Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 41.00: CONNECTIVE TISSUE DISORDERS

Facility

$12,727.19

Service Code	APR-DRG 3461
Min. Negotiated Rate	$10,165.00
Max. Negotiated Rate	$12,727.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,165.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,727.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,387.48

APR-DRG 41.00: CONNECTIVE TISSUE DISORDERS

Facility

$17,124.89

Service Code	APR-DRG 3462
Min. Negotiated Rate	$13,677.38
Max. Negotiated Rate	$17,124.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,677.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,124.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,322.27

APR-DRG 41.00: CONNECTIVE TISSUE DISORDERS

Facility

$75,116.12

Service Code	APR-DRG 3464
Min. Negotiated Rate	$59,994.06
Max. Negotiated Rate	$75,116.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$59,994.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$75,116.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$67,209.16

APR-DRG 41.00: CONNECTIVE TISSUE DISORDERS

Facility

$25,936.94

Service Code	APR-DRG 3463
Min. Negotiated Rate	$20,715.42
Max. Negotiated Rate	$25,936.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$20,715.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$25,936.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,206.73

APR-DRG 41.00: CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$11,590.93

Service Code	APR-DRG 3841
Min. Negotiated Rate	$9,257.49
Max. Negotiated Rate	$11,590.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,257.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,590.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,370.83

APR-DRG 41.00: CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$21,194.56

Service Code	APR-DRG 3843
Min. Negotiated Rate	$16,927.76
Max. Negotiated Rate	$21,194.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,927.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$21,194.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,963.55

APR-DRG 41.00: CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$14,412.58

Service Code	APR-DRG 3842
Min. Negotiated Rate	$11,511.10
Max. Negotiated Rate	$14,412.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,511.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,412.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,895.47

APR-DRG 41.00: CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$49,280.91

Service Code	APR-DRG 3844
Min. Negotiated Rate	$39,359.88
Max. Negotiated Rate	$49,280.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$39,359.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$49,280.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,093.44

APR-DRG 41.00: CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$79,493.85

Service Code	APR-DRG 1651
Min. Negotiated Rate	$63,490.49
Max. Negotiated Rate	$79,493.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$63,490.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$79,493.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$71,126.08

APR-DRG 41.00: CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$216,465.94

Service Code	APR-DRG 1654
Min. Negotiated Rate	$172,887.93
Max. Negotiated Rate	$216,465.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$172,887.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$216,465.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$193,680.05

APR-DRG 41.00: CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$92,304.24

Service Code	APR-DRG 1652
Min. Negotiated Rate	$73,721.94
Max. Negotiated Rate	$92,304.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$73,721.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$92,304.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$82,588.01

APR-DRG 41.00: CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$110,971.91

Service Code	APR-DRG 1653
Min. Negotiated Rate	$88,631.51
Max. Negotiated Rate	$110,971.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$88,631.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$110,971.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$99,290.66

APR-DRG 41.00: CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$92,553.85

Service Code	APR-DRG 1663
Min. Negotiated Rate	$73,921.29
Max. Negotiated Rate	$92,553.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$73,921.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$92,553.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$82,811.34

APR-DRG 41.00: CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$78,307.66

Service Code	APR-DRG 1662
Min. Negotiated Rate	$62,543.09
Max. Negotiated Rate	$78,307.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$62,543.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$78,307.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$70,064.75

APR-DRG 41.00: CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$70,215.89

Service Code	APR-DRG 1661
Min. Negotiated Rate	$56,080.32
Max. Negotiated Rate	$70,215.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$56,080.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$70,215.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$62,824.74

APR-DRG 41.00: CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$190,547.54

Service Code	APR-DRG 1664
Min. Negotiated Rate	$152,187.31
Max. Negotiated Rate	$190,547.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$152,187.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$190,547.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$170,489.91

APR-DRG 41.00: CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$85,546.06

Service Code	APR-DRG 9103
Min. Negotiated Rate	$68,324.28
Max. Negotiated Rate	$85,546.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$68,324.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$85,546.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$76,541.21

APR-DRG 41.00: CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$192,081.73

Service Code	APR-DRG 9104
Min. Negotiated Rate	$153,412.65
Max. Negotiated Rate	$192,081.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$153,412.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$192,081.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$171,862.61

APR-DRG 41.00: CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$57,260.49

Service Code	APR-DRG 9102
Min. Negotiated Rate	$45,733.05
Max. Negotiated Rate	$57,260.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$45,733.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$57,260.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$51,233.07

APR-DRG 41.00: CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$54,398.41

Service Code	APR-DRG 9101
Min. Negotiated Rate	$43,447.15
Max. Negotiated Rate	$54,398.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$43,447.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$54,398.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$48,672.26

APR-DRG 41.00: CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION

Facility

$16,038.55

Service Code	APR-DRG 0451
Min. Negotiated Rate	$12,809.73
Max. Negotiated Rate	$16,038.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,809.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$16,038.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,350.28

APR-DRG 41.00: CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION

Facility

$26,740.43

Service Code	APR-DRG 0453
Min. Negotiated Rate	$21,357.16
Max. Negotiated Rate	$26,740.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$21,357.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$26,740.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,925.65

APR-DRG 41.00: CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION

Facility

$19,910.90

Service Code	APR-DRG 0452
Min. Negotiated Rate	$15,902.52
Max. Negotiated Rate	$19,910.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$15,902.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$19,910.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,815.01

APR-DRG 41.00: CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION

Facility

$57,484.40

Service Code	APR-DRG 0454
Min. Negotiated Rate	$45,911.89
Max. Negotiated Rate	$57,484.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$45,911.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$57,484.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$51,433.42

APR-DRG 41.00: CYSTIC FIBROSIS - PULMONARY DISEASE

Facility

$30,130.22

Service Code	APR-DRG 1312
Min. Negotiated Rate	$24,064.53
Max. Negotiated Rate	$30,130.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$24,064.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$30,130.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,958.62

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