Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 33.00: ACUTE & SUBACUTE ENDOCARDITIS W CC

Facility

$47,799.24

Service Code	MSDRG 289
Min. Negotiated Rate	$27,248.00
Max. Negotiated Rate	$47,799.24
Rate for Payer: United Healthcare All Other Commercial	$33,040.00
Rate for Payer: United Healthcare All Other HMO	$39,155.00
Rate for Payer: United Healthcare HMO Rider	$29,741.00
Rate for Payer: United Healthcare Select/Navigate/Core	$27,248.00

MS-DRG 33.00: ACUTE & SUBACUTE ENDOCARDITIS W MCC

Facility

$82,808.15

Service Code	MSDRG 288
Min. Negotiated Rate	$34,413.00
Max. Negotiated Rate	$82,808.15
Rate for Payer: United Healthcare All Other Commercial	$37,549.00
Rate for Payer: United Healthcare All Other HMO	$49,452.00
Rate for Payer: United Healthcare HMO Rider	$37,563.00
Rate for Payer: United Healthcare Select/Navigate/Core	$34,413.00

MS-DRG 33.00: ACUTE & SUBACUTE ENDOCARDITIS W/O CC/MCC

Facility

$38,760.24

Service Code	MSDRG 290
Min. Negotiated Rate	$18,102.52
Max. Negotiated Rate	$38,760.24
Rate for Payer: United Healthcare All Other Commercial	$33,040.00
Rate for Payer: United Healthcare All Other HMO	$33,480.00
Rate for Payer: United Healthcare HMO Rider	$25,436.00
Rate for Payer: United Healthcare Select/Navigate/Core	$23,302.00

MS-DRG 33.00: AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W MCC

Facility

$202,134.96

Service Code	MSDRG 268
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$202,134.96
Rate for Payer: United Healthcare All Other Commercial	$127,168.00
Rate for Payer: United Healthcare All Other HMO	$111,805.00
Rate for Payer: United Healthcare HMO Rider	$84,927.00
Rate for Payer: United Healthcare Select/Navigate/Core	$77,806.00

MS-DRG 33.00: AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W/O MCC

Facility

$126,135.78

Service Code	MSDRG 269
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$126,135.78
Rate for Payer: United Healthcare All Other Commercial	$79,046.00
Rate for Payer: United Healthcare All Other HMO	$69,501.00
Rate for Payer: United Healthcare HMO Rider	$52,792.00
Rate for Payer: United Healthcare Select/Navigate/Core	$48,365.00

MS-DRG 33.00: AUTOLOGOUS BONE MARROW TRANSPLANT W CC/MCC

Facility

$182,984.34

Service Code	MSDRG 016
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$182,984.34
Rate for Payer: Networks By Design Commercial	$140,000.00

MS-DRG 33.00: AUTOLOGOUS BONE MARROW TRANSPLANT W/O CC/MCC

Facility

$182,984.34

Service Code	MSDRG 017
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$182,984.34
Rate for Payer: Networks By Design Commercial	$140,000.00

MS-DRG 33.00: BACK & NECK PROC EXC SPINAL FUSION W CC

Facility

$59,780.12

Service Code	MSDRG 519
Min. Negotiated Rate	$14,908.00
Max. Negotiated Rate	$59,780.12
Rate for Payer: United Healthcare All Other Commercial	$18,257.00
Rate for Payer: United Healthcare All Other HMO	$16,907.00
Rate for Payer: United Healthcare HMO Rider	$16,273.00
Rate for Payer: United Healthcare Select/Navigate/Core	$14,908.00

MS-DRG 33.00: BACK & NECK PROC EXC SPINAL FUSION W MCC OR DISC DEVICE/NEUROSTIM

Facility

$108,652.54

Service Code	MSDRG 518
Min. Negotiated Rate	$14,908.00
Max. Negotiated Rate	$108,652.54
Rate for Payer: United Healthcare All Other Commercial	$18,257.00
Rate for Payer: United Healthcare All Other HMO	$16,907.00
Rate for Payer: United Healthcare HMO Rider	$16,273.00
Rate for Payer: United Healthcare Select/Navigate/Core	$14,908.00

MS-DRG 33.00: BACK & NECK PROC EXC SPINAL FUSION W/O CC/MCC

Facility

$45,209.76

Service Code	MSDRG 520
Min. Negotiated Rate	$11,314.00
Max. Negotiated Rate	$45,209.76
Rate for Payer: United Healthcare All Other Commercial	$21,329.00
Rate for Payer: United Healthcare All Other HMO	$16,260.00
Rate for Payer: United Healthcare HMO Rider	$12,349.00
Rate for Payer: United Healthcare Select/Navigate/Core	$11,314.00

MS-DRG 33.00: 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 33.00: 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 33.00: 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 33.00: 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 33.00: 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 33.00: 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 33.00: 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 33.00: 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 33.00: 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 33.00: 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 33.00: 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 33.00: 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 33.00: 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 33.00: 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 33.00: 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

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All Charges