Loma Linda University Children's Hospital

All Charges

Charge

Type

Price

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility IP

$96,216.86

Service Code	APR-DRG 5912
Min. Negotiated Rate	$73,808.46
Max. Negotiated Rate	$96,216.86
Rate for Payer: 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 IP

$2,613.64

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

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility IP

$444,447.52

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

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 IP

$1,931.29

Service Code	APR-DRG 5894
Min. Negotiated Rate	$1,481.51
Max. Negotiated Rate	$1,931.29
Rate for Payer: 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 IP

$79,486.48

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

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 IP

$95,746.89

Service Code	APR-DRG 5891
Min. Negotiated Rate	$73,447.94
Max. Negotiated Rate	$95,746.89
Rate for Payer: 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 IP

$63,223.85

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

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility IP

$205,535.14

Service Code	APR-DRG 5933
Min. Negotiated Rate	$157,667.09
Max. Negotiated Rate	$205,535.14
Rate for Payer: 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 IP

$3,017.10

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

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility IP

$460,249.05

Service Code	APR-DRG 5934
Min. Negotiated Rate	$353,059.47
Max. Negotiated Rate	$460,249.05
Rate for Payer: 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 IP

$162,905.60

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

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility IP

$11,345.18

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

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility IP

$2,050.56

Service Code	APR-DRG 5811
Min. Negotiated Rate	$1,572.99
Max. Negotiated Rate	$2,050.56
Rate for Payer: 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 IP

$4,708.54

Service Code	APR-DRG 5813
Min. Negotiated Rate	$3,611.95
Max. Negotiated Rate	$4,708.54
Rate for Payer: IEHP Medi-Cal	$3,611.95
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$4,708.54

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility IP

$3,070.30

Service Code	APR-DRG 5812
Min. Negotiated Rate	$2,355.25
Max. Negotiated Rate	$3,070.30
Rate for Payer: IEHP Medi-Cal	$2,355.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$3,070.30

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility IP

$12,352.15

Service Code	APR-DRG 5803
Min. Negotiated Rate	$9,475.40
Max. Negotiated Rate	$12,352.15
Rate for Payer: IEHP Medi-Cal	$9,475.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,352.15

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility IP

$7,528.33

Service Code	APR-DRG 5802
Min. Negotiated Rate	$5,775.02
Max. Negotiated Rate	$7,528.33
Rate for Payer: IEHP Medi-Cal	$5,775.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$7,528.33

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility IP

$29,164.20

Service Code	APR-DRG 5804
Min. Negotiated Rate	$22,372.01
Max. Negotiated Rate	$29,164.20
Rate for Payer: IEHP Medi-Cal	$22,372.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$29,164.20

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility IP

$5,887.89

Service Code	APR-DRG 5801
Min. Negotiated Rate	$4,516.63
Max. Negotiated Rate	$5,887.89
Rate for Payer: IEHP Medi-Cal	$4,516.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$5,887.89

NEONATE WITH ECMO

Facility IP

$473,187.95

Service Code	APR-DRG 5833
Min. Negotiated Rate	$362,984.97
Max. Negotiated Rate	$473,187.95
Rate for Payer: IEHP Medi-Cal	$362,984.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$473,187.95

NEONATE WITH ECMO

Facility IP

$860,321.41

Service Code	APR-DRG 5834
Min. Negotiated Rate	$659,957.08
Max. Negotiated Rate	$860,321.41
Rate for Payer: IEHP Medi-Cal	$659,957.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$860,321.41

NEONATE WITH ECMO

Facility IP

$348,930.48

Service Code	APR-DRG 5832
Min. Negotiated Rate	$267,666.41
Max. Negotiated Rate	$348,930.48
Rate for Payer: IEHP Medi-Cal	$267,666.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$348,930.48

NEONATE WITH ECMO

Facility IP

$301,539.20

Service Code	APR-DRG 5831
Min. Negotiated Rate	$231,312.30
Max. Negotiated Rate	$301,539.20
Rate for Payer: IEHP Medi-Cal	$231,312.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$301,539.20

NEOSTIGMINE METHYLSULFATE 1 MG/ML INJECTION SOLUTION. [4085490]

Facility IP

$3.02

Service Code	CPT J2710
Hospital Charge Code	NDG120692
Hospital Revenue Code	636
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$2.57
Rate for Payer: Blue Shield of California Commercial	$2.15
Rate for Payer: Blue Shield of California EPN	$1.55
Rate for Payer: Cash Price	$1.36
Rate for Payer: Cigna of CA HMO	$2.11
Rate for Payer: Cigna of CA PPO	$2.11
Rate for Payer: EPIC Health Plan Commercial	$1.21
Rate for Payer: EPIC Health Plan Transplant	$1.21
Rate for Payer: Galaxy Health WC	$2.57
Rate for Payer: Global Benefits Group Commercial	$1.81
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$2.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$1.15
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: Multiplan Commercial	$2.42
Rate for Payer: Networks By Design Commercial	$1.51
Rate for Payer: Prime Health Services Commercial	$2.57

NEOSTIGMINE METHYLSULFATE 1 MG/ML INJECTION SOLUTION. [4085490]

Facility OP

$3.02

Service Code	CPT J2710
Hospital Charge Code	NDG120692
Hospital Revenue Code	636
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$22.24
Rate for Payer: Aetna of CA HMO/PPO	$4.98
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$2.57
Rate for Payer: AlphaCare Medical Group Medi-Cal	$1.66
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$1.66
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$22.24
Rate for Payer: BCBS Transplant Transplant	$1.81
Rate for Payer: Blue Shield of California Commercial	$2.23
Rate for Payer: Blue Shield of California EPN	$2.08
Rate for Payer: Cash Price	$1.36
Rate for Payer: Cash Price	$1.36
Rate for Payer: Cigna of CA HMO	$2.11
Rate for Payer: Cigna of CA PPO	$2.11
Rate for Payer: Dignity Health Commercial/Exchange	$2.57
Rate for Payer: Dignity Health Media	$2.57
Rate for Payer: Dignity Health Medi-Cal	$2.57
Rate for Payer: EPIC Health Plan Commercial	$1.21
Rate for Payer: EPIC Health Plan Transplant	$1.21
Rate for Payer: Galaxy Health WC	$2.57
Rate for Payer: Global Benefits Group Commercial	$1.81
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other	$2.26
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$2.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10.49
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: Multiplan Commercial	$2.42
Rate for Payer: Networks By Design Commercial	$1.51
Rate for Payer: Prime Health Services Commercial	$2.57
Rate for Payer: Temecula Valley Physicians Medical Group Commercial	$1.81
Rate for Payer: TriValley Medical Group Commercial/Senior	$1.81
Rate for Payer: United Healthcare All Other Commercial	$1.51
Rate for Payer: United Healthcare All Other HMO	$1.51
Rate for Payer: United Healthcare HMO Rider	$1.51
Rate for Payer: United Healthcare Select/Navigate/Core	$1.51
Rate for Payer: Vantage Medical Group Commercial/Exchange	$2.57
Rate for Payer: Vantage Medical Group Medi-Cal	$2.57
Rate for Payer: Vantage Medical Group Senior	$2.57

Price Transparency.

All Charges