Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

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

APR-DRG 41.00: SICKLE CELL ANEMIA CRISIS

Facility

$10,426.12

Service Code	APR-DRG 6621
Min. Negotiated Rate	$8,327.18
Max. Negotiated Rate	$10,426.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,327.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,426.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,328.63

APR-DRG 41.00: SICKLE CELL ANEMIA CRISIS

Facility

$60,020.35

Service Code	APR-DRG 6624
Min. Negotiated Rate	$47,937.31
Max. Negotiated Rate	$60,020.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$47,937.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$60,020.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$53,702.42

APR-DRG 41.00: SICKLE CELL ANEMIA CRISIS

Facility

$14,243.81

Service Code	APR-DRG 6622
Min. Negotiated Rate	$11,376.30
Max. Negotiated Rate	$14,243.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,376.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,243.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,744.46

APR-DRG 41.00: SICKLE CELL ANEMIA CRISIS

Facility

$20,543.22

Service Code	APR-DRG 6623
Min. Negotiated Rate	$16,407.54
Max. Negotiated Rate	$20,543.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,407.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$20,543.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,380.77

APR-DRG 41.00: SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$37,113.76

Service Code	APR-DRG 8614
Min. Negotiated Rate	$29,642.18
Max. Negotiated Rate	$37,113.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$29,642.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$37,113.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,207.05

APR-DRG 41.00: SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$7,773.24

Service Code	APR-DRG 8611
Min. Negotiated Rate	$6,208.37
Max. Negotiated Rate	$7,773.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,208.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$7,773.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$6,955.01

APR-DRG 41.00: SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$12,698.67

Service Code	APR-DRG 8612
Min. Negotiated Rate	$10,142.23
Max. Negotiated Rate	$12,698.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,142.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,698.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,361.97

APR-DRG 41.00: SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$18,456.09

Service Code	APR-DRG 8613
Min. Negotiated Rate	$14,740.59
Max. Negotiated Rate	$18,456.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,740.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$18,456.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,513.34

APR-DRG 41.00: SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility

$23,921.13

Service Code	APR-DRG 3121
Min. Negotiated Rate	$19,105.43
Max. Negotiated Rate	$23,921.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,105.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$23,921.13
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,403.12

APR-DRG 41.00: SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility

$157,177.77

Service Code	APR-DRG 3124
Min. Negotiated Rate	$125,535.40
Max. Negotiated Rate	$157,177.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$125,535.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$157,177.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$140,632.74

APR-DRG 41.00: SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility

$62,946.60

Service Code	APR-DRG 3123
Min. Negotiated Rate	$50,274.46
Max. Negotiated Rate	$62,946.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$50,274.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$62,946.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$56,320.64

APR-DRG 41.00: SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility

$37,782.22

Service Code	APR-DRG 3122
Min. Negotiated Rate	$30,176.06
Max. Negotiated Rate	$37,782.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$30,176.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$37,782.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,805.15

APR-DRG 41.00: SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$52,579.90

Service Code	APR-DRG 3613
Min. Negotiated Rate	$41,994.73
Max. Negotiated Rate	$52,579.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$41,994.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$52,579.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,045.17

APR-DRG 41.00: SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$28,135.81

Service Code	APR-DRG 3611
Min. Negotiated Rate	$22,471.63
Max. Negotiated Rate	$28,135.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$22,471.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$28,135.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,174.14

APR-DRG 41.00: SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$155,114.40

Service Code	APR-DRG 3614
Min. Negotiated Rate	$123,887.43
Max. Negotiated Rate	$155,114.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$123,887.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$155,114.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$138,786.57

APR-DRG 41.00: SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$35,428.86

Service Code	APR-DRG 3612
Min. Negotiated Rate	$28,296.47
Max. Negotiated Rate	$35,428.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$28,296.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$35,428.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,699.51

APR-DRG 41.00: SKIN ULCERS

Facility

$14,101.17

Service Code	APR-DRG 3802
Min. Negotiated Rate	$11,262.38
Max. Negotiated Rate	$14,101.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,262.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,101.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,616.84

APR-DRG 41.00: SKIN ULCERS

Facility

$50,206.09

Service Code	APR-DRG 3804
Min. Negotiated Rate	$40,098.81
Max. Negotiated Rate	$50,206.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$40,098.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$50,206.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,921.24

APR-DRG 41.00: SKIN ULCERS

Facility

$10,946.72

Service Code	APR-DRG 3801
Min. Negotiated Rate	$8,742.97
Max. Negotiated Rate	$10,946.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,742.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,946.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,794.43

APR-DRG 41.00: SKIN ULCERS

Facility

$20,612.15

Service Code	APR-DRG 3803
Min. Negotiated Rate	$16,462.60
Max. Negotiated Rate	$20,612.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,462.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$20,612.15
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,442.45

APR-DRG 41.00: SPINAL DISORDERS AND INJURIES

Facility

$25,499.56

Service Code	APR-DRG 0402
Min. Negotiated Rate	$20,366.09
Max. Negotiated Rate	$25,499.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$20,366.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$25,499.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,815.39

APR-DRG 41.00: SPINAL DISORDERS AND INJURIES

Facility

$74,370.65

Service Code	APR-DRG 0404
Min. Negotiated Rate	$59,398.67
Max. Negotiated Rate	$74,370.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$59,398.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$74,370.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$66,542.16

APR-DRG 41.00: SPINAL DISORDERS AND INJURIES

Facility

$18,059.12

Service Code	APR-DRG 0401
Min. Negotiated Rate	$14,423.53
Max. Negotiated Rate	$18,059.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,423.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$18,059.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,158.16

APR-DRG 41.00: SPINAL DISORDERS AND INJURIES

Facility

$35,787.81

Service Code	APR-DRG 0403
Min. Negotiated Rate	$28,583.16
Max. Negotiated Rate	$35,787.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$28,583.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$35,787.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,020.67

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All Charges