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

$1.13

Service Code	APR-DRG 3121
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.13

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

Facility

$2.48

Service Code	APR-DRG 3613
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$2.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$2.48

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

Facility

$5.22

Service Code	APR-DRG 3614
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$5.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5.22

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

Facility

$1.67

Service Code	APR-DRG 3612
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$1.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.67

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

Facility

$1.32

Service Code	APR-DRG 3611
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.32

APR-DRG 41.00: SKIN ULCERS

Facility

$0.52

Service Code	APR-DRG 3801
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$0.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.52

APR-DRG 41.00: SKIN ULCERS

Facility

$0.97

Service Code	APR-DRG 3803
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$0.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.97

APR-DRG 41.00: SKIN ULCERS

Facility

$1.69

Service Code	APR-DRG 3804
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.69

APR-DRG 41.00: SKIN ULCERS

Facility

$0.66

Service Code	APR-DRG 3802
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.66

APR-DRG 41.00: SPINAL DISORDERS AND INJURIES

Facility

$0.85

Service Code	APR-DRG 0401
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.85

APR-DRG 41.00: SPINAL DISORDERS AND INJURIES

Facility

$1.20

Service Code	APR-DRG 0402
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.20

APR-DRG 41.00: SPINAL DISORDERS AND INJURIES

Facility

$2.50

Service Code	APR-DRG 0404
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$2.50

APR-DRG 41.00: SPINAL DISORDERS AND INJURIES

Facility

$1.69

Service Code	APR-DRG 0403
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.69

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

Facility

$4.54

Service Code	APR-DRG 3214
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$4.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4.54

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

Facility

$2.07

Service Code	APR-DRG 3212
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$2.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$2.07

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

Facility

$2.83

Service Code	APR-DRG 3213
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$2.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$2.83

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

Facility

$1.72

Service Code	APR-DRG 3211
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$1.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.72

APR-DRG 41.00: SPINAL PROCEDURES

Facility

$5.60

Service Code	APR-DRG 0234
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$5.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5.60

APR-DRG 41.00: SPINAL PROCEDURES

Facility

$1.55

Service Code	APR-DRG 0231
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$1.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.55

APR-DRG 41.00: SPINAL PROCEDURES

Facility

$3.54

Service Code	APR-DRG 0233
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$3.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$3.54

APR-DRG 41.00: SPINAL PROCEDURES

Facility

$2.11

Service Code	APR-DRG 0232
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$2.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$2.11

APR-DRG 41.00: SPLENECTOMY

Facility

$1.36

Service Code	APR-DRG 6501
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$1.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.36

APR-DRG 41.00: SPLENECTOMY

Facility

$2.52

Service Code	APR-DRG 6503
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$2.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$2.52

APR-DRG 41.00: SPLENECTOMY

Facility

$1.78

Service Code	APR-DRG 6502
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$1.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.78

APR-DRG 41.00: SPLENECTOMY

Facility

$4.02

Service Code	APR-DRG 6504
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$4.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4.02

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All Charges