Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

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

APR-DRG 41.00: PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$18,377.65

Service Code	APR-DRG 1973
Min. Negotiated Rate	$14,677.94
Max. Negotiated Rate	$18,377.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,677.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$18,377.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,443.17

APR-DRG 41.00: PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$45,257.37

Service Code	APR-DRG 1974
Min. Negotiated Rate	$36,146.35
Max. Negotiated Rate	$45,257.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$36,146.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$45,257.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,493.44

APR-DRG 41.00: PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$13,012.45

Service Code	APR-DRG 1972
Min. Negotiated Rate	$10,392.84
Max. Negotiated Rate	$13,012.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,392.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$13,012.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,642.72

APR-DRG 41.00: PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$9,798.57

Service Code	APR-DRG 1971
Min. Negotiated Rate	$7,825.96
Max. Negotiated Rate	$9,798.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,825.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,798.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,767.14

APR-DRG 41.00: PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$12,648.76

Service Code	APR-DRG 0481
Min. Negotiated Rate	$10,102.36
Max. Negotiated Rate	$12,648.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,102.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,648.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,317.31

APR-DRG 41.00: PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$14,557.59

Service Code	APR-DRG 0482
Min. Negotiated Rate	$11,626.92
Max. Negotiated Rate	$14,557.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,626.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,557.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,025.21

APR-DRG 41.00: PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$53,534.10

Service Code	APR-DRG 0484
Min. Negotiated Rate	$42,756.84
Max. Negotiated Rate	$53,534.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$42,756.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$53,534.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,898.93

APR-DRG 41.00: PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$19,853.86

Service Code	APR-DRG 0483
Min. Negotiated Rate	$15,856.96
Max. Negotiated Rate	$19,853.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$15,856.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$19,853.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,763.98

APR-DRG 41.00: PERITONEAL ADHESIOLYSIS

Facility

$46,394.60

Service Code	APR-DRG 2243
Min. Negotiated Rate	$37,054.63
Max. Negotiated Rate	$46,394.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$37,054.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$46,394.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,510.96

APR-DRG 41.00: PERITONEAL ADHESIOLYSIS

Facility

$33,144.44

Service Code	APR-DRG 2242
Min. Negotiated Rate	$26,471.94
Max. Negotiated Rate	$33,144.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$26,471.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$33,144.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,655.55

APR-DRG 41.00: PERITONEAL ADHESIOLYSIS

Facility

$28,223.76

Service Code	APR-DRG 2241
Min. Negotiated Rate	$22,541.87
Max. Negotiated Rate	$28,223.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$22,541.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$28,223.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,252.84

APR-DRG 41.00: PERITONEAL ADHESIOLYSIS

Facility

$112,645.89

Service Code	APR-DRG 2244
Min. Negotiated Rate	$89,968.49
Max. Negotiated Rate	$112,645.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$89,968.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$112,645.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$100,788.43

APR-DRG 41.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK

Facility

$48,232.13

Service Code	APR-DRG 1702
Min. Negotiated Rate	$38,522.24
Max. Negotiated Rate	$48,232.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$38,522.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$48,232.13
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,155.06

APR-DRG 41.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK

Facility

$64,777.00

Service Code	APR-DRG 1703
Min. Negotiated Rate	$51,736.37
Max. Negotiated Rate	$64,777.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$51,736.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$64,777.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$57,958.37

APR-DRG 41.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK

Facility

$127,362.28

Service Code	APR-DRG 1704
Min. Negotiated Rate	$101,722.24
Max. Negotiated Rate	$127,362.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$101,722.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$127,362.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$113,955.73

APR-DRG 41.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK

Facility

$46,477.80

Service Code	APR-DRG 1701
Min. Negotiated Rate	$37,121.08
Max. Negotiated Rate	$46,477.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$37,121.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$46,477.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,585.40

APR-DRG 41.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK

Facility

$48,807.39

Service Code	APR-DRG 1713
Min. Negotiated Rate	$38,981.69
Max. Negotiated Rate	$48,807.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$38,981.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$48,807.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,669.77

APR-DRG 41.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK

Facility

$33,151.56

Service Code	APR-DRG 1711
Min. Negotiated Rate	$26,477.63
Max. Negotiated Rate	$33,151.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$26,477.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$33,151.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,661.92

APR-DRG 41.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK

Facility

$106,865.16

Service Code	APR-DRG 1714
Min. Negotiated Rate	$85,351.51
Max. Negotiated Rate	$106,865.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$85,351.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$106,865.16
Rate for Payer: Molina Healthcare of CA Medi-Cal	$95,616.19

APR-DRG 41.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK

Facility

$37,601.57

Service Code	APR-DRG 1712
Min. Negotiated Rate	$30,031.78
Max. Negotiated Rate	$37,601.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$30,031.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$37,601.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,643.51

APR-DRG 41.00: POISONING OF MEDICINAL AGENTS

Facility

$41,826.20

Service Code	APR-DRG 8124
Min. Negotiated Rate	$33,405.93
Max. Negotiated Rate	$41,826.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$33,405.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$41,826.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,423.44

APR-DRG 41.00: POISONING OF MEDICINAL AGENTS

Facility

$10,335.79

Service Code	APR-DRG 8122
Min. Negotiated Rate	$8,255.03
Max. Negotiated Rate	$10,335.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,255.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,335.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,247.81

APR-DRG 41.00: POISONING OF MEDICINAL AGENTS

Facility

$7,121.90

Service Code	APR-DRG 8121
Min. Negotiated Rate	$5,688.15
Max. Negotiated Rate	$7,121.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,688.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$7,121.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$6,372.23

APR-DRG 41.00: POISONING OF MEDICINAL AGENTS

Facility

$15,684.35

Service Code	APR-DRG 8123
Min. Negotiated Rate	$12,526.84
Max. Negotiated Rate	$15,684.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,526.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,684.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,033.36

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