Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

021V4JT

Facility

$11,208.00

Service Code	ICD 021V4JT
Hospital Charge Code	489
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

021V4JU

Facility

$11,208.00

Service Code	ICD 021V4JU
Hospital Charge Code	490
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

021V4KP

Facility

$11,208.00

Service Code	ICD 021V4KP
Hospital Charge Code	2988
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

021V4KP

Facility

$11,208.00

Service Code	ICD 021V4KP
Hospital Charge Code	10437
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

021V4KQ

Facility

$11,208.00

Service Code	ICD 021V4KQ
Hospital Charge Code	2989
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

021V4KQ

Facility

$11,208.00

Service Code	ICD 021V4KQ
Hospital Charge Code	10438
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

021V4KR

Facility

$11,208.00

Service Code	ICD 021V4KR
Hospital Charge Code	10439
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

021V4KR

Facility

$11,208.00

Service Code	ICD 021V4KR
Hospital Charge Code	2990
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

021V4KS

Facility

$11,208.00

Service Code	ICD 021V4KS
Hospital Charge Code	491
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

021V4KT

Facility

$11,208.00

Service Code	ICD 021V4KT
Hospital Charge Code	492
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

021V4KU

Facility

$11,208.00

Service Code	ICD 021V4KU
Hospital Charge Code	493
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

021V4ZP

Facility

$11,208.00

Service Code	ICD 021V4ZP
Hospital Charge Code	10440
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

021V4ZP

Facility

$11,208.00

Service Code	ICD 021V4ZP
Hospital Charge Code	2991
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

021V4ZQ

Facility

$11,208.00

Service Code	ICD 021V4ZQ
Hospital Charge Code	2992
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

021V4ZQ

Facility

$11,208.00

Service Code	ICD 021V4ZQ
Hospital Charge Code	10441
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

021V4ZR

Facility

$11,208.00

Service Code	ICD 021V4ZR
Hospital Charge Code	10442
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

021V4ZR

Facility

$11,208.00

Service Code	ICD 021V4ZR
Hospital Charge Code	2993
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

021V4ZS

Facility

$11,208.00

Service Code	ICD 021V4ZS
Hospital Charge Code	494
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

021V4ZT

Facility

$11,208.00

Service Code	ICD 021V4ZT
Hospital Charge Code	495
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

021V4ZU

Facility

$11,208.00

Service Code	ICD 021V4ZU
Hospital Charge Code	496
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

021W08A

Facility

$11,208.00

Service Code	ICD 021W08A
Hospital Charge Code	497
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

021W08P

Facility

$11,208.00

Service Code	ICD 021W08P
Hospital Charge Code	498
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

021W08Q

Facility

$11,208.00

Service Code	ICD 021W08Q
Hospital Charge Code	2994
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

021W08R

Facility

$11,208.00

Service Code	ICD 021W08R
Hospital Charge Code	2995
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

021W09A

Facility

$11,208.00

Service Code	ICD 021W09A
Hospital Charge Code	499
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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