Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

H35.3111

Facility

$9,161.00

Service Code	ICD H35.3111
Hospital Charge Code	3
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3112

Facility

$9,161.00

Service Code	ICD H35.3112
Hospital Charge Code	4
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3113

Facility

$9,161.00

Service Code	ICD H35.3113
Hospital Charge Code	5
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3114

Facility

$9,161.00

Service Code	ICD H35.3114
Hospital Charge Code	6
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3120

Facility

$9,161.00

Service Code	ICD H35.3120
Hospital Charge Code	7
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3121

Facility

$9,161.00

Service Code	ICD H35.3121
Hospital Charge Code	8
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3122

Facility

$9,161.00

Service Code	ICD H35.3122
Hospital Charge Code	9
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3123

Facility

$9,161.00

Service Code	ICD H35.3123
Hospital Charge Code	10
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3124

Facility

$9,161.00

Service Code	ICD H35.3124
Hospital Charge Code	11
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3130

Facility

$9,161.00

Service Code	ICD H35.3130
Hospital Charge Code	12
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3131

Facility

$9,161.00

Service Code	ICD H35.3131
Hospital Charge Code	13
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3132

Facility

$9,161.00

Service Code	ICD H35.3132
Hospital Charge Code	14
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3133

Facility

$9,161.00

Service Code	ICD H35.3133
Hospital Charge Code	15
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3134

Facility

$9,161.00

Service Code	ICD H35.3134
Hospital Charge Code	16
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3190

Facility

$9,161.00

Service Code	ICD H35.3190
Hospital Charge Code	17
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3191

Facility

$9,161.00

Service Code	ICD H35.3191
Hospital Charge Code	18
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3192

Facility

$9,161.00

Service Code	ICD H35.3192
Hospital Charge Code	19
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3193

Facility

$9,161.00

Service Code	ICD H35.3193
Hospital Charge Code	20
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3194

Facility

$9,161.00

Service Code	ICD H35.3194
Hospital Charge Code	21
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3210

Facility

$9,161.00

Service Code	ICD H35.3210
Hospital Charge Code	22
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3211

Facility

$9,161.00

Service Code	ICD H35.3211
Hospital Charge Code	23
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3212

Facility

$9,161.00

Service Code	ICD H35.3212
Hospital Charge Code	24
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3213

Facility

$9,161.00

Service Code	ICD H35.3213
Hospital Charge Code	25
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3220

Facility

$9,161.00

Service Code	ICD H35.3220
Hospital Charge Code	26
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

H35.3221

Facility

$9,161.00

Service Code	ICD H35.3221
Hospital Charge Code	27
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$9,161.00
Rate for Payer: United Healthcare All Other Commercial	$9,161.00
Rate for Payer: United Healthcare All Other HMO	$8,895.00
Rate for Payer: United Healthcare HMO Rider	$8,465.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,756.00
Rate for Payer: Upland Medical Group Pediatric	$3,000.00

Know your out-of-pocket cost for care.

All Charges