Loma Linda University Medical Center

All Charges

Charge

Type

Price

NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE

Facility IP

$153,157.26

Service Code	APR-DRG 5881
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$153,157.26
Rate for Payer: Adventist Health Medi-Cal	$128,523.58
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$153,157.26

NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE

Facility IP

$232,675.71

Service Code	APR-DRG 5882
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$232,675.71
Rate for Payer: Adventist Health Medi-Cal	$195,252.35
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$232,675.71

NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE

Facility IP

$531,129.30

Service Code	APR-DRG 5884
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$531,129.30
Rate for Payer: Adventist Health Medi-Cal	$445,702.91
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$531,129.30

NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE

Facility IP

$237,621.01

Service Code	APR-DRG 5883
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$237,621.01
Rate for Payer: Adventist Health Medi-Cal	$199,402.25
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$237,621.01

NEONATE BIRTH WEIGHT 2000-2499 GRAMS, NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM

Facility IP

$50,646.21

Service Code	APR-DRG 6264
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$50,646.21
Rate for Payer: Adventist Health Medi-Cal	$42,500.32
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$50,646.21

NEONATE BIRTH WEIGHT 2000-2499 GRAMS, NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM

Facility IP

$34,005.88

Service Code	APR-DRG 6263
Min. Negotiated Rate	$5,356.79
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$5,356.79
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$6,383.51

NEONATE BIRTH WEIGHT 2000-2499 GRAMS, NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM

Facility IP

$34,005.88

Service Code	APR-DRG 6262
Min. Negotiated Rate	$1,810.04
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$1,810.04
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$2,156.97

NEONATE BIRTH WEIGHT 2000-2499 GRAMS, NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM

Facility IP

$34,005.88

Service Code	APR-DRG 6261
Min. Negotiated Rate	$1,551.31
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$1,551.31
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$1,848.65

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility IP

$34,005.88

Service Code	APR-DRG 6231
Min. Negotiated Rate	$11,090.20
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$11,090.20
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$13,215.82

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility IP

$82,362.55

Service Code	APR-DRG 6234
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$82,362.55
Rate for Payer: Adventist Health Medi-Cal	$69,115.43
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$82,362.55

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility IP

$47,165.49

Service Code	APR-DRG 6233
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$47,165.49
Rate for Payer: Adventist Health Medi-Cal	$39,579.43
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$47,165.49

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility IP

$34,005.88

Service Code	APR-DRG 6232
Min. Negotiated Rate	$17,988.48
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$17,988.48
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$21,436.27

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY

Facility IP

$34,005.88

Service Code	APR-DRG 6212
Min. Negotiated Rate	$16,354.57
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$16,354.57
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$19,489.20

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY

Facility IP

$34,005.88

Service Code	APR-DRG 6211
Min. Negotiated Rate	$5,050.16
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$5,050.16
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$6,018.11

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY

Facility IP

$46,347.94

Service Code	APR-DRG 6213
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$46,347.94
Rate for Payer: Adventist Health Medi-Cal	$38,893.38
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$46,347.94

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY

Facility IP

$113,699.30

Service Code	APR-DRG 6214
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$113,699.30
Rate for Payer: Adventist Health Medi-Cal	$95,412.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$113,699.30

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility IP

$34,005.88

Service Code	APR-DRG 6252
Min. Negotiated Rate	$17,424.24
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$17,424.24
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$20,763.89

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility IP

$37,551.86

Service Code	APR-DRG 6253
Min. Negotiated Rate	$31,512.05
Max. Negotiated Rate	$37,551.86
Rate for Payer: Adventist Health Medi-Cal	$31,512.05
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$37,551.86

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility IP

$34,005.88

Service Code	APR-DRG 6251
Min. Negotiated Rate	$12,813.72
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$12,813.72
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$15,269.68

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility IP

$75,875.61

Service Code	APR-DRG 6254
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$75,875.61
Rate for Payer: IEHP medi-cal	$75,875.61
Rate for Payer: Adventist Health Medi-Cal	$63,671.84
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88

NEONATE, BIRTH WEIGHT 2000-2499 GRAMS, WITHOUT SIGNIFICANT O.R. PROCEDURES, WITH MAJOR PROBLEM

Facility IP

$34,005.88

Service Code	TRIS-DRG 678
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 2000-2499 GRAMS, WITHOUT SIGNIFICANT O.R. PROCEDURES, WITH MINOR PROBLEM

Facility IP

$34,005.88

Service Code	TRIS-DRG 679
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 2000-2499 GRAMS, WITHOUT SIGNIFICANT O.R. PROCEDURES, WITH MULTIPLE MAJOR PROBLEMS

Facility IP

$34,005.88

Service Code	TRIS-DRG 677
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 2000-2499 GRAMS, WITHOUT SIGNIFICANT O.R. PROCEDURES, WITH OTHER PROBLEM

Facility IP

$34,005.88

Service Code	TRIS-DRG 680
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 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility IP

$89,743.25

Service Code	APR-DRG 6224
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$89,743.25
Rate for Payer: Adventist Health Medi-Cal	$75,309.02
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$89,743.25

Price Transparency.

All Charges