White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 8634: NEONATAL AFTERCARE

Facility

$17.02

Service Code	APR-DRG 8634
Hospital Charge Code	APRDRG 8634
Min. Negotiated Rate	$17.02
Max. Negotiated Rate	$17.02
Rate for Payer: Amerigroup CHIP/Medicaid	$17.02
Rate for Payer: Cigna Medicaid	$17.02
Rate for Payer: Molina CHIP/Medicaid	$17.02
Rate for Payer: Parkland Medicaid	$17.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.02

INPATIENT APRDRG 8901: HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$1.16

Service Code	APR-DRG 8901
Hospital Charge Code	APRDRG 8901
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 8902: HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$1.25

Service Code	APR-DRG 8902
Hospital Charge Code	APRDRG 8902
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.25
Rate for Payer: Amerigroup CHIP/Medicaid	$1.25
Rate for Payer: Cigna Medicaid	$1.25
Rate for Payer: Molina CHIP/Medicaid	$1.25
Rate for Payer: Parkland Medicaid	$1.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.25

INPATIENT APRDRG 8903: HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$2.20

Service Code	APR-DRG 8903
Hospital Charge Code	APRDRG 8903
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 8904: HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$4.63

Service Code	APR-DRG 8904
Hospital Charge Code	APRDRG 8904
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$4.63
Rate for Payer: Amerigroup CHIP/Medicaid	$4.63
Rate for Payer: Cigna Medicaid	$4.63
Rate for Payer: Molina CHIP/Medicaid	$4.63
Rate for Payer: Parkland Medicaid	$4.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.63

INPATIENT APRDRG 8921: HIV W MAJOR HIV RELATED CONDITION

Facility

$0.84

Service Code	APR-DRG 8921
Hospital Charge Code	APRDRG 8921
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Amerigroup CHIP/Medicaid	$0.84
Rate for Payer: Cigna Medicaid	$0.84
Rate for Payer: Molina CHIP/Medicaid	$0.84
Rate for Payer: Parkland Medicaid	$0.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.84

INPATIENT APRDRG 8922: HIV W MAJOR HIV RELATED CONDITION

Facility

$1.04

Service Code	APR-DRG 8922
Hospital Charge Code	APRDRG 8922
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.04
Rate for Payer: Amerigroup CHIP/Medicaid	$1.04
Rate for Payer: Cigna Medicaid	$1.04
Rate for Payer: Molina CHIP/Medicaid	$1.04
Rate for Payer: Parkland Medicaid	$1.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.04

INPATIENT APRDRG 8923: HIV W MAJOR HIV RELATED CONDITION

Facility

$1.63

Service Code	APR-DRG 8923
Hospital Charge Code	APRDRG 8923
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$1.63
Rate for Payer: Amerigroup CHIP/Medicaid	$1.63
Rate for Payer: Cigna Medicaid	$1.63
Rate for Payer: Molina CHIP/Medicaid	$1.63
Rate for Payer: Parkland Medicaid	$1.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.63

INPATIENT APRDRG 8924: HIV W MAJOR HIV RELATED CONDITION

Facility

$2.46

Service Code	APR-DRG 8924
Hospital Charge Code	APRDRG 8924
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.46
Rate for Payer: Amerigroup CHIP/Medicaid	$2.46
Rate for Payer: Cigna Medicaid	$2.46
Rate for Payer: Molina CHIP/Medicaid	$2.46
Rate for Payer: Parkland Medicaid	$2.46
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.46

INPATIENT APRDRG 8931: HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$0.73

Service Code	APR-DRG 8931
Hospital Charge Code	APRDRG 8931
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Amerigroup CHIP/Medicaid	$0.73
Rate for Payer: Cigna Medicaid	$0.73
Rate for Payer: Molina CHIP/Medicaid	$0.73
Rate for Payer: Parkland Medicaid	$0.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.73

INPATIENT APRDRG 8932: HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$1.04

Service Code	APR-DRG 8932
Hospital Charge Code	APRDRG 8932
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.04
Rate for Payer: Amerigroup CHIP/Medicaid	$1.04
Rate for Payer: Cigna Medicaid	$1.04
Rate for Payer: Molina CHIP/Medicaid	$1.04
Rate for Payer: Parkland Medicaid	$1.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.04

INPATIENT APRDRG 8933: HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$1.45

Service Code	APR-DRG 8933
Hospital Charge Code	APRDRG 8933
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 8934: HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$2.73

Service Code	APR-DRG 8934
Hospital Charge Code	APRDRG 8934
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$2.73
Rate for Payer: Amerigroup CHIP/Medicaid	$2.73
Rate for Payer: Cigna Medicaid	$2.73
Rate for Payer: Molina CHIP/Medicaid	$2.73
Rate for Payer: Parkland Medicaid	$2.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.73

INPATIENT APRDRG 8941: HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND

Facility

$0.90

Service Code	APR-DRG 8941
Hospital Charge Code	APRDRG 8941
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Amerigroup CHIP/Medicaid	$0.90
Rate for Payer: Cigna Medicaid	$0.90
Rate for Payer: Molina CHIP/Medicaid	$0.90
Rate for Payer: Parkland Medicaid	$0.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.90

INPATIENT APRDRG 8942: HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND

Facility

$1.05

Service Code	APR-DRG 8942
Hospital Charge Code	APRDRG 8942
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Amerigroup CHIP/Medicaid	$1.05
Rate for Payer: Cigna Medicaid	$1.05
Rate for Payer: Molina CHIP/Medicaid	$1.05
Rate for Payer: Parkland Medicaid	$1.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.05

INPATIENT APRDRG 8943: HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND

Facility

$1.53

Service Code	APR-DRG 8943
Hospital Charge Code	APRDRG 8943
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$1.53
Rate for Payer: Amerigroup CHIP/Medicaid	$1.53
Rate for Payer: Cigna Medicaid	$1.53
Rate for Payer: Molina CHIP/Medicaid	$1.53
Rate for Payer: Parkland Medicaid	$1.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.53

INPATIENT APRDRG 8944: HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND

Facility

$2.01

Service Code	APR-DRG 8944
Hospital Charge Code	APRDRG 8944
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.01
Rate for Payer: Amerigroup CHIP/Medicaid	$2.01
Rate for Payer: Cigna Medicaid	$2.01
Rate for Payer: Molina CHIP/Medicaid	$2.01
Rate for Payer: Parkland Medicaid	$2.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.01

INPATIENT APRDRG 9101: CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$3.41

Service Code	APR-DRG 9101
Hospital Charge Code	APRDRG 9101
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$3.41
Rate for Payer: Amerigroup CHIP/Medicaid	$3.41
Rate for Payer: Cigna Medicaid	$3.41
Rate for Payer: Molina CHIP/Medicaid	$3.41
Rate for Payer: Parkland Medicaid	$3.41
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.41

INPATIENT APRDRG 9102: CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$3.54

Service Code	APR-DRG 9102
Hospital Charge Code	APRDRG 9102
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$3.54
Rate for Payer: Amerigroup CHIP/Medicaid	$3.54
Rate for Payer: Cigna Medicaid	$3.54
Rate for Payer: Molina CHIP/Medicaid	$3.54
Rate for Payer: Parkland Medicaid	$3.54
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.54

INPATIENT APRDRG 9103: CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$4.63

Service Code	APR-DRG 9103
Hospital Charge Code	APRDRG 9103
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$4.63
Rate for Payer: Amerigroup CHIP/Medicaid	$4.63
Rate for Payer: Cigna Medicaid	$4.63
Rate for Payer: Molina CHIP/Medicaid	$4.63
Rate for Payer: Parkland Medicaid	$4.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.63

INPATIENT APRDRG 9104: CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$12.17

Service Code	APR-DRG 9104
Hospital Charge Code	APRDRG 9104
Min. Negotiated Rate	$12.17
Max. Negotiated Rate	$12.17
Rate for Payer: Amerigroup CHIP/Medicaid	$12.17
Rate for Payer: Cigna Medicaid	$12.17
Rate for Payer: Molina CHIP/Medicaid	$12.17
Rate for Payer: Parkland Medicaid	$12.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.17

INPATIENT APRDRG 9111: EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA

Facility

$1.86

Service Code	APR-DRG 9111
Hospital Charge Code	APRDRG 9111
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$1.86
Rate for Payer: Amerigroup CHIP/Medicaid	$1.86
Rate for Payer: Cigna Medicaid	$1.86
Rate for Payer: Molina CHIP/Medicaid	$1.86
Rate for Payer: Parkland Medicaid	$1.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.86

INPATIENT APRDRG 9112: EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA

Facility

$2.07

Service Code	APR-DRG 9112
Hospital Charge Code	APRDRG 9112
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$2.07
Rate for Payer: Amerigroup CHIP/Medicaid	$2.07
Rate for Payer: Cigna Medicaid	$2.07
Rate for Payer: Molina CHIP/Medicaid	$2.07
Rate for Payer: Parkland Medicaid	$2.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.07

INPATIENT APRDRG 9113: EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA

Facility

$3.86

Service Code	APR-DRG 9113
Hospital Charge Code	APRDRG 9113
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$3.86
Rate for Payer: Amerigroup CHIP/Medicaid	$3.86
Rate for Payer: Cigna Medicaid	$3.86
Rate for Payer: Molina CHIP/Medicaid	$3.86
Rate for Payer: Parkland Medicaid	$3.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.86

INPATIENT APRDRG 9114: EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA

Facility

$10.31

Service Code	APR-DRG 9114
Hospital Charge Code	APRDRG 9114
Min. Negotiated Rate	$10.31
Max. Negotiated Rate	$10.31
Rate for Payer: Amerigroup CHIP/Medicaid	$10.31
Rate for Payer: Cigna Medicaid	$10.31
Rate for Payer: Molina CHIP/Medicaid	$10.31
Rate for Payer: Parkland Medicaid	$10.31
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10.31

Know your out-of-pocket cost for care.

All Charges