Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 41.00: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$11,814.37

Service Code	APR-DRG 3852
Min. Negotiated Rate	$9,435.95
Max. Negotiated Rate	$11,814.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,435.95
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,814.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,570.75

APR-DRG 41.00: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$18,387.15

Service Code	APR-DRG 3853
Min. Negotiated Rate	$14,685.53
Max. Negotiated Rate	$18,387.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,685.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$18,387.15
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,451.67

APR-DRG 41.00: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$46,392.22

Service Code	APR-DRG 3854
Min. Negotiated Rate	$37,052.74
Max. Negotiated Rate	$46,392.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$37,052.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$46,392.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,508.83

APR-DRG 41.00: OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES

Facility

$33,750.59

Service Code	APR-DRG 3643
Min. Negotiated Rate	$26,956.07
Max. Negotiated Rate	$33,750.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$26,956.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$33,750.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,197.90

APR-DRG 41.00: OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES

Facility

$83,229.77

Service Code	APR-DRG 3644
Min. Negotiated Rate	$66,474.30
Max. Negotiated Rate	$83,229.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$66,474.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$83,229.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$74,468.74

APR-DRG 41.00: OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES

Facility

$15,636.81

Service Code	APR-DRG 3641
Min. Negotiated Rate	$12,488.87
Max. Negotiated Rate	$15,636.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,488.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,636.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,990.83

APR-DRG 41.00: OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES

Facility

$21,358.58

Service Code	APR-DRG 3642
Min. Negotiated Rate	$17,058.76
Max. Negotiated Rate	$21,358.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,058.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$21,358.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,110.31

APR-DRG 41.00: OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$30,612.78

Service Code	APR-DRG 2232
Min. Negotiated Rate	$24,449.94
Max. Negotiated Rate	$30,612.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$24,449.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$30,612.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,390.38

APR-DRG 41.00: OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$24,650.92

Service Code	APR-DRG 2231
Min. Negotiated Rate	$19,688.30
Max. Negotiated Rate	$24,650.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,688.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$24,650.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,056.09

APR-DRG 41.00: OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$105,973.26

Service Code	APR-DRG 2234
Min. Negotiated Rate	$84,639.17
Max. Negotiated Rate	$105,973.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$84,639.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$105,973.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$94,818.18

APR-DRG 41.00: OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$41,649.82

Service Code	APR-DRG 2233
Min. Negotiated Rate	$33,265.06
Max. Negotiated Rate	$41,649.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$33,265.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$41,649.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,265.63

APR-DRG 41.00: OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$15,270.74

Service Code	APR-DRG 2221
Min. Negotiated Rate	$12,196.50
Max. Negotiated Rate	$15,270.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,196.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,270.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,663.29

APR-DRG 41.00: OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$39,032.59

Service Code	APR-DRG 2223
Min. Negotiated Rate	$31,174.72
Max. Negotiated Rate	$39,032.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$31,174.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$39,032.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,923.90

APR-DRG 41.00: OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$26,497.95

Service Code	APR-DRG 2222
Min. Negotiated Rate	$21,163.50
Max. Negotiated Rate	$26,497.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$21,163.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$26,497.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,708.69

APR-DRG 41.00: OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$107,331.10

Service Code	APR-DRG 2224
Min. Negotiated Rate	$85,723.65
Max. Negotiated Rate	$107,331.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$85,723.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$107,331.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$96,033.09

APR-DRG 41.00: PANCREAS TRANSPLANT

Facility

$159,406.09

Service Code	APR-DRG 0062
Min. Negotiated Rate	$83,897.94
Max. Negotiated Rate	$159,406.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$127,315.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant	$83,897.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$159,406.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$142,626.50

APR-DRG 41.00: PANCREAS TRANSPLANT

Facility

$194,060.00

Service Code	APR-DRG 0063
Min. Negotiated Rate	$102,136.84
Max. Negotiated Rate	$194,060.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$154,992.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant	$102,136.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$194,060.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$173,632.63

APR-DRG 41.00: PANCREAS TRANSPLANT

Facility

$343,169.28

Service Code	APR-DRG 0064
Min. Negotiated Rate	$180,615.41
Max. Negotiated Rate	$343,169.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$274,083.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant	$180,615.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$343,169.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$307,046.20

APR-DRG 41.00: PANCREAS TRANSPLANT

Facility

$132,418.45

Service Code	APR-DRG 0061
Min. Negotiated Rate	$69,693.92
Max. Negotiated Rate	$132,418.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$105,760.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant	$69,693.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$132,418.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$118,479.66

APR-DRG 41.00: PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT

Facility

$7,487.98

Service Code	APR-DRG 8441
Min. Negotiated Rate	$5,980.53
Max. Negotiated Rate	$7,487.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,980.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$7,487.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$6,699.77

APR-DRG 41.00: PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT

Facility

$12,513.25

Service Code	APR-DRG 8442
Min. Negotiated Rate	$9,994.13
Max. Negotiated Rate	$12,513.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,994.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,513.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,196.06

APR-DRG 41.00: PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT

Facility

$21,860.17

Service Code	APR-DRG 8443
Min. Negotiated Rate	$17,459.37
Max. Negotiated Rate	$21,860.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,459.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$21,860.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,559.10

APR-DRG 41.00: PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT

Facility

$66,885.99

Service Code	APR-DRG 8444
Min. Negotiated Rate	$53,420.78
Max. Negotiated Rate	$66,885.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$53,420.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$66,885.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$59,845.36

APR-DRG 41.00: PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND OTHER RADICAL GYNECOLOGICAL PROCEDURES

Facility

$27,332.34

Service Code	APR-DRG 5101
Min. Negotiated Rate	$21,829.91
Max. Negotiated Rate	$27,332.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$21,829.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$27,332.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,455.25

APR-DRG 41.00: PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND OTHER RADICAL GYNECOLOGICAL PROCEDURES

Facility

$32,362.36

Service Code	APR-DRG 5102
Min. Negotiated Rate	$25,847.30
Max. Negotiated Rate	$32,362.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$25,847.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$32,362.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,955.79

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All Charges