Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility

$60,517.46

Service Code	APR-DRG 6333
Min. Negotiated Rate	$33,394.64
Max. Negotiated Rate	$60,517.46
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$33,394.64
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$41,812.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$60,517.46

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility

$112,095.97

Service Code	APR-DRG 6302
Min. Negotiated Rate	$61,856.59
Max. Negotiated Rate	$112,095.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$61,856.59
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$77,448.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$112,095.97

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility

$284,581.85

Service Code	APR-DRG 6303
Min. Negotiated Rate	$157,037.44
Max. Negotiated Rate	$284,581.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$157,037.44
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$196,620.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$284,581.85

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility

$63,724.26

Service Code	APR-DRG 6301
Min. Negotiated Rate	$35,164.21
Max. Negotiated Rate	$63,724.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$35,164.21
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$44,027.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$63,724.26

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility

$670,713.81

Service Code	APR-DRG 6304
Min. Negotiated Rate	$370,112.07
Max. Negotiated Rate	$670,713.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$370,112.07
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$463,402.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$670,713.81

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility

$789,321.20

Service Code	APR-DRG 6314
Min. Negotiated Rate	$435,561.79
Max. Negotiated Rate	$789,321.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$435,561.79
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$545,349.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$789,321.20

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility

$170,539.93

Service Code	APR-DRG 6313
Min. Negotiated Rate	$94,107.03
Max. Negotiated Rate	$170,539.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$94,107.03
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$117,827.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$170,539.93

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility

$12,160.33

Service Code	APR-DRG 6311
Min. Negotiated Rate	$6,710.29
Max. Negotiated Rate	$12,160.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,710.29
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$8,401.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,160.33

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility

$90,369.87

Service Code	APR-DRG 6312
Min. Negotiated Rate	$49,867.74
Max. Negotiated Rate	$90,369.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$49,867.74
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$62,437.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$90,369.87

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$12,932.89

Service Code	APR-DRG 6392
Min. Negotiated Rate	$7,136.61
Max. Negotiated Rate	$12,932.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,136.61
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$8,935.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,932.89

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$45,598.55

Service Code	APR-DRG 6393
Min. Negotiated Rate	$25,162.11
Max. Negotiated Rate	$45,598.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$25,162.11
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$31,504.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,598.55

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$7,269.95

Service Code	APR-DRG 6391
Min. Negotiated Rate	$4,011.69
Max. Negotiated Rate	$7,269.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,011.69
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$5,022.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$7,269.95

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$83,656.73

Service Code	APR-DRG 6394
Min. Negotiated Rate	$46,163.31
Max. Negotiated Rate	$83,656.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$46,163.31
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$57,799.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$83,656.73

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

Facility

$25,563.31

Service Code	APR-DRG 6342
Min. Negotiated Rate	$14,106.30
Max. Negotiated Rate	$25,563.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,106.30
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$17,661.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,563.31

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

Facility

$15,286.98

Service Code	APR-DRG 6341
Min. Negotiated Rate	$8,435.63
Max. Negotiated Rate	$15,286.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,435.63
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$10,561.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,286.98

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

Facility

$57,143.05

Service Code	APR-DRG 6343
Min. Negotiated Rate	$31,532.57
Max. Negotiated Rate	$57,143.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$31,532.57
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$39,480.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$57,143.05

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

Facility

$148,707.02

Service Code	APR-DRG 6344
Min. Negotiated Rate	$82,059.24
Max. Negotiated Rate	$148,707.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$82,059.24
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$102,743.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$148,707.02

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$436,161.58

Service Code	APR-DRG 5912
Min. Negotiated Rate	$240,681.89
Max. Negotiated Rate	$436,161.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$240,681.89
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$301,348.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$436,161.58

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$904,896.69

Service Code	APR-DRG 5914
Min. Negotiated Rate	$499,338.44
Max. Negotiated Rate	$904,896.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$499,338.44
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$625,201.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$904,896.69

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$11,376.86

Service Code	APR-DRG 5911
Min. Negotiated Rate	$6,277.96
Max. Negotiated Rate	$11,376.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,277.96
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$7,860.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,376.86

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$537,154.01

Service Code	APR-DRG 5913
Min. Negotiated Rate	$296,411.35
Max. Negotiated Rate	$537,154.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$296,411.35
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$371,124.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$537,154.01

NEONATE BIRTH WEIGHT < 500 GRAMS, OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS, OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION

Facility

$545,692.10

Service Code	APR-DRG 5893
Min. Negotiated Rate	$301,122.82
Max. Negotiated Rate	$545,692.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$301,122.82
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$377,023.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$545,692.10

NEONATE BIRTH WEIGHT < 500 GRAMS, OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS, OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION

Facility

$545,692.10

Service Code	APR-DRG 5892
Min. Negotiated Rate	$301,122.82
Max. Negotiated Rate	$545,692.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$301,122.82
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$377,023.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$545,692.10

NEONATE BIRTH WEIGHT < 500 GRAMS, OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS, OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION

Facility

$2,528.13

Service Code	APR-DRG 5894
Min. Negotiated Rate	$1,395.07
Max. Negotiated Rate	$2,528.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1,395.07
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$1,746.71
Rate for Payer: Molina Healthcare of CA Medi-Cal	$2,528.13

NEONATE BIRTH WEIGHT < 500 GRAMS, OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS, OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION

Facility

$545,692.10

Service Code	APR-DRG 5891
Min. Negotiated Rate	$301,122.82
Max. Negotiated Rate	$545,692.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$301,122.82
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$377,023.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$545,692.10

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