Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 40.00: COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT 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: Heritage Provider Network Commercial/Senior	$29,434.00
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 40.00: CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$66,505.48

Service Code	MSDRG 545
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$66,505.48
Rate for Payer: Heritage Provider Network Commercial/Senior	$17,258.00

MS-DRG 40.00: CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC

Facility

$205,719.83

Service Code	MSDRG 233
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$205,719.83
Rate for Payer: Heritage Provider Network Commercial/Senior	$33,409.00
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 40.00: CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC

Facility

$140,022.34

Service Code	MSDRG 234
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$140,022.34
Rate for Payer: Heritage Provider Network Commercial/Senior	$33,409.00
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 40.00: CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$154,866.26

Service Code	MSDRG 235
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$154,866.26
Rate for Payer: Heritage Provider Network Commercial/Senior	$33,409.00
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 40.00: CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$108,226.36

Service Code	MSDRG 236
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$108,226.36
Rate for Payer: Heritage Provider Network Commercial/Senior	$33,409.00
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 40.00: CORONARY BYPASS WITH PTCA WITH MCC

Facility

$223,024.57

Service Code	MSDRG 231
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$223,024.57
Rate for Payer: Heritage Provider Network Commercial/Senior	$33,409.00
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 40.00: CORONARY BYPASS WITH PTCA WITHOUT MCC

Facility

$160,774.88

Service Code	MSDRG 232
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$160,774.88
Rate for Payer: Heritage Provider Network Commercial/Senior	$33,409.00
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 40.00: ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC

Facility

$216,703.00

Service Code	MSDRG 266
Min. Negotiated Rate	$25,551.00
Max. Negotiated Rate	$216,703.00
Rate for Payer: Heritage Provider Network Commercial/Senior	$25,551.00
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 40.00: ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC

Facility

$162,712.00

Service Code	MSDRG 267
Min. Negotiated Rate	$25,551.00
Max. Negotiated Rate	$162,712.00
Rate for Payer: Heritage Provider Network Commercial/Senior	$25,551.00
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 40.00: HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC

Facility

$74,534.00

Service Code	MSDRG 481
Min. Negotiated Rate	$21,830.00
Max. Negotiated Rate	$74,534.00
Rate for Payer: Heritage Provider Network Commercial/Senior	$24,564.00
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 40.00: HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC

Facility

$77,404.18

Service Code	MSDRG 480
Min. Negotiated Rate	$24,564.00
Max. Negotiated Rate	$77,404.18
Rate for Payer: Heritage Provider Network Commercial/Senior	$24,564.00
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 40.00: HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT 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: Heritage Provider Network Commercial/Senior	$24,564.00
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 40.00: HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC

Facility

$76,711.99

Service Code	MSDRG 521
Min. Negotiated Rate	$40,528.90
Max. Negotiated Rate	$76,711.99
Rate for Payer: United Healthcare All Other Commercial	$59,995.00
Rate for Payer: United Healthcare All Other HMO	$57,548.00
Rate for Payer: United Healthcare HMO Rider	$54,441.00
Rate for Payer: United Healthcare Select/Navigate/Core	$52,540.00

MS-DRG 40.00: HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC

Facility

$75,160.00

Service Code	MSDRG 522
Min. Negotiated Rate	$29,530.58
Max. Negotiated Rate	$75,160.00
Rate for Payer: United Healthcare All Other Commercial	$75,160.00
Rate for Payer: United Healthcare All Other HMO	$47,209.00
Rate for Payer: United Healthcare HMO Rider	$35,860.00
Rate for Payer: United Healthcare Select/Navigate/Core	$32,854.00

MS-DRG 40.00: LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES 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: Heritage Provider Network Commercial/Senior	$25,608.00
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 40.00: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC

Facility

$35,335.89

Service Code	MSDRG 497
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$35,335.89
Rate for Payer: Heritage Provider Network Commercial/Senior	$13,083.00

MS-DRG 40.00: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC

Facility

$63,191.92

Service Code	MSDRG 493
Min. Negotiated Rate	$17,710.00
Max. Negotiated Rate	$63,191.92
Rate for Payer: Heritage Provider Network Commercial/Senior	$21,433.00
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 40.00: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC

Facility

$93,464.03

Service Code	MSDRG 492
Min. Negotiated Rate	$21,433.00
Max. Negotiated Rate	$93,464.03
Rate for Payer: Heritage Provider Network Commercial/Senior	$21,433.00
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 40.00: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT 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: Heritage Provider Network Commercial/Senior	$21,433.00
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 40.00: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT

Facility

$86,028.92

Service Code	MSDRG 469
Min. Negotiated Rate	$23,506.00
Max. Negotiated Rate	$86,028.92
Rate for Payer: Heritage Provider Network Commercial/Senior	$23,506.00
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 40.00: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC

Facility

$53,685.00

Service Code	MSDRG 470
Min. Negotiated Rate	$23,467.00
Max. Negotiated Rate	$53,685.00
Rate for Payer: Heritage Provider Network Commercial/Senior	$23,506.00
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 40.00: MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES

Facility

$67,066.08

Service Code	MSDRG 483
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$67,066.08
Rate for Payer: Heritage Provider Network Commercial/Senior	$23,506.00

MS-DRG 40.00: MAJOR MALE PELVIC PROCEDURES WITH 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 40.00: MAJOR MALE PELVIC PROCEDURES WITHOUT 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

Know your out-of-pocket cost for care.

All Charges