parkland Medicaid	$1.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.09

INPATIENT APRDRG 4243: OTHER ENDOCRINE DISORDERS

Facility

$1.74

Service Code	APR-DRG 4243
Hospital Charge Code	APRDRG 4243
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$1.74
Rate for Payer: Amerigroup CHIP/Medicaid	$1.74
Rate for Payer: Cigna Medicaid	$1.74
Rate for Payer: Molina CHIP/Medicaid	$1.74
Rate for Payer: Parkland Medicaid	$1.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.74

INPATIENT APRDRG 4244: OTHER ENDOCRINE DISORDERS

Facility

$4.53

Service Code	APR-DRG 4244
Hospital Charge Code	APRDRG 4244
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$4.53
Rate for Payer: Amerigroup CHIP/Medicaid	$4.53
Rate for Payer: Cigna Medicaid	$4.53
Rate for Payer: Molina CHIP/Medicaid	$4.53
Rate for Payer: Parkland Medicaid	$4.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.53

INPATIENT APRDRG 4251: OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$0.57

Service Code	APR-DRG 4251
Hospital Charge Code	APRDRG 4251
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.57
Rate for Payer: Amerigroup CHIP/Medicaid	$0.57
Rate for Payer: Cigna Medicaid	$0.57
Rate for Payer: Molina CHIP/Medicaid	$0.57
Rate for Payer: Parkland Medicaid	$0.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.57

INPATIENT APRDRG 4252: OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$0.58

Service Code	APR-DRG 4252
Hospital Charge Code	APRDRG 4252
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 4253: OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$0.97

Service Code	APR-DRG 4253
Hospital Charge Code	APRDRG 4253
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 4254: OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$2.23

Service Code	APR-DRG 4254
Hospital Charge Code	APRDRG 4254
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 4261: NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$0.65

Service Code	APR-DRG 4261
Hospital Charge Code	APRDRG 4261
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 4262: NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$0.79

Service Code	APR-DRG 4262
Hospital Charge Code	APRDRG 4262
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Amerigroup CHIP/Medicaid	$0.79
Rate for Payer: Cigna Medicaid	$0.79
Rate for Payer: Molina CHIP/Medicaid	$0.79
Rate for Payer: Parkland Medicaid	$0.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.79

Know your out-of-pocket cost for care.

All Charges