White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 5642: ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$0.50

Service Code	APR-DRG 5642
Hospital Charge Code	APRDRG 5642
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 5643: ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$0.96

Service Code	APR-DRG 5643
Hospital Charge Code	APRDRG 5643
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 5644: ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$3.60

Service Code	APR-DRG 5644
Hospital Charge Code	APRDRG 5644
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Amerigroup CHIP/Medicaid	$3.60
Rate for Payer: Cigna Medicaid	$3.60
Rate for Payer: Molina CHIP/Medicaid	$3.60
Rate for Payer: Parkland Medicaid	$3.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.60

INPATIENT APRDRG 5661: OTHER ANTEPARTUM DIAGNOSES

Facility

$0.33

Service Code	APR-DRG 5661
Hospital Charge Code	APRDRG 5661
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Amerigroup CHIP/Medicaid	$0.33
Rate for Payer: Cigna Medicaid	$0.33
Rate for Payer: Molina CHIP/Medicaid	$0.33
Rate for Payer: Parkland Medicaid	$0.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.33

INPATIENT APRDRG 5662: OTHER ANTEPARTUM DIAGNOSES

Facility

$0.45

Service Code	APR-DRG 5662
Hospital Charge Code	APRDRG 5662
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 5663: OTHER ANTEPARTUM DIAGNOSES

Facility

$0.72

Service Code	APR-DRG 5663
Hospital Charge Code	APRDRG 5663
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 5664: OTHER ANTEPARTUM DIAGNOSES

Facility

$1.31

Service Code	APR-DRG 5664
Hospital Charge Code	APRDRG 5664
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 5801: NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE

Facility

$0.36

Service Code	APR-DRG 5801
Hospital Charge Code	APRDRG 5801
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Amerigroup CHIP/Medicaid	$0.36
Rate for Payer: Cigna Medicaid	$0.36
Rate for Payer: Molina CHIP/Medicaid	$0.36
Rate for Payer: Parkland Medicaid	$0.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.36

INPATIENT APRDRG 5802: NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE

Facility

$0.52

Service Code	APR-DRG 5802
Hospital Charge Code	APRDRG 5802
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.52
Rate for Payer: Amerigroup CHIP/Medicaid	$0.52
Rate for Payer: Cigna Medicaid	$0.52
Rate for Payer: Molina CHIP/Medicaid	$0.52
Rate for Payer: Parkland Medicaid	$0.52
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.52

INPATIENT APRDRG 5803: NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE

Facility

$0.85

Service Code	APR-DRG 5803
Hospital Charge Code	APRDRG 5803
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 5804: NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE

Facility

$1.53

Service Code	APR-DRG 5804
Hospital Charge Code	APRDRG 5804
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 5811: NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$0.16

Service Code	APR-DRG 5811
Hospital Charge Code	APRDRG 5811
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Amerigroup CHIP/Medicaid	$0.16
Rate for Payer: Cigna Medicaid	$0.16
Rate for Payer: Molina CHIP/Medicaid	$0.16
Rate for Payer: Parkland Medicaid	$0.16
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.16

INPATIENT APRDRG 5812: NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$0.26

Service Code	APR-DRG 5812
Hospital Charge Code	APRDRG 5812
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Amerigroup CHIP/Medicaid	$0.26
Rate for Payer: Cigna Medicaid	$0.26
Rate for Payer: Molina CHIP/Medicaid	$0.26
Rate for Payer: Parkland Medicaid	$0.26
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.26

INPATIENT APRDRG 5813: NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$0.39

Service Code	APR-DRG 5813
Hospital Charge Code	APRDRG 5813
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 5814: NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$0.75

Service Code	APR-DRG 5814
Hospital Charge Code	APRDRG 5814
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 5831: NEONATE W ECMO

Facility

$28.22

Service Code	APR-DRG 5831
Hospital Charge Code	APRDRG 5831
Min. Negotiated Rate	$28.22
Max. Negotiated Rate	$28.22
Rate for Payer: Amerigroup CHIP/Medicaid	$28.22
Rate for Payer: Cigna Medicaid	$28.22
Rate for Payer: Molina CHIP/Medicaid	$28.22
Rate for Payer: Parkland Medicaid	$28.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$28.22

INPATIENT APRDRG 5832: NEONATE W ECMO

Facility

$32.05

Service Code	APR-DRG 5832
Hospital Charge Code	APRDRG 5832
Min. Negotiated Rate	$32.05
Max. Negotiated Rate	$32.05
Rate for Payer: Amerigroup CHIP/Medicaid	$32.05
Rate for Payer: Cigna Medicaid	$32.05
Rate for Payer: Molina CHIP/Medicaid	$32.05
Rate for Payer: Parkland Medicaid	$32.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$32.05

INPATIENT APRDRG 5833: NEONATE W ECMO

Facility

$64.31

Service Code	APR-DRG 5833
Hospital Charge Code	APRDRG 5833
Min. Negotiated Rate	$64.31
Max. Negotiated Rate	$64.31
Rate for Payer: Amerigroup CHIP/Medicaid	$64.31
Rate for Payer: Cigna Medicaid	$64.31
Rate for Payer: Molina CHIP/Medicaid	$64.31
Rate for Payer: Parkland Medicaid	$64.31
Rate for Payer: Superior Health Plan CHIP/Medicaid	$64.31

INPATIENT APRDRG 5834: NEONATE W ECMO

Facility

$75.95

Service Code	APR-DRG 5834
Hospital Charge Code	APRDRG 5834
Min. Negotiated Rate	$75.95
Max. Negotiated Rate	$75.95
Rate for Payer: Amerigroup CHIP/Medicaid	$75.95
Rate for Payer: Cigna Medicaid	$75.95
Rate for Payer: Molina CHIP/Medicaid	$75.95
Rate for Payer: Parkland Medicaid	$75.95
Rate for Payer: Superior Health Plan CHIP/Medicaid	$75.95

INPATIENT APRDRG 5881: NEONATE BWT <1500G W MAJOR PROCEDURE

Facility

$24.20

Service Code	APR-DRG 5881
Hospital Charge Code	APRDRG 5881
Min. Negotiated Rate	$24.20
Max. Negotiated Rate	$24.20
Rate for Payer: Amerigroup CHIP/Medicaid	$24.20
Rate for Payer: Cigna Medicaid	$24.20
Rate for Payer: Molina CHIP/Medicaid	$24.20
Rate for Payer: Parkland Medicaid	$24.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$24.20

INPATIENT APRDRG 5882: NEONATE BWT <1500G W MAJOR PROCEDURE

Facility

$25.68

Service Code	APR-DRG 5882
Hospital Charge Code	APRDRG 5882
Min. Negotiated Rate	$25.68
Max. Negotiated Rate	$25.68
Rate for Payer: Amerigroup CHIP/Medicaid	$25.68
Rate for Payer: Cigna Medicaid	$25.68
Rate for Payer: Molina CHIP/Medicaid	$25.68
Rate for Payer: Parkland Medicaid	$25.68
Rate for Payer: Superior Health Plan CHIP/Medicaid	$25.68

INPATIENT APRDRG 5883: NEONATE BWT <1500G W MAJOR PROCEDURE

Facility

$25.80

Service Code	APR-DRG 5883
Hospital Charge Code	APRDRG 5883
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$25.80
Rate for Payer: Amerigroup CHIP/Medicaid	$25.80
Rate for Payer: Cigna Medicaid	$25.80
Rate for Payer: Molina CHIP/Medicaid	$25.80
Rate for Payer: Parkland Medicaid	$25.80
Rate for Payer: Superior Health Plan CHIP/Medicaid	$25.80

INPATIENT APRDRG 5884: NEONATE BWT <1500G W MAJOR PROCEDURE

Facility

$48.08

Service Code	APR-DRG 5884
Hospital Charge Code	APRDRG 5884
Min. Negotiated Rate	$48.08
Max. Negotiated Rate	$48.08
Rate for Payer: Amerigroup CHIP/Medicaid	$48.08
Rate for Payer: Cigna Medicaid	$48.08
Rate for Payer: Molina CHIP/Medicaid	$48.08
Rate for Payer: Parkland Medicaid	$48.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$48.08

INPATIENT APRDRG 5891: NEONATE BWT <500G OR GA <24 WEEKS

Facility

$20.29

Service Code	APR-DRG 5891
Hospital Charge Code	APRDRG 5891
Min. Negotiated Rate	$20.29
Max. Negotiated Rate	$20.29
Rate for Payer: Amerigroup CHIP/Medicaid	$20.29
Rate for Payer: Cigna Medicaid	$20.29
Rate for Payer: Molina CHIP/Medicaid	$20.29
Rate for Payer: Parkland Medicaid	$20.29
Rate for Payer: Superior Health Plan CHIP/Medicaid	$20.29

INPATIENT APRDRG 5892: NEONATE BWT <500G OR GA <24 WEEKS

Facility

$19.66

Service Code	APR-DRG 5892
Hospital Charge Code	APRDRG 5892
Min. Negotiated Rate	$19.66
Max. Negotiated Rate	$19.66
Rate for Payer: Amerigroup CHIP/Medicaid	$19.66
Rate for Payer: Cigna Medicaid	$19.66
Rate for Payer: Molina CHIP/Medicaid	$19.66
Rate for Payer: Parkland Medicaid	$19.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$19.66

Know your out-of-pocket cost for care.

All Charges