Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 41.00: ALCOHOLIC LIVER DISEASE

Facility

$61,481.34

Service Code	APR-DRG 2804
Min. Negotiated Rate	$49,104.18
Max. Negotiated Rate	$61,481.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$49,104.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$61,481.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$55,009.62

APR-DRG 41.00: ALCOHOLIC LIVER DISEASE

Facility

$20,994.89

Service Code	APR-DRG 2803
Min. Negotiated Rate	$16,768.28
Max. Negotiated Rate	$20,994.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,768.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$20,994.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,784.90

APR-DRG 41.00: ALCOHOLIC LIVER DISEASE

Facility

$13,785.01

Service Code	APR-DRG 2802
Min. Negotiated Rate	$11,009.87
Max. Negotiated Rate	$13,785.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,009.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$13,785.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,333.96

APR-DRG 41.00: ALLERGIC REACTIONS

Facility

$9,786.67

Service Code	APR-DRG 8112
Min. Negotiated Rate	$7,816.46
Max. Negotiated Rate	$9,786.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,816.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,786.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,756.50

APR-DRG 41.00: ALLERGIC REACTIONS

Facility

$6,613.20

Service Code	APR-DRG 8111
Min. Negotiated Rate	$5,281.86
Max. Negotiated Rate	$6,613.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,281.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$6,613.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$5,917.07

APR-DRG 41.00: ALLERGIC REACTIONS

Facility

$19,589.99

Service Code	APR-DRG 8113
Min. Negotiated Rate	$15,646.21
Max. Negotiated Rate	$19,589.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$15,646.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$19,589.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,527.88

APR-DRG 41.00: ALLERGIC REACTIONS

Facility

$55,763.84

Service Code	APR-DRG 8114
Min. Negotiated Rate	$44,537.70
Max. Negotiated Rate	$55,763.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$44,537.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$55,763.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,893.96

APR-DRG 41.00: ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$113,006.74

Service Code	APR-DRG 0071
Min. Negotiated Rate	$59,477.23
Max. Negotiated Rate	$113,006.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$90,256.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant	$59,477.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$113,006.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$101,111.29

APR-DRG 41.00: ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$143,286.71

Service Code	APR-DRG 0072
Min. Negotiated Rate	$75,414.06
Max. Negotiated Rate	$143,286.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$114,440.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant	$75,414.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$143,286.71
Rate for Payer: Molina Healthcare of CA Medi-Cal	$128,203.90

APR-DRG 41.00: ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$181,905.70

Service Code	APR-DRG 0073
Min. Negotiated Rate	$95,739.84
Max. Negotiated Rate	$181,905.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$145,285.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant	$95,739.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$181,905.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$162,757.73

APR-DRG 41.00: ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$444,270.35

Service Code	APR-DRG 0074
Min. Negotiated Rate	$233,826.50
Max. Negotiated Rate	$444,270.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$354,831.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant	$233,826.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$444,270.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$397,505.05

APR-DRG 41.00: ALTERATION IN CONSCIOUSNESS

Facility

$11,788.23

Service Code	APR-DRG 0521
Min. Negotiated Rate	$9,415.07
Max. Negotiated Rate	$11,788.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,415.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,788.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,547.36

APR-DRG 41.00: ALTERATION IN CONSCIOUSNESS

Facility

$18,627.26

Service Code	APR-DRG 0523
Min. Negotiated Rate	$14,877.30
Max. Negotiated Rate	$18,627.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,877.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$18,627.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,666.49

APR-DRG 41.00: ALTERATION IN CONSCIOUSNESS

Facility

$53,713.80

Service Code	APR-DRG 0524
Min. Negotiated Rate	$42,900.36
Max. Negotiated Rate	$53,713.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$42,900.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$53,713.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$48,059.71

APR-DRG 41.00: ALTERATION IN CONSCIOUSNESS

Facility

$13,911.00

Service Code	APR-DRG 0522
Min. Negotiated Rate	$11,110.50
Max. Negotiated Rate	$13,911.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,110.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$13,911.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,446.69

APR-DRG 41.00: AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$21,574.90

Service Code	APR-DRG 3051
Min. Negotiated Rate	$17,231.53
Max. Negotiated Rate	$21,574.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,231.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$21,574.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,303.86

APR-DRG 41.00: AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$43,019.06

Service Code	APR-DRG 3053
Min. Negotiated Rate	$34,358.64
Max. Negotiated Rate	$43,019.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$34,358.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$43,019.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,490.74

APR-DRG 41.00: AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$107,896.84

Service Code	APR-DRG 3054
Min. Negotiated Rate	$86,175.50
Max. Negotiated Rate	$107,896.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$86,175.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$107,896.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$96,539.28

APR-DRG 41.00: AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$28,711.07

Service Code	APR-DRG 3052
Min. Negotiated Rate	$22,931.08
Max. Negotiated Rate	$28,711.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$22,931.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$28,711.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,688.85

APR-DRG 41.00: ANAL AND PERINEAL PROCEDURES

Facility

$77,119.57

Service Code	APR-DRG 2264
Min. Negotiated Rate	$61,594.19
Max. Negotiated Rate	$77,119.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$61,594.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$77,119.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$69,001.73

APR-DRG 41.00: ANAL AND PERINEAL PROCEDURES

Facility

$20,250.83

Service Code	APR-DRG 2262
Min. Negotiated Rate	$16,174.02
Max. Negotiated Rate	$20,250.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,174.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$20,250.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,119.16

APR-DRG 41.00: ANAL AND PERINEAL PROCEDURES

Facility

$16,059.94

Service Code	APR-DRG 2261
Min. Negotiated Rate	$12,826.82
Max. Negotiated Rate	$16,059.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,826.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$16,059.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,369.42

APR-DRG 41.00: ANAL AND PERINEAL PROCEDURES

Facility

$30,486.79

Service Code	APR-DRG 2263
Min. Negotiated Rate	$24,349.32
Max. Negotiated Rate	$30,486.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$24,349.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$30,486.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,277.66

APR-DRG 41.00: ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS

Facility

$15,163.77

Service Code	APR-DRG 1983
Min. Negotiated Rate	$12,111.06
Max. Negotiated Rate	$15,163.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,111.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,163.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,567.58

APR-DRG 41.00: ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS

Facility

$9,717.74

Service Code	APR-DRG 1981
Min. Negotiated Rate	$7,761.41
Max. Negotiated Rate	$9,717.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,761.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,717.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,694.82

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