Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 25.00: 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	$112,353.00
Rate for Payer: United Healthcare HMO Rider	$30,180.00
Rate for Payer: United Healthcare Select/Navigate/Core	$27,650.00

MS-DRG 29.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC

Facility

$95,558.89

Service Code	MSDRG 281
Min. Negotiated Rate	$15,502.00
Max. Negotiated Rate	$95,558.89
Rate for Payer: United Healthcare All Other Commercial	$26,466.00
Rate for Payer: United Healthcare All Other HMO	$26,466.00
Rate for Payer: United Healthcare HMO Rider	$16,920.00
Rate for Payer: United Healthcare Select/Navigate/Core	$15,502.00

MS-DRG 29.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC

Facility

$107,714.10

Service Code	MSDRG 280
Min. Negotiated Rate	$20,535.00
Max. Negotiated Rate	$107,714.10
Rate for Payer: United Healthcare All Other Commercial	$27,038.00
Rate for Payer: United Healthcare All Other HMO	$27,038.00
Rate for Payer: United Healthcare HMO Rider	$22,413.00
Rate for Payer: United Healthcare Select/Navigate/Core	$20,535.00

MS-DRG 29.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC

Facility

$92,080.91

Service Code	MSDRG 282
Min. Negotiated Rate	$12,537.00
Max. Negotiated Rate	$92,080.91
Rate for Payer: United Healthcare All Other Commercial	$28,087.00
Rate for Payer: United Healthcare All Other HMO	$28,087.00
Rate for Payer: United Healthcare HMO Rider	$13,685.00
Rate for Payer: United Healthcare Select/Navigate/Core	$12,537.00

MS-DRG 29.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED W CC

Facility

$91,532.58

Service Code	MSDRG 284
Min. Negotiated Rate	$14,254.00
Max. Negotiated Rate	$91,532.58
Rate for Payer: United Healthcare All Other Commercial	$28,275.00
Rate for Payer: United Healthcare All Other HMO	$28,275.00
Rate for Payer: United Healthcare HMO Rider	$15,558.00
Rate for Payer: United Healthcare Select/Navigate/Core	$14,254.00

MS-DRG 29.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC

Facility

$114,398.56

Service Code	MSDRG 283
Min. Negotiated Rate	$18,641.00
Max. Negotiated Rate	$114,398.56
Rate for Payer: United Healthcare All Other Commercial	$29,007.00
Rate for Payer: United Healthcare All Other HMO	$29,007.00
Rate for Payer: United Healthcare HMO Rider	$20,346.00
Rate for Payer: United Healthcare Select/Navigate/Core	$18,641.00

MS-DRG 29.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED W/O CC/MCC

Facility

$89,876.99

Service Code	MSDRG 285
Min. Negotiated Rate	$12,305.00
Max. Negotiated Rate	$89,876.99
Rate for Payer: United Healthcare All Other Commercial	$27,865.00
Rate for Payer: United Healthcare All Other HMO	$27,865.00
Rate for Payer: United Healthcare HMO Rider	$13,432.00
Rate for Payer: United Healthcare Select/Navigate/Core	$12,305.00

MS-DRG 29.00: ACUTE & SUBACUTE ENDOCARDITIS W CC

Facility

$109,538.25

Service Code	MSDRG 289
Min. Negotiated Rate	$27,248.00
Max. Negotiated Rate	$109,538.25
Rate for Payer: United Healthcare All Other Commercial	$33,040.00
Rate for Payer: United Healthcare All Other HMO	$33,040.00
Rate for Payer: United Healthcare HMO Rider	$29,741.00
Rate for Payer: United Healthcare Select/Navigate/Core	$27,248.00

MS-DRG 29.00: ACUTE & SUBACUTE ENDOCARDITIS W MCC

Facility

$127,270.65

Service Code	MSDRG 288
Min. Negotiated Rate	$34,413.00
Max. Negotiated Rate	$127,270.65
Rate for Payer: United Healthcare All Other Commercial	$37,549.00
Rate for Payer: United Healthcare All Other HMO	$37,549.00
Rate for Payer: United Healthcare HMO Rider	$37,563.00
Rate for Payer: United Healthcare Select/Navigate/Core	$34,413.00

MS-DRG 29.00: ACUTE & SUBACUTE ENDOCARDITIS W/O CC/MCC

Facility

$95,746.99

Service Code	MSDRG 290
Min. Negotiated Rate	$23,302.00
Max. Negotiated Rate	$95,746.99
Rate for Payer: United Healthcare All Other Commercial	$33,040.00
Rate for Payer: United Healthcare All Other HMO	$33,040.00
Rate for Payer: United Healthcare HMO Rider	$25,436.00
Rate for Payer: United Healthcare Select/Navigate/Core	$23,302.00

MS-DRG 29.00: BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W MCC

Facility

$177,254.30

Service Code	MSDRG 461
Min. Negotiated Rate	$45,279.00
Max. Negotiated Rate	$177,254.30
Rate for Payer: United Healthcare All Other Commercial	$64,494.00
Rate for Payer: United Healthcare All Other HMO	$64,494.00
Rate for Payer: United Healthcare HMO Rider	$49,424.00
Rate for Payer: United Healthcare Select/Navigate/Core	$45,279.00

MS-DRG 29.00: BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W/O MCC

Facility

$126,450.85

Service Code	MSDRG 462
Min. Negotiated Rate	$36,596.00
Max. Negotiated Rate	$126,450.85
Rate for Payer: United Healthcare All Other Commercial	$52,127.00
Rate for Payer: United Healthcare All Other HMO	$52,127.00
Rate for Payer: United Healthcare HMO Rider	$39,944.00
Rate for Payer: United Healthcare Select/Navigate/Core	$36,596.00

MS-DRG 29.00: CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W MCC

Facility

$124,263.00

Service Code	MSDRG 222
Min. Negotiated Rate	$12,764.00
Max. Negotiated Rate	$124,263.00
Rate for Payer: Cigna of CA PPO	$14,790.00
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 29.00: CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W/O MCC

Facility

$106,570.00

Service Code	MSDRG 223
Min. Negotiated Rate	$12,764.00
Max. Negotiated Rate	$106,570.00
Rate for Payer: Cigna of CA PPO	$14,790.00
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 29.00: CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W MCC

Facility

$113,336.00

Service Code	MSDRG 224
Min. Negotiated Rate	$12,764.00
Max. Negotiated Rate	$113,336.00
Rate for Payer: Cigna of CA PPO	$14,790.00
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 29.00: 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	$12,764.00
Max. Negotiated Rate	$101,501.00
Rate for Payer: Cigna of CA PPO	$14,790.00
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 29.00: CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W MCC

Facility

$92,297.00

Service Code	MSDRG 226
Min. Negotiated Rate	$12,764.00
Max. Negotiated Rate	$92,297.00
Rate for Payer: Cigna of CA PPO	$14,790.00
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 29.00: CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W/O MCC

Facility

$91,296.00

Service Code	MSDRG 227
Min. Negotiated Rate	$12,764.00
Max. Negotiated Rate	$91,296.00
Rate for Payer: Cigna of CA PPO	$14,790.00
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 29.00: CARDIAC PACEMAKER DEVICE REPLACEMENT W MCC

Facility

$135,005.64

Service Code	MSDRG 258
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$135,005.64
Rate for Payer: United Healthcare All Other Commercial	$38,532.00
Rate for Payer: United Healthcare All Other HMO	$38,532.00
Rate for Payer: United Healthcare HMO Rider	$23,768.00
Rate for Payer: United Healthcare Select/Navigate/Core	$21,774.00

MS-DRG 29.00: CARDIAC PACEMAKER DEVICE REPLACEMENT W/O MCC

Facility

$115,131.44

Service Code	MSDRG 259
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$115,131.44
Rate for Payer: United Healthcare All Other Commercial	$38,532.00
Rate for Payer: United Healthcare All Other HMO	$38,532.00
Rate for Payer: United Healthcare HMO Rider	$23,768.00
Rate for Payer: United Healthcare Select/Navigate/Core	$21,774.00

MS-DRG 29.00: CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W CC

Facility

$112,796.21

Service Code	MSDRG 261
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$112,796.21
Rate for Payer: United Healthcare All Other Commercial	$51,377.00
Rate for Payer: United Healthcare All Other HMO	$51,377.00
Rate for Payer: United Healthcare HMO Rider	$31,691.00
Rate for Payer: United Healthcare Select/Navigate/Core	$29,035.00

MS-DRG 29.00: CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W MCC

Facility

$136,970.00

Service Code	MSDRG 260
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$136,970.00
Rate for Payer: United Healthcare All Other Commercial	$51,377.00
Rate for Payer: United Healthcare All Other HMO	$51,377.00
Rate for Payer: United Healthcare HMO Rider	$31,691.00
Rate for Payer: United Healthcare Select/Navigate/Core	$29,035.00

MS-DRG 29.00: CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W/O CC/MCC

Facility

$108,171.89

Service Code	MSDRG 262
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$108,171.89
Rate for Payer: United Healthcare All Other Commercial	$51,377.00
Rate for Payer: United Healthcare All Other HMO	$51,377.00
Rate for Payer: United Healthcare HMO Rider	$31,691.00
Rate for Payer: United Healthcare Select/Navigate/Core	$29,035.00

MS-DRG 29.00: CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W CC

Facility

$199,336.79

Service Code	MSDRG 217
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$199,336.79
Rate for Payer: United Healthcare All Other Commercial	$126,798.00
Rate for Payer: United Healthcare All Other HMO	$126,798.00
Rate for Payer: United Healthcare HMO Rider	$97,715.00
Rate for Payer: United Healthcare Select/Navigate/Core	$89,522.00

MS-DRG 29.00: CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W MCC

Facility

$296,575.36

Service Code	MSDRG 216
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$296,575.36
Rate for Payer: United Healthcare All Other Commercial	$155,615.00
Rate for Payer: United Healthcare All Other HMO	$155,615.00
Rate for Payer: United Healthcare HMO Rider	$119,917.00
Rate for Payer: United Healthcare Select/Navigate/Core	$109,864.00

Know your out-of-pocket cost for care.

All Charges