Loma Linda University Medical Center

All Charges

Charge

Type

Price

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility IP

$154,692.24

Service Code	APR-DRG 5933
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$154,692.24
Rate for Payer: Adventist Health Medi-Cal	$129,811.67
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$154,692.24

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility IP

$122,607.90

Service Code	APR-DRG 5932
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$122,607.90
Rate for Payer: Adventist Health Medi-Cal	$102,887.75
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$122,607.90

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility IP

$346,397.97

Service Code	APR-DRG 5934
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$346,397.97
Rate for Payer: Adventist Health Medi-Cal	$290,683.61
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$346,397.97

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility IP

$34,005.88

Service Code	APR-DRG 5931
Min. Negotiated Rate	$1,905.54
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$1,905.54
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$2,270.77

NEONATE, BIRTH WEIGHT <750 GRAMS, DIED

Facility IP

$34,005.88

Service Code	TRIS-DRG 613
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 GRAMS, DISCHARGED ALIVE

Facility IP

$34,005.88

Service Code	TRIS-DRG 612
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, DIED WITHIN ONE DAY OF BIRTH

Facility IP

$34,005.88

Service Code	TRIS-DRG 610
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, TRANSFERRED <5 DAYS OLD

Facility IP

$34,005.88

Service Code	TRIS-DRG 611
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, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility IP

$34,005.88

Service Code	APR-DRG 5811
Min. Negotiated Rate	$1,295.09
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$1,295.09
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$1,543.31

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility IP

$34,005.88

Service Code	APR-DRG 5812
Min. Negotiated Rate	$1,939.14
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$1,939.14
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$2,310.81

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility IP

$34,005.88

Service Code	APR-DRG 5813
Min. Negotiated Rate	$2,973.82
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$2,973.82
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$3,543.80

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility IP

$34,005.88

Service Code	APR-DRG 5814
Min. Negotiated Rate	$7,165.38
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$7,165.38
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$8,538.74

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility IP

$34,005.88

Service Code	APR-DRG 5801
Min. Negotiated Rate	$3,718.67
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$3,718.67
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$4,431.41

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility IP

$34,005.88

Service Code	APR-DRG 5803
Min. Negotiated Rate	$7,801.36
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$7,801.36
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$9,296.62

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility IP

$34,005.88

Service Code	APR-DRG 5804
Min. Negotiated Rate	$18,419.50
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$18,419.50
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$21,949.90

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility IP

$34,005.88

Service Code	APR-DRG 5802
Min. Negotiated Rate	$4,754.74
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$4,754.74
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$5,666.06

NEONATE WITH ECMO

Facility IP

$226,947.92

Service Code	APR-DRG 5831
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$226,947.92
Rate for Payer: Adventist Health Medi-Cal	$190,445.81
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$226,947.92

NEONATE WITH ECMO

Facility IP

$262,616.10

Service Code	APR-DRG 5832
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$262,616.10
Rate for Payer: Adventist Health Medi-Cal	$220,377.14
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$262,616.10

NEONATE WITH ECMO

Facility IP

$647,505.06

Service Code	APR-DRG 5834
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$647,505.06
Rate for Payer: Adventist Health Medi-Cal	$543,360.89
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$647,505.06

NEONATE WITH ECMO

Facility IP

$356,136.19

Service Code	APR-DRG 5833
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$356,136.19
Rate for Payer: Adventist Health Medi-Cal	$298,855.55
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$356,136.19

NEOSTIGMINE METHYLSULFATE 1 MG/ML INJECTION SOLUTION. [4085490]

Facility OP

$3.02

Service Code	CPT J2710
Hospital Charge Code	NDG120692
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$22.61
Rate for Payer: Aetna of CA HMO/PPO	$4.91
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$2.57
Rate for Payer: AlphaCare Medical Group Medi-Cal	$1.66
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$1.66
Rate for Payer: Anthem Blue Cross of CA Exchange	$20.65
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$22.61
Rate for Payer: BCBS Transplant Transplant	$1.81
Rate for Payer: Blue Shield of California Commercial	$2.29
Rate for Payer: Blue Shield of California EPN	$2.08
Rate for Payer: Cash Price	$1.36
Rate for Payer: Cash Price	$1.36
Rate for Payer: Central Health Plan Commercial	$2.42
Rate for Payer: Cigna of CA HMO	$2.11
Rate for Payer: Cigna of CA PPO	$2.11
Rate for Payer: Dignity Health Commercial/Exchange	$2.57
Rate for Payer: EPIC Health Plan Commercial	$1.21
Rate for Payer: EPIC Health Plan Transplant	$1.21
Rate for Payer: Galaxy Health WC	$2.57
Rate for Payer: Global Benefits Group Commercial	$1.81
Rate for Payer: Health Management Network EPO/PPO	$2.72
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other	$2.26
Rate for Payer: IEHP medi-cal	$1.06
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$2.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Commercial	$2.26
Rate for Payer: Networks By Design Commercial	$1.51
Rate for Payer: Prime Health Services Commercial	$2.57
Rate for Payer: Riverside University Health MISP	$1.21
Rate for Payer: Temecula Valley Physicians Medical Group Commercial	$1.81
Rate for Payer: TriValley Medical Group Commercial/Senior	$1.81
Rate for Payer: United Healthcare All Other Commercial	$1.51
Rate for Payer: United Healthcare All Other HMO	$1.51
Rate for Payer: United Healthcare HMO Rider	$1.51
Rate for Payer: United Healthcare Select/Navigate/Core	$1.51
Rate for Payer: Vantage Medical Group Medi-Cal	$2.57
Rate for Payer: Vantage Medical Group Senior	$2.57

NEOSTIGMINE METHYLSULFATE 1 MG/ML INJECTION SOLUTION. [4085490]

Facility IP

$3.02

Service Code	CPT J2710
Hospital Charge Code	NDG120692
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$34,005.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: Blue Shield of California Commercial	$2.26
Rate for Payer: Blue Shield of California EPN	$1.61
Rate for Payer: Cash Price	$1.36
Rate for Payer: Cash Price	$1.36
Rate for Payer: Central Health Plan Commercial	$2.42
Rate for Payer: Cigna of CA HMO	$2.11
Rate for Payer: Cigna of CA PPO	$2.11
Rate for Payer: EPIC Health Plan Commercial	$1.21
Rate for Payer: EPIC Health Plan Transplant	$1.21
Rate for Payer: Galaxy Health WC	$2.57
Rate for Payer: Global Benefits Group Commercial	$1.81
Rate for Payer: Health Management Network EPO/PPO	$2.72
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$2.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Commercial	$2.26
Rate for Payer: Networks By Design Commercial	$1.51
Rate for Payer: Prime Health Services Commercial	$2.57

NEOSTIGMINE METHYLSULFATE 5 MG/5 ML (1 MG/ML) INTRAVENOUS SYRINGE [120692]

Facility IP

$3.02

Service Code	CPT J2710
Hospital Charge Code	NDG120692
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$34,005.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: Blue Shield of California Commercial	$2.26
Rate for Payer: Blue Shield of California EPN	$1.61
Rate for Payer: Cash Price	$1.36
Rate for Payer: Cash Price	$1.36
Rate for Payer: Central Health Plan Commercial	$2.42
Rate for Payer: Cigna of CA HMO	$2.11
Rate for Payer: Cigna of CA PPO	$2.11
Rate for Payer: EPIC Health Plan Commercial	$1.21
Rate for Payer: EPIC Health Plan Transplant	$1.21
Rate for Payer: Galaxy Health WC	$2.57
Rate for Payer: Global Benefits Group Commercial	$1.81
Rate for Payer: Health Management Network EPO/PPO	$2.72
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$2.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Commercial	$2.26
Rate for Payer: Networks By Design Commercial	$1.51
Rate for Payer: Prime Health Services Commercial	$2.57

NEOSTIGMINE METHYLSULFATE 5 MG/5 ML (1 MG/ML) INTRAVENOUS SYRINGE [120692]

Facility OP

$3.02

Service Code	CPT J2710
Hospital Charge Code	NDG120692
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$22.61
Rate for Payer: Aetna of CA HMO/PPO	$4.91
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$2.57
Rate for Payer: AlphaCare Medical Group Medi-Cal	$1.66
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$1.66
Rate for Payer: Anthem Blue Cross of CA Exchange	$20.65
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$22.61
Rate for Payer: BCBS Transplant Transplant	$1.81
Rate for Payer: Blue Shield of California Commercial	$2.29
Rate for Payer: Blue Shield of California EPN	$2.08
Rate for Payer: Cash Price	$1.36
Rate for Payer: Cash Price	$1.36
Rate for Payer: Central Health Plan Commercial	$2.42
Rate for Payer: Cigna of CA HMO	$2.11
Rate for Payer: Cigna of CA PPO	$2.11
Rate for Payer: Dignity Health Commercial/Exchange	$2.57
Rate for Payer: EPIC Health Plan Commercial	$1.21
Rate for Payer: EPIC Health Plan Transplant	$1.21
Rate for Payer: Galaxy Health WC	$2.57
Rate for Payer: Global Benefits Group Commercial	$1.81
Rate for Payer: Health Management Network EPO/PPO	$2.72
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other	$2.26
Rate for Payer: IEHP medi-cal	$1.06
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$2.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.60
Rate for Payer: Multiplan Commercial	$2.26
Rate for Payer: Networks By Design Commercial	$1.51
Rate for Payer: Prime Health Services Commercial	$2.57
Rate for Payer: Riverside University Health MISP	$1.21
Rate for Payer: Temecula Valley Physicians Medical Group Commercial	$1.81
Rate for Payer: TriValley Medical Group Commercial/Senior	$1.81
Rate for Payer: United Healthcare All Other Commercial	$1.51
Rate for Payer: United Healthcare All Other HMO	$1.51
Rate for Payer: United Healthcare HMO Rider	$1.51
Rate for Payer: United Healthcare Select/Navigate/Core	$1.51
Rate for Payer: Vantage Medical Group Medi-Cal	$2.57
Rate for Payer: Vantage Medical Group Senior	$2.57

NEPAFENAC 0.1 % EYE DROPS,SUSPENSION [42486]

Facility OP

$125.38

Service Code	NDC 0065-0002-03
Hospital Charge Code	1740380
Hospital Revenue Code	259
Min. Negotiated Rate	$25.08
Max. Negotiated Rate	$112.84
Rate for Payer: Aetna of CA HMO/PPO	$76.14
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$106.57
Rate for Payer: AlphaCare Medical Group Medi-Cal	$68.96
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$68.96
Rate for Payer: Anthem Blue Cross of CA Exchange	$60.71
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$74.07
Rate for Payer: BCBS Transplant Transplant	$75.23
Rate for Payer: Blue Shield of California Commercial	$78.86
Rate for Payer: Blue Shield of California EPN	$61.31
Rate for Payer: Cash Price	$56.42
Rate for Payer: Central Health Plan Commercial	$100.30
Rate for Payer: Cigna of CA HMO	$87.77
Rate for Payer: Cigna of CA PPO	$87.77
Rate for Payer: Dignity Health Commercial/Exchange	$106.57
Rate for Payer: EPIC Health Plan Commercial	$50.15
Rate for Payer: EPIC Health Plan Transplant	$50.15
Rate for Payer: Galaxy Health WC	$106.57
Rate for Payer: Global Benefits Group Commercial	$75.23
Rate for Payer: Health Management Network EPO/PPO	$112.84
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other	$94.04
Rate for Payer: IEHP medi-cal	$43.88
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$83.63
Rate for Payer: LLUH Dept of Risk Management WC	$25.08
Rate for Payer: Multiplan Commercial	$94.04
Rate for Payer: Networks By Design Commercial	$81.50
Rate for Payer: Prime Health Services Commercial	$106.57
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior	$75.23
Rate for Payer: Riverside University Health MISP	$50.15
Rate for Payer: Temecula Valley Physicians Medical Group Commercial	$75.23
Rate for Payer: TriValley Medical Group Commercial/Senior	$75.23
Rate for Payer: United Healthcare All Other Commercial	$62.69
Rate for Payer: United Healthcare All Other HMO	$62.69
Rate for Payer: United Healthcare HMO Rider	$62.69
Rate for Payer: United Healthcare Select/Navigate/Core	$62.69
Rate for Payer: Vantage Medical Group Medi-Cal	$106.57
Rate for Payer: Vantage Medical Group Senior	$106.57

Price Transparency.

All Charges