Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

02H00YZ

Facility

$11,208.00

Service Code	ICD 02H00YZ
Hospital Charge Code	1047
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

02H03DZ

Facility

$4,070.00

Service Code	ICD 02H03DZ
Hospital Charge Code	3149
Min. Negotiated Rate	$4,070.00
Max. Negotiated Rate	$4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,070.00

02H03YZ

Facility

$11,208.00

Service Code	ICD 02H03YZ
Hospital Charge Code	1048
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

02H04DZ

Facility

$4,070.00

Service Code	ICD 02H04DZ
Hospital Charge Code	3150
Min. Negotiated Rate	$4,070.00
Max. Negotiated Rate	$4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,070.00

02H04YZ

Facility

$11,208.00

Service Code	ICD 02H04YZ
Hospital Charge Code	1049
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

02H10DZ

Facility

$4,070.00

Service Code	ICD 02H10DZ
Hospital Charge Code	3151
Min. Negotiated Rate	$4,070.00
Max. Negotiated Rate	$4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,070.00

02H10YZ

Facility

$11,208.00

Service Code	ICD 02H10YZ
Hospital Charge Code	1050
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

02H13DZ

Facility

$4,070.00

Service Code	ICD 02H13DZ
Hospital Charge Code	3152
Min. Negotiated Rate	$4,070.00
Max. Negotiated Rate	$4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,070.00

02H13YZ

Facility

$11,208.00

Service Code	ICD 02H13YZ
Hospital Charge Code	1051
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

02H14DZ

Facility

$4,070.00

Service Code	ICD 02H14DZ
Hospital Charge Code	3153
Min. Negotiated Rate	$4,070.00
Max. Negotiated Rate	$4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,070.00

02H14YZ

Facility

$11,208.00

Service Code	ICD 02H14YZ
Hospital Charge Code	1052
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

02H20DZ

Facility

$4,070.00

Service Code	ICD 02H20DZ
Hospital Charge Code	3154
Min. Negotiated Rate	$4,070.00
Max. Negotiated Rate	$4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,070.00

02H20YZ

Facility

$11,208.00

Service Code	ICD 02H20YZ
Hospital Charge Code	1053
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

02H23DZ

Facility

$4,070.00

Service Code	ICD 02H23DZ
Hospital Charge Code	3155
Min. Negotiated Rate	$4,070.00
Max. Negotiated Rate	$4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,070.00

02H23YZ

Facility

$11,208.00

Service Code	ICD 02H23YZ
Hospital Charge Code	1054
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

02H24DZ

Facility

$4,070.00

Service Code	ICD 02H24DZ
Hospital Charge Code	3156
Min. Negotiated Rate	$4,070.00
Max. Negotiated Rate	$4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,070.00

02H24YZ

Facility

$11,208.00

Service Code	ICD 02H24YZ
Hospital Charge Code	1055
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

02H30DZ

Facility

$4,070.00

Service Code	ICD 02H30DZ
Hospital Charge Code	3157
Min. Negotiated Rate	$4,070.00
Max. Negotiated Rate	$4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,070.00

02H30YZ

Facility

$11,208.00

Service Code	ICD 02H30YZ
Hospital Charge Code	1056
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

02H33DZ

Facility

$4,070.00

Service Code	ICD 02H33DZ
Hospital Charge Code	3158
Min. Negotiated Rate	$4,070.00
Max. Negotiated Rate	$4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,070.00

02H33YZ

Facility

$11,208.00

Service Code	ICD 02H33YZ
Hospital Charge Code	1057
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

02H34DZ

Facility

$4,070.00

Service Code	ICD 02H34DZ
Hospital Charge Code	3159
Min. Negotiated Rate	$4,070.00
Max. Negotiated Rate	$4,070.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,070.00

02H34YZ

Facility

$11,208.00

Service Code	ICD 02H34YZ
Hospital Charge Code	1058
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

02H400Z

Facility

$11,208.00

Service Code	ICD 02H400Z
Hospital Charge Code	1059
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

02H402Z

Facility

$11,208.00

Service Code	ICD 02H402Z
Hospital Charge Code	1060
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