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

$0.53

Service Code	APR-DRG 6341
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.53

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

Facility

$1.13

Service Code	APR-DRG 6342
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.13

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

Facility

$11.01

Service Code	APR-DRG 5913
Min. Negotiated Rate	$11.01
Max. Negotiated Rate	$11.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11.01

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

Facility

$0.10

Service Code	APR-DRG 5911
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.10

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

Facility

$16.82

Service Code	APR-DRG 5914
Min. Negotiated Rate	$16.82
Max. Negotiated Rate	$16.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16.82

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

Facility

$6.51

Service Code	APR-DRG 5912
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$6.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6.51

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

$6.15

Service Code	APR-DRG 5891
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$6.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6.15

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

$4.48

Service Code	APR-DRG 5892
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$4.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4.48

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

$3.76

Service Code	APR-DRG 5893
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$3.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$3.76

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

$0.07

Service Code	APR-DRG 5894
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.07

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

Facility

$16.99

Service Code	APR-DRG 5934
Min. Negotiated Rate	$16.99
Max. Negotiated Rate	$16.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16.99

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

Facility

$11.45

Service Code	APR-DRG 5933
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$11.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11.45

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

Facility

$0.17

Service Code	APR-DRG 5931
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.17

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

Facility

$8.89

Service Code	APR-DRG 5932
Min. Negotiated Rate	$8.89
Max. Negotiated Rate	$8.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8.89

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

Facility

$0.10

Service Code	APR-DRG 5811
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.10

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

Facility

$0.16

Service Code	APR-DRG 5812
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.16

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

Facility

$0.24

Service Code	APR-DRG 5813
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.24

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

Facility

$0.38

Service Code	APR-DRG 5814
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.38

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

Facility

$0.29

Service Code	APR-DRG 5801
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.29

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

Facility

$0.40

Service Code	APR-DRG 5802
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.40

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

Facility

$0.58

Service Code	APR-DRG 5803
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.58

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

Facility

$1.03

Service Code	APR-DRG 5804
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$1.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.03

APR-DRG 41.00: NEONATE WITH ECMO

Facility

$15.33

Service Code	APR-DRG 5831
Min. Negotiated Rate	$15.33
Max. Negotiated Rate	$15.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$15.33

APR-DRG 41.00: NEONATE WITH ECMO

Facility

$18.94

Service Code	APR-DRG 5832
Min. Negotiated Rate	$18.94
Max. Negotiated Rate	$18.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18.94

APR-DRG 41.00: NEONATE WITH ECMO

Facility

$30.17

Service Code	APR-DRG 5833
Min. Negotiated Rate	$30.17
Max. Negotiated Rate	$30.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$30.17

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All Charges