Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility

$9,248.59

Service Code	APR-DRG 6392
Min. Negotiated Rate	$5,841.22
Max. Negotiated Rate	$9,248.59
Rate for Payer: Adventist Health Medi-Cal	$5,841.22
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$6,960.78
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	$4,271.70
Max. Negotiated Rate	$6,763.52
Rate for Payer: Adventist Health Medi-Cal	$4,271.70
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$5,090.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$6,763.52

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	$66,464.21
Max. Negotiated Rate	$105,235.00
Rate for Payer: Adventist Health Medi-Cal	$66,464.21
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$79,203.18
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	$14,059.80
Max. Negotiated Rate	$22,261.35
Rate for Payer: Adventist Health Medi-Cal	$14,059.80
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$16,754.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22,261.35

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	$15,875.74
Max. Negotiated Rate	$25,136.58
Rate for Payer: Adventist Health Medi-Cal	$15,875.74
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$18,918.59
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	$6,853.49
Max. Negotiated Rate	$10,851.36
Rate for Payer: Adventist Health Medi-Cal	$6,853.49
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$8,167.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,851.36

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$444,447.52

Service Code	APR-DRG 5914
Min. Negotiated Rate	$280,703.70
Max. Negotiated Rate	$444,447.52
Rate for Payer: Adventist Health Medi-Cal	$280,703.70
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$334,505.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$444,447.52

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$2,613.64

Service Code	APR-DRG 5911
Min. Negotiated Rate	$1,650.72
Max. Negotiated Rate	$2,613.64
Rate for Payer: Adventist Health Medi-Cal	$1,650.72
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$1,967.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$2,613.64

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$180,817.55

Service Code	APR-DRG 5913
Min. Negotiated Rate	$114,200.56
Max. Negotiated Rate	$180,817.55
Rate for Payer: Adventist Health Medi-Cal	$114,200.56
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$136,089.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$180,817.55

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$96,216.86

Service Code	APR-DRG 5912
Min. Negotiated Rate	$60,768.54
Max. Negotiated Rate	$96,216.86
Rate for Payer: Adventist Health Medi-Cal	$60,768.54
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$72,415.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$96,216.86

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	$1,219.76
Max. Negotiated Rate	$1,931.29
Rate for Payer: Adventist Health Medi-Cal	$1,219.76
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$1,453.55
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

$63,223.85

Service Code	APR-DRG 5893
Min. Negotiated Rate	$39,930.85
Max. Negotiated Rate	$63,223.85
Rate for Payer: Adventist Health Medi-Cal	$39,930.85
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$47,584.27
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	$60,471.72
Max. Negotiated Rate	$95,746.89
Rate for Payer: Adventist Health Medi-Cal	$60,471.72
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$72,062.13
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

$79,486.48

Service Code	APR-DRG 5892
Min. Negotiated Rate	$50,201.99
Max. Negotiated Rate	$79,486.48
Rate for Payer: Adventist Health Medi-Cal	$50,201.99
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$59,824.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$79,486.48

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$162,905.60

Service Code	APR-DRG 5932
Min. Negotiated Rate	$102,887.75
Max. Negotiated Rate	$162,905.60
Rate for Payer: Adventist Health Medi-Cal	$102,887.75
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$122,607.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$162,905.60

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$3,017.10

Service Code	APR-DRG 5931
Min. Negotiated Rate	$1,905.54
Max. Negotiated Rate	$3,017.10
Rate for Payer: Adventist Health Medi-Cal	$1,905.54
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$2,270.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$3,017.10

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$205,535.14

Service Code	APR-DRG 5933
Min. Negotiated Rate	$129,811.67
Max. Negotiated Rate	$205,535.14
Rate for Payer: Adventist Health Medi-Cal	$129,811.67
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$154,692.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$205,535.14

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$460,249.05

Service Code	APR-DRG 5934
Min. Negotiated Rate	$290,683.61
Max. Negotiated Rate	$460,249.05
Rate for Payer: Adventist Health Medi-Cal	$290,683.61
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$346,397.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$460,249.05

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$3,070.30

Service Code	APR-DRG 5812
Min. Negotiated Rate	$1,939.14
Max. Negotiated Rate	$3,070.30
Rate for Payer: Adventist Health Medi-Cal	$1,939.14
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$2,310.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$3,070.30

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$11,345.18

Service Code	APR-DRG 5814
Min. Negotiated Rate	$7,165.38
Max. Negotiated Rate	$11,345.18
Rate for Payer: Adventist Health Medi-Cal	$7,165.38
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$8,538.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,345.18

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$4,708.54

Service Code	APR-DRG 5813
Min. Negotiated Rate	$2,973.82
Max. Negotiated Rate	$4,708.54
Rate for Payer: Adventist Health Medi-Cal	$2,973.82
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$3,543.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$4,708.54

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$2,050.56

Service Code	APR-DRG 5811
Min. Negotiated Rate	$1,295.09
Max. Negotiated Rate	$2,050.56
Rate for Payer: Adventist Health Medi-Cal	$1,295.09
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$1,543.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$2,050.56

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$5,887.89

Service Code	APR-DRG 5801
Min. Negotiated Rate	$3,718.67
Max. Negotiated Rate	$5,887.89
Rate for Payer: Adventist Health Medi-Cal	$3,718.67
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$4,431.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$5,887.89

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$29,164.20

Service Code	APR-DRG 5804
Min. Negotiated Rate	$18,419.50
Max. Negotiated Rate	$29,164.20
Rate for Payer: Adventist Health Medi-Cal	$18,419.50
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$21,949.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$29,164.20

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$7,528.33

Service Code	APR-DRG 5802
Min. Negotiated Rate	$4,754.74
Max. Negotiated Rate	$7,528.33
Rate for Payer: Adventist Health Medi-Cal	$4,754.74
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$5,666.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$7,528.33

Know your out-of-pocket cost for care.

All Charges