Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

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: AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$77,109.58

Service Code	APR-DRG 0082
Min. Negotiated Rate	$40,583.99
Max. Negotiated Rate	$77,109.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$61,586.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant	$40,583.99
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$77,109.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$68,992.78

APR-DRG 41.00: AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$92,311.39

Service Code	APR-DRG 0083
Min. Negotiated Rate	$48,584.94
Max. Negotiated Rate	$92,311.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$73,727.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant	$48,584.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$92,311.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$82,594.40

APR-DRG 41.00: AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$47,918.34

Service Code	APR-DRG 0081
Min. Negotiated Rate	$25,220.18
Max. Negotiated Rate	$47,918.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$38,271.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant	$25,220.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$47,918.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,874.31

APR-DRG 41.00: AUTOLOGOUS BONE MARROW TRANSPLANT

Facility

$215,650.59

Service Code	APR-DRG 0084
Min. Negotiated Rate	$113,500.31
Max. Negotiated Rate	$215,650.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$172,236.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant	$113,500.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$215,650.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$192,950.53

APR-DRG 41.00: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$18,002.06

Service Code	APR-DRG 0491
Min. Negotiated Rate	$14,377.96
Max. Negotiated Rate	$18,002.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,377.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$18,002.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,107.11

APR-DRG 41.00: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$38,347.99

Service Code	APR-DRG 0492
Min. Negotiated Rate	$30,627.93
Max. Negotiated Rate	$38,347.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$30,627.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$38,347.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,311.36

APR-DRG 41.00: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$42,536.50

Service Code	APR-DRG 0493
Min. Negotiated Rate	$33,973.23
Max. Negotiated Rate	$42,536.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$33,973.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$42,536.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,058.97

APR-DRG 41.00: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$97,929.51

Service Code	APR-DRG 0494
Min. Negotiated Rate	$78,214.76
Max. Negotiated Rate	$97,929.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$78,214.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$97,929.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$87,621.15

APR-DRG 41.00: BEHAVIORAL DISORDERS

Facility

$7,460.41

Service Code	APR-DRG 7582
Min. Negotiated Rate	$5,958.51
Max. Negotiated Rate	$7,460.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,958.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$7,460.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$6,675.10

APR-DRG 41.00: BEHAVIORAL DISORDERS

Facility

$5,847.76

Service Code	APR-DRG 7581
Min. Negotiated Rate	$4,670.52
Max. Negotiated Rate	$5,847.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,670.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$5,847.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$5,232.21

APR-DRG 41.00: BEHAVIORAL DISORDERS

Facility

$13,043.82

Service Code	APR-DRG 7583
Min. Negotiated Rate	$10,417.90
Max. Negotiated Rate	$13,043.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,417.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$13,043.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,670.79

APR-DRG 41.00: BEHAVIORAL DISORDERS

Facility

$17,170.55

Service Code	APR-DRG 7584
Min. Negotiated Rate	$13,713.84
Max. Negotiated Rate	$17,170.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,713.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,170.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,363.12

APR-DRG 41.00: BIPOLAR DISORDERS

Facility

$6,534.27

Service Code	APR-DRG 7531
Min. Negotiated Rate	$5,218.82
Max. Negotiated Rate	$6,534.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,218.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$6,534.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$5,846.45

APR-DRG 41.00: BIPOLAR DISORDERS

Facility

$30,434.96

Service Code	APR-DRG 7534
Min. Negotiated Rate	$24,307.92
Max. Negotiated Rate	$30,434.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$24,307.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$30,434.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,231.28

APR-DRG 41.00: BIPOLAR DISORDERS

Facility

$8,816.32

Service Code	APR-DRG 7532
Min. Negotiated Rate	$7,041.46
Max. Negotiated Rate	$8,816.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,041.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,816.32
Rate for Payer: Molina Healthcare of CA Medi-Cal	$7,888.29

APR-DRG 41.00: BIPOLAR DISORDERS

Facility

$15,318.27

Service Code	APR-DRG 7533
Min. Negotiated Rate	$12,234.46
Max. Negotiated Rate	$15,318.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,234.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,318.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,705.83

APR-DRG 41.00: BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD

Facility

$18,448.96

Service Code	APR-DRG 1323
Min. Negotiated Rate	$14,734.89
Max. Negotiated Rate	$18,448.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,734.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$18,448.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,506.97

APR-DRG 41.00: BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD

Facility

$9,905.54

Service Code	APR-DRG 1322
Min. Negotiated Rate	$7,911.40
Max. Negotiated Rate	$9,905.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,911.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,905.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,862.85

APR-DRG 41.00: BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD

Facility

$39,940.47

Service Code	APR-DRG 1324
Min. Negotiated Rate	$31,899.82
Max. Negotiated Rate	$39,940.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$31,899.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$39,940.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,736.21

APR-DRG 41.00: BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD

Facility

$7,323.97

Service Code	APR-DRG 1321
Min. Negotiated Rate	$5,849.54
Max. Negotiated Rate	$7,323.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,849.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$7,323.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$6,553.02

APR-DRG 41.00: BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA

Facility

$24,893.38

Service Code	APR-DRG 0563
Min. Negotiated Rate	$19,881.95
Max. Negotiated Rate	$24,893.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,881.95
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$24,893.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,273.03

APR-DRG 41.00: BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA

Facility

$55,697.28

Service Code	APR-DRG 0564
Min. Negotiated Rate	$44,484.54
Max. Negotiated Rate	$55,697.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$44,484.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$55,697.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,834.41

APR-DRG 41.00: BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA

Facility

$16,442.66

Service Code	APR-DRG 0562
Min. Negotiated Rate	$13,132.49
Max. Negotiated Rate	$16,442.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,132.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$16,442.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,711.85

APR-DRG 41.00: BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA

Facility

$12,308.83

Service Code	APR-DRG 0561
Min. Negotiated Rate	$9,830.87
Max. Negotiated Rate	$12,308.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,830.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,308.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,013.16

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