Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

021L4Z5

Facility

$11,208.00

Service Code	ICD 021L4Z5
Hospital Charge Code	10404
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

021L4Z5

Facility

$11,208.00

Service Code	ICD 021L4Z5
Hospital Charge Code	450
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

021L4Z8

Facility

$11,208.00

Service Code	ICD 021L4Z8
Hospital Charge Code	10405
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

021L4Z8

Facility

$11,208.00

Service Code	ICD 021L4Z8
Hospital Charge Code	451
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

021L4Z9

Facility

$11,208.00

Service Code	ICD 021L4Z9
Hospital Charge Code	10406
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

021L4Z9

Facility

$11,208.00

Service Code	ICD 021L4Z9
Hospital Charge Code	2959
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

021L4ZC

Facility

$11,208.00

Service Code	ICD 021L4ZC
Hospital Charge Code	10407
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

021L4ZC

Facility

$11,208.00

Service Code	ICD 021L4ZC
Hospital Charge Code	2960
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

021L4ZF

Facility

$11,208.00

Service Code	ICD 021L4ZF
Hospital Charge Code	10408
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

021L4ZF

Facility

$11,208.00

Service Code	ICD 021L4ZF
Hospital Charge Code	2961
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

021L4ZP

Facility

$11,208.00

Service Code	ICD 021L4ZP
Hospital Charge Code	10409
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

021L4ZP

Facility

$11,208.00

Service Code	ICD 021L4ZP
Hospital Charge Code	2962
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

021L4ZQ

Facility

$11,208.00

Service Code	ICD 021L4ZQ
Hospital Charge Code	10410
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

021L4ZQ

Facility

$11,208.00

Service Code	ICD 021L4ZQ
Hospital Charge Code	2963
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

021L4ZR

Facility

$11,208.00

Service Code	ICD 021L4ZR
Hospital Charge Code	2964
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

021L4ZR

Facility

$11,208.00

Service Code	ICD 021L4ZR
Hospital Charge Code	10411
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

021L4ZW

Facility

$11,208.00

Service Code	ICD 021L4ZW
Hospital Charge Code	452
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

021L4ZW

Facility

$11,208.00

Service Code	ICD 021L4ZW
Hospital Charge Code	10412
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

021V08P

Facility

$11,208.00

Service Code	ICD 021V08P
Hospital Charge Code	454
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

021V08Q

Facility

$11,208.00

Service Code	ICD 021V08Q
Hospital Charge Code	455
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

021V08R

Facility

$11,208.00

Service Code	ICD 021V08R
Hospital Charge Code	456
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

021V08S

Facility

$11,208.00

Service Code	ICD 021V08S
Hospital Charge Code	457
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

021V08T

Facility

$11,208.00

Service Code	ICD 021V08T
Hospital Charge Code	458
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

021V08U

Facility

$11,208.00

Service Code	ICD 021V08U
Hospital Charge Code	459
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

021V09P

Facility

$11,208.00

Service Code	ICD 021V09P
Hospital Charge Code	2965
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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