Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

021V49P

Facility

$11,208.00

Service Code	ICD 021V49P
Hospital Charge Code	2979
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

021V49P

Facility

$11,208.00

Service Code	ICD 021V49P
Hospital Charge Code	10428
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

021V49Q

Facility

$11,208.00

Service Code	ICD 021V49Q
Hospital Charge Code	2980
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

021V49Q

Facility

$11,208.00

Service Code	ICD 021V49Q
Hospital Charge Code	10429
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

021V49R

Facility

$11,208.00

Service Code	ICD 021V49R
Hospital Charge Code	2981
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

021V49R

Facility

$11,208.00

Service Code	ICD 021V49R
Hospital Charge Code	10430
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

021V49S

Facility

$11,208.00

Service Code	ICD 021V49S
Hospital Charge Code	482
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

021V49T

Facility

$11,208.00

Service Code	ICD 021V49T
Hospital Charge Code	483
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

021V49U

Facility

$11,208.00

Service Code	ICD 021V49U
Hospital Charge Code	484
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

021V4AP

Facility

$11,208.00

Service Code	ICD 021V4AP
Hospital Charge Code	10431
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

021V4AP

Facility

$11,208.00

Service Code	ICD 021V4AP
Hospital Charge Code	2982
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

021V4AQ

Facility

$11,208.00

Service Code	ICD 021V4AQ
Hospital Charge Code	2983
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

021V4AQ

Facility

$11,208.00

Service Code	ICD 021V4AQ
Hospital Charge Code	10432
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

021V4AR

Facility

$11,208.00

Service Code	ICD 021V4AR
Hospital Charge Code	2984
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

021V4AR

Facility

$11,208.00

Service Code	ICD 021V4AR
Hospital Charge Code	10433
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

021V4AS

Facility

$11,208.00

Service Code	ICD 021V4AS
Hospital Charge Code	485
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

021V4AT

Facility

$11,208.00

Service Code	ICD 021V4AT
Hospital Charge Code	486
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

021V4AU

Facility

$11,208.00

Service Code	ICD 021V4AU
Hospital Charge Code	487
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

021V4JP

Facility

$11,208.00

Service Code	ICD 021V4JP
Hospital Charge Code	10434
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

021V4JP

Facility

$11,208.00

Service Code	ICD 021V4JP
Hospital Charge Code	2985
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

021V4JQ

Facility

$11,208.00

Service Code	ICD 021V4JQ
Hospital Charge Code	10435
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

021V4JQ

Facility

$11,208.00

Service Code	ICD 021V4JQ
Hospital Charge Code	2986
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

021V4JR

Facility

$11,208.00

Service Code	ICD 021V4JR
Hospital Charge Code	10436
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

021V4JR

Facility

$11,208.00

Service Code	ICD 021V4JR
Hospital Charge Code	2987
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

021V4JS

Facility

$11,208.00

Service Code	ICD 021V4JS
Hospital Charge Code	488
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