Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility

$423,963.00

Service Code	APR-DRG 6314
Min. Negotiated Rate	$325,224.25
Max. Negotiated Rate	$423,963.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$325,224.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$423,963.00

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility

$69,342.29

Service Code	APR-DRG 6312
Min. Negotiated Rate	$53,192.83
Max. Negotiated Rate	$69,342.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$53,192.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$69,342.29

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility

$113,064.72

Service Code	APR-DRG 6313
Min. Negotiated Rate	$86,732.55
Max. Negotiated Rate	$113,064.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$86,732.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$113,064.72

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$9,248.59

Service Code	APR-DRG 6392
Min. Negotiated Rate	$7,094.64
Max. Negotiated Rate	$9,248.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,094.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,248.59

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$6,763.52

Service Code	APR-DRG 6391
Min. Negotiated Rate	$5,188.34
Max. Negotiated Rate	$6,763.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,188.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$6,763.52

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$64,409.58

Service Code	APR-DRG 6394
Min. Negotiated Rate	$49,408.93
Max. Negotiated Rate	$64,409.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$49,408.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$64,409.58

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$30,288.49

Service Code	APR-DRG 6393
Min. Negotiated Rate	$23,234.46
Max. Negotiated Rate	$30,288.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$23,234.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$30,288.49

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

Facility

$25,136.58

Service Code	APR-DRG 6343
Min. Negotiated Rate	$19,282.40
Max. Negotiated Rate	$25,136.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,282.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$25,136.58

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

Facility

$10,851.36

Service Code	APR-DRG 6341
Min. Negotiated Rate	$8,324.13
Max. Negotiated Rate	$10,851.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,324.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,851.36

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

Facility

$105,235.00

Service Code	APR-DRG 6344
Min. Negotiated Rate	$80,726.32
Max. Negotiated Rate	$105,235.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$80,726.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$105,235.00

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

Facility

$22,261.35

Service Code	APR-DRG 6342
Min. Negotiated Rate	$17,076.80
Max. Negotiated Rate	$22,261.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,076.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22,261.35

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$444,447.52

Service Code	APR-DRG 5914
Min. Negotiated Rate	$340,938.04
Max. Negotiated Rate	$444,447.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$340,938.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$444,447.52

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$96,216.86

Service Code	APR-DRG 5912
Min. Negotiated Rate	$73,808.46
Max. Negotiated Rate	$96,216.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$73,808.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$96,216.86

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$180,817.55

Service Code	APR-DRG 5913
Min. Negotiated Rate	$138,706.09
Max. Negotiated Rate	$180,817.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$138,706.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$180,817.55

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$2,613.64

Service Code	APR-DRG 5911
Min. Negotiated Rate	$2,004.94
Max. Negotiated Rate	$2,613.64
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$2,004.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$2,613.64

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

$63,223.85

Service Code	APR-DRG 5893
Min. Negotiated Rate	$48,499.35
Max. Negotiated Rate	$63,223.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$48,499.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$63,223.85

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

$95,746.89

Service Code	APR-DRG 5891
Min. Negotiated Rate	$73,447.94
Max. Negotiated Rate	$95,746.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$73,447.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$95,746.89

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

$1,931.29

Service Code	APR-DRG 5894
Min. Negotiated Rate	$1,481.51
Max. Negotiated Rate	$1,931.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1,481.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$1,931.29

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

$79,486.48

Service Code	APR-DRG 5892
Min. Negotiated Rate	$60,974.50
Max. Negotiated Rate	$79,486.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$60,974.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$79,486.48

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$460,249.05

Service Code	APR-DRG 5934
Min. Negotiated Rate	$353,059.47
Max. Negotiated Rate	$460,249.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$353,059.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$460,249.05

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$162,905.60

Service Code	APR-DRG 5932
Min. Negotiated Rate	$124,965.74
Max. Negotiated Rate	$162,905.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$124,965.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$162,905.60

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$205,535.14

Service Code	APR-DRG 5933
Min. Negotiated Rate	$157,667.09
Max. Negotiated Rate	$205,535.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$157,667.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$205,535.14

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$3,017.10

Service Code	APR-DRG 5931
Min. Negotiated Rate	$2,314.44
Max. Negotiated Rate	$3,017.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$2,314.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$3,017.10

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$2,050.56

Service Code	APR-DRG 5811
Min. Negotiated Rate	$1,572.99
Max. Negotiated Rate	$2,050.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1,572.99
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$2,050.56

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$11,345.18

Service Code	APR-DRG 5814
Min. Negotiated Rate	$8,702.95
Max. Negotiated Rate	$11,345.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,702.95
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,345.18

Know your out-of-pocket cost for care.

All Charges