Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

02104ZF

Facility

$12,567.00

Service Code	ICD 02104ZF
Hospital Charge Code	129
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

0211083

Facility

$12,567.00

Service Code	ICD 0211083
Hospital Charge Code	130
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

0211088

Facility

$12,567.00

Service Code	ICD 0211088
Hospital Charge Code	131
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

0211089

Facility

$12,567.00

Service Code	ICD 0211089
Hospital Charge Code	132
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

021108C

Facility

$12,567.00

Service Code	ICD 021108C
Hospital Charge Code	133
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

021108F

Facility

$12,567.00

Service Code	ICD 021108F
Hospital Charge Code	134
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

021108W

Facility

$12,567.00

Service Code	ICD 021108W
Hospital Charge Code	135
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

0211093

Facility

$12,567.00

Service Code	ICD 0211093
Hospital Charge Code	136
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

0211098

Facility

$12,567.00

Service Code	ICD 0211098
Hospital Charge Code	137
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

0211099

Facility

$12,567.00

Service Code	ICD 0211099
Hospital Charge Code	138
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

021109C

Facility

$12,567.00

Service Code	ICD 021109C
Hospital Charge Code	139
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

021109F

Facility

$12,567.00

Service Code	ICD 021109F
Hospital Charge Code	140
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

02110A3

Facility

$12,567.00

Service Code	ICD 02110A3
Hospital Charge Code	141
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

02110A8

Facility

$12,567.00

Service Code	ICD 02110A8
Hospital Charge Code	142
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

02110A9

Facility

$12,567.00

Service Code	ICD 02110A9
Hospital Charge Code	143
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

02110AC

Facility

$12,567.00

Service Code	ICD 02110AC
Hospital Charge Code	144
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

02110AF

Facility

$12,567.00

Service Code	ICD 02110AF
Hospital Charge Code	145
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

02110J3

Facility

$12,567.00

Service Code	ICD 02110J3
Hospital Charge Code	146
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

02110J8

Facility

$12,567.00

Service Code	ICD 02110J8
Hospital Charge Code	147
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

02110J9

Facility

$12,567.00

Service Code	ICD 02110J9
Hospital Charge Code	148
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

02110JC

Facility

$12,567.00

Service Code	ICD 02110JC
Hospital Charge Code	149
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

02110JF

Facility

$12,567.00

Service Code	ICD 02110JF
Hospital Charge Code	150
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

02110K3

Facility

$12,567.00

Service Code	ICD 02110K3
Hospital Charge Code	151
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

02110K8

Facility

$12,567.00

Service Code	ICD 02110K8
Hospital Charge Code	152
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

02110K9

Facility

$12,567.00

Service Code	ICD 02110K9
Hospital Charge Code	153
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