Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

00H00MZ

Facility

$30,092.00

Service Code	ICD 00H00MZ
Hospital Charge Code	54
Min. Negotiated Rate	$30,092.00
Max. Negotiated Rate	$30,092.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,092.00

00H60MZ

Facility

$30,092.00

Service Code	ICD 00H60MZ
Hospital Charge Code	55
Min. Negotiated Rate	$30,092.00
Max. Negotiated Rate	$30,092.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,092.00

00HE0MZ

Facility

$30,092.00

Service Code	ICD 00HE0MZ
Hospital Charge Code	56
Min. Negotiated Rate	$30,092.00
Max. Negotiated Rate	$30,092.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,092.00

00HE3MZ

Facility

$30,092.00

Service Code	ICD 00HE3MZ
Hospital Charge Code	57
Min. Negotiated Rate	$30,092.00
Max. Negotiated Rate	$30,092.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,092.00

00HE4MZ

Facility

$30,092.00

Service Code	ICD 00HE4MZ
Hospital Charge Code	58
Min. Negotiated Rate	$30,092.00
Max. Negotiated Rate	$30,092.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,092.00

00HU0MZ

Facility

$30,092.00

Service Code	ICD 00HU0MZ
Hospital Charge Code	59
Min. Negotiated Rate	$30,092.00
Max. Negotiated Rate	$30,092.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,092.00

00HU3MZ

Facility

$30,092.00

Service Code	ICD 00HU3MZ
Hospital Charge Code	60
Min. Negotiated Rate	$30,092.00
Max. Negotiated Rate	$30,092.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,092.00

00HU4MZ

Facility

$30,092.00

Service Code	ICD 00HU4MZ
Hospital Charge Code	61
Min. Negotiated Rate	$30,092.00
Max. Negotiated Rate	$30,092.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,092.00

00HV0MZ

Facility

$30,092.00

Service Code	ICD 00HV0MZ
Hospital Charge Code	62
Min. Negotiated Rate	$30,092.00
Max. Negotiated Rate	$30,092.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,092.00

00HV3MZ

Facility

$30,092.00

Service Code	ICD 00HV3MZ
Hospital Charge Code	63
Min. Negotiated Rate	$30,092.00
Max. Negotiated Rate	$30,092.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,092.00

00HV4MZ

Facility

$30,092.00

Service Code	ICD 00HV4MZ
Hospital Charge Code	64
Min. Negotiated Rate	$30,092.00
Max. Negotiated Rate	$30,092.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,092.00

00PV0MZ

Facility

$30,092.00

Service Code	ICD 00PV0MZ
Hospital Charge Code	65
Min. Negotiated Rate	$30,092.00
Max. Negotiated Rate	$30,092.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,092.00

00PV3MZ

Facility

$30,092.00

Service Code	ICD 00PV3MZ
Hospital Charge Code	66
Min. Negotiated Rate	$30,092.00
Max. Negotiated Rate	$30,092.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,092.00

00PV4MZ

Facility

$30,092.00

Service Code	ICD 00PV4MZ
Hospital Charge Code	67
Min. Negotiated Rate	$30,092.00
Max. Negotiated Rate	$30,092.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,092.00

01HY0MZ

Facility

$30,092.00

Service Code	ICD 01HY0MZ
Hospital Charge Code	68
Min. Negotiated Rate	$30,092.00
Max. Negotiated Rate	$30,092.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,092.00

01HY3MZ

Facility

$30,092.00

Service Code	ICD 01HY3MZ
Hospital Charge Code	69
Min. Negotiated Rate	$30,092.00
Max. Negotiated Rate	$30,092.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,092.00

01HY4MZ

Facility

$30,092.00

Service Code	ICD 01HY4MZ
Hospital Charge Code	70
Min. Negotiated Rate	$30,092.00
Max. Negotiated Rate	$30,092.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,092.00

0210083

Facility

$12,567.00

Service Code	ICD 0210083
Hospital Charge Code	2819
Min. Negotiated Rate	$12,567.00
Max. Negotiated Rate	$12,567.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$12,567.00

0210088

Facility

$12,567.00

Service Code	ICD 0210088
Hospital Charge Code	2818
Min. Negotiated Rate	$12,567.00
Max. Negotiated Rate	$12,567.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$12,567.00

0210089

Facility

$12,567.00

Service Code	ICD 0210089
Hospital Charge Code	2820
Min. Negotiated Rate	$12,567.00
Max. Negotiated Rate	$12,567.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$12,567.00

021008C

Facility

$12,567.00

Service Code	ICD 021008C
Hospital Charge Code	74
Min. Negotiated Rate	$12,567.00
Max. Negotiated Rate	$12,567.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$12,567.00

021008F

Facility

$12,567.00

Service Code	ICD 021008F
Hospital Charge Code	75
Min. Negotiated Rate	$12,567.00
Max. Negotiated Rate	$12,567.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$12,567.00

021008W

Facility

$12,567.00

Service Code	ICD 021008W
Hospital Charge Code	76
Min. Negotiated Rate	$12,567.00
Max. Negotiated Rate	$12,567.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$12,567.00

0210093

Facility

$12,567.00

Service Code	ICD 0210093
Hospital Charge Code	2821
Min. Negotiated Rate	$12,567.00
Max. Negotiated Rate	$12,567.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$12,567.00

0210098

Facility

$12,567.00

Service Code	ICD 0210098
Hospital Charge Code	2822
Min. Negotiated Rate	$12,567.00
Max. Negotiated Rate	$12,567.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$12,567.00

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All Charges