Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM PARVOVIRUS B19 AB IGG

Facility

$11.23

Service Code	CPT 86747
Hospital Charge Code	900912538
Hospital Revenue Code	302
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$8.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.74
Rate for Payer: Aetna of CA Government/Medicare	$6.74
Rate for Payer: Cash Price	$5.05
Rate for Payer: Health Smart Auto/Commercial	$6.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.74
Rate for Payer: LLUH Dept of Risk Management WC	$6.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42

HC SOM PARVOVIRUS B19 AB IGG

Facility

$11.23

Service Code	CPT 86747
Hospital Charge Code	900912538
Hospital Revenue Code	302
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$8.98
Rate for Payer: Cash Price	$5.05
Rate for Payer: Cigna of CA HMO/PPO	$8.98
Rate for Payer: Health Smart Auto/Commercial	$6.74
Rate for Payer: LLUH Dept of Risk Management WC	$6.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42

HC SOM PARVOVIRUS B19 AB IGG

Facility

$11.23

Service Code	CPT 86747 90
Hospital Charge Code	900912538
Hospital Revenue Code	302
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$8.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.74
Rate for Payer: Aetna of CA Government/Medicare	$6.74
Rate for Payer: Cash Price	$5.05
Rate for Payer: Health Smart Auto/Commercial	$6.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.74
Rate for Payer: LLUH Dept of Risk Management WC	$6.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42

HC SOM PARVOVIRUS B19 AB IGM

Facility

$11.23

Service Code	CPT 86747 90
Hospital Charge Code	900912694
Hospital Revenue Code	302
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$8.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.74
Rate for Payer: Aetna of CA Government/Medicare	$6.74
Rate for Payer: Cash Price	$5.05
Rate for Payer: Health Smart Auto/Commercial	$6.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.74
Rate for Payer: LLUH Dept of Risk Management WC	$6.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42

HC SOM PARVOVIRUS B19 AB IGM

Facility

$11.23

Service Code	CPT 86747
Hospital Charge Code	900912694
Hospital Revenue Code	302
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$8.98
Rate for Payer: Cash Price	$5.05
Rate for Payer: Cigna of CA HMO/PPO	$8.98
Rate for Payer: Health Smart Auto/Commercial	$6.74
Rate for Payer: LLUH Dept of Risk Management WC	$6.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42

HC SOM PARVOVIRUS B19 AB IGM

Facility

$11.23

Service Code	CPT 86747 90
Hospital Charge Code	900912694
Hospital Revenue Code	302
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$8.98
Rate for Payer: Cash Price	$5.05
Rate for Payer: Cigna of CA HMO/PPO	$8.98
Rate for Payer: Health Smart Auto/Commercial	$6.74
Rate for Payer: LLUH Dept of Risk Management WC	$6.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42

HC SOM PARVOVIRUS B19 AB IGM

Facility

$11.23

Service Code	CPT 86747
Hospital Charge Code	900912694
Hospital Revenue Code	302
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$8.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.74
Rate for Payer: Aetna of CA Government/Medicare	$6.74
Rate for Payer: Cash Price	$5.05
Rate for Payer: Health Smart Auto/Commercial	$6.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.74
Rate for Payer: LLUH Dept of Risk Management WC	$6.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42

HC SOM PARVOVIRUS B19 PCR BF

Facility

$41.48

Service Code	CPT 87798 90
Hospital Charge Code	900912782
Hospital Revenue Code	306
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$33.18
Rate for Payer: Cash Price	$18.67
Rate for Payer: Cigna of CA HMO/PPO	$33.18
Rate for Payer: Health Smart Auto/Commercial	$24.89
Rate for Payer: LLUH Dept of Risk Management WC	$22.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$31.11

HC SOM PARVOVIRUS B19 PCR BF

Facility

$41.48

Service Code	CPT 87798
Hospital Charge Code	900912782
Hospital Revenue Code	306
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$31.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.89
Rate for Payer: Aetna of CA Government/Medicare	$24.89
Rate for Payer: Cash Price	$18.67
Rate for Payer: Health Smart Auto/Commercial	$24.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.89
Rate for Payer: LLUH Dept of Risk Management WC	$22.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$31.11

HC SOM PARVOVIRUS B19 PCR BF

Facility

$41.48

Service Code	CPT 87798 90
Hospital Charge Code	900912782
Hospital Revenue Code	306
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$31.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.89
Rate for Payer: Aetna of CA Government/Medicare	$24.89
Rate for Payer: Cash Price	$18.67
Rate for Payer: Health Smart Auto/Commercial	$24.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.89
Rate for Payer: LLUH Dept of Risk Management WC	$22.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$31.11

HC SOM PARVOVIRUS B19 PCR BF

Facility

$41.48

Service Code	CPT 87798
Hospital Charge Code	900912782
Hospital Revenue Code	306
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$33.18
Rate for Payer: Cash Price	$18.67
Rate for Payer: Cigna of CA HMO/PPO	$33.18
Rate for Payer: Health Smart Auto/Commercial	$24.89
Rate for Payer: LLUH Dept of Risk Management WC	$22.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$31.11

HC SOM PARVOVIRUS PCR

Facility

$41.48

Service Code	CPT 87798
Hospital Charge Code	900911590
Hospital Revenue Code	306
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$31.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.89
Rate for Payer: Aetna of CA Government/Medicare	$24.89
Rate for Payer: Cash Price	$18.67
Rate for Payer: Health Smart Auto/Commercial	$24.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.89
Rate for Payer: LLUH Dept of Risk Management WC	$22.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$31.11

HC SOM PARVOVIRUS PCR

Facility

$41.48

Service Code	CPT 87798 90
Hospital Charge Code	900911590
Hospital Revenue Code	306
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$31.11
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.89
Rate for Payer: Aetna of CA Government/Medicare	$24.89
Rate for Payer: Cash Price	$18.67
Rate for Payer: Health Smart Auto/Commercial	$24.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.89
Rate for Payer: LLUH Dept of Risk Management WC	$22.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$31.11

HC SOM PARVOVIRUS PCR

Facility

$41.48

Service Code	CPT 87798 90
Hospital Charge Code	900911590
Hospital Revenue Code	306
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$33.18
Rate for Payer: Cash Price	$18.67
Rate for Payer: Cigna of CA HMO/PPO	$33.18
Rate for Payer: Health Smart Auto/Commercial	$24.89
Rate for Payer: LLUH Dept of Risk Management WC	$22.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$31.11

HC SOM PARVOVIRUS PCR

Facility

$41.48

Service Code	CPT 87798
Hospital Charge Code	900911590
Hospital Revenue Code	306
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$33.18
Rate for Payer: Cash Price	$18.67
Rate for Payer: Cigna of CA HMO/PPO	$33.18
Rate for Payer: Health Smart Auto/Commercial	$24.89
Rate for Payer: LLUH Dept of Risk Management WC	$22.81
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$31.11

HC SOM PCA3 U

Facility

$500.00

Service Code	CPT 81479
Hospital Charge Code	900913905
Hospital Revenue Code	309
Min. Negotiated Rate	$275.00
Max. Negotiated Rate	$400.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cigna of CA HMO/PPO	$400.00
Rate for Payer: Health Smart Auto/Commercial	$300.00
Rate for Payer: LLUH Dept of Risk Management WC	$275.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$375.00

HC SOM PCA3 U

Facility

$500.00

Service Code	CPT 81479
Hospital Charge Code	900913905
Hospital Revenue Code	309
Min. Negotiated Rate	$275.00
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$300.00
Rate for Payer: Aetna of CA Government/Medicare	$300.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Health Smart Auto/Commercial	$300.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$300.00
Rate for Payer: LLUH Dept of Risk Management WC	$275.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$375.00

HC SOM PCA3 U

Facility

$500.00

Service Code	CPT 81479 90
Hospital Charge Code	900913905
Hospital Revenue Code	300
Min. Negotiated Rate	$275.00
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$300.00
Rate for Payer: Aetna of CA Government/Medicare	$300.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Health Smart Auto/Commercial	$300.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$300.00
Rate for Payer: LLUH Dept of Risk Management WC	$275.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$375.00

HC SOM PCA3 U

Facility

$500.00

Service Code	CPT 81479 90
Hospital Charge Code	900913905
Hospital Revenue Code	300
Min. Negotiated Rate	$275.00
Max. Negotiated Rate	$400.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cigna of CA HMO/PPO	$400.00
Rate for Payer: Health Smart Auto/Commercial	$300.00
Rate for Payer: LLUH Dept of Risk Management WC	$275.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$375.00

HC SOM PENICILLIN G IGE

Facility

$4.75

Service Code	CPT 86003 90
Hospital Charge Code	900912843
Hospital Revenue Code	302
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$3.80
Rate for Payer: Cash Price	$2.14
Rate for Payer: Cigna of CA HMO/PPO	$3.80
Rate for Payer: Health Smart Auto/Commercial	$2.85
Rate for Payer: LLUH Dept of Risk Management WC	$2.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.56

HC SOM PENICILLIN G IGE

Facility

$4.75

Service Code	CPT 86003 90
Hospital Charge Code	900912843
Hospital Revenue Code	302
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$3.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.85
Rate for Payer: Aetna of CA Government/Medicare	$2.85
Rate for Payer: Cash Price	$2.14
Rate for Payer: Health Smart Auto/Commercial	$2.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.85
Rate for Payer: LLUH Dept of Risk Management WC	$2.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.56

HC SOM PENICILLIN G IGE

Facility

$4.75

Service Code	CPT 86003
Hospital Charge Code	900912843
Hospital Revenue Code	302
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$3.80
Rate for Payer: Cash Price	$2.14
Rate for Payer: Cigna of CA HMO/PPO	$3.80
Rate for Payer: Health Smart Auto/Commercial	$2.85
Rate for Payer: LLUH Dept of Risk Management WC	$2.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.56

HC SOM PENICILLIN G IGE

Facility

$4.75

Service Code	CPT 86003
Hospital Charge Code	900912843
Hospital Revenue Code	302
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$3.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.85
Rate for Payer: Aetna of CA Government/Medicare	$2.85
Rate for Payer: Cash Price	$2.14
Rate for Payer: Health Smart Auto/Commercial	$2.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.85
Rate for Payer: LLUH Dept of Risk Management WC	$2.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.56

HC SOM PENICILLIN V IGE

Facility

$4.75

Service Code	CPT 86003 90
Hospital Charge Code	900912842
Hospital Revenue Code	302
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$3.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.85
Rate for Payer: Aetna of CA Government/Medicare	$2.85
Rate for Payer: Cash Price	$2.14
Rate for Payer: Health Smart Auto/Commercial	$2.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.85
Rate for Payer: LLUH Dept of Risk Management WC	$2.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.56

HC SOM PENICILLIN V IGE

Facility

$4.75

Service Code	CPT 86003
Hospital Charge Code	900912842
Hospital Revenue Code	302
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$3.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.85
Rate for Payer: Aetna of CA Government/Medicare	$2.85
Rate for Payer: Cash Price	$2.14
Rate for Payer: Health Smart Auto/Commercial	$2.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.85
Rate for Payer: LLUH Dept of Risk Management WC	$2.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.56

Know your out-of-pocket cost for care.

All Charges