White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 6084: NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$16.00

Service Code	APR-DRG 6084
Hospital Charge Code	APRDRG 6084
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$16.00
Rate for Payer: Amerigroup CHIP/Medicaid	$16.00
Rate for Payer: Cigna Medicaid	$16.00
Rate for Payer: Molina CHIP/Medicaid	$16.00
Rate for Payer: Parkland Medicaid	$16.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16.00

INPATIENT APRDRG 6091: NEONATE BWT 1500-2499G W MAJOR PROCEDURE

Facility

$2.86

Service Code	APR-DRG 6091
Hospital Charge Code	APRDRG 6091
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$2.86
Rate for Payer: Amerigroup CHIP/Medicaid	$2.86
Rate for Payer: Cigna Medicaid	$2.86
Rate for Payer: Molina CHIP/Medicaid	$2.86
Rate for Payer: Parkland Medicaid	$2.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.86

INPATIENT APRDRG 6092: NEONATE BWT 1500-2499G W MAJOR PROCEDURE

Facility

$2.96

Service Code	APR-DRG 6092
Hospital Charge Code	APRDRG 6092
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 6093: NEONATE BWT 1500-2499G W MAJOR PROCEDURE

Facility

$11.40

Service Code	APR-DRG 6093
Hospital Charge Code	APRDRG 6093
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$11.40
Rate for Payer: Amerigroup CHIP/Medicaid	$11.40
Rate for Payer: Cigna Medicaid	$11.40
Rate for Payer: Molina CHIP/Medicaid	$11.40
Rate for Payer: Parkland Medicaid	$11.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11.40

INPATIENT APRDRG 6094: NEONATE BWT 1500-2499G W MAJOR PROCEDURE

Facility

$35.45

Service Code	APR-DRG 6094
Hospital Charge Code	APRDRG 6094
Min. Negotiated Rate	$35.45
Max. Negotiated Rate	$35.45
Rate for Payer: Amerigroup CHIP/Medicaid	$35.45
Rate for Payer: Cigna Medicaid	$35.45
Rate for Payer: Molina CHIP/Medicaid	$35.45
Rate for Payer: Parkland Medicaid	$35.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$35.45

INPATIENT APRDRG 6111: NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY

Facility

$2.47

Service Code	APR-DRG 6111
Hospital Charge Code	APRDRG 6111
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$2.47
Rate for Payer: Amerigroup CHIP/Medicaid	$2.47
Rate for Payer: Cigna Medicaid	$2.47
Rate for Payer: Molina CHIP/Medicaid	$2.47
Rate for Payer: Parkland Medicaid	$2.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.47

INPATIENT APRDRG 6112: NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY

Facility

$3.31

Service Code	APR-DRG 6112
Hospital Charge Code	APRDRG 6112
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$3.31
Rate for Payer: Amerigroup CHIP/Medicaid	$3.31
Rate for Payer: Cigna Medicaid	$3.31
Rate for Payer: Molina CHIP/Medicaid	$3.31
Rate for Payer: Parkland Medicaid	$3.31
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.31

INPATIENT APRDRG 6113: NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY

Facility

$5.65

Service Code	APR-DRG 6113
Hospital Charge Code	APRDRG 6113
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$5.65
Rate for Payer: Amerigroup CHIP/Medicaid	$5.65
Rate for Payer: Cigna Medicaid	$5.65
Rate for Payer: Molina CHIP/Medicaid	$5.65
Rate for Payer: Parkland Medicaid	$5.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.65

INPATIENT APRDRG 6114: NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY

Facility

$14.43

Service Code	APR-DRG 6114
Hospital Charge Code	APRDRG 6114
Min. Negotiated Rate	$14.43
Max. Negotiated Rate	$14.43
Rate for Payer: Amerigroup CHIP/Medicaid	$14.43
Rate for Payer: Cigna Medicaid	$14.43
Rate for Payer: Molina CHIP/Medicaid	$14.43
Rate for Payer: Parkland Medicaid	$14.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14.43

INPATIENT APRDRG 6121: NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$2.73

Service Code	APR-DRG 6121
Hospital Charge Code	APRDRG 6121
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 6122: NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$3.87

Service Code	APR-DRG 6122
Hospital Charge Code	APRDRG 6122
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$3.87
Rate for Payer: Amerigroup CHIP/Medicaid	$3.87
Rate for Payer: Cigna Medicaid	$3.87
Rate for Payer: Molina CHIP/Medicaid	$3.87
Rate for Payer: Parkland Medicaid	$3.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.87

INPATIENT APRDRG 6123: NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$5.40

Service Code	APR-DRG 6123
Hospital Charge Code	APRDRG 6123
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Amerigroup CHIP/Medicaid	$5.40
Rate for Payer: Cigna Medicaid	$5.40
Rate for Payer: Molina CHIP/Medicaid	$5.40
Rate for Payer: Parkland Medicaid	$5.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.40

INPATIENT APRDRG 6124: NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$9.24

Service Code	APR-DRG 6124
Hospital Charge Code	APRDRG 6124
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$9.24
Rate for Payer: Amerigroup CHIP/Medicaid	$9.24
Rate for Payer: Cigna Medicaid	$9.24
Rate for Payer: Molina CHIP/Medicaid	$9.24
Rate for Payer: Parkland Medicaid	$9.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.24

INPATIENT APRDRG 6131: NEONATE BIRTHWT 1500-1999G W CONGENITAL/PERINATAL INFECTION

Facility

$2.09

Service Code	APR-DRG 6131
Hospital Charge Code	APRDRG 6131
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 6132: NEONATE BIRTHWT 1500-1999G W CONGENITAL/PERINATAL INFECTION

Facility

$3.07

Service Code	APR-DRG 6132
Hospital Charge Code	APRDRG 6132
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$3.07
Rate for Payer: Amerigroup CHIP/Medicaid	$3.07
Rate for Payer: Cigna Medicaid	$3.07
Rate for Payer: Molina CHIP/Medicaid	$3.07
Rate for Payer: Parkland Medicaid	$3.07
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.07

INPATIENT APRDRG 6133: NEONATE BIRTHWT 1500-1999G W CONGENITAL/PERINATAL INFECTION

Facility

$5.22

Service Code	APR-DRG 6133
Hospital Charge Code	APRDRG 6133
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$5.22
Rate for Payer: Amerigroup CHIP/Medicaid	$5.22
Rate for Payer: Cigna Medicaid	$5.22
Rate for Payer: Molina CHIP/Medicaid	$5.22
Rate for Payer: Parkland Medicaid	$5.22
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.22

INPATIENT APRDRG 6134: NEONATE BIRTHWT 1500-1999G W CONGENITAL/PERINATAL INFECTION

Facility

$12.43

Service Code	APR-DRG 6134
Hospital Charge Code	APRDRG 6134
Min. Negotiated Rate	$12.43
Max. Negotiated Rate	$12.43
Rate for Payer: Amerigroup CHIP/Medicaid	$12.43
Rate for Payer: Cigna Medicaid	$12.43
Rate for Payer: Molina CHIP/Medicaid	$12.43
Rate for Payer: Parkland Medicaid	$12.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12.43

INPATIENT APRDRG 6141: NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$1.53

Service Code	APR-DRG 6141
Hospital Charge Code	APRDRG 6141
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 6142: NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$2.49

Service Code	APR-DRG 6142
Hospital Charge Code	APRDRG 6142
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$2.49
Rate for Payer: Amerigroup CHIP/Medicaid	$2.49
Rate for Payer: Cigna Medicaid	$2.49
Rate for Payer: Molina CHIP/Medicaid	$2.49
Rate for Payer: Parkland Medicaid	$2.49
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.49

INPATIENT APRDRG 6143: NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$4.71

Service Code	APR-DRG 6143
Hospital Charge Code	APRDRG 6143
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$4.71
Rate for Payer: Amerigroup CHIP/Medicaid	$4.71
Rate for Payer: Cigna Medicaid	$4.71
Rate for Payer: Molina CHIP/Medicaid	$4.71
Rate for Payer: Parkland Medicaid	$4.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.71

INPATIENT APRDRG 6144: NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$10.65

Service Code	APR-DRG 6144
Hospital Charge Code	APRDRG 6144
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Amerigroup CHIP/Medicaid	$10.65
Rate for Payer: Cigna Medicaid	$10.65
Rate for Payer: Molina CHIP/Medicaid	$10.65
Rate for Payer: Parkland Medicaid	$10.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10.65

INPATIENT APRDRG 6211: NEONATE BWT 2000-2499G W MAJOR ANOMALY

Facility

$1.09

Service Code	APR-DRG 6211
Hospital Charge Code	APRDRG 6211
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Amerigroup CHIP/Medicaid	$1.09
Rate for Payer: Cigna Medicaid	$1.09
Rate for Payer: Molina CHIP/Medicaid	$1.09
Rate for Payer: Parkland Medicaid	$1.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.09

INPATIENT APRDRG 6212: NEONATE BWT 2000-2499G W MAJOR ANOMALY

Facility

$2.31

Service Code	APR-DRG 6212
Hospital Charge Code	APRDRG 6212
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Amerigroup CHIP/Medicaid	$2.31
Rate for Payer: Cigna Medicaid	$2.31
Rate for Payer: Molina CHIP/Medicaid	$2.31
Rate for Payer: Parkland Medicaid	$2.31
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.31

INPATIENT APRDRG 6213: NEONATE BWT 2000-2499G W MAJOR ANOMALY

Facility

$5.28

Service Code	APR-DRG 6213
Hospital Charge Code	APRDRG 6213
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$5.28
Rate for Payer: Amerigroup CHIP/Medicaid	$5.28
Rate for Payer: Cigna Medicaid	$5.28
Rate for Payer: Molina CHIP/Medicaid	$5.28
Rate for Payer: Parkland Medicaid	$5.28
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.28

INPATIENT APRDRG 6214: NEONATE BWT 2000-2499G W MAJOR ANOMALY

Facility

$17.66

Service Code	APR-DRG 6214
Hospital Charge Code	APRDRG 6214
Min. Negotiated Rate	$17.66
Max. Negotiated Rate	$17.66
Rate for Payer: Amerigroup CHIP/Medicaid	$17.66
Rate for Payer: Cigna Medicaid	$17.66
Rate for Payer: Molina CHIP/Medicaid	$17.66
Rate for Payer: Parkland Medicaid	$17.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17.66

Know your out-of-pocket cost for care.

All Charges