Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

02104K8

Facility

$10,777.00

Service Code	ICD 02104K8
Hospital Charge Code	124
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

02104K9

Facility

$10,777.00

Service Code	ICD 02104K9
Hospital Charge Code	125
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

02104KC

Facility

$10,777.00

Service Code	ICD 02104KC
Hospital Charge Code	126
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

02104KF

Facility

$10,777.00

Service Code	ICD 02104KF
Hospital Charge Code	127
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

02104KW

Facility

$10,777.00

Service Code	ICD 02104KW
Hospital Charge Code	2854
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

02104Z3

Facility

$10,777.00

Service Code	ICD 02104Z3
Hospital Charge Code	128
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

02104Z8

Facility

$10,777.00

Service Code	ICD 02104Z8
Hospital Charge Code	2855
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

02104Z9

Facility

$10,777.00

Service Code	ICD 02104Z9
Hospital Charge Code	2856
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

02104ZC

Facility

$10,777.00

Service Code	ICD 02104ZC
Hospital Charge Code	2857
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

02104ZF

Facility

$10,777.00

Service Code	ICD 02104ZF
Hospital Charge Code	129
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

0211083

Facility

$10,777.00

Service Code	ICD 0211083
Hospital Charge Code	130
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

0211088

Facility

$10,777.00

Service Code	ICD 0211088
Hospital Charge Code	131
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

0211089

Facility

$10,777.00

Service Code	ICD 0211089
Hospital Charge Code	132
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

021108C

Facility

$10,777.00

Service Code	ICD 021108C
Hospital Charge Code	133
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

021108F

Facility

$10,777.00

Service Code	ICD 021108F
Hospital Charge Code	134
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

021108W

Facility

$10,777.00

Service Code	ICD 021108W
Hospital Charge Code	135
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

0211093

Facility

$10,777.00

Service Code	ICD 0211093
Hospital Charge Code	136
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

0211098

Facility

$10,777.00

Service Code	ICD 0211098
Hospital Charge Code	137
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

0211099

Facility

$10,777.00

Service Code	ICD 0211099
Hospital Charge Code	138
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

021109C

Facility

$10,777.00

Service Code	ICD 021109C
Hospital Charge Code	139
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

021109F

Facility

$10,777.00

Service Code	ICD 021109F
Hospital Charge Code	140
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

021109W

Facility

$10,777.00

Service Code	ICD 021109W
Hospital Charge Code	2858
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

02110A3

Facility

$10,777.00

Service Code	ICD 02110A3
Hospital Charge Code	141
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

02110A8

Facility

$10,777.00

Service Code	ICD 02110A8
Hospital Charge Code	142
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

02110A9

Facility

$10,777.00

Service Code	ICD 02110A9
Hospital Charge Code	143
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

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All Charges