Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 41.00: TRANSURETHRAL PROSTATECTOMY

Facility

$33,394.02

Service Code	APR-DRG 4823
Min. Negotiated Rate	$26,671.28
Max. Negotiated Rate	$33,394.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$26,671.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$33,394.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,878.86

APR-DRG 41.00: TRANSURETHRAL PROSTATECTOMY

Facility

$14,814.32

Service Code	APR-DRG 4821
Min. Negotiated Rate	$11,831.96
Max. Negotiated Rate	$14,814.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,831.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,814.32
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,254.92

APR-DRG 41.00: URETHRAL AND TRANSURETHRAL PROCEDURES

Facility

$20,904.54

Service Code	APR-DRG 4462
Min. Negotiated Rate	$16,696.13
Max. Negotiated Rate	$20,904.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,696.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$20,904.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,704.06

APR-DRG 41.00: URETHRAL AND TRANSURETHRAL PROCEDURES

Facility

$17,217.61

Service Code	APR-DRG 4461
Min. Negotiated Rate	$13,751.43
Max. Negotiated Rate	$17,217.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,751.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,217.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,405.23

APR-DRG 41.00: URETHRAL AND TRANSURETHRAL PROCEDURES

Facility

$32,966.14

Service Code	APR-DRG 4463
Min. Negotiated Rate	$26,329.54
Max. Negotiated Rate	$32,966.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$26,329.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$32,966.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,496.02

APR-DRG 41.00: URETHRAL AND TRANSURETHRAL PROCEDURES

Facility

$80,753.74

Service Code	APR-DRG 4464
Min. Negotiated Rate	$64,496.74
Max. Negotiated Rate	$80,753.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$64,496.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$80,753.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$72,253.35

APR-DRG 41.00: URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION

Facility

$49,437.33

Service Code	APR-DRG 4654
Min. Negotiated Rate	$39,484.82
Max. Negotiated Rate	$49,437.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$39,484.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$49,437.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,233.40

APR-DRG 41.00: URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION

Facility

$20,963.97

Service Code	APR-DRG 4653
Min. Negotiated Rate	$16,743.59
Max. Negotiated Rate	$20,963.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,743.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$20,963.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,757.24

APR-DRG 41.00: URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION

Facility

$12,686.77

Service Code	APR-DRG 4652
Min. Negotiated Rate	$10,132.73
Max. Negotiated Rate	$12,686.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,132.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,686.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,351.33

APR-DRG 41.00: URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION

Facility

$10,540.23

Service Code	APR-DRG 4651
Min. Negotiated Rate	$8,418.32
Max. Negotiated Rate	$10,540.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,418.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,540.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,430.73

APR-DRG 41.00: UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$19,000.46

Service Code	APR-DRG 5191
Min. Negotiated Rate	$15,175.36
Max. Negotiated Rate	$19,000.46
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$15,175.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$19,000.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,000.41

APR-DRG 41.00: UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$24,291.97

Service Code	APR-DRG 5192
Min. Negotiated Rate	$19,401.62
Max. Negotiated Rate	$24,291.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,401.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$24,291.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,734.92

APR-DRG 41.00: UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$109,497.61

Service Code	APR-DRG 5194
Min. Negotiated Rate	$87,454.01
Max. Negotiated Rate	$109,497.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$87,454.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$109,497.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$97,971.54

APR-DRG 41.00: UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$38,768.74

Service Code	APR-DRG 5193
Min. Negotiated Rate	$30,963.98
Max. Negotiated Rate	$38,768.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$30,963.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$38,768.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,687.82

APR-DRG 41.00: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$20,074.92

Service Code	APR-DRG 5131
Min. Negotiated Rate	$16,033.53
Max. Negotiated Rate	$20,074.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,033.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$20,074.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,961.78

APR-DRG 41.00: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$24,163.61

Service Code	APR-DRG 5132
Min. Negotiated Rate	$19,299.09
Max. Negotiated Rate	$24,163.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,299.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$24,163.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,620.07

APR-DRG 41.00: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$37,962.89

Service Code	APR-DRG 5133
Min. Negotiated Rate	$30,320.36
Max. Negotiated Rate	$37,962.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$30,320.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$37,962.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,966.80

APR-DRG 41.00: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$91,742.77

Service Code	APR-DRG 5134
Min. Negotiated Rate	$73,273.50
Max. Negotiated Rate	$91,742.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$73,273.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$91,742.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$82,085.64

APR-DRG 41.00: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility

$30,299.00

Service Code	APR-DRG 5122
Min. Negotiated Rate	$24,199.33
Max. Negotiated Rate	$30,299.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$24,199.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$30,299.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,109.63

APR-DRG 41.00: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility

$26,165.15

Service Code	APR-DRG 5121
Min. Negotiated Rate	$20,897.69
Max. Negotiated Rate	$26,165.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$20,897.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$26,165.15
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,410.92

APR-DRG 41.00: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility

$47,053.06

Service Code	APR-DRG 5123
Min. Negotiated Rate	$37,580.54
Max. Negotiated Rate	$47,053.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$37,580.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$47,053.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,100.11

APR-DRG 41.00: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility

$124,147.43

Service Code	APR-DRG 5124
Min. Negotiated Rate	$99,154.59
Max. Negotiated Rate	$124,147.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$99,154.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$124,147.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$111,079.27

APR-DRG 41.00: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY

Facility

$48,764.60

Service Code	APR-DRG 5113
Min. Negotiated Rate	$38,947.52
Max. Negotiated Rate	$48,764.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$38,947.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$48,764.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,631.49

APR-DRG 41.00: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY

Facility

$134,128.09

Service Code	APR-DRG 5114
Min. Negotiated Rate	$107,125.99
Max. Negotiated Rate	$134,128.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$107,125.99
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$134,128.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$120,009.34

APR-DRG 41.00: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY

Facility

$34,223.65

Service Code	APR-DRG 5112
Min. Negotiated Rate	$27,333.89
Max. Negotiated Rate	$34,223.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$27,333.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$34,223.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,621.17

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All Charges