Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 33.00: CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W CC

Facility

$146,353.00

Service Code	MSDRG 220
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$146,353.00
Rate for Payer: United Healthcare All Other Commercial	$117,371.00
Rate for Payer: United Healthcare All Other HMO	$146,353.00
Rate for Payer: United Healthcare HMO Rider	$111,169.00
Rate for Payer: United Healthcare Select/Navigate/Core	$101,848.00

MS-DRG 33.00: CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W MCC

Facility

$203,643.26

Service Code	MSDRG 219
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$203,643.26
Rate for Payer: United Healthcare All Other Commercial	$147,690.00
Rate for Payer: United Healthcare All Other HMO	$146,353.00
Rate for Payer: United Healthcare HMO Rider	$111,169.00
Rate for Payer: United Healthcare Select/Navigate/Core	$101,848.00

MS-DRG 33.00: 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	$146,353.00
Rate for Payer: United Healthcare HMO Rider	$111,169.00
Rate for Payer: United Healthcare Select/Navigate/Core	$101,848.00

MS-DRG 33.00: CERVICAL SPINAL FUSION W CC

Facility

$76,251.41

Service Code	MSDRG 472
Min. Negotiated Rate	$22,650.00
Max. Negotiated Rate	$76,251.41
Rate for Payer: United Healthcare All Other Commercial	$30,096.00
Rate for Payer: United Healthcare All Other HMO	$42,113.00
Rate for Payer: United Healthcare HMO Rider	$24,721.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,650.00

MS-DRG 33.00: CERVICAL SPINAL FUSION W MCC

Facility

$127,839.28

Service Code	MSDRG 471
Min. Negotiated Rate	$24,564.00
Max. Negotiated Rate	$127,839.28
Rate for Payer: United Healthcare All Other Commercial	$42,108.00
Rate for Payer: United Healthcare All Other HMO	$38,993.00
Rate for Payer: United Healthcare HMO Rider	$34,591.00
Rate for Payer: United Healthcare Select/Navigate/Core	$31,692.00

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

Facility

$62,307.60

Service Code	MSDRG 473
Min. Negotiated Rate	$22,963.00
Max. Negotiated Rate	$62,307.60
Rate for Payer: United Healthcare All Other Commercial	$42,292.00
Rate for Payer: United Healthcare All Other HMO	$32,996.00
Rate for Payer: United Healthcare HMO Rider	$25,065.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,963.00

MS-DRG 33.00: CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W MCC

Facility

$58,251.84

Service Code	MSDRG 286
Min. Negotiated Rate	$4,504.00
Max. Negotiated Rate	$58,251.84
Rate for Payer: United Healthcare All Other Commercial	$20,829.00
Rate for Payer: United Healthcare All Other HMO	$20,011.00
Rate for Payer: United Healthcare HMO Rider	$15,202.00
Rate for Payer: United Healthcare Select/Navigate/Core	$13,927.00

MS-DRG 33.00: CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC

Facility

$28,679.81

Service Code	MSDRG 287
Min. Negotiated Rate	$4,504.00
Max. Negotiated Rate	$28,679.81
Rate for Payer: United Healthcare All Other Commercial	$27,003.00
Rate for Payer: United Healthcare All Other HMO	$19,364.00
Rate for Payer: United Healthcare HMO Rider	$14,707.00
Rate for Payer: United Healthcare Select/Navigate/Core	$13,475.00

MS-DRG 33.00: 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 33.00: 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 33.00: 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 33.00: 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: 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 33.00: 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: 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 33.00: 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: 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 33.00: 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: 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 33.00: 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: 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 33.00: 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: 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 33.00: ENDOVASCULAR CARDIAC VALVE REPLACEMENT W MCC

Facility

$216,703.00

Service Code	MSDRG 266
Min. Negotiated Rate	$25,551.00
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	$204,544.00
Rate for Payer: United Healthcare HMO Rider	$155,367.00
Rate for Payer: United Healthcare Select/Navigate/Core	$142,342.00

MS-DRG 33.00: ENDOVASCULAR CARDIAC VALVE REPLACEMENT W/O MCC

Facility

$162,712.00

Service Code	MSDRG 267
Min. Negotiated Rate	$25,551.00
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	$153,580.00
Rate for Payer: United Healthcare HMO Rider	$116,659.00
Rate for Payer: United Healthcare Select/Navigate/Core	$106,879.00

MS-DRG 33.00: 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 33.00: 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 33.00: 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 33.00: KIDNEY TRANSPLANT

Facility

$322,497.00

Service Code	MSDRG 652
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$322,497.00
Rate for Payer: Networks By Design Commercial	$75,000.00

MS-DRG 33.00: 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 33.00: 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

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