Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 41.00: MAJOR BILIARY TRACT PROCEDURES

Facility

$30,299.00

Service Code	APR-DRG 2611
Min. Negotiated Rate	$24,199.33
Max. Negotiated Rate	$30,299.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$24,199.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$30,299.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,109.63

APR-DRG 41.00: MAJOR BILIARY TRACT PROCEDURES

Facility

$145,423.28

Service Code	APR-DRG 2614
Min. Negotiated Rate	$116,147.28
Max. Negotiated Rate	$145,423.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$116,147.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$145,423.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$130,115.57

APR-DRG 41.00: MAJOR BILIARY TRACT PROCEDURES

Facility

$53,331.08

Service Code	APR-DRG 2613
Min. Negotiated Rate	$42,594.69
Max. Negotiated Rate	$53,331.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$42,594.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$53,331.08
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,717.28

APR-DRG 41.00: MAJOR BLADDER PROCEDURES

Facility

$46,996.01

Service Code	APR-DRG 4412
Min. Negotiated Rate	$37,534.97
Max. Negotiated Rate	$46,996.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$37,534.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$46,996.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,049.06

APR-DRG 41.00: MAJOR BLADDER PROCEDURES

Facility

$29,253.05

Service Code	APR-DRG 4411
Min. Negotiated Rate	$23,363.95
Max. Negotiated Rate	$29,253.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$23,363.95
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$29,253.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,173.78

APR-DRG 41.00: MAJOR BLADDER PROCEDURES

Facility

$61,175.63

Service Code	APR-DRG 4413
Min. Negotiated Rate	$48,860.01
Max. Negotiated Rate	$61,175.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$48,860.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$61,175.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$54,736.09

APR-DRG 41.00: MAJOR BLADDER PROCEDURES

Facility

$154,661.79

Service Code	APR-DRG 4414
Min. Negotiated Rate	$123,525.93
Max. Negotiated Rate	$154,661.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$123,525.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$154,661.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$138,381.60

APR-DRG 41.00: MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$322,988.33

Service Code	APR-DRG 1604
Min. Negotiated Rate	$257,965.68
Max. Negotiated Rate	$322,988.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$257,965.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$322,988.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$288,989.56

APR-DRG 41.00: MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$59,392.78

Service Code	APR-DRG 1601
Min. Negotiated Rate	$47,436.08
Max. Negotiated Rate	$59,392.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$47,436.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$59,392.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$53,140.91

APR-DRG 41.00: MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$70,551.07

Service Code	APR-DRG 1602
Min. Negotiated Rate	$56,348.02
Max. Negotiated Rate	$70,551.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$56,348.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$70,551.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$63,124.64

APR-DRG 41.00: MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$108,970.36

Service Code	APR-DRG 1603
Min. Negotiated Rate	$87,032.90
Max. Negotiated Rate	$108,970.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$87,032.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$108,970.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$97,499.79

APR-DRG 41.00: MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$60,585.05

Service Code	APR-DRG 1354
Min. Negotiated Rate	$48,388.33
Max. Negotiated Rate	$60,585.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$48,388.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$60,585.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$54,207.68

APR-DRG 41.00: MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$24,085.16

Service Code	APR-DRG 1353
Min. Negotiated Rate	$19,236.44
Max. Negotiated Rate	$24,085.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,236.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$24,085.16
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,549.88

APR-DRG 41.00: MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$16,611.43

Service Code	APR-DRG 1352
Min. Negotiated Rate	$13,267.29
Max. Negotiated Rate	$16,611.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,267.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$16,611.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,862.86

APR-DRG 41.00: MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$14,524.30

Service Code	APR-DRG 1351
Min. Negotiated Rate	$11,600.33
Max. Negotiated Rate	$14,524.30
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,600.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,524.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,995.43

APR-DRG 41.00: MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$157,663.65

Service Code	APR-DRG 0894
Min. Negotiated Rate	$125,923.47
Max. Negotiated Rate	$157,663.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$125,923.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$157,663.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$141,067.48

APR-DRG 41.00: MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$79,351.22

Service Code	APR-DRG 0893
Min. Negotiated Rate	$63,376.57
Max. Negotiated Rate	$79,351.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$63,376.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$79,351.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$70,998.46

APR-DRG 41.00: MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$31,299.76

Service Code	APR-DRG 0891
Min. Negotiated Rate	$24,998.63
Max. Negotiated Rate	$31,299.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$24,998.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$31,299.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,005.05

APR-DRG 41.00: MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$41,566.62

Service Code	APR-DRG 0892
Min. Negotiated Rate	$33,198.61
Max. Negotiated Rate	$41,566.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$33,198.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$41,566.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,191.19

APR-DRG 41.00: MAJOR DEPRESSIVE DISORDERS AND OTHER OR UNSPECIFIED PSYCHOSES

Facility

$6,055.05

Service Code	APR-DRG 7511
Min. Negotiated Rate	$4,836.08
Max. Negotiated Rate	$6,055.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,836.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$6,055.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$5,417.68

APR-DRG 41.00: MAJOR DEPRESSIVE DISORDERS AND OTHER OR UNSPECIFIED PSYCHOSES

Facility

$31,768.06

Service Code	APR-DRG 7514
Min. Negotiated Rate	$25,372.65
Max. Negotiated Rate	$31,768.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$25,372.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$31,768.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,424.05

APR-DRG 41.00: MAJOR DEPRESSIVE DISORDERS AND OTHER OR UNSPECIFIED PSYCHOSES

Facility

$8,105.10

Service Code	APR-DRG 7512
Min. Negotiated Rate	$6,473.41
Max. Negotiated Rate	$8,105.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,473.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,105.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$7,251.93

APR-DRG 41.00: MAJOR DEPRESSIVE DISORDERS AND OTHER OR UNSPECIFIED PSYCHOSES

Facility

$14,464.42

Service Code	APR-DRG 7513
Min. Negotiated Rate	$11,552.50
Max. Negotiated Rate	$14,464.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,552.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,464.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,941.84

APR-DRG 41.00: MAJOR ESOPHAGEAL DISORDERS

Facility

$11,241.48

Service Code	APR-DRG 2421
Min. Negotiated Rate	$8,978.39
Max. Negotiated Rate	$11,241.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,978.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,241.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,058.17

APR-DRG 41.00: MAJOR ESOPHAGEAL DISORDERS

Facility

$14,747.76

Service Code	APR-DRG 2422
Min. Negotiated Rate	$11,778.80
Max. Negotiated Rate	$14,747.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,778.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,747.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,195.37

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