Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

X2C3361

Facility

$10,777.00

Service Code	ICD X2C3361
Hospital Charge Code	5650
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

X2RF032

Facility

$10,777.00

Service Code	ICD X2RF032
Hospital Charge Code	2778
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

X2RF332

Facility

$10,777.00

Service Code	ICD X2RF332
Hospital Charge Code	2779
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

X2RF432

Facility

$10,777.00

Service Code	ICD X2RF432
Hospital Charge Code	2780
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

XRG0092

Facility

$15,230.00

Service Code	ICD XRG0092
Hospital Charge Code	2781
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRG00F3

Facility

$15,230.00

Service Code	ICD XRG00F3
Hospital Charge Code	2782
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRG1092

Facility

$15,230.00

Service Code	ICD XRG1092
Hospital Charge Code	2783
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRG10F3

Facility

$15,230.00

Service Code	ICD XRG10F3
Hospital Charge Code	2784
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRG2092

Facility

$15,230.00

Service Code	ICD XRG2092
Hospital Charge Code	2785
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRG20F3

Facility

$15,230.00

Service Code	ICD XRG20F3
Hospital Charge Code	2786
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRG4092

Facility

$15,230.00

Service Code	ICD XRG4092
Hospital Charge Code	2787
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRG40F3

Facility

$15,230.00

Service Code	ICD XRG40F3
Hospital Charge Code	2788
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRG6092

Facility

$15,230.00

Service Code	ICD XRG6092
Hospital Charge Code	2789
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRG60F3

Facility

$15,230.00

Service Code	ICD XRG60F3
Hospital Charge Code	2790
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRG7092

Facility

$15,230.00

Service Code	ICD XRG7092
Hospital Charge Code	2791
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRG70F3

Facility

$15,230.00

Service Code	ICD XRG70F3
Hospital Charge Code	2792
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRG8092

Facility

$15,230.00

Service Code	ICD XRG8092
Hospital Charge Code	2793
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRG80F3

Facility

$15,230.00

Service Code	ICD XRG80F3
Hospital Charge Code	2794
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRGA092

Facility

$15,230.00

Service Code	ICD XRGA092
Hospital Charge Code	2795
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRGA0F3

Facility

$15,230.00

Service Code	ICD XRGA0F3
Hospital Charge Code	2796
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRGB092

Facility

$15,230.00

Service Code	ICD XRGB092
Hospital Charge Code	2797
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRGB0F3

Facility

$15,230.00

Service Code	ICD XRGB0F3
Hospital Charge Code	2798
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRGC092

Facility

$15,230.00

Service Code	ICD XRGC092
Hospital Charge Code	2799
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRGC0F3

Facility

$15,230.00

Service Code	ICD XRGC0F3
Hospital Charge Code	2800
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

XRGD092

Facility

$15,230.00

Service Code	ICD XRGD092
Hospital Charge Code	2801
Min. Negotiated Rate	$15,230.00
Max. Negotiated Rate	$15,230.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$15,230.00

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All Charges