Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 40.00: CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC

Facility

$176,184.28

Service Code	MSDRG 234
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$176,184.28
Rate for Payer: Heritage Provider Network Commercial/Senior	$33,409.00
Rate for Payer: United Healthcare All Other Commercial	$103,054.00
Rate for Payer: United Healthcare All Other HMO	$103,054.00
Rate for Payer: United Healthcare HMO Rider	$74,111.00
Rate for Payer: United Healthcare Select/Navigate/Core	$67,897.00

MS-DRG 40.00: CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$183,386.89

Service Code	MSDRG 235
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$183,386.89
Rate for Payer: Heritage Provider Network Commercial/Senior	$33,409.00
Rate for Payer: United Healthcare All Other Commercial	$83,791.00
Rate for Payer: United Healthcare All Other HMO	$83,791.00
Rate for Payer: United Healthcare HMO Rider	$56,388.00
Rate for Payer: United Healthcare Select/Navigate/Core	$51,660.00

MS-DRG 40.00: CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$153,579.13

Service Code	MSDRG 236
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$153,579.13
Rate for Payer: Heritage Provider Network Commercial/Senior	$33,409.00
Rate for Payer: United Healthcare All Other Commercial	$76,448.00
Rate for Payer: United Healthcare All Other HMO	$76,448.00
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: CORONARY BYPASS WITH PTCA WITH MCC

Facility

$255,560.85

Service Code	MSDRG 231
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$255,560.85
Rate for Payer: Heritage Provider Network Commercial/Senior	$33,409.00
Rate for Payer: United Healthcare All Other Commercial	$107,429.00
Rate for Payer: United Healthcare All Other HMO	$107,429.00
Rate for Payer: United Healthcare HMO Rider	$94,080.00
Rate for Payer: United Healthcare Select/Navigate/Core	$86,191.00

MS-DRG 40.00: CORONARY BYPASS WITH PTCA WITHOUT MCC

Facility

$186,829.40

Service Code	MSDRG 232
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$186,829.40
Rate for Payer: Heritage Provider Network Commercial/Senior	$33,409.00
Rate for Payer: United Healthcare All Other Commercial	$94,061.00
Rate for Payer: United Healthcare All Other HMO	$94,061.00
Rate for Payer: United Healthcare HMO Rider	$79,841.00
Rate for Payer: United Healthcare Select/Navigate/Core	$73,147.00

MS-DRG 40.00: ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC

Facility

$216,703.00

Service Code	MSDRG 266
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$216,703.00
Rate for Payer: Heritage Provider Network Commercial/Senior	$25,651.00
Rate for Payer: United Healthcare All Other Commercial	$216,703.00
Rate for Payer: United Healthcare All Other HMO	$216,703.00
Rate for Payer: United Healthcare HMO Rider	$155,367.00
Rate for Payer: United Healthcare Select/Navigate/Core	$142,342.00

MS-DRG 40.00: ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC

Facility

$163,729.19

Service Code	MSDRG 267
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$163,729.19
Rate for Payer: Heritage Provider Network Commercial/Senior	$25,651.00
Rate for Payer: United Healthcare All Other Commercial	$162,712.00
Rate for Payer: United Healthcare All Other HMO	$162,712.00
Rate for Payer: United Healthcare HMO Rider	$116,659.00
Rate for Payer: United Healthcare Select/Navigate/Core	$106,879.00

MS-DRG 40.00: HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC

Facility

$116,416.15

Service Code	MSDRG 481
Min. Negotiated Rate	$21,830.00
Max. Negotiated Rate	$116,416.15
Rate for Payer: Heritage Provider Network Commercial/Senior	$24,564.00
Rate for Payer: United Healthcare All Other Commercial	$74,534.00
Rate for Payer: United Healthcare All Other HMO	$74,534.00
Rate for Payer: United Healthcare HMO Rider	$23,828.00
Rate for Payer: United Healthcare Select/Navigate/Core	$21,830.00

MS-DRG 40.00: HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC

Facility

$130,927.88

Service Code	MSDRG 480
Min. Negotiated Rate	$24,564.00
Max. Negotiated Rate	$130,927.88
Rate for Payer: Heritage Provider Network Commercial/Senior	$24,564.00
Rate for Payer: United Healthcare All Other Commercial	$56,679.00
Rate for Payer: United Healthcare All Other HMO	$56,679.00
Rate for Payer: United Healthcare HMO Rider	$30,970.00
Rate for Payer: United Healthcare Select/Navigate/Core	$28,371.00

MS-DRG 40.00: HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT 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: Heritage Provider Network Commercial/Senior	$24,564.00
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 40.00: HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC

Facility

$130,180.81

Service Code	MSDRG 521
Min. Negotiated Rate	$52,540.00
Max. Negotiated Rate	$130,180.81
Rate for Payer: United Healthcare All Other Commercial	$59,995.00
Rate for Payer: United Healthcare All Other HMO	$59,995.00
Rate for Payer: United Healthcare HMO Rider	$54,441.00
Rate for Payer: United Healthcare Select/Navigate/Core	$52,540.00

MS-DRG 40.00: HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC

Facility

$116,827.82

Service Code	MSDRG 522
Min. Negotiated Rate	$32,854.00
Max. Negotiated Rate	$116,827.82
Rate for Payer: United Healthcare All Other Commercial	$75,160.00
Rate for Payer: United Healthcare All Other HMO	$75,160.00
Rate for Payer: United Healthcare HMO Rider	$35,860.00
Rate for Payer: United Healthcare Select/Navigate/Core	$32,854.00

MS-DRG 40.00: LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES 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: Heritage Provider Network Commercial/Senior	$25,608.00
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 40.00: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC

Facility

$100,690.71

Service Code	MSDRG 497
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$100,690.71
Rate for Payer: Heritage Provider Network Commercial/Senior	$13,083.00

MS-DRG 40.00: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC

Facility

$124,252.29

Service Code	MSDRG 493
Min. Negotiated Rate	$17,710.00
Max. Negotiated Rate	$124,252.29
Rate for Payer: Heritage Provider Network Commercial/Senior	$21,433.00
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 40.00: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC

Facility

$144,401.52

Service Code	MSDRG 492
Min. Negotiated Rate	$21,433.00
Max. Negotiated Rate	$144,401.52
Rate for Payer: Heritage Provider Network Commercial/Senior	$21,433.00
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 40.00: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT 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: Heritage Provider Network Commercial/Senior	$21,433.00
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 40.00: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT

Facility

$133,073.23

Service Code	MSDRG 469
Min. Negotiated Rate	$23,506.00
Max. Negotiated Rate	$133,073.23
Rate for Payer: Heritage Provider Network Commercial/Senior	$23,506.00
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 40.00: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC

Facility

$113,477.61

Service Code	MSDRG 470
Min. Negotiated Rate	$23,467.00
Max. Negotiated Rate	$113,477.61
Rate for Payer: Heritage Provider Network Commercial/Senior	$23,506.00
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 40.00: MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES

Facility

$128,436.51

Service Code	MSDRG 483
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$128,436.51
Rate for Payer: Heritage Provider Network Commercial/Senior	$23,506.00

MS-DRG 40.00: MAJOR MALE PELVIC PROCEDURES WITH 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 40.00: MAJOR MALE PELVIC PROCEDURES WITHOUT 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 40.00: MEDICAL BACK PROBLEMS WITH 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 40.00: MEDICAL BACK PROBLEMS WITHOUT 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 40.00: O.R. PROCEDURES FOR OBESITY WITH CC

Facility

$107,646.68

Service Code	MSDRG 620
Min. Negotiated Rate	$12,166.00
Max. Negotiated Rate	$107,646.68
Rate for Payer: Heritage Provider Network Commercial/Senior	$12,166.00
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

Know your out-of-pocket cost for care.

All Charges