Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

057T4DZ

Facility

$4,070.00

Service Code	ICD 057T4DZ
Hospital Charge Code	4734
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

057V0DZ

Facility

$4,070.00

Service Code	ICD 057V0DZ
Hospital Charge Code	4735
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

057V3DZ

Facility

$4,070.00

Service Code	ICD 057V3DZ
Hospital Charge Code	4736
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

057V4DZ

Facility

$4,070.00

Service Code	ICD 057V4DZ
Hospital Charge Code	4737
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

057Y0DZ

Facility

$4,070.00

Service Code	ICD 057Y0DZ
Hospital Charge Code	4738
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

057Y3DZ

Facility

$4,070.00

Service Code	ICD 057Y3DZ
Hospital Charge Code	4739
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

057Y4DZ

Facility

$4,070.00

Service Code	ICD 057Y4DZ
Hospital Charge Code	4740
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

061007P

Facility

$11,208.00

Service Code	ICD 061007P
Hospital Charge Code	2463
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

061007Q

Facility

$11,208.00

Service Code	ICD 061007Q
Hospital Charge Code	2464
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

061007R

Facility

$11,208.00

Service Code	ICD 061007R
Hospital Charge Code	2465
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

061009P

Facility

$11,208.00

Service Code	ICD 061009P
Hospital Charge Code	2466
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

061009Q

Facility

$11,208.00

Service Code	ICD 061009Q
Hospital Charge Code	2467
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

061009R

Facility

$11,208.00

Service Code	ICD 061009R
Hospital Charge Code	2468
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

06100AP

Facility

$11,208.00

Service Code	ICD 06100AP
Hospital Charge Code	2469
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

06100AQ

Facility

$11,208.00

Service Code	ICD 06100AQ
Hospital Charge Code	2470
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

06100AR

Facility

$11,208.00

Service Code	ICD 06100AR
Hospital Charge Code	2471
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

06100JP

Facility

$11,208.00

Service Code	ICD 06100JP
Hospital Charge Code	2472
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

06100JQ

Facility

$11,208.00

Service Code	ICD 06100JQ
Hospital Charge Code	2473
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

06100JR

Facility

$11,208.00

Service Code	ICD 06100JR
Hospital Charge Code	2474
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

06100KP

Facility

$11,208.00

Service Code	ICD 06100KP
Hospital Charge Code	2475
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

06100KQ

Facility

$11,208.00

Service Code	ICD 06100KQ
Hospital Charge Code	2476
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

06100KR

Facility

$11,208.00

Service Code	ICD 06100KR
Hospital Charge Code	2477
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

06100ZP

Facility

$11,208.00

Service Code	ICD 06100ZP
Hospital Charge Code	2478
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

06100ZQ

Facility

$11,208.00

Service Code	ICD 06100ZQ
Hospital Charge Code	2479
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

06100ZR

Facility

$11,208.00

Service Code	ICD 06100ZR
Hospital Charge Code	2480
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

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All Charges