Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 41.00: MALIGNANT BREAST DISORDERS

Facility

$20,880.77

Service Code	APR-DRG 3823
Min. Negotiated Rate	$16,677.14
Max. Negotiated Rate	$20,880.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,677.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$20,880.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,682.80

APR-DRG 41.00: MALIGNANT BREAST DISORDERS

Facility

$11,376.97

Service Code	APR-DRG 3821
Min. Negotiated Rate	$9,086.61
Max. Negotiated Rate	$11,376.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,086.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,376.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,179.40

APR-DRG 41.00: MALIGNANT BREAST DISORDERS

Facility

$14,564.72

Service Code	APR-DRG 3822
Min. Negotiated Rate	$11,632.61
Max. Negotiated Rate	$14,564.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,632.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,564.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,031.59

APR-DRG 41.00: MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS

Facility

$8,315.24

Service Code	APR-DRG 4211
Min. Negotiated Rate	$6,641.25
Max. Negotiated Rate	$8,315.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,641.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,315.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$7,439.95

APR-DRG 41.00: MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS

Facility

$51,996.56

Service Code	APR-DRG 4214
Min. Negotiated Rate	$41,528.83
Max. Negotiated Rate	$51,996.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$41,528.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$51,996.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,523.24

APR-DRG 41.00: MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS

Facility

$19,121.69

Service Code	APR-DRG 4213
Min. Negotiated Rate	$15,272.20
Max. Negotiated Rate	$19,121.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$15,272.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$19,121.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,108.88

APR-DRG 41.00: MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS

Facility

$12,427.67

Service Code	APR-DRG 4212
Min. Negotiated Rate	$9,925.79
Max. Negotiated Rate	$12,427.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,925.79
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,427.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,119.50

APR-DRG 41.00: MASTECTOMY PROCEDURES

Facility

$103,044.64

Service Code	APR-DRG 3624
Min. Negotiated Rate	$82,300.13
Max. Negotiated Rate	$103,044.64
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$82,300.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$103,044.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$92,197.83

APR-DRG 41.00: MASTECTOMY PROCEDURES

Facility

$44,801.90

Service Code	APR-DRG 3623
Min. Negotiated Rate	$35,782.57
Max. Negotiated Rate	$44,801.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$35,782.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$44,801.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,085.92

APR-DRG 41.00: MASTECTOMY PROCEDURES

Facility

$39,729.10

Service Code	APR-DRG 3622
Min. Negotiated Rate	$31,731.00
Max. Negotiated Rate	$39,729.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$31,731.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$39,729.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,547.08

APR-DRG 41.00: MASTECTOMY PROCEDURES

Facility

$26,172.29

Service Code	APR-DRG 3621
Min. Negotiated Rate	$20,903.40
Max. Negotiated Rate	$26,172.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$20,903.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$26,172.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,417.31

APR-DRG 41.00: MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS

Facility

$16,454.55

Service Code	APR-DRG 5323
Min. Negotiated Rate	$13,141.99
Max. Negotiated Rate	$16,454.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,141.99
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$16,454.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,722.49

APR-DRG 41.00: MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS

Facility

$10,609.16

Service Code	APR-DRG 5322
Min. Negotiated Rate	$8,473.37
Max. Negotiated Rate	$10,609.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,473.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,609.16
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,492.41

APR-DRG 41.00: MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS

Facility

$40,351.92

Service Code	APR-DRG 5324
Min. Negotiated Rate	$32,228.44
Max. Negotiated Rate	$40,351.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$32,228.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$40,351.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,104.35

APR-DRG 41.00: MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS

Facility

$8,410.31

Service Code	APR-DRG 5321
Min. Negotiated Rate	$6,717.18
Max. Negotiated Rate	$8,410.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,717.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,410.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$7,525.02

APR-DRG 41.00: MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE

Facility

$82,186.21

Service Code	APR-DRG 7404
Min. Negotiated Rate	$65,640.83
Max. Negotiated Rate	$82,186.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$65,640.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$82,186.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$73,535.03

APR-DRG 41.00: MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE

Facility

$40,238.28

Service Code	APR-DRG 7403
Min. Negotiated Rate	$32,137.68
Max. Negotiated Rate	$40,238.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$32,137.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$40,238.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,002.67

APR-DRG 41.00: MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE

Facility

$14,705.92

Service Code	APR-DRG 7401
Min. Negotiated Rate	$11,745.39
Max. Negotiated Rate	$14,705.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,745.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,705.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,157.93

APR-DRG 41.00: MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE

Facility

$23,303.56

Service Code	APR-DRG 7402
Min. Negotiated Rate	$18,612.18
Max. Negotiated Rate	$23,303.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,612.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$23,303.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,850.55

APR-DRG 41.00: MIGRAINE AND OTHER HEADACHES

Facility

$11,590.93

Service Code	APR-DRG 0541
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: MIGRAINE AND OTHER HEADACHES

Facility

$17,467.21

Service Code	APR-DRG 0543
Min. Negotiated Rate	$13,950.79
Max. Negotiated Rate	$17,467.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,950.79
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,467.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,628.56

APR-DRG 41.00: MIGRAINE AND OTHER HEADACHES

Facility

$13,853.96

Service Code	APR-DRG 0542
Min. Negotiated Rate	$11,064.94
Max. Negotiated Rate	$13,853.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,064.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$13,853.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,395.65

APR-DRG 41.00: MIGRAINE AND OTHER HEADACHES

Facility

$40,039.08

Service Code	APR-DRG 0544
Min. Negotiated Rate	$31,978.58
Max. Negotiated Rate	$40,039.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$31,978.58
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$40,039.08
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,824.44

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

Facility

$20,871.27

Service Code	APR-DRG 7931
Min. Negotiated Rate	$16,669.56
Max. Negotiated Rate	$20,871.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,669.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$20,871.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,674.30

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

Facility

$40,240.18

Service Code	APR-DRG 7933
Min. Negotiated Rate	$32,139.19
Max. Negotiated Rate	$40,240.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$32,139.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$40,240.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,004.37

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All Charges