Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 33.00: PERC CARDIOVASC PROC W NON-DRUG-ELUTING STENT W MCC OR 4+ VES/STENTS

Facility

$38,180.00

Service Code	MSDRG 248
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$38,180.00
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 33.00: PERC CARDIOVASC PROC W NON-DRUG-ELUTING STENT W/O MCC

Facility

$35,065.00

Service Code	MSDRG 249
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$35,065.00
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 33.00: PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W MCC

Facility

$60,865.32

Service Code	MSDRG 250
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$60,865.32
Rate for Payer: United Healthcare All Other Commercial	$32,556.00
Rate for Payer: United Healthcare All Other HMO	$35,635.00
Rate for Payer: United Healthcare HMO Rider	$27,066.00
Rate for Payer: United Healthcare Select/Navigate/Core	$24,796.00

MS-DRG 33.00: PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W/O MCC

Facility

$41,406.00

Service Code	MSDRG 251
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$41,406.00
Rate for Payer: United Healthcare All Other Commercial	$41,406.00
Rate for Payer: United Healthcare All Other HMO	$29,656.00
Rate for Payer: United Healthcare HMO Rider	$22,531.00
Rate for Payer: United Healthcare Select/Navigate/Core	$20,641.00

MS-DRG 33.00: PERCUTANEOUS INTRACARDIAC PROCEDURES W MCC

Facility

$102,915.19

Service Code	MSDRG 273
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$102,915.19
Rate for Payer: United Healthcare All Other Commercial	$62,136.00
Rate for Payer: United Healthcare All Other HMO	$52,172.00
Rate for Payer: United Healthcare HMO Rider	$36,699.00
Rate for Payer: United Healthcare Select/Navigate/Core	$33,623.00

MS-DRG 33.00: PERCUTANEOUS INTRACARDIAC PROCEDURES W/O MCC

Facility

$82,141.60

Service Code	MSDRG 274
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$82,141.60
Rate for Payer: United Healthcare All Other Commercial	$42,353.00
Rate for Payer: United Healthcare All Other HMO	$35,562.00
Rate for Payer: United Healthcare HMO Rider	$25,015.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,918.00

MS-DRG 33.00: PERMANENT CARDIAC PACEMAKER IMPLANT W CC

Facility

$59,291.44

Service Code	MSDRG 243
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$59,291.44
Rate for Payer: United Healthcare All Other Commercial	$29,923.00
Rate for Payer: United Healthcare All Other HMO	$27,707.00
Rate for Payer: United Healthcare HMO Rider	$24,583.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,521.00

MS-DRG 33.00: PERMANENT CARDIAC PACEMAKER IMPLANT W MCC

Facility

$89,274.05

Service Code	MSDRG 242
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$89,274.05
Rate for Payer: United Healthcare All Other Commercial	$38,262.00
Rate for Payer: United Healthcare All Other HMO	$35,430.00
Rate for Payer: United Healthcare HMO Rider	$36,089.00
Rate for Payer: United Healthcare Select/Navigate/Core	$33,062.00

MS-DRG 33.00: PERMANENT CARDIAC PACEMAKER IMPLANT W/O CC/MCC

Facility

$47,497.90

Service Code	MSDRG 244
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$47,497.90
Rate for Payer: United Healthcare All Other Commercial	$25,087.00
Rate for Payer: United Healthcare All Other HMO	$23,231.00
Rate for Payer: United Healthcare HMO Rider	$20,612.00
Rate for Payer: United Healthcare Select/Navigate/Core	$18,884.00

MS-DRG 33.00: PROSTATECTOMY W/O CC/MCC

Facility

$27,050.67

Service Code	MSDRG 667
Min. Negotiated Rate	$14,800.25
Max. Negotiated Rate	$27,050.67
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 33.00: REVISION OF HIP OR KNEE REPLACEMENT W CC

Facility

$90,147.84

Service Code	MSDRG 467
Min. Negotiated Rate	$32,499.00
Max. Negotiated Rate	$90,147.84
Rate for Payer: United Healthcare All Other Commercial	$36,468.00
Rate for Payer: United Healthcare All Other HMO	$33,770.00
Rate for Payer: United Healthcare HMO Rider	$35,474.00
Rate for Payer: United Healthcare Select/Navigate/Core	$32,499.00

MS-DRG 33.00: REVISION OF HIP OR KNEE REPLACEMENT W MCC

Facility

$134,084.78

Service Code	MSDRG 466
Min. Negotiated Rate	$39,477.00
Max. Negotiated Rate	$134,084.78
Rate for Payer: United Healthcare All Other Commercial	$39,477.00
Rate for Payer: United Healthcare All Other HMO	$43,441.00
Rate for Payer: United Healthcare HMO Rider	$45,640.00
Rate for Payer: United Healthcare Select/Navigate/Core	$41,813.00

MS-DRG 33.00: REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC

Facility

$69,042.63

Service Code	MSDRG 468
Min. Negotiated Rate	$28,986.00
Max. Negotiated Rate	$69,042.63
Rate for Payer: United Healthcare All Other Commercial	$39,477.00
Rate for Payer: United Healthcare All Other HMO	$30,116.00
Rate for Payer: United Healthcare HMO Rider	$31,639.00
Rate for Payer: United Healthcare Select/Navigate/Core	$28,986.00

MS-DRG 33.00: SIMULTANEOUS PANCREAS/KIDNEY TRANSPLANT

Facility

$171,250.00

Service Code	MSDRG 008
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$171,250.00
Rate for Payer: Networks By Design Commercial	$85,000.00

MS-DRG 33.00: SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W CC

Facility

$151,055.27

Service Code	MSDRG 457
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$151,055.27
Rate for Payer: United Healthcare All Other Commercial	$90,575.00
Rate for Payer: United Healthcare All Other HMO	$82,014.00
Rate for Payer: United Healthcare HMO Rider	$62,293.00
Rate for Payer: United Healthcare Select/Navigate/Core	$57,072.00

MS-DRG 33.00: SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W MCC

Facility

$222,900.87

Service Code	MSDRG 456
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$222,900.87
Rate for Payer: United Healthcare All Other Commercial	$112,148.00
Rate for Payer: United Healthcare All Other HMO	$99,575.00
Rate for Payer: United Healthcare HMO Rider	$75,636.00
Rate for Payer: United Healthcare Select/Navigate/Core	$69,294.00

MS-DRG 33.00: SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT 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 33.00: 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 33.00: 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 33.00: 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 33.00: 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 33.00: 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 33.00: 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 33.00: 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 33.00: 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

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All Charges