Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 29.00: MAJOR CARDIOVASC PROCEDURES W MCC

Facility

$79,185.00

Service Code	MSDRG 237
Min. Negotiated Rate	$14,790.00
Max. Negotiated Rate	$79,185.00
Rate for Payer: Cigna of CA PPO	$14,790.00
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 29.00: 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: Cigna of CA PPO	$14,790.00
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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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: Cigna of CA PPO	$14,790.00
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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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 29.00: 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: Cigna of CA PPO	$14,790.00
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 29.00: 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: Cigna of CA PPO	$14,790.00
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 29.00: 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: Cigna of CA PPO	$14,790.00
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

MS-DRG 29.00: PERC CARDIOVASC PROC W NON-DRUG-ELUTING STENT W/O MCC

Facility

$35,065.00

Service Code	MSDRG 249
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$35,065.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: United Healthcare All Other HMO	$35,065.00
Rate for Payer: United Healthcare HMO Rider	$17,320.00
Rate for Payer: United Healthcare Select/Navigate/Core	$15,867.00

MS-DRG 29.00: PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W MCC

Facility

$117,977.71

Service Code	MSDRG 250
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$117,977.71
Rate for Payer: United Healthcare All Other Commercial	$32,556.00
Rate for Payer: United Healthcare All Other HMO	$32,556.00
Rate for Payer: United Healthcare HMO Rider	$27,066.00
Rate for Payer: United Healthcare Select/Navigate/Core	$24,796.00

MS-DRG 29.00: PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W/O MCC

Facility

$105,769.26

Service Code	MSDRG 251
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$105,769.26
Rate for Payer: United Healthcare All Other Commercial	$41,406.00
Rate for Payer: United Healthcare All Other HMO	$41,406.00
Rate for Payer: United Healthcare HMO Rider	$22,531.00
Rate for Payer: United Healthcare Select/Navigate/Core	$20,641.00

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