Loma Linda University Medical Center

All Charges

Charge

Type

Price

NEONATAL AFTERCARE

Facility IP

$34,005.88

Service Code	APR-DRG 8631
Min. Negotiated Rate	$10,714.97
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$10,714.97
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$12,768.67

NEONATAL AFTERCARE

Facility IP

$63,309.43

Service Code	APR-DRG 8633
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$63,309.43
Rate for Payer: Adventist Health Medi-Cal	$53,126.80
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$63,309.43

NEONATAL AFTERCARE

Facility IP

$34,005.88

Service Code	APR-DRG 8632
Min. Negotiated Rate	$27,258.55
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$27,258.55
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$32,483.11

NEONATAL AFTERCARE FOR WEIGHT GAIN

Facility IP

$34,005.88

Service Code	TRIS-DRG 793
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$34,005.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88

NEONATAL DIAGNOSIS, AGE >28 DAYS

Facility IP

$34,005.88

Service Code	TRIS-DRG 794
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$34,005.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility IP

$94,097.39

Service Code	APR-DRG 6033
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$94,097.39
Rate for Payer: Adventist Health Medi-Cal	$78,962.84
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$94,097.39

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility IP

$278,446.04

Service Code	APR-DRG 6034
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$278,446.04
Rate for Payer: Adventist Health Medi-Cal	$233,661.01
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$278,446.04

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility IP

$34,005.88

Service Code	APR-DRG 6031
Min. Negotiated Rate	$1,891.54
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$1,891.54
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$2,254.08

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility IP

$46,426.37

Service Code	APR-DRG 6032
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$46,426.37
Rate for Payer: Adventist Health Medi-Cal	$38,959.19
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$46,426.37

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY

Facility IP

$34,005.88

Service Code	APR-DRG 6021
Min. Negotiated Rate	$17,119.02
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$17,119.02
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$20,400.17

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY

Facility IP

$103,744.38

Service Code	APR-DRG 6022
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$103,744.38
Rate for Payer: Adventist Health Medi-Cal	$87,058.22
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$103,744.38

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY

Facility IP

$248,298.56

Service Code	APR-DRG 6024
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$248,298.56
Rate for Payer: Adventist Health Medi-Cal	$208,362.43
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$248,298.56

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY

Facility IP

$135,965.53

Service Code	APR-DRG 6023
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$135,965.53
Rate for Payer: Adventist Health Medi-Cal	$114,096.95
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$135,965.53

NEONATE, BIRTH WEIGHT 1000-1499 GRAMS, DIED

Facility IP

$34,005.88

Service Code	TRIS-DRG 635
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$34,005.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88

NEONATE, BIRTH WEIGHT 1000-1499 GRAMS, WITHOUT SIGNIFICANT O.R. PROCEDURES, DISCHARGED ALIVE

Facility IP

$34,005.88

Service Code	TRIS-DRG 634
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$34,005.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88

NEONATE, BIRTH WEIGHT 1000-1499 GRAMS, WITH SIGNIFICANT O.R. PROCEDURES, DISCHARGED ALIVE

Facility IP

$34,005.88

Service Code	TRIS-DRG 633
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$34,005.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility IP

$34,005.88

Service Code	APR-DRG 6081
Min. Negotiated Rate	$6,702.28
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$6,702.28
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$7,986.88

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility IP

$58,956.44

Service Code	APR-DRG 6082
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$58,956.44
Rate for Payer: Adventist Health Medi-Cal	$49,473.94
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$58,956.44

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility IP

$120,753.25

Service Code	APR-DRG 6084
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$120,753.25
Rate for Payer: Adventist Health Medi-Cal	$101,331.40
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$120,753.25

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility IP

$79,863.81

Service Code	APR-DRG 6083
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$79,863.81
Rate for Payer: Adventist Health Medi-Cal	$67,018.58
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$79,863.81

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

Facility IP

$103,031.94

Service Code	APR-DRG 6073
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$103,031.94
Rate for Payer: Adventist Health Medi-Cal	$86,460.37
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$103,031.94

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

Facility IP

$190,713.74

Service Code	APR-DRG 6074
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$190,713.74
Rate for Payer: Adventist Health Medi-Cal	$160,039.50
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$190,713.74

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

Facility IP

$34,005.88

Service Code	APR-DRG 6071
Min. Negotiated Rate	$27,710.78
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$27,710.78
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$33,022.02

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

Facility IP

$79,780.39

Service Code	APR-DRG 6072
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$79,780.39
Rate for Payer: Adventist Health Medi-Cal	$66,948.58
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$79,780.39

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

Facility IP

$135,971.14

Service Code	APR-DRG 6134
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$135,971.14
Rate for Payer: Adventist Health Medi-Cal	$114,101.65
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$135,971.14

Price Transparency.

All Charges