Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM MECONIUM METHAMPHETAMINE CONF

Facility

$23.42

Service Code	CPT G0480
Hospital Charge Code	900912831
Hospital Revenue Code	301
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$18.74
Rate for Payer: Cash Price	$10.54
Rate for Payer: Cigna of CA HMO/PPO	$18.74
Rate for Payer: Health Smart Auto/Commercial	$14.05
Rate for Payer: LLUH Dept of Risk Management WC	$12.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.56

HC SOM MECONIUM METHAMPHETAMINE CONF

Facility

$23.42

Service Code	CPT G0480
Hospital Charge Code	900912831
Hospital Revenue Code	301
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$17.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.05
Rate for Payer: Aetna of CA Government/Medicare	$14.05
Rate for Payer: Cash Price	$10.54
Rate for Payer: Health Smart Auto/Commercial	$14.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.05
Rate for Payer: LLUH Dept of Risk Management WC	$12.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.56

HC SOM MECONIUM METHAMPHETAMINE CONF

Facility

$23.42

Service Code	CPT G0480 90
Hospital Charge Code	900912831
Hospital Revenue Code	301
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$17.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.05
Rate for Payer: Aetna of CA Government/Medicare	$14.05
Rate for Payer: Cash Price	$10.54
Rate for Payer: Health Smart Auto/Commercial	$14.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.05
Rate for Payer: LLUH Dept of Risk Management WC	$12.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.56

HC SOM MECONIUM METHAMPHETAMINE CONF

Facility

$23.42

Service Code	CPT G0480 90
Hospital Charge Code	900912831
Hospital Revenue Code	301
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$18.74
Rate for Payer: Cash Price	$10.54
Rate for Payer: Cigna of CA HMO/PPO	$18.74
Rate for Payer: Health Smart Auto/Commercial	$14.05
Rate for Payer: LLUH Dept of Risk Management WC	$12.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.56

HC SOM MECONIUM METHAMPHETAMINE CONF

Facility

$23.42

Service Code	CPT 80359
Hospital Charge Code	900912831
Hospital Revenue Code	301
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$18.74
Rate for Payer: Cash Price	$10.54
Rate for Payer: Cigna of CA HMO/PPO	$18.74
Rate for Payer: Health Smart Auto/Commercial	$14.05
Rate for Payer: LLUH Dept of Risk Management WC	$12.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.56

HC SOM MECONIUM METHAMPHETAMINE CONF

Facility

$23.42

Service Code	CPT 80359
Hospital Charge Code	900912831
Hospital Revenue Code	301
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$17.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.05
Rate for Payer: Aetna of CA Government/Medicare	$14.05
Rate for Payer: Cash Price	$10.54
Rate for Payer: Health Smart Auto/Commercial	$14.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.05
Rate for Payer: LLUH Dept of Risk Management WC	$12.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.56

HC SOM MECONIUM OPIATE CONFIRM

Facility

$49.07

Service Code	CPT 80361
Hospital Charge Code	900912833
Hospital Revenue Code	301
Min. Negotiated Rate	$26.99
Max. Negotiated Rate	$39.26
Rate for Payer: Cash Price	$22.08
Rate for Payer: Cigna of CA HMO/PPO	$39.26
Rate for Payer: Health Smart Auto/Commercial	$29.44
Rate for Payer: LLUH Dept of Risk Management WC	$26.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.80

HC SOM MECONIUM OPIATE CONFIRM

Facility

$49.07

Service Code	CPT G0480
Hospital Charge Code	900912833
Hospital Revenue Code	301
Min. Negotiated Rate	$26.99
Max. Negotiated Rate	$36.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$29.44
Rate for Payer: Aetna of CA Government/Medicare	$29.44
Rate for Payer: Cash Price	$22.08
Rate for Payer: Health Smart Auto/Commercial	$29.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$29.44
Rate for Payer: LLUH Dept of Risk Management WC	$26.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.80

HC SOM MECONIUM OPIATE CONFIRM

Facility

$49.07

Service Code	CPT G0480 90
Hospital Charge Code	900912833
Hospital Revenue Code	301
Min. Negotiated Rate	$26.99
Max. Negotiated Rate	$36.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$29.44
Rate for Payer: Aetna of CA Government/Medicare	$29.44
Rate for Payer: Cash Price	$22.08
Rate for Payer: Health Smart Auto/Commercial	$29.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$29.44
Rate for Payer: LLUH Dept of Risk Management WC	$26.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.80

HC SOM MECONIUM OPIATE CONFIRM

Facility

$49.07

Service Code	CPT 80361
Hospital Charge Code	900912833
Hospital Revenue Code	301
Min. Negotiated Rate	$26.99
Max. Negotiated Rate	$36.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$29.44
Rate for Payer: Aetna of CA Government/Medicare	$29.44
Rate for Payer: Cash Price	$22.08
Rate for Payer: Health Smart Auto/Commercial	$29.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$29.44
Rate for Payer: LLUH Dept of Risk Management WC	$26.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.80

HC SOM MECONIUM OPIATE CONFIRM

Facility

$49.07

Service Code	CPT G0480
Hospital Charge Code	900912833
Hospital Revenue Code	301
Min. Negotiated Rate	$26.99
Max. Negotiated Rate	$39.26
Rate for Payer: Cash Price	$22.08
Rate for Payer: Cigna of CA HMO/PPO	$39.26
Rate for Payer: Health Smart Auto/Commercial	$29.44
Rate for Payer: LLUH Dept of Risk Management WC	$26.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.80

HC SOM MECONIUM OPIATE CONFIRM

Facility

$49.07

Service Code	CPT G0480 90
Hospital Charge Code	900912833
Hospital Revenue Code	301
Min. Negotiated Rate	$26.99
Max. Negotiated Rate	$39.26
Rate for Payer: Cash Price	$22.08
Rate for Payer: Cigna of CA HMO/PPO	$39.26
Rate for Payer: Health Smart Auto/Commercial	$29.44
Rate for Payer: LLUH Dept of Risk Management WC	$26.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.80

HC SOM MECONIUM PCP CONFIRM

Facility

$180.00

Service Code	CPT 83992 90
Hospital Charge Code	900912835
Hospital Revenue Code	301
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$108.00
Rate for Payer: Aetna of CA Government/Medicare	$108.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Smart Auto/Commercial	$108.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$108.00
Rate for Payer: LLUH Dept of Risk Management WC	$99.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$135.00

HC SOM MECONIUM PCP CONFIRM

Facility

$180.00

Service Code	CPT 83992 90
Hospital Charge Code	900912835
Hospital Revenue Code	301
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$144.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cigna of CA HMO/PPO	$144.00
Rate for Payer: Health Smart Auto/Commercial	$108.00
Rate for Payer: LLUH Dept of Risk Management WC	$99.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$135.00

HC SOM MECONIUM PCP CONFIRM

Facility

$180.00

Service Code	CPT 83992
Hospital Charge Code	900912835
Hospital Revenue Code	301
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$144.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cigna of CA HMO/PPO	$144.00
Rate for Payer: Health Smart Auto/Commercial	$108.00
Rate for Payer: LLUH Dept of Risk Management WC	$99.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$135.00

HC SOM MECONIUM PCP CONFIRM

Facility

$180.00

Service Code	CPT 83992
Hospital Charge Code	900912835
Hospital Revenue Code	301
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$108.00
Rate for Payer: Aetna of CA Government/Medicare	$108.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Smart Auto/Commercial	$108.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$108.00
Rate for Payer: LLUH Dept of Risk Management WC	$99.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$135.00

HC SOM MECONIUM THC LAB REF CONFIRM

Facility

$76.10

Service Code	CPT G0480
Hospital Charge Code	900912834
Hospital Revenue Code	301
Min. Negotiated Rate	$41.86
Max. Negotiated Rate	$60.88
Rate for Payer: Cash Price	$34.25
Rate for Payer: Cigna of CA HMO/PPO	$60.88
Rate for Payer: Health Smart Auto/Commercial	$45.66
Rate for Payer: LLUH Dept of Risk Management WC	$41.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$57.08

HC SOM MECONIUM THC LAB REF CONFIRM

Facility

$76.10

Service Code	CPT 80349
Hospital Charge Code	900912834
Hospital Revenue Code	301
Min. Negotiated Rate	$41.86
Max. Negotiated Rate	$57.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$45.66
Rate for Payer: Aetna of CA Government/Medicare	$45.66
Rate for Payer: Cash Price	$34.25
Rate for Payer: Health Smart Auto/Commercial	$45.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$45.66
Rate for Payer: LLUH Dept of Risk Management WC	$41.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$57.08

HC SOM MECONIUM THC LAB REF CONFIRM

Facility

$76.10

Service Code	CPT G0480 90
Hospital Charge Code	900912834
Hospital Revenue Code	301
Min. Negotiated Rate	$41.86
Max. Negotiated Rate	$60.88
Rate for Payer: Cash Price	$34.25
Rate for Payer: Cigna of CA HMO/PPO	$60.88
Rate for Payer: Health Smart Auto/Commercial	$45.66
Rate for Payer: LLUH Dept of Risk Management WC	$41.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$57.08

HC SOM MECONIUM THC LAB REF CONFIRM

Facility

$76.10

Service Code	CPT G0480
Hospital Charge Code	900912834
Hospital Revenue Code	301
Min. Negotiated Rate	$41.86
Max. Negotiated Rate	$57.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$45.66
Rate for Payer: Aetna of CA Government/Medicare	$45.66
Rate for Payer: Cash Price	$34.25
Rate for Payer: Health Smart Auto/Commercial	$45.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$45.66
Rate for Payer: LLUH Dept of Risk Management WC	$41.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$57.08

HC SOM MECONIUM THC LAB REF CONFIRM

Facility

$76.10

Service Code	CPT G0480 90
Hospital Charge Code	900912834
Hospital Revenue Code	301
Min. Negotiated Rate	$41.86
Max. Negotiated Rate	$57.08
Rate for Payer: Health Smart Auto/Commercial	$45.66
Rate for Payer: Cash Price	$34.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$45.66
Rate for Payer: Aetna of CA Government/Medicare	$45.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$45.66
Rate for Payer: LLUH Dept of Risk Management WC	$41.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$57.08

HC SOM MECONIUM THC LAB REF CONFIRM

Facility

$76.10

Service Code	CPT 80349
Hospital Charge Code	900912834
Hospital Revenue Code	301
Min. Negotiated Rate	$41.86
Max. Negotiated Rate	$60.88
Rate for Payer: Cash Price	$34.25
Rate for Payer: Cigna of CA HMO/PPO	$60.88
Rate for Payer: Health Smart Auto/Commercial	$45.66
Rate for Payer: LLUH Dept of Risk Management WC	$41.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$57.08

HC SOM MEPERIDINE

Facility

$98.28

Service Code	CPT G0480 90
Hospital Charge Code	900910758
Hospital Revenue Code	301
Min. Negotiated Rate	$54.05
Max. Negotiated Rate	$73.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$58.97
Rate for Payer: Aetna of CA Government/Medicare	$58.97
Rate for Payer: Cash Price	$44.23
Rate for Payer: Health Smart Auto/Commercial	$58.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$58.97
Rate for Payer: LLUH Dept of Risk Management WC	$54.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$73.71

HC SOM MEPERIDINE

Facility

$98.28

Service Code	CPT 80362
Hospital Charge Code	900910758
Hospital Revenue Code	301
Min. Negotiated Rate	$54.05
Max. Negotiated Rate	$73.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$58.97
Rate for Payer: Aetna of CA Government/Medicare	$58.97
Rate for Payer: Cash Price	$44.23
Rate for Payer: Health Smart Auto/Commercial	$58.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$58.97
Rate for Payer: LLUH Dept of Risk Management WC	$54.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$73.71

HC SOM MEPERIDINE

Facility

$98.28

Service Code	CPT G0480
Hospital Charge Code	900910758
Hospital Revenue Code	301
Min. Negotiated Rate	$54.05
Max. Negotiated Rate	$73.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$58.97
Rate for Payer: Aetna of CA Government/Medicare	$58.97
Rate for Payer: Cash Price	$44.23
Rate for Payer: Health Smart Auto/Commercial	$58.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$58.97
Rate for Payer: LLUH Dept of Risk Management WC	$54.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$73.71

Know your out-of-pocket cost for care.

All Charges