Loma Linda University Medical Center

All Charges

Charge

Type

Price

SKIN DEBRIDEMENT WITH CC

Facility IP

$34,005.88

Service Code	TRIS-DRG 571
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

SKIN DEBRIDEMENT WITH MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 570
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

SKIN DEBRIDEMENT WITHOUT CC/MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 572
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

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility IP

$34,005.88

Service Code	TRIS-DRG 577
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

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 576
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

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 578
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

SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility IP

$36,161.37

Service Code	APR-DRG 3123
Min. Negotiated Rate	$30,345.20
Max. Negotiated Rate	$36,161.37
Rate for Payer: Adventist Health Medi-Cal	$30,345.20
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$36,161.37

SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility IP

$34,005.88

Service Code	APR-DRG 3121
Min. Negotiated Rate	$11,214.24
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$11,214.24
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$13,363.64

SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility IP

$34,005.88

Service Code	APR-DRG 3122
Min. Negotiated Rate	$17,964.96
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$17,964.96
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$21,408.24

SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility IP

$73,337.16

Service Code	APR-DRG 3124
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$73,337.16
Rate for Payer: Adventist Health Medi-Cal	$61,541.68
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$73,337.16

SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES

Facility IP

$62,106.47

Service Code	APR-DRG 3614
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$62,106.47
Rate for Payer: Adventist Health Medi-Cal	$52,117.32
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$62,106.47

SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES

Facility IP

$34,005.88

Service Code	APR-DRG 3612
Min. Negotiated Rate	$16,998.34
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$16,998.34
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$20,256.35

SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES

Facility IP

$34,005.88

Service Code	APR-DRG 3613
Min. Negotiated Rate	$25,919.77
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$25,919.77
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$30,887.73

SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES

Facility IP

$34,005.88

Service Code	APR-DRG 3611
Min. Negotiated Rate	$13,685.14
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$13,685.14
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$16,308.12

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility IP

$34,005.88

Service Code	TRIS-DRG 574
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

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 573
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

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 575
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

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility IP

$34,005.88

Service Code	TRIS-DRG 623
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

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 622
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

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 624
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

SKIN GRAFTS FOR INJURIES WITH CC/MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 904
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

SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 905
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

SKIN ULCERS

Facility IP

$34,005.88

Service Code	APR-DRG 3801
Min. Negotiated Rate	$5,221.81
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$5,221.81
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$6,222.66

SKIN ULCERS

Facility IP

$34,005.88

Service Code	APR-DRG 3804
Min. Negotiated Rate	$17,240.27
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$17,240.27
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$20,544.65

SKIN ULCERS

Facility IP

$34,005.88

Service Code	APR-DRG 3802
Min. Negotiated Rate	$6,798.89
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$6,798.89
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$8,102.01

Price Transparency.

All Charges