Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

021X08Q

Facility

$11,208.00

Service Code	ICD 021X08Q
Hospital Charge Code	3018
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

021X08R

Facility

$11,208.00

Service Code	ICD 021X08R
Hospital Charge Code	3019
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

021X09A

Facility

$11,208.00

Service Code	ICD 021X09A
Hospital Charge Code	523
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

021X09P

Facility

$11,208.00

Service Code	ICD 021X09P
Hospital Charge Code	524
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

021X09Q

Facility

$11,208.00

Service Code	ICD 021X09Q
Hospital Charge Code	3020
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

021X09R

Facility

$11,208.00

Service Code	ICD 021X09R
Hospital Charge Code	3021
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

021X0AA

Facility

$11,208.00

Service Code	ICD 021X0AA
Hospital Charge Code	525
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

021X0AP

Facility

$11,208.00

Service Code	ICD 021X0AP
Hospital Charge Code	526
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

021X0AQ

Facility

$11,208.00

Service Code	ICD 021X0AQ
Hospital Charge Code	3022
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

021X0AR

Facility

$11,208.00

Service Code	ICD 021X0AR
Hospital Charge Code	3023
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

021X0JA

Facility

$11,208.00

Service Code	ICD 021X0JA
Hospital Charge Code	527
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

021X0JP

Facility

$11,208.00

Service Code	ICD 021X0JP
Hospital Charge Code	528
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

021X0JQ

Facility

$11,208.00

Service Code	ICD 021X0JQ
Hospital Charge Code	3024
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

021X0JR

Facility

$11,208.00

Service Code	ICD 021X0JR
Hospital Charge Code	3025
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

021X0KA

Facility

$11,208.00

Service Code	ICD 021X0KA
Hospital Charge Code	529
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

021X0KP

Facility

$11,208.00

Service Code	ICD 021X0KP
Hospital Charge Code	530
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

021X0KQ

Facility

$11,208.00

Service Code	ICD 021X0KQ
Hospital Charge Code	3026
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

021X0KR

Facility

$11,208.00

Service Code	ICD 021X0KR
Hospital Charge Code	3027
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

021X0ZA

Facility

$11,208.00

Service Code	ICD 021X0ZA
Hospital Charge Code	531
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

021X0ZP

Facility

$11,208.00

Service Code	ICD 021X0ZP
Hospital Charge Code	532
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

021X0ZQ

Facility

$11,208.00

Service Code	ICD 021X0ZQ
Hospital Charge Code	3028
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

021X0ZR

Facility

$11,208.00

Service Code	ICD 021X0ZR
Hospital Charge Code	3029
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

021X48A

Facility

$11,208.00

Service Code	ICD 021X48A
Hospital Charge Code	533
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

021X48P

Facility

$11,208.00

Service Code	ICD 021X48P
Hospital Charge Code	534
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

021X48Q

Facility

$11,208.00

Service Code	ICD 021X48Q
Hospital Charge Code	3030
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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