White Rock Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 6332: NEONATE BIRTHWT >2499G W MAJOR ANOMALY

Facility

$1.37

Service Code	APR-DRG 6332
Hospital Charge Code	APRDRG 6332
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$1.37
Rate for Payer: Amerigroup CHIP/Medicaid	$1.37
Rate for Payer: Cigna Medicaid	$1.37
Rate for Payer: Molina CHIP/Medicaid	$1.37
Rate for Payer: Parkland Medicaid	$1.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.37

INPATIENT APRDRG 6333: NEONATE BIRTHWT >2499G W MAJOR ANOMALY

Facility

$3.73

Service Code	APR-DRG 6333
Hospital Charge Code	APRDRG 6333
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Amerigroup CHIP/Medicaid	$3.73
Rate for Payer: Cigna Medicaid	$3.73
Rate for Payer: Molina CHIP/Medicaid	$3.73
Rate for Payer: Parkland Medicaid	$3.73
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3.73

INPATIENT APRDRG 6334: NEONATE BIRTHWT >2499G W MAJOR ANOMALY

Facility

$13.42

Service Code	APR-DRG 6334
Hospital Charge Code	APRDRG 6334
Min. Negotiated Rate	$13.42
Max. Negotiated Rate	$13.42
Rate for Payer: Amerigroup CHIP/Medicaid	$13.42
Rate for Payer: Cigna Medicaid	$13.42
Rate for Payer: Molina CHIP/Medicaid	$13.42
Rate for Payer: Parkland Medicaid	$13.42
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13.42

INPATIENT APRDRG 6341: NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$0.97

Service Code	APR-DRG 6341
Hospital Charge Code	APRDRG 6341
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$0.97
Rate for Payer: Amerigroup CHIP/Medicaid	$0.97
Rate for Payer: Cigna Medicaid	$0.97
Rate for Payer: Molina CHIP/Medicaid	$0.97
Rate for Payer: Parkland Medicaid	$0.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.97

INPATIENT APRDRG 6342: NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$1.66

Service Code	APR-DRG 6342
Hospital Charge Code	APRDRG 6342
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$1.66
Rate for Payer: Amerigroup CHIP/Medicaid	$1.66
Rate for Payer: Cigna Medicaid	$1.66
Rate for Payer: Molina CHIP/Medicaid	$1.66
Rate for Payer: Parkland Medicaid	$1.66
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.66

INPATIENT APRDRG 6343: NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$2.31

Service Code	APR-DRG 6343
Hospital Charge Code	APRDRG 6343
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 6344: NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND

Facility

$6.82

Service Code	APR-DRG 6344
Hospital Charge Code	APRDRG 6344
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$6.82
Rate for Payer: Amerigroup CHIP/Medicaid	$6.82
Rate for Payer: Cigna Medicaid	$6.82
Rate for Payer: Molina CHIP/Medicaid	$6.82
Rate for Payer: Parkland Medicaid	$6.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6.82

INPATIENT APRDRG 6361: NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION

Facility

$0.74

Service Code	APR-DRG 6361
Hospital Charge Code	APRDRG 6361
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$0.74
Rate for Payer: Amerigroup CHIP/Medicaid	$0.74
Rate for Payer: Cigna Medicaid	$0.74
Rate for Payer: Molina CHIP/Medicaid	$0.74
Rate for Payer: Parkland Medicaid	$0.74
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.74

INPATIENT APRDRG 6362: NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION

Facility

$1.24

Service Code	APR-DRG 6362
Hospital Charge Code	APRDRG 6362
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.24
Rate for Payer: Amerigroup CHIP/Medicaid	$1.24
Rate for Payer: Cigna Medicaid	$1.24
Rate for Payer: Molina CHIP/Medicaid	$1.24
Rate for Payer: Parkland Medicaid	$1.24
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.24

INPATIENT APRDRG 6363: NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION

Facility

$2.35

Service Code	APR-DRG 6363
Hospital Charge Code	APRDRG 6363
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$2.35
Rate for Payer: Amerigroup CHIP/Medicaid	$2.35
Rate for Payer: Cigna Medicaid	$2.35
Rate for Payer: Molina CHIP/Medicaid	$2.35
Rate for Payer: Parkland Medicaid	$2.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.35

INPATIENT APRDRG 6364: NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION

Facility

$4.01

Service Code	APR-DRG 6364
Hospital Charge Code	APRDRG 6364
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$4.01
Rate for Payer: Amerigroup CHIP/Medicaid	$4.01
Rate for Payer: Cigna Medicaid	$4.01
Rate for Payer: Molina CHIP/Medicaid	$4.01
Rate for Payer: Parkland Medicaid	$4.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.01

INPATIENT APRDRG 6391: NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION

Facility

$0.72

Service Code	APR-DRG 6391
Hospital Charge Code	APRDRG 6391
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 6392: NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION

Facility

$1.48

Service Code	APR-DRG 6392
Hospital Charge Code	APRDRG 6392
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$1.48
Rate for Payer: Amerigroup CHIP/Medicaid	$1.48
Rate for Payer: Cigna Medicaid	$1.48
Rate for Payer: Molina CHIP/Medicaid	$1.48
Rate for Payer: Parkland Medicaid	$1.48
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.48

INPATIENT APRDRG 6393: NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION

Facility

$2.48

Service Code	APR-DRG 6393
Hospital Charge Code	APRDRG 6393
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$2.48
Rate for Payer: Amerigroup CHIP/Medicaid	$2.48
Rate for Payer: Cigna Medicaid	$2.48
Rate for Payer: Molina CHIP/Medicaid	$2.48
Rate for Payer: Parkland Medicaid	$2.48
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.48

INPATIENT APRDRG 6394: NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION

Facility

$4.70

Service Code	APR-DRG 6394
Hospital Charge Code	APRDRG 6394
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$4.70
Rate for Payer: Amerigroup CHIP/Medicaid	$4.70
Rate for Payer: Cigna Medicaid	$4.70
Rate for Payer: Molina CHIP/Medicaid	$4.70
Rate for Payer: Parkland Medicaid	$4.70
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4.70

INPATIENT APRDRG 6401: NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility

$0.10

Service Code	APR-DRG 6401
Hospital Charge Code	APRDRG 6401
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Amerigroup CHIP/Medicaid	$0.10
Rate for Payer: Cigna Medicaid	$0.10
Rate for Payer: Molina CHIP/Medicaid	$0.10
Rate for Payer: Parkland Medicaid	$0.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.10

INPATIENT APRDRG 6402: NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility

$0.17

Service Code	APR-DRG 6402
Hospital Charge Code	APRDRG 6402
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Amerigroup CHIP/Medicaid	$0.17
Rate for Payer: Cigna Medicaid	$0.17
Rate for Payer: Molina CHIP/Medicaid	$0.17
Rate for Payer: Parkland Medicaid	$0.17
Rate for Payer: Superior Health Plan CHIP/Medicaid	$0.17

INPATIENT APRDRG 6403: NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility

$0.45

Service Code	APR-DRG 6403
Hospital Charge Code	APRDRG 6403
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 6404: NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM

Facility

$4.84

Service Code	APR-DRG 6404
Hospital Charge Code	APRDRG 6404
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 6501: SPLENECTOMY

Facility

$1.65

Service Code	APR-DRG 6501
Hospital Charge Code	APRDRG 6501
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$1.65
Rate for Payer: Amerigroup CHIP/Medicaid	$1.65
Rate for Payer: Cigna Medicaid	$1.65
Rate for Payer: Molina CHIP/Medicaid	$1.65
Rate for Payer: Parkland Medicaid	$1.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.65

INPATIENT APRDRG 6502: SPLENECTOMY

Facility

$2.36

Service Code	APR-DRG 6502
Hospital Charge Code	APRDRG 6502
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$2.36
Rate for Payer: Amerigroup CHIP/Medicaid	$2.36
Rate for Payer: Cigna Medicaid	$2.36
Rate for Payer: Molina CHIP/Medicaid	$2.36
Rate for Payer: Parkland Medicaid	$2.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2.36

INPATIENT APRDRG 6503: SPLENECTOMY

Facility

$3.60

Service Code	APR-DRG 6503
Hospital Charge Code	APRDRG 6503
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 6504: SPLENECTOMY

Facility

$5.53

Service Code	APR-DRG 6504
Hospital Charge Code	APRDRG 6504
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$5.53
Rate for Payer: Amerigroup CHIP/Medicaid	$5.53
Rate for Payer: Cigna Medicaid	$5.53
Rate for Payer: Molina CHIP/Medicaid	$5.53
Rate for Payer: Parkland Medicaid	$5.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5.53

INPATIENT APRDRG 6511: OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS

Facility

$1.41

Service Code	APR-DRG 6511
Hospital Charge Code	APRDRG 6511
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.41
Rate for Payer: Amerigroup CHIP/Medicaid	$1.41
Rate for Payer: Cigna Medicaid	$1.41
Rate for Payer: Molina CHIP/Medicaid	$1.41
Rate for Payer: Parkland Medicaid	$1.41
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.41

INPATIENT APRDRG 6512: OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS

Facility

$1.94

Service Code	APR-DRG 6512
Hospital Charge Code	APRDRG 6512
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$1.94
Rate for Payer: Amerigroup CHIP/Medicaid	$1.94
Rate for Payer: Cigna Medicaid	$1.94
Rate for Payer: Molina CHIP/Medicaid	$1.94
Rate for Payer: Parkland Medicaid	$1.94
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1.94

Know your out-of-pocket cost for care.

All Charges