Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

05773D1

Facility

$4,070.00

Service Code	ICD 05773D1
Hospital Charge Code	4659
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

05773DZ

Facility

$4,070.00

Service Code	ICD 05773DZ
Hospital Charge Code	4660
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

05774D1

Facility

$4,070.00

Service Code	ICD 05774D1
Hospital Charge Code	4661
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

05774DZ

Facility

$4,070.00

Service Code	ICD 05774DZ
Hospital Charge Code	4662
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

05780D1

Facility

$4,070.00

Service Code	ICD 05780D1
Hospital Charge Code	4663
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

05780DZ

Facility

$4,070.00

Service Code	ICD 05780DZ
Hospital Charge Code	4664
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

05783D1

Facility

$4,070.00

Service Code	ICD 05783D1
Hospital Charge Code	4665
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

05783DZ

Facility

$4,070.00

Service Code	ICD 05783DZ
Hospital Charge Code	4666
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

05784D1

Facility

$4,070.00

Service Code	ICD 05784D1
Hospital Charge Code	4667
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

05784DZ

Facility

$4,070.00

Service Code	ICD 05784DZ
Hospital Charge Code	4668
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

05790D1

Facility

$4,070.00

Service Code	ICD 05790D1
Hospital Charge Code	4669
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

05790DZ

Facility

$4,070.00

Service Code	ICD 05790DZ
Hospital Charge Code	4670
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

05793D1

Facility

$4,070.00

Service Code	ICD 05793D1
Hospital Charge Code	4671
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

05793DZ

Facility

$4,070.00

Service Code	ICD 05793DZ
Hospital Charge Code	4672
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

05794D1

Facility

$4,070.00

Service Code	ICD 05794D1
Hospital Charge Code	4673
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

05794DZ

Facility

$4,070.00

Service Code	ICD 05794DZ
Hospital Charge Code	4674
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

057A0D1

Facility

$4,070.00

Service Code	ICD 057A0D1
Hospital Charge Code	4675
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

057A0DZ

Facility

$4,070.00

Service Code	ICD 057A0DZ
Hospital Charge Code	4676
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

057A3D1

Facility

$4,070.00

Service Code	ICD 057A3D1
Hospital Charge Code	4677
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

057A3DZ

Facility

$4,070.00

Service Code	ICD 057A3DZ
Hospital Charge Code	4678
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

057A4D1

Facility

$4,070.00

Service Code	ICD 057A4D1
Hospital Charge Code	4679
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

057A4DZ

Facility

$4,070.00

Service Code	ICD 057A4DZ
Hospital Charge Code	4680
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

057B0D1

Facility

$4,070.00

Service Code	ICD 057B0D1
Hospital Charge Code	4681
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

057B0DZ

Facility

$4,070.00

Service Code	ICD 057B0DZ
Hospital Charge Code	4682
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

057B3D1

Facility

$4,070.00

Service Code	ICD 057B3D1
Hospital Charge Code	4683
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