White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 7543: DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER

Facility

$0.85

Service Code	APR-DRG 7543
Hospital Charge Code	APRDRG 7543
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Amerigroup CHIP/Medicaid	$0.85
Rate for Payer: Cigna Medicaid	$0.85
Rate for Payer: Molina CHIP/Medicaid	$0.85
Rate for Payer: Parkland Medicaid	$0.85
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.85

INPATIENT APRDRG 7544: DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER

Facility

$2.45

Service Code	APR-DRG 7544
Hospital Charge Code	APRDRG 7544
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$2.45
Rate for Payer: Amerigroup CHIP/Medicaid	$2.45
Rate for Payer: Cigna Medicaid	$2.45
Rate for Payer: Molina CHIP/Medicaid	$2.45
Rate for Payer: Parkland Medicaid	$2.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.45

INPATIENT APRDRG 7551: ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES

Facility

$0.32

Service Code	APR-DRG 7551
Hospital Charge Code	APRDRG 7551
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 7552: ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES

Facility

$0.52

Service Code	APR-DRG 7552
Hospital Charge Code	APRDRG 7552
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.52
Rate for Payer: Amerigroup CHIP/Medicaid	$0.52
Rate for Payer: Cigna Medicaid	$0.52
Rate for Payer: Molina CHIP/Medicaid	$0.52
Rate for Payer: Parkland Medicaid	$0.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.52

INPATIENT APRDRG 7553: ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES

Facility

$1.16

Service Code	APR-DRG 7553
Hospital Charge Code	APRDRG 7553
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Amerigroup CHIP/Medicaid	$1.16
Rate for Payer: Cigna Medicaid	$1.16
Rate for Payer: Molina CHIP/Medicaid	$1.16
Rate for Payer: Parkland Medicaid	$1.16
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.16

INPATIENT APRDRG 7554: ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES

Facility

$2.21

Service Code	APR-DRG 7554
Hospital Charge Code	APRDRG 7554
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$2.21
Rate for Payer: Amerigroup CHIP/Medicaid	$2.21
Rate for Payer: Cigna Medicaid	$2.21
Rate for Payer: Molina CHIP/Medicaid	$2.21
Rate for Payer: Parkland Medicaid	$2.21
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.21

INPATIENT APRDRG 7561: ACUTE ANXIETY & DELIRIUM STATES

Facility

$0.57

Service Code	APR-DRG 7561
Hospital Charge Code	APRDRG 7561
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 7562: ACUTE ANXIETY & DELIRIUM STATES

Facility

$0.72

Service Code	APR-DRG 7562
Hospital Charge Code	APRDRG 7562
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 7563: ACUTE ANXIETY & DELIRIUM STATES

Facility

$1.09

Service Code	APR-DRG 7563
Hospital Charge Code	APRDRG 7563
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 7564: ACUTE ANXIETY & DELIRIUM STATES

Facility

$1.28

Service Code	APR-DRG 7564
Hospital Charge Code	APRDRG 7564
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$1.28
Rate for Payer: Amerigroup CHIP/Medicaid	$1.28
Rate for Payer: Cigna Medicaid	$1.28
Rate for Payer: Molina CHIP/Medicaid	$1.28
Rate for Payer: Parkland Medicaid	$1.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.28

INPATIENT APRDRG 7571: ORGANIC MENTAL HEALTH DISTURBANCES

Facility

$0.44

Service Code	APR-DRG 7571
Hospital Charge Code	APRDRG 7571
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.44
Rate for Payer: Amerigroup CHIP/Medicaid	$0.44
Rate for Payer: Cigna Medicaid	$0.44
Rate for Payer: Molina CHIP/Medicaid	$0.44
Rate for Payer: Parkland Medicaid	$0.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.44

INPATIENT APRDRG 7572: ORGANIC MENTAL HEALTH DISTURBANCES

Facility

$1.29

Service Code	APR-DRG 7572
Hospital Charge Code	APRDRG 7572
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.29
Rate for Payer: Amerigroup CHIP/Medicaid	$1.29
Rate for Payer: Cigna Medicaid	$1.29
Rate for Payer: Molina CHIP/Medicaid	$1.29
Rate for Payer: Parkland Medicaid	$1.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.29

INPATIENT APRDRG 7573: ORGANIC MENTAL HEALTH DISTURBANCES

Facility

$1.82

Service Code	APR-DRG 7573
Hospital Charge Code	APRDRG 7573
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$1.82
Rate for Payer: Amerigroup CHIP/Medicaid	$1.82
Rate for Payer: Cigna Medicaid	$1.82
Rate for Payer: Molina CHIP/Medicaid	$1.82
Rate for Payer: Parkland Medicaid	$1.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.82

INPATIENT APRDRG 7574: ORGANIC MENTAL HEALTH DISTURBANCES

Facility

$4.11

Service Code	APR-DRG 7574
Hospital Charge Code	APRDRG 7574
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$4.11
Rate for Payer: Amerigroup CHIP/Medicaid	$4.11
Rate for Payer: Cigna Medicaid	$4.11
Rate for Payer: Molina CHIP/Medicaid	$4.11
Rate for Payer: Parkland Medicaid	$4.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.11

INPATIENT APRDRG 7581: BEHAVIORAL DISORDERS

Facility

$0.32

Service Code	APR-DRG 7581
Hospital Charge Code	APRDRG 7581
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 7582: BEHAVIORAL DISORDERS

Facility

$0.48

Service Code	APR-DRG 7582
Hospital Charge Code	APRDRG 7582
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Amerigroup CHIP/Medicaid	$0.48
Rate for Payer: Cigna Medicaid	$0.48
Rate for Payer: Molina CHIP/Medicaid	$0.48
Rate for Payer: Parkland Medicaid	$0.48
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.48

INPATIENT APRDRG 7583: BEHAVIORAL DISORDERS

Facility

$0.50

Service Code	APR-DRG 7583
Hospital Charge Code	APRDRG 7583
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Amerigroup CHIP/Medicaid	$0.50
Rate for Payer: Cigna Medicaid	$0.50
Rate for Payer: Molina CHIP/Medicaid	$0.50
Rate for Payer: Parkland Medicaid	$0.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.50

INPATIENT APRDRG 7584: BEHAVIORAL DISORDERS

Facility

$2.06

Service Code	APR-DRG 7584
Hospital Charge Code	APRDRG 7584
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$2.06
Rate for Payer: Amerigroup CHIP/Medicaid	$2.06
Rate for Payer: Cigna Medicaid	$2.06
Rate for Payer: Molina CHIP/Medicaid	$2.06
Rate for Payer: Parkland Medicaid	$2.06
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.06

INPATIENT APRDRG 7591: EATING DISORDERS

Facility

$1.54

Service Code	APR-DRG 7591
Hospital Charge Code	APRDRG 7591
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 7592: EATING DISORDERS

Facility

$1.92

Service Code	APR-DRG 7592
Hospital Charge Code	APRDRG 7592
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$1.92
Rate for Payer: Amerigroup CHIP/Medicaid	$1.92
Rate for Payer: Cigna Medicaid	$1.92
Rate for Payer: Molina CHIP/Medicaid	$1.92
Rate for Payer: Parkland Medicaid	$1.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.92

INPATIENT APRDRG 7593: EATING DISORDERS

Facility

$3.79

Service Code	APR-DRG 7593
Hospital Charge Code	APRDRG 7593
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$3.79
Rate for Payer: Amerigroup CHIP/Medicaid	$3.79
Rate for Payer: Cigna Medicaid	$3.79
Rate for Payer: Molina CHIP/Medicaid	$3.79
Rate for Payer: Parkland Medicaid	$3.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.79

INPATIENT APRDRG 7594: EATING DISORDERS

Facility

$5.54

Service Code	APR-DRG 7594
Hospital Charge Code	APRDRG 7594
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$5.54
Rate for Payer: Amerigroup CHIP/Medicaid	$5.54
Rate for Payer: Cigna Medicaid	$5.54
Rate for Payer: Molina CHIP/Medicaid	$5.54
Rate for Payer: Parkland Medicaid	$5.54
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.54

INPATIENT APRDRG 7601: OTHER MENTAL HEALTH DISORDERS

Facility

$0.49

Service Code	APR-DRG 7601
Hospital Charge Code	APRDRG 7601
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.49
Rate for Payer: Amerigroup CHIP/Medicaid	$0.49
Rate for Payer: Cigna Medicaid	$0.49
Rate for Payer: Molina CHIP/Medicaid	$0.49
Rate for Payer: Parkland Medicaid	$0.49
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.49

INPATIENT APRDRG 7602: OTHER MENTAL HEALTH DISORDERS

Facility

$1.17

Service Code	APR-DRG 7602
Hospital Charge Code	APRDRG 7602
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.17
Rate for Payer: Amerigroup CHIP/Medicaid	$1.17
Rate for Payer: Cigna Medicaid	$1.17
Rate for Payer: Molina CHIP/Medicaid	$1.17
Rate for Payer: Parkland Medicaid	$1.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.17

INPATIENT APRDRG 7603: OTHER MENTAL HEALTH DISORDERS

Facility

$1.83

Service Code	APR-DRG 7603
Hospital Charge Code	APRDRG 7603
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$1.83
Rate for Payer: Amerigroup CHIP/Medicaid	$1.83
Rate for Payer: Cigna Medicaid	$1.83
Rate for Payer: Molina CHIP/Medicaid	$1.83
Rate for Payer: Parkland Medicaid	$1.83
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.83

Know your out-of-pocket cost for care.

All Charges