Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

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

APR-DRG 41.00: ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$10,980.00

Service Code	APR-DRG 0591
Min. Negotiated Rate	$8,769.56
Max. Negotiated Rate	$10,980.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,769.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,980.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,824.22

APR-DRG 41.00: ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$50,459.02

Service Code	APR-DRG 0594
Min. Negotiated Rate	$40,300.82
Max. Negotiated Rate	$50,459.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$40,300.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$50,459.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,147.55

APR-DRG 41.00: ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$25,112.07

Service Code	APR-DRG 0593
Min. Negotiated Rate	$20,056.62
Max. Negotiated Rate	$25,112.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$20,056.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$25,112.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,468.70

APR-DRG 41.00: ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$17,526.63

Service Code	APR-DRG 0592
Min. Negotiated Rate	$13,998.24
Max. Negotiated Rate	$17,526.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,998.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,526.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,681.72

APR-DRG 41.00: ANTEPARTUM WITH O.R. PROCEDURE

Facility

$21,529.15

Service Code	APR-DRG 5472
Min. Negotiated Rate	$11,880.17
Max. Negotiated Rate	$21,529.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,880.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,874.68
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,529.15

APR-DRG 41.00: ANTEPARTUM WITH O.R. PROCEDURE

Facility

$33,036.25

Service Code	APR-DRG 5473
Min. Negotiated Rate	$18,230.00
Max. Negotiated Rate	$33,036.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,230.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22,825.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,036.25

APR-DRG 41.00: ANTEPARTUM WITH O.R. PROCEDURE

Facility

$15,139.55

Service Code	APR-DRG 5471
Min. Negotiated Rate	$8,354.28
Max. Negotiated Rate	$15,139.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,354.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,460.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,139.55

APR-DRG 41.00: ANTEPARTUM WITH O.R. PROCEDURE

Facility

$62,150.06

Service Code	APR-DRG 5474
Min. Negotiated Rate	$34,295.53
Max. Negotiated Rate	$62,150.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$34,295.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$42,940.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$62,150.06

APR-DRG 41.00: ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$8,049.72

Service Code	APR-DRG 5662
Min. Negotiated Rate	$4,441.98
Max. Negotiated Rate	$8,049.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,441.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$5,561.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,049.72

APR-DRG 41.00: ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$12,043.95

Service Code	APR-DRG 5663
Min. Negotiated Rate	$6,646.07
Max. Negotiated Rate	$12,043.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,646.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,321.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,043.95

APR-DRG 41.00: ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$5,981.14

Service Code	APR-DRG 5661
Min. Negotiated Rate	$3,300.50
Max. Negotiated Rate	$5,981.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$3,300.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$4,132.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$5,981.14

APR-DRG 41.00: ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$28,200.21

Service Code	APR-DRG 5664
Min. Negotiated Rate	$15,561.39
Max. Negotiated Rate	$28,200.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$15,561.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$19,483.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,200.21

APR-DRG 41.00: APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$21,544.01

Service Code	APR-DRG 2331
Min. Negotiated Rate	$17,206.86
Max. Negotiated Rate	$21,544.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,206.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$21,544.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,276.22

APR-DRG 41.00: APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$38,718.81

Service Code	APR-DRG 2333
Min. Negotiated Rate	$30,924.10
Max. Negotiated Rate	$38,718.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$30,924.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$38,718.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,643.14

APR-DRG 41.00: APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$84,580.93

Service Code	APR-DRG 2334
Min. Negotiated Rate	$67,553.45
Max. Negotiated Rate	$84,580.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$67,553.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$84,580.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$75,677.68

APR-DRG 41.00: APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$27,539.13

Service Code	APR-DRG 2332
Min. Negotiated Rate	$21,995.07
Max. Negotiated Rate	$27,539.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$21,995.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$27,539.13
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,640.28

APR-DRG 41.00: APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$77,429.07

Service Code	APR-DRG 2344
Min. Negotiated Rate	$61,841.37
Max. Negotiated Rate	$77,429.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$61,841.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$77,429.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$69,278.64

APR-DRG 41.00: APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$17,300.81

Service Code	APR-DRG 2341
Min. Negotiated Rate	$13,817.88
Max. Negotiated Rate	$17,300.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,817.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,300.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,479.67

APR-DRG 41.00: APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$32,086.61

Service Code	APR-DRG 2343
Min. Negotiated Rate	$25,627.07
Max. Negotiated Rate	$32,086.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$25,627.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$32,086.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,709.07

APR-DRG 41.00: APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$22,007.55

Service Code	APR-DRG 2342
Min. Negotiated Rate	$17,577.08
Max. Negotiated Rate	$22,007.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,577.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22,007.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,690.96

APR-DRG 41.00: ASTHMA

Facility

$11,750.19

Service Code	APR-DRG 1412
Min. Negotiated Rate	$9,384.69
Max. Negotiated Rate	$11,750.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,384.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,750.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,513.33

APR-DRG 41.00: ASTHMA

Facility

$39,183.97

Service Code	APR-DRG 1414
Min. Negotiated Rate	$31,295.61
Max. Negotiated Rate	$39,183.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$31,295.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$39,183.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,059.34

APR-DRG 41.00: ASTHMA

Facility

$8,022.85

Service Code	APR-DRG 1411
Min. Negotiated Rate	$6,407.72
Max. Negotiated Rate	$8,022.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,407.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,022.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$7,178.34

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