White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 8132: OTHER COMPLICATIONS OF TREATMENT

Facility

$0.96

Service Code	APR-DRG 8132
Hospital Charge Code	APRDRG 8132
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$0.96
Rate for Payer: Amerigroup CHIP/Medicaid	$0.96
Rate for Payer: Cigna Medicaid	$0.96
Rate for Payer: Molina CHIP/Medicaid	$0.96
Rate for Payer: Parkland Medicaid	$0.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.96

INPATIENT APRDRG 8133: OTHER COMPLICATIONS OF TREATMENT

Facility

$1.54

Service Code	APR-DRG 8133
Hospital Charge Code	APRDRG 8133
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 8134: OTHER COMPLICATIONS OF TREATMENT

Facility

$4.05

Service Code	APR-DRG 8134
Hospital Charge Code	APRDRG 8134
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Amerigroup CHIP/Medicaid	$4.05
Rate for Payer: Cigna Medicaid	$4.05
Rate for Payer: Molina CHIP/Medicaid	$4.05
Rate for Payer: Parkland Medicaid	$4.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.05

INPATIENT APRDRG 8151: OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES

Facility

$0.56

Service Code	APR-DRG 8151
Hospital Charge Code	APRDRG 8151
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 8152: OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES

Facility

$0.85

Service Code	APR-DRG 8152
Hospital Charge Code	APRDRG 8152
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 8153: OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES

Facility

$1.98

Service Code	APR-DRG 8153
Hospital Charge Code	APRDRG 8153
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$1.98
Rate for Payer: Amerigroup CHIP/Medicaid	$1.98
Rate for Payer: Cigna Medicaid	$1.98
Rate for Payer: Molina CHIP/Medicaid	$1.98
Rate for Payer: Parkland Medicaid	$1.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.98

INPATIENT APRDRG 8154: OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES

Facility

$6.51

Service Code	APR-DRG 8154
Hospital Charge Code	APRDRG 8154
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$6.51
Rate for Payer: Amerigroup CHIP/Medicaid	$6.51
Rate for Payer: Cigna Medicaid	$6.51
Rate for Payer: Molina CHIP/Medicaid	$6.51
Rate for Payer: Parkland Medicaid	$6.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.51

INPATIENT APRDRG 8161: TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES

Facility

$0.98

Service Code	APR-DRG 8161
Hospital Charge Code	APRDRG 8161
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Amerigroup CHIP/Medicaid	$0.98
Rate for Payer: Cigna Medicaid	$0.98
Rate for Payer: Molina CHIP/Medicaid	$0.98
Rate for Payer: Parkland Medicaid	$0.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.98

INPATIENT APRDRG 8162: TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES

Facility

$1.58

Service Code	APR-DRG 8162
Hospital Charge Code	APRDRG 8162
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$1.58
Rate for Payer: Amerigroup CHIP/Medicaid	$1.58
Rate for Payer: Cigna Medicaid	$1.58
Rate for Payer: Molina CHIP/Medicaid	$1.58
Rate for Payer: Parkland Medicaid	$1.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.58

INPATIENT APRDRG 8163: TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES

Facility

$1.77

Service Code	APR-DRG 8163
Hospital Charge Code	APRDRG 8163
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$1.77
Rate for Payer: Amerigroup CHIP/Medicaid	$1.77
Rate for Payer: Cigna Medicaid	$1.77
Rate for Payer: Molina CHIP/Medicaid	$1.77
Rate for Payer: Parkland Medicaid	$1.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.77

INPATIENT APRDRG 8164: TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES

Facility

$1.96

Service Code	APR-DRG 8164
Hospital Charge Code	APRDRG 8164
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$1.96
Rate for Payer: Amerigroup CHIP/Medicaid	$1.96
Rate for Payer: Cigna Medicaid	$1.96
Rate for Payer: Molina CHIP/Medicaid	$1.96
Rate for Payer: Parkland Medicaid	$1.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.96

INPATIENT APRDRG 8171: OVERDOSE

Facility

$0.49

Service Code	APR-DRG 8171
Hospital Charge Code	APRDRG 8171
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 8172: OVERDOSE

Facility

$0.62

Service Code	APR-DRG 8172
Hospital Charge Code	APRDRG 8172
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.62
Rate for Payer: Amerigroup CHIP/Medicaid	$0.62
Rate for Payer: Cigna Medicaid	$0.62
Rate for Payer: Molina CHIP/Medicaid	$0.62
Rate for Payer: Parkland Medicaid	$0.62
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.62

INPATIENT APRDRG 8173: OVERDOSE

Facility

$0.96

Service Code	APR-DRG 8173
Hospital Charge Code	APRDRG 8173
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$0.96
Rate for Payer: Amerigroup CHIP/Medicaid	$0.96
Rate for Payer: Cigna Medicaid	$0.96
Rate for Payer: Molina CHIP/Medicaid	$0.96
Rate for Payer: Parkland Medicaid	$0.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.96

INPATIENT APRDRG 8174: OVERDOSE

Facility

$2.09

Service Code	APR-DRG 8174
Hospital Charge Code	APRDRG 8174
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.09
Rate for Payer: Amerigroup CHIP/Medicaid	$2.09
Rate for Payer: Cigna Medicaid	$2.09
Rate for Payer: Molina CHIP/Medicaid	$2.09
Rate for Payer: Parkland Medicaid	$2.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.09

INPATIENT APRDRG 8411: EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT

Facility

$7.11

Service Code	APR-DRG 8411
Hospital Charge Code	APRDRG 8411
Min. Negotiated Rate	$7.11
Max. Negotiated Rate	$7.11
Rate for Payer: Amerigroup CHIP/Medicaid	$7.11
Rate for Payer: Cigna Medicaid	$7.11
Rate for Payer: Molina CHIP/Medicaid	$7.11
Rate for Payer: Parkland Medicaid	$7.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.11

INPATIENT APRDRG 8412: EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT

Facility

$7.16

Service Code	APR-DRG 8412
Hospital Charge Code	APRDRG 8412
Min. Negotiated Rate	$7.16
Max. Negotiated Rate	$7.16
Rate for Payer: Amerigroup CHIP/Medicaid	$7.16
Rate for Payer: Cigna Medicaid	$7.16
Rate for Payer: Molina CHIP/Medicaid	$7.16
Rate for Payer: Parkland Medicaid	$7.16
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.16

INPATIENT APRDRG 8413: EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT

Facility

$11.02

Service Code	APR-DRG 8413
Hospital Charge Code	APRDRG 8413
Min. Negotiated Rate	$11.02
Max. Negotiated Rate	$11.02
Rate for Payer: Amerigroup CHIP/Medicaid	$11.02
Rate for Payer: Cigna Medicaid	$11.02
Rate for Payer: Molina CHIP/Medicaid	$11.02
Rate for Payer: Parkland Medicaid	$11.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11.02

INPATIENT APRDRG 8414: EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT

Facility

$25.50

Service Code	APR-DRG 8414
Hospital Charge Code	APRDRG 8414
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$25.50
Rate for Payer: Amerigroup CHIP/Medicaid	$25.50
Rate for Payer: Cigna Medicaid	$25.50
Rate for Payer: Molina CHIP/Medicaid	$25.50
Rate for Payer: Parkland Medicaid	$25.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$25.50

INPATIENT APRDRG 8421: BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS

Facility

$1.45

Service Code	APR-DRG 8421
Hospital Charge Code	APRDRG 8421
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Amerigroup CHIP/Medicaid	$1.45
Rate for Payer: Cigna Medicaid	$1.45
Rate for Payer: Molina CHIP/Medicaid	$1.45
Rate for Payer: Parkland Medicaid	$1.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.45

INPATIENT APRDRG 8422: BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS

Facility

$2.20

Service Code	APR-DRG 8422
Hospital Charge Code	APRDRG 8422
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 8423: BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS

Facility

$4.23

Service Code	APR-DRG 8423
Hospital Charge Code	APRDRG 8423
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$4.23
Rate for Payer: Amerigroup CHIP/Medicaid	$4.23
Rate for Payer: Cigna Medicaid	$4.23
Rate for Payer: Molina CHIP/Medicaid	$4.23
Rate for Payer: Parkland Medicaid	$4.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.23

INPATIENT APRDRG 8424: BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS

Facility

$8.70

Service Code	APR-DRG 8424
Hospital Charge Code	APRDRG 8424
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$8.70
Rate for Payer: Amerigroup CHIP/Medicaid	$8.70
Rate for Payer: Cigna Medicaid	$8.70
Rate for Payer: Molina CHIP/Medicaid	$8.70
Rate for Payer: Parkland Medicaid	$8.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.70

INPATIENT APRDRG 8431: EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT

Facility

$0.76

Service Code	APR-DRG 8431
Hospital Charge Code	APRDRG 8431
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.76
Rate for Payer: Amerigroup CHIP/Medicaid	$0.76
Rate for Payer: Cigna Medicaid	$0.76
Rate for Payer: Molina CHIP/Medicaid	$0.76
Rate for Payer: Parkland Medicaid	$0.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.76

INPATIENT APRDRG 8432: EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT

Facility

$1.41

Service Code	APR-DRG 8432
Hospital Charge Code	APRDRG 8432
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

Know your out-of-pocket cost for care.

All Charges