Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

APR-DRG 41.00: NEONATE BIRTH WEIGHT > 2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$134,581.54

Service Code	APR-DRG 6344
Min. Negotiated Rate	$84,998.87
Max. Negotiated Rate	$134,581.54
Rate for Payer: Adventist Health Medi-Cal	$84,998.87
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$101,290.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$134,581.54

APR-DRG 41.00: NEONATE BIRTH WEIGHT > 2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION

Facility

$35,047.10

Service Code	APR-DRG 6343
Min. Negotiated Rate	$22,135.01
Max. Negotiated Rate	$35,047.10
Rate for Payer: Adventist Health Medi-Cal	$22,135.01
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$26,377.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$35,047.10

APR-DRG 41.00: NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$193,432.90

Service Code	APR-DRG 5912
Min. Negotiated Rate	$122,168.15
Max. Negotiated Rate	$193,432.90
Rate for Payer: Adventist Health Medi-Cal	$122,168.15
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$145,583.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$193,432.90

APR-DRG 41.00: NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$2,905.33

Service Code	APR-DRG 5911
Min. Negotiated Rate	$1,834.94
Max. Negotiated Rate	$2,905.33
Rate for Payer: Adventist Health Medi-Cal	$1,834.94
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$2,186.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$2,905.33

APR-DRG 41.00: NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$327,234.85

Service Code	APR-DRG 5913
Min. Negotiated Rate	$206,674.64
Max. Negotiated Rate	$327,234.85
Rate for Payer: Adventist Health Medi-Cal	$206,674.64
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$246,287.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$327,234.85

APR-DRG 41.00: NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$656,912.25

Service Code	APR-DRG 5914
Min. Negotiated Rate	$414,891.95
Max. Negotiated Rate	$656,912.25
Rate for Payer: Adventist Health Medi-Cal	$414,891.95
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$494,412.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$656,912.25

APR-DRG 41.00: 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

$133,076.44

Service Code	APR-DRG 5892
Min. Negotiated Rate	$84,048.28
Max. Negotiated Rate	$133,076.44
Rate for Payer: Adventist Health Medi-Cal	$84,048.28
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$100,157.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$133,076.44

APR-DRG 41.00: 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

$182,726.76

Service Code	APR-DRG 5891
Min. Negotiated Rate	$115,406.38
Max. Negotiated Rate	$182,726.76
Rate for Payer: Adventist Health Medi-Cal	$115,406.38
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$137,525.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$182,726.76

APR-DRG 41.00: 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

$111,753.99

Service Code	APR-DRG 5893
Min. Negotiated Rate	$70,581.47
Max. Negotiated Rate	$111,753.99
Rate for Payer: Adventist Health Medi-Cal	$70,581.47
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$84,109.58
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$111,753.99

APR-DRG 41.00: 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

$2,650.59

Service Code	APR-DRG 5894
Min. Negotiated Rate	$1,674.06
Max. Negotiated Rate	$2,650.59
Rate for Payer: Adventist Health Medi-Cal	$1,674.06
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$1,994.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$2,650.59

APR-DRG 41.00: NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$340,054.27

Service Code	APR-DRG 5933
Min. Negotiated Rate	$214,771.12
Max. Negotiated Rate	$340,054.27
Rate for Payer: Adventist Health Medi-Cal	$214,771.12
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$255,935.58
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$340,054.27

APR-DRG 41.00: NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$663,530.01

Service Code	APR-DRG 5934
Min. Negotiated Rate	$419,071.58
Max. Negotiated Rate	$663,530.01
Rate for Payer: Adventist Health Medi-Cal	$419,071.58
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$499,393.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$663,530.01

APR-DRG 41.00: NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$5,138.42

Service Code	APR-DRG 5931
Min. Negotiated Rate	$3,245.32
Max. Negotiated Rate	$5,138.42
Rate for Payer: Adventist Health Medi-Cal	$3,245.32
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$3,867.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$5,138.42

APR-DRG 41.00: NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$264,402.35

Service Code	APR-DRG 5932
Min. Negotiated Rate	$166,990.96
Max. Negotiated Rate	$264,402.35
Rate for Payer: Adventist Health Medi-Cal	$166,990.96
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$198,997.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$264,402.35

APR-DRG 41.00: NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$15,081.33

Service Code	APR-DRG 5814
Min. Negotiated Rate	$9,525.05
Max. Negotiated Rate	$15,081.33
Rate for Payer: Adventist Health Medi-Cal	$9,525.05
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$11,350.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,081.33

APR-DRG 41.00: NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$6,855.66

Service Code	APR-DRG 5813
Min. Negotiated Rate	$4,329.89
Max. Negotiated Rate	$6,855.66
Rate for Payer: Adventist Health Medi-Cal	$4,329.89
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$5,159.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$6,855.66

APR-DRG 41.00: NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$3,025.14

Service Code	APR-DRG 5811
Min. Negotiated Rate	$1,910.62
Max. Negotiated Rate	$3,025.14
Rate for Payer: Adventist Health Medi-Cal	$1,910.62
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$2,276.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$3,025.14

APR-DRG 41.00: NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$4,542.71

Service Code	APR-DRG 5812
Min. Negotiated Rate	$2,869.08
Max. Negotiated Rate	$4,542.71
Rate for Payer: Adventist Health Medi-Cal	$2,869.08
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$3,418.99
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$4,542.71

APR-DRG 41.00: NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$8,642.80

Service Code	APR-DRG 5801
Min. Negotiated Rate	$5,458.61
Max. Negotiated Rate	$8,642.80
Rate for Payer: Adventist Health Medi-Cal	$5,458.61
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$6,504.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,642.80

APR-DRG 41.00: NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$17,461.97

Service Code	APR-DRG 5803
Min. Negotiated Rate	$11,028.61
Max. Negotiated Rate	$17,461.97
Rate for Payer: Adventist Health Medi-Cal	$11,028.61
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$13,142.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,461.97

APR-DRG 41.00: NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$40,187.70

Service Code	APR-DRG 5804
Min. Negotiated Rate	$25,381.70
Max. Negotiated Rate	$40,187.70
Rate for Payer: Adventist Health Medi-Cal	$25,381.70
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$30,246.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$40,187.70

APR-DRG 41.00: NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$11,967.45

Service Code	APR-DRG 5802
Min. Negotiated Rate	$7,558.39
Max. Negotiated Rate	$11,967.45
Rate for Payer: Adventist Health Medi-Cal	$7,558.39
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$9,007.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,967.45

APR-DRG 41.00: NEONATE WITH ECMO

Facility

$1,353,238.01

Service Code	APR-DRG 5834
Min. Negotiated Rate	$854,676.64
Max. Negotiated Rate	$1,353,238.01
Rate for Payer: Adventist Health Medi-Cal	$854,676.64
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$1,018,489.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$1,353,238.01

APR-DRG 41.00: NEONATE WITH ECMO

Facility

$455,675.39

Service Code	APR-DRG 5831
Min. Negotiated Rate	$287,794.98
Max. Negotiated Rate	$455,675.39
Rate for Payer: Adventist Health Medi-Cal	$287,794.98
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$342,955.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$455,675.39

APR-DRG 41.00: NEONATE WITH ECMO

Facility

$562,690.32

Service Code	APR-DRG 5832
Min. Negotiated Rate	$355,383.36
Max. Negotiated Rate	$562,690.32
Rate for Payer: Adventist Health Medi-Cal	$355,383.36
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$423,498.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$562,690.32

Know your out-of-pocket cost for care.

All Charges