Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

021X48R

Facility

$11,208.00

Service Code	ICD 021X48R
Hospital Charge Code	3031
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

021X49A

Facility

$11,208.00

Service Code	ICD 021X49A
Hospital Charge Code	535
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

021X49P

Facility

$11,208.00

Service Code	ICD 021X49P
Hospital Charge Code	536
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

021X49Q

Facility

$11,208.00

Service Code	ICD 021X49Q
Hospital Charge Code	3032
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

021X49R

Facility

$11,208.00

Service Code	ICD 021X49R
Hospital Charge Code	3033
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

021X4AA

Facility

$11,208.00

Service Code	ICD 021X4AA
Hospital Charge Code	537
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

021X4AP

Facility

$11,208.00

Service Code	ICD 021X4AP
Hospital Charge Code	538
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

021X4AQ

Facility

$11,208.00

Service Code	ICD 021X4AQ
Hospital Charge Code	3034
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

021X4AR

Facility

$11,208.00

Service Code	ICD 021X4AR
Hospital Charge Code	3035
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

021X4JA

Facility

$11,208.00

Service Code	ICD 021X4JA
Hospital Charge Code	539
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

021X4JP

Facility

$11,208.00

Service Code	ICD 021X4JP
Hospital Charge Code	540
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

021X4JQ

Facility

$11,208.00

Service Code	ICD 021X4JQ
Hospital Charge Code	3036
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

021X4JR

Facility

$11,208.00

Service Code	ICD 021X4JR
Hospital Charge Code	3037
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

021X4KA

Facility

$11,208.00

Service Code	ICD 021X4KA
Hospital Charge Code	541
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

021X4KP

Facility

$11,208.00

Service Code	ICD 021X4KP
Hospital Charge Code	542
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

021X4KQ

Facility

$11,208.00

Service Code	ICD 021X4KQ
Hospital Charge Code	3038
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

021X4KR

Facility

$11,208.00

Service Code	ICD 021X4KR
Hospital Charge Code	3039
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

021X4ZA

Facility

$11,208.00

Service Code	ICD 021X4ZA
Hospital Charge Code	543
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

021X4ZP

Facility

$11,208.00

Service Code	ICD 021X4ZP
Hospital Charge Code	544
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

021X4ZQ

Facility

$11,208.00

Service Code	ICD 021X4ZQ
Hospital Charge Code	3040
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

021X4ZR

Facility

$11,208.00

Service Code	ICD 021X4ZR
Hospital Charge Code	3041
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

024F07J

Facility

$11,208.00

Service Code	ICD 024F07J
Hospital Charge Code	545
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

024F08J

Facility

$11,208.00

Service Code	ICD 024F08J
Hospital Charge Code	546
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

024F0JJ

Facility

$11,208.00

Service Code	ICD 024F0JJ
Hospital Charge Code	547
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

024F0KJ

Facility

$11,208.00

Service Code	ICD 024F0KJ
Hospital Charge Code	548
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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All Charges