Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM BARBITURATE CONFIRM, U

Facility

$61.25

Service Code	CPT G0480
Hospital Charge Code	900912916
Hospital Revenue Code	301
Min. Negotiated Rate	$33.69
Max. Negotiated Rate	$45.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$36.75
Rate for Payer: Aetna of CA Government/Medicare	$36.75
Rate for Payer: Cash Price	$27.56
Rate for Payer: Health Smart Auto/Commercial	$36.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$36.75
Rate for Payer: LLUH Dept of Risk Management WC	$33.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.94

HC SOM BARBITURATE CONFIRM, U

Facility

$61.25

Service Code	CPT 80345
Hospital Charge Code	900912916
Hospital Revenue Code	301
Min. Negotiated Rate	$33.69
Max. Negotiated Rate	$45.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$36.75
Rate for Payer: Aetna of CA Government/Medicare	$36.75
Rate for Payer: Cash Price	$27.56
Rate for Payer: Health Smart Auto/Commercial	$36.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$36.75
Rate for Payer: LLUH Dept of Risk Management WC	$33.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.94

HC SOM BARBITURATE CONFIRM, U

Facility

$61.25

Service Code	CPT G0480 90
Hospital Charge Code	900912916
Hospital Revenue Code	301
Min. Negotiated Rate	$33.69
Max. Negotiated Rate	$49.00
Rate for Payer: Cash Price	$27.56
Rate for Payer: Cigna of CA HMO/PPO	$49.00
Rate for Payer: Health Smart Auto/Commercial	$36.75
Rate for Payer: LLUH Dept of Risk Management WC	$33.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.94

HC SOM BARTONELLA HENSELAE AB IGG

Facility

$9.83

Service Code	CPT 86611
Hospital Charge Code	900911386
Hospital Revenue Code	302
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$7.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.90
Rate for Payer: Aetna of CA Government/Medicare	$5.90
Rate for Payer: Cash Price	$4.42
Rate for Payer: Health Smart Auto/Commercial	$5.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.90
Rate for Payer: LLUH Dept of Risk Management WC	$5.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.37

HC SOM BARTONELLA HENSELAE AB IGG

Facility

$9.83

Service Code	CPT 86611
Hospital Charge Code	900911386
Hospital Revenue Code	302
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$7.86
Rate for Payer: Cash Price	$4.42
Rate for Payer: Cigna of CA HMO/PPO	$7.86
Rate for Payer: Health Smart Auto/Commercial	$5.90
Rate for Payer: LLUH Dept of Risk Management WC	$5.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.37

HC SOM BARTONELLA HENSELAE AB IGG

Facility

$9.83

Service Code	CPT 86611 90
Hospital Charge Code	900911386
Hospital Revenue Code	302
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$7.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.90
Rate for Payer: Aetna of CA Government/Medicare	$5.90
Rate for Payer: Cash Price	$4.42
Rate for Payer: Health Smart Auto/Commercial	$5.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.90
Rate for Payer: LLUH Dept of Risk Management WC	$5.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.37

HC SOM BARTONELLA HENSELAE AB IGG

Facility

$9.83

Service Code	CPT 86611 90
Hospital Charge Code	900911386
Hospital Revenue Code	302
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$7.86
Rate for Payer: Cash Price	$4.42
Rate for Payer: Cigna of CA HMO/PPO	$7.86
Rate for Payer: Health Smart Auto/Commercial	$5.90
Rate for Payer: LLUH Dept of Risk Management WC	$5.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.37

HC SOM BARTONELLA HENSELAE AB IGM

Facility

$9.83

Service Code	CPT 86611 90
Hospital Charge Code	900912690
Hospital Revenue Code	302
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$7.86
Rate for Payer: Cash Price	$4.42
Rate for Payer: Cigna of CA HMO/PPO	$7.86
Rate for Payer: Health Smart Auto/Commercial	$5.90
Rate for Payer: LLUH Dept of Risk Management WC	$5.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.37

HC SOM BARTONELLA HENSELAE AB IGM

Facility

$9.83

Service Code	CPT 86611
Hospital Charge Code	900912690
Hospital Revenue Code	302
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$7.86
Rate for Payer: Cash Price	$4.42
Rate for Payer: Cigna of CA HMO/PPO	$7.86
Rate for Payer: Health Smart Auto/Commercial	$5.90
Rate for Payer: LLUH Dept of Risk Management WC	$5.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.37

HC SOM BARTONELLA HENSELAE AB IGM

Facility

$9.83

Service Code	CPT 86611 90
Hospital Charge Code	900912690
Hospital Revenue Code	302
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$7.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.90
Rate for Payer: Aetna of CA Government/Medicare	$5.90
Rate for Payer: Cash Price	$4.42
Rate for Payer: Health Smart Auto/Commercial	$5.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.90
Rate for Payer: LLUH Dept of Risk Management WC	$5.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.37

HC SOM BARTONELLA HENSELAE AB IGM

Facility

$9.83

Service Code	CPT 86611
Hospital Charge Code	900912690
Hospital Revenue Code	302
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$7.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.90
Rate for Payer: Aetna of CA Government/Medicare	$5.90
Rate for Payer: Cash Price	$4.42
Rate for Payer: Health Smart Auto/Commercial	$5.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.90
Rate for Payer: LLUH Dept of Risk Management WC	$5.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.37

HC SOM BARTONELLA QUINTANA AB IGG

Facility

$9.83

Service Code	CPT 86611
Hospital Charge Code	900912691
Hospital Revenue Code	302
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$7.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.90
Rate for Payer: Aetna of CA Government/Medicare	$5.90
Rate for Payer: Cash Price	$4.42
Rate for Payer: Health Smart Auto/Commercial	$5.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.90
Rate for Payer: LLUH Dept of Risk Management WC	$5.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.37

HC SOM BARTONELLA QUINTANA AB IGG

Facility

$9.83

Service Code	CPT 86611 90
Hospital Charge Code	900912691
Hospital Revenue Code	302
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$7.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.90
Rate for Payer: Aetna of CA Government/Medicare	$5.90
Rate for Payer: Cash Price	$4.42
Rate for Payer: Health Smart Auto/Commercial	$5.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.90
Rate for Payer: LLUH Dept of Risk Management WC	$5.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.37

HC SOM BARTONELLA QUINTANA AB IGG

Facility

$9.83

Service Code	CPT 86611 90
Hospital Charge Code	900912691
Hospital Revenue Code	302
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$7.86
Rate for Payer: Cash Price	$4.42
Rate for Payer: Cigna of CA HMO/PPO	$7.86
Rate for Payer: Health Smart Auto/Commercial	$5.90
Rate for Payer: LLUH Dept of Risk Management WC	$5.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.37

HC SOM BARTONELLA QUINTANA AB IGG

Facility

$9.83

Service Code	CPT 86611
Hospital Charge Code	900912691
Hospital Revenue Code	302
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$7.86
Rate for Payer: Cash Price	$4.42
Rate for Payer: Cigna of CA HMO/PPO	$7.86
Rate for Payer: Health Smart Auto/Commercial	$5.90
Rate for Payer: LLUH Dept of Risk Management WC	$5.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.37

HC SOM BARTONELLA QUINTANA AB IGM

Facility

$9.83

Service Code	CPT 86611
Hospital Charge Code	900912692
Hospital Revenue Code	302
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$7.86
Rate for Payer: Cash Price	$4.42
Rate for Payer: Cigna of CA HMO/PPO	$7.86
Rate for Payer: Health Smart Auto/Commercial	$5.90
Rate for Payer: LLUH Dept of Risk Management WC	$5.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.37

HC SOM BARTONELLA QUINTANA AB IGM

Facility

$9.83

Service Code	CPT 86611
Hospital Charge Code	900912692
Hospital Revenue Code	302
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$7.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.90
Rate for Payer: Aetna of CA Government/Medicare	$5.90
Rate for Payer: Cash Price	$4.42
Rate for Payer: Health Smart Auto/Commercial	$5.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.90
Rate for Payer: LLUH Dept of Risk Management WC	$5.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.37

HC SOM BARTONELLA QUINTANA AB IGM

Facility

$9.83

Service Code	CPT 86611 90
Hospital Charge Code	900912692
Hospital Revenue Code	302
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$7.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.90
Rate for Payer: Aetna of CA Government/Medicare	$5.90
Rate for Payer: Cash Price	$4.42
Rate for Payer: Health Smart Auto/Commercial	$5.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.90
Rate for Payer: LLUH Dept of Risk Management WC	$5.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.37

HC SOM BARTONELLA QUINTANA AB IGM

Facility

$9.83

Service Code	CPT 86611 90
Hospital Charge Code	900912692
Hospital Revenue Code	302
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$7.86
Rate for Payer: Cash Price	$4.42
Rate for Payer: Cigna of CA HMO/PPO	$7.86
Rate for Payer: Health Smart Auto/Commercial	$5.90
Rate for Payer: LLUH Dept of Risk Management WC	$5.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.37

HC SOM B-CELL LYMPH FISH INTERP

Facility

$254.50

Service Code	CPT 88291 90
Hospital Charge Code	900914116
Hospital Revenue Code	310
Min. Negotiated Rate	$139.98
Max. Negotiated Rate	$203.60
Rate for Payer: Cash Price	$114.53
Rate for Payer: Cigna of CA HMO/PPO	$203.60
Rate for Payer: Health Smart Auto/Commercial	$152.70
Rate for Payer: LLUH Dept of Risk Management WC	$139.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$190.88

HC SOM B-CELL LYMPH FISH INTERP

Facility

$254.50

Service Code	CPT 88291 90
Hospital Charge Code	900914116
Hospital Revenue Code	310
Min. Negotiated Rate	$139.98
Max. Negotiated Rate	$190.88
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$152.70
Rate for Payer: Aetna of CA Government/Medicare	$152.70
Rate for Payer: Cash Price	$114.53
Rate for Payer: Health Smart Auto/Commercial	$152.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$152.70
Rate for Payer: LLUH Dept of Risk Management WC	$139.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$190.88

HC SOM B-CELL LYMPH FISH INTERP

Facility

$254.50

Service Code	CPT 88291
Hospital Charge Code	900914116
Hospital Revenue Code	310
Min. Negotiated Rate	$139.98
Max. Negotiated Rate	$190.88
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$152.70
Rate for Payer: Aetna of CA Government/Medicare	$152.70
Rate for Payer: Cash Price	$114.53
Rate for Payer: Health Smart Auto/Commercial	$152.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$152.70
Rate for Payer: LLUH Dept of Risk Management WC	$139.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$190.88

HC SOM B-CELL LYMPH FISH INTERP

Facility

$254.50

Service Code	CPT 88291
Hospital Charge Code	900914116
Hospital Revenue Code	310
Min. Negotiated Rate	$139.98
Max. Negotiated Rate	$203.60
Rate for Payer: Cash Price	$114.53
Rate for Payer: Cigna of CA HMO/PPO	$203.60
Rate for Payer: Health Smart Auto/Commercial	$152.70
Rate for Payer: LLUH Dept of Risk Management WC	$139.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$190.88

HC SOM BCR ABL MUTAT ASPE

Facility

$435.08

Service Code	CPT 81403 90
Hospital Charge Code	900914536
Hospital Revenue Code	301
Min. Negotiated Rate	$239.29
Max. Negotiated Rate	$326.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$261.05
Rate for Payer: Aetna of CA Government/Medicare	$261.05
Rate for Payer: Cash Price	$195.79
Rate for Payer: Health Smart Auto/Commercial	$261.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$261.05
Rate for Payer: LLUH Dept of Risk Management WC	$239.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$326.31

HC SOM BCR ABL MUTAT ASPE

Facility

$435.08

Service Code	CPT 81403
Hospital Charge Code	900914536
Hospital Revenue Code	309
Min. Negotiated Rate	$239.29
Max. Negotiated Rate	$326.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$261.05
Rate for Payer: Aetna of CA Government/Medicare	$261.05
Rate for Payer: Cash Price	$195.79
Rate for Payer: Health Smart Auto/Commercial	$261.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$261.05
Rate for Payer: LLUH Dept of Risk Management WC	$239.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$326.31

Know your out-of-pocket cost for care.

All Charges