Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

10D07Z5

Facility

$12,042.00

Service Code	ICD 10D07Z5
Hospital Charge Code	15255
Min. Negotiated Rate	$12,042.00
Max. Negotiated Rate	$12,042.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$12,042.00

10D07Z6

Facility

$12,042.00

Service Code	ICD 10D07Z6
Hospital Charge Code	15256
Min. Negotiated Rate	$12,042.00
Max. Negotiated Rate	$12,042.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$12,042.00

10D07Z7

Facility

$12,042.00

Service Code	ICD 10D07Z7
Hospital Charge Code	15257
Min. Negotiated Rate	$12,042.00
Max. Negotiated Rate	$12,042.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$12,042.00

10D07Z8

Facility

$12,042.00

Service Code	ICD 10D07Z8
Hospital Charge Code	15258
Min. Negotiated Rate	$12,042.00
Max. Negotiated Rate	$12,042.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$12,042.00

10D07Z8

Facility

$12,042.00

Service Code	ICD 10D07Z8
Hospital Charge Code	2729
Min. Negotiated Rate	$12,042.00
Max. Negotiated Rate	$12,042.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$12,042.00

10E0XZZ

Facility

$12,042.00

Service Code	ICD 10E0XZZ
Hospital Charge Code	2730
Min. Negotiated Rate	$12,042.00
Max. Negotiated Rate	$12,042.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$12,042.00

10E0XZZ

Facility

$12,042.00

Service Code	ICD 10E0XZZ
Hospital Charge Code	15259
Min. Negotiated Rate	$12,042.00
Max. Negotiated Rate	$12,042.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$12,042.00

10J07ZZ

Facility

$12,042.00

Service Code	ICD 10J07ZZ
Hospital Charge Code	2731
Min. Negotiated Rate	$12,042.00
Max. Negotiated Rate	$12,042.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$12,042.00

1-STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH SIMPLE MEATAL ADVANCEMENT (EG, MAGPI, V-FLAP)

Facility

$32,312.00

Service Code	CPT 54322
Hospital Revenue Code	360
Min. Negotiated Rate	$1,133.34
Max. Negotiated Rate	$32,312.00
Rate for Payer: Aetna of CA HMO/PPO	$32,312.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$6,800.56
Rate for Payer: Alpha Care Medical Group Medi-Cal	$4,987.08
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$4,533.71
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$6,716.00
Rate for Payer: Blue Shield of California Commercial	$4,454.70
Rate for Payer: Blue Shield of California Commercial	$2,942.61
Rate for Payer: Dignity Health Commercial/Exchange	$6,800.56
Rate for Payer: Dignity Health Medi-Cal	$4,987.08
Rate for Payer: Dignity Health Medicare Advantage	$4,533.71
Rate for Payer: EPIC Health Plan Commercial	$7,480.62
Rate for Payer: EPIC Health Plan Senior	$4,987.08
Rate for Payer: Heritage Provider Network Commercial/Senior	$7,435.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1,133.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$4,533.71
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$1,281.76
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$6,347.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$5,712.47
Rate for Payer: Molina Healthcare of CA Medicare	$6,075.17
Rate for Payer: Multiplan WC	$6,982.34
Rate for Payer: Prime Health Services WC	$6,911.09
Rate for Payer: United Healthcare All Other HMO	$20,902.00
Rate for Payer: United Healthcare HMO Rider	$13,066.00
Rate for Payer: United Healthcare Select/Navigate/Core	$11,971.00
Rate for Payer: Upland Medical Group Pediatric	$4,533.71
Rate for Payer: Vantage Medical Group Commercial/Exchange	$6,800.56
Rate for Payer: Vantage Medical Group Medi-Cal	$4,987.08
Rate for Payer: Vantage Medical Group Senior	$4,533.71

1-STAGE PROXIMAL PENILE OR PENOSCROTAL HYPOSPADIAS REPAIR REQUIRING EXTENSIVE DISSECTION TO CORRECT CHORDEE AND URETHROPLASTY BY USE OF SKIN GRAFT TUBE AND/OR ISLAND FLAP

Facility

$32,312.00

Service Code	CPT 54332
Hospital Revenue Code	360
Min. Negotiated Rate	$1,416.68
Max. Negotiated Rate	$32,312.00
Rate for Payer: Aetna of CA HMO/PPO	$32,312.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$6,800.56
Rate for Payer: Alpha Care Medical Group Medi-Cal	$4,987.08
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$4,533.71
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$9,104.00
Rate for Payer: Blue Shield of California Commercial	$2,912.69
Rate for Payer: Blue Shield of California Commercial	$1,924.01
Rate for Payer: Dignity Health Commercial/Exchange	$6,800.56
Rate for Payer: Dignity Health Medi-Cal	$4,987.08
Rate for Payer: Dignity Health Medicare Advantage	$4,533.71
Rate for Payer: EPIC Health Plan Commercial	$7,480.62
Rate for Payer: EPIC Health Plan Senior	$4,987.08
Rate for Payer: Heritage Provider Network Commercial/Senior	$7,435.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1,416.68
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$4,533.71
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$1,602.19
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$6,347.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$5,712.47
Rate for Payer: Molina Healthcare of CA Medicare	$6,075.17
Rate for Payer: Multiplan WC	$6,982.34
Rate for Payer: Prime Health Services WC	$6,911.09
Rate for Payer: United Healthcare All Other HMO	$20,902.00
Rate for Payer: United Healthcare HMO Rider	$13,066.00
Rate for Payer: United Healthcare Select/Navigate/Core	$11,971.00
Rate for Payer: Upland Medical Group Pediatric	$4,533.71
Rate for Payer: Vantage Medical Group Commercial/Exchange	$6,800.56
Rate for Payer: Vantage Medical Group Medi-Cal	$4,987.08
Rate for Payer: Vantage Medical Group Senior	$4,533.71

3E080GC

Facility

$13,133.00

Service Code	ICD 3E080GC
Hospital Charge Code	2734
Min. Negotiated Rate	$13,133.00
Max. Negotiated Rate	$13,133.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$13,133.00

3E083GC

Facility

$13,133.00

Service Code	ICD 3E083GC
Hospital Charge Code	2735
Min. Negotiated Rate	$13,133.00
Max. Negotiated Rate	$13,133.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$13,133.00

3E0U0GB

Facility

$15,077.00

Service Code	ICD 3E0U0GB
Hospital Charge Code	2736
Min. Negotiated Rate	$15,077.00
Max. Negotiated Rate	$15,077.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,077.00

3E0U3GB

Facility

$15,077.00

Service Code	ICD 3E0U3GB
Hospital Charge Code	2737
Min. Negotiated Rate	$15,077.00
Max. Negotiated Rate	$15,077.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,077.00

3E0V0GB

Facility

$15,077.00

Service Code	ICD 3E0V0GB
Hospital Charge Code	2738
Min. Negotiated Rate	$15,077.00
Max. Negotiated Rate	$15,077.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,077.00

3E0V3GB

Facility

$15,077.00

Service Code	ICD 3E0V3GB
Hospital Charge Code	2739
Min. Negotiated Rate	$15,077.00
Max. Negotiated Rate	$15,077.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,077.00

4A020N6

Facility

$13,133.00

Service Code	ICD 4A020N6
Hospital Charge Code	2740
Min. Negotiated Rate	$13,133.00
Max. Negotiated Rate	$13,133.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$13,133.00

4A020N6

Facility

$13,133.00

Service Code	ICD 4A020N6
Hospital Charge Code	13981
Min. Negotiated Rate	$13,133.00
Max. Negotiated Rate	$13,133.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$13,133.00

4A020N7

Facility

$13,133.00

Service Code	ICD 4A020N7
Hospital Charge Code	13982
Min. Negotiated Rate	$13,133.00
Max. Negotiated Rate	$13,133.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$13,133.00

4A020N7

Facility

$13,133.00

Service Code	ICD 4A020N7
Hospital Charge Code	2741
Min. Negotiated Rate	$13,133.00
Max. Negotiated Rate	$13,133.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$13,133.00

4A020N8

Facility

$13,133.00

Service Code	ICD 4A020N8
Hospital Charge Code	2742
Min. Negotiated Rate	$13,133.00
Max. Negotiated Rate	$13,133.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$13,133.00

4A020N8

Facility

$13,133.00

Service Code	ICD 4A020N8
Hospital Charge Code	13983
Min. Negotiated Rate	$13,133.00
Max. Negotiated Rate	$13,133.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$13,133.00

4A023N6

Facility

$13,133.00

Service Code	ICD 4A023N6
Hospital Charge Code	13984
Min. Negotiated Rate	$13,133.00
Max. Negotiated Rate	$13,133.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$13,133.00

4A023N6

Facility

$13,133.00

Service Code	ICD 4A023N6
Hospital Charge Code	2743
Min. Negotiated Rate	$13,133.00
Max. Negotiated Rate	$13,133.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$13,133.00

4A023N7

Facility

$13,133.00

Service Code	ICD 4A023N7
Hospital Charge Code	2744
Min. Negotiated Rate	$13,133.00
Max. Negotiated Rate	$13,133.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$13,133.00

Know your out-of-pocket cost for care.

All Charges