Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

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

APR-DRG 41.00: NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$6,574.98

Service Code	APR-DRG 5812
Min. Negotiated Rate	$3,628.19
Max. Negotiated Rate	$6,574.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$3,628.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$4,542.71
Rate for Payer: Molina Healthcare of CA Medi-Cal	$6,574.98

APR-DRG 41.00: NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$4,378.49

Service Code	APR-DRG 5811
Min. Negotiated Rate	$2,416.13
Max. Negotiated Rate	$4,378.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$2,416.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$3,025.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$4,378.49

APR-DRG 41.00: NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$9,922.66

Service Code	APR-DRG 5813
Min. Negotiated Rate	$5,475.50
Max. Negotiated Rate	$9,922.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,475.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$6,855.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,922.66

APR-DRG 41.00: NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$21,828.24

Service Code	APR-DRG 5814
Min. Negotiated Rate	$12,045.22
Max. Negotiated Rate	$21,828.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,045.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,081.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,828.24

APR-DRG 41.00: NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$12,509.31

Service Code	APR-DRG 5801
Min. Negotiated Rate	$6,902.86
Max. Negotiated Rate	$12,509.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,902.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,642.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,509.31

APR-DRG 41.00: NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$25,273.90

Service Code	APR-DRG 5803
Min. Negotiated Rate	$13,946.60
Max. Negotiated Rate	$25,273.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,946.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,461.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,273.90

APR-DRG 41.00: NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$58,166.40

Service Code	APR-DRG 5804
Min. Negotiated Rate	$32,097.28
Max. Negotiated Rate	$58,166.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$32,097.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$40,187.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$58,166.40

APR-DRG 41.00: NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$17,321.31

Service Code	APR-DRG 5802
Min. Negotiated Rate	$9,558.22
Max. Negotiated Rate	$17,321.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,558.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,967.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,321.31

APR-DRG 41.00: NEONATE WITH ECMO

Facility

$814,420.20

Service Code	APR-DRG 5832
Min. Negotiated Rate	$449,411.87
Max. Negotiated Rate	$814,420.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$449,411.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$562,690.32
Rate for Payer: Molina Healthcare of CA Medi-Cal	$814,420.20

APR-DRG 41.00: NEONATE WITH ECMO

Facility

$1,958,633.96

Service Code	APR-DRG 5834
Min. Negotiated Rate	$1,080,809.83
Max. Negotiated Rate	$1,958,633.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1,080,809.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$1,353,238.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$1,958,633.96

APR-DRG 41.00: NEONATE WITH ECMO

Facility

$659,530.16

Service Code	APR-DRG 5831
Min. Negotiated Rate	$363,940.74
Max. Negotiated Rate	$659,530.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$363,940.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$455,675.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$659,530.16

APR-DRG 41.00: NEONATE WITH ECMO

Facility

$1,297,827.74

Service Code	APR-DRG 5833
Min. Negotiated Rate	$716,164.94
Max. Negotiated Rate	$1,297,827.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$716,164.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$896,680.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$1,297,827.74

APR-DRG 41.00: NEPHRITIS AND NEPHROSIS

Facility

$12,912.61

Service Code	APR-DRG 4622
Min. Negotiated Rate	$10,313.10
Max. Negotiated Rate	$12,912.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,313.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,912.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,553.39

APR-DRG 41.00: NEPHRITIS AND NEPHROSIS

Facility

$23,597.85

Service Code	APR-DRG 4623
Min. Negotiated Rate	$18,847.23
Max. Negotiated Rate	$23,597.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,847.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$23,597.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,113.86

APR-DRG 41.00: NEPHRITIS AND NEPHROSIS

Facility

$8,880.98

Service Code	APR-DRG 4621
Min. Negotiated Rate	$7,093.10
Max. Negotiated Rate	$8,880.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,093.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,880.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$7,946.14

APR-DRG 41.00: NEPHRITIS AND NEPHROSIS

Facility

$63,724.40

Service Code	APR-DRG 4624
Min. Negotiated Rate	$50,895.68
Max. Negotiated Rate	$63,724.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$50,895.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$63,724.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$57,016.57

APR-DRG 41.00: NERVOUS SYSTEM MALIGNANCY

Facility

$16,385.60

Service Code	APR-DRG 0412
Min. Negotiated Rate	$13,086.92
Max. Negotiated Rate	$16,385.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,086.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$16,385.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,660.80

APR-DRG 41.00: NERVOUS SYSTEM MALIGNANCY

Facility

$21,677.12

Service Code	APR-DRG 0413
Min. Negotiated Rate	$17,313.17
Max. Negotiated Rate	$21,677.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,313.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$21,677.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,395.32

APR-DRG 41.00: NERVOUS SYSTEM MALIGNANCY

Facility

$44,328.86

Service Code	APR-DRG 0414
Min. Negotiated Rate	$35,404.76
Max. Negotiated Rate	$44,328.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$35,404.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$44,328.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$39,662.67

APR-DRG 41.00: NERVOUS SYSTEM MALIGNANCY

Facility

$15,739.03

Service Code	APR-DRG 0411
Min. Negotiated Rate	$12,570.51
Max. Negotiated Rate	$15,739.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,570.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,739.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,082.29

APR-DRG 41.00: NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS

Facility

$13,956.17

Service Code	APR-DRG 0501
Min. Negotiated Rate	$11,146.57
Max. Negotiated Rate	$13,956.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,146.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$13,956.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,487.09

APR-DRG 41.00: NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS

Facility

$37,266.39

Service Code	APR-DRG 0503
Min. Negotiated Rate	$29,764.08
Max. Negotiated Rate	$37,266.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$29,764.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$37,266.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,343.61

APR-DRG 41.00: NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS

Facility

$23,585.95

Service Code	APR-DRG 0502
Min. Negotiated Rate	$18,837.73
Max. Negotiated Rate	$23,585.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,837.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$23,585.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,103.22

APR-DRG 41.00: NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS

Facility

$102,994.71

Service Code	APR-DRG 0504
Min. Negotiated Rate	$82,260.25
Max. Negotiated Rate	$102,994.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$82,260.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$102,994.71
Rate for Payer: Molina Healthcare of CA Medi-Cal	$92,153.16

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