Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

02174AU

Facility

$10,777.00

Service Code	ICD 02174AU
Hospital Charge Code	399
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

02174JP

Facility

$10,777.00

Service Code	ICD 02174JP
Hospital Charge Code	2904
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

02174JQ

Facility

$10,777.00

Service Code	ICD 02174JQ
Hospital Charge Code	2905
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

02174JR

Facility

$10,777.00

Service Code	ICD 02174JR
Hospital Charge Code	2906
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

02174JS

Facility

$10,777.00

Service Code	ICD 02174JS
Hospital Charge Code	400
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

02174JT

Facility

$10,777.00

Service Code	ICD 02174JT
Hospital Charge Code	401
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

02174JU

Facility

$10,777.00

Service Code	ICD 02174JU
Hospital Charge Code	402
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

02174KP

Facility

$10,777.00

Service Code	ICD 02174KP
Hospital Charge Code	2907
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

02174KQ

Facility

$10,777.00

Service Code	ICD 02174KQ
Hospital Charge Code	2908
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

02174KR

Facility

$10,777.00

Service Code	ICD 02174KR
Hospital Charge Code	2909
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

02174KS

Facility

$10,777.00

Service Code	ICD 02174KS
Hospital Charge Code	403
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

02174KT

Facility

$10,777.00

Service Code	ICD 02174KT
Hospital Charge Code	404
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

02174KU

Facility

$10,777.00

Service Code	ICD 02174KU
Hospital Charge Code	405
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

02174ZP

Facility

$10,777.00

Service Code	ICD 02174ZP
Hospital Charge Code	2910
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

02174ZQ

Facility

$10,777.00

Service Code	ICD 02174ZQ
Hospital Charge Code	2911
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

02174ZR

Facility

$10,777.00

Service Code	ICD 02174ZR
Hospital Charge Code	2912
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

02174ZS

Facility

$10,777.00

Service Code	ICD 02174ZS
Hospital Charge Code	406
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

02174ZT

Facility

$10,777.00

Service Code	ICD 02174ZT
Hospital Charge Code	407
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

02174ZU

Facility

$10,777.00

Service Code	ICD 02174ZU
Hospital Charge Code	408
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

021K08P

Facility

$10,777.00

Service Code	ICD 021K08P
Hospital Charge Code	409
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

021K08Q

Facility

$10,777.00

Service Code	ICD 021K08Q
Hospital Charge Code	410
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

021K08R

Facility

$10,777.00

Service Code	ICD 021K08R
Hospital Charge Code	411
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

021K09P

Facility

$10,777.00

Service Code	ICD 021K09P
Hospital Charge Code	412
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

021K09Q

Facility

$10,777.00

Service Code	ICD 021K09Q
Hospital Charge Code	413
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

021K09R

Facility

$10,777.00

Service Code	ICD 021K09R
Hospital Charge Code	414
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

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