Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

02104Z9

Facility

$11,208.00

Service Code	ICD 02104Z9
Hospital Charge Code	10078
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

02104Z9

Facility

$11,208.00

Service Code	ICD 02104Z9
Hospital Charge Code	2856
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

02104ZC

Facility

$11,208.00

Service Code	ICD 02104ZC
Hospital Charge Code	2857
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

02104ZC

Facility

$11,208.00

Service Code	ICD 02104ZC
Hospital Charge Code	10079
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

02104ZF

Facility

$11,208.00

Service Code	ICD 02104ZF
Hospital Charge Code	10080
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

02104ZF

Facility

$11,208.00

Service Code	ICD 02104ZF
Hospital Charge Code	129
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

0211083

Facility

$11,208.00

Service Code	ICD 0211083
Hospital Charge Code	130
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

0211088

Facility

$11,208.00

Service Code	ICD 0211088
Hospital Charge Code	131
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

0211089

Facility

$11,208.00

Service Code	ICD 0211089
Hospital Charge Code	132
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

021108C

Facility

$11,208.00

Service Code	ICD 021108C
Hospital Charge Code	133
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

021108F

Facility

$11,208.00

Service Code	ICD 021108F
Hospital Charge Code	134
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

021108W

Facility

$11,208.00

Service Code	ICD 021108W
Hospital Charge Code	135
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

0211093

Facility

$11,208.00

Service Code	ICD 0211093
Hospital Charge Code	10081
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

0211093

Facility

$11,208.00

Service Code	ICD 0211093
Hospital Charge Code	136
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

0211098

Facility

$11,208.00

Service Code	ICD 0211098
Hospital Charge Code	10082
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

0211098

Facility

$11,208.00

Service Code	ICD 0211098
Hospital Charge Code	137
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

0211099

Facility

$11,208.00

Service Code	ICD 0211099
Hospital Charge Code	10083
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

0211099

Facility

$11,208.00

Service Code	ICD 0211099
Hospital Charge Code	138
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

021109C

Facility

$11,208.00

Service Code	ICD 021109C
Hospital Charge Code	139
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

021109C

Facility

$11,208.00

Service Code	ICD 021109C
Hospital Charge Code	10084
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

021109F

Facility

$11,208.00

Service Code	ICD 021109F
Hospital Charge Code	10085
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

021109F

Facility

$11,208.00

Service Code	ICD 021109F
Hospital Charge Code	140
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

021109W

Facility

$11,208.00

Service Code	ICD 021109W
Hospital Charge Code	10086
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

021109W

Facility

$11,208.00

Service Code	ICD 021109W
Hospital Charge Code	2858
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

02110A3

Facility

$11,208.00

Service Code	ICD 02110A3
Hospital Charge Code	10087
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