Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM BRUCELLA AB CONFIRMATION

Facility

$116.41

Service Code	CPT 86622
Hospital Charge Code	900912841
Hospital Revenue Code	302
Min. Negotiated Rate	$64.03
Max. Negotiated Rate	$87.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$69.85
Rate for Payer: Aetna of CA Government/Medicare	$69.85
Rate for Payer: Cash Price	$52.38
Rate for Payer: Health Smart Auto/Commercial	$69.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$69.85
Rate for Payer: LLUH Dept of Risk Management WC	$64.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$87.31

HC SOM BRUCELLA AB IGG

Facility

$20.74

Service Code	CPT 86622 90
Hospital Charge Code	900911628
Hospital Revenue Code	302
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$16.59
Rate for Payer: Cash Price	$9.33
Rate for Payer: Cigna of CA HMO/PPO	$16.59
Rate for Payer: Health Smart Auto/Commercial	$12.44
Rate for Payer: LLUH Dept of Risk Management WC	$11.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.56

HC SOM BRUCELLA AB IGG

Facility

$20.74

Service Code	CPT 86622
Hospital Charge Code	900911628
Hospital Revenue Code	302
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$15.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.44
Rate for Payer: Aetna of CA Government/Medicare	$12.44
Rate for Payer: Cash Price	$9.33
Rate for Payer: Health Smart Auto/Commercial	$12.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.44
Rate for Payer: LLUH Dept of Risk Management WC	$11.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.56

HC SOM BRUCELLA AB IGG

Facility

$20.74

Service Code	CPT 86622
Hospital Charge Code	900911628
Hospital Revenue Code	302
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$16.59
Rate for Payer: Cash Price	$9.33
Rate for Payer: Cigna of CA HMO/PPO	$16.59
Rate for Payer: Health Smart Auto/Commercial	$12.44
Rate for Payer: LLUH Dept of Risk Management WC	$11.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.56

HC SOM BRUCELLA AB IGG

Facility

$20.74

Service Code	CPT 86622 90
Hospital Charge Code	900911628
Hospital Revenue Code	302
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$15.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.44
Rate for Payer: Aetna of CA Government/Medicare	$12.44
Rate for Payer: Cash Price	$9.33
Rate for Payer: Health Smart Auto/Commercial	$12.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.44
Rate for Payer: LLUH Dept of Risk Management WC	$11.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.56

HC SOM BRUCELLA AB IGM

Facility

$20.74

Service Code	CPT 86622
Hospital Charge Code	900912667
Hospital Revenue Code	302
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$15.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.44
Rate for Payer: Aetna of CA Government/Medicare	$12.44
Rate for Payer: Cash Price	$9.33
Rate for Payer: Health Smart Auto/Commercial	$12.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.44
Rate for Payer: LLUH Dept of Risk Management WC	$11.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.56

HC SOM BRUCELLA AB IGM

Facility

$20.74

Service Code	CPT 86622 90
Hospital Charge Code	900912667
Hospital Revenue Code	302
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$15.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.44
Rate for Payer: Aetna of CA Government/Medicare	$12.44
Rate for Payer: Cash Price	$9.33
Rate for Payer: Health Smart Auto/Commercial	$12.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.44
Rate for Payer: LLUH Dept of Risk Management WC	$11.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.56

HC SOM BRUCELLA AB IGM

Facility

$20.74

Service Code	CPT 86622 90
Hospital Charge Code	900912667
Hospital Revenue Code	302
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$16.59
Rate for Payer: Cash Price	$9.33
Rate for Payer: Cigna of CA HMO/PPO	$16.59
Rate for Payer: Health Smart Auto/Commercial	$12.44
Rate for Payer: LLUH Dept of Risk Management WC	$11.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.56

HC SOM BRUCELLA AB IGM

Facility

$20.74

Service Code	CPT 86622
Hospital Charge Code	900912667
Hospital Revenue Code	302
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$16.59
Rate for Payer: Cash Price	$9.33
Rate for Payer: Cigna of CA HMO/PPO	$16.59
Rate for Payer: Health Smart Auto/Commercial	$12.44
Rate for Payer: LLUH Dept of Risk Management WC	$11.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.56

HC SOM C-1 ESTERASE INHIBITOR ACTIVIT

Facility

$18.00

Service Code	CPT 83883
Hospital Charge Code	900911175
Hospital Revenue Code	301
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$14.40
Rate for Payer: Cash Price	$8.10
Rate for Payer: Cigna of CA HMO/PPO	$14.40
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.50

HC SOM C-1 ESTERASE INHIBITOR ACTIVIT

Facility

$18.00

Service Code	CPT 83883 90
Hospital Charge Code	900911175
Hospital Revenue Code	301
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.80
Rate for Payer: Aetna of CA Government/Medicare	$10.80
Rate for Payer: Cash Price	$8.10
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.80
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.50

HC SOM C-1 ESTERASE INHIBITOR ACTIVIT

Facility

$18.00

Service Code	CPT 83883 90
Hospital Charge Code	900911175
Hospital Revenue Code	301
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$14.40
Rate for Payer: Cash Price	$8.10
Rate for Payer: Cigna of CA HMO/PPO	$14.40
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.50

HC SOM C-1 ESTERASE INHIBITOR ACTIVIT

Facility

$18.00

Service Code	CPT 83883
Hospital Charge Code	900911175
Hospital Revenue Code	301
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.80
Rate for Payer: Aetna of CA Government/Medicare	$10.80
Rate for Payer: Cash Price	$8.10
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.80
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.50

HC SOM C1 EXTERASE INHIBITOR FUNCTION

Facility

$30.00

Service Code	CPT 83520
Hospital Charge Code	900912844
Hospital Revenue Code	302
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.00
Rate for Payer: Aetna of CA Government/Medicare	$18.00
Rate for Payer: Cash Price	$13.50
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.50

HC SOM C1 EXTERASE INHIBITOR FUNCTION

Facility

$30.00

Service Code	CPT 83520
Hospital Charge Code	900912844
Hospital Revenue Code	302
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$24.00
Rate for Payer: Cash Price	$13.50
Rate for Payer: Cigna of CA HMO/PPO	$24.00
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.50

HC SOM C1 EXTERASE INHIBITOR FUNCTION

Facility

$30.00

Service Code	CPT 83520 90
Hospital Charge Code	900912844
Hospital Revenue Code	302
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.00
Rate for Payer: Aetna of CA Government/Medicare	$18.00
Rate for Payer: Cash Price	$13.50
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.50

HC SOM C1 EXTERASE INHIBITOR FUNCTION

Facility

$30.00

Service Code	CPT 83520 90
Hospital Charge Code	900912844
Hospital Revenue Code	302
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$24.00
Rate for Payer: Cash Price	$13.50
Rate for Payer: Cigna of CA HMO/PPO	$24.00
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.50

HC SOM CA 27.29

Facility

$14.75

Service Code	CPT 86300
Hospital Charge Code	900911430
Hospital Revenue Code	302
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$11.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.85
Rate for Payer: Aetna of CA Government/Medicare	$8.85
Rate for Payer: Cash Price	$6.64
Rate for Payer: Health Smart Auto/Commercial	$8.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.85
Rate for Payer: LLUH Dept of Risk Management WC	$8.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.06

HC SOM CA 27.29

Facility

$14.75

Service Code	CPT 86300
Hospital Charge Code	900911430
Hospital Revenue Code	302
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$11.80
Rate for Payer: Cash Price	$6.64
Rate for Payer: Cigna of CA HMO/PPO	$11.80
Rate for Payer: Health Smart Auto/Commercial	$8.85
Rate for Payer: LLUH Dept of Risk Management WC	$8.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.06

HC SOM CA 27.29

Facility

$14.75

Service Code	CPT 86300 90
Hospital Charge Code	900911430
Hospital Revenue Code	302
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$11.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.85
Rate for Payer: Aetna of CA Government/Medicare	$8.85
Rate for Payer: Cash Price	$6.64
Rate for Payer: Health Smart Auto/Commercial	$8.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.85
Rate for Payer: LLUH Dept of Risk Management WC	$8.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.06

HC SOM CA 27.29

Facility

$14.75

Service Code	CPT 86300 90
Hospital Charge Code	900911430
Hospital Revenue Code	302
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$11.80
Rate for Payer: Cash Price	$6.64
Rate for Payer: Cigna of CA HMO/PPO	$11.80
Rate for Payer: Health Smart Auto/Commercial	$8.85
Rate for Payer: LLUH Dept of Risk Management WC	$8.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.06

HC SOM CADMIUM WHOLE BLOOD

Facility

$30.00

Service Code	CPT 82300
Hospital Charge Code	900911051
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$24.00
Rate for Payer: Cash Price	$13.50
Rate for Payer: Cigna of CA HMO/PPO	$24.00
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.50

HC SOM CADMIUM WHOLE BLOOD

Facility

$30.00

Service Code	CPT 82300
Hospital Charge Code	900911051
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.00
Rate for Payer: Aetna of CA Government/Medicare	$18.00
Rate for Payer: Cash Price	$13.50
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.50

HC SOM CADMIUM WHOLE BLOOD

Facility

$30.00

Service Code	CPT 82300 90
Hospital Charge Code	900911051
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$24.00
Rate for Payer: Cash Price	$13.50
Rate for Payer: Cigna of CA HMO/PPO	$24.00
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.50

HC SOM CADMIUM WHOLE BLOOD

Facility

$30.00

Service Code	CPT 82300 90
Hospital Charge Code	900911051
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.00
Rate for Payer: Aetna of CA Government/Medicare	$18.00
Rate for Payer: Cash Price	$13.50
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.50

Know your out-of-pocket cost for care.

All Charges