Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

021W0KR

Facility

$11,208.00

Service Code	ICD 021W0KR
Hospital Charge Code	10462
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

021W0KR

Facility

$11,208.00

Service Code	ICD 021W0KR
Hospital Charge Code	3003
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

021W0ZA

Facility

$11,208.00

Service Code	ICD 021W0ZA
Hospital Charge Code	507
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

021W0ZP

Facility

$11,208.00

Service Code	ICD 021W0ZP
Hospital Charge Code	10465
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

021W0ZP

Facility

$11,208.00

Service Code	ICD 021W0ZP
Hospital Charge Code	508
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

021W0ZQ

Facility

$11,208.00

Service Code	ICD 021W0ZQ
Hospital Charge Code	3004
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

021W0ZQ

Facility

$11,208.00

Service Code	ICD 021W0ZQ
Hospital Charge Code	10466
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

021W0ZR

Facility

$11,208.00

Service Code	ICD 021W0ZR
Hospital Charge Code	3005
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

021W0ZR

Facility

$11,208.00

Service Code	ICD 021W0ZR
Hospital Charge Code	10467
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

021W48A

Facility

$11,208.00

Service Code	ICD 021W48A
Hospital Charge Code	509
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

021W48P

Facility

$11,208.00

Service Code	ICD 021W48P
Hospital Charge Code	510
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

021W48Q

Facility

$11,208.00

Service Code	ICD 021W48Q
Hospital Charge Code	3006
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

021W48R

Facility

$11,208.00

Service Code	ICD 021W48R
Hospital Charge Code	3007
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

021W49A

Facility

$11,208.00

Service Code	ICD 021W49A
Hospital Charge Code	511
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

021W49P

Facility

$11,208.00

Service Code	ICD 021W49P
Hospital Charge Code	512
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

021W49P

Facility

$11,208.00

Service Code	ICD 021W49P
Hospital Charge Code	10470
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

021W49Q

Facility

$11,208.00

Service Code	ICD 021W49Q
Hospital Charge Code	3008
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

021W49Q

Facility

$11,208.00

Service Code	ICD 021W49Q
Hospital Charge Code	10471
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

021W49R

Facility

$11,208.00

Service Code	ICD 021W49R
Hospital Charge Code	10472
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

021W49R

Facility

$11,208.00

Service Code	ICD 021W49R
Hospital Charge Code	3009
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

021W4AA

Facility

$11,208.00

Service Code	ICD 021W4AA
Hospital Charge Code	513
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

021W4AP

Facility

$11,208.00

Service Code	ICD 021W4AP
Hospital Charge Code	514
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

021W4AP

Facility

$11,208.00

Service Code	ICD 021W4AP
Hospital Charge Code	10475
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

021W4AQ

Facility

$11,208.00

Service Code	ICD 021W4AQ
Hospital Charge Code	10476
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

021W4AQ

Facility

$11,208.00

Service Code	ICD 021W4AQ
Hospital Charge Code	3010
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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