Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 40.00: OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC

Facility

$93,598.26

Service Code	MSDRG 271
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$93,598.26
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

$138,866.94

Service Code	MSDRG 270
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$138,866.94
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

$67,192.41

Service Code	MSDRG 272
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$67,192.41
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

$54,693.51

Service Code	MSDRG 516
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$54,693.51
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

$40,444.41

Service Code	MSDRG 517
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$40,444.41
Rate for Payer: Heritage Provider Network Commercial/Senior	$17,258.00

MS-DRG 40.00: OTHER VASCULAR PROCEDURES WITH CC

Facility

$68,313.60

Service Code	MSDRG 253
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$68,313.60
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

$91,808.57

Service Code	MSDRG 252
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$91,808.57
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

$56,697.00

Service Code	MSDRG 254
Min. Negotiated Rate	$19,823.00
Max. Negotiated Rate	$56,697.00
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

$35,412.21

Service Code	MSDRG 735
Min. Negotiated Rate	$19,458.80
Max. Negotiated Rate	$35,412.21
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

$108,579.03

Service Code	MSDRG 273
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$108,579.03
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

$86,634.25

Service Code	MSDRG 274
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$86,634.25
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

$57,441.22

Service Code	MSDRG 250
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$57,441.22
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

$41,406.00

Service Code	MSDRG 251
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$41,406.00
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

$56,083.16

Service Code	MSDRG 243
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$56,083.16
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

MS-DRG 40.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC

Facility

$84,031.30

Service Code	MSDRG 242
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$84,031.30
Rate for Payer: Heritage Provider Network Commercial/Senior	$7,978.00
Rate for Payer: United Healthcare All Other Commercial	$38,262.00
Rate for Payer: United Healthcare All Other HMO	$38,262.00
Rate for Payer: United Healthcare HMO Rider	$36,089.00
Rate for Payer: United Healthcare Select/Navigate/Core	$33,062.00

MS-DRG 40.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC

Facility

$47,571.59

Service Code	MSDRG 244
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$47,571.59
Rate for Payer: Heritage Provider Network Commercial/Senior	$7,978.00
Rate for Payer: United Healthcare All Other Commercial	$25,087.00
Rate for Payer: United Healthcare All Other HMO	$25,087.00
Rate for Payer: United Healthcare HMO Rider	$20,612.00
Rate for Payer: United Healthcare Select/Navigate/Core	$18,884.00

MS-DRG 40.00: PROSTATECTOMY WITHOUT CC/MCC

Facility

$29,114.08

Service Code	MSDRG 667
Min. Negotiated Rate	$16,158.37
Max. Negotiated Rate	$29,114.08
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: REVISION OF HIP OR KNEE REPLACEMENT WITH 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 40.00: REVISION OF HIP OR KNEE REPLACEMENT WITH 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 40.00: REVISION OF HIP OR KNEE REPLACEMENT WITHOUT 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 40.00: SPINAL FUSION EXCEPT CERVICAL WITH MCC

Facility

$76,782.00

Service Code	MSDRG 459
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$76,782.00
Rate for Payer: Heritage Provider Network Commercial/Senior	$29,434.00
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

Know your out-of-pocket cost for care.

All Charges