Loma Linda University Medical Center

All Charges

Charge

Type

Price

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

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility IP

$34,005.88

Service Code	APR-DRG 6391
Min. Negotiated Rate	$4,271.70
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$4,271.70
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$5,090.44

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility IP

$48,476.69

Service Code	APR-DRG 6394
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$48,476.69
Rate for Payer: Adventist Health Medi-Cal	$40,679.74
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$48,476.69

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility IP

$34,005.88

Service Code	APR-DRG 6393
Min. Negotiated Rate	$19,129.57
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$19,129.57
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$22,796.07

NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION

Facility IP

$34,005.88

Service Code	APR-DRG 6392
Min. Negotiated Rate	$5,841.22
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$5,841.22
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$6,960.78

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

Facility IP

$34,005.88

Service Code	TRIS-DRG 790
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, WITHOUT SIGNIFICANT O.R. PROCEDURES, WITH MINOR PROBLEM

Facility IP

$34,005.88

Service Code	TRIS-DRG 791
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, WITHOUT SIGNIFICANT O.R. PROCEDURES, WITH MULTIPLE MAJOR PROBLEMS

Facility IP

$34,005.88

Service Code	TRIS-DRG 789
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, WITHOUT SIGNIFICANT O.R. PROCEDURES, WITH OTHER PROBLEM

Facility IP

$34,005.88

Service Code	TRIS-DRG 792
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 RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility IP

$34,005.88

Service Code	APR-DRG 6341
Min. Negotiated Rate	$6,853.49
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$6,853.49
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$8,167.07

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

Facility IP

$79,203.18

Service Code	APR-DRG 6344
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$79,203.18
Rate for Payer: Adventist Health Medi-Cal	$66,464.21
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$79,203.18

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

Facility IP

$34,005.88

Service Code	APR-DRG 6342
Min. Negotiated Rate	$14,059.80
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$14,059.80
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$16,754.60

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

Facility IP

$34,005.88

Service Code	APR-DRG 6343
Min. Negotiated Rate	$15,875.74
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$15,875.74
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$18,918.59

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

Facility IP

$34,005.88

Service Code	TRIS-DRG 681
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 SIGNIFICANT O.R. PROCEDURES, WITHOUT MULTIPLE MAJOR PROBLEMS

Facility IP

$34,005.88

Service Code	TRIS-DRG 787
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 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility IP

$334,505.24

Service Code	APR-DRG 5914
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$334,505.24
Rate for Payer: Adventist Health Medi-Cal	$280,703.70
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$334,505.24

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility IP

$34,005.88

Service Code	APR-DRG 5911
Min. Negotiated Rate	$1,650.72
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$1,650.72
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$1,967.11

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility IP

$72,415.84

Service Code	APR-DRG 5912
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$72,415.84
Rate for Payer: Adventist Health Medi-Cal	$60,768.54
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$72,415.84

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility IP

$136,089.00

Service Code	APR-DRG 5913
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$136,089.00
Rate for Payer: Adventist Health Medi-Cal	$114,200.56
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$136,089.00

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 IP

$47,584.27

Service Code	APR-DRG 5893
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$47,584.27
Rate for Payer: Adventist Health Medi-Cal	$39,930.85
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$47,584.27

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 IP

$59,824.04

Service Code	APR-DRG 5892
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$59,824.04
Rate for Payer: Adventist Health Medi-Cal	$50,201.99
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$59,824.04

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 IP

$72,062.13

Service Code	APR-DRG 5891
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$72,062.13
Rate for Payer: Adventist Health Medi-Cal	$60,471.72
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$72,062.13

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 IP

$34,005.88

Service Code	APR-DRG 5894
Min. Negotiated Rate	$1,219.76
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$1,219.76
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$1,453.55

NEONATE, BIRTH WEIGHT 750-999 GRAMS, DIED

Facility IP

$34,005.88

Service Code	TRIS-DRG 632
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 750-999 GRAMS, DISCHARGED ALIVE

Facility IP

$34,005.88

Service Code	TRIS-DRG 631
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

Price Transparency.

All Charges