Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

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

APR-DRG 41.00: VAGINAL DELIVERY

Facility

$13,251.84

Service Code	APR-DRG 5603
Min. Negotiated Rate	$7,312.60
Max. Negotiated Rate	$13,251.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,312.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,155.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,251.84

APR-DRG 41.00: VAGINAL DELIVERY

Facility

$8,884.15

Service Code	APR-DRG 5601
Min. Negotiated Rate	$4,902.44
Max. Negotiated Rate	$8,884.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,902.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$6,138.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,884.15

APR-DRG 41.00: VAGINAL DELIVERY

Facility

$23,201.45

Service Code	APR-DRG 5604
Min. Negotiated Rate	$12,802.98
Max. Negotiated Rate	$23,201.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,802.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$16,030.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,201.45

APR-DRG 41.00: VAGINAL DELIVERY

Facility

$10,150.42

Service Code	APR-DRG 5602
Min. Negotiated Rate	$5,601.18
Max. Negotiated Rate	$10,150.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,601.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$7,013.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,150.42

APR-DRG 41.00: VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$11,676.33

Service Code	APR-DRG 5422
Min. Negotiated Rate	$6,443.21
Max. Negotiated Rate	$11,676.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,443.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,067.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,676.33

APR-DRG 41.00: VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$51,849.74

Service Code	APR-DRG 5424
Min. Negotiated Rate	$28,611.63
Max. Negotiated Rate	$51,849.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$28,611.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$35,823.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$51,849.74

APR-DRG 41.00: VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$10,267.12

Service Code	APR-DRG 5421
Min. Negotiated Rate	$5,665.59
Max. Negotiated Rate	$10,267.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,665.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$7,093.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,267.12

APR-DRG 41.00: VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$17,342.35

Service Code	APR-DRG 5423
Min. Negotiated Rate	$9,569.83
Max. Negotiated Rate	$17,342.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,569.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,981.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,342.35

APR-DRG 41.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C

Facility

$20,537.17

Service Code	APR-DRG 5413
Min. Negotiated Rate	$11,332.78
Max. Negotiated Rate	$20,537.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,332.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,189.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,537.17

APR-DRG 41.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C

Facility

$15,585.95

Service Code	APR-DRG 5411
Min. Negotiated Rate	$8,600.61
Max. Negotiated Rate	$15,585.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,600.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,768.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,585.95

APR-DRG 41.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C

Facility

$16,335.77

Service Code	APR-DRG 5412
Min. Negotiated Rate	$9,014.37
Max. Negotiated Rate	$16,335.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,014.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,286.53
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,335.77

APR-DRG 41.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C

Facility

$32,330.02

Service Code	APR-DRG 5414
Min. Negotiated Rate	$17,840.29
Max. Negotiated Rate	$32,330.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,840.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22,337.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,330.02

APR-DRG 41.00: VENTRICULAR SHUNT PROCEDURES

Facility

$32,214.97

Service Code	APR-DRG 0222
Min. Negotiated Rate	$25,729.59
Max. Negotiated Rate	$32,214.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$25,729.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$32,214.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,823.92

APR-DRG 41.00: VENTRICULAR SHUNT PROCEDURES

Facility

$27,914.72

Service Code	APR-DRG 0221
Min. Negotiated Rate	$22,295.05
Max. Negotiated Rate	$27,914.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$22,295.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$27,914.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,976.33

APR-DRG 41.00: VENTRICULAR SHUNT PROCEDURES

Facility

$117,661.17

Service Code	APR-DRG 0224
Min. Negotiated Rate	$93,974.12
Max. Negotiated Rate	$117,661.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$93,974.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$117,661.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$105,275.78

APR-DRG 41.00: VENTRICULAR SHUNT PROCEDURES

Facility

$44,797.15

Service Code	APR-DRG 0223
Min. Negotiated Rate	$35,778.78
Max. Negotiated Rate	$44,797.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$35,778.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$44,797.15
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,081.67

APR-DRG 41.00: VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$31,190.42

Service Code	APR-DRG 3102
Min. Negotiated Rate	$24,911.30
Max. Negotiated Rate	$31,190.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$24,911.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$31,190.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,907.22

APR-DRG 41.00: VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$42,705.27

Service Code	APR-DRG 3103
Min. Negotiated Rate	$34,108.03
Max. Negotiated Rate	$42,705.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$34,108.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$42,705.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,209.98

APR-DRG 41.00: VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$23,360.14

Service Code	APR-DRG 3101
Min. Negotiated Rate	$18,657.37
Max. Negotiated Rate	$23,360.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,657.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$23,360.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,901.18

APR-DRG 41.00: VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$111,294.72

Service Code	APR-DRG 3104
Min. Negotiated Rate	$88,889.34
Max. Negotiated Rate	$111,294.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$88,889.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$111,294.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$99,579.49

APR-DRG 41.00: VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$15,895.91

Service Code	APR-DRG 1113
Min. Negotiated Rate	$12,695.81
Max. Negotiated Rate	$15,895.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,695.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,895.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,222.66

APR-DRG 41.00: VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$46,182.56

Service Code	APR-DRG 1114
Min. Negotiated Rate	$36,885.28
Max. Negotiated Rate	$46,182.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$36,885.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$46,182.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,321.24

APR-DRG 41.00: VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$11,422.15

Service Code	APR-DRG 1111
Min. Negotiated Rate	$9,122.69
Max. Negotiated Rate	$11,422.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,122.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,422.15
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,219.82

APR-DRG 41.00: VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$13,095.66

Service Code	APR-DRG 1112
Min. Negotiated Rate	$10,459.29
Max. Negotiated Rate	$13,095.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,459.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$13,095.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,717.17

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