Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$992,962.80

Service Code	APR-DRG 6304
Min. Negotiated Rate	$547,934.92
Max. Negotiated Rate	$992,962.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$547,934.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$686,047.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$992,962.80

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 OTHER MAJOR PROCEDURE

Facility

$233,072.02

Service Code	APR-DRG 6313
Min. Negotiated Rate	$128,613.38
Max. Negotiated Rate	$233,072.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$128,613.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$161,031.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$233,072.02

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

Facility

$934,055.70

Service Code	APR-DRG 6314
Min. Negotiated Rate	$515,428.92
Max. Negotiated Rate	$934,055.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$515,428.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$645,347.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$934,055.70

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

Facility

$17,576.62

Service Code	APR-DRG 6311
Min. Negotiated Rate	$9,699.10
Max. Negotiated Rate	$17,576.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,699.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,143.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,576.62

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

Facility

$135,988.79

Service Code	APR-DRG 6312
Min. Negotiated Rate	$75,041.09
Max. Negotiated Rate	$135,988.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$75,041.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$93,955.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$135,988.79

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

Facility

$19,479.27

Service Code	APR-DRG 6392
Min. Negotiated Rate	$10,749.01
Max. Negotiated Rate	$19,479.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,749.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$13,458.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,479.27

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

Facility

$140,528.71

Service Code	APR-DRG 6394
Min. Negotiated Rate	$77,546.30
Max. Negotiated Rate	$140,528.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$77,546.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$97,092.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$140,528.71

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

Facility

$64,092.76

Service Code	APR-DRG 6393
Min. Negotiated Rate	$35,367.55
Max. Negotiated Rate	$64,092.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$35,367.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$44,282.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$64,092.76

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

Facility

$13,188.48

Service Code	APR-DRG 6391
Min. Negotiated Rate	$7,277.64
Max. Negotiated Rate	$13,188.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,277.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,112.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,188.48

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

Facility

$48,510.30

Service Code	APR-DRG 6342
Min. Negotiated Rate	$26,768.87
Max. Negotiated Rate	$48,510.30
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$26,768.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$33,516.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$48,510.30

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

Facility

$50,726.06

Service Code	APR-DRG 6343
Min. Negotiated Rate	$27,991.56
Max. Negotiated Rate	$50,726.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$27,991.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$35,047.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$50,726.06

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

Facility

$194,789.07

Service Code	APR-DRG 6344
Min. Negotiated Rate	$107,488.15
Max. Negotiated Rate	$194,789.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$107,488.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$134,581.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$194,789.07

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

Facility

$22,754.71

Service Code	APR-DRG 6341
Min. Negotiated Rate	$12,556.46
Max. Negotiated Rate	$22,754.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,556.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,721.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,754.71

APR-DRG 41.00: NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$4,205.08

Service Code	APR-DRG 5911
Min. Negotiated Rate	$2,320.44
Max. Negotiated Rate	$4,205.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$2,320.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$2,905.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$4,205.08

APR-DRG 41.00: NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$950,794.05

Service Code	APR-DRG 5914
Min. Negotiated Rate	$524,665.44
Max. Negotiated Rate	$950,794.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$524,665.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$656,912.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$950,794.05

APR-DRG 41.00: NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$473,629.39

Service Code	APR-DRG 5913
Min. Negotiated Rate	$261,357.31
Max. Negotiated Rate	$473,629.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$261,357.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$327,234.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$473,629.39

APR-DRG 41.00: NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$279,968.67

Service Code	APR-DRG 5912
Min. Negotiated Rate	$154,491.80
Max. Negotiated Rate	$279,968.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$154,491.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$193,432.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$279,968.67

APR-DRG 41.00: 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

$192,610.63

Service Code	APR-DRG 5892
Min. Negotiated Rate	$106,286.05
Max. Negotiated Rate	$192,610.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$106,286.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$133,076.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$192,610.63

APR-DRG 41.00: 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

$161,749.20

Service Code	APR-DRG 5893
Min. Negotiated Rate	$89,256.15
Max. Negotiated Rate	$161,749.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$89,256.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$111,753.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$161,749.20

APR-DRG 41.00: 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

$264,472.95

Service Code	APR-DRG 5891
Min. Negotiated Rate	$145,940.98
Max. Negotiated Rate	$264,472.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$145,940.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$182,726.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$264,472.95

APR-DRG 41.00: 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

$3,836.39

Service Code	APR-DRG 5894
Min. Negotiated Rate	$2,116.99
Max. Negotiated Rate	$3,836.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$2,116.99
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$2,650.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$3,836.39

APR-DRG 41.00: NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$960,372.38

Service Code	APR-DRG 5934
Min. Negotiated Rate	$529,950.94
Max. Negotiated Rate	$960,372.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$529,950.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$663,530.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$960,372.38

APR-DRG 41.00: NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$7,437.18

Service Code	APR-DRG 5931
Min. Negotiated Rate	$4,103.97
Max. Negotiated Rate	$7,437.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,103.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$5,138.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$7,437.18

APR-DRG 41.00: NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$382,687.61

Service Code	APR-DRG 5932
Min. Negotiated Rate	$211,173.98
Max. Negotiated Rate	$382,687.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$211,173.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$264,402.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$382,687.61

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