Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$50,357.28

Service Code	APR-DRG 3123
Min. Negotiated Rate	$31,804.60
Max. Negotiated Rate	$50,357.28
Rate for Payer: Adventist Health Medi-Cal	$31,804.60
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$37,900.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$50,357.28

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

Facility

$22,508.63

Service Code	APR-DRG 3611
Min. Negotiated Rate	$14,215.98
Max. Negotiated Rate	$22,508.63
Rate for Payer: Adventist Health Medi-Cal	$14,215.98
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$16,940.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22,508.63

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

Facility

$28,343.08

Service Code	APR-DRG 3612
Min. Negotiated Rate	$17,900.89
Max. Negotiated Rate	$28,343.08
Rate for Payer: Adventist Health Medi-Cal	$17,900.89
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$21,331.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$28,343.08

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

Facility

$88,636.80

Service Code	APR-DRG 3614
Min. Negotiated Rate	$55,981.14
Max. Negotiated Rate	$88,636.80
Rate for Payer: Adventist Health Medi-Cal	$55,981.14
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$66,710.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$88,636.80

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

Facility

$42,063.93

Service Code	APR-DRG 3613
Min. Negotiated Rate	$26,566.69
Max. Negotiated Rate	$42,063.93
Rate for Payer: Adventist Health Medi-Cal	$26,566.69
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$31,658.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$42,063.93

APR-DRG 41.00: SKIN ULCERS

Facility

$28,689.20

Service Code	APR-DRG 3804
Min. Negotiated Rate	$18,119.50
Max. Negotiated Rate	$28,689.20
Rate for Payer: Adventist Health Medi-Cal	$18,119.50
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$21,592.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$28,689.20

APR-DRG 41.00: SKIN ULCERS

Facility

$16,489.72

Service Code	APR-DRG 3803
Min. Negotiated Rate	$10,414.56
Max. Negotiated Rate	$16,489.72
Rate for Payer: Adventist Health Medi-Cal	$10,414.56
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$12,410.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$16,489.72

APR-DRG 41.00: SKIN ULCERS

Facility

$11,280.95

Service Code	APR-DRG 3802
Min. Negotiated Rate	$7,124.81
Max. Negotiated Rate	$11,280.95
Rate for Payer: Adventist Health Medi-Cal	$7,124.81
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$8,490.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,280.95

APR-DRG 41.00: SKIN ULCERS

Facility

$8,757.37

Service Code	APR-DRG 3801
Min. Negotiated Rate	$5,530.97
Max. Negotiated Rate	$8,757.37
Rate for Payer: Adventist Health Medi-Cal	$5,530.97
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$6,591.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,757.37

APR-DRG 41.00: SPINAL DISORDERS AND INJURIES

Facility

$14,447.30

Service Code	APR-DRG 0401
Min. Negotiated Rate	$9,124.61
Max. Negotiated Rate	$14,447.30
Rate for Payer: Adventist Health Medi-Cal	$9,124.61
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$10,873.49
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,447.30

APR-DRG 41.00: SPINAL DISORDERS AND INJURIES

Facility

$20,399.63

Service Code	APR-DRG 0402
Min. Negotiated Rate	$12,883.98
Max. Negotiated Rate	$20,399.63
Rate for Payer: Adventist Health Medi-Cal	$12,883.98
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$15,353.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$20,399.63

APR-DRG 41.00: SPINAL DISORDERS AND INJURIES

Facility

$42,497.51

Service Code	APR-DRG 0404
Min. Negotiated Rate	$26,840.53
Max. Negotiated Rate	$42,497.51
Rate for Payer: Adventist Health Medi-Cal	$26,840.53
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$31,984.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$42,497.51

APR-DRG 41.00: SPINAL DISORDERS AND INJURIES

Facility

$28,630.24

Service Code	APR-DRG 0403
Min. Negotiated Rate	$18,082.26
Max. Negotiated Rate	$28,630.24
Rate for Payer: Adventist Health Medi-Cal	$18,082.26
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$21,548.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$28,630.24

APR-DRG 41.00: SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$35,156.92

Service Code	APR-DRG 3212
Min. Negotiated Rate	$22,204.37
Max. Negotiated Rate	$35,156.92
Rate for Payer: Adventist Health Medi-Cal	$22,204.37
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$26,460.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$35,156.92

APR-DRG 41.00: SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$29,341.49

Service Code	APR-DRG 3211
Min. Negotiated Rate	$18,531.47
Max. Negotiated Rate	$29,341.49
Rate for Payer: Adventist Health Medi-Cal	$18,531.47
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$22,083.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$29,341.49

APR-DRG 41.00: SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$48,023.89

Service Code	APR-DRG 3213
Min. Negotiated Rate	$30,330.88
Max. Negotiated Rate	$48,023.89
Rate for Payer: Adventist Health Medi-Cal	$30,330.88
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$36,144.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$48,023.89

APR-DRG 41.00: SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$76,941.28

Service Code	APR-DRG 3214
Min. Negotiated Rate	$48,594.49
Max. Negotiated Rate	$76,941.28
Rate for Payer: Adventist Health Medi-Cal	$48,594.49
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$57,908.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$76,941.28

APR-DRG 41.00: SPINAL PROCEDURES

Facility

$60,149.19

Service Code	APR-DRG 0233
Min. Negotiated Rate	$37,988.96
Max. Negotiated Rate	$60,149.19
Rate for Payer: Adventist Health Medi-Cal	$37,988.96
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$45,270.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$60,149.19

APR-DRG 41.00: SPINAL PROCEDURES

Facility

$35,744.55

Service Code	APR-DRG 0232
Min. Negotiated Rate	$22,575.50
Max. Negotiated Rate	$35,744.55
Rate for Payer: Adventist Health Medi-Cal	$22,575.50
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$26,902.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$35,744.55

APR-DRG 41.00: SPINAL PROCEDURES

Facility

$95,024.64

Service Code	APR-DRG 0234
Min. Negotiated Rate	$60,015.56
Max. Negotiated Rate	$95,024.64
Rate for Payer: Adventist Health Medi-Cal	$60,015.56
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$71,518.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$95,024.64

APR-DRG 41.00: SPINAL PROCEDURES

Facility

$26,325.37

Service Code	APR-DRG 0231
Min. Negotiated Rate	$16,626.55
Max. Negotiated Rate	$26,325.37
Rate for Payer: Adventist Health Medi-Cal	$16,626.55
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$19,813.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$26,325.37

APR-DRG 41.00: SPLENECTOMY

Facility

$30,180.13

Service Code	APR-DRG 6502
Min. Negotiated Rate	$19,061.14
Max. Negotiated Rate	$30,180.13
Rate for Payer: Adventist Health Medi-Cal	$19,061.14
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$22,714.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$30,180.13

APR-DRG 41.00: SPLENECTOMY

Facility

$23,044.93

Service Code	APR-DRG 6501
Min. Negotiated Rate	$14,554.69
Max. Negotiated Rate	$23,044.93
Rate for Payer: Adventist Health Medi-Cal	$14,554.69
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$17,344.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$23,044.93

APR-DRG 41.00: SPLENECTOMY

Facility

$68,235.25

Service Code	APR-DRG 6504
Min. Negotiated Rate	$43,095.95
Max. Negotiated Rate	$68,235.25
Rate for Payer: Adventist Health Medi-Cal	$43,095.95
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$51,356.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$68,235.25

APR-DRG 41.00: SPLENECTOMY

Facility

$42,714.30

Service Code	APR-DRG 6503
Min. Negotiated Rate	$26,977.45
Max. Negotiated Rate	$42,714.30
Rate for Payer: Adventist Health Medi-Cal	$26,977.45
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$32,148.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$42,714.30

Know your out-of-pocket cost for care.

All Charges