Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

021V09T

Facility

$10,777.00

Service Code	ICD 021V09T
Hospital Charge Code	461
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

021V09U

Facility

$10,777.00

Service Code	ICD 021V09U
Hospital Charge Code	462
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

021V0AP

Facility

$10,777.00

Service Code	ICD 021V0AP
Hospital Charge Code	463
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

021V0AQ

Facility

$10,777.00

Service Code	ICD 021V0AQ
Hospital Charge Code	2968
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

021V0AR

Facility

$10,777.00

Service Code	ICD 021V0AR
Hospital Charge Code	2969
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

021V0AS

Facility

$10,777.00

Service Code	ICD 021V0AS
Hospital Charge Code	464
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

021V0AT

Facility

$10,777.00

Service Code	ICD 021V0AT
Hospital Charge Code	465
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

021V0AU

Facility

$10,777.00

Service Code	ICD 021V0AU
Hospital Charge Code	466
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

021V0JP

Facility

$10,777.00

Service Code	ICD 021V0JP
Hospital Charge Code	2970
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

021V0JQ

Facility

$10,777.00

Service Code	ICD 021V0JQ
Hospital Charge Code	2971
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

021V0JR

Facility

$10,777.00

Service Code	ICD 021V0JR
Hospital Charge Code	2972
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

021V0JS

Facility

$10,777.00

Service Code	ICD 021V0JS
Hospital Charge Code	467
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

021V0JT

Facility

$10,777.00

Service Code	ICD 021V0JT
Hospital Charge Code	468
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

021V0JU

Facility

$10,777.00

Service Code	ICD 021V0JU
Hospital Charge Code	469
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

021V0KP

Facility

$10,777.00

Service Code	ICD 021V0KP
Hospital Charge Code	2973
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

021V0KQ

Facility

$10,777.00

Service Code	ICD 021V0KQ
Hospital Charge Code	2974
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

021V0KR

Facility

$10,777.00

Service Code	ICD 021V0KR
Hospital Charge Code	2975
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

021V0KS

Facility

$10,777.00

Service Code	ICD 021V0KS
Hospital Charge Code	470
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

021V0KT

Facility

$10,777.00

Service Code	ICD 021V0KT
Hospital Charge Code	471
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

021V0KU

Facility

$10,777.00

Service Code	ICD 021V0KU
Hospital Charge Code	472
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

021V0ZP

Facility

$10,777.00

Service Code	ICD 021V0ZP
Hospital Charge Code	2976
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

021V0ZQ

Facility

$10,777.00

Service Code	ICD 021V0ZQ
Hospital Charge Code	2977
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

021V0ZR

Facility

$10,777.00

Service Code	ICD 021V0ZR
Hospital Charge Code	2978
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

021V0ZS

Facility

$10,777.00

Service Code	ICD 021V0ZS
Hospital Charge Code	473
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

021V0ZT

Facility

$10,777.00

Service Code	ICD 021V0ZT
Hospital Charge Code	474
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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