Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

02170KT

Facility

$11,208.00

Service Code	ICD 02170KT
Hospital Charge Code	376
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

02170KU

Facility

$11,208.00

Service Code	ICD 02170KU
Hospital Charge Code	377
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

02170ZP

Facility

$11,208.00

Service Code	ICD 02170ZP
Hospital Charge Code	10311
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

02170ZP

Facility

$11,208.00

Service Code	ICD 02170ZP
Hospital Charge Code	378
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

02170ZQ

Facility

$11,208.00

Service Code	ICD 02170ZQ
Hospital Charge Code	379
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

02170ZQ

Facility

$11,208.00

Service Code	ICD 02170ZQ
Hospital Charge Code	10312
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

02170ZR

Facility

$11,208.00

Service Code	ICD 02170ZR
Hospital Charge Code	10313
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

02170ZR

Facility

$11,208.00

Service Code	ICD 02170ZR
Hospital Charge Code	380
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

02170ZS

Facility

$11,208.00

Service Code	ICD 02170ZS
Hospital Charge Code	381
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

02170ZT

Facility

$11,208.00

Service Code	ICD 02170ZT
Hospital Charge Code	382
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

02170ZU

Facility

$11,208.00

Service Code	ICD 02170ZU
Hospital Charge Code	383
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

02173J6

Facility

$11,208.00

Service Code	ICD 02173J6
Hospital Charge Code	384
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

021748P

Facility

$11,208.00

Service Code	ICD 021748P
Hospital Charge Code	385
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

021748Q

Facility

$11,208.00

Service Code	ICD 021748Q
Hospital Charge Code	386
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

021748R

Facility

$11,208.00

Service Code	ICD 021748R
Hospital Charge Code	387
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

021748S

Facility

$11,208.00

Service Code	ICD 021748S
Hospital Charge Code	388
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

021748T

Facility

$11,208.00

Service Code	ICD 021748T
Hospital Charge Code	389
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

021748U

Facility

$11,208.00

Service Code	ICD 021748U
Hospital Charge Code	390
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

021749P

Facility

$11,208.00

Service Code	ICD 021749P
Hospital Charge Code	10314
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

021749P

Facility

$11,208.00

Service Code	ICD 021749P
Hospital Charge Code	2901
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

021749Q

Facility

$11,208.00

Service Code	ICD 021749Q
Hospital Charge Code	10315
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

021749Q

Facility

$11,208.00

Service Code	ICD 021749Q
Hospital Charge Code	2902
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

021749R

Facility

$11,208.00

Service Code	ICD 021749R
Hospital Charge Code	2903
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

021749R

Facility

$11,208.00

Service Code	ICD 021749R
Hospital Charge Code	10316
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

021749S

Facility

$11,208.00

Service Code	ICD 021749S
Hospital Charge Code	391
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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