Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 35.00: CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W/O 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: 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 35.00: CERVICAL SPINAL FUSION W CC

Facility

$77,538.41

Service Code	MSDRG 472
Min. Negotiated Rate	$22,650.00
Max. Negotiated Rate	$77,538.41
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 35.00: CERVICAL SPINAL FUSION W MCC

Facility

$127,086.56

Service Code	MSDRG 471
Min. Negotiated Rate	$24,564.00
Max. Negotiated Rate	$127,086.56
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 35.00: CERVICAL SPINAL FUSION W/O CC/MCC

Facility

$64,252.57

Service Code	MSDRG 473
Min. Negotiated Rate	$22,963.00
Max. Negotiated Rate	$64,252.57
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 35.00: CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W MCC

Facility

$58,238.68

Service Code	MSDRG 286
Min. Negotiated Rate	$4,504.00
Max. Negotiated Rate	$58,238.68
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 35.00: CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC

Facility

$28,163.96

Service Code	MSDRG 287
Min. Negotiated Rate	$4,504.00
Max. Negotiated Rate	$28,163.96
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 35.00: COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W CC

Facility

$128,918.00

Service Code	MSDRG 454
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$128,918.00
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 35.00: COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W MCC

Facility

$152,808.00

Service Code	MSDRG 453
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$152,808.00
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 35.00: COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W/O 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: 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 35.00: CORONARY BYPASS W CARDIAC CATH W MCC

Facility

$201,214.02

Service Code	MSDRG 233
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$201,214.02
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

MS-DRG 35.00: CORONARY BYPASS W CARDIAC CATH W/O MCC

Facility

$143,772.80

Service Code	MSDRG 234
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$143,772.80
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 35.00: CORONARY BYPASS W/O CARDIAC CATH W MCC

Facility

$154,455.68

Service Code	MSDRG 235
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$154,455.68
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 35.00: CORONARY BYPASS W/O CARDIAC CATH W/O MCC

Facility

$110,245.03

Service Code	MSDRG 236
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$110,245.03
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 35.00: CORONARY BYPASS W PTCA W MCC

Facility

$221,866.54

Service Code	MSDRG 231
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$221,866.54
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 35.00: CORONARY BYPASS W PTCA W/O MCC

Facility

$159,561.57

Service Code	MSDRG 232
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$159,561.57
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 35.00: ENDOVASCULAR CARDIAC VALVE REPLACEMENT W MCC

Facility

$216,703.00

Service Code	MSDRG 266
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$216,703.00
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 35.00: ENDOVASCULAR CARDIAC VALVE REPLACEMENT W/O MCC

Facility

$162,712.00

Service Code	MSDRG 267
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$162,712.00
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 35.00: FALSE LABOR

Facility

$5,106.00

Service Code	MSDRG 780
Min. Negotiated Rate	$3,009.00
Max. Negotiated Rate	$5,106.00
Rate for Payer: United Healthcare All Other Commercial	$5,106.00
Rate for Payer: United Healthcare All Other HMO	$3,804.00
Rate for Payer: United Healthcare HMO Rider	$3,284.00
Rate for Payer: United Healthcare Select/Navigate/Core	$3,009.00

MS-DRG 35.00: HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC

Facility

$74,534.00

Service Code	MSDRG 481
Min. Negotiated Rate	$21,830.00
Max. Negotiated Rate	$74,534.00
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 35.00: HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC

Facility

$76,648.82

Service Code	MSDRG 480
Min. Negotiated Rate	$24,564.00
Max. Negotiated Rate	$76,648.82
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 35.00: HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC

Facility

$60,760.00

Service Code	MSDRG 482
Min. Negotiated Rate	$18,472.00
Max. Negotiated Rate	$60,760.00
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 35.00: LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$99,038.40

Service Code	MSDRG 956
Min. Negotiated Rate	$25,608.00
Max. Negotiated Rate	$99,038.40
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 35.00: LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W CC

Facility

$66,747.62

Service Code	MSDRG 493
Min. Negotiated Rate	$17,710.00
Max. Negotiated Rate	$66,747.62
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 35.00: LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W MCC

Facility

$96,632.84

Service Code	MSDRG 492
Min. Negotiated Rate	$21,433.00
Max. Negotiated Rate	$96,632.84
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 35.00: LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W/O CC/MCC

Facility

$52,809.07

Service Code	MSDRG 494
Min. Negotiated Rate	$15,056.00
Max. Negotiated Rate	$52,809.07
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

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