Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 25.00: Bilateral or multiple major joint procs of lower extremity w MCC

Facility

$186,040.20

Service Code	MSDRG 461
Min. Negotiated Rate	$45,279.00
Max. Negotiated Rate	$186,040.20
Rate for Payer: United Healthcare All Other Commercial	$64,494.00
Rate for Payer: United Healthcare All Other HMO	$65,063.00
Rate for Payer: United Healthcare HMO Rider	$49,424.00
Rate for Payer: United Healthcare Select/Navigate/Core	$45,279.00

MS-DRG 25.00: Bilateral or multiple major joint procs of lower extremity w/o MCC

Facility

$86,818.96

Service Code	MSDRG 462
Min. Negotiated Rate	$36,596.00
Max. Negotiated Rate	$86,818.96
Rate for Payer: United Healthcare All Other Commercial	$52,127.00
Rate for Payer: United Healthcare All Other HMO	$52,587.00
Rate for Payer: United Healthcare HMO Rider	$39,944.00
Rate for Payer: United Healthcare Select/Navigate/Core	$36,596.00

MS-DRG 25.00: Cardiac defib implant w cardiac cath w AMI/HF/shock w MCC

Facility

$124,263.00

Service Code	MSDRG 222
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$124,263.00
Rate for Payer: United Healthcare All Other HMO	$124,263.00
Rate for Payer: United Healthcare HMO Rider	$119,757.00
Rate for Payer: United Healthcare Select/Navigate/Core	$109,717.00

MS-DRG 25.00: Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC

Facility

$106,570.00

Service Code	MSDRG 223
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$106,570.00
Rate for Payer: United Healthcare All Other HMO	$106,570.00
Rate for Payer: United Healthcare HMO Rider	$94,546.00
Rate for Payer: United Healthcare Select/Navigate/Core	$86,620.00

MS-DRG 25.00: Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC

Facility

$113,336.00

Service Code	MSDRG 224
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$113,336.00
Rate for Payer: United Healthcare All Other HMO	$113,336.00
Rate for Payer: United Healthcare HMO Rider	$101,501.00
Rate for Payer: United Healthcare Select/Navigate/Core	$92,990.00

MS-DRG 25.00: Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/o MCC

Facility

$101,501.00

Service Code	MSDRG 225
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$101,501.00
Rate for Payer: United Healthcare All Other HMO	$97,504.00
Rate for Payer: United Healthcare HMO Rider	$101,501.00
Rate for Payer: United Healthcare Select/Navigate/Core	$92,990.00

MS-DRG 25.00: Cardiac defibrillator implant w/o cardiac cath w MCC

Facility

$92,297.00

Service Code	MSDRG 226
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$92,297.00
Rate for Payer: United Healthcare All Other HMO	$92,297.00
Rate for Payer: United Healthcare HMO Rider	$91,296.00
Rate for Payer: United Healthcare Select/Navigate/Core	$83,643.00

MS-DRG 25.00: Cardiac defibrillator implant w/o cardiac cath w/o MCC

Facility

$91,296.00

Service Code	MSDRG 227
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$91,296.00
Rate for Payer: United Healthcare All Other HMO	$78,692.00
Rate for Payer: United Healthcare HMO Rider	$91,296.00
Rate for Payer: United Healthcare Select/Navigate/Core	$83,643.00

MS-DRG 25.00: Cardiac pacemaker device replacement w MCC

Facility

$85,051.54

Service Code	MSDRG 258
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$85,051.54
Rate for Payer: United Healthcare All Other Commercial	$38,532.00
Rate for Payer: United Healthcare All Other HMO	$31,946.00
Rate for Payer: United Healthcare HMO Rider	$23,768.00
Rate for Payer: United Healthcare Select/Navigate/Core	$21,774.00

MS-DRG 25.00: Cardiac pacemaker device replacement w/o MCC

Facility

$53,286.43

Service Code	MSDRG 259
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$53,286.43
Rate for Payer: United Healthcare All Other Commercial	$38,532.00
Rate for Payer: United Healthcare All Other HMO	$30,540.00
Rate for Payer: United Healthcare HMO Rider	$23,768.00
Rate for Payer: United Healthcare Select/Navigate/Core	$21,774.00

MS-DRG 25.00: Cardiac pacemaker revision except device replacement w CC

Facility

$57,527.64

Service Code	MSDRG 261
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$57,527.64
Rate for Payer: United Healthcare All Other Commercial	$51,377.00
Rate for Payer: United Healthcare All Other HMO	$42,600.00
Rate for Payer: United Healthcare HMO Rider	$31,691.00
Rate for Payer: United Healthcare Select/Navigate/Core	$29,035.00

MS-DRG 25.00: Cardiac pacemaker revision except device replacement w MCC

Facility

$103,262.36

Service Code	MSDRG 260
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$103,262.36
Rate for Payer: United Healthcare All Other Commercial	$51,377.00
Rate for Payer: United Healthcare All Other HMO	$21,266.00
Rate for Payer: United Healthcare HMO Rider	$31,691.00
Rate for Payer: United Healthcare Select/Navigate/Core	$29,035.00

MS-DRG 25.00: Cardiac pacemaker revision except device replacement w/o CC/MCC

Facility

$51,377.00

Service Code	MSDRG 262
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$51,377.00
Rate for Payer: United Healthcare All Other Commercial	$51,377.00
Rate for Payer: United Healthcare All Other HMO	$42,600.00
Rate for Payer: United Healthcare HMO Rider	$31,691.00
Rate for Payer: United Healthcare Select/Navigate/Core	$29,035.00

MS-DRG 25.00: Cardiac valve & oth maj cardiothoracic proc w card cath w CC

Facility

$195,777.70

Service Code	MSDRG 217
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$195,777.70
Rate for Payer: United Healthcare All Other Commercial	$126,798.00
Rate for Payer: United Healthcare All Other HMO	$128,643.00
Rate for Payer: United Healthcare HMO Rider	$97,715.00
Rate for Payer: United Healthcare Select/Navigate/Core	$89,522.00

MS-DRG 25.00: Cardiac valve & oth maj cardiothoracic proc w card cath w MCC

Facility

$292,582.75

Service Code	MSDRG 216
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$292,582.75
Rate for Payer: United Healthcare All Other Commercial	$155,615.00
Rate for Payer: United Healthcare All Other HMO	$157,872.00
Rate for Payer: United Healthcare HMO Rider	$119,917.00
Rate for Payer: United Healthcare Select/Navigate/Core	$109,864.00

MS-DRG 25.00: Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC

Facility

$180,358.98

Service Code	MSDRG 218
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$180,358.98
Rate for Payer: United Healthcare All Other Commercial	$164,634.00
Rate for Payer: United Healthcare All Other HMO	$116,390.00
Rate for Payer: United Healthcare HMO Rider	$88,410.00
Rate for Payer: United Healthcare Select/Navigate/Core	$80,997.00

MS-DRG 25.00: Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC

Facility

$160,574.76

Service Code	MSDRG 220
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$160,574.76
Rate for Payer: United Healthcare All Other Commercial	$117,371.00
Rate for Payer: United Healthcare All Other HMO	$146,353.00
Rate for Payer: United Healthcare HMO Rider	$111,169.00
Rate for Payer: United Healthcare Select/Navigate/Core	$101,848.00

MS-DRG 25.00: Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC

Facility

$234,570.05

Service Code	MSDRG 219
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$234,570.05
Rate for Payer: United Healthcare All Other Commercial	$147,690.00
Rate for Payer: United Healthcare All Other HMO	$146,353.00
Rate for Payer: United Healthcare HMO Rider	$111,169.00
Rate for Payer: United Healthcare Select/Navigate/Core	$101,848.00

MS-DRG 25.00: Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC

Facility

$171,252.00

Service Code	MSDRG 221
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$171,252.00
Rate for Payer: United Healthcare All Other Commercial	$171,252.00
Rate for Payer: United Healthcare All Other HMO	$146,353.00
Rate for Payer: United Healthcare HMO Rider	$111,169.00
Rate for Payer: United Healthcare Select/Navigate/Core	$101,848.00

MS-DRG 25.00: Cervical spinal fusion w CC

Facility

$87,831.52

Service Code	MSDRG 472
Min. Negotiated Rate	$22,650.00
Max. Negotiated Rate	$87,831.52
Rate for Payer: United Healthcare All Other Commercial	$30,096.00
Rate for Payer: United Healthcare All Other HMO	$42,113.00
Rate for Payer: United Healthcare HMO Rider	$24,721.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,650.00

MS-DRG 25.00: Cervical spinal fusion w MCC

Facility

$147,253.91

Service Code	MSDRG 471
Min. Negotiated Rate	$24,564.00
Max. Negotiated Rate	$147,253.91
Rate for Payer: United Healthcare All Other Commercial	$42,108.00
Rate for Payer: United Healthcare All Other HMO	$38,993.00
Rate for Payer: United Healthcare HMO Rider	$34,591.00
Rate for Payer: United Healthcare Select/Navigate/Core	$31,692.00

MS-DRG 25.00: Cervical spinal fusion w/o CC/MCC

Facility

$71,770.10

Service Code	MSDRG 473
Min. Negotiated Rate	$22,963.00
Max. Negotiated Rate	$71,770.10
Rate for Payer: United Healthcare All Other Commercial	$42,292.00
Rate for Payer: United Healthcare All Other HMO	$32,996.00
Rate for Payer: United Healthcare HMO Rider	$25,065.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,963.00

MS-DRG 25.00: Circulatory disorders except AMI, w card cath w MCC

Facility

$67,098.40

Service Code	MSDRG 286
Min. Negotiated Rate	$4,504.00
Max. Negotiated Rate	$67,098.40
Rate for Payer: United Healthcare All Other Commercial	$20,829.00
Rate for Payer: United Healthcare All Other HMO	$20,011.00
Rate for Payer: United Healthcare HMO Rider	$15,202.00
Rate for Payer: United Healthcare Select/Navigate/Core	$13,927.00

MS-DRG 25.00: Circulatory disorders except AMI, w card cath w/o MCC

Facility

$40,330.48

Service Code	MSDRG 287
Min. Negotiated Rate	$4,504.00
Max. Negotiated Rate	$40,330.48
Rate for Payer: United Healthcare All Other Commercial	$27,003.00
Rate for Payer: United Healthcare All Other HMO	$19,364.00
Rate for Payer: United Healthcare HMO Rider	$14,707.00
Rate for Payer: United Healthcare Select/Navigate/Core	$13,475.00

MS-DRG 25.00: Combined anterior/posterior spinal fusion w CC

Facility

$128,918.00

Service Code	MSDRG 454
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$128,918.00
Rate for Payer: United Healthcare All Other Commercial	$128,918.00
Rate for Payer: United Healthcare All Other HMO	$99,335.00
Rate for Payer: United Healthcare HMO Rider	$75,453.00
Rate for Payer: United Healthcare Select/Navigate/Core	$69,126.00

Know your out-of-pocket cost for care.

All Charges