Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 41.00: OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS

Facility

$25,069.28

Service Code	APR-DRG 3443
Min. Negotiated Rate	$20,022.44
Max. Negotiated Rate	$25,069.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$20,022.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$25,069.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,430.41

APR-DRG 41.00: OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS

Facility

$13,670.92

Service Code	APR-DRG 3441
Min. Negotiated Rate	$10,918.75
Max. Negotiated Rate	$13,670.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,918.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$13,670.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,231.87

APR-DRG 41.00: OTHER AFTERCARE AND CONVALESCENCE

Facility

$17,754.83

Service Code	APR-DRG 8624
Min. Negotiated Rate	$14,180.51
Max. Negotiated Rate	$17,754.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,180.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,754.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,885.91

APR-DRG 41.00: OTHER AFTERCARE AND CONVALESCENCE

Facility

$6,741.56

Service Code	APR-DRG 8621
Min. Negotiated Rate	$5,384.38
Max. Negotiated Rate	$6,741.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,384.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$6,741.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$6,031.92

APR-DRG 41.00: OTHER AFTERCARE AND CONVALESCENCE

Facility

$9,408.70

Service Code	APR-DRG 8622
Min. Negotiated Rate	$7,514.58
Max. Negotiated Rate	$9,408.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,514.58
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,408.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,418.32

APR-DRG 41.00: OTHER AFTERCARE AND CONVALESCENCE

Facility

$12,078.24

Service Code	APR-DRG 8623
Min. Negotiated Rate	$9,646.70
Max. Negotiated Rate	$12,078.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,646.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,078.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,806.85

APR-DRG 41.00: OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$21,622.44

Service Code	APR-DRG 2533
Min. Negotiated Rate	$17,269.50
Max. Negotiated Rate	$21,622.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,269.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$21,622.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,346.39

APR-DRG 41.00: OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$11,788.23

Service Code	APR-DRG 2531
Min. Negotiated Rate	$9,415.07
Max. Negotiated Rate	$11,788.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,415.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,788.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,547.36

APR-DRG 41.00: OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$52,083.08

Service Code	APR-DRG 2534
Min. Negotiated Rate	$41,597.94
Max. Negotiated Rate	$52,083.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$41,597.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$52,083.08
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,600.65

APR-DRG 41.00: OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$15,206.56

Service Code	APR-DRG 2532
Min. Negotiated Rate	$12,145.24
Max. Negotiated Rate	$15,206.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,145.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,206.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,605.86

APR-DRG 41.00: OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$47,131.04

Service Code	APR-DRG 6634
Min. Negotiated Rate	$37,642.82
Max. Negotiated Rate	$47,131.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$37,642.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$47,131.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,169.88

APR-DRG 41.00: OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$19,737.37

Service Code	APR-DRG 6633
Min. Negotiated Rate	$15,763.93
Max. Negotiated Rate	$19,737.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$15,763.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$19,737.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,659.75

APR-DRG 41.00: OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$14,158.23

Service Code	APR-DRG 6632
Min. Negotiated Rate	$11,307.95
Max. Negotiated Rate	$14,158.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,307.95
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,158.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,667.89

APR-DRG 41.00: OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$9,872.25

Service Code	APR-DRG 6631
Min. Negotiated Rate	$7,884.81
Max. Negotiated Rate	$9,872.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,884.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,872.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,833.06

APR-DRG 41.00: OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility

$15,608.29

Service Code	APR-DRG 3472
Min. Negotiated Rate	$12,466.10
Max. Negotiated Rate	$15,608.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,466.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,608.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,965.31

APR-DRG 41.00: OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility

$21,418.02

Service Code	APR-DRG 3473
Min. Negotiated Rate	$17,106.23
Max. Negotiated Rate	$21,418.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,106.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$21,418.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,163.49

APR-DRG 41.00: OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility

$12,318.33

Service Code	APR-DRG 3471
Min. Negotiated Rate	$9,838.45
Max. Negotiated Rate	$12,318.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,838.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,318.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,021.66

APR-DRG 41.00: OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility

$54,958.47

Service Code	APR-DRG 3474
Min. Negotiated Rate	$43,894.46
Max. Negotiated Rate	$54,958.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$43,894.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$54,958.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,173.37

APR-DRG 41.00: OTHER BLADDER PROCEDURES

Facility

$34,796.54

Service Code	APR-DRG 4453
Min. Negotiated Rate	$27,791.45
Max. Negotiated Rate	$34,796.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$27,791.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$34,796.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,133.75

APR-DRG 41.00: OTHER BLADDER PROCEDURES

Facility

$24,765.02

Service Code	APR-DRG 4452
Min. Negotiated Rate	$19,779.43
Max. Negotiated Rate	$24,765.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,779.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$24,765.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,158.17

APR-DRG 41.00: OTHER BLADDER PROCEDURES

Facility

$93,060.65

Service Code	APR-DRG 4454
Min. Negotiated Rate	$74,326.07
Max. Negotiated Rate	$93,060.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$74,326.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$93,060.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$83,264.79

APR-DRG 41.00: OTHER BLADDER PROCEDURES

Facility

$20,203.29

Service Code	APR-DRG 4451
Min. Negotiated Rate	$16,136.05
Max. Negotiated Rate	$20,203.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,136.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$20,203.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,076.63

APR-DRG 41.00: OTHER CARDIOTHORACIC AND THORACIC VASCULAR PROCEDURES

Facility

$60,096.41

Service Code	APR-DRG 1671
Min. Negotiated Rate	$47,998.05
Max. Negotiated Rate	$60,096.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$47,998.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$60,096.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$53,770.47

APR-DRG 41.00: OTHER CARDIOTHORACIC AND THORACIC VASCULAR PROCEDURES

Facility

$93,364.46

Service Code	APR-DRG 1673
Min. Negotiated Rate	$74,568.72
Max. Negotiated Rate	$93,364.46
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$74,568.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$93,364.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$83,536.62

APR-DRG 41.00: OTHER CARDIOTHORACIC AND THORACIC VASCULAR PROCEDURES

Facility

$216,063.25

Service Code	APR-DRG 1674
Min. Negotiated Rate	$172,566.31
Max. Negotiated Rate	$216,063.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$172,566.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$216,063.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$193,319.75

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