Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 41.00: CYSTIC FIBROSIS - PULMONARY DISEASE

Facility

$40,829.71

Service Code	APR-DRG 1313
Min. Negotiated Rate	$32,610.04
Max. Negotiated Rate	$40,829.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$32,610.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$40,829.71
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,531.84

APR-DRG 41.00: CYSTIC FIBROSIS - PULMONARY DISEASE

Facility

$76,327.79

Service Code	APR-DRG 1314
Min. Negotiated Rate	$60,961.80
Max. Negotiated Rate	$76,327.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$60,961.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$76,327.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$68,293.28

APR-DRG 41.00: CYSTIC FIBROSIS - PULMONARY DISEASE

Facility

$22,965.53

Service Code	APR-DRG 1311
Min. Negotiated Rate	$18,342.20
Max. Negotiated Rate	$22,965.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,342.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22,965.53
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,548.10

APR-DRG 41.00: DEFIBRILLATOR IMPLANTS

Facility

$69,847.44

Service Code	APR-DRG 1791
Min. Negotiated Rate	$55,786.05
Max. Negotiated Rate	$69,847.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$55,786.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$69,847.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$62,495.08

APR-DRG 41.00: DEFIBRILLATOR IMPLANTS

Facility

$95,903.24

Service Code	APR-DRG 1793
Min. Negotiated Rate	$76,596.40
Max. Negotiated Rate	$95,903.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$76,596.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$95,903.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$85,808.16

APR-DRG 41.00: DEFIBRILLATOR IMPLANTS

Facility

$192,367.95

Service Code	APR-DRG 1794
Min. Negotiated Rate	$153,641.25
Max. Negotiated Rate	$192,367.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$153,641.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$192,367.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$172,118.69

APR-DRG 41.00: DEFIBRILLATOR IMPLANTS

Facility

$78,939.98

Service Code	APR-DRG 1792
Min. Negotiated Rate	$63,048.12
Max. Negotiated Rate	$78,939.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$63,048.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$78,939.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$70,630.51

APR-DRG 41.00: DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS

Facility

$59,913.84

Service Code	APR-DRG 0424
Min. Negotiated Rate	$47,852.24
Max. Negotiated Rate	$59,913.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$47,852.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$59,913.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$53,607.12

APR-DRG 41.00: DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS

Facility

$13,618.63

Service Code	APR-DRG 0421
Min. Negotiated Rate	$10,876.98
Max. Negotiated Rate	$13,618.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,876.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$13,618.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,185.09

APR-DRG 41.00: DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS

Facility

$23,604.97

Service Code	APR-DRG 0423
Min. Negotiated Rate	$18,852.92
Max. Negotiated Rate	$23,604.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,852.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$23,604.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,120.24

APR-DRG 41.00: DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS

Facility

$17,345.97

Service Code	APR-DRG 0422
Min. Negotiated Rate	$13,853.96
Max. Negotiated Rate	$17,345.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,853.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,345.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,520.08

APR-DRG 41.00: DENTAL DISEASES AND DISORDERS

Facility

$11,293.77

Service Code	APR-DRG 1142
Min. Negotiated Rate	$9,020.16
Max. Negotiated Rate	$11,293.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,020.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,293.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,104.95

APR-DRG 41.00: DENTAL DISEASES AND DISORDERS

Facility

$45,011.10

Service Code	APR-DRG 1144
Min. Negotiated Rate	$35,949.65
Max. Negotiated Rate	$45,011.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$35,949.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$45,011.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,273.08

APR-DRG 41.00: DENTAL DISEASES AND DISORDERS

Facility

$16,630.45

Service Code	APR-DRG 1143
Min. Negotiated Rate	$13,282.48
Max. Negotiated Rate	$16,630.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,282.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$16,630.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,879.88

APR-DRG 41.00: DENTAL DISEASES AND DISORDERS

Facility

$8,046.61

Service Code	APR-DRG 1141
Min. Negotiated Rate	$6,426.70
Max. Negotiated Rate	$8,046.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,426.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,046.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$7,199.60

APR-DRG 41.00: DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER

Facility

$11,404.56

Service Code	APR-DRG 7543
Min. Negotiated Rate	$9,108.64
Max. Negotiated Rate	$11,404.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,108.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,404.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,204.08

APR-DRG 41.00: DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER

Facility

$7,093.38

Service Code	APR-DRG 7542
Min. Negotiated Rate	$5,665.37
Max. Negotiated Rate	$7,093.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,665.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$7,093.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$6,346.71

APR-DRG 41.00: DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER

Facility

$26,800.79

Service Code	APR-DRG 7544
Min. Negotiated Rate	$21,405.37
Max. Negotiated Rate	$26,800.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$21,405.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$26,800.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,979.66

APR-DRG 41.00: DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER

Facility

$5,265.83

Service Code	APR-DRG 7541
Min. Negotiated Rate	$4,205.74
Max. Negotiated Rate	$5,265.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,205.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$5,265.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$4,711.53

APR-DRG 41.00: DIABETES

Facility

$49,260.94

Service Code	APR-DRG 4204
Min. Negotiated Rate	$39,343.93
Max. Negotiated Rate	$49,260.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$39,343.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$49,260.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,075.58

APR-DRG 41.00: DIABETES

Facility

$17,208.09

Service Code	APR-DRG 4203
Min. Negotiated Rate	$13,743.83
Max. Negotiated Rate	$17,208.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,743.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,208.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,396.71

APR-DRG 41.00: DIABETES

Facility

$11,574.29

Service Code	APR-DRG 4202
Min. Negotiated Rate	$9,244.20
Max. Negotiated Rate	$11,574.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,244.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,574.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,355.94

APR-DRG 41.00: DIABETES

Facility

$9,178.12

Service Code	APR-DRG 4201
Min. Negotiated Rate	$7,330.42
Max. Negotiated Rate	$9,178.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,330.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,178.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,212.00

APR-DRG 41.00: DIGESTIVE MALIGNANCY

Facility

$17,455.32

Service Code	APR-DRG 2402
Min. Negotiated Rate	$13,941.29
Max. Negotiated Rate	$17,455.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,941.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,455.32
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,617.92

APR-DRG 41.00: DIGESTIVE MALIGNANCY

Facility

$14,567.09

Service Code	APR-DRG 2401
Min. Negotiated Rate	$11,634.51
Max. Negotiated Rate	$14,567.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,634.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,567.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,033.71

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All Charges