Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 41.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES

Facility

$21,950.49

Service Code	APR-DRG 3201
Min. Negotiated Rate	$17,531.51
Max. Negotiated Rate	$21,950.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,531.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$21,950.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,639.91

APR-DRG 41.00: OTHER NERVOUS SYSTEM AND RELATED PROCEDURES

Facility

$32,150.79

Service Code	APR-DRG 0262
Min. Negotiated Rate	$25,678.33
Max. Negotiated Rate	$32,150.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$25,678.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$32,150.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,766.50

APR-DRG 41.00: OTHER NERVOUS SYSTEM AND RELATED PROCEDURES

Facility

$25,925.06

Service Code	APR-DRG 0261
Min. Negotiated Rate	$20,705.94
Max. Negotiated Rate	$25,925.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$20,705.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$25,925.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,196.11

APR-DRG 41.00: OTHER NERVOUS SYSTEM AND RELATED PROCEDURES

Facility

$49,458.73

Service Code	APR-DRG 0263
Min. Negotiated Rate	$39,501.91
Max. Negotiated Rate	$49,458.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$39,501.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$49,458.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,252.55

APR-DRG 41.00: OTHER NERVOUS SYSTEM AND RELATED PROCEDURES

Facility

$121,292.01

Service Code	APR-DRG 0264
Min. Negotiated Rate	$96,874.01
Max. Negotiated Rate	$121,292.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$96,874.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$121,292.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$108,524.43

APR-DRG 41.00: OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$11,101.23

Service Code	APR-DRG 4252
Min. Negotiated Rate	$8,866.37
Max. Negotiated Rate	$11,101.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,866.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,101.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,932.67

APR-DRG 41.00: OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$15,456.14

Service Code	APR-DRG 4253
Min. Negotiated Rate	$12,344.57
Max. Negotiated Rate	$15,456.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,344.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,456.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,829.18

APR-DRG 41.00: OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$9,083.05

Service Code	APR-DRG 4251
Min. Negotiated Rate	$7,254.48
Max. Negotiated Rate	$9,083.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,254.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,083.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,126.94

APR-DRG 41.00: OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$46,944.67

Service Code	APR-DRG 4254
Min. Negotiated Rate	$37,493.97
Max. Negotiated Rate	$46,944.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$37,493.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$46,944.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,003.12

APR-DRG 41.00: OTHER OPEN CRANIOTOMY

Facility

$35,298.12

Service Code	APR-DRG 0271
Min. Negotiated Rate	$28,192.05
Max. Negotiated Rate	$35,298.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$28,192.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$35,298.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,582.53

APR-DRG 41.00: OTHER OPEN CRANIOTOMY

Facility

$39,317.86

Service Code	APR-DRG 0272
Min. Negotiated Rate	$31,402.55
Max. Negotiated Rate	$39,317.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$31,402.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$39,317.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,179.14

APR-DRG 41.00: OTHER OPEN CRANIOTOMY

Facility

$148,232.11

Service Code	APR-DRG 0274
Min. Negotiated Rate	$118,390.65
Max. Negotiated Rate	$148,232.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$118,390.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$148,232.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$132,628.73

APR-DRG 41.00: OTHER OPEN CRANIOTOMY

Facility

$61,577.37

Service Code	APR-DRG 0273
Min. Negotiated Rate	$49,180.87
Max. Negotiated Rate	$61,577.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$49,180.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$61,577.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$55,095.54

APR-DRG 41.00: OTHER O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$24,025.73

Service Code	APR-DRG 6811
Min. Negotiated Rate	$19,188.97
Max. Negotiated Rate	$24,025.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,188.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$24,025.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,496.70

APR-DRG 41.00: OTHER O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$161,098.13

Service Code	APR-DRG 6814
Min. Negotiated Rate	$128,666.53
Max. Negotiated Rate	$161,098.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$128,666.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$161,098.13
Rate for Payer: Molina Healthcare of CA Medi-Cal	$144,140.43

APR-DRG 41.00: OTHER O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$50,830.34

Service Code	APR-DRG 6813
Min. Negotiated Rate	$40,597.39
Max. Negotiated Rate	$50,830.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$40,597.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$50,830.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,479.78

APR-DRG 41.00: OTHER O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$31,090.57

Service Code	APR-DRG 6812
Min. Negotiated Rate	$24,831.55
Max. Negotiated Rate	$31,090.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$24,831.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$31,090.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,817.88

APR-DRG 41.00: OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$46,772.57

Service Code	APR-DRG 0292
Min. Negotiated Rate	$37,356.51
Max. Negotiated Rate	$46,772.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$37,356.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$46,772.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,849.14

APR-DRG 41.00: OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$52,209.07

Service Code	APR-DRG 0293
Min. Negotiated Rate	$41,698.56
Max. Negotiated Rate	$52,209.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$41,698.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$52,209.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,713.38

APR-DRG 41.00: OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$115,444.74

Service Code	APR-DRG 0294
Min. Negotiated Rate	$92,203.89
Max. Negotiated Rate	$115,444.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$92,203.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$115,444.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$103,292.66

APR-DRG 41.00: OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$41,336.04

Service Code	APR-DRG 0291
Min. Negotiated Rate	$33,014.44
Max. Negotiated Rate	$41,336.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$33,014.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$41,336.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,984.88

APR-DRG 41.00: OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$50,121.94

Service Code	APR-DRG 1823
Min. Negotiated Rate	$40,031.60
Max. Negotiated Rate	$50,121.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$40,031.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$50,121.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,845.95

APR-DRG 41.00: OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$41,704.51

Service Code	APR-DRG 1822
Min. Negotiated Rate	$33,308.73
Max. Negotiated Rate	$41,704.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$33,308.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$41,704.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,314.56

APR-DRG 41.00: OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$123,275.50

Service Code	APR-DRG 1824
Min. Negotiated Rate	$98,458.19
Max. Negotiated Rate	$123,275.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$98,458.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$123,275.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$110,299.13

APR-DRG 41.00: OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$37,786.97

Service Code	APR-DRG 1821
Min. Negotiated Rate	$30,179.86
Max. Negotiated Rate	$37,786.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$30,179.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$37,786.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,809.40

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