White Rock Medical Center

All Charges

Charge

Type

Setting

Price

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY

Facility

$70,127.36

Service Code	APR-DRG 6024
Min. Negotiated Rate	$66,118.53
Max. Negotiated Rate	$70,127.36
Rate for Payer: Amerigroup CHIP/Medicaid	$66,118.53
Rate for Payer: Cigna Medicaid	$66,118.53
Rate for Payer: Molina CHIP/Medicaid	$66,118.53
Rate for Payer: Parkland Medicaid	$66,118.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$70,127.36

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY

Facility

$17,336.36

Service Code	APR-DRG 6021
Min. Negotiated Rate	$16,345.33
Max. Negotiated Rate	$17,336.36
Rate for Payer: Amerigroup CHIP/Medicaid	$16,345.33
Rate for Payer: Cigna Medicaid	$16,345.33
Rate for Payer: Molina CHIP/Medicaid	$16,345.33
Rate for Payer: Parkland Medicaid	$16,345.33
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17,336.36

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY

Facility

$34,243.86

Service Code	APR-DRG 6022
Min. Negotiated Rate	$32,286.31
Max. Negotiated Rate	$34,243.86
Rate for Payer: Amerigroup CHIP/Medicaid	$32,286.31
Rate for Payer: Cigna Medicaid	$32,286.31
Rate for Payer: Molina CHIP/Medicaid	$32,286.31
Rate for Payer: Parkland Medicaid	$32,286.31
Rate for Payer: Superior Health Plan CHIP/Medicaid	$34,243.86

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$23,913.03

Service Code	APR-DRG 6083
Min. Negotiated Rate	$22,546.04
Max. Negotiated Rate	$23,913.03
Rate for Payer: Amerigroup CHIP/Medicaid	$22,546.04
Rate for Payer: Cigna Medicaid	$22,546.04
Rate for Payer: Molina CHIP/Medicaid	$22,546.04
Rate for Payer: Parkland Medicaid	$22,546.04
Rate for Payer: Superior Health Plan CHIP/Medicaid	$23,913.03

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$18,257.83

Service Code	APR-DRG 6082
Min. Negotiated Rate	$17,214.12
Max. Negotiated Rate	$18,257.83
Rate for Payer: Amerigroup CHIP/Medicaid	$17,214.12
Rate for Payer: Cigna Medicaid	$17,214.12
Rate for Payer: Molina CHIP/Medicaid	$17,214.12
Rate for Payer: Parkland Medicaid	$17,214.12
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18,257.83

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$11,457.49

Service Code	APR-DRG 6081
Min. Negotiated Rate	$10,802.53
Max. Negotiated Rate	$11,457.49
Rate for Payer: Amerigroup CHIP/Medicaid	$10,802.53
Rate for Payer: Cigna Medicaid	$10,802.53
Rate for Payer: Molina CHIP/Medicaid	$10,802.53
Rate for Payer: Parkland Medicaid	$10,802.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,457.49

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$60,337.04

Service Code	APR-DRG 6084
Min. Negotiated Rate	$56,887.87
Max. Negotiated Rate	$60,337.04
Rate for Payer: Amerigroup CHIP/Medicaid	$56,887.87
Rate for Payer: Cigna Medicaid	$56,887.87
Rate for Payer: Molina CHIP/Medicaid	$56,887.87
Rate for Payer: Parkland Medicaid	$56,887.87
Rate for Payer: Superior Health Plan CHIP/Medicaid	$60,337.04

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY

Facility

$49,470.60

Service Code	APR-DRG 6074
Min. Negotiated Rate	$46,642.61
Max. Negotiated Rate	$49,470.60
Rate for Payer: Amerigroup CHIP/Medicaid	$46,642.61
Rate for Payer: Cigna Medicaid	$46,642.61
Rate for Payer: Molina CHIP/Medicaid	$46,642.61
Rate for Payer: Parkland Medicaid	$46,642.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$49,470.60

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY

Facility

$31,357.61

Service Code	APR-DRG 6073
Min. Negotiated Rate	$29,565.05
Max. Negotiated Rate	$31,357.61
Rate for Payer: Amerigroup CHIP/Medicaid	$29,565.05
Rate for Payer: Cigna Medicaid	$29,565.05
Rate for Payer: Molina CHIP/Medicaid	$29,565.05
Rate for Payer: Parkland Medicaid	$29,565.05
Rate for Payer: Superior Health Plan CHIP/Medicaid	$31,357.61

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY

Facility

$22,560.43

Service Code	APR-DRG 6072
Min. Negotiated Rate	$21,270.76
Max. Negotiated Rate	$22,560.43
Rate for Payer: Amerigroup CHIP/Medicaid	$21,270.76
Rate for Payer: Cigna Medicaid	$21,270.76
Rate for Payer: Molina CHIP/Medicaid	$21,270.76
Rate for Payer: Parkland Medicaid	$21,270.76
Rate for Payer: Superior Health Plan CHIP/Medicaid	$22,560.43

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY

Facility

$18,491.69

Service Code	APR-DRG 6071
Min. Negotiated Rate	$17,434.61
Max. Negotiated Rate	$18,491.69
Rate for Payer: Amerigroup CHIP/Medicaid	$17,434.61
Rate for Payer: Cigna Medicaid	$17,434.61
Rate for Payer: Molina CHIP/Medicaid	$17,434.61
Rate for Payer: Parkland Medicaid	$17,434.61
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18,491.69

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$11,572.91

Service Code	APR-DRG 6132
Min. Negotiated Rate	$10,911.35
Max. Negotiated Rate	$11,572.91
Rate for Payer: Amerigroup CHIP/Medicaid	$10,911.35
Rate for Payer: Cigna Medicaid	$10,911.35
Rate for Payer: Molina CHIP/Medicaid	$10,911.35
Rate for Payer: Parkland Medicaid	$10,911.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,572.91

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$7,873.44

Service Code	APR-DRG 6131
Min. Negotiated Rate	$7,423.36
Max. Negotiated Rate	$7,873.44
Rate for Payer: Amerigroup CHIP/Medicaid	$7,423.36
Rate for Payer: Cigna Medicaid	$7,423.36
Rate for Payer: Molina CHIP/Medicaid	$7,423.36
Rate for Payer: Parkland Medicaid	$7,423.36
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,873.44

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$46,884.22

Service Code	APR-DRG 6134
Min. Negotiated Rate	$44,204.08
Max. Negotiated Rate	$46,884.22
Rate for Payer: Amerigroup CHIP/Medicaid	$44,204.08
Rate for Payer: Cigna Medicaid	$44,204.08
Rate for Payer: Molina CHIP/Medicaid	$44,204.08
Rate for Payer: Parkland Medicaid	$44,204.08
Rate for Payer: Superior Health Plan CHIP/Medicaid	$46,884.22

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$19,682.10

Service Code	APR-DRG 6133
Min. Negotiated Rate	$18,556.97
Max. Negotiated Rate	$19,682.10
Rate for Payer: Amerigroup CHIP/Medicaid	$18,556.97
Rate for Payer: Cigna Medicaid	$18,556.97
Rate for Payer: Molina CHIP/Medicaid	$18,556.97
Rate for Payer: Parkland Medicaid	$18,556.97
Rate for Payer: Superior Health Plan CHIP/Medicaid	$19,682.10

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY

Facility

$54,421.58

Service Code	APR-DRG 6114
Min. Negotiated Rate	$51,310.57
Max. Negotiated Rate	$54,421.58
Rate for Payer: Amerigroup CHIP/Medicaid	$51,310.57
Rate for Payer: Cigna Medicaid	$51,310.57
Rate for Payer: Molina CHIP/Medicaid	$51,310.57
Rate for Payer: Parkland Medicaid	$51,310.57
Rate for Payer: Superior Health Plan CHIP/Medicaid	$54,421.58

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY

Facility

$12,477.41

Service Code	APR-DRG 6112
Min. Negotiated Rate	$11,764.14
Max. Negotiated Rate	$12,477.41
Rate for Payer: Amerigroup CHIP/Medicaid	$11,764.14
Rate for Payer: Cigna Medicaid	$11,764.14
Rate for Payer: Molina CHIP/Medicaid	$11,764.14
Rate for Payer: Parkland Medicaid	$11,764.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$12,477.41

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY

Facility

$21,314.57

Service Code	APR-DRG 6113
Min. Negotiated Rate	$20,096.13
Max. Negotiated Rate	$21,314.57
Rate for Payer: Amerigroup CHIP/Medicaid	$20,096.13
Rate for Payer: Cigna Medicaid	$20,096.13
Rate for Payer: Molina CHIP/Medicaid	$20,096.13
Rate for Payer: Parkland Medicaid	$20,096.13
Rate for Payer: Superior Health Plan CHIP/Medicaid	$21,314.57

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY

Facility

$9,333.54

Service Code	APR-DRG 6111
Min. Negotiated Rate	$8,799.99
Max. Negotiated Rate	$9,333.54
Rate for Payer: Amerigroup CHIP/Medicaid	$8,799.99
Rate for Payer: Cigna Medicaid	$8,799.99
Rate for Payer: Molina CHIP/Medicaid	$8,799.99
Rate for Payer: Parkland Medicaid	$8,799.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,333.54

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH OR WITHOUT OTHER SIGNIFICANT CONDITION

Facility

$17,773.52

Service Code	APR-DRG 6143
Min. Negotiated Rate	$16,757.50
Max. Negotiated Rate	$17,773.52
Rate for Payer: Amerigroup CHIP/Medicaid	$16,757.50
Rate for Payer: Cigna Medicaid	$16,757.50
Rate for Payer: Molina CHIP/Medicaid	$16,757.50
Rate for Payer: Parkland Medicaid	$16,757.50
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17,773.52

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH OR WITHOUT OTHER SIGNIFICANT CONDITION

Facility

$5,769.48

Service Code	APR-DRG 6141
Min. Negotiated Rate	$5,439.67
Max. Negotiated Rate	$5,769.48
Rate for Payer: Amerigroup CHIP/Medicaid	$5,439.67
Rate for Payer: Cigna Medicaid	$5,439.67
Rate for Payer: Molina CHIP/Medicaid	$5,439.67
Rate for Payer: Parkland Medicaid	$5,439.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,769.48

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH OR WITHOUT OTHER SIGNIFICANT CONDITION

Facility

$40,183.45

Service Code	APR-DRG 6144
Min. Negotiated Rate	$37,886.37
Max. Negotiated Rate	$40,183.45
Rate for Payer: Amerigroup CHIP/Medicaid	$37,886.37
Rate for Payer: Cigna Medicaid	$37,886.37
Rate for Payer: Molina CHIP/Medicaid	$37,886.37
Rate for Payer: Parkland Medicaid	$37,886.37
Rate for Payer: Superior Health Plan CHIP/Medicaid	$40,183.45

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH OR WITHOUT OTHER SIGNIFICANT CONDITION

Facility

$9,378.80

Service Code	APR-DRG 6142
Min. Negotiated Rate	$8,842.67
Max. Negotiated Rate	$9,378.80
Rate for Payer: Amerigroup CHIP/Medicaid	$8,842.67
Rate for Payer: Cigna Medicaid	$8,842.67
Rate for Payer: Molina CHIP/Medicaid	$8,842.67
Rate for Payer: Parkland Medicaid	$8,842.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,378.80

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$14,612.30

Service Code	APR-DRG 6122
Min. Negotiated Rate	$13,776.99
Max. Negotiated Rate	$14,612.30
Rate for Payer: Amerigroup CHIP/Medicaid	$13,776.99
Rate for Payer: Cigna Medicaid	$13,776.99
Rate for Payer: Molina CHIP/Medicaid	$13,776.99
Rate for Payer: Parkland Medicaid	$13,776.99
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14,612.30

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$34,869.99

Service Code	APR-DRG 6124
Min. Negotiated Rate	$32,876.65
Max. Negotiated Rate	$34,869.99
Rate for Payer: Amerigroup CHIP/Medicaid	$32,876.65
Rate for Payer: Cigna Medicaid	$32,876.65
Rate for Payer: Molina CHIP/Medicaid	$32,876.65
Rate for Payer: Parkland Medicaid	$32,876.65
Rate for Payer: Superior Health Plan CHIP/Medicaid	$34,869.99

Know your out-of-pocket cost for care.

All Charges