Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM COXIELLA BURNETTI AB PANEL

Facility

$10.02

Service Code	CPT 86638 90
Hospital Charge Code	900911769
Hospital Revenue Code	302
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$7.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.01
Rate for Payer: Aetna of CA Government/Medicare	$6.01
Rate for Payer: Cash Price	$4.51
Rate for Payer: Health Smart Auto/Commercial	$6.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.01
Rate for Payer: LLUH Dept of Risk Management WC	$5.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.52

HC SOM COXIELLA BURNETTI AB PANEL

Facility

$10.02

Service Code	CPT 86638
Hospital Charge Code	900911769
Hospital Revenue Code	302
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$8.02
Rate for Payer: Cash Price	$4.51
Rate for Payer: Cigna of CA HMO/PPO	$8.02
Rate for Payer: Health Smart Auto/Commercial	$6.01
Rate for Payer: LLUH Dept of Risk Management WC	$5.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.52

HC SOM COXIELLA BURNETTI AB PANEL

Facility

$10.02

Service Code	CPT 86638 90
Hospital Charge Code	900911769
Hospital Revenue Code	302
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$8.02
Rate for Payer: Cash Price	$4.51
Rate for Payer: Cigna of CA HMO/PPO	$8.02
Rate for Payer: Health Smart Auto/Commercial	$6.01
Rate for Payer: LLUH Dept of Risk Management WC	$5.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.52

HC SOM COXIELLA BURNETTI AB PANEL

Facility

$10.02

Service Code	CPT 86638
Hospital Charge Code	900911769
Hospital Revenue Code	302
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$7.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.01
Rate for Payer: Aetna of CA Government/Medicare	$6.01
Rate for Payer: Cash Price	$4.51
Rate for Payer: Health Smart Auto/Commercial	$6.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.01
Rate for Payer: LLUH Dept of Risk Management WC	$5.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.52

HC SOM C-PEPTIDE

Facility

$12.00

Service Code	CPT 84681 90
Hospital Charge Code	900911116
Hospital Revenue Code	301
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 C-PEPTIDE

Facility

$12.00

Service Code	CPT 84681
Hospital Charge Code	900911116
Hospital Revenue Code	301
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 C-PEPTIDE

Facility

$12.00

Service Code	CPT 84681 90
Hospital Charge Code	900911116
Hospital Revenue Code	301
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 C-PEPTIDE

Facility

$12.00

Service Code	CPT 84681
Hospital Charge Code	900911116
Hospital Revenue Code	301
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 C PNEUMONIA IGG

Facility

$6.00

Service Code	CPT 86631
Hospital Charge Code	900911125
Hospital Revenue Code	301
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

HC SOM C PNEUMONIA IGG

Facility

$6.00

Service Code	CPT 86631 90
Hospital Charge Code	900911125
Hospital Revenue Code	301
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

HC SOM C PNEUMONIA IGG

Facility

$6.00

Service Code	CPT 86631
Hospital Charge Code	900911125
Hospital Revenue Code	301
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

HC SOM C PNEUMONIA IGG

Facility

$6.00

Service Code	CPT 86631 90
Hospital Charge Code	900911125
Hospital Revenue Code	301
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

HC SOM C. PNEUMONIA IGM

Facility

$6.00

Service Code	CPT 86632 90
Hospital Charge Code	900912797
Hospital Revenue Code	302
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

HC SOM C. PNEUMONIA IGM

Facility

$6.00

Service Code	CPT 86632
Hospital Charge Code	900912797
Hospital Revenue Code	302
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

HC SOM C. PNEUMONIA IGM

Facility

$6.00

Service Code	CPT 86632 90
Hospital Charge Code	900912797
Hospital Revenue Code	302
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

HC SOM C. PNEUMONIA IGM

Facility

$6.00

Service Code	CPT 86632
Hospital Charge Code	900912797
Hospital Revenue Code	302
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

HC SOM C. PSITTACI IGG

Facility

$7.00

Service Code	CPT 86631 90
Hospital Charge Code	900912800
Hospital Revenue Code	302
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$5.60
Rate for Payer: Cash Price	$3.15
Rate for Payer: Cigna of CA HMO/PPO	$5.60
Rate for Payer: Health Smart Auto/Commercial	$4.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.25

HC SOM C. PSITTACI IGG

Facility

$7.00

Service Code	CPT 86631
Hospital Charge Code	900912800
Hospital Revenue Code	302
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$5.60
Rate for Payer: Cash Price	$3.15
Rate for Payer: Cigna of CA HMO/PPO	$5.60
Rate for Payer: Health Smart Auto/Commercial	$4.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.25

HC SOM C. PSITTACI IGG

Facility

$7.00

Service Code	CPT 86631
Hospital Charge Code	900912800
Hospital Revenue Code	302
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.20
Rate for Payer: Aetna of CA Government/Medicare	$4.20
Rate for Payer: Cash Price	$3.15
Rate for Payer: Health Smart Auto/Commercial	$4.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.25

HC SOM C. PSITTACI IGG

Facility

$7.00

Service Code	CPT 86631 90
Hospital Charge Code	900912800
Hospital Revenue Code	302
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$5.25
Rate for Payer: Health Smart Auto/Commercial	$4.20
Rate for Payer: Cash Price	$3.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.20
Rate for Payer: Aetna of CA Government/Medicare	$4.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.25

HC SOM C. PSITTACI IGM

Facility

$7.00

Service Code	CPT 86632
Hospital Charge Code	900912798
Hospital Revenue Code	302
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$5.60
Rate for Payer: Cash Price	$3.15
Rate for Payer: Cigna of CA HMO/PPO	$5.60
Rate for Payer: Health Smart Auto/Commercial	$4.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.25

HC SOM C. PSITTACI IGM

Facility

$7.00

Service Code	CPT 86632 90
Hospital Charge Code	900912798
Hospital Revenue Code	302
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$5.60
Rate for Payer: Cash Price	$3.15
Rate for Payer: Cigna of CA HMO/PPO	$5.60
Rate for Payer: Health Smart Auto/Commercial	$4.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.25

HC SOM C. PSITTACI IGM

Facility

$7.00

Service Code	CPT 86632
Hospital Charge Code	900912798
Hospital Revenue Code	302
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.20
Rate for Payer: Aetna of CA Government/Medicare	$4.20
Rate for Payer: Cash Price	$3.15
Rate for Payer: Health Smart Auto/Commercial	$4.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.25

HC SOM C. PSITTACI IGM

Facility

$7.00

Service Code	CPT 86632 90
Hospital Charge Code	900912798
Hospital Revenue Code	302
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.20
Rate for Payer: Aetna of CA Government/Medicare	$4.20
Rate for Payer: Cash Price	$3.15
Rate for Payer: Health Smart Auto/Commercial	$4.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.25

HC SOM CRYOFIBRINOGEN

Facility

$10.00

Service Code	CPT 82585 90
Hospital Charge Code	900911373
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cigna of CA HMO/PPO	$8.00
Rate for Payer: Health Smart Auto/Commercial	$6.00
Rate for Payer: LLUH Dept of Risk Management WC	$5.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.50

Know your out-of-pocket cost for care.

All Charges