Loma Linda University Medical Center

All Charges

Charge

Type

Price

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

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

Facility IP

$38,254.27

Service Code	APR-DRG 6132
Min. Negotiated Rate	$32,101.49
Max. Negotiated Rate	$38,254.27
Rate for Payer: Adventist Health Medi-Cal	$32,101.49
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$38,254.27

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

Facility IP

$34,005.88

Service Code	APR-DRG 6131
Min. Negotiated Rate	$17,687.46
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$17,687.46
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$21,077.56

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY

Facility IP

$37,548.53

Service Code	APR-DRG 6112
Min. Negotiated Rate	$31,509.25
Max. Negotiated Rate	$37,548.53
Rate for Payer: Adventist Health Medi-Cal	$31,509.25
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$37,548.53

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY

Facility IP

$34,005.88

Service Code	APR-DRG 6111
Min. Negotiated Rate	$14,177.41
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$14,177.41
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$16,894.75

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY

Facility IP

$144,927.93

Service Code	APR-DRG 6114
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$144,927.93
Rate for Payer: Adventist Health Medi-Cal	$121,617.84
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$144,927.93

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY

Facility IP

$65,553.50

Service Code	APR-DRG 6113
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$65,553.50
Rate for Payer: Adventist Health Medi-Cal	$55,009.93
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$65,553.50

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

Facility IP

$34,005.88

Service Code	APR-DRG 6142
Min. Negotiated Rate	$26,838.52
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$26,838.52
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$31,982.56

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

Facility IP

$34,005.88

Service Code	APR-DRG 6141
Min. Negotiated Rate	$11,048.18
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$11,048.18
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$13,165.75

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

Facility IP

$58,212.31

Service Code	APR-DRG 6143
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$58,212.31
Rate for Payer: Adventist Health Medi-Cal	$48,849.49
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$58,212.31

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

Facility IP

$109,268.96

Service Code	APR-DRG 6144
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$109,268.96
Rate for Payer: Adventist Health Medi-Cal	$91,694.23
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$109,268.96

NEONATE, BIRTH WEIGHT 1500-1999 GRAMS, WITHOUT SIGNIFICANT O.R. PROCEDURES, WITH MAJOR PROBLEM

Facility IP

$34,005.88

Service Code	TRIS-DRG 648
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 1500-1999 GRAMS, WITHOUT SIGNIFICANT O.R. PROCEDURES, WITH MINOR PROBLEM

Facility IP

$34,005.88

Service Code	TRIS-DRG 649
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 1500-1999 GRAMS, WITHOUT SIGNIFICANT O.R. PROCEDURES, WITH MULTIPLE MAJOR PROBLEMS

Facility IP

$34,005.88

Service Code	TRIS-DRG 647
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 1500-1999 GRAMS, WITHOUT SIGNIFICANT O.R. PROCEDURES, WITH OTHER PROBLEM

Facility IP

$34,005.88

Service Code	TRIS-DRG 650
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 1500-1999 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility IP

$67,684.12

Service Code	APR-DRG 6123
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$67,684.12
Rate for Payer: Adventist Health Medi-Cal	$56,797.86
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$67,684.12

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

Facility IP

$52,414.43

Service Code	APR-DRG 6122
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$52,414.43
Rate for Payer: Adventist Health Medi-Cal	$43,984.14
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$52,414.43

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

Facility IP

$138,587.53

Service Code	APR-DRG 6124
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$138,587.53
Rate for Payer: Adventist Health Medi-Cal	$116,297.23
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$138,587.53

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

Facility IP

$34,260.00

Service Code	APR-DRG 6121
Min. Negotiated Rate	$28,749.65
Max. Negotiated Rate	$34,260.00
Rate for Payer: Adventist Health Medi-Cal	$28,749.65
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$34,260.00

NEONATE, BIRTH WEIGHT 1500-1999 GRAMS, WITH SIGNIFICANT O.R. PROCEDURES, WITH MULTIPLE MAJOR PROBLEMS

Facility IP

$34,005.88

Service Code	TRIS-DRG 636
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 1500-1999 GRAMS, WITH SIGNIFICANT O.R. PROCEDURES, WITHOUT MULTIPLE MAJOR PROBLEMS

Facility IP

$34,005.88

Service Code	TRIS-DRG 646
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 1500-2499 GRAMS WITH MAJOR PROCEDURE

Facility IP

$114,991.42

Service Code	APR-DRG 6093
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$114,991.42
Rate for Payer: Adventist Health Medi-Cal	$96,496.30
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$114,991.42

NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE

Facility IP

$54,620.12

Service Code	APR-DRG 6092
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$54,620.12
Rate for Payer: Adventist Health Medi-Cal	$45,835.07
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$54,620.12

NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE

Facility IP

$332,371.75

Service Code	APR-DRG 6094
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$332,371.75
Rate for Payer: Adventist Health Medi-Cal	$278,913.36
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$332,371.75

NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE

Facility IP

$51,888.88

Service Code	APR-DRG 6091
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$51,888.88
Rate for Payer: Adventist Health Medi-Cal	$43,543.12
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$51,888.88

Price Transparency.

All Charges