Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 40.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC

Facility

$47,371.78

Service Code	MSDRG 251
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$47,371.78
Rate for Payer: Heritage Provider Network Commercial	$7,978.00
Rate for Payer: United Healthcare All Other Commercial	$41,406.00
Rate for Payer: United Healthcare All Other HMO	$29,656.00
Rate for Payer: United Healthcare HMO Rider	$22,531.00
Rate for Payer: United Healthcare Select/Navigate/Core	$20,641.00

MS-DRG 40.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC

Facility

$68,295.88

Service Code	MSDRG 243
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$68,295.88
Rate for Payer: Heritage Provider Network Commercial	$7,978.00
Rate for Payer: United Healthcare All Other Commercial	$29,923.00
Rate for Payer: United Healthcare All Other HMO	$27,707.00
Rate for Payer: United Healthcare HMO Rider	$24,583.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,521.00

MS-DRG 40.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC

Facility

$102,831.87

Service Code	MSDRG 242
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$102,831.87
Rate for Payer: Heritage Provider Network Commercial	$7,978.00
Rate for Payer: United Healthcare All Other Commercial	$38,262.00
Rate for Payer: United Healthcare All Other HMO	$35,430.00
Rate for Payer: United Healthcare HMO Rider	$36,089.00
Rate for Payer: United Healthcare Select/Navigate/Core	$33,062.00

MS-DRG 40.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC

Facility

$54,711.29

Service Code	MSDRG 244
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$54,711.29
Rate for Payer: Heritage Provider Network Commercial	$7,978.00
Rate for Payer: United Healthcare All Other Commercial	$25,087.00
Rate for Payer: United Healthcare All Other HMO	$23,231.00
Rate for Payer: United Healthcare HMO Rider	$20,612.00
Rate for Payer: United Healthcare Select/Navigate/Core	$18,884.00

MS-DRG 40.00: PROSTATECTOMY WITHOUT CC/MCC

Facility

$39,451.54

Service Code	MSDRG 667
Min. Negotiated Rate	$19,004.87
Max. Negotiated Rate	$39,451.54
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 40.00: REVISION OF HIP OR KNEE REPLACEMENT WITH CC

Facility

$103,838.36

Service Code	MSDRG 467
Min. Negotiated Rate	$32,499.00
Max. Negotiated Rate	$103,838.36
Rate for Payer: United Healthcare All Other Commercial	$36,468.00
Rate for Payer: United Healthcare All Other HMO	$33,770.00
Rate for Payer: United Healthcare HMO Rider	$35,474.00
Rate for Payer: United Healthcare Select/Navigate/Core	$32,499.00

MS-DRG 40.00: REVISION OF HIP OR KNEE REPLACEMENT WITH MCC

Facility

$154,447.89

Service Code	MSDRG 466
Min. Negotiated Rate	$39,477.00
Max. Negotiated Rate	$154,447.89
Rate for Payer: United Healthcare All Other Commercial	$39,477.00
Rate for Payer: United Healthcare All Other HMO	$43,441.00
Rate for Payer: United Healthcare HMO Rider	$45,640.00
Rate for Payer: United Healthcare Select/Navigate/Core	$41,813.00

MS-DRG 40.00: REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC

Facility

$79,527.96

Service Code	MSDRG 468
Min. Negotiated Rate	$28,986.00
Max. Negotiated Rate	$79,527.96
Rate for Payer: United Healthcare All Other Commercial	$39,477.00
Rate for Payer: United Healthcare All Other HMO	$30,116.00
Rate for Payer: United Healthcare HMO Rider	$31,639.00
Rate for Payer: United Healthcare Select/Navigate/Core	$28,986.00

MS-DRG 40.00: SPINAL FUSION EXCEPT CERVICAL WITH MCC

Facility

$76,782.00

Service Code	MSDRG 459
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$76,782.00
Rate for Payer: Heritage Provider Network Commercial	$29,434.00
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 40.00: SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC

Facility

$81,808.00

Service Code	MSDRG 460
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$81,808.00
Rate for Payer: Heritage Provider Network Commercial	$29,434.00
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 40.00: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC

Facility

$173,995.65

Service Code	MSDRG 457
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$173,995.65
Rate for Payer: Heritage Provider Network Commercial	$29,434.00
Rate for Payer: United Healthcare All Other Commercial	$90,575.00
Rate for Payer: United Healthcare All Other HMO	$82,014.00
Rate for Payer: United Healthcare HMO Rider	$62,293.00
Rate for Payer: United Healthcare Select/Navigate/Core	$57,072.00

MS-DRG 40.00: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC

Facility

$256,752.27

Service Code	MSDRG 456
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$256,752.27
Rate for Payer: Heritage Provider Network Commercial	$29,434.00
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 40.00: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT 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: Heritage Provider Network Commercial	$29,434.00
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 40.00: SPINAL PROCEDURES WITH 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: Heritage Provider Network Commercial	$25,608.00
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 40.00: SPINAL PROCEDURES WITH MCC

Facility

$184,306.12

Service Code	MSDRG 028
Min. Negotiated Rate	$25,608.00
Max. Negotiated Rate	$184,306.12
Rate for Payer: Heritage Provider Network Commercial	$25,608.00
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 40.00: SPINAL PROCEDURES WITHOUT 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: Heritage Provider Network Commercial	$25,608.00
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 40.00: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH 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 40.00: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT 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 40.00: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT 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 40.00: VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C

Facility

$40,424.21

Service Code	MSDRG 768
Min. Negotiated Rate	$4,760.00
Max. Negotiated Rate	$40,424.21
Rate for Payer: Heritage Provider Network Commercial	$7,387.00

MS-DRG 40.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH 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 40.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH 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 40.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT 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 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$40,135.97

Service Code	MSDRG 770
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$40,135.97
Rate for Payer: Aetna of CA HMO/PPO	$32,620.02
Rate for Payer: EPIC Health Plan Commercial	$40,135.97
Rate for Payer: EPIC Health Plan Senior	$29,730.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,730.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,730.35
Rate for Payer: Molina Healthcare of CA Medicare	$39,838.67
Rate for Payer: Multiplan WC	$20,101.24
Rate for Payer: Prime Health Services WC	$19,896.13
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: ABORTION WITHOUT D&C

Facility

$38,130.97

Service Code	MSDRG 779
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$38,130.97
Rate for Payer: Aetna of CA HMO/PPO	$28,339.40
Rate for Payer: EPIC Health Plan Commercial	$38,130.97
Rate for Payer: EPIC Health Plan Senior	$28,245.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,245.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,245.16
Rate for Payer: Molina Healthcare of CA Medicare	$37,848.51
Rate for Payer: Multiplan WC	$17,463.42
Rate for Payer: Prime Health Services WC	$17,285.23
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

Know your out-of-pocket cost for care.

All Charges