Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 31.00: SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR 9+ FUS W/O CC/MCC

Facility

$113,645.44

Service Code	MSDRG 458
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$113,645.44
Rate for Payer: United Healthcare All Other Commercial	$81,933.00
Rate for Payer: United Healthcare All Other HMO	$71,046.00
Rate for Payer: United Healthcare HMO Rider	$53,969.00
Rate for Payer: United Healthcare Select/Navigate/Core	$49,445.00

MS-DRG 31.00: 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	$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: 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	$43,068.00
Rate for Payer: United Healthcare HMO Rider	$32,713.00
Rate for Payer: United Healthcare Select/Navigate/Core	$29,970.00

MS-DRG 31.00: SPINAL PROCEDURES W CC OR SPINAL NEUROSTIMULATORS

Facility

$88,344.99

Service Code	MSDRG 029
Min. Negotiated Rate	$25,604.00
Max. Negotiated Rate	$88,344.99
Rate for Payer: United Healthcare All Other Commercial	$76,644.00
Rate for Payer: United Healthcare All Other HMO	$48,114.00
Rate for Payer: United Healthcare HMO Rider	$36,551.00
Rate for Payer: United Healthcare Select/Navigate/Core	$33,485.00

MS-DRG 31.00: SPINAL PROCEDURES W MCC

Facility

$160,006.36

Service Code	MSDRG 028
Min. Negotiated Rate	$25,604.00
Max. Negotiated Rate	$160,006.36
Rate for Payer: United Healthcare All Other Commercial	$58,958.00
Rate for Payer: United Healthcare All Other HMO	$71,841.00
Rate for Payer: United Healthcare HMO Rider	$54,569.00
Rate for Payer: United Healthcare Select/Navigate/Core	$49,994.00

MS-DRG 31.00: 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	$29,890.00
Rate for Payer: United Healthcare HMO Rider	$22,701.00
Rate for Payer: United Healthcare Select/Navigate/Core	$20,798.00

MS-DRG 31.00: URINARY STONES W ESW LITHOTRIPSY W CC/MCC

Facility

$7,890.00

Service Code	MSDRG 691
Min. Negotiated Rate	$6,240.00
Max. Negotiated Rate	$7,890.00
Rate for Payer: Cigna of CA HMO	$6,240.00

MS-DRG 31.00: URINARY STONES W ESW LITHOTRIPSY W/O CC/MCC

Facility

$7,890.00

Service Code	MSDRG 692
Min. Negotiated Rate	$6,240.00
Max. Negotiated Rate	$7,890.00
Rate for Payer: Cigna of CA HMO	$6,240.00

MS-DRG 31.00: UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC

Facility

$48,076.92

Service Code	MSDRG 742
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$48,076.92
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: UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC

Facility

$31,548.59

Service Code	MSDRG 743
Min. Negotiated Rate	$17,130.54
Max. Negotiated Rate	$31,548.59
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: UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W/O CC/MCC

Facility

$36,151.78

Service Code	MSDRG 741
Min. Negotiated Rate	$19,515.38
Max. Negotiated Rate	$36,151.78
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: VAGINAL DELIVERY W COMPLICATING DIAGNOSES

Facility

$4,760.00

Service Code	MSDRG 774
Min. Negotiated Rate	$4,760.00
Max. Negotiated Rate	$4,760.00
Rate for Payer: Cigna of CA HMO	$4,760.00

MS-DRG 31.00: VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES

Facility

$4,760.00

Service Code	MSDRG 775
Min. Negotiated Rate	$4,760.00
Max. Negotiated Rate	$4,760.00
Rate for Payer: Cigna of CA HMO	$4,760.00

MS-DRG 31.00: VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C

Facility

$28,853.52

Service Code	MSDRG 768
Min. Negotiated Rate	$4,760.00
Max. Negotiated Rate	$28,853.52
Rate for Payer: Cigna of CA HMO	$4,760.00

MS-DRG 31.00: VAGINAL DELIVERY W STERILIZATION &/OR D&C

Facility

$4,760.00

Service Code	MSDRG 767
Min. Negotiated Rate	$4,760.00
Max. Negotiated Rate	$4,760.00
Rate for Payer: Cigna of CA HMO	$4,760.00

MS-DRG 31.00: 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	$48,905.00
Rate for Payer: United Healthcare HMO Rider	$37,147.00
Rate for Payer: United Healthcare Select/Navigate/Core	$34,033.00

MS-DRG 31.00: WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W MCC

Facility

$142,148.92

Service Code	MSDRG 463
Min. Negotiated Rate	$46,778.00
Max. Negotiated Rate	$142,148.92
Rate for Payer: United Healthcare All Other Commercial	$112,353.00
Rate for Payer: United Healthcare All Other HMO	$67,223.00
Rate for Payer: United Healthcare HMO Rider	$51,058.00
Rate for Payer: United Healthcare Select/Navigate/Core	$46,778.00

MS-DRG 31.00: 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	$24,458.22
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	$39,735.00
Rate for Payer: United Healthcare HMO Rider	$30,180.00
Rate for Payer: United Healthcare Select/Navigate/Core	$27,650.00

MS-DRG 33.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC

Facility

$26,466.00

Service Code	MSDRG 281
Min. Negotiated Rate	$13,354.92
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	$22,273.00
Rate for Payer: United Healthcare HMO Rider	$16,920.00
Rate for Payer: United Healthcare Select/Navigate/Core	$15,502.00

MS-DRG 33.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC

Facility

$43,200.01

Service Code	MSDRG 280
Min. Negotiated Rate	$20,535.00
Max. Negotiated Rate	$43,200.01
Rate for Payer: United Healthcare All Other Commercial	$27,038.00
Rate for Payer: United Healthcare All Other HMO	$29,511.00
Rate for Payer: United Healthcare HMO Rider	$22,413.00
Rate for Payer: United Healthcare Select/Navigate/Core	$20,535.00

MS-DRG 33.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC

Facility

$28,087.00

Service Code	MSDRG 282
Min. Negotiated Rate	$10,672.83
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	$18,018.00
Rate for Payer: United Healthcare HMO Rider	$13,685.00
Rate for Payer: United Healthcare Select/Navigate/Core	$12,537.00

MS-DRG 33.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED W CC

Facility

$28,275.00

Service Code	MSDRG 284
Min. Negotiated Rate	$10,889.62
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	$20,489.00
Rate for Payer: United Healthcare HMO Rider	$15,558.00
Rate for Payer: United Healthcare Select/Navigate/Core	$14,254.00

MS-DRG 33.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC

Facility

$51,464.17

Service Code	MSDRG 283
Min. Negotiated Rate	$18,641.00
Max. Negotiated Rate	$51,464.17
Rate for Payer: United Healthcare All Other Commercial	$29,007.00
Rate for Payer: United Healthcare All Other HMO	$26,787.00
Rate for Payer: United Healthcare HMO Rider	$20,346.00
Rate for Payer: United Healthcare Select/Navigate/Core	$18,641.00

MS-DRG 33.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED W/O CC/MCC

Facility

$27,865.00

Service Code	MSDRG 285
Min. Negotiated Rate	$8,440.71
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	$17,683.00
Rate for Payer: United Healthcare HMO Rider	$13,432.00
Rate for Payer: United Healthcare Select/Navigate/Core	$12,305.00

MS-DRG 33.00: ACUTE & SUBACUTE ENDOCARDITIS W CC

Facility

$41,497.17

Service Code	MSDRG 289
Min. Negotiated Rate	$22,284.71
Max. Negotiated Rate	$41,497.17
Rate for Payer: United Healthcare All Other Commercial	$33,040.00
Rate for Payer: United Healthcare All Other HMO	$39,155.00
Rate for Payer: United Healthcare HMO Rider	$29,741.00
Rate for Payer: United Healthcare Select/Navigate/Core	$27,248.00

Know your out-of-pocket cost for care.

All Charges