Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 40.00: CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITH MCC

Facility

$113,336.00

Service Code	MSDRG 224
Min. Negotiated Rate	$12,764.00
Max. Negotiated Rate	$113,336.00
Rate for Payer: Heritage Provider Network Commercial/Senior	$12,764.00
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 40.00: CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITHOUT MCC

Facility

$101,501.00

Service Code	MSDRG 225
Min. Negotiated Rate	$12,764.00
Max. Negotiated Rate	$101,501.00
Rate for Payer: Heritage Provider Network Commercial/Senior	$12,764.00
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 40.00: CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$92,297.00

Service Code	MSDRG 226
Min. Negotiated Rate	$12,764.00
Max. Negotiated Rate	$92,297.00
Rate for Payer: Heritage Provider Network Commercial/Senior	$12,764.00
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 40.00: CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$91,296.00

Service Code	MSDRG 227
Min. Negotiated Rate	$12,764.00
Max. Negotiated Rate	$91,296.00
Rate for Payer: Heritage Provider Network Commercial/Senior	$12,764.00
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 40.00: CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC

Facility

$135,005.64

Service Code	MSDRG 258
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$135,005.64
Rate for Payer: Heritage Provider Network Commercial/Senior	$7,978.00
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 40.00: CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC

Facility

$115,131.44

Service Code	MSDRG 259
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$115,131.44
Rate for Payer: Heritage Provider Network Commercial/Senior	$7,978.00
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 40.00: CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC

Facility

$112,796.21

Service Code	MSDRG 261
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$112,796.21
Rate for Payer: Heritage Provider Network Commercial/Senior	$7,978.00
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 40.00: CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC

Facility

$136,970.00

Service Code	MSDRG 260
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$136,970.00
Rate for Payer: Heritage Provider Network Commercial/Senior	$7,978.00
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 40.00: CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT 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: Heritage Provider Network Commercial/Senior	$7,978.00
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 40.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC

Facility

$199,336.79

Service Code	MSDRG 217
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$199,336.79
Rate for Payer: Heritage Provider Network Commercial/Senior	$30,123.00
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 40.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$296,575.36

Service Code	MSDRG 216
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$296,575.36
Rate for Payer: Heritage Provider Network Commercial/Senior	$30,123.00
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

MS-DRG 40.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$199,336.79

Service Code	MSDRG 218
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$199,336.79
Rate for Payer: Heritage Provider Network Commercial/Senior	$30,123.00
Rate for Payer: United Healthcare All Other Commercial	$164,634.00
Rate for Payer: United Healthcare All Other HMO	$164,634.00
Rate for Payer: United Healthcare HMO Rider	$88,410.00
Rate for Payer: United Healthcare Select/Navigate/Core	$80,997.00

MS-DRG 40.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC

Facility

$173,879.21

Service Code	MSDRG 220
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$173,879.21
Rate for Payer: Heritage Provider Network Commercial/Senior	$30,123.00
Rate for Payer: United Healthcare All Other Commercial	$117,371.00
Rate for Payer: United Healthcare All Other HMO	$117,371.00
Rate for Payer: United Healthcare HMO Rider	$111,169.00
Rate for Payer: United Healthcare Select/Navigate/Core	$101,848.00

MS-DRG 40.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$232,775.34

Service Code	MSDRG 219
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$232,775.34
Rate for Payer: Heritage Provider Network Commercial/Senior	$30,123.00
Rate for Payer: United Healthcare All Other Commercial	$147,690.00
Rate for Payer: United Healthcare All Other HMO	$147,690.00
Rate for Payer: United Healthcare HMO Rider	$111,169.00
Rate for Payer: United Healthcare Select/Navigate/Core	$101,848.00

MS-DRG 40.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$171,252.00

Service Code	MSDRG 221
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$171,252.00
Rate for Payer: Heritage Provider Network Commercial/Senior	$30,123.00
Rate for Payer: United Healthcare All Other Commercial	$171,252.00
Rate for Payer: United Healthcare All Other HMO	$171,252.00
Rate for Payer: United Healthcare HMO Rider	$111,169.00
Rate for Payer: United Healthcare Select/Navigate/Core	$101,848.00

MS-DRG 40.00: CERVICAL SPINAL FUSION WITH CC

Facility

$131,527.64

Service Code	MSDRG 472
Min. Negotiated Rate	$22,650.00
Max. Negotiated Rate	$131,527.64
Rate for Payer: Heritage Provider Network Commercial/Senior	$24,564.00
Rate for Payer: United Healthcare All Other Commercial	$30,096.00
Rate for Payer: United Healthcare All Other HMO	$30,096.00
Rate for Payer: United Healthcare HMO Rider	$24,721.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,650.00

MS-DRG 40.00: CERVICAL SPINAL FUSION WITH MCC

Facility

$164,934.07

Service Code	MSDRG 471
Min. Negotiated Rate	$24,564.00
Max. Negotiated Rate	$164,934.07
Rate for Payer: Heritage Provider Network Commercial/Senior	$24,564.00
Rate for Payer: United Healthcare All Other Commercial	$42,108.00
Rate for Payer: United Healthcare All Other HMO	$42,108.00
Rate for Payer: United Healthcare HMO Rider	$34,591.00
Rate for Payer: United Healthcare Select/Navigate/Core	$31,692.00

MS-DRG 40.00: CERVICAL SPINAL FUSION WITHOUT CC/MCC

Facility

$122,570.05

Service Code	MSDRG 473
Min. Negotiated Rate	$22,963.00
Max. Negotiated Rate	$122,570.05
Rate for Payer: Heritage Provider Network Commercial/Senior	$24,564.00
Rate for Payer: United Healthcare All Other Commercial	$42,292.00
Rate for Payer: United Healthcare All Other HMO	$42,292.00
Rate for Payer: United Healthcare HMO Rider	$25,065.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,963.00

MS-DRG 40.00: CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$118,515.38

Service Code	MSDRG 286
Min. Negotiated Rate	$4,504.00
Max. Negotiated Rate	$118,515.38
Rate for Payer: Heritage Provider Network Commercial/Senior	$4,504.00
Rate for Payer: United Healthcare All Other Commercial	$20,829.00
Rate for Payer: United Healthcare All Other HMO	$20,829.00
Rate for Payer: United Healthcare HMO Rider	$15,202.00
Rate for Payer: United Healthcare Select/Navigate/Core	$13,927.00

MS-DRG 40.00: CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$98,238.36

Service Code	MSDRG 287
Min. Negotiated Rate	$4,504.00
Max. Negotiated Rate	$98,238.36
Rate for Payer: Heritage Provider Network Commercial/Senior	$4,504.00
Rate for Payer: United Healthcare All Other Commercial	$27,003.00
Rate for Payer: United Healthcare All Other HMO	$27,003.00
Rate for Payer: United Healthcare HMO Rider	$14,707.00
Rate for Payer: United Healthcare Select/Navigate/Core	$13,475.00

MS-DRG 40.00: COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC

Facility

$128,918.00

Service Code	MSDRG 454
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$128,918.00
Rate for Payer: Heritage Provider Network Commercial/Senior	$29,434.00
Rate for Payer: United Healthcare All Other Commercial	$128,918.00
Rate for Payer: United Healthcare All Other HMO	$128,918.00
Rate for Payer: United Healthcare HMO Rider	$75,453.00
Rate for Payer: United Healthcare Select/Navigate/Core	$69,126.00

MS-DRG 40.00: COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC

Facility

$152,808.00

Service Code	MSDRG 453
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$152,808.00
Rate for Payer: Heritage Provider Network Commercial/Senior	$29,434.00
Rate for Payer: United Healthcare All Other Commercial	$152,808.00
Rate for Payer: United Healthcare All Other HMO	$152,808.00
Rate for Payer: United Healthcare HMO Rider	$96,665.00
Rate for Payer: United Healthcare Select/Navigate/Core	$88,562.00

MS-DRG 40.00: COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC

Facility

$111,708.00

Service Code	MSDRG 455
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$111,708.00
Rate for Payer: Heritage Provider Network Commercial/Senior	$29,434.00
Rate for Payer: United Healthcare All Other Commercial	$111,708.00
Rate for Payer: United Healthcare All Other HMO	$111,708.00
Rate for Payer: United Healthcare HMO Rider	$63,390.00
Rate for Payer: United Healthcare Select/Navigate/Core	$58,075.00

MS-DRG 40.00: CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$123,286.96

Service Code	MSDRG 545
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$123,286.96
Rate for Payer: Heritage Provider Network Commercial/Senior	$17,258.00

MS-DRG 40.00: CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC

Facility

$231,771.88

Service Code	MSDRG 233
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$231,771.88
Rate for Payer: Heritage Provider Network Commercial/Senior	$33,409.00
Rate for Payer: United Healthcare All Other Commercial	$143,136.00
Rate for Payer: United Healthcare All Other HMO	$143,136.00
Rate for Payer: United Healthcare HMO Rider	$80,682.00
Rate for Payer: United Healthcare Select/Navigate/Core	$73,919.00

Know your out-of-pocket cost for care.

All Charges