Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 41.00: HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS

Facility

$11,671.74

Service Code	APR-DRG 8941
Min. Negotiated Rate	$9,322.03
Max. Negotiated Rate	$11,671.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,322.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,671.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,443.13

APR-DRG 41.00: HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS

Facility

$14,488.66

Service Code	APR-DRG 8942
Min. Negotiated Rate	$11,571.86
Max. Negotiated Rate	$14,488.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,571.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,488.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,963.54

APR-DRG 41.00: HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS

Facility

$20,476.66

Service Code	APR-DRG 8943
Min. Negotiated Rate	$16,354.39
Max. Negotiated Rate	$20,476.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,354.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$20,476.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,321.22

APR-DRG 41.00: HYPERTENSION

Facility

$17,595.58

Service Code	APR-DRG 1993
Min. Negotiated Rate	$14,053.31
Max. Negotiated Rate	$17,595.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,053.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,595.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,743.41

APR-DRG 41.00: HYPERTENSION

Facility

$43,120.80

Service Code	APR-DRG 1994
Min. Negotiated Rate	$34,439.91
Max. Negotiated Rate	$43,120.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$34,439.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$43,120.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,581.77

APR-DRG 41.00: HYPERTENSION

Facility

$10,418.99

Service Code	APR-DRG 1991
Min. Negotiated Rate	$8,321.48
Max. Negotiated Rate	$10,418.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,321.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,418.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,322.26

APR-DRG 41.00: HYPERTENSION

Facility

$12,712.94

Service Code	APR-DRG 1992
Min. Negotiated Rate	$10,153.62
Max. Negotiated Rate	$12,712.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,153.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,712.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,374.73

APR-DRG 41.00: HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS

Facility

$7,240.77

Service Code	APR-DRG 4221
Min. Negotiated Rate	$5,783.09
Max. Negotiated Rate	$7,240.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,783.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$7,240.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$6,478.58

APR-DRG 41.00: HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS

Facility

$35,373.23

Service Code	APR-DRG 4224
Min. Negotiated Rate	$28,252.04
Max. Negotiated Rate	$35,373.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$28,252.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$35,373.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,649.73

APR-DRG 41.00: HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS

Facility

$15,239.82

Service Code	APR-DRG 4223
Min. Negotiated Rate	$12,171.81
Max. Negotiated Rate	$15,239.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,171.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,239.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,635.63

APR-DRG 41.00: HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS

Facility

$10,459.41

Service Code	APR-DRG 4222
Min. Negotiated Rate	$8,353.76
Max. Negotiated Rate	$10,459.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,353.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,459.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,358.42

APR-DRG 41.00: IMPLANTABLE HEART ASSIST SYSTEMS

Facility

$708,349.89

Service Code	APR-DRG 1614
Min. Negotiated Rate	$565,747.87
Max. Negotiated Rate	$708,349.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$565,747.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$708,349.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$633,786.74

APR-DRG 41.00: IMPLANTABLE HEART ASSIST SYSTEMS

Facility

$292,444.96

Service Code	APR-DRG 1611
Min. Negotiated Rate	$233,571.17
Max. Negotiated Rate	$292,444.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$233,571.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$292,444.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$261,661.28

APR-DRG 41.00: IMPLANTABLE HEART ASSIST SYSTEMS

Facility

$383,403.76

Service Code	APR-DRG 1613
Min. Negotiated Rate	$306,218.53
Max. Negotiated Rate	$383,403.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$306,218.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$383,403.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$343,045.47

APR-DRG 41.00: IMPLANTABLE HEART ASSIST SYSTEMS

Facility

$307,468.47

Service Code	APR-DRG 1612
Min. Negotiated Rate	$245,570.21
Max. Negotiated Rate	$307,468.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$245,570.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$307,468.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$275,103.37

APR-DRG 41.00: INBORN ERRORS OF METABOLISM

Facility

$22,288.04

Service Code	APR-DRG 4233
Min. Negotiated Rate	$17,801.11
Max. Negotiated Rate	$22,288.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,801.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22,288.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,941.94

APR-DRG 41.00: INBORN ERRORS OF METABOLISM

Facility

$13,920.52

Service Code	APR-DRG 4232
Min. Negotiated Rate	$11,118.10
Max. Negotiated Rate	$13,920.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,118.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$13,920.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,455.20

APR-DRG 41.00: INBORN ERRORS OF METABOLISM

Facility

$72,763.24

Service Code	APR-DRG 4234
Min. Negotiated Rate	$58,114.85
Max. Negotiated Rate	$72,763.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$58,114.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$72,763.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$65,103.95

APR-DRG 41.00: INBORN ERRORS OF METABOLISM

Facility

$10,949.09

Service Code	APR-DRG 4231
Min. Negotiated Rate	$8,744.87
Max. Negotiated Rate	$10,949.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,744.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,949.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,796.56

APR-DRG 41.00: INFECTIONS OF UPPER RESPIRATORY TRACT

Facility

$42,162.04

Service Code	APR-DRG 1134
Min. Negotiated Rate	$33,674.16
Max. Negotiated Rate	$42,162.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$33,674.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$42,162.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,723.93

APR-DRG 41.00: INFECTIONS OF UPPER RESPIRATORY TRACT

Facility

$6,760.58

Service Code	APR-DRG 1131
Min. Negotiated Rate	$5,399.57
Max. Negotiated Rate	$6,760.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,399.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$6,760.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$6,048.94

APR-DRG 41.00: INFECTIONS OF UPPER RESPIRATORY TRACT

Facility

$9,843.73

Service Code	APR-DRG 1132
Min. Negotiated Rate	$7,862.03
Max. Negotiated Rate	$9,843.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,862.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,843.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,807.55

APR-DRG 41.00: INFECTIONS OF UPPER RESPIRATORY TRACT

Facility

$14,783.42

Service Code	APR-DRG 1133
Min. Negotiated Rate	$11,807.29
Max. Negotiated Rate	$14,783.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,807.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,783.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,227.27

APR-DRG 41.00: INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE

Facility

$20,631.17

Service Code	APR-DRG 7101
Min. Negotiated Rate	$16,477.79
Max. Negotiated Rate	$20,631.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,477.79
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$20,631.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,459.47

APR-DRG 41.00: INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE

Facility

$124,204.01

Service Code	APR-DRG 7104
Min. Negotiated Rate	$99,199.78
Max. Negotiated Rate	$124,204.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$99,199.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$124,204.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$111,129.90

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