Loma Linda University Children's Hospital

All Charges

Charge

Type

Price

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY

Facility IP

$106,001.91

Service Code	APR-DRG 6072
Min. Negotiated Rate	$81,314.62
Max. Negotiated Rate	$106,001.91
Rate for Payer: IEHP Medi-Cal	$81,314.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$106,001.91

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY

Facility IP

$136,895.59

Service Code	APR-DRG 6073
Min. Negotiated Rate	$105,013.33
Max. Negotiated Rate	$136,895.59
Rate for Payer: IEHP Medi-Cal	$105,013.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$136,895.59

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility IP

$81,809.71

Service Code	APR-DRG 6133
Min. Negotiated Rate	$62,756.66
Max. Negotiated Rate	$81,809.71
Rate for Payer: IEHP Medi-Cal	$62,756.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$81,809.71

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility IP

$180,660.95

Service Code	APR-DRG 6134
Min. Negotiated Rate	$138,585.96
Max. Negotiated Rate	$180,660.95
Rate for Payer: IEHP Medi-Cal	$138,585.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$180,660.95

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility IP

$28,005.14

Service Code	APR-DRG 6131
Min. Negotiated Rate	$21,482.89
Max. Negotiated Rate	$28,005.14
Rate for Payer: IEHP Medi-Cal	$21,482.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$28,005.14

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility IP

$50,827.36

Service Code	APR-DRG 6132
Min. Negotiated Rate	$38,989.93
Max. Negotiated Rate	$50,827.36
Rate for Payer: IEHP Medi-Cal	$38,989.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$50,827.36

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY

Facility IP

$49,889.65

Service Code	APR-DRG 6112
Min. Negotiated Rate	$38,270.61
Max. Negotiated Rate	$49,889.65
Rate for Payer: IEHP Medi-Cal	$38,270.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$49,889.65

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY

Facility IP

$87,099.06

Service Code	APR-DRG 6113
Min. Negotiated Rate	$66,814.15
Max. Negotiated Rate	$87,099.06
Rate for Payer: IEHP Medi-Cal	$66,814.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$87,099.06

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY

Facility IP

$192,561.58

Service Code	APR-DRG 6114
Min. Negotiated Rate	$147,715.00
Max. Negotiated Rate	$192,561.58
Rate for Payer: IEHP Medi-Cal	$147,715.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$192,561.58

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY

Facility IP

$22,447.57

Service Code	APR-DRG 6111
Min. Negotiated Rate	$17,219.65
Max. Negotiated Rate	$22,447.57
Rate for Payer: IEHP Medi-Cal	$17,219.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22,447.57

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH OR WITHOUT OTHER SIGNIFICANT CONDITION

Facility IP

$42,494.32

Service Code	APR-DRG 6142
Min. Negotiated Rate	$32,597.61
Max. Negotiated Rate	$42,494.32
Rate for Payer: IEHP Medi-Cal	$32,597.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$42,494.32

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH OR WITHOUT OTHER SIGNIFICANT CONDITION

Facility IP

$145,182.53

Service Code	APR-DRG 6144
Min. Negotiated Rate	$111,370.29
Max. Negotiated Rate	$145,182.53
Rate for Payer: IEHP Medi-Cal	$111,370.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$145,182.53

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH OR WITHOUT OTHER SIGNIFICANT CONDITION

Facility IP

$77,345.03

Service Code	APR-DRG 6143
Min. Negotiated Rate	$59,331.78
Max. Negotiated Rate	$77,345.03
Rate for Payer: IEHP Medi-Cal	$59,331.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$77,345.03

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH OR WITHOUT OTHER SIGNIFICANT CONDITION

Facility IP

$17,492.96

Service Code	APR-DRG 6141
Min. Negotiated Rate	$13,418.94
Max. Negotiated Rate	$17,492.96
Rate for Payer: IEHP Medi-Cal	$13,418.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,492.96

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility IP

$89,929.94

Service Code	APR-DRG 6123
Min. Negotiated Rate	$68,985.73
Max. Negotiated Rate	$89,929.94
Rate for Payer: IEHP Medi-Cal	$68,985.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$89,929.94

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility IP

$45,520.28

Service Code	APR-DRG 6121
Min. Negotiated Rate	$34,918.84
Max. Negotiated Rate	$45,520.28
Rate for Payer: IEHP Medi-Cal	$34,918.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$45,520.28

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility IP

$184,137.28

Service Code	APR-DRG 6124
Min. Negotiated Rate	$141,252.68
Max. Negotiated Rate	$184,137.28
Rate for Payer: IEHP Medi-Cal	$141,252.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$184,137.28

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility IP

$69,641.56

Service Code	APR-DRG 6122
Min. Negotiated Rate	$53,422.40
Max. Negotiated Rate	$69,641.56
Rate for Payer: IEHP Medi-Cal	$53,422.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$69,641.56

NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE

Facility IP

$68,943.27

Service Code	APR-DRG 6091
Min. Negotiated Rate	$52,886.74
Max. Negotiated Rate	$68,943.27
Rate for Payer: IEHP Medi-Cal	$52,886.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$68,943.27

NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE

Facility IP

$152,785.80

Service Code	APR-DRG 6093
Min. Negotiated Rate	$117,202.79
Max. Negotiated Rate	$152,785.80
Rate for Payer: IEHP Medi-Cal	$117,202.79
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$152,785.80

NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE

Facility IP

$72,572.19

Service Code	APR-DRG 6092
Min. Negotiated Rate	$55,670.51
Max. Negotiated Rate	$72,572.19
Rate for Payer: IEHP Medi-Cal	$55,670.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$72,572.19

NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE

Facility IP

$441,612.82

Service Code	APR-DRG 6094
Min. Negotiated Rate	$338,763.52
Max. Negotiated Rate	$441,612.82
Rate for Payer: IEHP Medi-Cal	$338,763.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$441,612.82

NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE

Facility IP

$705,696.27

Service Code	APR-DRG 5884
Min. Negotiated Rate	$541,343.32
Max. Negotiated Rate	$705,696.27
Rate for Payer: IEHP Medi-Cal	$541,343.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$705,696.27

NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE

Facility IP

$203,495.66

Service Code	APR-DRG 5881
Min. Negotiated Rate	$156,102.59
Max. Negotiated Rate	$203,495.66
Rate for Payer: IEHP Medi-Cal	$156,102.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$203,495.66

NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE

Facility IP

$309,149.55

Service Code	APR-DRG 5882
Min. Negotiated Rate	$237,150.25
Max. Negotiated Rate	$309,149.55
Rate for Payer: IEHP Medi-Cal	$237,150.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$309,149.55

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