Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

06104JP

Facility

$12,567.00

Service Code	ICD 06104JP
Hospital Charge Code	2490
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

06104JQ

Facility

$12,567.00

Service Code	ICD 06104JQ
Hospital Charge Code	2491
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

06104JR

Facility

$12,567.00

Service Code	ICD 06104JR
Hospital Charge Code	2492
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

06104KP

Facility

$12,567.00

Service Code	ICD 06104KP
Hospital Charge Code	2493
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

06104KQ

Facility

$12,567.00

Service Code	ICD 06104KQ
Hospital Charge Code	2494
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

06104KR

Facility

$12,567.00

Service Code	ICD 06104KR
Hospital Charge Code	2495
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

06104ZP

Facility

$12,567.00

Service Code	ICD 06104ZP
Hospital Charge Code	2496
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

06104ZQ

Facility

$12,567.00

Service Code	ICD 06104ZQ
Hospital Charge Code	2497
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

06104ZR

Facility

$12,567.00

Service Code	ICD 06104ZR
Hospital Charge Code	2498
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

06183J4

Facility

$12,567.00

Service Code	ICD 06183J4
Hospital Charge Code	2499
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

06183JY

Facility

$12,567.00

Service Code	ICD 06183JY
Hospital Charge Code	2500
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

06184J4

Facility

$12,567.00

Service Code	ICD 06184J4
Hospital Charge Code	2501
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

09HD05Z

Facility

$30,379.00

Service Code	ICD 09HD05Z
Hospital Charge Code	2502
Min. Negotiated Rate	$30,379.00
Max. Negotiated Rate	$30,379.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,379.00

09HD06Z

Facility

$30,379.00

Service Code	ICD 09HD06Z
Hospital Charge Code	2503
Min. Negotiated Rate	$30,379.00
Max. Negotiated Rate	$30,379.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,379.00

09HD0SZ

Facility

$30,379.00

Service Code	ICD 09HD0SZ
Hospital Charge Code	2504
Min. Negotiated Rate	$30,379.00
Max. Negotiated Rate	$30,379.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,379.00

09HD35Z

Facility

$30,379.00

Service Code	ICD 09HD35Z
Hospital Charge Code	2505
Min. Negotiated Rate	$30,379.00
Max. Negotiated Rate	$30,379.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,379.00

09HD36Z

Facility

$30,379.00

Service Code	ICD 09HD36Z
Hospital Charge Code	2506
Min. Negotiated Rate	$30,379.00
Max. Negotiated Rate	$30,379.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,379.00

09HD3SZ

Facility

$30,379.00

Service Code	ICD 09HD3SZ
Hospital Charge Code	2507
Min. Negotiated Rate	$30,379.00
Max. Negotiated Rate	$30,379.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,379.00

09HD45Z

Facility

$30,379.00

Service Code	ICD 09HD45Z
Hospital Charge Code	2508
Min. Negotiated Rate	$30,379.00
Max. Negotiated Rate	$30,379.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,379.00

09HD46Z

Facility

$30,379.00

Service Code	ICD 09HD46Z
Hospital Charge Code	2509
Min. Negotiated Rate	$30,379.00
Max. Negotiated Rate	$30,379.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,379.00

09HD4SZ

Facility

$30,379.00

Service Code	ICD 09HD4SZ
Hospital Charge Code	2510
Min. Negotiated Rate	$30,379.00
Max. Negotiated Rate	$30,379.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,379.00

09HE05Z

Facility

$30,379.00

Service Code	ICD 09HE05Z
Hospital Charge Code	2511
Min. Negotiated Rate	$30,379.00
Max. Negotiated Rate	$30,379.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,379.00

09HE06Z

Facility

$30,379.00

Service Code	ICD 09HE06Z
Hospital Charge Code	2512
Min. Negotiated Rate	$30,379.00
Max. Negotiated Rate	$30,379.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,379.00

09HE0SZ

Facility

$30,379.00

Service Code	ICD 09HE0SZ
Hospital Charge Code	2513
Min. Negotiated Rate	$30,379.00
Max. Negotiated Rate	$30,379.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,379.00

09HE35Z

Facility

$30,379.00

Service Code	ICD 09HE35Z
Hospital Charge Code	2514
Min. Negotiated Rate	$30,379.00
Max. Negotiated Rate	$30,379.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$30,379.00

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All Charges