White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 6513: OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS

Facility

$2.34

Service Code	APR-DRG 6513
Hospital Charge Code	APRDRG 6513
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$2.34
Rate for Payer: Amerigroup CHIP/Medicaid	$2.34
Rate for Payer: Cigna Medicaid	$2.34
Rate for Payer: Molina CHIP/Medicaid	$2.34
Rate for Payer: Parkland Medicaid	$2.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.34

INPATIENT APRDRG 6514: OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS

Facility

$10.80

Service Code	APR-DRG 6514
Hospital Charge Code	APRDRG 6514
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Amerigroup CHIP/Medicaid	$10.80
Rate for Payer: Cigna Medicaid	$10.80
Rate for Payer: Molina CHIP/Medicaid	$10.80
Rate for Payer: Parkland Medicaid	$10.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10.80

INPATIENT APRDRG 6601: MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL

Facility

$1.30

Service Code	APR-DRG 6601
Hospital Charge Code	APRDRG 6601
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.30
Rate for Payer: Amerigroup CHIP/Medicaid	$1.30
Rate for Payer: Cigna Medicaid	$1.30
Rate for Payer: Molina CHIP/Medicaid	$1.30
Rate for Payer: Parkland Medicaid	$1.30
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.30

INPATIENT APRDRG 6602: MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL

Facility

$1.31

Service Code	APR-DRG 6602
Hospital Charge Code	APRDRG 6602
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.31
Rate for Payer: Amerigroup CHIP/Medicaid	$1.31
Rate for Payer: Cigna Medicaid	$1.31
Rate for Payer: Molina CHIP/Medicaid	$1.31
Rate for Payer: Parkland Medicaid	$1.31
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.31

INPATIENT APRDRG 6603: MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL

Facility

$2.12

Service Code	APR-DRG 6603
Hospital Charge Code	APRDRG 6603
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$2.12
Rate for Payer: Amerigroup CHIP/Medicaid	$2.12
Rate for Payer: Cigna Medicaid	$2.12
Rate for Payer: Molina CHIP/Medicaid	$2.12
Rate for Payer: Parkland Medicaid	$2.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.12

INPATIENT APRDRG 6604: MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL

Facility

$8.71

Service Code	APR-DRG 6604
Hospital Charge Code	APRDRG 6604
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$8.71
Rate for Payer: Amerigroup CHIP/Medicaid	$8.71
Rate for Payer: Cigna Medicaid	$8.71
Rate for Payer: Molina CHIP/Medicaid	$8.71
Rate for Payer: Parkland Medicaid	$8.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.71

INPATIENT APRDRG 6611: COAGULATION & PLATELET DISORDERS

Facility

$1.21

Service Code	APR-DRG 6611
Hospital Charge Code	APRDRG 6611
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 6612: COAGULATION & PLATELET DISORDERS

Facility

$1.32

Service Code	APR-DRG 6612
Hospital Charge Code	APRDRG 6612
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.32
Rate for Payer: Amerigroup CHIP/Medicaid	$1.32
Rate for Payer: Cigna Medicaid	$1.32
Rate for Payer: Molina CHIP/Medicaid	$1.32
Rate for Payer: Parkland Medicaid	$1.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.32

INPATIENT APRDRG 6613: COAGULATION & PLATELET DISORDERS

Facility

$6.12

Service Code	APR-DRG 6613
Hospital Charge Code	APRDRG 6613
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$6.12
Rate for Payer: Amerigroup CHIP/Medicaid	$6.12
Rate for Payer: Cigna Medicaid	$6.12
Rate for Payer: Molina CHIP/Medicaid	$6.12
Rate for Payer: Parkland Medicaid	$6.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.12

INPATIENT APRDRG 6614: COAGULATION & PLATELET DISORDERS

Facility

$7.46

Service Code	APR-DRG 6614
Hospital Charge Code	APRDRG 6614
Min. Negotiated Rate	$7.46
Max. Negotiated Rate	$7.46
Rate for Payer: Amerigroup CHIP/Medicaid	$7.46
Rate for Payer: Cigna Medicaid	$7.46
Rate for Payer: Molina CHIP/Medicaid	$7.46
Rate for Payer: Parkland Medicaid	$7.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.46

INPATIENT APRDRG 6621: SICKLE CELL ANEMIA CRISIS

Facility

$0.68

Service Code	APR-DRG 6621
Hospital Charge Code	APRDRG 6621
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Amerigroup CHIP/Medicaid	$0.68
Rate for Payer: Cigna Medicaid	$0.68
Rate for Payer: Molina CHIP/Medicaid	$0.68
Rate for Payer: Parkland Medicaid	$0.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.68

INPATIENT APRDRG 6622: SICKLE CELL ANEMIA CRISIS

Facility

$0.95

Service Code	APR-DRG 6622
Hospital Charge Code	APRDRG 6622
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 6623: SICKLE CELL ANEMIA CRISIS

Facility

$1.53

Service Code	APR-DRG 6623
Hospital Charge Code	APRDRG 6623
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$1.53
Rate for Payer: Amerigroup CHIP/Medicaid	$1.53
Rate for Payer: Cigna Medicaid	$1.53
Rate for Payer: Molina CHIP/Medicaid	$1.53
Rate for Payer: Parkland Medicaid	$1.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.53

INPATIENT APRDRG 6624: SICKLE CELL ANEMIA CRISIS

Facility

$3.99

Service Code	APR-DRG 6624
Hospital Charge Code	APRDRG 6624
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 6631: OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS

Facility

$0.60

Service Code	APR-DRG 6631
Hospital Charge Code	APRDRG 6631
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 6632: OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS

Facility

$0.84

Service Code	APR-DRG 6632
Hospital Charge Code	APRDRG 6632
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 6633: OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS

Facility

$1.38

Service Code	APR-DRG 6633
Hospital Charge Code	APRDRG 6633
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$1.38
Rate for Payer: Amerigroup CHIP/Medicaid	$1.38
Rate for Payer: Cigna Medicaid	$1.38
Rate for Payer: Molina CHIP/Medicaid	$1.38
Rate for Payer: Parkland Medicaid	$1.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.38

INPATIENT APRDRG 6634: OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS

Facility

$2.33

Service Code	APR-DRG 6634
Hospital Charge Code	APRDRG 6634
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 6801: MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$2.33

Service Code	APR-DRG 6801
Hospital Charge Code	APRDRG 6801
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 6802: MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$2.66

Service Code	APR-DRG 6802
Hospital Charge Code	APRDRG 6802
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$2.66
Rate for Payer: Amerigroup CHIP/Medicaid	$2.66
Rate for Payer: Cigna Medicaid	$2.66
Rate for Payer: Molina CHIP/Medicaid	$2.66
Rate for Payer: Parkland Medicaid	$2.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.66

INPATIENT APRDRG 6803: MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$5.87

Service Code	APR-DRG 6803
Hospital Charge Code	APRDRG 6803
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 6804: MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$16.04

Service Code	APR-DRG 6804
Hospital Charge Code	APRDRG 6804
Min. Negotiated Rate	$16.04
Max. Negotiated Rate	$16.04
Rate for Payer: Amerigroup CHIP/Medicaid	$16.04
Rate for Payer: Cigna Medicaid	$16.04
Rate for Payer: Molina CHIP/Medicaid	$16.04
Rate for Payer: Parkland Medicaid	$16.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16.04

INPATIENT APRDRG 6811: OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$2.55

Service Code	APR-DRG 6811
Hospital Charge Code	APRDRG 6811
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Amerigroup CHIP/Medicaid	$2.55
Rate for Payer: Cigna Medicaid	$2.55
Rate for Payer: Molina CHIP/Medicaid	$2.55
Rate for Payer: Parkland Medicaid	$2.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.55

INPATIENT APRDRG 6812: OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$2.68

Service Code	APR-DRG 6812
Hospital Charge Code	APRDRG 6812
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$2.68
Rate for Payer: Amerigroup CHIP/Medicaid	$2.68
Rate for Payer: Cigna Medicaid	$2.68
Rate for Payer: Molina CHIP/Medicaid	$2.68
Rate for Payer: Parkland Medicaid	$2.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.68

INPATIENT APRDRG 6813: OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$5.76

Service Code	APR-DRG 6813
Hospital Charge Code	APRDRG 6813
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$5.76
Rate for Payer: Amerigroup CHIP/Medicaid	$5.76
Rate for Payer: Cigna Medicaid	$5.76
Rate for Payer: Molina CHIP/Medicaid	$5.76
Rate for Payer: Parkland Medicaid	$5.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.76

Know your out-of-pocket cost for care.

All Charges