Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM SOTALOL

Facility

$82.23

Service Code	CPT 80299
Hospital Charge Code	900910789
Hospital Revenue Code	301
Min. Negotiated Rate	$45.23
Max. Negotiated Rate	$61.67
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$49.34
Rate for Payer: Aetna of CA Government/Medicare	$49.34
Rate for Payer: Cash Price	$37.00
Rate for Payer: Health Smart Auto/Commercial	$49.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$49.34
Rate for Payer: LLUH Dept of Risk Management WC	$45.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$61.67

HC SOM SPCL HC COAG INTERPRETATION

Facility

$36.00

Service Code	CPT 85390 90
Hospital Charge Code	900913972
Hospital Revenue Code	305
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.60
Rate for Payer: Aetna of CA Government/Medicare	$21.60
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.00

HC SOM SPCL HC COAG INTERPRETATION

Facility

$36.00

Service Code	CPT 85390
Hospital Charge Code	900913972
Hospital Revenue Code	305
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.60
Rate for Payer: Aetna of CA Government/Medicare	$21.60
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.00

HC SOM SPCL HC COAG INTERPRETATION

Facility

$36.00

Service Code	CPT 85390
Hospital Charge Code	900913972
Hospital Revenue Code	305
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$28.80
Rate for Payer: Cash Price	$16.20
Rate for Payer: Cigna of CA HMO/PPO	$28.80
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.00

HC SOM SPCL HC COAG INTERPRETATION

Facility

$36.00

Service Code	CPT 85390 90
Hospital Charge Code	900913972
Hospital Revenue Code	305
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$28.80
Rate for Payer: Cash Price	$16.20
Rate for Payer: Cigna of CA HMO/PPO	$28.80
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.00

HC SOM SPN 87206

Facility

$48.68

Service Code	CPT 87206
Hospital Charge Code	900914919
Hospital Revenue Code	306
Min. Negotiated Rate	$26.77
Max. Negotiated Rate	$36.51
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$29.21
Rate for Payer: Aetna of CA Government/Medicare	$29.21
Rate for Payer: Cash Price	$21.91
Rate for Payer: Health Smart Auto/Commercial	$29.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$29.21
Rate for Payer: LLUH Dept of Risk Management WC	$26.77
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.51

HC SOM SPN 87206

Facility

$48.68

Service Code	CPT 87206 90
Hospital Charge Code	900914919
Hospital Revenue Code	306
Min. Negotiated Rate	$26.77
Max. Negotiated Rate	$36.51
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$29.21
Rate for Payer: Aetna of CA Government/Medicare	$29.21
Rate for Payer: Cash Price	$21.91
Rate for Payer: Health Smart Auto/Commercial	$29.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$29.21
Rate for Payer: LLUH Dept of Risk Management WC	$26.77
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.51

HC SOM SPN 87206

Facility

$48.68

Service Code	CPT 87206
Hospital Charge Code	900914919
Hospital Revenue Code	306
Min. Negotiated Rate	$26.77
Max. Negotiated Rate	$38.94
Rate for Payer: Cash Price	$21.91
Rate for Payer: Cigna of CA HMO/PPO	$38.94
Rate for Payer: Health Smart Auto/Commercial	$29.21
Rate for Payer: LLUH Dept of Risk Management WC	$26.77
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.51

HC SOM SPN 87206

Facility

$48.68

Service Code	CPT 87206 90
Hospital Charge Code	900914919
Hospital Revenue Code	306
Min. Negotiated Rate	$26.77
Max. Negotiated Rate	$38.94
Rate for Payer: Cash Price	$21.91
Rate for Payer: Cigna of CA HMO/PPO	$38.94
Rate for Payer: Health Smart Auto/Commercial	$29.21
Rate for Payer: LLUH Dept of Risk Management WC	$26.77
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.51

HC SOM SSDNA 86226

Facility

$55.00

Service Code	CPT 86226 90
Hospital Charge Code	900914817
Hospital Revenue Code	300
Min. Negotiated Rate	$30.25
Max. Negotiated Rate	$44.00
Rate for Payer: Cash Price	$24.75
Rate for Payer: Cigna of CA HMO/PPO	$44.00
Rate for Payer: Health Smart Auto/Commercial	$33.00
Rate for Payer: LLUH Dept of Risk Management WC	$30.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$41.25

HC SOM SSDNA 86226

Facility

$55.00

Service Code	CPT 86226
Hospital Charge Code	900914817
Hospital Revenue Code	302
Min. Negotiated Rate	$30.25
Max. Negotiated Rate	$41.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.00
Rate for Payer: Aetna of CA Government/Medicare	$33.00
Rate for Payer: Cash Price	$24.75
Rate for Payer: Health Smart Auto/Commercial	$33.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.00
Rate for Payer: LLUH Dept of Risk Management WC	$30.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$41.25

HC SOM SSDNA 86226

Facility

$55.00

Service Code	CPT 86226 90
Hospital Charge Code	900914817
Hospital Revenue Code	300
Min. Negotiated Rate	$30.25
Max. Negotiated Rate	$41.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.00
Rate for Payer: Aetna of CA Government/Medicare	$33.00
Rate for Payer: Cash Price	$24.75
Rate for Payer: Health Smart Auto/Commercial	$33.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.00
Rate for Payer: LLUH Dept of Risk Management WC	$30.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$41.25

HC SOM SSDNA 86226

Facility

$55.00

Service Code	CPT 86226
Hospital Charge Code	900914817
Hospital Revenue Code	302
Min. Negotiated Rate	$30.25
Max. Negotiated Rate	$44.00
Rate for Payer: Cash Price	$24.75
Rate for Payer: Cigna of CA HMO/PPO	$44.00
Rate for Payer: Health Smart Auto/Commercial	$33.00
Rate for Payer: LLUH Dept of Risk Management WC	$30.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$41.25

HC SOM ST LOUIS ENCEPH AB IGM

Facility

$25.00

Service Code	CPT 86653
Hospital Charge Code	900912812
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 ST LOUIS ENCEPH AB IGM

Facility

$25.00

Service Code	CPT 86653 90
Hospital Charge Code	900912812
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 ST LOUIS ENCEPH AB IGM

Facility

$25.00

Service Code	CPT 86653 90
Hospital Charge Code	900912812
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

HC SOM ST LOUIS ENCEPH AB IGM

Facility

$25.00

Service Code	CPT 86653
Hospital Charge Code	900912812
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

HC SOM ST LOUIS ENCEPHALITIS AB IGG

Facility

$25.00

Service Code	CPT 86653
Hospital Charge Code	900911336
Hospital Revenue Code	302
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$18.75
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: Cash Price	$11.25
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: 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

HC SOM ST LOUIS ENCEPHALITIS AB IGG

Facility

$25.00

Service Code	CPT 86653 90
Hospital Charge Code	900911336
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

HC SOM ST LOUIS ENCEPHALITIS AB IGG

Facility

$25.00

Service Code	CPT 86653
Hospital Charge Code	900911336
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 ST LOUIS ENCEPHALITIS AB IGG

Facility

$25.00

Service Code	CPT 86653 90
Hospital Charge Code	900911336
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 STONE ANALYSIS

Facility

$16.63

Service Code	CPT 82365 90
Hospital Charge Code	900911025
Hospital Revenue Code	301
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$13.30
Rate for Payer: Cash Price	$7.48
Rate for Payer: Cigna of CA HMO/PPO	$13.30
Rate for Payer: Health Smart Auto/Commercial	$9.98
Rate for Payer: LLUH Dept of Risk Management WC	$9.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.47

HC SOM STONE ANALYSIS

Facility

$16.63

Service Code	CPT 82365
Hospital Charge Code	900911025
Hospital Revenue Code	301
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$12.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.98
Rate for Payer: Aetna of CA Government/Medicare	$9.98
Rate for Payer: Cash Price	$7.48
Rate for Payer: Health Smart Auto/Commercial	$9.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.98
Rate for Payer: LLUH Dept of Risk Management WC	$9.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.47

HC SOM STONE ANALYSIS

Facility

$16.63

Service Code	CPT 82365
Hospital Charge Code	900911025
Hospital Revenue Code	301
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$13.30
Rate for Payer: Cash Price	$7.48
Rate for Payer: Cigna of CA HMO/PPO	$13.30
Rate for Payer: Health Smart Auto/Commercial	$9.98
Rate for Payer: LLUH Dept of Risk Management WC	$9.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.47

HC SOM STONE ANALYSIS

Facility

$16.63

Service Code	CPT 82365 90
Hospital Charge Code	900911025
Hospital Revenue Code	301
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$12.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.98
Rate for Payer: Aetna of CA Government/Medicare	$9.98
Rate for Payer: Cash Price	$7.48
Rate for Payer: Health Smart Auto/Commercial	$9.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.98
Rate for Payer: LLUH Dept of Risk Management WC	$9.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.47

Know your out-of-pocket cost for care.

All Charges