Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 33.00: LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W/O CC/MCC

Facility

$57,157.79

Service Code	MSDRG 494
Min. Negotiated Rate	$15,056.00
Max. Negotiated Rate	$57,157.79
Rate for Payer: United Healthcare All Other Commercial	$29,464.00
Rate for Payer: United Healthcare All Other HMO	$21,638.00
Rate for Payer: United Healthcare HMO Rider	$16,434.00
Rate for Payer: United Healthcare Select/Navigate/Core	$15,056.00

MS-DRG 33.00: MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC

Facility

$99,093.91

Service Code	MSDRG 469
Min. Negotiated Rate	$23,506.00
Max. Negotiated Rate	$99,093.91
Rate for Payer: United Healthcare All Other Commercial	$41,904.00
Rate for Payer: United Healthcare All Other HMO	$38,803.00
Rate for Payer: United Healthcare HMO Rider	$34,363.00
Rate for Payer: United Healthcare Select/Navigate/Core	$31,483.00

MS-DRG 33.00: MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC

Facility

$57,160.82

Service Code	MSDRG 470
Min. Negotiated Rate	$23,467.00
Max. Negotiated Rate	$57,160.82
Rate for Payer: United Healthcare All Other Commercial	$53,685.00
Rate for Payer: United Healthcare All Other HMO	$33,721.00
Rate for Payer: United Healthcare HMO Rider	$25,615.00
Rate for Payer: United Healthcare Select/Navigate/Core	$23,467.00

MS-DRG 33.00: MAJOR MALE PELVIC PROCEDURES W CC/MCC

Facility

$58,831.23

Service Code	MSDRG 707
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$58,831.23
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 33.00: MAJOR MALE PELVIC PROCEDURES W/O CC/MCC

Facility

$45,908.15

Service Code	MSDRG 708
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$45,908.15
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 33.00: MEDICAL BACK PROBLEMS W MCC

Facility

$59,884.00

Service Code	MSDRG 551
Min. Negotiated Rate	$13,734.00
Max. Negotiated Rate	$59,884.00
Rate for Payer: United Healthcare All Other Commercial	$59,884.00
Rate for Payer: United Healthcare All Other HMO	$19,739.00
Rate for Payer: United Healthcare HMO Rider	$14,990.00
Rate for Payer: United Healthcare Select/Navigate/Core	$13,734.00

MS-DRG 33.00: MEDICAL BACK PROBLEMS W/O MCC

Facility

$59,884.00

Service Code	MSDRG 552
Min. Negotiated Rate	$13,778.00
Max. Negotiated Rate	$59,884.00
Rate for Payer: United Healthcare All Other Commercial	$59,884.00
Rate for Payer: United Healthcare All Other HMO	$19,797.00
Rate for Payer: United Healthcare HMO Rider	$15,038.00
Rate for Payer: United Healthcare Select/Navigate/Core	$13,778.00

MS-DRG 33.00: O.R. PROCEDURES FOR OBESITY W CC

Facility

$48,414.65

Service Code	MSDRG 620
Min. Negotiated Rate	$12,166.00
Max. Negotiated Rate	$48,414.65
Rate for Payer: Networks By Design Commercial	$20,000.00
Rate for Payer: United Healthcare All Other Commercial	$28,919.00
Rate for Payer: United Healthcare All Other HMO	$28,337.00
Rate for Payer: United Healthcare HMO Rider	$28,283.00
Rate for Payer: United Healthcare Select/Navigate/Core	$25,912.00

MS-DRG 33.00: O.R. PROCEDURES FOR OBESITY W MCC

Facility

$82,656.57

Service Code	MSDRG 619
Min. Negotiated Rate	$12,166.00
Max. Negotiated Rate	$82,656.57
Rate for Payer: Networks By Design Commercial	$20,000.00
Rate for Payer: United Healthcare All Other Commercial	$28,919.00
Rate for Payer: United Healthcare All Other HMO	$28,337.00
Rate for Payer: United Healthcare HMO Rider	$28,283.00
Rate for Payer: United Healthcare Select/Navigate/Core	$25,912.00

MS-DRG 33.00: O.R. PROCEDURES FOR OBESITY W/O CC/MCC

Facility

$45,614.21

Service Code	MSDRG 621
Min. Negotiated Rate	$12,166.00
Max. Negotiated Rate	$45,614.21
Rate for Payer: Networks By Design Commercial	$20,000.00
Rate for Payer: United Healthcare All Other Commercial	$28,919.00
Rate for Payer: United Healthcare All Other HMO	$28,337.00
Rate for Payer: United Healthcare HMO Rider	$28,283.00
Rate for Payer: United Healthcare Select/Navigate/Core	$25,912.00

MS-DRG 33.00: OTHER CARDIOTHORACIC PROCEDURES W CC

Facility

$94,170.59

Service Code	MSDRG 229
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$94,170.59
Rate for Payer: United Healthcare All Other Commercial	$71,243.00
Rate for Payer: United Healthcare All Other HMO	$65,974.00
Rate for Payer: United Healthcare HMO Rider	$68,556.00
Rate for Payer: United Healthcare Select/Navigate/Core	$62,809.00

MS-DRG 33.00: OTHER CARDIOTHORACIC PROCEDURES W MCC

Facility

$151,073.72

Service Code	MSDRG 228
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$151,073.72
Rate for Payer: United Healthcare All Other Commercial	$120,397.00
Rate for Payer: United Healthcare All Other HMO	$83,596.00
Rate for Payer: United Healthcare HMO Rider	$86,872.00
Rate for Payer: United Healthcare Select/Navigate/Core	$79,589.00

MS-DRG 33.00: OTHER CARDIOTHORACIC PROCEDURES W/O CC/MCC

Facility

$81,188.00

Service Code	MSDRG 230
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$81,188.00
Rate for Payer: United Healthcare All Other HMO	$81,188.00
Rate for Payer: United Healthcare HMO Rider	$61,670.00
Rate for Payer: United Healthcare Select/Navigate/Core	$56,499.00

MS-DRG 33.00: OTHER HEART ASSIST SYSTEM IMPLANT

Facility

$321,191.96

Service Code	MSDRG 215
Min. Negotiated Rate	$129,852.03
Max. Negotiated Rate	$321,191.96
Rate for Payer: United Healthcare All Other Commercial	$200,732.00
Rate for Payer: United Healthcare All Other HMO	$207,861.00
Rate for Payer: United Healthcare HMO Rider	$157,887.00
Rate for Payer: United Healthcare Select/Navigate/Core	$144,650.00

MS-DRG 33.00: OTHER MAJOR CARDIOVASCULAR PROCEDURES W CC

Facility

$104,420.43

Service Code	MSDRG 271
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$104,420.43
Rate for Payer: United Healthcare All Other Commercial	$63,629.00
Rate for Payer: United Healthcare All Other HMO	$55,944.00
Rate for Payer: United Healthcare HMO Rider	$42,494.00
Rate for Payer: United Healthcare Select/Navigate/Core	$38,930.00

MS-DRG 33.00: OTHER MAJOR CARDIOVASCULAR PROCEDURES W MCC

Facility

$155,612.03

Service Code	MSDRG 270
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$155,612.03
Rate for Payer: United Healthcare All Other Commercial	$95,869.00
Rate for Payer: United Healthcare All Other HMO	$84,289.00
Rate for Payer: United Healthcare HMO Rider	$64,025.00
Rate for Payer: United Healthcare Select/Navigate/Core	$58,657.00

MS-DRG 33.00: OTHER MAJOR CARDIOVASCULAR PROCEDURES W/O CC/MCC

Facility

$75,856.70

Service Code	MSDRG 272
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$75,856.70
Rate for Payer: United Healthcare All Other Commercial	$45,573.00
Rate for Payer: United Healthcare All Other HMO	$40,069.00
Rate for Payer: United Healthcare HMO Rider	$30,435.00
Rate for Payer: United Healthcare Select/Navigate/Core	$27,883.00

MS-DRG 33.00: OTHER VASCULAR PROCEDURES W CC

Facility

$77,396.75

Service Code	MSDRG 253
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$77,396.75
Rate for Payer: United Healthcare All Other Commercial	$43,936.00
Rate for Payer: United Healthcare All Other HMO	$38,236.00
Rate for Payer: United Healthcare HMO Rider	$29,046.00
Rate for Payer: United Healthcare Select/Navigate/Core	$26,610.00

MS-DRG 33.00: OTHER VASCULAR PROCEDURES W MCC

Facility

$103,996.01

Service Code	MSDRG 252
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$103,996.01
Rate for Payer: United Healthcare All Other Commercial	$42,180.00
Rate for Payer: United Healthcare All Other HMO	$41,854.00
Rate for Payer: United Healthcare HMO Rider	$31,795.00
Rate for Payer: United Healthcare Select/Navigate/Core	$29,128.00

MS-DRG 33.00: OTHER VASCULAR PROCEDURES W/O CC/MCC

Facility

$56,697.00

Service Code	MSDRG 254
Min. Negotiated Rate	$19,823.00
Max. Negotiated Rate	$56,697.00
Rate for Payer: United Healthcare All Other Commercial	$56,697.00
Rate for Payer: United Healthcare All Other HMO	$28,481.00
Rate for Payer: United Healthcare HMO Rider	$21,636.00
Rate for Payer: United Healthcare Select/Navigate/Core	$19,823.00

MS-DRG 33.00: PANCREAS TRANSPLANT

Facility

$241,709.47

Service Code	MSDRG 010
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$241,709.47
Rate for Payer: Networks By Design Commercial	$60,000.00

MS-DRG 33.00: PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY W/O CC/MCC

Facility

$42,094.11

Service Code	MSDRG 735
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$42,094.11
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 33.00: PERC CARDIOVASC PROC W DRUG-ELUTING STENT W MCC OR 4+ VESSELS/STENTS

Facility

$39,873.00

Service Code	MSDRG 246
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$39,873.00
Rate for Payer: United Healthcare All Other HMO	$39,873.00
Rate for Payer: United Healthcare HMO Rider	$30,287.00
Rate for Payer: United Healthcare Select/Navigate/Core	$27,748.00

MS-DRG 33.00: PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCC

Facility

$37,475.00

Service Code	MSDRG 247
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$37,475.00
Rate for Payer: United Healthcare All Other HMO	$37,475.00
Rate for Payer: United Healthcare HMO Rider	$28,460.00
Rate for Payer: United Healthcare Select/Navigate/Core	$26,075.00

MS-DRG 33.00: PERC CARDIOVASC PROC W NON-DRUG-ELUTING STENT W MCC OR 4+ VES/STENTS

Facility

$38,180.00

Service Code	MSDRG 248
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$38,180.00
Rate for Payer: United Healthcare All Other HMO	$38,180.00
Rate for Payer: United Healthcare HMO Rider	$29,001.00
Rate for Payer: United Healthcare Select/Navigate/Core	$26,569.00

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