White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 7921: EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$1.75

Service Code	APR-DRG 7921
Hospital Charge Code	APRDRG 7921
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$1.75
Rate for Payer: Amerigroup CHIP/Medicaid	$1.75
Rate for Payer: Cigna Medicaid	$1.75
Rate for Payer: Molina CHIP/Medicaid	$1.75
Rate for Payer: Parkland Medicaid	$1.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.75

INPATIENT APRDRG 7922: EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$2.80

Service Code	APR-DRG 7922
Hospital Charge Code	APRDRG 7922
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$2.80
Rate for Payer: Amerigroup CHIP/Medicaid	$2.80
Rate for Payer: Cigna Medicaid	$2.80
Rate for Payer: Molina CHIP/Medicaid	$2.80
Rate for Payer: Parkland Medicaid	$2.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.80

INPATIENT APRDRG 7923: EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$5.78

Service Code	APR-DRG 7923
Hospital Charge Code	APRDRG 7923
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$5.78
Rate for Payer: Amerigroup CHIP/Medicaid	$5.78
Rate for Payer: Cigna Medicaid	$5.78
Rate for Payer: Molina CHIP/Medicaid	$5.78
Rate for Payer: Parkland Medicaid	$5.78
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.78

INPATIENT APRDRG 7924: EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$11.08

Service Code	APR-DRG 7924
Hospital Charge Code	APRDRG 7924
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$11.08
Rate for Payer: Amerigroup CHIP/Medicaid	$11.08
Rate for Payer: Cigna Medicaid	$11.08
Rate for Payer: Molina CHIP/Medicaid	$11.08
Rate for Payer: Parkland Medicaid	$11.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11.08

INPATIENT APRDRG 7931: MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$0.99

Service Code	APR-DRG 7931
Hospital Charge Code	APRDRG 7931
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 7932: MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$1.84

Service Code	APR-DRG 7932
Hospital Charge Code	APRDRG 7932
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$1.84
Rate for Payer: Amerigroup CHIP/Medicaid	$1.84
Rate for Payer: Cigna Medicaid	$1.84
Rate for Payer: Molina CHIP/Medicaid	$1.84
Rate for Payer: Parkland Medicaid	$1.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.84

INPATIENT APRDRG 7933: MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$4.61

Service Code	APR-DRG 7933
Hospital Charge Code	APRDRG 7933
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$4.61
Rate for Payer: Amerigroup CHIP/Medicaid	$4.61
Rate for Payer: Cigna Medicaid	$4.61
Rate for Payer: Molina CHIP/Medicaid	$4.61
Rate for Payer: Parkland Medicaid	$4.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.61

INPATIENT APRDRG 7934: MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$6.03

Service Code	APR-DRG 7934
Hospital Charge Code	APRDRG 7934
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$6.03
Rate for Payer: Amerigroup CHIP/Medicaid	$6.03
Rate for Payer: Cigna Medicaid	$6.03
Rate for Payer: Molina CHIP/Medicaid	$6.03
Rate for Payer: Parkland Medicaid	$6.03
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.03

INPATIENT APRDRG 7941: NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$0.75

Service Code	APR-DRG 7941
Hospital Charge Code	APRDRG 7941
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Amerigroup CHIP/Medicaid	$0.75
Rate for Payer: Cigna Medicaid	$0.75
Rate for Payer: Molina CHIP/Medicaid	$0.75
Rate for Payer: Parkland Medicaid	$0.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.75

INPATIENT APRDRG 7942: NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$1.37

Service Code	APR-DRG 7942
Hospital Charge Code	APRDRG 7942
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$1.37
Rate for Payer: Amerigroup CHIP/Medicaid	$1.37
Rate for Payer: Cigna Medicaid	$1.37
Rate for Payer: Molina CHIP/Medicaid	$1.37
Rate for Payer: Parkland Medicaid	$1.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.37

INPATIENT APRDRG 7943: NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$1.92

Service Code	APR-DRG 7943
Hospital Charge Code	APRDRG 7943
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 7944: NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$3.76

Service Code	APR-DRG 7944
Hospital Charge Code	APRDRG 7944
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$3.76
Rate for Payer: Amerigroup CHIP/Medicaid	$3.76
Rate for Payer: Cigna Medicaid	$3.76
Rate for Payer: Molina CHIP/Medicaid	$3.76
Rate for Payer: Parkland Medicaid	$3.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.76

INPATIENT APRDRG 8101: HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION

Facility

$0.48

Service Code	APR-DRG 8101
Hospital Charge Code	APRDRG 8101
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 8102: HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION

Facility

$0.92

Service Code	APR-DRG 8102
Hospital Charge Code	APRDRG 8102
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$0.92
Rate for Payer: Amerigroup CHIP/Medicaid	$0.92
Rate for Payer: Cigna Medicaid	$0.92
Rate for Payer: Molina CHIP/Medicaid	$0.92
Rate for Payer: Parkland Medicaid	$0.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.92

INPATIENT APRDRG 8103: HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION

Facility

$1.39

Service Code	APR-DRG 8103
Hospital Charge Code	APRDRG 8103
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 8104: HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION

Facility

$6.40

Service Code	APR-DRG 8104
Hospital Charge Code	APRDRG 8104
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$6.40
Rate for Payer: Amerigroup CHIP/Medicaid	$6.40
Rate for Payer: Cigna Medicaid	$6.40
Rate for Payer: Molina CHIP/Medicaid	$6.40
Rate for Payer: Parkland Medicaid	$6.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.40

INPATIENT APRDRG 8111: ALLERGIC REACTIONS

Facility

$0.39

Service Code	APR-DRG 8111
Hospital Charge Code	APRDRG 8111
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.39
Rate for Payer: Amerigroup CHIP/Medicaid	$0.39
Rate for Payer: Cigna Medicaid	$0.39
Rate for Payer: Molina CHIP/Medicaid	$0.39
Rate for Payer: Parkland Medicaid	$0.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.39

INPATIENT APRDRG 8112: ALLERGIC REACTIONS

Facility

$0.71

Service Code	APR-DRG 8112
Hospital Charge Code	APRDRG 8112
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$0.71
Rate for Payer: Amerigroup CHIP/Medicaid	$0.71
Rate for Payer: Cigna Medicaid	$0.71
Rate for Payer: Molina CHIP/Medicaid	$0.71
Rate for Payer: Parkland Medicaid	$0.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.71

INPATIENT APRDRG 8113: ALLERGIC REACTIONS

Facility

$1.31

Service Code	APR-DRG 8113
Hospital Charge Code	APRDRG 8113
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 8114: ALLERGIC REACTIONS

Facility

$2.20

Service Code	APR-DRG 8114
Hospital Charge Code	APRDRG 8114
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$2.20
Rate for Payer: Amerigroup CHIP/Medicaid	$2.20
Rate for Payer: Cigna Medicaid	$2.20
Rate for Payer: Molina CHIP/Medicaid	$2.20
Rate for Payer: Parkland Medicaid	$2.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.20

INPATIENT APRDRG 8121: POISONING OF MEDICINAL AGENTS

Facility

$0.43

Service Code	APR-DRG 8121
Hospital Charge Code	APRDRG 8121
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.43
Rate for Payer: Amerigroup CHIP/Medicaid	$0.43
Rate for Payer: Cigna Medicaid	$0.43
Rate for Payer: Molina CHIP/Medicaid	$0.43
Rate for Payer: Parkland Medicaid	$0.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.43

INPATIENT APRDRG 8122: POISONING OF MEDICINAL AGENTS

Facility

$0.63

Service Code	APR-DRG 8122
Hospital Charge Code	APRDRG 8122
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Amerigroup CHIP/Medicaid	$0.63
Rate for Payer: Cigna Medicaid	$0.63
Rate for Payer: Molina CHIP/Medicaid	$0.63
Rate for Payer: Parkland Medicaid	$0.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.63

INPATIENT APRDRG 8123: POISONING OF MEDICINAL AGENTS

Facility

$0.95

Service Code	APR-DRG 8123
Hospital Charge Code	APRDRG 8123
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 8124: POISONING OF MEDICINAL AGENTS

Facility

$1.97

Service Code	APR-DRG 8124
Hospital Charge Code	APRDRG 8124
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$1.97
Rate for Payer: Amerigroup CHIP/Medicaid	$1.97
Rate for Payer: Cigna Medicaid	$1.97
Rate for Payer: Molina CHIP/Medicaid	$1.97
Rate for Payer: Parkland Medicaid	$1.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.97

INPATIENT APRDRG 8131: OTHER COMPLICATIONS OF TREATMENT

Facility

$0.77

Service Code	APR-DRG 8131
Hospital Charge Code	APRDRG 8131
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.77
Rate for Payer: Amerigroup CHIP/Medicaid	$0.77
Rate for Payer: Cigna Medicaid	$0.77
Rate for Payer: Molina CHIP/Medicaid	$0.77
Rate for Payer: Parkland Medicaid	$0.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.77

Know your out-of-pocket cost for care.

All Charges