Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

021W09P

Facility

$11,208.00

Service Code	ICD 021W09P
Hospital Charge Code	500
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

021W09P

Facility

$11,208.00

Service Code	ICD 021W09P
Hospital Charge Code	10445
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

021W09Q

Facility

$11,208.00

Service Code	ICD 021W09Q
Hospital Charge Code	2996
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

021W09Q

Facility

$11,208.00

Service Code	ICD 021W09Q
Hospital Charge Code	10446
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

021W09R

Facility

$11,208.00

Service Code	ICD 021W09R
Hospital Charge Code	10447
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

021W09R

Facility

$11,208.00

Service Code	ICD 021W09R
Hospital Charge Code	2997
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

021W0AA

Facility

$11,208.00

Service Code	ICD 021W0AA
Hospital Charge Code	501
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

021W0AP

Facility

$11,208.00

Service Code	ICD 021W0AP
Hospital Charge Code	502
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

021W0AP

Facility

$11,208.00

Service Code	ICD 021W0AP
Hospital Charge Code	10450
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

021W0AQ

Facility

$11,208.00

Service Code	ICD 021W0AQ
Hospital Charge Code	10451
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

021W0AQ

Facility

$11,208.00

Service Code	ICD 021W0AQ
Hospital Charge Code	2998
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

021W0AR

Facility

$11,208.00

Service Code	ICD 021W0AR
Hospital Charge Code	10452
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

021W0AR

Facility

$11,208.00

Service Code	ICD 021W0AR
Hospital Charge Code	2999
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

021W0JA

Facility

$11,208.00

Service Code	ICD 021W0JA
Hospital Charge Code	503
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

021W0JP

Facility

$11,208.00

Service Code	ICD 021W0JP
Hospital Charge Code	504
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

021W0JP

Facility

$11,208.00

Service Code	ICD 021W0JP
Hospital Charge Code	10455
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

021W0JQ

Facility

$11,208.00

Service Code	ICD 021W0JQ
Hospital Charge Code	10456
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

021W0JQ

Facility

$11,208.00

Service Code	ICD 021W0JQ
Hospital Charge Code	3000
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

021W0JR

Facility

$11,208.00

Service Code	ICD 021W0JR
Hospital Charge Code	10457
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

021W0JR

Facility

$11,208.00

Service Code	ICD 021W0JR
Hospital Charge Code	3001
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

021W0KA

Facility

$11,208.00

Service Code	ICD 021W0KA
Hospital Charge Code	505
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

021W0KP

Facility

$11,208.00

Service Code	ICD 021W0KP
Hospital Charge Code	506
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

021W0KP

Facility

$11,208.00

Service Code	ICD 021W0KP
Hospital Charge Code	10460
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

021W0KQ

Facility

$11,208.00

Service Code	ICD 021W0KQ
Hospital Charge Code	3002
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

021W0KQ

Facility

$11,208.00

Service Code	ICD 021W0KQ
Hospital Charge Code	10461
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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