Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 35.00: 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 35.00: 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 35.00: UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC

Facility

$41,878.26

Service Code	MSDRG 743
Min. Negotiated Rate	$22,164.96
Max. Negotiated Rate	$41,878.26
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 35.00: UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W/O CC/MCC

Facility

$44,361.78

Service Code	MSDRG 741
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$44,361.78
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 35.00: 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 35.00: 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 35.00: 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 40.00: ACUTE AND SUBACUTE ENDOCARDITIS WITH 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 40.00: ACUTE AND SUBACUTE ENDOCARDITIS WITH 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 40.00: ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC

Facility

$38,758.58

Service Code	MSDRG 290
Min. Negotiated Rate	$18,102.52
Max. Negotiated Rate	$38,758.58
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 40.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC

Facility

$37,946.37

Service Code	MSDRG 281
Min. Negotiated Rate	$15,502.00
Max. Negotiated Rate	$37,946.37
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 40.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH 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 40.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC

Facility

$35,153.28

Service Code	MSDRG 282
Min. Negotiated Rate	$12,537.00
Max. Negotiated Rate	$35,153.28
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 40.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC

Facility

$35,379.04

Service Code	MSDRG 284
Min. Negotiated Rate	$13,701.71
Max. Negotiated Rate	$35,379.04
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 40.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH 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 40.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC

Facility

$32,828.79

Service Code	MSDRG 285
Min. Negotiated Rate	$10,380.75
Max. Negotiated Rate	$32,828.79
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

MS-DRG 40.00: AICD GENERATOR PROCEDURES

Facility

$148,148.23

Service Code	MSDRG 245
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$148,148.23
Rate for Payer: Heritage Provider Network Commercial	$9,547.00

MS-DRG 40.00: AICD LEAD PROCEDURES

Facility

$108,143.24

Service Code	MSDRG 265
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$108,143.24
Rate for Payer: Heritage Provider Network Commercial	$9,547.00

MS-DRG 40.00: AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC

Facility

$202,134.96

Service Code	MSDRG 268
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$202,134.96
Rate for Payer: Heritage Provider Network Commercial	$25,651.00
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 40.00: AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC

Facility

$126,135.78

Service Code	MSDRG 269
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$126,135.78
Rate for Payer: Heritage Provider Network Commercial	$25,651.00
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 40.00: BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH 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 40.00: BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR

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 40.00: BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC

Facility

$45,208.10

Service Code	MSDRG 520
Min. Negotiated Rate	$11,314.00
Max. Negotiated Rate	$45,208.10
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 40.00: BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH 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 40.00: BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT 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

Know your out-of-pocket cost for care.

All Charges