Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$421,887.21

Service Code	APR-DRG 5912
Min. Negotiated Rate	$266,455.08
Max. Negotiated Rate	$421,887.21
Rate for Payer: Adventist Health Medi-Cal	$266,455.08
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$317,525.64
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$421,887.21

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$519,574.42

Service Code	APR-DRG 5913
Min. Negotiated Rate	$328,152.26
Max. Negotiated Rate	$519,574.42
Rate for Payer: Adventist Health Medi-Cal	$328,152.26
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$391,048.11
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$519,574.42

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$820,576.77

Service Code	APR-DRG 5914
Min. Negotiated Rate	$518,259.01
Max. Negotiated Rate	$820,576.77
Rate for Payer: Adventist Health Medi-Cal	$518,259.01
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$617,591.99
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$820,576.77

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$11,004.53

Service Code	APR-DRG 5911
Min. Negotiated Rate	$6,950.23
Max. Negotiated Rate	$11,004.53
Rate for Payer: Adventist Health Medi-Cal	$6,950.23
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$8,282.36
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$11,004.53

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

$527,833.09

Service Code	APR-DRG 5892
Min. Negotiated Rate	$333,368.27
Max. Negotiated Rate	$527,833.09
Rate for Payer: Adventist Health Medi-Cal	$333,368.27
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$397,263.85
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$527,833.09

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

$527,833.09

Service Code	APR-DRG 5891
Min. Negotiated Rate	$333,368.27
Max. Negotiated Rate	$527,833.09
Rate for Payer: Adventist Health Medi-Cal	$333,368.27
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$397,263.85
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$527,833.09

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

$527,833.09

Service Code	APR-DRG 5893
Min. Negotiated Rate	$333,368.27
Max. Negotiated Rate	$527,833.09
Rate for Payer: Adventist Health Medi-Cal	$333,368.27
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$397,263.85
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$527,833.09

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

$2,292.56

Service Code	APR-DRG 5894
Min. Negotiated Rate	$1,447.93
Max. Negotiated Rate	$2,292.56
Rate for Payer: Adventist Health Medi-Cal	$1,447.93
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$1,725.45
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$2,292.56

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$166,202.90

Service Code	APR-DRG 5931
Min. Negotiated Rate	$104,970.25
Max. Negotiated Rate	$166,202.90
Rate for Payer: Adventist Health Medi-Cal	$104,970.25
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$125,089.55
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$166,202.90

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$724,331.93

Service Code	APR-DRG 5934
Min. Negotiated Rate	$457,472.80
Max. Negotiated Rate	$724,331.93
Rate for Payer: Adventist Health Medi-Cal	$457,472.80
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$545,155.08
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$724,331.93

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$431,206.86

Service Code	APR-DRG 5933
Min. Negotiated Rate	$272,341.18
Max. Negotiated Rate	$431,206.86
Rate for Payer: Adventist Health Medi-Cal	$272,341.18
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$324,539.90
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$431,206.86

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$335,271.49

Service Code	APR-DRG 5932
Min. Negotiated Rate	$211,750.42
Max. Negotiated Rate	$335,271.49
Rate for Payer: Adventist Health Medi-Cal	$211,750.42
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$252,335.91
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$335,271.49

NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY

Facility

$47,432.10

Service Code	MSDRG 789
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$47,432.10
Rate for Payer: Aetna of CA HMO/PPO	$47,432.10
Rate for Payer: Anthem Blue Cross of CA Exchange	$30,639.20
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$42,895.96
Rate for Payer: EPIC Health Plan Commercial	$42,500.11
Rate for Payer: EPIC Health Plan Senior	$28,333.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,757.64
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$36,060.70
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$34,515.24
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$25,757.64
Rate for Payer: Prime Health Services Medicare	$27,303.10
Rate for Payer: United Healthcare All Other Commercial	$10,809.00
Rate for Payer: United Healthcare All Other HMO	$8,601.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$4,208.65

Service Code	APR-DRG 5812
Min. Negotiated Rate	$2,658.10
Max. Negotiated Rate	$4,208.65
Rate for Payer: Adventist Health Medi-Cal	$2,658.10
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$3,167.56
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$4,208.65

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$15,020.01

Service Code	APR-DRG 5814
Min. Negotiated Rate	$9,486.32
Max. Negotiated Rate	$15,020.01
Rate for Payer: Adventist Health Medi-Cal	$9,486.32
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$11,304.54
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$15,020.01

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$2,907.99

Service Code	APR-DRG 5811
Min. Negotiated Rate	$1,836.62
Max. Negotiated Rate	$2,907.99
Rate for Payer: Adventist Health Medi-Cal	$1,836.62
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$2,188.64
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$2,907.99

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$7,232.96

Service Code	APR-DRG 5813
Min. Negotiated Rate	$4,568.18
Max. Negotiated Rate	$7,232.96
Rate for Payer: Adventist Health Medi-Cal	$4,568.18
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$5,443.75
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$7,232.96

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$11,512.10

Service Code	APR-DRG 5802
Min. Negotiated Rate	$7,270.80
Max. Negotiated Rate	$11,512.10
Rate for Payer: Adventist Health Medi-Cal	$7,270.80
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$8,664.37
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$11,512.10

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$8,071.86

Service Code	APR-DRG 5801
Min. Negotiated Rate	$5,098.02
Max. Negotiated Rate	$8,071.86
Rate for Payer: Adventist Health Medi-Cal	$5,098.02
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$6,075.14
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$8,071.86

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$20,352.38

Service Code	APR-DRG 5803
Min. Negotiated Rate	$12,854.14
Max. Negotiated Rate	$20,352.38
Rate for Payer: Adventist Health Medi-Cal	$12,854.14
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$15,317.85
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$20,352.38

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$38,296.61

Service Code	APR-DRG 5804
Min. Negotiated Rate	$24,187.33
Max. Negotiated Rate	$38,296.61
Rate for Payer: Adventist Health Medi-Cal	$24,187.33
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$28,823.24
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$38,296.61

NEONATE WITH ECMO

Facility

$1,886,900.64

Service Code	APR-DRG 5834
Min. Negotiated Rate	$1,191,726.72
Max. Negotiated Rate	$1,886,900.64
Rate for Payer: Adventist Health Medi-Cal	$1,191,726.72
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$1,420,141.01
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$1,886,900.64

NEONATE WITH ECMO

Facility

$595,760.14

Service Code	APR-DRG 5832
Min. Negotiated Rate	$376,269.56
Max. Negotiated Rate	$595,760.14
Rate for Payer: Adventist Health Medi-Cal	$376,269.56
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$448,387.90
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$595,760.14

NEONATE WITH ECMO

Facility

$502,672.84

Service Code	APR-DRG 5831
Min. Negotiated Rate	$317,477.58
Max. Negotiated Rate	$502,672.84
Rate for Payer: Adventist Health Medi-Cal	$317,477.58
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$378,327.45
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$502,672.84

NEONATE WITH ECMO

Facility

$949,385.43

Service Code	APR-DRG 5833
Min. Negotiated Rate	$599,611.85
Max. Negotiated Rate	$949,385.43
Rate for Payer: Adventist Health Medi-Cal	$599,611.85
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$714,537.45
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$949,385.43

Know your out-of-pocket cost for care.

All Charges