White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 7604: OTHER MENTAL HEALTH DISORDERS

Facility

$2.48

Service Code	APR-DRG 7604
Hospital Charge Code	APRDRG 7604
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$2.48
Rate for Payer: Amerigroup CHIP/Medicaid	$2.48
Rate for Payer: Cigna Medicaid	$2.48
Rate for Payer: Molina CHIP/Medicaid	$2.48
Rate for Payer: Parkland Medicaid	$2.48
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.48

INPATIENT APRDRG 7701: DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE

Facility

$0.34

Service Code	APR-DRG 7701
Hospital Charge Code	APRDRG 7701
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.34
Rate for Payer: Amerigroup CHIP/Medicaid	$0.34
Rate for Payer: Cigna Medicaid	$0.34
Rate for Payer: Molina CHIP/Medicaid	$0.34
Rate for Payer: Parkland Medicaid	$0.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.34

INPATIENT APRDRG 7702: DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE

Facility

$0.45

Service Code	APR-DRG 7702
Hospital Charge Code	APRDRG 7702
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 7703: DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE

Facility

$0.72

Service Code	APR-DRG 7703
Hospital Charge Code	APRDRG 7703
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 7704: DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE

Facility

$1.68

Service Code	APR-DRG 7704
Hospital Charge Code	APRDRG 7704
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$1.68
Rate for Payer: Amerigroup CHIP/Medicaid	$1.68
Rate for Payer: Cigna Medicaid	$1.68
Rate for Payer: Molina CHIP/Medicaid	$1.68
Rate for Payer: Parkland Medicaid	$1.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.68

INPATIENT APRDRG 7721: ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY

Facility

$0.38

Service Code	APR-DRG 7721
Hospital Charge Code	APRDRG 7721
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Amerigroup CHIP/Medicaid	$0.38
Rate for Payer: Cigna Medicaid	$0.38
Rate for Payer: Molina CHIP/Medicaid	$0.38
Rate for Payer: Parkland Medicaid	$0.38
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.38

INPATIENT APRDRG 7722: ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY

Facility

$0.45

Service Code	APR-DRG 7722
Hospital Charge Code	APRDRG 7722
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 7723: ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY

Facility

$0.57

Service Code	APR-DRG 7723
Hospital Charge Code	APRDRG 7723
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 7724: ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY

Facility

$3.26

Service Code	APR-DRG 7724
Hospital Charge Code	APRDRG 7724
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$3.26
Rate for Payer: Amerigroup CHIP/Medicaid	$3.26
Rate for Payer: Cigna Medicaid	$3.26
Rate for Payer: Molina CHIP/Medicaid	$3.26
Rate for Payer: Parkland Medicaid	$3.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.26

INPATIENT APRDRG 7731: OPIOID ABUSE & DEPENDENCE

Facility

$0.31

Service Code	APR-DRG 7731
Hospital Charge Code	APRDRG 7731
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: Amerigroup CHIP/Medicaid	$0.31
Rate for Payer: Cigna Medicaid	$0.31
Rate for Payer: Molina CHIP/Medicaid	$0.31
Rate for Payer: Parkland Medicaid	$0.31
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.31

INPATIENT APRDRG 7732: OPIOID ABUSE & DEPENDENCE

Facility

$0.50

Service Code	APR-DRG 7732
Hospital Charge Code	APRDRG 7732
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 7733: OPIOID ABUSE & DEPENDENCE

Facility

$0.81

Service Code	APR-DRG 7733
Hospital Charge Code	APRDRG 7733
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Amerigroup CHIP/Medicaid	$0.81
Rate for Payer: Cigna Medicaid	$0.81
Rate for Payer: Molina CHIP/Medicaid	$0.81
Rate for Payer: Parkland Medicaid	$0.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.81

INPATIENT APRDRG 7734: OPIOID ABUSE & DEPENDENCE

Facility

$2.44

Service Code	APR-DRG 7734
Hospital Charge Code	APRDRG 7734
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$2.44
Rate for Payer: Amerigroup CHIP/Medicaid	$2.44
Rate for Payer: Cigna Medicaid	$2.44
Rate for Payer: Molina CHIP/Medicaid	$2.44
Rate for Payer: Parkland Medicaid	$2.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.44

INPATIENT APRDRG 7741: COCAINE ABUSE & DEPENDENCE

Facility

$0.34

Service Code	APR-DRG 7741
Hospital Charge Code	APRDRG 7741
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.34
Rate for Payer: Amerigroup CHIP/Medicaid	$0.34
Rate for Payer: Cigna Medicaid	$0.34
Rate for Payer: Molina CHIP/Medicaid	$0.34
Rate for Payer: Parkland Medicaid	$0.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.34

INPATIENT APRDRG 7742: COCAINE ABUSE & DEPENDENCE

Facility

$0.56

Service Code	APR-DRG 7742
Hospital Charge Code	APRDRG 7742
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Amerigroup CHIP/Medicaid	$0.56
Rate for Payer: Cigna Medicaid	$0.56
Rate for Payer: Molina CHIP/Medicaid	$0.56
Rate for Payer: Parkland Medicaid	$0.56
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.56

INPATIENT APRDRG 7743: COCAINE ABUSE & DEPENDENCE

Facility

$0.82

Service Code	APR-DRG 7743
Hospital Charge Code	APRDRG 7743
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.82
Rate for Payer: Amerigroup CHIP/Medicaid	$0.82
Rate for Payer: Cigna Medicaid	$0.82
Rate for Payer: Molina CHIP/Medicaid	$0.82
Rate for Payer: Parkland Medicaid	$0.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.82

INPATIENT APRDRG 7744: COCAINE ABUSE & DEPENDENCE

Facility

$2.14

Service Code	APR-DRG 7744
Hospital Charge Code	APRDRG 7744
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$2.14
Rate for Payer: Amerigroup CHIP/Medicaid	$2.14
Rate for Payer: Cigna Medicaid	$2.14
Rate for Payer: Molina CHIP/Medicaid	$2.14
Rate for Payer: Parkland Medicaid	$2.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.14

INPATIENT APRDRG 7751: ALCOHOL ABUSE & DEPENDENCE

Facility

$0.51

Service Code	APR-DRG 7751
Hospital Charge Code	APRDRG 7751
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.51
Rate for Payer: Amerigroup CHIP/Medicaid	$0.51
Rate for Payer: Cigna Medicaid	$0.51
Rate for Payer: Molina CHIP/Medicaid	$0.51
Rate for Payer: Parkland Medicaid	$0.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.51

INPATIENT APRDRG 7752: ALCOHOL ABUSE & DEPENDENCE

Facility

$0.69

Service Code	APR-DRG 7752
Hospital Charge Code	APRDRG 7752
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Amerigroup CHIP/Medicaid	$0.69
Rate for Payer: Cigna Medicaid	$0.69
Rate for Payer: Molina CHIP/Medicaid	$0.69
Rate for Payer: Parkland Medicaid	$0.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.69

INPATIENT APRDRG 7753: ALCOHOL ABUSE & DEPENDENCE

Facility

$1.21

Service Code	APR-DRG 7753
Hospital Charge Code	APRDRG 7753
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 7754: ALCOHOL ABUSE & DEPENDENCE

Facility

$2.21

Service Code	APR-DRG 7754
Hospital Charge Code	APRDRG 7754
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 7761: OTHER DRUG ABUSE & DEPENDENCE

Facility

$0.40

Service Code	APR-DRG 7761
Hospital Charge Code	APRDRG 7761
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.40
Rate for Payer: Amerigroup CHIP/Medicaid	$0.40
Rate for Payer: Cigna Medicaid	$0.40
Rate for Payer: Molina CHIP/Medicaid	$0.40
Rate for Payer: Parkland Medicaid	$0.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.40

INPATIENT APRDRG 7762: OTHER DRUG ABUSE & DEPENDENCE

Facility

$0.61

Service Code	APR-DRG 7762
Hospital Charge Code	APRDRG 7762
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Amerigroup CHIP/Medicaid	$0.61
Rate for Payer: Cigna Medicaid	$0.61
Rate for Payer: Molina CHIP/Medicaid	$0.61
Rate for Payer: Parkland Medicaid	$0.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.61

INPATIENT APRDRG 7763: OTHER DRUG ABUSE & DEPENDENCE

Facility

$1.15

Service Code	APR-DRG 7763
Hospital Charge Code	APRDRG 7763
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$1.15
Rate for Payer: Amerigroup CHIP/Medicaid	$1.15
Rate for Payer: Cigna Medicaid	$1.15
Rate for Payer: Molina CHIP/Medicaid	$1.15
Rate for Payer: Parkland Medicaid	$1.15
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.15

INPATIENT APRDRG 7764: OTHER DRUG ABUSE & DEPENDENCE

Facility

$2.24

Service Code	APR-DRG 7764
Hospital Charge Code	APRDRG 7764
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$2.24
Rate for Payer: Amerigroup CHIP/Medicaid	$2.24
Rate for Payer: Cigna Medicaid	$2.24
Rate for Payer: Molina CHIP/Medicaid	$2.24
Rate for Payer: Parkland Medicaid	$2.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.24

Know your out-of-pocket cost for care.

All Charges