Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 40.00: O.R. PROCEDURES FOR OBESITY WITH MCC

Facility

$130,486.03

Service Code	MSDRG 619
Min. Negotiated Rate	$12,166.00
Max. Negotiated Rate	$130,486.03
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

MS-DRG 40.00: O.R. PROCEDURES FOR OBESITY WITHOUT 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: 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

MS-DRG 40.00: OTHER CARDIOTHORACIC PROCEDURES WITH MCC

Facility

$167,040.37

Service Code	MSDRG 228
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$167,040.37
Rate for Payer: Heritage Provider Network Commercial/Senior	$25,651.00
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 40.00: OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC

Facility

$135,136.93

Service Code	MSDRG 229
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$135,136.93
Rate for Payer: Heritage Provider Network Commercial/Senior	$25,651.00
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 40.00: OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC

Facility

$158,442.98

Service Code	MSDRG 319
Min. Negotiated Rate	$56,595.00
Max. Negotiated Rate	$158,442.98
Rate for Payer: United Healthcare All Other Commercial	$86,080.00
Rate for Payer: United Healthcare All Other HMO	$86,080.00
Rate for Payer: United Healthcare HMO Rider	$61,775.00
Rate for Payer: United Healthcare Select/Navigate/Core	$56,595.00

MS-DRG 40.00: OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC

Facility

$121,931.22

Service Code	MSDRG 320
Min. Negotiated Rate	$32,402.00
Max. Negotiated Rate	$121,931.22
Rate for Payer: United Healthcare All Other Commercial	$49,280.00
Rate for Payer: United Healthcare All Other HMO	$49,280.00
Rate for Payer: United Healthcare HMO Rider	$35,366.00
Rate for Payer: United Healthcare Select/Navigate/Core	$32,402.00

MS-DRG 40.00: 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 40.00: OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC

Facility

$142,355.52

Service Code	MSDRG 271
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$142,355.52
Rate for Payer: Heritage Provider Network Commercial/Senior	$25,651.00
Rate for Payer: United Healthcare All Other Commercial	$63,629.00
Rate for Payer: United Healthcare All Other HMO	$63,629.00
Rate for Payer: United Healthcare HMO Rider	$42,494.00
Rate for Payer: United Healthcare Select/Navigate/Core	$38,930.00

MS-DRG 40.00: OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC

Facility

$172,876.64

Service Code	MSDRG 270
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$172,876.64
Rate for Payer: Heritage Provider Network Commercial/Senior	$25,651.00
Rate for Payer: United Healthcare All Other Commercial	$95,869.00
Rate for Payer: United Healthcare All Other HMO	$95,869.00
Rate for Payer: United Healthcare HMO Rider	$64,025.00
Rate for Payer: United Healthcare Select/Navigate/Core	$58,657.00

MS-DRG 40.00: OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$124,552.15

Service Code	MSDRG 272
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$124,552.15
Rate for Payer: Heritage Provider Network Commercial/Senior	$25,651.00
Rate for Payer: United Healthcare All Other Commercial	$45,573.00
Rate for Payer: United Healthcare All Other HMO	$45,573.00
Rate for Payer: United Healthcare HMO Rider	$30,435.00
Rate for Payer: United Healthcare Select/Navigate/Core	$27,883.00

MS-DRG 40.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC

Facility

$116,125.14

Service Code	MSDRG 516
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$116,125.14
Rate for Payer: Heritage Provider Network Commercial/Senior	$17,258.00

MS-DRG 40.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC

Facility

$106,518.08

Service Code	MSDRG 517
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$106,518.08
Rate for Payer: Heritage Provider Network Commercial/Senior	$17,258.00

MS-DRG 40.00: OTHER VASCULAR PROCEDURES WITH CC

Facility

$125,308.08

Service Code	MSDRG 253
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$125,308.08
Rate for Payer: Heritage Provider Network Commercial/Senior	$25,651.00
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 40.00: OTHER VASCULAR PROCEDURES WITH MCC

Facility

$141,148.89

Service Code	MSDRG 252
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$141,148.89
Rate for Payer: Heritage Provider Network Commercial/Senior	$25,651.00
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 40.00: OTHER VASCULAR PROCEDURES WITHOUT 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: Heritage Provider Network Commercial/Senior	$25,651.00
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 40.00: PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT 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 40.00: PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC

Facility

$152,455.89

Service Code	MSDRG 273
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$152,455.89
Rate for Payer: Heritage Provider Network Commercial/Senior	$7,978.00
Rate for Payer: United Healthcare All Other Commercial	$62,136.00
Rate for Payer: United Healthcare All Other HMO	$62,136.00
Rate for Payer: United Healthcare HMO Rider	$36,699.00
Rate for Payer: United Healthcare Select/Navigate/Core	$33,623.00

MS-DRG 40.00: PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC

Facility

$137,660.26

Service Code	MSDRG 274
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$137,660.26
Rate for Payer: Heritage Provider Network Commercial/Senior	$7,978.00
Rate for Payer: United Healthcare All Other Commercial	$42,353.00
Rate for Payer: United Healthcare All Other HMO	$42,353.00
Rate for Payer: United Healthcare HMO Rider	$25,015.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,918.00

MS-DRG 40.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS

Facility

$39,873.00

Service Code	MSDRG 246
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$39,873.00
Rate for Payer: Heritage Provider Network Commercial/Senior	$7,978.00
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 40.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC

Facility

$37,475.00

Service Code	MSDRG 247
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$37,475.00
Rate for Payer: Heritage Provider Network Commercial/Senior	$7,978.00
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 40.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS

Facility

$38,180.00

Service Code	MSDRG 248
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$38,180.00
Rate for Payer: Heritage Provider Network Commercial/Senior	$7,978.00
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 40.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITHOUT MCC

Facility

$35,065.00

Service Code	MSDRG 249
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$35,065.00
Rate for Payer: Heritage Provider Network Commercial/Senior	$7,978.00
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 40.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC

Facility

$117,977.71

Service Code	MSDRG 250
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$117,977.71
Rate for Payer: Heritage Provider Network Commercial/Senior	$7,978.00
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 40.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC

Facility

$105,769.26

Service Code	MSDRG 251
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$105,769.26
Rate for Payer: Heritage Provider Network Commercial/Senior	$7,978.00
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

MS-DRG 40.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC

Facility

$117,062.07

Service Code	MSDRG 243
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$117,062.07
Rate for Payer: Heritage Provider Network Commercial/Senior	$7,978.00
Rate for Payer: United Healthcare All Other Commercial	$29,923.00
Rate for Payer: United Healthcare All Other HMO	$29,923.00
Rate for Payer: United Healthcare HMO Rider	$24,583.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,521.00

Know your out-of-pocket cost for care.

All Charges