Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

04CW3ZZ

Facility

$11,208.00

Service Code	ICD 04CW3ZZ
Hospital Charge Code	2436
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

04CY3ZZ

Facility

$11,208.00

Service Code	ICD 04CY3ZZ
Hospital Charge Code	2437
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

04H002Z

Facility

$11,208.00

Service Code	ICD 04H002Z
Hospital Charge Code	2438
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

04H032Z

Facility

$11,208.00

Service Code	ICD 04H032Z
Hospital Charge Code	2450
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

04H042Z

Facility

$11,208.00

Service Code	ICD 04H042Z
Hospital Charge Code	2451
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

04U03JZ

Facility

$11,208.00

Service Code	ICD 04U03JZ
Hospital Charge Code	2452
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

04U04JZ

Facility

$11,208.00

Service Code	ICD 04U04JZ
Hospital Charge Code	2453
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

04V00DJ

Facility

$11,208.00

Service Code	ICD 04V00DJ
Hospital Charge Code	2454
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

04V00EZ

Facility

$11,208.00

Service Code	ICD 04V00EZ
Hospital Charge Code	2455
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

04V00FZ

Facility

$11,208.00

Service Code	ICD 04V00FZ
Hospital Charge Code	2456
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

04V03DJ

Facility

$11,208.00

Service Code	ICD 04V03DJ
Hospital Charge Code	2457
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

04V03DZ

Facility

$11,208.00

Service Code	ICD 04V03DZ
Hospital Charge Code	4625
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

04V03EZ

Facility

$11,208.00

Service Code	ICD 04V03EZ
Hospital Charge Code	2458
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

04V03FZ

Facility

$11,208.00

Service Code	ICD 04V03FZ
Hospital Charge Code	2459
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

04V04DJ

Facility

$11,208.00

Service Code	ICD 04V04DJ
Hospital Charge Code	2460
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

04V04DZ

Facility

$11,208.00

Service Code	ICD 04V04DZ
Hospital Charge Code	4626
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

04V04EZ

Facility

$11,208.00

Service Code	ICD 04V04EZ
Hospital Charge Code	2461
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

04V04FZ

Facility

$11,208.00

Service Code	ICD 04V04FZ
Hospital Charge Code	2462
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

05700DZ

Facility

$4,070.00

Service Code	ICD 05700DZ
Hospital Charge Code	4627
Min. Negotiated Rate	$4,070.00
Max. Negotiated Rate	$4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,070.00

05703DZ

Facility

$4,070.00

Service Code	ICD 05703DZ
Hospital Charge Code	4628
Min. Negotiated Rate	$4,070.00
Max. Negotiated Rate	$4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,070.00

05704DZ

Facility

$4,070.00

Service Code	ICD 05704DZ
Hospital Charge Code	4629
Min. Negotiated Rate	$4,070.00
Max. Negotiated Rate	$4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,070.00

05710DZ

Facility

$4,070.00

Service Code	ICD 05710DZ
Hospital Charge Code	4630
Min. Negotiated Rate	$4,070.00
Max. Negotiated Rate	$4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,070.00

05713DZ

Facility

$4,070.00

Service Code	ICD 05713DZ
Hospital Charge Code	4631
Min. Negotiated Rate	$4,070.00
Max. Negotiated Rate	$4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,070.00

05714DZ

Facility

$4,070.00

Service Code	ICD 05714DZ
Hospital Charge Code	4632
Min. Negotiated Rate	$4,070.00
Max. Negotiated Rate	$4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,070.00

05730D1

Facility

$4,070.00

Service Code	ICD 05730D1
Hospital Charge Code	4633
Min. Negotiated Rate	$4,070.00
Max. Negotiated Rate	$4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,070.00

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All Charges