Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

02174KR

Facility

$11,208.00

Service Code	ICD 02174KR
Hospital Charge Code	10325
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

02174KS

Facility

$11,208.00

Service Code	ICD 02174KS
Hospital Charge Code	403
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

02174KT

Facility

$11,208.00

Service Code	ICD 02174KT
Hospital Charge Code	404
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

02174KU

Facility

$11,208.00

Service Code	ICD 02174KU
Hospital Charge Code	405
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

02174ZP

Facility

$11,208.00

Service Code	ICD 02174ZP
Hospital Charge Code	10326
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

02174ZP

Facility

$11,208.00

Service Code	ICD 02174ZP
Hospital Charge Code	2910
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

02174ZQ

Facility

$11,208.00

Service Code	ICD 02174ZQ
Hospital Charge Code	10327
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

02174ZQ

Facility

$11,208.00

Service Code	ICD 02174ZQ
Hospital Charge Code	2911
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

02174ZR

Facility

$11,208.00

Service Code	ICD 02174ZR
Hospital Charge Code	10328
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

02174ZR

Facility

$11,208.00

Service Code	ICD 02174ZR
Hospital Charge Code	2912
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

02174ZS

Facility

$11,208.00

Service Code	ICD 02174ZS
Hospital Charge Code	406
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

02174ZT

Facility

$11,208.00

Service Code	ICD 02174ZT
Hospital Charge Code	407
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

02174ZU

Facility

$11,208.00

Service Code	ICD 02174ZU
Hospital Charge Code	408
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

021K08P

Facility

$11,208.00

Service Code	ICD 021K08P
Hospital Charge Code	409
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

021K08Q

Facility

$11,208.00

Service Code	ICD 021K08Q
Hospital Charge Code	410
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

021K08R

Facility

$11,208.00

Service Code	ICD 021K08R
Hospital Charge Code	411
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

021K09P

Facility

$11,208.00

Service Code	ICD 021K09P
Hospital Charge Code	412
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

021K09P

Facility

$11,208.00

Service Code	ICD 021K09P
Hospital Charge Code	10329
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

021K09Q

Facility

$11,208.00

Service Code	ICD 021K09Q
Hospital Charge Code	10330
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

021K09Q

Facility

$11,208.00

Service Code	ICD 021K09Q
Hospital Charge Code	413
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

021K09R

Facility

$11,208.00

Service Code	ICD 021K09R
Hospital Charge Code	10331
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

021K09R

Facility

$11,208.00

Service Code	ICD 021K09R
Hospital Charge Code	414
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

021K0AP

Facility

$11,208.00

Service Code	ICD 021K0AP
Hospital Charge Code	415
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

021K0AP

Facility

$11,208.00

Service Code	ICD 021K0AP
Hospital Charge Code	10332
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

021K0AQ

Facility

$11,208.00

Service Code	ICD 021K0AQ
Hospital Charge Code	10333
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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