Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM PWDNA 81331

Facility

$561.17

Service Code	CPT 81331
Hospital Charge Code	900914888
Hospital Revenue Code	309
Min. Negotiated Rate	$308.64
Max. Negotiated Rate	$448.94
Rate for Payer: Cash Price	$252.53
Rate for Payer: Cigna of CA HMO/PPO	$448.94
Rate for Payer: Health Smart Auto/Commercial	$336.70
Rate for Payer: LLUH Dept of Risk Management WC	$308.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$420.88

HC SOM PWDNA 81331

Facility

$561.17

Service Code	CPT 81331 90
Hospital Charge Code	900914888
Hospital Revenue Code	300
Min. Negotiated Rate	$308.64
Max. Negotiated Rate	$448.94
Rate for Payer: Cash Price	$252.53
Rate for Payer: Cigna of CA HMO/PPO	$448.94
Rate for Payer: Health Smart Auto/Commercial	$336.70
Rate for Payer: LLUH Dept of Risk Management WC	$308.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$420.88

HC SOM PYRUVATE KINASE

Facility

$65.00

Service Code	CPT 84220 90
Hospital Charge Code	900911491
Hospital Revenue Code	301
Min. Negotiated Rate	$35.75
Max. Negotiated Rate	$48.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$39.00
Rate for Payer: Aetna of CA Government/Medicare	$39.00
Rate for Payer: Cash Price	$29.25
Rate for Payer: Health Smart Auto/Commercial	$39.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$39.00
Rate for Payer: LLUH Dept of Risk Management WC	$35.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$48.75

HC SOM PYRUVATE KINASE

Facility

$65.00

Service Code	CPT 84220
Hospital Charge Code	900911491
Hospital Revenue Code	301
Min. Negotiated Rate	$35.75
Max. Negotiated Rate	$52.00
Rate for Payer: Cash Price	$29.25
Rate for Payer: Cigna of CA HMO/PPO	$52.00
Rate for Payer: Health Smart Auto/Commercial	$39.00
Rate for Payer: LLUH Dept of Risk Management WC	$35.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$48.75

HC SOM PYRUVATE KINASE

Facility

$65.00

Service Code	CPT 84220 90
Hospital Charge Code	900911491
Hospital Revenue Code	301
Min. Negotiated Rate	$35.75
Max. Negotiated Rate	$52.00
Rate for Payer: Cash Price	$29.25
Rate for Payer: Cigna of CA HMO/PPO	$52.00
Rate for Payer: Health Smart Auto/Commercial	$39.00
Rate for Payer: LLUH Dept of Risk Management WC	$35.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$48.75

HC SOM PYRUVATE KINASE

Facility

$65.00

Service Code	CPT 84220
Hospital Charge Code	900911491
Hospital Revenue Code	301
Min. Negotiated Rate	$35.75
Max. Negotiated Rate	$48.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$39.00
Rate for Payer: Aetna of CA Government/Medicare	$39.00
Rate for Payer: Cash Price	$29.25
Rate for Payer: Health Smart Auto/Commercial	$39.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$39.00
Rate for Payer: LLUH Dept of Risk Management WC	$35.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$48.75

HC SOM Q FEVER IGG PHAS I

Facility

$10.02

Service Code	CPT 86638 90
Hospital Charge Code	900914336
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 Q FEVER IGG PHAS I

Facility

$10.02

Service Code	CPT 86638
Hospital Charge Code	900914336
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 Q FEVER IGG PHAS I

Facility

$10.02

Service Code	CPT 86638
Hospital Charge Code	900914336
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 Q FEVER IGG PHAS I

Facility

$10.02

Service Code	CPT 86638 90
Hospital Charge Code	900914336
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 Q FEVER IGG PHAS II

Facility

$10.02

Service Code	CPT 86638 90
Hospital Charge Code	900914334
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 Q FEVER IGG PHAS II

Facility

$10.02

Service Code	CPT 86638
Hospital Charge Code	900914334
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 Q FEVER IGG PHAS II

Facility

$10.02

Service Code	CPT 86638 90
Hospital Charge Code	900914334
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 Q FEVER IGG PHAS II

Facility

$10.02

Service Code	CPT 86638
Hospital Charge Code	900914334
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 Q FEVER IGM PHAS I

Facility

$10.03

Service Code	CPT 86638 90
Hospital Charge Code	900914337
Hospital Revenue Code	302
Min. Negotiated Rate	$5.52
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	$6.02
Rate for Payer: LLUH Dept of Risk Management WC	$5.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.52

HC SOM Q FEVER IGM PHAS I

Facility

$10.03

Service Code	CPT 86638 90
Hospital Charge Code	900914337
Hospital Revenue Code	302
Min. Negotiated Rate	$5.52
Max. Negotiated Rate	$7.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.02
Rate for Payer: Aetna of CA Government/Medicare	$6.02
Rate for Payer: Cash Price	$4.51
Rate for Payer: Health Smart Auto/Commercial	$6.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.02
Rate for Payer: LLUH Dept of Risk Management WC	$5.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.52

HC SOM Q FEVER IGM PHAS I

Facility

$10.03

Service Code	CPT 86638
Hospital Charge Code	900914337
Hospital Revenue Code	302
Min. Negotiated Rate	$5.52
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	$6.02
Rate for Payer: LLUH Dept of Risk Management WC	$5.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.52

HC SOM Q FEVER IGM PHAS I

Facility

$10.03

Service Code	CPT 86638
Hospital Charge Code	900914337
Hospital Revenue Code	302
Min. Negotiated Rate	$5.52
Max. Negotiated Rate	$7.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.02
Rate for Payer: Aetna of CA Government/Medicare	$6.02
Rate for Payer: Cash Price	$4.51
Rate for Payer: Health Smart Auto/Commercial	$6.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.02
Rate for Payer: LLUH Dept of Risk Management WC	$5.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.52

HC SOM Q FEVER IGM PHAS II

Facility

$10.03

Service Code	CPT 86638 90
Hospital Charge Code	900914335
Hospital Revenue Code	302
Min. Negotiated Rate	$5.52
Max. Negotiated Rate	$7.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.02
Rate for Payer: Aetna of CA Government/Medicare	$6.02
Rate for Payer: Cash Price	$4.51
Rate for Payer: Health Smart Auto/Commercial	$6.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.02
Rate for Payer: LLUH Dept of Risk Management WC	$5.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.52

HC SOM Q FEVER IGM PHAS II

Facility

$10.03

Service Code	CPT 86638
Hospital Charge Code	900914335
Hospital Revenue Code	302
Min. Negotiated Rate	$5.52
Max. Negotiated Rate	$7.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.02
Rate for Payer: Aetna of CA Government/Medicare	$6.02
Rate for Payer: Cash Price	$4.51
Rate for Payer: Health Smart Auto/Commercial	$6.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.02
Rate for Payer: LLUH Dept of Risk Management WC	$5.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.52

HC SOM Q FEVER IGM PHAS II

Facility

$10.03

Service Code	CPT 86638 90
Hospital Charge Code	900914335
Hospital Revenue Code	302
Min. Negotiated Rate	$5.52
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	$6.02
Rate for Payer: LLUH Dept of Risk Management WC	$5.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.52

HC SOM Q FEVER IGM PHAS II

Facility

$10.03

Service Code	CPT 86638
Hospital Charge Code	900914335
Hospital Revenue Code	302
Min. Negotiated Rate	$5.52
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	$6.02
Rate for Payer: LLUH Dept of Risk Management WC	$5.52
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.52

HC SOM QUANTIFERON TB GOLD

Facility

$40.00

Service Code	CPT 86480 90
Hospital Charge Code	900912882
Hospital Revenue Code	306
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.00
Rate for Payer: Aetna of CA Government/Medicare	$24.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Smart Auto/Commercial	$24.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.00
Rate for Payer: LLUH Dept of Risk Management WC	$22.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.00

HC SOM QUANTIFERON TB GOLD

Facility

$40.00

Service Code	CPT 86480 90
Hospital Charge Code	900912882
Hospital Revenue Code	306
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$32.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cigna of CA HMO/PPO	$32.00
Rate for Payer: Health Smart Auto/Commercial	$24.00
Rate for Payer: LLUH Dept of Risk Management WC	$22.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.00

HC SOM QUANTIFERON TB GOLD

Facility

$40.00

Service Code	CPT 86480
Hospital Charge Code	900912882
Hospital Revenue Code	306
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$32.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cigna of CA HMO/PPO	$32.00
Rate for Payer: Health Smart Auto/Commercial	$24.00
Rate for Payer: LLUH Dept of Risk Management WC	$22.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.00

Know your out-of-pocket cost for care.

All Charges