Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

021W4AR

Facility

$11,208.00

Service Code	ICD 021W4AR
Hospital Charge Code	3011
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

021W4AR

Facility

$11,208.00

Service Code	ICD 021W4AR
Hospital Charge Code	10477
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

021W4JA

Facility

$11,208.00

Service Code	ICD 021W4JA
Hospital Charge Code	515
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

021W4JP

Facility

$11,208.00

Service Code	ICD 021W4JP
Hospital Charge Code	10480
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

021W4JP

Facility

$11,208.00

Service Code	ICD 021W4JP
Hospital Charge Code	516
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

021W4JQ

Facility

$11,208.00

Service Code	ICD 021W4JQ
Hospital Charge Code	10481
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

021W4JQ

Facility

$11,208.00

Service Code	ICD 021W4JQ
Hospital Charge Code	3012
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

021W4JR

Facility

$11,208.00

Service Code	ICD 021W4JR
Hospital Charge Code	10482
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

021W4JR

Facility

$11,208.00

Service Code	ICD 021W4JR
Hospital Charge Code	3013
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

021W4KA

Facility

$11,208.00

Service Code	ICD 021W4KA
Hospital Charge Code	517
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

021W4KP

Facility

$11,208.00

Service Code	ICD 021W4KP
Hospital Charge Code	10485
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

021W4KP

Facility

$11,208.00

Service Code	ICD 021W4KP
Hospital Charge Code	518
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

021W4KQ

Facility

$11,208.00

Service Code	ICD 021W4KQ
Hospital Charge Code	3014
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

021W4KQ

Facility

$11,208.00

Service Code	ICD 021W4KQ
Hospital Charge Code	10486
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

021W4KR

Facility

$11,208.00

Service Code	ICD 021W4KR
Hospital Charge Code	3015
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

021W4KR

Facility

$11,208.00

Service Code	ICD 021W4KR
Hospital Charge Code	10487
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

021W4ZA

Facility

$11,208.00

Service Code	ICD 021W4ZA
Hospital Charge Code	519
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

021W4ZP

Facility

$11,208.00

Service Code	ICD 021W4ZP
Hospital Charge Code	520
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

021W4ZP

Facility

$11,208.00

Service Code	ICD 021W4ZP
Hospital Charge Code	10490
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

021W4ZQ

Facility

$11,208.00

Service Code	ICD 021W4ZQ
Hospital Charge Code	3016
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

021W4ZQ

Facility

$11,208.00

Service Code	ICD 021W4ZQ
Hospital Charge Code	10491
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

021W4ZR

Facility

$11,208.00

Service Code	ICD 021W4ZR
Hospital Charge Code	3017
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

021W4ZR

Facility

$11,208.00

Service Code	ICD 021W4ZR
Hospital Charge Code	10492
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

021X08A

Facility

$11,208.00

Service Code	ICD 021X08A
Hospital Charge Code	521
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

021X08P

Facility

$11,208.00

Service Code	ICD 021X08P
Hospital Charge Code	522
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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