Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 41.00: NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY

Facility

$15,274.16

Service Code	APR-DRG 6211
Min. Negotiated Rate	$8,428.56
Max. Negotiated Rate	$15,274.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,428.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,553.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,274.16

APR-DRG 41.00: NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY

Facility

$118,209.85

Service Code	APR-DRG 6213
Min. Negotiated Rate	$65,230.34
Max. Negotiated Rate	$118,209.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$65,230.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$81,672.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$118,209.85

APR-DRG 41.00: NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY

Facility

$319,117.53

Service Code	APR-DRG 6214
Min. Negotiated Rate	$176,094.86
Max. Negotiated Rate	$319,117.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$176,094.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$220,481.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$319,117.53

APR-DRG 41.00: NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$42,566.34

Service Code	APR-DRG 6251
Min. Negotiated Rate	$23,488.88
Max. Negotiated Rate	$42,566.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$23,488.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$29,409.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,566.34

APR-DRG 41.00: NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$211,419.81

Service Code	APR-DRG 6254
Min. Negotiated Rate	$116,665.29
Max. Negotiated Rate	$211,419.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$116,665.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$146,071.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$211,419.81

APR-DRG 41.00: NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$54,801.09

Service Code	APR-DRG 6252
Min. Negotiated Rate	$30,240.24
Max. Negotiated Rate	$54,801.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$30,240.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$37,862.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$54,801.09

APR-DRG 41.00: NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$111,018.32

Service Code	APR-DRG 6253
Min. Negotiated Rate	$61,261.93
Max. Negotiated Rate	$111,018.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$61,261.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$76,703.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$111,018.32

APR-DRG 41.00: NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$89,718.31

Service Code	APR-DRG 6222
Min. Negotiated Rate	$49,508.19
Max. Negotiated Rate	$89,718.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$49,508.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$61,987.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$89,718.31

APR-DRG 41.00: NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$100,623.60

Service Code	APR-DRG 6223
Min. Negotiated Rate	$55,525.93
Max. Negotiated Rate	$100,623.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$55,525.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$69,521.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$100,623.60

APR-DRG 41.00: NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$59,752.80

Service Code	APR-DRG 6221
Min. Negotiated Rate	$32,972.68
Max. Negotiated Rate	$59,752.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$32,972.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$41,283.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$59,752.80

APR-DRG 41.00: NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$219,940.93

Service Code	APR-DRG 6224
Min. Negotiated Rate	$121,367.40
Max. Negotiated Rate	$219,940.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$121,367.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$151,959.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$219,940.93

APR-DRG 41.00: NEONATE BIRTH WEIGHT > 2499 GRAMS, NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM

Facility

$2,559.81

Service Code	APR-DRG 6401
Min. Negotiated Rate	$1,412.55
Max. Negotiated Rate	$2,559.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1,412.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$1,768.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$2,559.81

APR-DRG 41.00: NEONATE BIRTH WEIGHT > 2499 GRAMS, NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM

Facility

$6,093.97

Service Code	APR-DRG 6403
Min. Negotiated Rate	$3,362.76
Max. Negotiated Rate	$6,093.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$3,362.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$4,210.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$6,093.97

APR-DRG 41.00: NEONATE BIRTH WEIGHT > 2499 GRAMS, NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM

Facility

$3,388.30

Service Code	APR-DRG 6402
Min. Negotiated Rate	$1,869.73
Max. Negotiated Rate	$3,388.30
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1,869.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$2,341.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$3,388.30

APR-DRG 41.00: NEONATE BIRTH WEIGHT > 2499 GRAMS, NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM

Facility

$108,330.80

Service Code	APR-DRG 6404
Min. Negotiated Rate	$59,778.91
Max. Negotiated Rate	$108,330.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$59,778.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$74,846.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$108,330.80

APR-DRG 41.00: NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$161,255.41

Service Code	APR-DRG 6364
Min. Negotiated Rate	$88,983.67
Max. Negotiated Rate	$161,255.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$88,983.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$111,412.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$161,255.41

APR-DRG 41.00: NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$36,790.96

Service Code	APR-DRG 6362
Min. Negotiated Rate	$20,301.92
Max. Negotiated Rate	$36,790.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$20,301.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$25,419.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,790.96

APR-DRG 41.00: NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$21,083.26

Service Code	APR-DRG 6361
Min. Negotiated Rate	$11,634.13
Max. Negotiated Rate	$21,083.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,634.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,566.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,083.26

APR-DRG 41.00: NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$81,972.82

Service Code	APR-DRG 6363
Min. Negotiated Rate	$45,234.10
Max. Negotiated Rate	$81,972.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$45,234.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$56,635.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$81,972.82

APR-DRG 41.00: NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility

$79,872.71

Service Code	APR-DRG 6333
Min. Negotiated Rate	$44,075.21
Max. Negotiated Rate	$79,872.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$44,075.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$55,184.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$79,872.71

APR-DRG 41.00: NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility

$7,470.90

Service Code	APR-DRG 6331
Min. Negotiated Rate	$4,122.58
Max. Negotiated Rate	$7,470.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,122.58
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$5,161.71
Rate for Payer: Molina Healthcare of CA Medi-Cal	$7,470.90

APR-DRG 41.00: NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility

$300,302.72

Service Code	APR-DRG 6334
Min. Negotiated Rate	$165,712.50
Max. Negotiated Rate	$300,302.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$165,712.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$207,481.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$300,302.72

APR-DRG 41.00: NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility

$21,849.13

Service Code	APR-DRG 6332
Min. Negotiated Rate	$12,056.75
Max. Negotiated Rate	$21,849.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,056.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,095.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,849.13

APR-DRG 41.00: NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility

$199,672.11

Service Code	APR-DRG 6302
Min. Negotiated Rate	$110,182.70
Max. Negotiated Rate	$199,672.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$110,182.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$137,955.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$199,672.11

APR-DRG 41.00: NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility

$409,262.07

Service Code	APR-DRG 6303
Min. Negotiated Rate	$225,838.25
Max. Negotiated Rate	$409,262.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$225,838.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$282,762.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$409,262.07

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