Loma Linda University Medical Center

All Charges

Charge

Type

Price

OTHER DRUG ABUSE AND DEPENDENCE

Facility IP

$34,005.88

Service Code	APR-DRG 7762
Min. Negotiated Rate	$4,302.23
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$4,302.23
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$5,126.82

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES AGE 0-17

Facility IP

$34,005.88

Service Code	TRIS-DRG 118
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$34,005.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES AGE >17 WITH CC

Facility IP

$34,005.88

Service Code	TRIS-DRG 155
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$34,005.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES AGE >17 WITH MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 154
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$34,005.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES AGE >17 WITHOUT CC/MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 156
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$34,005.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES AGE 0-17

Facility IP

$34,005.88

Service Code	TRIS-DRG 400
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$34,005.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES AGE >17 WITH CC

Facility IP

$34,005.88

Service Code	TRIS-DRG 401
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$34,005.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES AGE >17 WITH MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 399
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$34,005.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES AGE >17 WITHOUT CC/MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 402
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$34,005.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88

OTHER EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility IP

$34,005.88

Service Code	APR-DRG 0982
Min. Negotiated Rate	$11,457.30
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$11,457.30
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$13,653.28

OTHER EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility IP

$39,172.59

Service Code	APR-DRG 0984
Min. Negotiated Rate	$32,872.10
Max. Negotiated Rate	$39,172.59
Rate for Payer: Adventist Health Medi-Cal	$32,872.10
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$39,172.59

OTHER EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility IP

$34,005.88

Service Code	APR-DRG 0983
Min. Negotiated Rate	$19,267.62
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$19,267.62
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$22,960.58

OTHER EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility IP

$34,005.88

Service Code	APR-DRG 0981
Min. Negotiated Rate	$8,275.15
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$8,275.15
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$9,861.22

OTHER EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL DIAGNOSES

Facility IP

$34,005.88

Service Code	APR-DRG 1153
Min. Negotiated Rate	$9,398.59
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$9,398.59
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$11,199.99

OTHER EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL DIAGNOSES

Facility IP

$34,005.88

Service Code	APR-DRG 1154
Min. Negotiated Rate	$17,190.98
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$17,190.98
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$20,485.92

OTHER EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL DIAGNOSES

Facility IP

$34,005.88

Service Code	APR-DRG 1151
Min. Negotiated Rate	$4,493.76
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$4,493.76
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$5,355.06

OTHER EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL DIAGNOSES

Facility IP

$34,005.88

Service Code	APR-DRG 1152
Min. Negotiated Rate	$6,209.72
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$6,209.72
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$7,399.92

OTHER ENDOCRINE DISORDERS

Facility IP

$34,005.88

Service Code	APR-DRG 4241
Min. Negotiated Rate	$4,837.62
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$4,837.62
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$5,764.83

OTHER ENDOCRINE DISORDERS

Facility IP

$34,005.88

Service Code	APR-DRG 4244
Min. Negotiated Rate	$17,497.88
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$17,497.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$20,851.65

OTHER ENDOCRINE DISORDERS

Facility IP

$34,005.88

Service Code	APR-DRG 4243
Min. Negotiated Rate	$9,900.38
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$9,900.38
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$11,797.96

OTHER ENDOCRINE DISORDERS

Facility IP

$34,005.88

Service Code	APR-DRG 4242
Min. Negotiated Rate	$6,732.80
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$6,732.80
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$8,023.26

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC

Facility IP

$34,005.88

Service Code	TRIS-DRG 629
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$34,005.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 628
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$34,005.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 630
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$34,005.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88

OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 319
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$34,005.88
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88

Price Transparency.

All Charges