Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 41.00: PULMONARY EMBOLISM

Facility

$22,330.83

Service Code	APR-DRG 1343
Min. Negotiated Rate	$17,835.28
Max. Negotiated Rate	$22,330.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,835.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22,330.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,980.22

APR-DRG 41.00: PULMONARY EMBOLISM

Facility

$53,177.52

Service Code	APR-DRG 1344
Min. Negotiated Rate	$42,472.05
Max. Negotiated Rate	$53,177.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$42,472.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$53,177.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,579.89

APR-DRG 41.00: PULMONARY EMBOLISM

Facility

$11,816.75

Service Code	APR-DRG 1341
Min. Negotiated Rate	$9,437.85
Max. Negotiated Rate	$11,816.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,437.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,816.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,572.88

APR-DRG 41.00: RADIOTHERAPY

Facility

$40,054.77

Service Code	APR-DRG 6923
Min. Negotiated Rate	$31,991.12
Max. Negotiated Rate	$40,054.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$31,991.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$40,054.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,838.48

APR-DRG 41.00: RADIOTHERAPY

Facility

$91,216.95

Service Code	APR-DRG 6924
Min. Negotiated Rate	$72,853.54
Max. Negotiated Rate	$91,216.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$72,853.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$91,216.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$81,615.16

APR-DRG 41.00: RADIOTHERAPY

Facility

$12,760.48

Service Code	APR-DRG 6921
Min. Negotiated Rate	$10,191.59
Max. Negotiated Rate	$12,760.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,191.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,760.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,417.27

APR-DRG 41.00: RADIOTHERAPY

Facility

$24,470.25

Service Code	APR-DRG 6922
Min. Negotiated Rate	$19,544.00
Max. Negotiated Rate	$24,470.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,544.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$24,470.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,894.44

APR-DRG 41.00: REHABILITATION

Facility

$16,210.17

Service Code	APR-DRG 8601
Min. Negotiated Rate	$12,946.81
Max. Negotiated Rate	$16,210.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,946.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$16,210.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,503.84

APR-DRG 41.00: REHABILITATION

Facility

$30,434.96

Service Code	APR-DRG 8604
Min. Negotiated Rate	$24,307.92
Max. Negotiated Rate	$30,434.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$24,307.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$30,434.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,231.28

APR-DRG 41.00: REHABILITATION

Facility

$24,815.41

Service Code	APR-DRG 8603
Min. Negotiated Rate	$19,819.67
Max. Negotiated Rate	$24,815.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,819.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$24,815.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,203.26

APR-DRG 41.00: REHABILITATION

Facility

$19,749.26

Service Code	APR-DRG 8602
Min. Negotiated Rate	$15,773.43
Max. Negotiated Rate	$19,749.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$15,773.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$19,749.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,670.40

APR-DRG 41.00: RENAL DIALYSIS ACCESS DEVICE PROCEDURES

Facility

$18,591.60

Service Code	APR-DRG 4441
Min. Negotiated Rate	$14,848.81
Max. Negotiated Rate	$18,591.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,848.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$18,591.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,634.58

APR-DRG 41.00: RENAL DIALYSIS ACCESS DEVICE PROCEDURES

Facility

$27,719.80

Service Code	APR-DRG 4442
Min. Negotiated Rate	$22,139.37
Max. Negotiated Rate	$27,719.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$22,139.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$27,719.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,801.93

APR-DRG 41.00: RENAL DIALYSIS ACCESS DEVICE PROCEDURES

Facility

$41,212.43

Service Code	APR-DRG 4443
Min. Negotiated Rate	$32,915.71
Max. Negotiated Rate	$41,212.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$32,915.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$41,212.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,874.28

APR-DRG 41.00: RENAL DIALYSIS ACCESS DEVICE PROCEDURES

Facility

$98,475.29

Service Code	APR-DRG 4444
Min. Negotiated Rate	$78,650.66
Max. Negotiated Rate	$98,475.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$78,650.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$98,475.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$88,109.47

APR-DRG 41.00: RESPIRATORY FAILURE

Facility

$22,171.56

Service Code	APR-DRG 1333
Min. Negotiated Rate	$17,708.07
Max. Negotiated Rate	$22,171.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,708.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22,171.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,837.71

APR-DRG 41.00: RESPIRATORY FAILURE

Facility

$52,811.24

Service Code	APR-DRG 1334
Min. Negotiated Rate	$42,179.50
Max. Negotiated Rate	$52,811.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$42,179.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$52,811.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,252.16

APR-DRG 41.00: RESPIRATORY FAILURE

Facility

$7,780.37

Service Code	APR-DRG 1331
Min. Negotiated Rate	$6,214.06
Max. Negotiated Rate	$7,780.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,214.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$7,780.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$6,961.38

APR-DRG 41.00: RESPIRATORY FAILURE

Facility

$14,723.99

Service Code	APR-DRG 1332
Min. Negotiated Rate	$11,759.82
Max. Negotiated Rate	$14,723.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,759.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,723.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,174.10

APR-DRG 41.00: RESPIRATORY MALIGNANCY

Facility

$24,810.18

Service Code	APR-DRG 1363
Min. Negotiated Rate	$19,815.50
Max. Negotiated Rate	$24,810.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,815.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$24,810.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,198.58

APR-DRG 41.00: RESPIRATORY MALIGNANCY

Facility

$53,307.60

Service Code	APR-DRG 1364
Min. Negotiated Rate	$42,575.94
Max. Negotiated Rate	$53,307.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$42,575.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$53,307.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,696.27

APR-DRG 41.00: RESPIRATORY MALIGNANCY

Facility

$17,379.24

Service Code	APR-DRG 1362
Min. Negotiated Rate	$13,880.53
Max. Negotiated Rate	$17,379.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,880.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,379.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,549.85

APR-DRG 41.00: RESPIRATORY MALIGNANCY

Facility

$12,748.58

Service Code	APR-DRG 1361
Min. Negotiated Rate	$10,182.09
Max. Negotiated Rate	$12,748.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,182.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,748.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,406.63

APR-DRG 41.00: RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$10,167.01

Service Code	APR-DRG 1441
Min. Negotiated Rate	$8,120.23
Max. Negotiated Rate	$10,167.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,120.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,167.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,096.80

APR-DRG 41.00: RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$19,818.20

Service Code	APR-DRG 1443
Min. Negotiated Rate	$15,828.48
Max. Negotiated Rate	$19,818.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$15,828.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$19,818.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,732.07

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All Charges