White Rock Medical Center

All Charges

Charge

Type

Setting

Price

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

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$6,549.13

Service Code	APR-DRG 6221
Min. Negotiated Rate	$6,174.75
Max. Negotiated Rate	$6,549.13
Rate for Payer: Amerigroup CHIP/Medicaid	$6,174.75
Rate for Payer: Cigna Medicaid	$6,174.75
Rate for Payer: Molina CHIP/Medicaid	$6,174.75
Rate for Payer: Parkland Medicaid	$6,174.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$6,549.13

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$11,359.05

Service Code	APR-DRG 6223
Min. Negotiated Rate	$10,709.71
Max. Negotiated Rate	$11,359.05
Rate for Payer: Amerigroup CHIP/Medicaid	$10,709.71
Rate for Payer: Cigna Medicaid	$10,709.71
Rate for Payer: Molina CHIP/Medicaid	$10,709.71
Rate for Payer: Parkland Medicaid	$10,709.71
Rate for Payer: Superior Health Plan CHIP/Medicaid	$11,359.05

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$9,226.80

Service Code	APR-DRG 6222
Min. Negotiated Rate	$8,699.35
Max. Negotiated Rate	$9,226.80
Rate for Payer: Amerigroup CHIP/Medicaid	$8,699.35
Rate for Payer: Cigna Medicaid	$8,699.35
Rate for Payer: Molina CHIP/Medicaid	$8,699.35
Rate for Payer: Parkland Medicaid	$8,699.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,226.80

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$17,071.20

Service Code	APR-DRG 6224
Min. Negotiated Rate	$16,095.32
Max. Negotiated Rate	$17,071.20
Rate for Payer: Amerigroup CHIP/Medicaid	$16,095.32
Rate for Payer: Cigna Medicaid	$16,095.32
Rate for Payer: Molina CHIP/Medicaid	$16,095.32
Rate for Payer: Parkland Medicaid	$16,095.32
Rate for Payer: Superior Health Plan CHIP/Medicaid	$17,071.20

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

Facility

$18,251.80

Service Code	APR-DRG 6404
Min. Negotiated Rate	$17,208.43
Max. Negotiated Rate	$18,251.80
Rate for Payer: Amerigroup CHIP/Medicaid	$17,208.43
Rate for Payer: Cigna Medicaid	$17,208.43
Rate for Payer: Molina CHIP/Medicaid	$17,208.43
Rate for Payer: Parkland Medicaid	$17,208.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$18,251.80

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

Facility

$635.56

Service Code	APR-DRG 6402
Min. Negotiated Rate	$599.23
Max. Negotiated Rate	$635.56
Rate for Payer: Amerigroup CHIP/Medicaid	$599.23
Rate for Payer: Cigna Medicaid	$599.23
Rate for Payer: Molina CHIP/Medicaid	$599.23
Rate for Payer: Parkland Medicaid	$599.23
Rate for Payer: Superior Health Plan CHIP/Medicaid	$635.56

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

Facility

$1,711.31

Service Code	APR-DRG 6403
Min. Negotiated Rate	$1,613.48
Max. Negotiated Rate	$1,711.31
Rate for Payer: Amerigroup CHIP/Medicaid	$1,613.48
Rate for Payer: Cigna Medicaid	$1,613.48
Rate for Payer: Molina CHIP/Medicaid	$1,613.48
Rate for Payer: Parkland Medicaid	$1,613.48
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,711.31

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

Facility

$373.79

Service Code	APR-DRG 6401
Min. Negotiated Rate	$352.43
Max. Negotiated Rate	$373.79
Rate for Payer: Amerigroup CHIP/Medicaid	$352.43
Rate for Payer: Cigna Medicaid	$352.43
Rate for Payer: Molina CHIP/Medicaid	$352.43
Rate for Payer: Parkland Medicaid	$352.43
Rate for Payer: Superior Health Plan CHIP/Medicaid	$373.79

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$15,126.03

Service Code	APR-DRG 6364
Min. Negotiated Rate	$14,261.35
Max. Negotiated Rate	$15,126.03
Rate for Payer: Amerigroup CHIP/Medicaid	$14,261.35
Rate for Payer: Cigna Medicaid	$14,261.35
Rate for Payer: Molina CHIP/Medicaid	$14,261.35
Rate for Payer: Parkland Medicaid	$14,261.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$15,126.03

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$4,683.56

Service Code	APR-DRG 6362
Min. Negotiated Rate	$4,415.82
Max. Negotiated Rate	$4,683.56
Rate for Payer: Amerigroup CHIP/Medicaid	$4,415.82
Rate for Payer: Cigna Medicaid	$4,415.82
Rate for Payer: Molina CHIP/Medicaid	$4,415.82
Rate for Payer: Parkland Medicaid	$4,415.82
Rate for Payer: Superior Health Plan CHIP/Medicaid	$4,683.56

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$2,788.94

Service Code	APR-DRG 6361
Min. Negotiated Rate	$2,629.51
Max. Negotiated Rate	$2,788.94
Rate for Payer: Amerigroup CHIP/Medicaid	$2,629.51
Rate for Payer: Cigna Medicaid	$2,629.51
Rate for Payer: Molina CHIP/Medicaid	$2,629.51
Rate for Payer: Parkland Medicaid	$2,629.51
Rate for Payer: Superior Health Plan CHIP/Medicaid	$2,788.94

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$8,845.84

Service Code	APR-DRG 6363
Min. Negotiated Rate	$8,340.16
Max. Negotiated Rate	$8,845.84
Rate for Payer: Amerigroup CHIP/Medicaid	$8,340.16
Rate for Payer: Cigna Medicaid	$8,340.16
Rate for Payer: Molina CHIP/Medicaid	$8,340.16
Rate for Payer: Parkland Medicaid	$8,340.16
Rate for Payer: Superior Health Plan CHIP/Medicaid	$8,845.84

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility

$50,608.96

Service Code	APR-DRG 6334
Min. Negotiated Rate	$47,715.90
Max. Negotiated Rate	$50,608.96
Rate for Payer: Amerigroup CHIP/Medicaid	$47,715.90
Rate for Payer: Cigna Medicaid	$47,715.90
Rate for Payer: Molina CHIP/Medicaid	$47,715.90
Rate for Payer: Parkland Medicaid	$47,715.90
Rate for Payer: Superior Health Plan CHIP/Medicaid	$50,608.96

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility

$1,322.05

Service Code	APR-DRG 6331
Min. Negotiated Rate	$1,246.47
Max. Negotiated Rate	$1,322.05
Rate for Payer: Amerigroup CHIP/Medicaid	$1,246.47
Rate for Payer: Cigna Medicaid	$1,246.47
Rate for Payer: Molina CHIP/Medicaid	$1,246.47
Rate for Payer: Parkland Medicaid	$1,246.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$1,322.05

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility

$5,154.66

Service Code	APR-DRG 6332
Min. Negotiated Rate	$4,860.00
Max. Negotiated Rate	$5,154.66
Rate for Payer: Amerigroup CHIP/Medicaid	$4,860.00
Rate for Payer: Cigna Medicaid	$4,860.00
Rate for Payer: Molina CHIP/Medicaid	$4,860.00
Rate for Payer: Parkland Medicaid	$4,860.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$5,154.66

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility

$14,082.73

Service Code	APR-DRG 6333
Min. Negotiated Rate	$13,277.69
Max. Negotiated Rate	$14,082.73
Rate for Payer: Amerigroup CHIP/Medicaid	$13,277.69
Rate for Payer: Cigna Medicaid	$13,277.69
Rate for Payer: Molina CHIP/Medicaid	$13,277.69
Rate for Payer: Parkland Medicaid	$13,277.69
Rate for Payer: Superior Health Plan CHIP/Medicaid	$14,082.73

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility

$13,363.81

Service Code	APR-DRG 6301
Min. Negotiated Rate	$12,599.86
Max. Negotiated Rate	$13,363.81
Rate for Payer: Amerigroup CHIP/Medicaid	$12,599.86
Rate for Payer: Cigna Medicaid	$12,599.86
Rate for Payer: Molina CHIP/Medicaid	$12,599.86
Rate for Payer: Parkland Medicaid	$12,599.86
Rate for Payer: Superior Health Plan CHIP/Medicaid	$13,363.81

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility

$22,954.97

Service Code	APR-DRG 6302
Min. Negotiated Rate	$21,642.75
Max. Negotiated Rate	$22,954.97
Rate for Payer: Amerigroup CHIP/Medicaid	$21,642.75
Rate for Payer: Cigna Medicaid	$21,642.75
Rate for Payer: Molina CHIP/Medicaid	$21,642.75
Rate for Payer: Parkland Medicaid	$21,642.75
Rate for Payer: Superior Health Plan CHIP/Medicaid	$22,954.97

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility

$134,926.54

Service Code	APR-DRG 6304
Min. Negotiated Rate	$127,213.47
Max. Negotiated Rate	$134,926.54
Rate for Payer: Amerigroup CHIP/Medicaid	$127,213.47
Rate for Payer: Cigna Medicaid	$127,213.47
Rate for Payer: Molina CHIP/Medicaid	$127,213.47
Rate for Payer: Parkland Medicaid	$127,213.47
Rate for Payer: Superior Health Plan CHIP/Medicaid	$134,926.54

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility

$63,593.31

Service Code	APR-DRG 6303
Min. Negotiated Rate	$59,958.00
Max. Negotiated Rate	$63,593.31
Rate for Payer: Amerigroup CHIP/Medicaid	$59,958.00
Rate for Payer: Cigna Medicaid	$59,958.00
Rate for Payer: Molina CHIP/Medicaid	$59,958.00
Rate for Payer: Parkland Medicaid	$59,958.00
Rate for Payer: Superior Health Plan CHIP/Medicaid	$63,593.31

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility

$35,255.48

Service Code	APR-DRG 6313
Min. Negotiated Rate	$33,240.10
Max. Negotiated Rate	$35,255.48
Rate for Payer: Amerigroup CHIP/Medicaid	$33,240.10
Rate for Payer: Cigna Medicaid	$33,240.10
Rate for Payer: Molina CHIP/Medicaid	$33,240.10
Rate for Payer: Parkland Medicaid	$33,240.10
Rate for Payer: Superior Health Plan CHIP/Medicaid	$35,255.48

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility

$19,000.52

Service Code	APR-DRG 6312
Min. Negotiated Rate	$17,914.35
Max. Negotiated Rate	$19,000.52
Rate for Payer: Amerigroup CHIP/Medicaid	$17,914.35
Rate for Payer: Cigna Medicaid	$17,914.35
Rate for Payer: Molina CHIP/Medicaid	$17,914.35
Rate for Payer: Parkland Medicaid	$17,914.35
Rate for Payer: Superior Health Plan CHIP/Medicaid	$19,000.52

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility

$95,228.15

Service Code	APR-DRG 6314
Min. Negotiated Rate	$89,784.44
Max. Negotiated Rate	$95,228.15
Rate for Payer: Amerigroup CHIP/Medicaid	$89,784.44
Rate for Payer: Cigna Medicaid	$89,784.44
Rate for Payer: Molina CHIP/Medicaid	$89,784.44
Rate for Payer: Parkland Medicaid	$89,784.44
Rate for Payer: Superior Health Plan CHIP/Medicaid	$95,228.15

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility

$9,270.55

Service Code	APR-DRG 6311
Min. Negotiated Rate	$8,740.60
Max. Negotiated Rate	$9,270.55
Rate for Payer: Amerigroup CHIP/Medicaid	$8,740.60
Rate for Payer: Cigna Medicaid	$8,740.60
Rate for Payer: Molina CHIP/Medicaid	$8,740.60
Rate for Payer: Parkland Medicaid	$8,740.60
Rate for Payer: Superior Health Plan CHIP/Medicaid	$9,270.55

Know your out-of-pocket cost for care.

All Charges