Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$53,976.83

Service Code	APR-DRG 5912
Min. Negotiated Rate	$53,976.83
Max. Negotiated Rate	$53,976.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$53,976.83

NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$249,331.28

Service Code	APR-DRG 5914
Min. Negotiated Rate	$249,331.28
Max. Negotiated Rate	$249,331.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$249,331.28

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

$35,468.04

Service Code	APR-DRG 5893
Min. Negotiated Rate	$35,468.04
Max. Negotiated Rate	$35,468.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$35,468.04

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

$1,083.45

Service Code	APR-DRG 5894
Min. Negotiated Rate	$1,083.45
Max. Negotiated Rate	$1,083.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1,083.45

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

$44,591.23

Service Code	APR-DRG 5892
Min. Negotiated Rate	$44,591.23
Max. Negotiated Rate	$44,591.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$44,591.23

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

$53,713.20

Service Code	APR-DRG 5891
Min. Negotiated Rate	$53,713.20
Max. Negotiated Rate	$53,713.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$53,713.20

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$258,195.81

Service Code	APR-DRG 5934
Min. Negotiated Rate	$258,195.81
Max. Negotiated Rate	$258,195.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$258,195.81

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$1,692.57

Service Code	APR-DRG 5931
Min. Negotiated Rate	$1,692.57
Max. Negotiated Rate	$1,692.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1,692.57

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$91,388.66

Service Code	APR-DRG 5932
Min. Negotiated Rate	$91,388.66
Max. Negotiated Rate	$91,388.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$91,388.66

NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE

Facility

$115,303.47

Service Code	APR-DRG 5933
Min. Negotiated Rate	$115,303.47
Max. Negotiated Rate	$115,303.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$115,303.47

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$6,364.55

Service Code	APR-DRG 5814
Min. Negotiated Rate	$6,364.55
Max. Negotiated Rate	$6,364.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,364.55

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$2,641.45

Service Code	APR-DRG 5813
Min. Negotiated Rate	$2,641.45
Max. Negotiated Rate	$2,641.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$2,641.45

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$1,722.42

Service Code	APR-DRG 5812
Min. Negotiated Rate	$1,722.42
Max. Negotiated Rate	$1,722.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1,722.42

NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE

Facility

$1,150.35

Service Code	APR-DRG 5811
Min. Negotiated Rate	$1,150.35
Max. Negotiated Rate	$1,150.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1,150.35

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$6,929.45

Service Code	APR-DRG 5803
Min. Negotiated Rate	$6,929.45
Max. Negotiated Rate	$6,929.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,929.45

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$4,223.33

Service Code	APR-DRG 5802
Min. Negotiated Rate	$4,223.33
Max. Negotiated Rate	$4,223.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,223.33

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$3,303.05

Service Code	APR-DRG 5801
Min. Negotiated Rate	$3,303.05
Max. Negotiated Rate	$3,303.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$3,303.05

NEONATE, TRANSFERRED < 5 DAYS OLD, NOT BORN HERE

Facility

$16,360.87

Service Code	APR-DRG 5804
Min. Negotiated Rate	$16,360.87
Max. Negotiated Rate	$16,360.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,360.87

NEONATE WITH ECMO

Facility

$265,454.42

Service Code	APR-DRG 5833
Min. Negotiated Rate	$265,454.42
Max. Negotiated Rate	$265,454.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$265,454.42

NEONATE WITH ECMO

Facility

$169,160.92

Service Code	APR-DRG 5831
Min. Negotiated Rate	$169,160.92
Max. Negotiated Rate	$169,160.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$169,160.92

NEONATE WITH ECMO

Facility

$195,747.03

Service Code	APR-DRG 5832
Min. Negotiated Rate	$195,747.03
Max. Negotiated Rate	$195,747.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$195,747.03

NEONATE WITH ECMO

Facility

$482,633.00

Service Code	APR-DRG 5834
Min. Negotiated Rate	$482,633.00
Max. Negotiated Rate	$482,633.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$482,633.00

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

Facility

$3.02

Service Code	CPT J2710
Hospital Charge Code	NDG120692
Hospital Revenue Code	636
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$2.26
Rate for Payer: Adventist Health Commercial	$0.60
Rate for Payer: Aetna of CA Non-Gatekeeper	$2.07
Rate for Payer: Cash Price	$1.36
Rate for Payer: Cigna of CA HMO/PPO	$1.39
Rate for Payer: EPIC Health Plan Commercial	$1.63
Rate for Payer: Heritage Provider Network Commercial	$2.04
Rate for Payer: Heritage Provider Network Senior	$2.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.55
Rate for Payer: LLUH Dept of Risk Management WC	$0.76
Rate for Payer: Multiplan Commercial	$2.26
Rate for Payer: United Healthcare All Other HMO/non HMO	$1.10
Rate for Payer: United Healthcare Navigate/Select/Select+	$1.01

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

Facility

$3.02

Service Code	CPT J2710
Hospital Charge Code	NDG120692
Hospital Revenue Code	636
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$22.30
Rate for Payer: Adventist Health Commercial	$0.60
Rate for Payer: Aetna of CA Gatekeeper	$1.95
Rate for Payer: Aetna of CA Non-Gatekeeper	$2.07
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$2.57
Rate for Payer: Alpha Care Medical Group Medi-Cal	$1.66
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$2.26
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$22.30
Rate for Payer: Blue Shield of California Commercial	$0.82
Rate for Payer: Blue Shield of California EPN	$0.82
Rate for Payer: Cash Price	$1.36
Rate for Payer: Cash Price	$1.36
Rate for Payer: Cigna of CA HMO/PPO	$1.39
Rate for Payer: Dignity Health Commercial/Exchange	$2.57
Rate for Payer: Dignity Health Medi-Cal	$2.57
Rate for Payer: Dignity Health Senior	$2.57
Rate for Payer: EPIC Health Plan Commercial	$1.93
Rate for Payer: Heritage Provider Network Commercial	$1.40
Rate for Payer: Heritage Provider Network Senior	$1.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8.61
Rate for Payer: Kaiser Permanente of CA Commercial	$1.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.55
Rate for Payer: LLUH Dept of Risk Management WC	$0.76
Rate for Payer: Multiplan Commercial	$2.26
Rate for Payer: TriValley Medical Group Commercial	$1.21
Rate for Payer: TriValley Medical Group Senior	$1.21
Rate for Payer: United Healthcare All Other HMO/non HMO	$1.10
Rate for Payer: United Healthcare Navigate/Select/Select+	$1.01
Rate for Payer: Vantage Medical Group Medi-Cal	$2.57
Rate for Payer: Vantage Medical Group Senior	$2.57

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

Facility

$3.02

Service Code	CPT J2710
Hospital Charge Code	NDG120692
Hospital Revenue Code	636
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$22.30
Rate for Payer: Adventist Health Commercial	$0.60
Rate for Payer: Aetna of CA Gatekeeper	$1.95
Rate for Payer: Aetna of CA Non-Gatekeeper	$2.07
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$2.57
Rate for Payer: Alpha Care Medical Group Medi-Cal	$1.66
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$2.26
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$22.30
Rate for Payer: Blue Shield of California Commercial	$0.82
Rate for Payer: Blue Shield of California EPN	$0.82
Rate for Payer: Cash Price	$1.36
Rate for Payer: Cash Price	$1.36
Rate for Payer: Cigna of CA HMO/PPO	$1.39
Rate for Payer: Dignity Health Commercial/Exchange	$2.57
Rate for Payer: Dignity Health Medi-Cal	$2.57
Rate for Payer: Dignity Health Senior	$2.57
Rate for Payer: EPIC Health Plan Commercial	$1.93
Rate for Payer: Heritage Provider Network Commercial	$1.40
Rate for Payer: Heritage Provider Network Senior	$1.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8.61
Rate for Payer: Kaiser Permanente of CA Commercial	$1.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.55
Rate for Payer: LLUH Dept of Risk Management WC	$0.76
Rate for Payer: Multiplan Commercial	$2.26
Rate for Payer: TriValley Medical Group Commercial	$1.21
Rate for Payer: TriValley Medical Group Senior	$1.21
Rate for Payer: United Healthcare All Other HMO/non HMO	$1.10
Rate for Payer: United Healthcare Navigate/Select/Select+	$1.01
Rate for Payer: Vantage Medical Group Medi-Cal	$2.57
Rate for Payer: Vantage Medical Group Senior	$2.57

Know your out-of-pocket cost for care.

All Charges