Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 31.00: 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	$99,335.00
Rate for Payer: United Healthcare HMO Rider	$75,453.00
Rate for Payer: United Healthcare Select/Navigate/Core	$69,126.00

MS-DRG 31.00: 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	$127,264.00
Rate for Payer: United Healthcare HMO Rider	$96,665.00
Rate for Payer: United Healthcare Select/Navigate/Core	$88,562.00

MS-DRG 31.00: 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	$83,450.00
Rate for Payer: United Healthcare HMO Rider	$63,390.00
Rate for Payer: United Healthcare Select/Navigate/Core	$58,075.00

MS-DRG 31.00: CORONARY BYPASS W CARDIAC CATH W MCC

Facility

$205,719.83

Service Code	MSDRG 233
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$205,719.83
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: United Healthcare All Other Commercial	$143,136.00
Rate for Payer: United Healthcare All Other HMO	$106,219.00
Rate for Payer: United Healthcare HMO Rider	$80,682.00
Rate for Payer: United Healthcare Select/Navigate/Core	$73,919.00

MS-DRG 31.00: CORONARY BYPASS W CARDIAC CATH W/O MCC

Facility

$140,022.34

Service Code	MSDRG 234
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$140,022.34
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: United Healthcare All Other Commercial	$103,054.00
Rate for Payer: United Healthcare All Other HMO	$97,568.00
Rate for Payer: United Healthcare HMO Rider	$74,111.00
Rate for Payer: United Healthcare Select/Navigate/Core	$67,897.00

MS-DRG 31.00: CORONARY BYPASS W/O CARDIAC CATH W MCC

Facility

$154,866.26

Service Code	MSDRG 235
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$154,866.26
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: United Healthcare All Other Commercial	$83,791.00
Rate for Payer: United Healthcare All Other HMO	$74,237.00
Rate for Payer: United Healthcare HMO Rider	$56,388.00
Rate for Payer: United Healthcare Select/Navigate/Core	$51,660.00

MS-DRG 31.00: CORONARY BYPASS W/O CARDIAC CATH W/O MCC

Facility

$108,226.36

Service Code	MSDRG 236
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$108,226.36
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: United Healthcare All Other Commercial	$76,448.00
Rate for Payer: United Healthcare All Other HMO	$68,582.00
Rate for Payer: United Healthcare HMO Rider	$52,096.00
Rate for Payer: United Healthcare Select/Navigate/Core	$47,726.00

MS-DRG 31.00: CORONARY BYPASS W PTCA W MCC

Facility

$223,024.57

Service Code	MSDRG 231
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$223,024.57
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: United Healthcare All Other Commercial	$107,429.00
Rate for Payer: United Healthcare All Other HMO	$102,631.00
Rate for Payer: United Healthcare HMO Rider	$94,080.00
Rate for Payer: United Healthcare Select/Navigate/Core	$86,191.00

MS-DRG 31.00: CORONARY BYPASS W PTCA W/O MCC

Facility

$160,774.88

Service Code	MSDRG 232
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$160,774.88
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: United Healthcare All Other Commercial	$94,061.00
Rate for Payer: United Healthcare All Other HMO	$87,101.00
Rate for Payer: United Healthcare HMO Rider	$79,841.00
Rate for Payer: United Healthcare Select/Navigate/Core	$73,147.00

MS-DRG 31.00: 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	$31,364.00
Rate for Payer: United Healthcare HMO Rider	$23,828.00
Rate for Payer: United Healthcare Select/Navigate/Core	$21,830.00

MS-DRG 31.00: HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC

Facility

$77,404.18

Service Code	MSDRG 480
Min. Negotiated Rate	$24,564.00
Max. Negotiated Rate	$77,404.18
Rate for Payer: United Healthcare All Other Commercial	$56,679.00
Rate for Payer: United Healthcare All Other HMO	$40,772.00
Rate for Payer: United Healthcare HMO Rider	$30,970.00
Rate for Payer: United Healthcare Select/Navigate/Core	$28,371.00

MS-DRG 31.00: 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	$26,545.00
Rate for Payer: United Healthcare HMO Rider	$20,163.00
Rate for Payer: United Healthcare Select/Navigate/Core	$18,472.00

MS-DRG 31.00: LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$100,601.75

Service Code	MSDRG 956
Min. Negotiated Rate	$25,608.00
Max. Negotiated Rate	$100,601.75
Rate for Payer: United Healthcare All Other Commercial	$91,491.00
Rate for Payer: United Healthcare All Other HMO	$59,139.00
Rate for Payer: United Healthcare HMO Rider	$44,920.00
Rate for Payer: United Healthcare Select/Navigate/Core	$41,155.00

MS-DRG 31.00: LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W CC

Facility

$63,191.92

Service Code	MSDRG 493
Min. Negotiated Rate	$17,710.00
Max. Negotiated Rate	$63,191.92
Rate for Payer: United Healthcare All Other Commercial	$36,150.00
Rate for Payer: United Healthcare All Other HMO	$25,455.00
Rate for Payer: United Healthcare HMO Rider	$19,332.00
Rate for Payer: United Healthcare Select/Navigate/Core	$17,710.00

MS-DRG 31.00: LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W MCC

Facility

$93,464.03

Service Code	MSDRG 492
Min. Negotiated Rate	$21,433.00
Max. Negotiated Rate	$93,464.03
Rate for Payer: United Healthcare All Other Commercial	$37,370.00
Rate for Payer: United Healthcare All Other HMO	$38,031.00
Rate for Payer: United Healthcare HMO Rider	$28,889.00
Rate for Payer: United Healthcare Select/Navigate/Core	$26,467.00

MS-DRG 31.00: LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W/O CC/MCC

Facility

$49,621.84

Service Code	MSDRG 494
Min. Negotiated Rate	$15,056.00
Max. Negotiated Rate	$49,621.84
Rate for Payer: United Healthcare All Other Commercial	$29,464.00
Rate for Payer: United Healthcare All Other HMO	$21,638.00
Rate for Payer: United Healthcare HMO Rider	$16,434.00
Rate for Payer: United Healthcare Select/Navigate/Core	$15,056.00

MS-DRG 31.00: MAJOR CARDIOVASC PROCEDURES W MCC

Facility

$79,185.00

Service Code	MSDRG 237
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$79,185.00
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: United Healthcare All Other HMO	$79,185.00
Rate for Payer: United Healthcare HMO Rider	$60,147.00
Rate for Payer: United Healthcare Select/Navigate/Core	$55,106.00

MS-DRG 31.00: MAJOR CARDIOVASC PROCEDURES W/O MCC

Facility

$68,582.00

Service Code	MSDRG 238
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$68,582.00
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: United Healthcare All Other HMO	$68,582.00
Rate for Payer: United Healthcare HMO Rider	$52,096.00
Rate for Payer: United Healthcare Select/Navigate/Core	$47,726.00

MS-DRG 31.00: MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC

Facility

$86,028.92

Service Code	MSDRG 469
Min. Negotiated Rate	$23,506.00
Max. Negotiated Rate	$86,028.92
Rate for Payer: United Healthcare All Other Commercial	$41,904.00
Rate for Payer: United Healthcare All Other HMO	$38,803.00
Rate for Payer: United Healthcare HMO Rider	$34,363.00
Rate for Payer: United Healthcare Select/Navigate/Core	$31,483.00

MS-DRG 31.00: MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC

Facility

$53,685.00

Service Code	MSDRG 470
Min. Negotiated Rate	$23,467.00
Max. Negotiated Rate	$53,685.00
Rate for Payer: United Healthcare All Other Commercial	$53,685.00
Rate for Payer: United Healthcare All Other HMO	$33,721.00
Rate for Payer: United Healthcare HMO Rider	$25,615.00
Rate for Payer: United Healthcare Select/Navigate/Core	$23,467.00

MS-DRG 31.00: MAJOR MALE PELVIC PROCEDURES W CC/MCC

Facility

$51,074.65

Service Code	MSDRG 707
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$51,074.65
Rate for Payer: United Healthcare All Other Commercial	$24,996.00
Rate for Payer: United Healthcare All Other HMO	$24,494.00
Rate for Payer: United Healthcare HMO Rider	$24,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,398.00

MS-DRG 31.00: MAJOR MALE PELVIC PROCEDURES W/O CC/MCC

Facility

$39,017.92

Service Code	MSDRG 708
Min. Negotiated Rate	$21,000.28
Max. Negotiated Rate	$39,017.92
Rate for Payer: United Healthcare All Other Commercial	$24,996.00
Rate for Payer: United Healthcare All Other HMO	$24,494.00
Rate for Payer: United Healthcare HMO Rider	$24,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,398.00

MS-DRG 31.00: MEDICAL BACK PROBLEMS W MCC

Facility

$59,884.00

Service Code	MSDRG 551
Min. Negotiated Rate	$13,734.00
Max. Negotiated Rate	$59,884.00
Rate for Payer: United Healthcare All Other Commercial	$59,884.00
Rate for Payer: United Healthcare All Other HMO	$19,739.00
Rate for Payer: United Healthcare HMO Rider	$14,990.00
Rate for Payer: United Healthcare Select/Navigate/Core	$13,734.00

MS-DRG 31.00: MEDICAL BACK PROBLEMS W/O MCC

Facility

$59,884.00

Service Code	MSDRG 552
Min. Negotiated Rate	$13,778.00
Max. Negotiated Rate	$59,884.00
Rate for Payer: United Healthcare All Other Commercial	$59,884.00
Rate for Payer: United Healthcare All Other HMO	$19,797.00
Rate for Payer: United Healthcare HMO Rider	$15,038.00
Rate for Payer: United Healthcare Select/Navigate/Core	$13,778.00

MS-DRG 31.00: O.R. PROCEDURES FOR OBESITY W CC

Facility

$42,031.44

Service Code	MSDRG 620
Min. Negotiated Rate	$12,116.00
Max. Negotiated Rate	$42,031.44
Rate for Payer: United Healthcare All Other Commercial	$28,919.00
Rate for Payer: United Healthcare All Other HMO	$28,337.00
Rate for Payer: United Healthcare HMO Rider	$28,283.00
Rate for Payer: United Healthcare Select/Navigate/Core	$25,912.00

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All Charges