Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 41.00: EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$58,957.76

Service Code	APR-DRG 9113
Min. Negotiated Rate	$47,088.63
Max. Negotiated Rate	$58,957.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$47,088.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$58,957.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$52,751.68

APR-DRG 41.00: EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$44,564.20

Service Code	APR-DRG 9112
Min. Negotiated Rate	$35,592.72
Max. Negotiated Rate	$44,564.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$35,592.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$44,564.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$39,873.23

APR-DRG 41.00: EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$31,178.54

Service Code	APR-DRG 9111
Min. Negotiated Rate	$24,901.81
Max. Negotiated Rate	$31,178.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$24,901.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$31,178.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,896.59

APR-DRG 41.00: EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$171,175.29

Service Code	APR-DRG 9114
Min. Negotiated Rate	$136,715.00
Max. Negotiated Rate	$171,175.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$136,715.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$171,175.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$153,156.84

APR-DRG 41.00: EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$51,569.63

Service Code	APR-DRG 7923
Min. Negotiated Rate	$41,187.85
Max. Negotiated Rate	$51,569.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$41,187.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$51,569.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,141.25

APR-DRG 41.00: EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$35,559.60

Service Code	APR-DRG 7922
Min. Negotiated Rate	$28,400.89
Max. Negotiated Rate	$35,559.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$28,400.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$35,559.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,816.49

APR-DRG 41.00: EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$28,428.18

Service Code	APR-DRG 7921
Min. Negotiated Rate	$22,705.14
Max. Negotiated Rate	$28,428.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$22,705.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$28,428.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,435.74

APR-DRG 41.00: EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$136,810.45

Service Code	APR-DRG 7924
Min. Negotiated Rate	$109,268.35
Max. Negotiated Rate	$136,810.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$109,268.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$136,810.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$122,409.35

APR-DRG 41.00: EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$157,074.60

Service Code	APR-DRG 9504
Min. Negotiated Rate	$125,453.00
Max. Negotiated Rate	$157,074.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$125,453.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$157,074.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$140,540.43

APR-DRG 41.00: EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$30,686.46

Service Code	APR-DRG 9501
Min. Negotiated Rate	$24,508.79
Max. Negotiated Rate	$30,686.46
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$24,508.79
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$30,686.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,456.31

APR-DRG 41.00: EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$61,705.73

Service Code	APR-DRG 9503
Min. Negotiated Rate	$49,283.39
Max. Negotiated Rate	$61,705.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$49,283.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$61,705.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$55,210.39

APR-DRG 41.00: EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$40,679.95

Service Code	APR-DRG 9502
Min. Negotiated Rate	$32,490.43
Max. Negotiated Rate	$40,679.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$32,490.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$40,679.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,397.85

APR-DRG 41.00: EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$57,710.71

Service Code	APR-DRG 8434
Min. Negotiated Rate	$46,092.64
Max. Negotiated Rate	$57,710.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$46,092.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$57,710.71
Rate for Payer: Molina Healthcare of CA Medi-Cal	$51,635.90

APR-DRG 41.00: EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$14,056.01

Service Code	APR-DRG 8432
Min. Negotiated Rate	$11,226.31
Max. Negotiated Rate	$14,056.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,226.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,056.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,576.43

APR-DRG 41.00: EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$10,062.42

Service Code	APR-DRG 8431
Min. Negotiated Rate	$8,036.70
Max. Negotiated Rate	$10,062.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,036.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,062.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,003.22

APR-DRG 41.00: EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$21,589.17

Service Code	APR-DRG 8433
Min. Negotiated Rate	$17,242.93
Max. Negotiated Rate	$21,589.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,242.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$21,589.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,316.62

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

Facility

$119,453.53

Service Code	APR-DRG 8413
Min. Negotiated Rate	$95,405.65
Max. Negotiated Rate	$119,453.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$95,405.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$119,453.53
Rate for Payer: Molina Healthcare of CA Medi-Cal	$106,879.48

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

Facility

$508,750.21

Service Code	APR-DRG 8414
Min. Negotiated Rate	$406,330.76
Max. Negotiated Rate	$508,750.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$406,330.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$508,750.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$455,197.56

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

Facility

$39,042.11

Service Code	APR-DRG 8412
Min. Negotiated Rate	$31,182.32
Max. Negotiated Rate	$39,042.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$31,182.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$39,042.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,932.42

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

Facility

$34,297.34

Service Code	APR-DRG 8411
Min. Negotiated Rate	$27,392.74
Max. Negotiated Rate	$34,297.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$27,392.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$34,297.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,687.09

APR-DRG 41.00: EXTERNAL HEART ASSIST SYSTEMS

Facility

$122,900.38

Service Code	APR-DRG 1783
Min. Negotiated Rate	$98,158.59
Max. Negotiated Rate	$122,900.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$98,158.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$122,900.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$109,963.50

APR-DRG 41.00: EXTERNAL HEART ASSIST SYSTEMS

Facility

$99,723.29

Service Code	APR-DRG 1781
Min. Negotiated Rate	$79,647.41
Max. Negotiated Rate	$99,723.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$79,647.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$99,723.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$89,226.10

APR-DRG 41.00: EXTERNAL HEART ASSIST SYSTEMS

Facility

$224,546.31

Service Code	APR-DRG 1784
Min. Negotiated Rate	$179,341.59
Max. Negotiated Rate	$224,546.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$179,341.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$224,546.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$200,909.86

APR-DRG 41.00: EXTERNAL HEART ASSIST SYSTEMS

Facility

$109,082.08

Service Code	APR-DRG 1782
Min. Negotiated Rate	$87,122.13
Max. Negotiated Rate	$109,082.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$87,122.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$109,082.08
Rate for Payer: Molina Healthcare of CA Medi-Cal	$97,599.75

APR-DRG 41.00: EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$147,895.98

Service Code	APR-DRG 0093
Min. Negotiated Rate	$118,122.18
Max. Negotiated Rate	$147,895.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$118,122.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$147,895.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$132,327.98

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