Loma Linda University Medical Center

All Charges

Charge

Type

Price

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility IP

$35,255.06

Service Code	APR-DRG 5134
Min. Negotiated Rate	$29,584.67
Max. Negotiated Rate	$35,255.06
Rate for Payer: Adventist Health Medi-Cal	$29,584.67
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$35,255.06

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility IP

$34,005.88

Service Code	APR-DRG 5132
Min. Negotiated Rate	$11,474.10
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$11,474.10
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$13,673.30

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 742
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

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 743
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

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility IP

$46,894.19

Service Code	APR-DRG 5124
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$46,894.19
Rate for Payer: Adventist Health Medi-Cal	$39,351.77
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$46,894.19

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility IP

$34,005.88

Service Code	APR-DRG 5123
Min. Negotiated Rate	$22,968.36
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$22,968.36
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$27,370.63

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility IP

$34,005.88

Service Code	APR-DRG 5122
Min. Negotiated Rate	$14,594.64
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$14,594.64
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$17,391.95

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility IP

$34,005.88

Service Code	APR-DRG 5121
Min. Negotiated Rate	$12,335.44
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$12,335.44
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$14,699.73

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC

Facility IP

$34,005.88

Service Code	TRIS-DRG 740
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

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 739
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

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 741
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

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY

Facility IP

$34,005.88

Service Code	APR-DRG 5111
Min. Negotiated Rate	$13,453.28
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$13,453.28
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$16,031.83

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY

Facility IP

$34,005.88

Service Code	APR-DRG 5113
Min. Negotiated Rate	$24,061.56
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$24,061.56
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$28,673.36

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY

Facility IP

$52,809.86

Service Code	APR-DRG 5114
Min. Negotiated Rate	$34,005.88
Max. Negotiated Rate	$52,809.86
Rate for Payer: Adventist Health Medi-Cal	$44,315.96
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$52,809.86

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY

Facility IP

$34,005.88

Service Code	APR-DRG 5112
Min. Negotiated Rate	$16,337.48
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$16,337.48
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$19,468.84

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC

Facility IP

$34,005.88

Service Code	TRIS-DRG 737
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

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 736
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

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 738
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

VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 746
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

VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC

Facility IP

$34,005.88

Service Code	TRIS-DRG 747
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

VAGINAL DELIVERY

Facility IP

$34,005.88

Service Code	APR-DRG 5603
Min. Negotiated Rate	$5,193.82
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$5,193.82
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$6,189.30

VAGINAL DELIVERY

Facility IP

$34,005.88

Service Code	APR-DRG 5604
Min. Negotiated Rate	$8,044.31
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$8,044.31
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$9,586.13

VAGINAL DELIVERY

Facility IP

$34,005.88

Service Code	APR-DRG 5602
Min. Negotiated Rate	$3,987.48
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$3,987.48
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$4,751.75

VAGINAL DELIVERY

Facility IP

$34,005.88

Service Code	APR-DRG 5601
Min. Negotiated Rate	$3,492.41
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$3,492.41
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$4,161.79

VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility IP

$34,005.88

Service Code	APR-DRG 5424
Min. Negotiated Rate	$17,065.66
Max. Negotiated Rate	$34,005.88
Rate for Payer: Adventist Health Medi-Cal	$17,065.66
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$34,005.88
Rate for Payer: IEHP medi-cal	$20,336.57

Price Transparency.

All Charges