White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 5893: NEONATE BWT <500G OR GA <24 WEEKS

Facility

$18.44

Service Code	APR-DRG 5893
Hospital Charge Code	APRDRG 5893
Min. Negotiated Rate	$18.44
Max. Negotiated Rate	$18.44
Rate for Payer: Amerigroup CHIP/Medicaid	$18.44
Rate for Payer: Cigna Medicaid	$18.44
Rate for Payer: Molina CHIP/Medicaid	$18.44
Rate for Payer: Parkland Medicaid	$18.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18.44

INPATIENT APRDRG 5894: NEONATE BWT <500G OR GA <24 WEEKS

Facility

$3.40

Service Code	APR-DRG 5894
Hospital Charge Code	APRDRG 5894
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 5911: NEONATE BIRTHWT 500-749G W/O MAJOR PROCEDURE

Facility

$9.55

Service Code	APR-DRG 5911
Hospital Charge Code	APRDRG 5911
Min. Negotiated Rate	$9.55
Max. Negotiated Rate	$9.55
Rate for Payer: Amerigroup CHIP/Medicaid	$9.55
Rate for Payer: Cigna Medicaid	$9.55
Rate for Payer: Molina CHIP/Medicaid	$9.55
Rate for Payer: Parkland Medicaid	$9.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.55

INPATIENT APRDRG 5912: NEONATE BIRTHWT 500-749G W/O MAJOR PROCEDURE

Facility

$13.25

Service Code	APR-DRG 5912
Hospital Charge Code	APRDRG 5912
Min. Negotiated Rate	$13.25
Max. Negotiated Rate	$13.25
Rate for Payer: Amerigroup CHIP/Medicaid	$13.25
Rate for Payer: Cigna Medicaid	$13.25
Rate for Payer: Molina CHIP/Medicaid	$13.25
Rate for Payer: Parkland Medicaid	$13.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.25

INPATIENT APRDRG 5913: NEONATE BIRTHWT 500-749G W/O MAJOR PROCEDURE

Facility

$16.04

Service Code	APR-DRG 5913
Hospital Charge Code	APRDRG 5913
Min. Negotiated Rate	$16.04
Max. Negotiated Rate	$16.04
Rate for Payer: Amerigroup CHIP/Medicaid	$16.04
Rate for Payer: Cigna Medicaid	$16.04
Rate for Payer: Molina CHIP/Medicaid	$16.04
Rate for Payer: Parkland Medicaid	$16.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16.04

INPATIENT APRDRG 5914: NEONATE BIRTHWT 500-749G W/O MAJOR PROCEDURE

Facility

$24.36

Service Code	APR-DRG 5914
Hospital Charge Code	APRDRG 5914
Min. Negotiated Rate	$24.36
Max. Negotiated Rate	$24.36
Rate for Payer: Amerigroup CHIP/Medicaid	$24.36
Rate for Payer: Cigna Medicaid	$24.36
Rate for Payer: Molina CHIP/Medicaid	$24.36
Rate for Payer: Parkland Medicaid	$24.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$24.36

INPATIENT APRDRG 5931: NEONATE BIRTHWT 750-999G W/O MAJOR PROCEDURE

Facility

$2.96

Service Code	APR-DRG 5931
Hospital Charge Code	APRDRG 5931
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$2.96
Rate for Payer: Amerigroup CHIP/Medicaid	$2.96
Rate for Payer: Cigna Medicaid	$2.96
Rate for Payer: Molina CHIP/Medicaid	$2.96
Rate for Payer: Parkland Medicaid	$2.96
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.96

INPATIENT APRDRG 5932: NEONATE BIRTHWT 750-999G W/O MAJOR PROCEDURE

Facility

$11.35

Service Code	APR-DRG 5932
Hospital Charge Code	APRDRG 5932
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Amerigroup CHIP/Medicaid	$11.35
Rate for Payer: Cigna Medicaid	$11.35
Rate for Payer: Molina CHIP/Medicaid	$11.35
Rate for Payer: Parkland Medicaid	$11.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11.35

INPATIENT APRDRG 5933: NEONATE BIRTHWT 750-999G W/O MAJOR PROCEDURE

Facility

$14.44

Service Code	APR-DRG 5933
Hospital Charge Code	APRDRG 5933
Min. Negotiated Rate	$14.44
Max. Negotiated Rate	$14.44
Rate for Payer: Amerigroup CHIP/Medicaid	$14.44
Rate for Payer: Cigna Medicaid	$14.44
Rate for Payer: Molina CHIP/Medicaid	$14.44
Rate for Payer: Parkland Medicaid	$14.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14.44

INPATIENT APRDRG 5934: NEONATE BIRTHWT 750-999G W/O MAJOR PROCEDURE

Facility

$20.22

Service Code	APR-DRG 5934
Hospital Charge Code	APRDRG 5934
Min. Negotiated Rate	$20.22
Max. Negotiated Rate	$20.22
Rate for Payer: Amerigroup CHIP/Medicaid	$20.22
Rate for Payer: Cigna Medicaid	$20.22
Rate for Payer: Molina CHIP/Medicaid	$20.22
Rate for Payer: Parkland Medicaid	$20.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$20.22

INPATIENT APRDRG 6021: NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$4.60

Service Code	APR-DRG 6021
Hospital Charge Code	APRDRG 6021
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$4.60
Rate for Payer: Amerigroup CHIP/Medicaid	$4.60
Rate for Payer: Cigna Medicaid	$4.60
Rate for Payer: Molina CHIP/Medicaid	$4.60
Rate for Payer: Parkland Medicaid	$4.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.60

INPATIENT APRDRG 6022: NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$9.08

Service Code	APR-DRG 6022
Hospital Charge Code	APRDRG 6022
Min. Negotiated Rate	$9.08
Max. Negotiated Rate	$9.08
Rate for Payer: Amerigroup CHIP/Medicaid	$9.08
Rate for Payer: Cigna Medicaid	$9.08
Rate for Payer: Molina CHIP/Medicaid	$9.08
Rate for Payer: Parkland Medicaid	$9.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.08

INPATIENT APRDRG 6023: NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$12.02

Service Code	APR-DRG 6023
Hospital Charge Code	APRDRG 6023
Min. Negotiated Rate	$12.02
Max. Negotiated Rate	$12.02
Rate for Payer: Amerigroup CHIP/Medicaid	$12.02
Rate for Payer: Cigna Medicaid	$12.02
Rate for Payer: Molina CHIP/Medicaid	$12.02
Rate for Payer: Parkland Medicaid	$12.02
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.02

INPATIENT APRDRG 6024: NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$18.59

Service Code	APR-DRG 6024
Hospital Charge Code	APRDRG 6024
Min. Negotiated Rate	$18.59
Max. Negotiated Rate	$18.59
Rate for Payer: Amerigroup CHIP/Medicaid	$18.59
Rate for Payer: Cigna Medicaid	$18.59
Rate for Payer: Molina CHIP/Medicaid	$18.59
Rate for Payer: Parkland Medicaid	$18.59
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18.59

INPATIENT APRDRG 6031: NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$3.37

Service Code	APR-DRG 6031
Hospital Charge Code	APRDRG 6031
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Amerigroup CHIP/Medicaid	$3.37
Rate for Payer: Cigna Medicaid	$3.37
Rate for Payer: Molina CHIP/Medicaid	$3.37
Rate for Payer: Parkland Medicaid	$3.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.37

INPATIENT APRDRG 6032: NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$6.39

Service Code	APR-DRG 6032
Hospital Charge Code	APRDRG 6032
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$6.39
Rate for Payer: Amerigroup CHIP/Medicaid	$6.39
Rate for Payer: Cigna Medicaid	$6.39
Rate for Payer: Molina CHIP/Medicaid	$6.39
Rate for Payer: Parkland Medicaid	$6.39
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.39

INPATIENT APRDRG 6033: NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$7.97

Service Code	APR-DRG 6033
Hospital Charge Code	APRDRG 6033
Min. Negotiated Rate	$7.97
Max. Negotiated Rate	$7.97
Rate for Payer: Amerigroup CHIP/Medicaid	$7.97
Rate for Payer: Cigna Medicaid	$7.97
Rate for Payer: Molina CHIP/Medicaid	$7.97
Rate for Payer: Parkland Medicaid	$7.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7.97

INPATIENT APRDRG 6034: NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$20.90

Service Code	APR-DRG 6034
Hospital Charge Code	APRDRG 6034
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$20.90
Rate for Payer: Amerigroup CHIP/Medicaid	$20.90
Rate for Payer: Cigna Medicaid	$20.90
Rate for Payer: Molina CHIP/Medicaid	$20.90
Rate for Payer: Parkland Medicaid	$20.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$20.90

INPATIENT APRDRG 6071: NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$4.90

Service Code	APR-DRG 6071
Hospital Charge Code	APRDRG 6071
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$4.90
Rate for Payer: Amerigroup CHIP/Medicaid	$4.90
Rate for Payer: Cigna Medicaid	$4.90
Rate for Payer: Molina CHIP/Medicaid	$4.90
Rate for Payer: Parkland Medicaid	$4.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.90

INPATIENT APRDRG 6072: NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$5.98

Service Code	APR-DRG 6072
Hospital Charge Code	APRDRG 6072
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$5.98
Rate for Payer: Amerigroup CHIP/Medicaid	$5.98
Rate for Payer: Cigna Medicaid	$5.98
Rate for Payer: Molina CHIP/Medicaid	$5.98
Rate for Payer: Parkland Medicaid	$5.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.98

INPATIENT APRDRG 6073: NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$8.31

Service Code	APR-DRG 6073
Hospital Charge Code	APRDRG 6073
Min. Negotiated Rate	$8.31
Max. Negotiated Rate	$8.31
Rate for Payer: Amerigroup CHIP/Medicaid	$8.31
Rate for Payer: Cigna Medicaid	$8.31
Rate for Payer: Molina CHIP/Medicaid	$8.31
Rate for Payer: Parkland Medicaid	$8.31
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.31

INPATIENT APRDRG 6074: NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM

Facility

$13.12

Service Code	APR-DRG 6074
Hospital Charge Code	APRDRG 6074
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$13.12
Rate for Payer: Amerigroup CHIP/Medicaid	$13.12
Rate for Payer: Cigna Medicaid	$13.12
Rate for Payer: Molina CHIP/Medicaid	$13.12
Rate for Payer: Parkland Medicaid	$13.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.12

INPATIENT APRDRG 6081: NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$3.04

Service Code	APR-DRG 6081
Hospital Charge Code	APRDRG 6081
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$3.04
Rate for Payer: Amerigroup CHIP/Medicaid	$3.04
Rate for Payer: Cigna Medicaid	$3.04
Rate for Payer: Molina CHIP/Medicaid	$3.04
Rate for Payer: Parkland Medicaid	$3.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.04

INPATIENT APRDRG 6082: NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$4.84

Service Code	APR-DRG 6082
Hospital Charge Code	APRDRG 6082
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$4.84
Rate for Payer: Amerigroup CHIP/Medicaid	$4.84
Rate for Payer: Cigna Medicaid	$4.84
Rate for Payer: Molina CHIP/Medicaid	$4.84
Rate for Payer: Parkland Medicaid	$4.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.84

INPATIENT APRDRG 6083: NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$6.34

Service Code	APR-DRG 6083
Hospital Charge Code	APRDRG 6083
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$6.34
Rate for Payer: Amerigroup CHIP/Medicaid	$6.34
Rate for Payer: Cigna Medicaid	$6.34
Rate for Payer: Molina CHIP/Medicaid	$6.34
Rate for Payer: Parkland Medicaid	$6.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.34

Know your out-of-pocket cost for care.

All Charges