White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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

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

Facility

$20,379.90

Service Code	APR-DRG 6123
Min. Negotiated Rate	$19,214.88
Max. Negotiated Rate	$20,379.90
Rate for Payer: Amerigroup CHIP/Medicaid	$19,214.88
Rate for Payer: Cigna Medicaid	$19,214.88
Rate for Payer: Molina CHIP/Medicaid	$19,214.88
Rate for Payer: Parkland Medicaid	$19,214.88
Rate for Payer: Superior Health Plan CHIP/Medicaid	$20,379.90

NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE

Facility

$133,730.85

Service Code	APR-DRG 6094
Min. Negotiated Rate	$126,086.13
Max. Negotiated Rate	$133,730.85
Rate for Payer: Amerigroup CHIP/Medicaid	$126,086.13
Rate for Payer: Cigna Medicaid	$126,086.13
Rate for Payer: Molina CHIP/Medicaid	$126,086.13
Rate for Payer: Parkland Medicaid	$126,086.13
Rate for Payer: Superior Health Plan CHIP/Medicaid	$133,730.85

NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE

Facility

$10,791.00

Service Code	APR-DRG 6091
Min. Negotiated Rate	$10,174.13
Max. Negotiated Rate	$10,791.00
Rate for Payer: Amerigroup CHIP/Medicaid	$10,174.13
Rate for Payer: Cigna Medicaid	$10,174.13
Rate for Payer: Molina CHIP/Medicaid	$10,174.13
Rate for Payer: Parkland Medicaid	$10,174.13
Rate for Payer: Superior Health Plan CHIP/Medicaid	$10,791.00

NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE

Facility

$11,183.28

Service Code	APR-DRG 6092
Min. Negotiated Rate	$10,543.98
Max. Negotiated Rate	$11,183.28
Rate for Payer: Amerigroup CHIP/Medicaid	$10,543.98
Rate for Payer: Cigna Medicaid	$10,543.98
Rate for Payer: Molina CHIP/Medicaid	$10,543.98
Rate for Payer: Parkland Medicaid	$10,543.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,183.28

NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE

Facility

$43,017.65

Service Code	APR-DRG 6093
Min. Negotiated Rate	$40,558.55
Max. Negotiated Rate	$43,017.65
Rate for Payer: Amerigroup CHIP/Medicaid	$40,558.55
Rate for Payer: Cigna Medicaid	$40,558.55
Rate for Payer: Molina CHIP/Medicaid	$40,558.55
Rate for Payer: Parkland Medicaid	$40,558.55
Rate for Payer: Superior Health Plan CHIP/Medicaid	$43,017.65

NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE

Facility

$96,854.59

Service Code	APR-DRG 5882
Min. Negotiated Rate	$91,317.90
Max. Negotiated Rate	$96,854.59
Rate for Payer: Amerigroup CHIP/Medicaid	$91,317.90
Rate for Payer: Cigna Medicaid	$91,317.90
Rate for Payer: Molina CHIP/Medicaid	$91,317.90
Rate for Payer: Parkland Medicaid	$91,317.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$96,854.59

NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE

Facility

$91,295.58

Service Code	APR-DRG 5881
Min. Negotiated Rate	$86,076.67
Max. Negotiated Rate	$91,295.58
Rate for Payer: Amerigroup CHIP/Medicaid	$86,076.67
Rate for Payer: Cigna Medicaid	$86,076.67
Rate for Payer: Molina CHIP/Medicaid	$86,076.67
Rate for Payer: Parkland Medicaid	$86,076.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$91,295.58

NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE

Facility

$181,336.63

Service Code	APR-DRG 5884
Min. Negotiated Rate	$170,970.53
Max. Negotiated Rate	$181,336.63
Rate for Payer: Amerigroup CHIP/Medicaid	$170,970.53
Rate for Payer: Cigna Medicaid	$170,970.53
Rate for Payer: Molina CHIP/Medicaid	$170,970.53
Rate for Payer: Parkland Medicaid	$170,970.53
Rate for Payer: Superior Health Plan CHIP/Medicaid	$181,336.63

NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE

Facility

$97,299.30

Service Code	APR-DRG 5883
Min. Negotiated Rate	$91,737.19
Max. Negotiated Rate	$97,299.30
Rate for Payer: Amerigroup CHIP/Medicaid	$91,737.19
Rate for Payer: Cigna Medicaid	$91,737.19
Rate for Payer: Molina CHIP/Medicaid	$91,737.19
Rate for Payer: Parkland Medicaid	$91,737.19
Rate for Payer: Superior Health Plan CHIP/Medicaid	$97,299.30

NEONATE BIRTH WEIGHT 2000-2499 GRAMS, NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM

Facility

$1,167.40

Service Code	APR-DRG 6262
Min. Negotiated Rate	$1,100.67
Max. Negotiated Rate	$1,167.40
Rate for Payer: Amerigroup CHIP/Medicaid	$1,100.67
Rate for Payer: Cigna Medicaid	$1,100.67
Rate for Payer: Molina CHIP/Medicaid	$1,100.67
Rate for Payer: Parkland Medicaid	$1,100.67
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,167.40

NEONATE BIRTH WEIGHT 2000-2499 GRAMS, NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM

Facility

$16,239.50

Service Code	APR-DRG 6264
Min. Negotiated Rate	$15,311.16
Max. Negotiated Rate	$16,239.50
Rate for Payer: Amerigroup CHIP/Medicaid	$15,311.16
Rate for Payer: Cigna Medicaid	$15,311.16
Rate for Payer: Molina CHIP/Medicaid	$15,311.16
Rate for Payer: Parkland Medicaid	$15,311.16
Rate for Payer: Superior Health Plan CHIP/Medicaid	$16,239.50

NEONATE BIRTH WEIGHT 2000-2499 GRAMS, NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM

Facility

$856.60

Service Code	APR-DRG 6261
Min. Negotiated Rate	$807.63
Max. Negotiated Rate	$856.60
Rate for Payer: Amerigroup CHIP/Medicaid	$807.63
Rate for Payer: Cigna Medicaid	$807.63
Rate for Payer: Molina CHIP/Medicaid	$807.63
Rate for Payer: Parkland Medicaid	$807.63
Rate for Payer: Superior Health Plan CHIP/Medicaid	$856.60

NEONATE BIRTH WEIGHT 2000-2499 GRAMS, NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM

Facility

$3,048.44

Service Code	APR-DRG 6263
Min. Negotiated Rate	$2,874.18
Max. Negotiated Rate	$3,048.44
Rate for Payer: Amerigroup CHIP/Medicaid	$2,874.18
Rate for Payer: Cigna Medicaid	$2,874.18
Rate for Payer: Molina CHIP/Medicaid	$2,874.18
Rate for Payer: Parkland Medicaid	$2,874.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$3,048.44

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$7,966.61

Service Code	APR-DRG 6232
Min. Negotiated Rate	$7,511.20
Max. Negotiated Rate	$7,966.61
Rate for Payer: Amerigroup CHIP/Medicaid	$7,511.20
Rate for Payer: Cigna Medicaid	$7,511.20
Rate for Payer: Molina CHIP/Medicaid	$7,511.20
Rate for Payer: Parkland Medicaid	$7,511.20
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,966.61

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$14,471.61

Service Code	APR-DRG 6233
Min. Negotiated Rate	$13,644.34
Max. Negotiated Rate	$14,471.61
Rate for Payer: Amerigroup CHIP/Medicaid	$13,644.34
Rate for Payer: Cigna Medicaid	$13,644.34
Rate for Payer: Molina CHIP/Medicaid	$13,644.34
Rate for Payer: Parkland Medicaid	$13,644.34
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14,471.61

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$5,264.43

Service Code	APR-DRG 6231
Min. Negotiated Rate	$4,963.49
Max. Negotiated Rate	$5,264.43
Rate for Payer: Amerigroup CHIP/Medicaid	$4,963.49
Rate for Payer: Cigna Medicaid	$4,963.49
Rate for Payer: Molina CHIP/Medicaid	$4,963.49
Rate for Payer: Parkland Medicaid	$4,963.49
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,264.43

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$32,850.90

Service Code	APR-DRG 6234
Min. Negotiated Rate	$30,972.98
Max. Negotiated Rate	$32,850.90
Rate for Payer: Amerigroup CHIP/Medicaid	$30,972.98
Rate for Payer: Cigna Medicaid	$30,972.98
Rate for Payer: Molina CHIP/Medicaid	$30,972.98
Rate for Payer: Parkland Medicaid	$30,972.98
Rate for Payer: Superior Health Plan CHIP/Medicaid	$32,850.90

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY

Facility

$4,097.40

Service Code	APR-DRG 6211
Min. Negotiated Rate	$3,863.18
Max. Negotiated Rate	$4,097.40
Rate for Payer: Amerigroup CHIP/Medicaid	$3,863.18
Rate for Payer: Cigna Medicaid	$3,863.18
Rate for Payer: Molina CHIP/Medicaid	$3,863.18
Rate for Payer: Parkland Medicaid	$3,863.18
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,097.40

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY

Facility

$19,910.68

Service Code	APR-DRG 6213
Min. Negotiated Rate	$18,772.48
Max. Negotiated Rate	$19,910.68
Rate for Payer: Amerigroup CHIP/Medicaid	$18,772.48
Rate for Payer: Cigna Medicaid	$18,772.48
Rate for Payer: Molina CHIP/Medicaid	$18,772.48
Rate for Payer: Parkland Medicaid	$18,772.48
Rate for Payer: Superior Health Plan CHIP/Medicaid	$19,910.68

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY

Facility

$66,593.85

Service Code	APR-DRG 6214
Min. Negotiated Rate	$62,787.01
Max. Negotiated Rate	$66,593.85
Rate for Payer: Amerigroup CHIP/Medicaid	$62,787.01
Rate for Payer: Cigna Medicaid	$62,787.01
Rate for Payer: Molina CHIP/Medicaid	$62,787.01
Rate for Payer: Parkland Medicaid	$62,787.01
Rate for Payer: Superior Health Plan CHIP/Medicaid	$66,593.85

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY

Facility

$8,710.05

Service Code	APR-DRG 6212
Min. Negotiated Rate	$8,212.14
Max. Negotiated Rate	$8,710.05
Rate for Payer: Amerigroup CHIP/Medicaid	$8,212.14
Rate for Payer: Cigna Medicaid	$8,212.14
Rate for Payer: Molina CHIP/Medicaid	$8,212.14
Rate for Payer: Parkland Medicaid	$8,212.14
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,710.05

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$34,970.70

Service Code	APR-DRG 6254
Min. Negotiated Rate	$32,971.60
Max. Negotiated Rate	$34,970.70
Rate for Payer: Amerigroup CHIP/Medicaid	$32,971.60
Rate for Payer: Cigna Medicaid	$32,971.60
Rate for Payer: Molina CHIP/Medicaid	$32,971.60
Rate for Payer: Parkland Medicaid	$32,971.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$34,970.70

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$5,779.29

Service Code	APR-DRG 6251
Min. Negotiated Rate	$5,448.92
Max. Negotiated Rate	$5,779.29
Rate for Payer: Amerigroup CHIP/Medicaid	$5,448.92
Rate for Payer: Cigna Medicaid	$5,448.92
Rate for Payer: Molina CHIP/Medicaid	$5,448.92
Rate for Payer: Parkland Medicaid	$5,448.92
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,779.29

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$7,841.76

Service Code	APR-DRG 6252
Min. Negotiated Rate	$7,393.49
Max. Negotiated Rate	$7,841.76
Rate for Payer: Amerigroup CHIP/Medicaid	$7,393.49
Rate for Payer: Cigna Medicaid	$7,393.49
Rate for Payer: Molina CHIP/Medicaid	$7,393.49
Rate for Payer: Parkland Medicaid	$7,393.49
Rate for Payer: Superior Health Plan CHIP/Medicaid	$7,841.76

Know your out-of-pocket cost for care.

All Charges