Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$13,266.81

Service Code	APR-DRG 1442
Min. Negotiated Rate	$10,595.99
Max. Negotiated Rate	$13,266.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,595.99
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$13,266.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,870.30

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

Facility

$48,272.25

Service Code	APR-DRG 1444
Min. Negotiated Rate	$38,554.29
Max. Negotiated Rate	$48,272.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$38,554.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$48,272.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,190.96

APR-DRG 41.00: RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$62,254.85

Service Code	APR-DRG 1301
Min. Negotiated Rate	$49,721.96
Max. Negotiated Rate	$62,254.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$49,721.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$62,254.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$55,701.71

APR-DRG 41.00: RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$70,413.18

Service Code	APR-DRG 1302
Min. Negotiated Rate	$56,237.90
Max. Negotiated Rate	$70,413.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$56,237.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$70,413.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$63,001.27

APR-DRG 41.00: RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$83,577.77

Service Code	APR-DRG 1303
Min. Negotiated Rate	$66,752.25
Max. Negotiated Rate	$83,577.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$66,752.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$83,577.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$74,780.11

APR-DRG 41.00: RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$157,334.93

Service Code	APR-DRG 1304
Min. Negotiated Rate	$125,660.93
Max. Negotiated Rate	$157,334.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$125,660.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$157,334.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$140,773.36

APR-DRG 41.00: SCHIZOPHRENIA

Facility

$39,403.43

Service Code	APR-DRG 7504
Min. Negotiated Rate	$31,470.90
Max. Negotiated Rate	$39,403.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$31,470.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$39,403.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,255.71

APR-DRG 41.00: SCHIZOPHRENIA

Facility

$8,683.21

Service Code	APR-DRG 7501
Min. Negotiated Rate	$6,935.14
Max. Negotiated Rate	$8,683.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,935.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,683.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$7,769.19

APR-DRG 41.00: SCHIZOPHRENIA

Facility

$17,689.70

Service Code	APR-DRG 7503
Min. Negotiated Rate	$14,128.49
Max. Negotiated Rate	$17,689.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,128.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,689.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,827.63

APR-DRG 41.00: SCHIZOPHRENIA

Facility

$11,024.22

Service Code	APR-DRG 7502
Min. Negotiated Rate	$8,804.87
Max. Negotiated Rate	$11,024.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,804.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,024.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,863.77

APR-DRG 41.00: SEIZURE

Facility

$55,005.06

Service Code	APR-DRG 0534
Min. Negotiated Rate	$43,931.67
Max. Negotiated Rate	$55,005.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$43,931.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$55,005.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,215.05

APR-DRG 41.00: SEIZURE

Facility

$9,827.08

Service Code	APR-DRG 0531
Min. Negotiated Rate	$7,848.74
Max. Negotiated Rate	$9,827.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,848.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,827.08
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,792.66

APR-DRG 41.00: SEIZURE

Facility

$17,450.57

Service Code	APR-DRG 0533
Min. Negotiated Rate	$13,937.49
Max. Negotiated Rate	$17,450.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,937.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,450.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,613.67

APR-DRG 41.00: SEIZURE

Facility

$12,777.12

Service Code	APR-DRG 0532
Min. Negotiated Rate	$10,204.88
Max. Negotiated Rate	$12,777.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,204.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,777.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,432.16

APR-DRG 41.00: SEPTICEMIA AND DISSEMINATED INFECTIONS

Facility

$58,030.20

Service Code	APR-DRG 7204
Min. Negotiated Rate	$46,347.80
Max. Negotiated Rate	$58,030.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$46,347.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$58,030.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$51,921.76

APR-DRG 41.00: SEPTICEMIA AND DISSEMINATED INFECTIONS

Facility

$11,828.64

Service Code	APR-DRG 7201
Min. Negotiated Rate	$9,447.35
Max. Negotiated Rate	$11,828.64
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,447.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,828.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,583.52

APR-DRG 41.00: SEPTICEMIA AND DISSEMINATED INFECTIONS

Facility

$15,144.75

Service Code	APR-DRG 7202
Min. Negotiated Rate	$12,095.87
Max. Negotiated Rate	$15,144.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,095.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,144.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,550.56

APR-DRG 41.00: SEPTICEMIA AND DISSEMINATED INFECTIONS

Facility

$22,625.60

Service Code	APR-DRG 7203
Min. Negotiated Rate	$18,070.71
Max. Negotiated Rate	$22,625.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,070.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22,625.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,243.96

APR-DRG 41.00: SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$52,907.95

Service Code	APR-DRG 3223
Min. Negotiated Rate	$42,256.75
Max. Negotiated Rate	$52,907.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$42,256.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$52,907.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,338.69

APR-DRG 41.00: SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$40,185.51

Service Code	APR-DRG 3222
Min. Negotiated Rate	$32,095.53
Max. Negotiated Rate	$40,185.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$32,095.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$40,185.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,955.46

APR-DRG 41.00: SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$37,237.85

Service Code	APR-DRG 3221
Min. Negotiated Rate	$29,741.29
Max. Negotiated Rate	$37,237.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$29,741.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$37,237.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,318.08

APR-DRG 41.00: SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$106,575.64

Service Code	APR-DRG 3224
Min. Negotiated Rate	$85,120.28
Max. Negotiated Rate	$106,575.64
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$85,120.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$106,575.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$95,357.15

APR-DRG 41.00: SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$20,350.67

Service Code	APR-DRG 3151
Min. Negotiated Rate	$16,253.76
Max. Negotiated Rate	$20,350.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,253.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$20,350.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,208.50

APR-DRG 41.00: SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$32,093.74

Service Code	APR-DRG 3152
Min. Negotiated Rate	$25,632.76
Max. Negotiated Rate	$32,093.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$25,632.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$32,093.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,715.45

APR-DRG 41.00: SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$108,412.69

Service Code	APR-DRG 3154
Min. Negotiated Rate	$86,587.50
Max. Negotiated Rate	$108,412.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$86,587.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$108,412.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$97,000.83

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All Charges