Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 33.00: 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 33.00: 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 33.00: 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 35.00: 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 35.00: 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 35.00: 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 35.00: 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 35.00: 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 35.00: 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 35.00: 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

MS-DRG 35.00: ACUTE & SUBACUTE ENDOCARDITIS W MCC

Facility

$71,890.35

Service Code	MSDRG 288
Min. Negotiated Rate	$34,413.00
Max. Negotiated Rate	$71,890.35
Rate for Payer: United Healthcare All Other Commercial	$37,549.00
Rate for Payer: United Healthcare All Other HMO	$49,452.00
Rate for Payer: United Healthcare HMO Rider	$37,563.00
Rate for Payer: United Healthcare Select/Navigate/Core	$34,413.00

MS-DRG 35.00: ACUTE & SUBACUTE ENDOCARDITIS W/O CC/MCC

Facility

$33,480.00

Service Code	MSDRG 290
Min. Negotiated Rate	$14,134.84
Max. Negotiated Rate	$33,480.00
Rate for Payer: United Healthcare All Other Commercial	$33,040.00
Rate for Payer: United Healthcare All Other HMO	$33,480.00
Rate for Payer: United Healthcare HMO Rider	$25,436.00
Rate for Payer: United Healthcare Select/Navigate/Core	$23,302.00

MS-DRG 35.00: AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W MCC

Facility

$175,484.56

Service Code	MSDRG 268
Min. Negotiated Rate	$25,661.00
Max. Negotiated Rate	$175,484.56
Rate for Payer: United Healthcare All Other Commercial	$127,168.00
Rate for Payer: United Healthcare All Other HMO	$111,805.00
Rate for Payer: United Healthcare HMO Rider	$84,927.00
Rate for Payer: United Healthcare Select/Navigate/Core	$77,806.00

MS-DRG 35.00: AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W/O MCC

Facility

$109,505.46

Service Code	MSDRG 269
Min. Negotiated Rate	$25,661.00
Max. Negotiated Rate	$109,505.46
Rate for Payer: United Healthcare All Other Commercial	$79,046.00
Rate for Payer: United Healthcare All Other HMO	$69,501.00
Rate for Payer: United Healthcare HMO Rider	$52,792.00
Rate for Payer: United Healthcare Select/Navigate/Core	$48,365.00

MS-DRG 35.00: BACK & NECK PROC EXC SPINAL FUSION W CC

Facility

$51,898.44

Service Code	MSDRG 519
Min. Negotiated Rate	$14,908.00
Max. Negotiated Rate	$51,898.44
Rate for Payer: United Healthcare All Other Commercial	$18,257.00
Rate for Payer: United Healthcare All Other HMO	$16,907.00
Rate for Payer: United Healthcare HMO Rider	$16,273.00
Rate for Payer: United Healthcare Select/Navigate/Core	$14,908.00

MS-DRG 35.00: BACK & NECK PROC EXC SPINAL FUSION W MCC OR DISC DEVICE/NEUROSTIM

Facility

$94,327.30

Service Code	MSDRG 518
Min. Negotiated Rate	$14,908.00
Max. Negotiated Rate	$94,327.30
Rate for Payer: United Healthcare All Other Commercial	$18,257.00
Rate for Payer: United Healthcare All Other HMO	$16,907.00
Rate for Payer: United Healthcare HMO Rider	$16,273.00
Rate for Payer: United Healthcare Select/Navigate/Core	$14,908.00

MS-DRG 35.00: BACK & NECK PROC EXC SPINAL FUSION W/O CC/MCC

Facility

$37,720.39

Service Code	MSDRG 520
Min. Negotiated Rate	$11,314.00
Max. Negotiated Rate	$37,720.39
Rate for Payer: United Healthcare All Other Commercial	$21,329.00
Rate for Payer: United Healthcare All Other HMO	$16,260.00
Rate for Payer: United Healthcare HMO Rider	$12,349.00
Rate for Payer: United Healthcare Select/Navigate/Core	$11,314.00

MS-DRG 35.00: BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W MCC

Facility

$161,511.81

Service Code	MSDRG 461
Min. Negotiated Rate	$45,279.00
Max. Negotiated Rate	$161,511.81
Rate for Payer: United Healthcare All Other Commercial	$64,494.00
Rate for Payer: United Healthcare All Other HMO	$65,063.00
Rate for Payer: United Healthcare HMO Rider	$49,424.00
Rate for Payer: United Healthcare Select/Navigate/Core	$45,279.00

MS-DRG 35.00: BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W/O MCC

Facility

$75,372.35

Service Code	MSDRG 462
Min. Negotiated Rate	$36,596.00
Max. Negotiated Rate	$75,372.35
Rate for Payer: United Healthcare All Other Commercial	$52,127.00
Rate for Payer: United Healthcare All Other HMO	$52,587.00
Rate for Payer: United Healthcare HMO Rider	$39,944.00
Rate for Payer: United Healthcare Select/Navigate/Core	$36,596.00

MS-DRG 35.00: CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W MCC

Facility

$124,263.00

Service Code	MSDRG 222
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$124,263.00
Rate for Payer: United Healthcare All Other HMO	$124,263.00
Rate for Payer: United Healthcare HMO Rider	$119,757.00
Rate for Payer: United Healthcare Select/Navigate/Core	$109,717.00

MS-DRG 35.00: CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W/O MCC

Facility

$106,570.00

Service Code	MSDRG 223
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$106,570.00
Rate for Payer: United Healthcare All Other HMO	$106,570.00
Rate for Payer: United Healthcare HMO Rider	$94,546.00
Rate for Payer: United Healthcare Select/Navigate/Core	$86,620.00

MS-DRG 35.00: CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W MCC

Facility

$113,336.00

Service Code	MSDRG 224
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$113,336.00
Rate for Payer: United Healthcare All Other HMO	$113,336.00
Rate for Payer: United Healthcare HMO Rider	$101,501.00
Rate for Payer: United Healthcare Select/Navigate/Core	$92,990.00

MS-DRG 35.00: CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W/O MCC

Facility

$101,501.00

Service Code	MSDRG 225
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$101,501.00
Rate for Payer: United Healthcare All Other HMO	$97,504.00
Rate for Payer: United Healthcare HMO Rider	$101,501.00
Rate for Payer: United Healthcare Select/Navigate/Core	$92,990.00

MS-DRG 35.00: CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W MCC

Facility

$92,297.00

Service Code	MSDRG 226
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$92,297.00
Rate for Payer: United Healthcare All Other HMO	$92,297.00
Rate for Payer: United Healthcare HMO Rider	$91,296.00
Rate for Payer: United Healthcare Select/Navigate/Core	$83,643.00

MS-DRG 35.00: CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W/O MCC

Facility

$91,296.00

Service Code	MSDRG 227
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$91,296.00
Rate for Payer: United Healthcare All Other HMO	$78,692.00
Rate for Payer: United Healthcare HMO Rider	$91,296.00
Rate for Payer: United Healthcare Select/Navigate/Core	$83,643.00

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