Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

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

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

Facility

$51,293.88

Service Code	APR-DRG 5103
Min. Negotiated Rate	$40,967.61
Max. Negotiated Rate	$51,293.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$40,967.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$51,293.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,894.53

APR-DRG 41.00: PENIS, TESTES AND SCROTAL PROCEDURES

Facility

$38,504.87

Service Code	APR-DRG 4833
Min. Negotiated Rate	$30,753.23
Max. Negotiated Rate	$38,504.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$30,753.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$38,504.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,451.72

APR-DRG 41.00: PENIS, TESTES AND SCROTAL PROCEDURES

Facility

$91,642.93

Service Code	APR-DRG 4834
Min. Negotiated Rate	$73,193.76
Max. Negotiated Rate	$91,642.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$73,193.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$91,642.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$81,996.30

APR-DRG 41.00: PENIS, TESTES AND SCROTAL PROCEDURES

Facility

$18,703.31

Service Code	APR-DRG 4831
Min. Negotiated Rate	$14,938.04
Max. Negotiated Rate	$18,703.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,938.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$18,703.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,734.54

APR-DRG 41.00: PENIS, TESTES AND SCROTAL PROCEDURES

Facility

$25,416.36

Service Code	APR-DRG 4832
Min. Negotiated Rate	$20,299.64
Max. Negotiated Rate	$25,416.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$20,299.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$25,416.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,740.95

APR-DRG 41.00: PEPTIC ULCER AND GASTRITIS

Facility

$61,767.54

Service Code	APR-DRG 2414
Min. Negotiated Rate	$49,332.76
Max. Negotiated Rate	$61,767.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$49,332.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$61,767.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$55,265.69

APR-DRG 41.00: PEPTIC ULCER AND GASTRITIS

Facility

$22,891.83

Service Code	APR-DRG 2413
Min. Negotiated Rate	$18,283.34
Max. Negotiated Rate	$22,891.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,283.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22,891.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,482.16

APR-DRG 41.00: PEPTIC ULCER AND GASTRITIS

Facility

$12,582.18

Service Code	APR-DRG 2411
Min. Negotiated Rate	$10,049.19
Max. Negotiated Rate	$12,582.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,049.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,582.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,257.74

APR-DRG 41.00: PEPTIC ULCER AND GASTRITIS

Facility

$15,579.75

Service Code	APR-DRG 2412
Min. Negotiated Rate	$12,443.30
Max. Negotiated Rate	$15,579.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,443.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,579.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,939.78

APR-DRG 41.00: PERCUTANEOUS CARDIAC INTERVENTION WITH AMI

Facility

$54,890.49

Service Code	APR-DRG 1743
Min. Negotiated Rate	$43,840.17
Max. Negotiated Rate	$54,890.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$43,840.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$54,890.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,112.54

APR-DRG 41.00: PERCUTANEOUS CARDIAC INTERVENTION WITH AMI

Facility

$110,319.62

Service Code	APR-DRG 1744
Min. Negotiated Rate	$88,110.54
Max. Negotiated Rate	$110,319.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$88,110.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$110,319.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$98,707.03

APR-DRG 41.00: PERCUTANEOUS CARDIAC INTERVENTION WITH AMI

Facility

$44,088.78

Service Code	APR-DRG 1742
Min. Negotiated Rate	$35,213.01
Max. Negotiated Rate	$44,088.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$35,213.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$44,088.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$39,447.85

APR-DRG 41.00: PERCUTANEOUS CARDIAC INTERVENTION WITH AMI

Facility

$40,843.98

Service Code	APR-DRG 1741
Min. Negotiated Rate	$32,621.44
Max. Negotiated Rate	$40,843.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$32,621.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$40,843.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,544.61

APR-DRG 41.00: PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI

Facility

$58,513.24

Service Code	APR-DRG 1753
Min. Negotiated Rate	$46,733.60
Max. Negotiated Rate	$58,513.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$46,733.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$58,513.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$52,353.95

APR-DRG 41.00: PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI

Facility

$46,934.20

Service Code	APR-DRG 1752
Min. Negotiated Rate	$37,485.60
Max. Negotiated Rate	$46,934.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$37,485.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$46,934.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,993.76

APR-DRG 41.00: PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI

Facility

$41,771.06

Service Code	APR-DRG 1751
Min. Negotiated Rate	$33,361.89
Max. Negotiated Rate	$41,771.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$33,361.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$41,771.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,374.11

APR-DRG 41.00: PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI

Facility

$122,766.32

Service Code	APR-DRG 1754
Min. Negotiated Rate	$98,051.52
Max. Negotiated Rate	$122,766.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$98,051.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$122,766.32
Rate for Payer: Molina Healthcare of CA Medi-Cal	$109,843.54

APR-DRG 41.00: PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES

Facility

$128,131.04

Service Code	APR-DRG 0304
Min. Negotiated Rate	$102,336.24
Max. Negotiated Rate	$128,131.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$102,336.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$128,131.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$114,643.56

APR-DRG 41.00: PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES

Facility

$68,825.26

Service Code	APR-DRG 0303
Min. Negotiated Rate	$54,969.65
Max. Negotiated Rate	$68,825.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$54,969.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$68,825.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$61,580.49

APR-DRG 41.00: PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES

Facility

$50,397.69

Service Code	APR-DRG 0302
Min. Negotiated Rate	$40,251.84
Max. Negotiated Rate	$50,397.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$40,251.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$50,397.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,092.67

APR-DRG 41.00: PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES

Facility

$38,079.36

Service Code	APR-DRG 0301
Min. Negotiated Rate	$30,413.39
Max. Negotiated Rate	$38,079.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$30,413.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$38,079.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,071.01

APR-DRG 41.00: PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$200,747.84

Service Code	APR-DRG 1834
Min. Negotiated Rate	$160,334.13
Max. Negotiated Rate	$200,747.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$160,334.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$200,747.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$179,616.49

APR-DRG 41.00: PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$95,777.25

Service Code	APR-DRG 1833
Min. Negotiated Rate	$76,495.78
Max. Negotiated Rate	$95,777.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$76,495.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$95,777.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$85,695.44

APR-DRG 41.00: PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$82,534.21

Service Code	APR-DRG 1832
Min. Negotiated Rate	$65,918.77
Max. Negotiated Rate	$82,534.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$65,918.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$82,534.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$73,846.40

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