Loma Linda University Medical Center

All Charges

Charge

Type

Price

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility IP

$34,005.88

Service Code	APR-DRG 6221
Min. Negotiated Rate	$17,956.28
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$17,956.28
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$21,397.91

NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility IP

$34,005.88

Service Code	APR-DRG 6222
Min. Negotiated Rate	$26,856.72
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$26,856.72
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$32,004.26

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

NEONATE, BIRTH WEIGHT 2000-2499 GRAMS, WITH SIGNIFICANT O.R. PROCEDURES, WITH MULTIPLE MAJOR PROBLEMS

Facility IP

$34,005.88

Service Code	TRIS-DRG 651
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 SIGNIFICANT O.R. PROCEDURES, WITHOUT MULTIPLE MAJOR PROBLEMS

Facility IP

$34,005.88

Service Code	TRIS-DRG 676
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 > 2499 GRAMS, NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM

Facility IP

$34,005.88

Service Code	APR-DRG 6401
Min. Negotiated Rate	$1,079.76
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$1,079.76
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$1,286.71

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

Facility IP

$41,790.33

Service Code	APR-DRG 6404
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$41,790.33
Rate for Payer: Adventist Health Medi-Cal	$35,068.81
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$41,790.33

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

Facility IP

$34,005.88

Service Code	APR-DRG 6402
Min. Negotiated Rate	$1,428.11
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$1,428.11
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$1,701.83

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

Facility IP

$34,005.88

Service Code	APR-DRG 6403
Min. Negotiated Rate	$2,581.79
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$2,581.79
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$3,076.63

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility IP

$65,568.57

Service Code	APR-DRG 6364
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$65,568.57
Rate for Payer: Adventist Health Medi-Cal	$55,022.58
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$65,568.57

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility IP

$34,005.88

Service Code	APR-DRG 6363
Min. Negotiated Rate	$23,646.29
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$23,646.29
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$28,178.49

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility IP

$34,005.88

Service Code	APR-DRG 6362
Min. Negotiated Rate	$11,438.82
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$11,438.82
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$13,631.26

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility IP

$34,005.88

Service Code	APR-DRG 6361
Min. Negotiated Rate	$6,107.23
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$6,107.23
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$7,277.78

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility IP

$103,341.81

Service Code	APR-DRG 6334
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$103,341.81
Rate for Payer: Adventist Health Medi-Cal	$86,720.40
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$103,341.81

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility IP

$34,005.88

Service Code	APR-DRG 6333
Min. Negotiated Rate	$23,287.86
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$23,287.86
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$27,751.37

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility IP

$34,005.88

Service Code	APR-DRG 6332
Min. Negotiated Rate	$6,560.87
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$6,560.87
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$7,818.37

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY

Facility IP

$34,005.88

Service Code	APR-DRG 6331
Min. Negotiated Rate	$2,308.76
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$2,308.76
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$2,751.28

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility IP

$82,071.17

Service Code	APR-DRG 6302
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$82,071.17
Rate for Payer: Adventist Health Medi-Cal	$68,870.92
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$82,071.17

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility IP

$129,355.13

Service Code	APR-DRG 6303
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$129,355.13
Rate for Payer: Adventist Health Medi-Cal	$108,549.76
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$129,355.13

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility IP

$34,005.88

Service Code	APR-DRG 6301
Min. Negotiated Rate	$27,320.15
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$27,320.15
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$32,556.51

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE

Facility IP

$385,514.24

Service Code	APR-DRG 6304
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$385,514.24
Rate for Payer: Adventist Health Medi-Cal	$323,508.46
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$385,514.24

NEONATE, BIRTH WEIGHT >2499 GRAMS, WITH MINOR ABDOMINAL PROCEDURES

Facility IP

$34,005.88

Service Code	TRIS-DRG 788
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 > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility IP

$85,096.08

Service Code	APR-DRG 6313
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$85,096.08
Rate for Payer: Adventist Health Medi-Cal	$71,409.30
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$85,096.08

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility IP

$52,189.19

Service Code	APR-DRG 6312
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$52,189.19
Rate for Payer: Adventist Health Medi-Cal	$43,795.13
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$52,189.19

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE

Facility IP

$34,005.88

Service Code	APR-DRG 6311
Min. Negotiated Rate	$5,655.00
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$5,655.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$6,738.88

Price Transparency.

All Charges