Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 29.00: 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: Cigna of CA PPO	$14,790.00
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 29.00: 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: Cigna of CA PPO	$14,790.00
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 29.00: 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: Cigna of CA PPO	$14,790.00
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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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

MS-DRG 29.00: COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W MCC

Facility

$152,808.00

Service Code	MSDRG 453
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$152,808.00
Rate for Payer: United Healthcare All Other Commercial	$152,808.00
Rate for Payer: United Healthcare All Other HMO	$127,264.00
Rate for Payer: United Healthcare HMO Rider	$96,665.00
Rate for Payer: United Healthcare Select/Navigate/Core	$88,562.00

MS-DRG 29.00: COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W/O CC/MCC

Facility

$111,708.00

Service Code	MSDRG 455
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$111,708.00
Rate for Payer: United Healthcare All Other Commercial	$111,708.00
Rate for Payer: United Healthcare All Other HMO	$83,450.00
Rate for Payer: United Healthcare HMO Rider	$63,390.00
Rate for Payer: United Healthcare Select/Navigate/Core	$58,075.00

MS-DRG 29.00: CORONARY BYPASS W CARDIAC CATH W MCC

Facility

$236,961.98

Service Code	MSDRG 233
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$236,961.98
Rate for Payer: United Healthcare All Other Commercial	$143,136.00
Rate for Payer: United Healthcare All Other HMO	$106,219.00
Rate for Payer: United Healthcare HMO Rider	$80,682.00
Rate for Payer: United Healthcare Select/Navigate/Core	$73,919.00

MS-DRG 29.00: CORONARY BYPASS W CARDIAC CATH W/O MCC

Facility

$161,287.18

Service Code	MSDRG 234
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$161,287.18
Rate for Payer: United Healthcare All Other Commercial	$103,054.00
Rate for Payer: United Healthcare All Other HMO	$97,568.00
Rate for Payer: United Healthcare HMO Rider	$74,111.00
Rate for Payer: United Healthcare Select/Navigate/Core	$67,897.00

MS-DRG 29.00: CORONARY BYPASS W/O CARDIAC CATH W MCC

Facility

$178,385.41

Service Code	MSDRG 235
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$178,385.41
Rate for Payer: United Healthcare All Other Commercial	$83,791.00
Rate for Payer: United Healthcare All Other HMO	$74,237.00
Rate for Payer: United Healthcare HMO Rider	$56,388.00
Rate for Payer: United Healthcare Select/Navigate/Core	$51,660.00

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