White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 6814: OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS

Facility

$21.68

Service Code	APR-DRG 6814
Hospital Charge Code	APRDRG 6814
Min. Negotiated Rate	$21.68
Max. Negotiated Rate	$21.68
Rate for Payer: Amerigroup CHIP/Medicaid	$21.68
Rate for Payer: Cigna Medicaid	$21.68
Rate for Payer: Molina CHIP/Medicaid	$21.68
Rate for Payer: Parkland Medicaid	$21.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$21.68

INPATIENT APRDRG 6901: ACUTE LEUKEMIA

Facility

$4.44

Service Code	APR-DRG 6901
Hospital Charge Code	APRDRG 6901
Min. Negotiated Rate	$4.44
Max. Negotiated Rate	$4.44
Rate for Payer: Amerigroup CHIP/Medicaid	$4.44
Rate for Payer: Cigna Medicaid	$4.44
Rate for Payer: Molina CHIP/Medicaid	$4.44
Rate for Payer: Parkland Medicaid	$4.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.44

INPATIENT APRDRG 6902: ACUTE LEUKEMIA

Facility

$5.35

Service Code	APR-DRG 6902
Hospital Charge Code	APRDRG 6902
Min. Negotiated Rate	$5.35
Max. Negotiated Rate	$5.35
Rate for Payer: Amerigroup CHIP/Medicaid	$5.35
Rate for Payer: Cigna Medicaid	$5.35
Rate for Payer: Molina CHIP/Medicaid	$5.35
Rate for Payer: Parkland Medicaid	$5.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.35

INPATIENT APRDRG 6903: ACUTE LEUKEMIA

Facility

$6.27

Service Code	APR-DRG 6903
Hospital Charge Code	APRDRG 6903
Min. Negotiated Rate	$6.27
Max. Negotiated Rate	$6.27
Rate for Payer: Amerigroup CHIP/Medicaid	$6.27
Rate for Payer: Cigna Medicaid	$6.27
Rate for Payer: Molina CHIP/Medicaid	$6.27
Rate for Payer: Parkland Medicaid	$6.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.27

INPATIENT APRDRG 6904: ACUTE LEUKEMIA

Facility

$14.24

Service Code	APR-DRG 6904
Hospital Charge Code	APRDRG 6904
Min. Negotiated Rate	$14.24
Max. Negotiated Rate	$14.24
Rate for Payer: Amerigroup CHIP/Medicaid	$14.24
Rate for Payer: Cigna Medicaid	$14.24
Rate for Payer: Molina CHIP/Medicaid	$14.24
Rate for Payer: Parkland Medicaid	$14.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14.24

INPATIENT APRDRG 6911: LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA

Facility

$1.54

Service Code	APR-DRG 6911
Hospital Charge Code	APRDRG 6911
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Amerigroup CHIP/Medicaid	$1.54
Rate for Payer: Cigna Medicaid	$1.54
Rate for Payer: Molina CHIP/Medicaid	$1.54
Rate for Payer: Parkland Medicaid	$1.54
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.54

INPATIENT APRDRG 6912: LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA

Facility

$1.93

Service Code	APR-DRG 6912
Hospital Charge Code	APRDRG 6912
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$1.93
Rate for Payer: Amerigroup CHIP/Medicaid	$1.93
Rate for Payer: Cigna Medicaid	$1.93
Rate for Payer: Molina CHIP/Medicaid	$1.93
Rate for Payer: Parkland Medicaid	$1.93
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.93

INPATIENT APRDRG 6913: LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA

Facility

$4.03

Service Code	APR-DRG 6913
Hospital Charge Code	APRDRG 6913
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$4.03
Rate for Payer: Amerigroup CHIP/Medicaid	$4.03
Rate for Payer: Cigna Medicaid	$4.03
Rate for Payer: Molina CHIP/Medicaid	$4.03
Rate for Payer: Parkland Medicaid	$4.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.03

INPATIENT APRDRG 6914: LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA

Facility

$7.80

Service Code	APR-DRG 6914
Hospital Charge Code	APRDRG 6914
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Amerigroup CHIP/Medicaid	$7.80
Rate for Payer: Cigna Medicaid	$7.80
Rate for Payer: Molina CHIP/Medicaid	$7.80
Rate for Payer: Parkland Medicaid	$7.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.80

INPATIENT APRDRG 6921: RADIOTHERAPY

Facility

$1.35

Service Code	APR-DRG 6921
Hospital Charge Code	APRDRG 6921
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Amerigroup CHIP/Medicaid	$1.35
Rate for Payer: Cigna Medicaid	$1.35
Rate for Payer: Molina CHIP/Medicaid	$1.35
Rate for Payer: Parkland Medicaid	$1.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.35

INPATIENT APRDRG 6922: RADIOTHERAPY

Facility

$2.35

Service Code	APR-DRG 6922
Hospital Charge Code	APRDRG 6922
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$2.35
Rate for Payer: Amerigroup CHIP/Medicaid	$2.35
Rate for Payer: Cigna Medicaid	$2.35
Rate for Payer: Molina CHIP/Medicaid	$2.35
Rate for Payer: Parkland Medicaid	$2.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.35

INPATIENT APRDRG 6923: RADIOTHERAPY

Facility

$3.46

Service Code	APR-DRG 6923
Hospital Charge Code	APRDRG 6923
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$3.46
Rate for Payer: Amerigroup CHIP/Medicaid	$3.46
Rate for Payer: Cigna Medicaid	$3.46
Rate for Payer: Molina CHIP/Medicaid	$3.46
Rate for Payer: Parkland Medicaid	$3.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.46

INPATIENT APRDRG 6924: RADIOTHERAPY

Facility

$6.45

Service Code	APR-DRG 6924
Hospital Charge Code	APRDRG 6924
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Amerigroup CHIP/Medicaid	$6.45
Rate for Payer: Cigna Medicaid	$6.45
Rate for Payer: Molina CHIP/Medicaid	$6.45
Rate for Payer: Parkland Medicaid	$6.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.45

INPATIENT APRDRG 6941: LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR

Facility

$0.84

Service Code	APR-DRG 6941
Hospital Charge Code	APRDRG 6941
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 6942: LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR

Facility

$1.14

Service Code	APR-DRG 6942
Hospital Charge Code	APRDRG 6942
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.14
Rate for Payer: Amerigroup CHIP/Medicaid	$1.14
Rate for Payer: Cigna Medicaid	$1.14
Rate for Payer: Molina CHIP/Medicaid	$1.14
Rate for Payer: Parkland Medicaid	$1.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.14

INPATIENT APRDRG 6943: LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR

Facility

$1.73

Service Code	APR-DRG 6943
Hospital Charge Code	APRDRG 6943
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 6944: LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR

Facility

$7.72

Service Code	APR-DRG 6944
Hospital Charge Code	APRDRG 6944
Min. Negotiated Rate	$7.72
Max. Negotiated Rate	$7.72
Rate for Payer: Amerigroup CHIP/Medicaid	$7.72
Rate for Payer: Cigna Medicaid	$7.72
Rate for Payer: Molina CHIP/Medicaid	$7.72
Rate for Payer: Parkland Medicaid	$7.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.72

INPATIENT APRDRG 6951: CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$1.07

Service Code	APR-DRG 6951
Hospital Charge Code	APRDRG 6951
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$1.07
Rate for Payer: Amerigroup CHIP/Medicaid	$1.07
Rate for Payer: Cigna Medicaid	$1.07
Rate for Payer: Molina CHIP/Medicaid	$1.07
Rate for Payer: Parkland Medicaid	$1.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.07

INPATIENT APRDRG 6952: CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$1.26

Service Code	APR-DRG 6952
Hospital Charge Code	APRDRG 6952
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 6953: CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$3.77

Service Code	APR-DRG 6953
Hospital Charge Code	APRDRG 6953
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$3.77
Rate for Payer: Amerigroup CHIP/Medicaid	$3.77
Rate for Payer: Cigna Medicaid	$3.77
Rate for Payer: Molina CHIP/Medicaid	$3.77
Rate for Payer: Parkland Medicaid	$3.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.77

INPATIENT APRDRG 6954: CHEMOTHERAPY FOR ACUTE LEUKEMIA

Facility

$11.03

Service Code	APR-DRG 6954
Hospital Charge Code	APRDRG 6954
Min. Negotiated Rate	$11.03
Max. Negotiated Rate	$11.03
Rate for Payer: Amerigroup CHIP/Medicaid	$11.03
Rate for Payer: Cigna Medicaid	$11.03
Rate for Payer: Molina CHIP/Medicaid	$11.03
Rate for Payer: Parkland Medicaid	$11.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11.03

INPATIENT APRDRG 6961: OTHER CHEMOTHERAPY

Facility

$0.99

Service Code	APR-DRG 6961
Hospital Charge Code	APRDRG 6961
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$0.99
Rate for Payer: Amerigroup CHIP/Medicaid	$0.99
Rate for Payer: Cigna Medicaid	$0.99
Rate for Payer: Molina CHIP/Medicaid	$0.99
Rate for Payer: Parkland Medicaid	$0.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.99

INPATIENT APRDRG 6962: OTHER CHEMOTHERAPY

Facility

$1.41

Service Code	APR-DRG 6962
Hospital Charge Code	APRDRG 6962
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 6963: OTHER CHEMOTHERAPY

Facility

$2.40

Service Code	APR-DRG 6963
Hospital Charge Code	APRDRG 6963
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Amerigroup CHIP/Medicaid	$2.40
Rate for Payer: Cigna Medicaid	$2.40
Rate for Payer: Molina CHIP/Medicaid	$2.40
Rate for Payer: Parkland Medicaid	$2.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.40

INPATIENT APRDRG 6964: OTHER CHEMOTHERAPY

Facility

$4.25

Service Code	APR-DRG 6964
Hospital Charge Code	APRDRG 6964
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.25
Rate for Payer: Amerigroup CHIP/Medicaid	$4.25
Rate for Payer: Cigna Medicaid	$4.25
Rate for Payer: Molina CHIP/Medicaid	$4.25
Rate for Payer: Parkland Medicaid	$4.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.25

Know your out-of-pocket cost for care.

All Charges