Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 33.00: REVISION OF HIP OR KNEE REPLACEMENT W CC

Facility

$92,816.59

Service Code	MSDRG 467
Min. Negotiated Rate	$32,499.00
Max. Negotiated Rate	$92,816.59
Rate for Payer: United Healthcare All Other Commercial	$36,468.00
Rate for Payer: United Healthcare All Other HMO	$36,468.00
Rate for Payer: United Healthcare HMO Rider	$35,474.00
Rate for Payer: United Healthcare Select/Navigate/Core	$32,499.00

MS-DRG 33.00: REVISION OF HIP OR KNEE REPLACEMENT W MCC

Facility

$137,000.92

Service Code	MSDRG 466
Min. Negotiated Rate	$39,477.00
Max. Negotiated Rate	$137,000.92
Rate for Payer: United Healthcare All Other Commercial	$39,477.00
Rate for Payer: United Healthcare All Other HMO	$39,477.00
Rate for Payer: United Healthcare HMO Rider	$45,640.00
Rate for Payer: United Healthcare Select/Navigate/Core	$41,813.00

MS-DRG 33.00: REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC

Facility

$72,324.61

Service Code	MSDRG 468
Min. Negotiated Rate	$28,986.00
Max. Negotiated Rate	$72,324.61
Rate for Payer: United Healthcare All Other Commercial	$39,477.00
Rate for Payer: United Healthcare All Other HMO	$39,477.00
Rate for Payer: United Healthcare HMO Rider	$31,639.00
Rate for Payer: United Healthcare Select/Navigate/Core	$28,986.00

MS-DRG 33.00: SIMULTANEOUS PANCREAS/KIDNEY TRANSPLANT

Facility

$192,500.00

Service Code	MSDRG 008
Min. Negotiated Rate	$78,200.51
Max. Negotiated Rate	$192,500.00
Rate for Payer: Networks By Design Commercial	$85,000.00

MS-DRG 33.00: SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W CC

Facility

$156,942.83

Service Code	MSDRG 457
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$156,942.83
Rate for Payer: United Healthcare All Other Commercial	$90,575.00
Rate for Payer: United Healthcare All Other HMO	$90,575.00
Rate for Payer: United Healthcare HMO Rider	$62,293.00
Rate for Payer: United Healthcare Select/Navigate/Core	$57,072.00

MS-DRG 33.00: SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W MCC

Facility

$221,169.08

Service Code	MSDRG 456
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$221,169.08
Rate for Payer: United Healthcare All Other Commercial	$112,148.00
Rate for Payer: United Healthcare All Other HMO	$112,148.00
Rate for Payer: United Healthcare HMO Rider	$75,636.00
Rate for Payer: United Healthcare Select/Navigate/Core	$69,294.00

MS-DRG 33.00: SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W/O CC/MCC

Facility

$109,818.66

Service Code	MSDRG 458
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$109,818.66
Rate for Payer: United Healthcare All Other Commercial	$81,933.00
Rate for Payer: United Healthcare All Other HMO	$81,933.00
Rate for Payer: United Healthcare HMO Rider	$53,969.00
Rate for Payer: United Healthcare Select/Navigate/Core	$49,445.00

MS-DRG 33.00: SPINAL FUSION EXCEPT CERVICAL W MCC

Facility

$76,782.00

Service Code	MSDRG 459
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$76,782.00
Rate for Payer: United Healthcare All Other Commercial	$76,782.00
Rate for Payer: United Healthcare All Other HMO	$76,782.00
Rate for Payer: United Healthcare HMO Rider	$52,096.00
Rate for Payer: United Healthcare Select/Navigate/Core	$47,726.00

MS-DRG 33.00: SPINAL FUSION EXCEPT CERVICAL W/O MCC

Facility

$81,808.00

Service Code	MSDRG 460
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$81,808.00
Rate for Payer: United Healthcare All Other Commercial	$81,808.00
Rate for Payer: United Healthcare All Other HMO	$81,808.00
Rate for Payer: United Healthcare HMO Rider	$32,713.00
Rate for Payer: United Healthcare Select/Navigate/Core	$29,970.00

MS-DRG 33.00: SPINAL PROCEDURES W CC OR SPINAL NEUROSTIMULATORS

Facility

$89,789.90

Service Code	MSDRG 029
Min. Negotiated Rate	$25,608.00
Max. Negotiated Rate	$89,789.90
Rate for Payer: United Healthcare All Other Commercial	$76,644.00
Rate for Payer: United Healthcare All Other HMO	$76,644.00
Rate for Payer: United Healthcare HMO Rider	$36,551.00
Rate for Payer: United Healthcare Select/Navigate/Core	$33,485.00

MS-DRG 33.00: SPINAL PROCEDURES W MCC

Facility

$158,132.45

Service Code	MSDRG 028
Min. Negotiated Rate	$25,608.00
Max. Negotiated Rate	$158,132.45
Rate for Payer: United Healthcare All Other Commercial	$58,958.00
Rate for Payer: United Healthcare All Other HMO	$58,958.00
Rate for Payer: United Healthcare HMO Rider	$54,569.00
Rate for Payer: United Healthcare Select/Navigate/Core	$49,994.00

MS-DRG 33.00: SPINAL PROCEDURES W/O CC/MCC

Facility

$58,958.00

Service Code	MSDRG 030
Min. Negotiated Rate	$20,798.00
Max. Negotiated Rate	$58,958.00
Rate for Payer: United Healthcare All Other Commercial	$58,958.00
Rate for Payer: United Healthcare All Other HMO	$58,958.00
Rate for Payer: United Healthcare HMO Rider	$22,701.00
Rate for Payer: United Healthcare Select/Navigate/Core	$20,798.00

MS-DRG 33.00: UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC

Facility

$48,290.10

Service Code	MSDRG 742
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$48,290.10
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 33.00: UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC

Facility

$32,653.98

Service Code	MSDRG 743
Min. Negotiated Rate	$18,013.39
Max. Negotiated Rate	$32,653.98
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 33.00: UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W/O CC/MCC

Facility

$37,533.53

Service Code	MSDRG 741
Min. Negotiated Rate	$20,570.44
Max. Negotiated Rate	$37,533.53
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 33.00: WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W CC

Facility

$112,353.00

Service Code	MSDRG 464
Min. Negotiated Rate	$34,033.00
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	$37,147.00
Rate for Payer: United Healthcare Select/Navigate/Core	$34,033.00

MS-DRG 33.00: WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W MCC

Facility

$150,005.14

Service Code	MSDRG 463
Min. Negotiated Rate	$46,778.00
Max. Negotiated Rate	$150,005.14
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	$51,058.00
Rate for Payer: United Healthcare Select/Navigate/Core	$46,778.00

MS-DRG 33.00: 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	$26,054.17
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 35.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC

Facility

$26,466.00

Service Code	MSDRG 281
Min. Negotiated Rate	$13,577.88
Max. Negotiated Rate	$26,466.00
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 35.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC

Facility

$42,218.31

Service Code	MSDRG 280
Min. Negotiated Rate	$20,535.00
Max. Negotiated Rate	$42,218.31
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 35.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC

Facility

$28,087.00

Service Code	MSDRG 282
Min. Negotiated Rate	$10,874.63
Max. Negotiated Rate	$28,087.00
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 35.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED W CC

Facility

$28,275.00

Service Code	MSDRG 284
Min. Negotiated Rate	$10,448.46
Max. Negotiated Rate	$28,275.00
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 35.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC

Facility

$52,132.68

Service Code	MSDRG 283
Min. Negotiated Rate	$18,641.00
Max. Negotiated Rate	$52,132.68
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 35.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED W/O CC/MCC

Facility

$27,865.00

Service Code	MSDRG 285
Min. Negotiated Rate	$9,161.66
Max. Negotiated Rate	$27,865.00
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 35.00: ACUTE & SUBACUTE ENDOCARDITIS W CC

Facility

$44,923.90

Service Code	MSDRG 289
Min. Negotiated Rate	$24,443.24
Max. Negotiated Rate	$44,923.90
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

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All Charges