White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 6221: NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$1.74

Service Code	APR-DRG 6221
Hospital Charge Code	APRDRG 6221
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$1.74
Rate for Payer: Amerigroup CHIP/Medicaid	$1.74
Rate for Payer: Cigna Medicaid	$1.74
Rate for Payer: Molina CHIP/Medicaid	$1.74
Rate for Payer: Parkland Medicaid	$1.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.74

INPATIENT APRDRG 6222: NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$2.45

Service Code	APR-DRG 6222
Hospital Charge Code	APRDRG 6222
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$2.45
Rate for Payer: Amerigroup CHIP/Medicaid	$2.45
Rate for Payer: Cigna Medicaid	$2.45
Rate for Payer: Molina CHIP/Medicaid	$2.45
Rate for Payer: Parkland Medicaid	$2.45
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.45

INPATIENT APRDRG 6223: NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$3.01

Service Code	APR-DRG 6223
Hospital Charge Code	APRDRG 6223
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$3.01
Rate for Payer: Amerigroup CHIP/Medicaid	$3.01
Rate for Payer: Cigna Medicaid	$3.01
Rate for Payer: Molina CHIP/Medicaid	$3.01
Rate for Payer: Parkland Medicaid	$3.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.01

INPATIENT APRDRG 6224: NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$4.53

Service Code	APR-DRG 6224
Hospital Charge Code	APRDRG 6224
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$4.53
Rate for Payer: Amerigroup CHIP/Medicaid	$4.53
Rate for Payer: Cigna Medicaid	$4.53
Rate for Payer: Molina CHIP/Medicaid	$4.53
Rate for Payer: Parkland Medicaid	$4.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.53

INPATIENT APRDRG 6231: NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION

Facility

$1.40

Service Code	APR-DRG 6231
Hospital Charge Code	APRDRG 6231
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$1.40
Rate for Payer: Amerigroup CHIP/Medicaid	$1.40
Rate for Payer: Cigna Medicaid	$1.40
Rate for Payer: Molina CHIP/Medicaid	$1.40
Rate for Payer: Parkland Medicaid	$1.40
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.40

INPATIENT APRDRG 6232: NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION

Facility

$2.11

Service Code	APR-DRG 6232
Hospital Charge Code	APRDRG 6232
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$2.11
Rate for Payer: Amerigroup CHIP/Medicaid	$2.11
Rate for Payer: Cigna Medicaid	$2.11
Rate for Payer: Molina CHIP/Medicaid	$2.11
Rate for Payer: Parkland Medicaid	$2.11
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.11

INPATIENT APRDRG 6233: NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION

Facility

$3.84

Service Code	APR-DRG 6233
Hospital Charge Code	APRDRG 6233
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$3.84
Rate for Payer: Amerigroup CHIP/Medicaid	$3.84
Rate for Payer: Cigna Medicaid	$3.84
Rate for Payer: Molina CHIP/Medicaid	$3.84
Rate for Payer: Parkland Medicaid	$3.84
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.84

INPATIENT APRDRG 6234: NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION

Facility

$8.71

Service Code	APR-DRG 6234
Hospital Charge Code	APRDRG 6234
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$8.71
Rate for Payer: Amerigroup CHIP/Medicaid	$8.71
Rate for Payer: Cigna Medicaid	$8.71
Rate for Payer: Molina CHIP/Medicaid	$8.71
Rate for Payer: Parkland Medicaid	$8.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8.71

INPATIENT APRDRG 6251: NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION

Facility

$1.53

Service Code	APR-DRG 6251
Hospital Charge Code	APRDRG 6251
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 6252: NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION

Facility

$2.08

Service Code	APR-DRG 6252
Hospital Charge Code	APRDRG 6252
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$2.08
Rate for Payer: Amerigroup CHIP/Medicaid	$2.08
Rate for Payer: Cigna Medicaid	$2.08
Rate for Payer: Molina CHIP/Medicaid	$2.08
Rate for Payer: Parkland Medicaid	$2.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.08

INPATIENT APRDRG 6253: NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION

Facility

$3.44

Service Code	APR-DRG 6253
Hospital Charge Code	APRDRG 6253
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$3.44
Rate for Payer: Amerigroup CHIP/Medicaid	$3.44
Rate for Payer: Cigna Medicaid	$3.44
Rate for Payer: Molina CHIP/Medicaid	$3.44
Rate for Payer: Parkland Medicaid	$3.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.44

INPATIENT APRDRG 6254: NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION

Facility

$9.27

Service Code	APR-DRG 6254
Hospital Charge Code	APRDRG 6254
Min. Negotiated Rate	$9.27
Max. Negotiated Rate	$9.27
Rate for Payer: Amerigroup CHIP/Medicaid	$9.27
Rate for Payer: Cigna Medicaid	$9.27
Rate for Payer: Molina CHIP/Medicaid	$9.27
Rate for Payer: Parkland Medicaid	$9.27
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.27

INPATIENT APRDRG 6261: NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility

$0.23

Service Code	APR-DRG 6261
Hospital Charge Code	APRDRG 6261
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.23
Rate for Payer: Amerigroup CHIP/Medicaid	$0.23
Rate for Payer: Cigna Medicaid	$0.23
Rate for Payer: Molina CHIP/Medicaid	$0.23
Rate for Payer: Parkland Medicaid	$0.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.23

INPATIENT APRDRG 6262: NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility

$0.31

Service Code	APR-DRG 6262
Hospital Charge Code	APRDRG 6262
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: Amerigroup CHIP/Medicaid	$0.31
Rate for Payer: Cigna Medicaid	$0.31
Rate for Payer: Molina CHIP/Medicaid	$0.31
Rate for Payer: Parkland Medicaid	$0.31
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.31

INPATIENT APRDRG 6263: NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility

$0.81

Service Code	APR-DRG 6263
Hospital Charge Code	APRDRG 6263
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Amerigroup CHIP/Medicaid	$0.81
Rate for Payer: Cigna Medicaid	$0.81
Rate for Payer: Molina CHIP/Medicaid	$0.81
Rate for Payer: Parkland Medicaid	$0.81
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.81

INPATIENT APRDRG 6264: NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility

$4.31

Service Code	APR-DRG 6264
Hospital Charge Code	APRDRG 6264
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$4.31
Rate for Payer: Amerigroup CHIP/Medicaid	$4.31
Rate for Payer: Cigna Medicaid	$4.31
Rate for Payer: Molina CHIP/Medicaid	$4.31
Rate for Payer: Parkland Medicaid	$4.31
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.31

INPATIENT APRDRG 6301: NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE

Facility

$3.54

Service Code	APR-DRG 6301
Hospital Charge Code	APRDRG 6301
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 6302: NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE

Facility

$6.09

Service Code	APR-DRG 6302
Hospital Charge Code	APRDRG 6302
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$6.09
Rate for Payer: Amerigroup CHIP/Medicaid	$6.09
Rate for Payer: Cigna Medicaid	$6.09
Rate for Payer: Molina CHIP/Medicaid	$6.09
Rate for Payer: Parkland Medicaid	$6.09
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.09

INPATIENT APRDRG 6303: NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE

Facility

$16.86

Service Code	APR-DRG 6303
Hospital Charge Code	APRDRG 6303
Min. Negotiated Rate	$16.86
Max. Negotiated Rate	$16.86
Rate for Payer: Amerigroup CHIP/Medicaid	$16.86
Rate for Payer: Cigna Medicaid	$16.86
Rate for Payer: Molina CHIP/Medicaid	$16.86
Rate for Payer: Parkland Medicaid	$16.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16.86

INPATIENT APRDRG 6304: NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE

Facility

$35.77

Service Code	APR-DRG 6304
Hospital Charge Code	APRDRG 6304
Min. Negotiated Rate	$35.77
Max. Negotiated Rate	$35.77
Rate for Payer: Amerigroup CHIP/Medicaid	$35.77
Rate for Payer: Cigna Medicaid	$35.77
Rate for Payer: Molina CHIP/Medicaid	$35.77
Rate for Payer: Parkland Medicaid	$35.77
Rate for Payer: Superior Health Plan CHIP/Medicaid	$35.77

INPATIENT APRDRG 6311: NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE

Facility

$2.46

Service Code	APR-DRG 6311
Hospital Charge Code	APRDRG 6311
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 6312: NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE

Facility

$5.04

Service Code	APR-DRG 6312
Hospital Charge Code	APRDRG 6312
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$5.04
Rate for Payer: Amerigroup CHIP/Medicaid	$5.04
Rate for Payer: Cigna Medicaid	$5.04
Rate for Payer: Molina CHIP/Medicaid	$5.04
Rate for Payer: Parkland Medicaid	$5.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.04

INPATIENT APRDRG 6313: NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE

Facility

$9.35

Service Code	APR-DRG 6313
Hospital Charge Code	APRDRG 6313
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$9.35
Rate for Payer: Amerigroup CHIP/Medicaid	$9.35
Rate for Payer: Cigna Medicaid	$9.35
Rate for Payer: Molina CHIP/Medicaid	$9.35
Rate for Payer: Parkland Medicaid	$9.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9.35

INPATIENT APRDRG 6314: NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE

Facility

$25.25

Service Code	APR-DRG 6314
Hospital Charge Code	APRDRG 6314
Min. Negotiated Rate	$25.25
Max. Negotiated Rate	$25.25
Rate for Payer: Amerigroup CHIP/Medicaid	$25.25
Rate for Payer: Cigna Medicaid	$25.25
Rate for Payer: Molina CHIP/Medicaid	$25.25
Rate for Payer: Parkland Medicaid	$25.25
Rate for Payer: Superior Health Plan CHIP/Medicaid	$25.25

INPATIENT APRDRG 6331: NEONATE BIRTHWT >2499G W MAJOR ANOMALY

Facility

$0.35

Service Code	APR-DRG 6331
Hospital Charge Code	APRDRG 6331
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.35
Rate for Payer: Amerigroup CHIP/Medicaid	$0.35
Rate for Payer: Cigna Medicaid	$0.35
Rate for Payer: Molina CHIP/Medicaid	$0.35
Rate for Payer: Parkland Medicaid	$0.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.35

Know your out-of-pocket cost for care.

All Charges