Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 25.00: Hip & femur procedures except major joint w/o CC/MCC

Facility

$108,191.42

Service Code	MSDRG 482
Min. Negotiated Rate	$18,472.00
Max. Negotiated Rate	$108,191.42
Rate for Payer: United Healthcare All Other Commercial	$60,760.00
Rate for Payer: United Healthcare All Other HMO	$60,760.00
Rate for Payer: United Healthcare HMO Rider	$20,163.00
Rate for Payer: United Healthcare Select/Navigate/Core	$18,472.00

MS-DRG 25.00: Limb reattachment, hip & femur proc for multiple significant trauma

Facility

$146,023.40

Service Code	MSDRG 956
Min. Negotiated Rate	$25,608.00
Max. Negotiated Rate	$146,023.40
Rate for Payer: United Healthcare All Other Commercial	$91,491.00
Rate for Payer: United Healthcare All Other HMO	$91,491.00
Rate for Payer: United Healthcare HMO Rider	$44,920.00
Rate for Payer: United Healthcare Select/Navigate/Core	$41,155.00

MS-DRG 25.00: Lower extrem & humer proc except hip,foot,femur w CC

Facility

$124,252.29

Service Code	MSDRG 493
Min. Negotiated Rate	$17,710.00
Max. Negotiated Rate	$124,252.29
Rate for Payer: United Healthcare All Other Commercial	$36,150.00
Rate for Payer: United Healthcare All Other HMO	$36,150.00
Rate for Payer: United Healthcare HMO Rider	$19,332.00
Rate for Payer: United Healthcare Select/Navigate/Core	$17,710.00

MS-DRG 25.00: Lower extrem & humer proc except hip,foot,femur w MCC

Facility

$144,401.52

Service Code	MSDRG 492
Min. Negotiated Rate	$21,433.00
Max. Negotiated Rate	$144,401.52
Rate for Payer: United Healthcare All Other Commercial	$37,370.00
Rate for Payer: United Healthcare All Other HMO	$37,370.00
Rate for Payer: United Healthcare HMO Rider	$28,889.00
Rate for Payer: United Healthcare Select/Navigate/Core	$26,467.00

MS-DRG 25.00: Lower extrem & humer proc except hip,foot,femur w/o CC/MCC

Facility

$114,854.62

Service Code	MSDRG 494
Min. Negotiated Rate	$15,056.00
Max. Negotiated Rate	$114,854.62
Rate for Payer: United Healthcare All Other Commercial	$29,464.00
Rate for Payer: United Healthcare All Other HMO	$29,464.00
Rate for Payer: United Healthcare HMO Rider	$16,434.00
Rate for Payer: United Healthcare Select/Navigate/Core	$15,056.00

MS-DRG 25.00: Major cardiovasc procedures w MCC or thoracic aortic anuerysm repair

Facility

$79,185.00

Service Code	MSDRG 237
Min. Negotiated Rate	$14,790.00
Max. Negotiated Rate	$79,185.00
Rate for Payer: United Healthcare All Other HMO	$79,185.00
Rate for Payer: United Healthcare HMO Rider	$60,147.00
Rate for Payer: United Healthcare Select/Navigate/Core	$55,106.00

MS-DRG 25.00: Major cardiovasc procedures w/o MCC

Facility

$68,582.00

Service Code	MSDRG 238
Min. Negotiated Rate	$14,790.00
Max. Negotiated Rate	$68,582.00
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 25.00: Major joint replacement or reattachment of lower extremity w MCC

Facility

$133,073.23

Service Code	MSDRG 469
Min. Negotiated Rate	$23,506.00
Max. Negotiated Rate	$133,073.23
Rate for Payer: United Healthcare All Other Commercial	$41,904.00
Rate for Payer: United Healthcare All Other HMO	$41,904.00
Rate for Payer: United Healthcare HMO Rider	$34,363.00
Rate for Payer: United Healthcare Select/Navigate/Core	$31,483.00

MS-DRG 25.00: Major joint replacement or reattachment of lower extremity w/o MCC

Facility

$113,477.61

Service Code	MSDRG 470
Min. Negotiated Rate	$23,467.00
Max. Negotiated Rate	$113,477.61
Rate for Payer: United Healthcare All Other Commercial	$53,685.00
Rate for Payer: United Healthcare All Other HMO	$53,685.00
Rate for Payer: United Healthcare HMO Rider	$25,615.00
Rate for Payer: United Healthcare Select/Navigate/Core	$23,467.00

MS-DRG 25.00: Major male pelvic procedures w CC/MCC

Facility

$114,744.60

Service Code	MSDRG 707
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$114,744.60
Rate for Payer: United Healthcare All Other Commercial	$24,996.00
Rate for Payer: United Healthcare All Other HMO	$24,996.00
Rate for Payer: United Healthcare HMO Rider	$24,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,398.00

MS-DRG 25.00: Major male pelvic procedures w/o CC/MCC

Facility

$106,473.74

Service Code	MSDRG 708
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$106,473.74
Rate for Payer: United Healthcare All Other Commercial	$24,996.00
Rate for Payer: United Healthcare All Other HMO	$24,996.00
Rate for Payer: United Healthcare HMO Rider	$24,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,398.00

MS-DRG 25.00: Medical back problems w MCC

Facility

$108,991.72

Service Code	MSDRG 551
Min. Negotiated Rate	$13,734.00
Max. Negotiated Rate	$108,991.72
Rate for Payer: United Healthcare All Other Commercial	$59,884.00
Rate for Payer: United Healthcare All Other HMO	$59,884.00
Rate for Payer: United Healthcare HMO Rider	$14,990.00
Rate for Payer: United Healthcare Select/Navigate/Core	$13,734.00

MS-DRG 25.00: Medical back problems w/o MCC

Facility

$96,307.71

Service Code	MSDRG 552
Min. Negotiated Rate	$13,778.00
Max. Negotiated Rate	$96,307.71
Rate for Payer: United Healthcare All Other Commercial	$59,884.00
Rate for Payer: United Healthcare All Other HMO	$59,884.00
Rate for Payer: United Healthcare HMO Rider	$15,038.00
Rate for Payer: United Healthcare Select/Navigate/Core	$13,778.00

MS-DRG 25.00: O.R. procedures for obesity w CC

Facility

$107,646.68

Service Code	MSDRG 620
Min. Negotiated Rate	$12,166.00
Max. Negotiated Rate	$107,646.68
Rate for Payer: United Healthcare All Other Commercial	$28,919.00
Rate for Payer: United Healthcare All Other HMO	$28,919.00
Rate for Payer: United Healthcare HMO Rider	$28,283.00
Rate for Payer: United Healthcare Select/Navigate/Core	$25,912.00

MS-DRG 25.00: O.R. procedures for obesity w MCC

Facility

$130,486.03

Service Code	MSDRG 619
Min. Negotiated Rate	$12,166.00
Max. Negotiated Rate	$130,486.03
Rate for Payer: United Healthcare All Other Commercial	$28,919.00
Rate for Payer: United Healthcare All Other HMO	$28,919.00
Rate for Payer: United Healthcare HMO Rider	$28,283.00
Rate for Payer: United Healthcare Select/Navigate/Core	$25,912.00

MS-DRG 25.00: O.R. procedures for obesity w/o CC/MCC

Facility

$106,015.90

Service Code	MSDRG 621
Min. Negotiated Rate	$12,166.00
Max. Negotiated Rate	$106,015.90
Rate for Payer: United Healthcare All Other Commercial	$28,919.00
Rate for Payer: United Healthcare All Other HMO	$28,919.00
Rate for Payer: United Healthcare HMO Rider	$28,283.00
Rate for Payer: United Healthcare Select/Navigate/Core	$25,912.00

MS-DRG 25.00: Other cardiothoracic procedures w CC

Facility

$135,136.93

Service Code	MSDRG 229
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$135,136.93
Rate for Payer: United Healthcare All Other Commercial	$71,243.00
Rate for Payer: United Healthcare All Other HMO	$71,243.00
Rate for Payer: United Healthcare HMO Rider	$68,556.00
Rate for Payer: United Healthcare Select/Navigate/Core	$62,809.00

MS-DRG 25.00: Other cardiothoracic procedures w MCC

Facility

$167,040.37

Service Code	MSDRG 228
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$167,040.37
Rate for Payer: United Healthcare All Other Commercial	$120,397.00
Rate for Payer: United Healthcare All Other HMO	$120,397.00
Rate for Payer: United Healthcare HMO Rider	$86,872.00
Rate for Payer: United Healthcare Select/Navigate/Core	$79,589.00

MS-DRG 25.00: Other cardiothoracic procedures w/o CC/MCC

Facility

$81,188.00

Service Code	MSDRG 230
Min. Negotiated Rate	$14,790.00
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 25.00: Other heart assist system implant

Facility

$301,856.41

Service Code	MSDRG 215
Min. Negotiated Rate	$144,650.00
Max. Negotiated Rate	$301,856.41
Rate for Payer: United Healthcare All Other Commercial	$200,732.00
Rate for Payer: United Healthcare All Other HMO	$200,732.00
Rate for Payer: United Healthcare HMO Rider	$157,887.00
Rate for Payer: United Healthcare Select/Navigate/Core	$144,650.00

MS-DRG 25.00: Other vascular procedures w CC

Facility

$125,308.08

Service Code	MSDRG 253
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$125,308.08
Rate for Payer: United Healthcare All Other Commercial	$43,936.00
Rate for Payer: United Healthcare All Other HMO	$43,936.00
Rate for Payer: United Healthcare HMO Rider	$29,046.00
Rate for Payer: United Healthcare Select/Navigate/Core	$26,610.00

MS-DRG 25.00: Other vascular procedures w MCC

Facility

$141,148.89

Service Code	MSDRG 252
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$141,148.89
Rate for Payer: United Healthcare All Other Commercial	$42,180.00
Rate for Payer: United Healthcare All Other HMO	$42,180.00
Rate for Payer: United Healthcare HMO Rider	$31,795.00
Rate for Payer: United Healthcare Select/Navigate/Core	$29,128.00

MS-DRG 25.00: Other vascular procedures w/o CC/MCC

Facility

$110,865.58

Service Code	MSDRG 254
Min. Negotiated Rate	$19,823.00
Max. Negotiated Rate	$110,865.58
Rate for Payer: United Healthcare All Other Commercial	$56,697.00
Rate for Payer: United Healthcare All Other HMO	$56,697.00
Rate for Payer: United Healthcare HMO Rider	$21,636.00
Rate for Payer: United Healthcare Select/Navigate/Core	$19,823.00

MS-DRG 25.00: Pelvic evisceration, rad hysterectomy & rad vulvectomy w/o CC/MCC

Facility

$103,125.28

Service Code	MSDRG 735
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$103,125.28
Rate for Payer: United Healthcare All Other Commercial	$24,996.00
Rate for Payer: United Healthcare All Other HMO	$24,996.00
Rate for Payer: United Healthcare HMO Rider	$24,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,398.00

MS-DRG 25.00: 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

Know your out-of-pocket cost for care.

All Charges