Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM COCCI AB IGG CSF BY CF

Facility

$12.00

Service Code	CPT 86635
Hospital Charge Code	900911338
Hospital Revenue Code	302
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.60
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cigna of CA HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

HC SOM COCCI AB IGG CSF BY CF

Facility

$12.00

Service Code	CPT 86635
Hospital Charge Code	900911338
Hospital Revenue Code	302
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.20
Rate for Payer: Aetna of CA Government/Medicare	$7.20
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

HC SOM COCCI AB IGG CSF BY CF

Facility

$12.00

Service Code	CPT 86635 90
Hospital Charge Code	900911338
Hospital Revenue Code	302
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.60
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cigna of CA HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

HC SOM COCCI AB IGG CSF BY ID

Facility

$13.00

Service Code	CPT 86635
Hospital Charge Code	900912666
Hospital Revenue Code	302
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$10.40
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cigna of CA HMO/PPO	$10.40
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC SOM COCCI AB IGG CSF BY ID

Facility

$13.00

Service Code	CPT 86635
Hospital Charge Code	900912666
Hospital Revenue Code	302
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.80
Rate for Payer: Aetna of CA Government/Medicare	$7.80
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC SOM COCCI AB IGG CSF BY ID

Facility

$13.00

Service Code	CPT 86635 90
Hospital Charge Code	900912666
Hospital Revenue Code	302
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.80
Rate for Payer: Aetna of CA Government/Medicare	$7.80
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC SOM COCCI AB IGG CSF BY ID

Facility

$13.00

Service Code	CPT 86635 90
Hospital Charge Code	900912666
Hospital Revenue Code	302
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$10.40
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cigna of CA HMO/PPO	$10.40
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC SOM COCCI AB IGM CSF BY ID

Facility

$13.00

Service Code	CPT 86635 90
Hospital Charge Code	900912665
Hospital Revenue Code	302
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.80
Rate for Payer: Aetna of CA Government/Medicare	$7.80
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC SOM COCCI AB IGM CSF BY ID

Facility

$13.00

Service Code	CPT 86635
Hospital Charge Code	900912665
Hospital Revenue Code	302
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$10.40
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cigna of CA HMO/PPO	$10.40
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC SOM COCCI AB IGM CSF BY ID

Facility

$13.00

Service Code	CPT 86635
Hospital Charge Code	900912665
Hospital Revenue Code	302
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.80
Rate for Payer: Aetna of CA Government/Medicare	$7.80
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC SOM COCCI AB IGM CSF BY ID

Facility

$13.00

Service Code	CPT 86635 90
Hospital Charge Code	900912665
Hospital Revenue Code	302
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$10.40
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cigna of CA HMO/PPO	$10.40
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC SOM COCCIDIOIDES AB IGG BY CF

Facility

$13.00

Service Code	CPT 86635 90
Hospital Charge Code	900912669
Hospital Revenue Code	302
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$10.40
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cigna of CA HMO/PPO	$10.40
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC SOM COCCIDIOIDES AB IGG BY CF

Facility

$13.00

Service Code	CPT 86635
Hospital Charge Code	900912669
Hospital Revenue Code	302
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$10.40
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cigna of CA HMO/PPO	$10.40
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC SOM COCCIDIOIDES AB IGG BY CF

Facility

$13.00

Service Code	CPT 86635 90
Hospital Charge Code	900912669
Hospital Revenue Code	302
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.80
Rate for Payer: Aetna of CA Government/Medicare	$7.80
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC SOM COCCIDIOIDES AB IGG BY CF

Facility

$13.00

Service Code	CPT 86635
Hospital Charge Code	900912669
Hospital Revenue Code	302
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.80
Rate for Payer: Aetna of CA Government/Medicare	$7.80
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC SOM COCCIDIOIDES AB IGG BY ID

Facility

$13.50

Service Code	CPT 86635
Hospital Charge Code	900911752
Hospital Revenue Code	302
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$10.80
Rate for Payer: Cash Price	$6.08
Rate for Payer: Cigna of CA HMO/PPO	$10.80
Rate for Payer: Health Smart Auto/Commercial	$8.10
Rate for Payer: LLUH Dept of Risk Management WC	$7.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.12

HC SOM COCCIDIOIDES AB IGG BY ID

Facility

$13.50

Service Code	CPT 86635
Hospital Charge Code	900911752
Hospital Revenue Code	302
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$10.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.10
Rate for Payer: Aetna of CA Government/Medicare	$8.10
Rate for Payer: Cash Price	$6.08
Rate for Payer: Health Smart Auto/Commercial	$8.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.10
Rate for Payer: LLUH Dept of Risk Management WC	$7.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.12

HC SOM COCCIDIOIDES AB IGG BY ID

Facility

$13.50

Service Code	CPT 86635 90
Hospital Charge Code	900911752
Hospital Revenue Code	302
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$10.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.10
Rate for Payer: Aetna of CA Government/Medicare	$8.10
Rate for Payer: Cash Price	$6.08
Rate for Payer: Health Smart Auto/Commercial	$8.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.10
Rate for Payer: LLUH Dept of Risk Management WC	$7.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.12

HC SOM COCCIDIOIDES AB IGG BY ID

Facility

$13.50

Service Code	CPT 86635 90
Hospital Charge Code	900911752
Hospital Revenue Code	302
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$10.80
Rate for Payer: Cash Price	$6.08
Rate for Payer: Cigna of CA HMO/PPO	$10.80
Rate for Payer: Health Smart Auto/Commercial	$8.10
Rate for Payer: LLUH Dept of Risk Management WC	$7.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.12

HC SOM COCCIDIOIDES AB IGM BY ID

Facility

$13.50

Service Code	CPT 86635
Hospital Charge Code	900912668
Hospital Revenue Code	302
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$10.80
Rate for Payer: Cash Price	$6.08
Rate for Payer: Cigna of CA HMO/PPO	$10.80
Rate for Payer: Health Smart Auto/Commercial	$8.10
Rate for Payer: LLUH Dept of Risk Management WC	$7.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.12

HC SOM COCCIDIOIDES AB IGM BY ID

Facility

$13.50

Service Code	CPT 86635
Hospital Charge Code	900912668
Hospital Revenue Code	302
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$10.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.10
Rate for Payer: Aetna of CA Government/Medicare	$8.10
Rate for Payer: Cash Price	$6.08
Rate for Payer: Health Smart Auto/Commercial	$8.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.10
Rate for Payer: LLUH Dept of Risk Management WC	$7.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.12

HC SOM COCCIDIOIDES AB IGM BY ID

Facility

$13.50

Service Code	CPT 86635 90
Hospital Charge Code	900912668
Hospital Revenue Code	302
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$10.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.10
Rate for Payer: Aetna of CA Government/Medicare	$8.10
Rate for Payer: Cash Price	$6.08
Rate for Payer: Health Smart Auto/Commercial	$8.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.10
Rate for Payer: LLUH Dept of Risk Management WC	$7.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.12

HC SOM COCCIDIOIDES AB IGM BY ID

Facility

$13.50

Service Code	CPT 86635 90
Hospital Charge Code	900912668
Hospital Revenue Code	302
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$10.80
Rate for Payer: Cash Price	$6.08
Rate for Payer: Cigna of CA HMO/PPO	$10.80
Rate for Payer: Health Smart Auto/Commercial	$8.10
Rate for Payer: LLUH Dept of Risk Management WC	$7.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.12

HC SOM COMPLEMENT C1Q

Facility

$25.00

Service Code	CPT 86160
Hospital Charge Code	900911109
Hospital Revenue Code	302
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Cigna of CA HMO/PPO	$20.00
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.75

HC SOM COMPLEMENT C1Q

Facility

$25.00

Service Code	CPT 86160 90
Hospital Charge Code	900911109
Hospital Revenue Code	302
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$18.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.00
Rate for Payer: Aetna of CA Government/Medicare	$15.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.75

Know your out-of-pocket cost for care.

All Charges