Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 31.00: SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR 9+ FUS W MCC

Facility

$256,752.27

Service Code	MSDRG 456
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$256,752.27
Rate for Payer: United Healthcare All Other Commercial	$112,148.00
Rate for Payer: United Healthcare All Other HMO	$99,575.00
Rate for Payer: United Healthcare HMO Rider	$75,636.00
Rate for Payer: United Healthcare Select/Navigate/Core	$69,294.00

MS-DRG 31.00: SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR 9+ FUS W/O CC/MCC

Facility

$130,904.49

Service Code	MSDRG 458
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$130,904.49
Rate for Payer: United Healthcare All Other Commercial	$81,933.00
Rate for Payer: United Healthcare All Other HMO	$71,046.00
Rate for Payer: United Healthcare HMO Rider	$53,969.00
Rate for Payer: United Healthcare Select/Navigate/Core	$49,445.00

MS-DRG 31.00: SPINAL FUSION EXCEPT CERVICAL W MCC

Facility

$76,782.00

Service Code	MSDRG 459
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$76,782.00
Rate for Payer: United Healthcare All Other Commercial	$76,782.00
Rate for Payer: United Healthcare All Other HMO	$68,582.00
Rate for Payer: United Healthcare HMO Rider	$52,096.00
Rate for Payer: United Healthcare Select/Navigate/Core	$47,726.00

MS-DRG 31.00: SPINAL FUSION EXCEPT CERVICAL W/O MCC

Facility

$81,808.00

Service Code	MSDRG 460
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$81,808.00
Rate for Payer: United Healthcare All Other Commercial	$81,808.00
Rate for Payer: United Healthcare All Other HMO	$43,068.00
Rate for Payer: United Healthcare HMO Rider	$32,713.00
Rate for Payer: United Healthcare Select/Navigate/Core	$29,970.00

MS-DRG 31.00: SPINAL PROCEDURES W CC OR SPINAL NEUROSTIMULATORS

Facility

$101,761.72

Service Code	MSDRG 029
Min. Negotiated Rate	$25,608.00
Max. Negotiated Rate	$101,761.72
Rate for Payer: United Healthcare All Other Commercial	$76,644.00
Rate for Payer: United Healthcare All Other HMO	$48,114.00
Rate for Payer: United Healthcare HMO Rider	$36,551.00
Rate for Payer: United Healthcare Select/Navigate/Core	$33,485.00

MS-DRG 31.00: SPINAL PROCEDURES W MCC

Facility

$184,306.12

Service Code	MSDRG 028
Min. Negotiated Rate	$25,608.00
Max. Negotiated Rate	$184,306.12
Rate for Payer: United Healthcare All Other Commercial	$58,958.00
Rate for Payer: United Healthcare All Other HMO	$71,841.00
Rate for Payer: United Healthcare HMO Rider	$54,569.00
Rate for Payer: United Healthcare Select/Navigate/Core	$49,994.00

MS-DRG 31.00: SPINAL PROCEDURES W/O CC/MCC

Facility

$67,465.23

Service Code	MSDRG 030
Min. Negotiated Rate	$20,798.00
Max. Negotiated Rate	$67,465.23
Rate for Payer: United Healthcare All Other Commercial	$58,958.00
Rate for Payer: United Healthcare All Other HMO	$29,890.00
Rate for Payer: United Healthcare HMO Rider	$22,701.00
Rate for Payer: United Healthcare Select/Navigate/Core	$20,798.00

MS-DRG 31.00: URINARY STONES W ESW LITHOTRIPSY W CC/MCC

Facility

$7,890.00

Service Code	MSDRG 691
Min. Negotiated Rate	$6,240.00
Max. Negotiated Rate	$7,890.00
Rate for Payer: Cigna of CA HMO	$6,240.00

MS-DRG 31.00: URINARY STONES W ESW LITHOTRIPSY W/O CC/MCC

Facility

$7,890.00

Service Code	MSDRG 692
Min. Negotiated Rate	$6,240.00
Max. Negotiated Rate	$7,890.00
Rate for Payer: Cigna of CA HMO	$6,240.00

MS-DRG 31.00: UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC

Facility

$55,378.24

Service Code	MSDRG 742
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$55,378.24
Rate for Payer: United Healthcare All Other Commercial	$24,996.00
Rate for Payer: United Healthcare All Other HMO	$24,494.00
Rate for Payer: United Healthcare HMO Rider	$24,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,398.00

MS-DRG 31.00: UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC

Facility

$41,879.92

Service Code	MSDRG 743
Min. Negotiated Rate	$22,164.96
Max. Negotiated Rate	$41,879.92
Rate for Payer: United Healthcare All Other Commercial	$24,996.00
Rate for Payer: United Healthcare All Other HMO	$24,494.00
Rate for Payer: United Healthcare HMO Rider	$24,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,398.00

MS-DRG 31.00: UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W/O CC/MCC

Facility

$44,363.44

Service Code	MSDRG 741
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$44,363.44
Rate for Payer: United Healthcare All Other Commercial	$24,996.00
Rate for Payer: United Healthcare All Other HMO	$24,494.00
Rate for Payer: United Healthcare HMO Rider	$24,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,398.00

MS-DRG 31.00: VAGINAL DELIVERY W COMPLICATING DIAGNOSES

Facility

$4,760.00

Service Code	MSDRG 774
Min. Negotiated Rate	$4,760.00
Max. Negotiated Rate	$4,760.00
Rate for Payer: Cigna of CA HMO	$4,760.00

MS-DRG 31.00: VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES

Facility

$4,760.00

Service Code	MSDRG 775
Min. Negotiated Rate	$4,760.00
Max. Negotiated Rate	$4,760.00
Rate for Payer: Cigna of CA HMO	$4,760.00

MS-DRG 31.00: VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C

Facility

$40,425.87

Service Code	MSDRG 768
Min. Negotiated Rate	$4,760.00
Max. Negotiated Rate	$40,425.87
Rate for Payer: Cigna of CA HMO	$4,760.00

MS-DRG 31.00: VAGINAL DELIVERY W STERILIZATION &/OR D&C

Facility

$4,760.00

Service Code	MSDRG 767
Min. Negotiated Rate	$4,760.00
Max. Negotiated Rate	$4,760.00
Rate for Payer: Cigna of CA HMO	$4,760.00

MS-DRG 31.00: WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W CC

Facility

$112,353.00

Service Code	MSDRG 464
Min. Negotiated Rate	$34,033.00
Max. Negotiated Rate	$112,353.00
Rate for Payer: United Healthcare All Other Commercial	$112,353.00
Rate for Payer: United Healthcare All Other HMO	$48,905.00
Rate for Payer: United Healthcare HMO Rider	$37,147.00
Rate for Payer: United Healthcare Select/Navigate/Core	$34,033.00

MS-DRG 31.00: WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W MCC

Facility

$163,736.72

Service Code	MSDRG 463
Min. Negotiated Rate	$46,778.00
Max. Negotiated Rate	$163,736.72
Rate for Payer: United Healthcare All Other Commercial	$112,353.00
Rate for Payer: United Healthcare All Other HMO	$67,223.00
Rate for Payer: United Healthcare HMO Rider	$51,058.00
Rate for Payer: United Healthcare Select/Navigate/Core	$46,778.00

MS-DRG 31.00: WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W/O CC/MCC

Facility

$112,353.00

Service Code	MSDRG 465
Min. Negotiated Rate	$27,650.00
Max. Negotiated Rate	$112,353.00
Rate for Payer: United Healthcare All Other Commercial	$112,353.00
Rate for Payer: United Healthcare All Other HMO	$39,735.00
Rate for Payer: United Healthcare HMO Rider	$30,180.00
Rate for Payer: United Healthcare Select/Navigate/Core	$27,650.00

MS-DRG 33.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC

Facility

$37,948.03

Service Code	MSDRG 281
Min. Negotiated Rate	$15,502.00
Max. Negotiated Rate	$37,948.03
Rate for Payer: United Healthcare All Other Commercial	$26,466.00
Rate for Payer: United Healthcare All Other HMO	$22,273.00
Rate for Payer: United Healthcare HMO Rider	$16,920.00
Rate for Payer: United Healthcare Select/Navigate/Core	$15,502.00

MS-DRG 33.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC

Facility

$49,760.68

Service Code	MSDRG 280
Min. Negotiated Rate	$20,535.00
Max. Negotiated Rate	$49,760.68
Rate for Payer: United Healthcare All Other Commercial	$27,038.00
Rate for Payer: United Healthcare All Other HMO	$29,511.00
Rate for Payer: United Healthcare HMO Rider	$22,413.00
Rate for Payer: United Healthcare Select/Navigate/Core	$20,535.00

MS-DRG 33.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC

Facility

$35,154.94

Service Code	MSDRG 282
Min. Negotiated Rate	$12,537.00
Max. Negotiated Rate	$35,154.94
Rate for Payer: United Healthcare All Other Commercial	$28,087.00
Rate for Payer: United Healthcare All Other HMO	$18,018.00
Rate for Payer: United Healthcare HMO Rider	$13,685.00
Rate for Payer: United Healthcare Select/Navigate/Core	$12,537.00

MS-DRG 33.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED W CC

Facility

$35,380.71

Service Code	MSDRG 284
Min. Negotiated Rate	$13,701.71
Max. Negotiated Rate	$35,380.71
Rate for Payer: United Healthcare All Other Commercial	$28,275.00
Rate for Payer: United Healthcare All Other HMO	$20,489.00
Rate for Payer: United Healthcare HMO Rider	$15,558.00
Rate for Payer: United Healthcare Select/Navigate/Core	$14,254.00

MS-DRG 33.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC

Facility

$59,279.91

Service Code	MSDRG 283
Min. Negotiated Rate	$18,641.00
Max. Negotiated Rate	$59,279.91
Rate for Payer: United Healthcare All Other Commercial	$29,007.00
Rate for Payer: United Healthcare All Other HMO	$26,787.00
Rate for Payer: United Healthcare HMO Rider	$20,346.00
Rate for Payer: United Healthcare Select/Navigate/Core	$18,641.00

MS-DRG 33.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED W/O CC/MCC

Facility

$32,830.45

Service Code	MSDRG 285
Min. Negotiated Rate	$10,380.75
Max. Negotiated Rate	$32,830.45
Rate for Payer: United Healthcare All Other Commercial	$27,865.00
Rate for Payer: United Healthcare All Other HMO	$17,683.00
Rate for Payer: United Healthcare HMO Rider	$13,432.00
Rate for Payer: United Healthcare Select/Navigate/Core	$12,305.00

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All Charges