Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 41.00: BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$40,556.34

Service Code	APR-DRG 3632
Min. Negotiated Rate	$32,391.71
Max. Negotiated Rate	$40,556.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$32,391.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$40,556.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,287.25

APR-DRG 41.00: BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$103,174.43

Service Code	APR-DRG 3634
Min. Negotiated Rate	$82,403.79
Max. Negotiated Rate	$103,174.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$82,403.79
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$103,174.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$92,313.96

APR-DRG 41.00: BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$21,289.65

Service Code	APR-DRG 3631
Min. Negotiated Rate	$17,003.71
Max. Negotiated Rate	$21,289.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,003.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$21,289.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,048.64

APR-DRG 41.00: BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$50,288.35

Service Code	APR-DRG 3633
Min. Negotiated Rate	$40,164.51
Max. Negotiated Rate	$50,288.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$40,164.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$50,288.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,994.83

APR-DRG 41.00: BRONCHIOLITIS AND RSV PNEUMONIA

Facility

$5,930.96

Service Code	APR-DRG 1381
Min. Negotiated Rate	$4,736.97
Max. Negotiated Rate	$5,930.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,736.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$5,930.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$5,306.65

APR-DRG 41.00: BRONCHIOLITIS AND RSV PNEUMONIA

Facility

$13,804.03

Service Code	APR-DRG 1383
Min. Negotiated Rate	$11,025.06
Max. Negotiated Rate	$13,804.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,025.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$13,804.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,350.98

APR-DRG 41.00: BRONCHIOLITIS AND RSV PNEUMONIA

Facility

$47,050.21

Service Code	APR-DRG 1384
Min. Negotiated Rate	$37,578.26
Max. Negotiated Rate	$47,050.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$37,578.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$47,050.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,097.56

APR-DRG 41.00: BRONCHIOLITIS AND RSV PNEUMONIA

Facility

$8,636.15

Service Code	APR-DRG 1382
Min. Negotiated Rate	$6,897.55
Max. Negotiated Rate	$8,636.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,897.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,636.15
Rate for Payer: Molina Healthcare of CA Medi-Cal	$7,727.08

APR-DRG 41.00: BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS

Facility

$38,110.28

Service Code	APR-DRG 8422
Min. Negotiated Rate	$30,438.08
Max. Negotiated Rate	$38,110.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$30,438.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$38,110.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,098.67

APR-DRG 41.00: BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS

Facility

$277,694.35

Service Code	APR-DRG 8424
Min. Negotiated Rate	$221,790.09
Max. Negotiated Rate	$277,694.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$221,790.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$277,694.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$248,463.36

APR-DRG 41.00: BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS

Facility

$24,513.04

Service Code	APR-DRG 8421
Min. Negotiated Rate	$19,578.18
Max. Negotiated Rate	$24,513.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,578.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$24,513.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,932.72

APR-DRG 41.00: BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS

Facility

$70,788.77

Service Code	APR-DRG 8423
Min. Negotiated Rate	$56,537.88
Max. Negotiated Rate	$70,788.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$56,537.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$70,788.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$63,337.32

APR-DRG 41.00: CARDIAC ARREST AND SHOCK

Facility

$11,567.14

Service Code	APR-DRG 1962
Min. Negotiated Rate	$9,238.49
Max. Negotiated Rate	$11,567.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,238.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,567.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,349.55

APR-DRG 41.00: CARDIAC ARREST AND SHOCK

Facility

$47,011.22

Service Code	APR-DRG 1964
Min. Negotiated Rate	$37,547.12
Max. Negotiated Rate	$47,011.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$37,547.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$47,011.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,062.68

APR-DRG 41.00: CARDIAC ARREST AND SHOCK

Facility

$18,277.81

Service Code	APR-DRG 1963
Min. Negotiated Rate	$14,598.20
Max. Negotiated Rate	$18,277.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,598.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$18,277.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,353.83

APR-DRG 41.00: CARDIAC ARREST AND SHOCK

Facility

$8,270.05

Service Code	APR-DRG 1961
Min. Negotiated Rate	$6,605.16
Max. Negotiated Rate	$8,270.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,605.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,270.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$7,399.52

APR-DRG 41.00: CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS

Facility

$18,035.35

Service Code	APR-DRG 2013
Min. Negotiated Rate	$14,404.55
Max. Negotiated Rate	$18,035.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,404.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$18,035.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,136.89

APR-DRG 41.00: CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS

Facility

$9,171.00

Service Code	APR-DRG 2011
Min. Negotiated Rate	$7,324.73
Max. Negotiated Rate	$9,171.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,324.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,171.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,205.63

APR-DRG 41.00: CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS

Facility

$11,847.66

Service Code	APR-DRG 2012
Min. Negotiated Rate	$9,462.54
Max. Negotiated Rate	$11,847.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,462.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,847.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,600.54

APR-DRG 41.00: CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS

Facility

$46,012.83

Service Code	APR-DRG 2014
Min. Negotiated Rate	$36,749.72
Max. Negotiated Rate	$46,012.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$36,749.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$46,012.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,169.38

APR-DRG 41.00: CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE

Facility

$22,230.99

Service Code	APR-DRG 1912
Min. Negotiated Rate	$17,755.54
Max. Negotiated Rate	$22,230.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,755.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22,230.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,890.88

APR-DRG 41.00: CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE

Facility

$28,934.51

Service Code	APR-DRG 1913
Min. Negotiated Rate	$23,109.54
Max. Negotiated Rate	$28,934.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$23,109.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$28,934.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,888.77

APR-DRG 41.00: CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE

Facility

$66,975.85

Service Code	APR-DRG 1914
Min. Negotiated Rate	$53,492.56
Max. Negotiated Rate	$66,975.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$53,492.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$66,975.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$59,925.76

APR-DRG 41.00: CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE

Facility

$19,093.18

Service Code	APR-DRG 1911
Min. Negotiated Rate	$15,249.42
Max. Negotiated Rate	$19,093.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$15,249.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$19,093.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,083.37

APR-DRG 41.00: CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS

Facility

$35,735.50

Service Code	APR-DRG 1923
Min. Negotiated Rate	$28,541.38
Max. Negotiated Rate	$35,735.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$28,541.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$35,735.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,973.87

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All Charges