White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 8433: EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT

Facility

$1.70

Service Code	APR-DRG 8433
Hospital Charge Code	APRDRG 8433
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.70
Rate for Payer: Amerigroup CHIP/Medicaid	$1.70
Rate for Payer: Cigna Medicaid	$1.70
Rate for Payer: Molina CHIP/Medicaid	$1.70
Rate for Payer: Parkland Medicaid	$1.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.70

INPATIENT APRDRG 8434: EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT

Facility

$4.72

Service Code	APR-DRG 8434
Hospital Charge Code	APRDRG 8434
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$4.72
Rate for Payer: Amerigroup CHIP/Medicaid	$4.72
Rate for Payer: Cigna Medicaid	$4.72
Rate for Payer: Molina CHIP/Medicaid	$4.72
Rate for Payer: Parkland Medicaid	$4.72
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.72

INPATIENT APRDRG 8441: PARTIAL THICKNESS BURNS W/O SKIN GRAFT

Facility

$0.58

Service Code	APR-DRG 8441
Hospital Charge Code	APRDRG 8441
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Amerigroup CHIP/Medicaid	$0.58
Rate for Payer: Cigna Medicaid	$0.58
Rate for Payer: Molina CHIP/Medicaid	$0.58
Rate for Payer: Parkland Medicaid	$0.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.58

INPATIENT APRDRG 8442: PARTIAL THICKNESS BURNS W/O SKIN GRAFT

Facility

$0.86

Service Code	APR-DRG 8442
Hospital Charge Code	APRDRG 8442
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Amerigroup CHIP/Medicaid	$0.86
Rate for Payer: Cigna Medicaid	$0.86
Rate for Payer: Molina CHIP/Medicaid	$0.86
Rate for Payer: Parkland Medicaid	$0.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.86

INPATIENT APRDRG 8443: PARTIAL THICKNESS BURNS W/O SKIN GRAFT

Facility

$1.43

Service Code	APR-DRG 8443
Hospital Charge Code	APRDRG 8443
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Amerigroup CHIP/Medicaid	$1.43
Rate for Payer: Cigna Medicaid	$1.43
Rate for Payer: Molina CHIP/Medicaid	$1.43
Rate for Payer: Parkland Medicaid	$1.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.43

INPATIENT APRDRG 8444: PARTIAL THICKNESS BURNS W/O SKIN GRAFT

Facility

$4.10

Service Code	APR-DRG 8444
Hospital Charge Code	APRDRG 8444
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.10
Rate for Payer: Amerigroup CHIP/Medicaid	$4.10
Rate for Payer: Cigna Medicaid	$4.10
Rate for Payer: Molina CHIP/Medicaid	$4.10
Rate for Payer: Parkland Medicaid	$4.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.10

INPATIENT APRDRG 8501: PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE

Facility

$1.91

Service Code	APR-DRG 8501
Hospital Charge Code	APRDRG 8501
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$1.91
Rate for Payer: Amerigroup CHIP/Medicaid	$1.91
Rate for Payer: Cigna Medicaid	$1.91
Rate for Payer: Molina CHIP/Medicaid	$1.91
Rate for Payer: Parkland Medicaid	$1.91
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.91

INPATIENT APRDRG 8502: PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE

Facility

$3.40

Service Code	APR-DRG 8502
Hospital Charge Code	APRDRG 8502
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.40
Rate for Payer: Amerigroup CHIP/Medicaid	$3.40
Rate for Payer: Cigna Medicaid	$3.40
Rate for Payer: Molina CHIP/Medicaid	$3.40
Rate for Payer: Parkland Medicaid	$3.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.40

INPATIENT APRDRG 8503: PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE

Facility

$5.18

Service Code	APR-DRG 8503
Hospital Charge Code	APRDRG 8503
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$5.18
Rate for Payer: Amerigroup CHIP/Medicaid	$5.18
Rate for Payer: Cigna Medicaid	$5.18
Rate for Payer: Molina CHIP/Medicaid	$5.18
Rate for Payer: Parkland Medicaid	$5.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.18

INPATIENT APRDRG 8504: PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE

Facility

$24.58

Service Code	APR-DRG 8504
Hospital Charge Code	APRDRG 8504
Min. Negotiated Rate	$24.58
Max. Negotiated Rate	$24.58
Rate for Payer: Amerigroup CHIP/Medicaid	$24.58
Rate for Payer: Cigna Medicaid	$24.58
Rate for Payer: Molina CHIP/Medicaid	$24.58
Rate for Payer: Parkland Medicaid	$24.58
Rate for Payer: Superior Health Plan CHIP/Medicaid	$24.58

INPATIENT APRDRG 8601: REHABILITATION

Facility

$0.85

Service Code	APR-DRG 8601
Hospital Charge Code	APRDRG 8601
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 8602: REHABILITATION

Facility

$1.23

Service Code	APR-DRG 8602
Hospital Charge Code	APRDRG 8602
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.23
Rate for Payer: Amerigroup CHIP/Medicaid	$1.23
Rate for Payer: Cigna Medicaid	$1.23
Rate for Payer: Molina CHIP/Medicaid	$1.23
Rate for Payer: Parkland Medicaid	$1.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.23

INPATIENT APRDRG 8603: REHABILITATION

Facility

$1.79

Service Code	APR-DRG 8603
Hospital Charge Code	APRDRG 8603
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$1.79
Rate for Payer: Amerigroup CHIP/Medicaid	$1.79
Rate for Payer: Cigna Medicaid	$1.79
Rate for Payer: Molina CHIP/Medicaid	$1.79
Rate for Payer: Parkland Medicaid	$1.79
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.79

INPATIENT APRDRG 8604: REHABILITATION

Facility

$2.80

Service Code	APR-DRG 8604
Hospital Charge Code	APRDRG 8604
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 8611: SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$0.51

Service Code	APR-DRG 8611
Hospital Charge Code	APRDRG 8611
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 8612: SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$0.82

Service Code	APR-DRG 8612
Hospital Charge Code	APRDRG 8612
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 8613: SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$1.56

Service Code	APR-DRG 8613
Hospital Charge Code	APRDRG 8613
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Amerigroup CHIP/Medicaid	$1.56
Rate for Payer: Cigna Medicaid	$1.56
Rate for Payer: Molina CHIP/Medicaid	$1.56
Rate for Payer: Parkland Medicaid	$1.56
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.56

INPATIENT APRDRG 8614: SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$3.17

Service Code	APR-DRG 8614
Hospital Charge Code	APRDRG 8614
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Amerigroup CHIP/Medicaid	$3.17
Rate for Payer: Cigna Medicaid	$3.17
Rate for Payer: Molina CHIP/Medicaid	$3.17
Rate for Payer: Parkland Medicaid	$3.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.17

INPATIENT APRDRG 8621: OTHER AFTERCARE & CONVALESCENCE

Facility

$1.45

Service Code	APR-DRG 8621
Hospital Charge Code	APRDRG 8621
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 8622: OTHER AFTERCARE & CONVALESCENCE

Facility

$1.96

Service Code	APR-DRG 8622
Hospital Charge Code	APRDRG 8622
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 8623: OTHER AFTERCARE & CONVALESCENCE

Facility

$2.93

Service Code	APR-DRG 8623
Hospital Charge Code	APRDRG 8623
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$2.93
Rate for Payer: Amerigroup CHIP/Medicaid	$2.93
Rate for Payer: Cigna Medicaid	$2.93
Rate for Payer: Molina CHIP/Medicaid	$2.93
Rate for Payer: Parkland Medicaid	$2.93
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.93

INPATIENT APRDRG 8624: OTHER AFTERCARE & CONVALESCENCE

Facility

$4.35

Service Code	APR-DRG 8624
Hospital Charge Code	APRDRG 8624
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$4.35
Rate for Payer: Amerigroup CHIP/Medicaid	$4.35
Rate for Payer: Cigna Medicaid	$4.35
Rate for Payer: Molina CHIP/Medicaid	$4.35
Rate for Payer: Parkland Medicaid	$4.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.35

INPATIENT APRDRG 8631: NEONATAL AFTERCARE

Facility

$0.97

Service Code	APR-DRG 8631
Hospital Charge Code	APRDRG 8631
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$0.97
Rate for Payer: Amerigroup CHIP/Medicaid	$0.97
Rate for Payer: Cigna Medicaid	$0.97
Rate for Payer: Molina CHIP/Medicaid	$0.97
Rate for Payer: Parkland Medicaid	$0.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.97

INPATIENT APRDRG 8632: NEONATAL AFTERCARE

Facility

$2.59

Service Code	APR-DRG 8632
Hospital Charge Code	APRDRG 8632
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$2.59
Rate for Payer: Amerigroup CHIP/Medicaid	$2.59
Rate for Payer: Cigna Medicaid	$2.59
Rate for Payer: Molina CHIP/Medicaid	$2.59
Rate for Payer: Parkland Medicaid	$2.59
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.59

INPATIENT APRDRG 8633: NEONATAL AFTERCARE

Facility

$3.95

Service Code	APR-DRG 8633
Hospital Charge Code	APRDRG 8633
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$3.95
Rate for Payer: Amerigroup CHIP/Medicaid	$3.95
Rate for Payer: Cigna Medicaid	$3.95
Rate for Payer: Molina CHIP/Medicaid	$3.95
Rate for Payer: Parkland Medicaid	$3.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.95

Know your out-of-pocket cost for care.

All Charges