Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$107,890.19

Service Code	APR-DRG 7934
Min. Negotiated Rate	$86,170.19
Max. Negotiated Rate	$107,890.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$86,170.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$107,890.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$96,533.33

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

Facility

$27,294.30

Service Code	APR-DRG 7932
Min. Negotiated Rate	$21,799.52
Max. Negotiated Rate	$27,294.30
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$21,799.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$27,294.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,421.21

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

Facility

$30,631.80

Service Code	APR-DRG 9512
Min. Negotiated Rate	$24,465.13
Max. Negotiated Rate	$30,631.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$24,465.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$30,631.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,407.40

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

Facility

$23,141.43

Service Code	APR-DRG 9511
Min. Negotiated Rate	$18,482.69
Max. Negotiated Rate	$23,141.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,482.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$23,141.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,705.49

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

Facility

$45,748.01

Service Code	APR-DRG 9513
Min. Negotiated Rate	$36,538.21
Max. Negotiated Rate	$45,748.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$36,538.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$45,748.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,932.43

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

Facility

$114,912.25

Service Code	APR-DRG 9514
Min. Negotiated Rate	$91,778.60
Max. Negotiated Rate	$114,912.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$91,778.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$114,912.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$102,816.22

APR-DRG 41.00: MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES

Facility

$91,692.84

Service Code	APR-DRG 0434
Min. Negotiated Rate	$73,233.62
Max. Negotiated Rate	$91,692.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$73,233.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$91,692.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$82,040.96

APR-DRG 41.00: MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES

Facility

$33,629.37

Service Code	APR-DRG 0433
Min. Negotiated Rate	$26,859.25
Max. Negotiated Rate	$33,629.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$26,859.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$33,629.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,089.44

APR-DRG 41.00: MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES

Facility

$22,718.30

Service Code	APR-DRG 0432
Min. Negotiated Rate	$18,144.75
Max. Negotiated Rate	$22,718.30
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,144.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22,718.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,326.90

APR-DRG 41.00: MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES

Facility

$16,963.26

Service Code	APR-DRG 0431
Min. Negotiated Rate	$13,548.29
Max. Negotiated Rate	$16,963.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,548.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$16,963.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,177.65

APR-DRG 41.00: MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE

Facility

$15,983.86

Service Code	APR-DRG 9301
Min. Negotiated Rate	$12,766.06
Max. Negotiated Rate	$15,983.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,766.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,983.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,301.35

APR-DRG 41.00: MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE

Facility

$18,807.91

Service Code	APR-DRG 9302
Min. Negotiated Rate	$15,021.58
Max. Negotiated Rate	$18,807.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$15,021.58
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$18,807.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,828.13

APR-DRG 41.00: MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE

Facility

$29,999.48

Service Code	APR-DRG 9303
Min. Negotiated Rate	$23,960.11
Max. Negotiated Rate	$29,999.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$23,960.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$29,999.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,841.64

APR-DRG 41.00: MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE

Facility

$82,803.79

Service Code	APR-DRG 9304
Min. Negotiated Rate	$66,134.08
Max. Negotiated Rate	$82,803.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$66,134.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$82,803.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$74,087.60

APR-DRG 41.00: MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$44,169.58

Service Code	APR-DRG 9122
Min. Negotiated Rate	$35,277.55
Max. Negotiated Rate	$44,169.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$35,277.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$44,169.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$39,520.15

APR-DRG 41.00: MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$68,925.10

Service Code	APR-DRG 9123
Min. Negotiated Rate	$55,049.39
Max. Negotiated Rate	$68,925.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$55,049.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$68,925.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$61,669.83

APR-DRG 41.00: MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$171,381.63

Service Code	APR-DRG 9124
Min. Negotiated Rate	$136,879.81
Max. Negotiated Rate	$171,381.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$136,879.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$171,381.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$153,341.46

APR-DRG 41.00: MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$41,961.23

Service Code	APR-DRG 9121
Min. Negotiated Rate	$33,513.78
Max. Negotiated Rate	$41,961.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$33,513.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$41,961.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,544.26

APR-DRG 41.00: MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY

Facility

$27,258.63

Service Code	APR-DRG 3433
Min. Negotiated Rate	$21,771.04
Max. Negotiated Rate	$27,258.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$21,771.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$27,258.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,389.31

APR-DRG 41.00: MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY

Facility

$63,541.36

Service Code	APR-DRG 3434
Min. Negotiated Rate	$50,749.48
Max. Negotiated Rate	$63,541.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$50,749.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$63,541.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$56,852.79

APR-DRG 41.00: MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY

Facility

$18,622.49

Service Code	APR-DRG 3432
Min. Negotiated Rate	$14,873.49
Max. Negotiated Rate	$18,622.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,873.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$18,622.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,662.23

APR-DRG 41.00: MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY

Facility

$15,498.95

Service Code	APR-DRG 3431
Min. Negotiated Rate	$12,378.76
Max. Negotiated Rate	$15,498.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,378.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,498.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,867.48

APR-DRG 41.00: NEONATAL AFTERCARE

Facility

$61,687.66

Service Code	APR-DRG 8632
Min. Negotiated Rate	$49,268.96
Max. Negotiated Rate	$61,687.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$49,268.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$61,687.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$55,194.22

APR-DRG 41.00: NEONATAL AFTERCARE

Facility

$24,976.58

Service Code	APR-DRG 8631
Min. Negotiated Rate	$19,948.40
Max. Negotiated Rate	$24,976.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,948.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$24,976.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,347.47

APR-DRG 41.00: NEONATAL AFTERCARE

Facility

$120,137.21

Service Code	APR-DRG 8633
Min. Negotiated Rate	$95,951.69
Max. Negotiated Rate	$120,137.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$95,951.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$120,137.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$107,491.19

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