Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM 5-FLUOROCYTOSINE

Facility

$34.02

Service Code	CPT 80299
Hospital Charge Code	900911263
Hospital Revenue Code	301
Min. Negotiated Rate	$18.64
Max. Negotiated Rate	$27.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.41
Rate for Payer: Aetna of CA Government/Medicare	$20.41
Rate for Payer: Cash Price	$34.02
Rate for Payer: Cash Price	$34.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$27.22
Rate for Payer: Health Smart Auto/Commercial	$20.41
Rate for Payer: Intervalley Health Plan Commercial	$18.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.41
Rate for Payer: LLUH Dept of Risk Management WC	$18.71
Rate for Payer: Multiplan Commercial	$25.52

HC SOM 5-FLUOROCYTOSINE

Facility

$34.02

Service Code	CPT 80299
Hospital Charge Code	900911263
Hospital Revenue Code	301
Min. Negotiated Rate	$18.71
Max. Negotiated Rate	$27.22
Rate for Payer: Cash Price	$34.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$27.22
Rate for Payer: Health Smart Auto/Commercial	$20.41
Rate for Payer: LLUH Dept of Risk Management WC	$18.71
Rate for Payer: Multiplan Commercial	$25.52

HC SOM 7-DEHYDROCHOLESTERL

Facility

$100.00

Service Code	CPT 82542
Hospital Charge Code	900910710
Hospital Revenue Code	301
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$80.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$80.00
Rate for Payer: Health Smart Auto/Commercial	$60.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.00
Rate for Payer: Multiplan Commercial	$75.00

HC SOM 7-DEHYDROCHOLESTERL

Facility

$100.00

Service Code	CPT 82542
Hospital Charge Code	900910710
Hospital Revenue Code	301
Min. Negotiated Rate	$24.09
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$60.00
Rate for Payer: Aetna of CA Government/Medicare	$60.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$80.00
Rate for Payer: Health Smart Auto/Commercial	$60.00
Rate for Payer: Intervalley Health Plan Commercial	$24.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$60.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.00
Rate for Payer: Multiplan Commercial	$75.00

HC SOM 8INHE FACTOR VIII ACTIVITY ASSAY

Facility

$26.81

Service Code	CPT 85240
Hospital Charge Code	900912802
Hospital Revenue Code	305
Min. Negotiated Rate	$14.75
Max. Negotiated Rate	$21.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.09
Rate for Payer: Aetna of CA Government/Medicare	$16.09
Rate for Payer: Cash Price	$26.81
Rate for Payer: Cash Price	$26.81
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$21.45
Rate for Payer: Health Smart Auto/Commercial	$16.09
Rate for Payer: Intervalley Health Plan Commercial	$17.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.09
Rate for Payer: LLUH Dept of Risk Management WC	$14.75
Rate for Payer: Multiplan Commercial	$20.11

HC SOM 8INHE FACTOR VIII ACTIVITY ASSAY

Facility

$26.81

Service Code	CPT 85240
Hospital Charge Code	900912802
Hospital Revenue Code	305
Min. Negotiated Rate	$14.75
Max. Negotiated Rate	$21.45
Rate for Payer: Cash Price	$26.81
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$21.45
Rate for Payer: Health Smart Auto/Commercial	$16.09
Rate for Payer: LLUH Dept of Risk Management WC	$14.75
Rate for Payer: Multiplan Commercial	$20.11

HC SOM 8INHE FACTOR VIII INHIB TECH INTERP

Facility

$23.19

Service Code	CPT 85390
Hospital Charge Code	900911120
Hospital Revenue Code	301
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$18.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.91
Rate for Payer: Aetna of CA Government/Medicare	$13.91
Rate for Payer: Cash Price	$23.19
Rate for Payer: Cash Price	$23.19
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$18.55
Rate for Payer: Health Smart Auto/Commercial	$13.91
Rate for Payer: Intervalley Health Plan Commercial	$15.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.91
Rate for Payer: LLUH Dept of Risk Management WC	$12.75
Rate for Payer: Multiplan Commercial	$17.39

HC SOM 8INHE FACTOR VIII INHIB TECH INTERP

Facility

$23.19

Service Code	CPT 85390
Hospital Charge Code	900911120
Hospital Revenue Code	301
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$18.55
Rate for Payer: Cash Price	$23.19
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$18.55
Rate for Payer: Health Smart Auto/Commercial	$13.91
Rate for Payer: LLUH Dept of Risk Management WC	$12.75
Rate for Payer: Multiplan Commercial	$17.39

HC SOM 9INHE FACTOR IX ACTIVITY ASSAY

Facility

$27.58

Service Code	CPT 85250
Hospital Charge Code	900915513
Hospital Revenue Code	300
Min. Negotiated Rate	$15.17
Max. Negotiated Rate	$22.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.55
Rate for Payer: Aetna of CA Government/Medicare	$16.55
Rate for Payer: Cash Price	$27.58
Rate for Payer: Cash Price	$27.58
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.06
Rate for Payer: Health Smart Auto/Commercial	$16.55
Rate for Payer: Intervalley Health Plan Commercial	$19.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.55
Rate for Payer: LLUH Dept of Risk Management WC	$15.17
Rate for Payer: Multiplan Commercial	$20.68

HC SOM 9INHE FACTOR IX ACTIVITY ASSAY

Facility

$27.58

Service Code	CPT 85250
Hospital Charge Code	900915513
Hospital Revenue Code	300
Min. Negotiated Rate	$15.17
Max. Negotiated Rate	$22.06
Rate for Payer: Cash Price	$27.58
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.06
Rate for Payer: Health Smart Auto/Commercial	$16.55
Rate for Payer: LLUH Dept of Risk Management WC	$15.17
Rate for Payer: Multiplan Commercial	$20.68

HC SOM 9INHE FACTOR IX INHIB TECH INTERP

Facility

$22.42

Service Code	CPT 85390
Hospital Charge Code	900915514
Hospital Revenue Code	300
Min. Negotiated Rate	$12.33
Max. Negotiated Rate	$17.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.45
Rate for Payer: Aetna of CA Government/Medicare	$13.45
Rate for Payer: Cash Price	$22.42
Rate for Payer: Cash Price	$22.42
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$17.94
Rate for Payer: Health Smart Auto/Commercial	$13.45
Rate for Payer: Intervalley Health Plan Commercial	$15.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.45
Rate for Payer: LLUH Dept of Risk Management WC	$12.33
Rate for Payer: Multiplan Commercial	$16.82

HC SOM 9INHE FACTOR IX INHIB TECH INTERP

Facility

$22.42

Service Code	CPT 85390
Hospital Charge Code	900915514
Hospital Revenue Code	300
Min. Negotiated Rate	$12.33
Max. Negotiated Rate	$17.94
Rate for Payer: Cash Price	$22.42
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$17.94
Rate for Payer: Health Smart Auto/Commercial	$13.45
Rate for Payer: LLUH Dept of Risk Management WC	$12.33
Rate for Payer: Multiplan Commercial	$16.82

HC SOM ACETYLCHOLINE RECPT AB BINDING

Facility

$39.75

Service Code	CPT 83519
Hospital Charge Code	900911205
Hospital Revenue Code	301
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$31.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.85
Rate for Payer: Aetna of CA Government/Medicare	$23.85
Rate for Payer: Cash Price	$39.75
Rate for Payer: Cash Price	$39.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$31.80
Rate for Payer: Health Smart Auto/Commercial	$23.85
Rate for Payer: Intervalley Health Plan Commercial	$18.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.85
Rate for Payer: LLUH Dept of Risk Management WC	$21.86
Rate for Payer: Multiplan Commercial	$29.81

HC SOM ACETYLCHOLINE RECPT AB BINDING

Facility

$39.75

Service Code	CPT 83519
Hospital Charge Code	900911205
Hospital Revenue Code	301
Min. Negotiated Rate	$21.86
Max. Negotiated Rate	$31.80
Rate for Payer: Cash Price	$39.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$31.80
Rate for Payer: Health Smart Auto/Commercial	$23.85
Rate for Payer: LLUH Dept of Risk Management WC	$21.86
Rate for Payer: Multiplan Commercial	$29.81

HC SOM ACETYLCHOLINESTERASE

Facility

$38.00

Service Code	CPT 82482
Hospital Charge Code	900910948
Hospital Revenue Code	301
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$30.40
Rate for Payer: Cash Price	$38.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.40
Rate for Payer: Health Smart Auto/Commercial	$22.80
Rate for Payer: LLUH Dept of Risk Management WC	$20.90
Rate for Payer: Multiplan Commercial	$28.50

HC SOM ACETYLCHOLINESTERASE

Facility

$38.00

Service Code	CPT 82482
Hospital Charge Code	900910948
Hospital Revenue Code	301
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$30.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.80
Rate for Payer: Aetna of CA Government/Medicare	$22.80
Rate for Payer: Cash Price	$38.00
Rate for Payer: Cash Price	$38.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.40
Rate for Payer: Health Smart Auto/Commercial	$22.80
Rate for Payer: Intervalley Health Plan Commercial	$9.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.80
Rate for Payer: LLUH Dept of Risk Management WC	$20.90
Rate for Payer: Multiplan Commercial	$28.50

HC SOM ACH RECEPTOR BINDING AB

Facility

$39.75

Service Code	CPT 83519
Hospital Charge Code	900912583
Hospital Revenue Code	301
Min. Negotiated Rate	$21.86
Max. Negotiated Rate	$31.80
Rate for Payer: Cash Price	$39.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$31.80
Rate for Payer: Health Smart Auto/Commercial	$23.85
Rate for Payer: LLUH Dept of Risk Management WC	$21.86
Rate for Payer: Multiplan Commercial	$29.81

HC SOM ACH RECEPTOR BINDING AB

Facility

$39.75

Service Code	CPT 83519
Hospital Charge Code	900912583
Hospital Revenue Code	301
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$31.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.85
Rate for Payer: Aetna of CA Government/Medicare	$23.85
Rate for Payer: Cash Price	$39.75
Rate for Payer: Cash Price	$39.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$31.80
Rate for Payer: Health Smart Auto/Commercial	$23.85
Rate for Payer: Intervalley Health Plan Commercial	$18.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.85
Rate for Payer: LLUH Dept of Risk Management WC	$21.86
Rate for Payer: Multiplan Commercial	$29.81

HC SOM ACID PHOSPHATASE TOTAL

Facility

$186.60

Service Code	CPT 84066
Hospital Charge Code	900910217
Hospital Revenue Code	301
Min. Negotiated Rate	$102.63
Max. Negotiated Rate	$149.28
Rate for Payer: Cash Price	$186.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$149.28
Rate for Payer: Health Smart Auto/Commercial	$111.96
Rate for Payer: LLUH Dept of Risk Management WC	$102.63
Rate for Payer: Multiplan Commercial	$139.95

HC SOM ACID PHOSPHATASE TOTAL

Facility

$186.60

Service Code	CPT 84066
Hospital Charge Code	900910217
Hospital Revenue Code	301
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$149.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$111.96
Rate for Payer: Aetna of CA Government/Medicare	$111.96
Rate for Payer: Cash Price	$186.60
Rate for Payer: Cash Price	$186.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$149.28
Rate for Payer: Health Smart Auto/Commercial	$111.96
Rate for Payer: Intervalley Health Plan Commercial	$9.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$111.96
Rate for Payer: LLUH Dept of Risk Management WC	$102.63
Rate for Payer: Multiplan Commercial	$139.95

HC SOM ACTIVATED PROTEIN C RESISTANCE

Facility

$35.00

Service Code	CPT 85307
Hospital Charge Code	900912508
Hospital Revenue Code	305
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$28.00
Rate for Payer: Cash Price	$35.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$28.00
Rate for Payer: Health Smart Auto/Commercial	$21.00
Rate for Payer: LLUH Dept of Risk Management WC	$19.25
Rate for Payer: Multiplan Commercial	$26.25

HC SOM ACTIVATED PROTEIN C RESISTANCE

Facility

$35.00

Service Code	CPT 85307
Hospital Charge Code	900912508
Hospital Revenue Code	305
Min. Negotiated Rate	$15.32
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.00
Rate for Payer: Aetna of CA Government/Medicare	$21.00
Rate for Payer: Cash Price	$35.00
Rate for Payer: Cash Price	$35.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$28.00
Rate for Payer: Health Smart Auto/Commercial	$21.00
Rate for Payer: Intervalley Health Plan Commercial	$15.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.00
Rate for Payer: LLUH Dept of Risk Management WC	$19.25
Rate for Payer: Multiplan Commercial	$26.25

HC SOM ACYCLOVIR

Facility

$164.00

Service Code	CPT 80299
Hospital Charge Code	900910711
Hospital Revenue Code	301
Min. Negotiated Rate	$18.64
Max. Negotiated Rate	$131.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$98.40
Rate for Payer: Aetna of CA Government/Medicare	$98.40
Rate for Payer: Cash Price	$164.00
Rate for Payer: Cash Price	$164.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$131.20
Rate for Payer: Health Smart Auto/Commercial	$98.40
Rate for Payer: Intervalley Health Plan Commercial	$18.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$98.40
Rate for Payer: LLUH Dept of Risk Management WC	$90.20
Rate for Payer: Multiplan Commercial	$123.00

HC SOM ACYCLOVIR

Facility

$164.00

Service Code	CPT 80299
Hospital Charge Code	900910711
Hospital Revenue Code	301
Min. Negotiated Rate	$90.20
Max. Negotiated Rate	$131.20
Rate for Payer: Cash Price	$164.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$131.20
Rate for Payer: Health Smart Auto/Commercial	$98.40
Rate for Payer: LLUH Dept of Risk Management WC	$90.20
Rate for Payer: Multiplan Commercial	$123.00

HC SOM ACYLCARNITINE PROFILE(PKU CARD

Facility

$41.20

Service Code	CPT 82017
Hospital Charge Code	900911486
Hospital Revenue Code	301
Min. Negotiated Rate	$22.66
Max. Negotiated Rate	$32.96
Rate for Payer: Cash Price	$41.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$32.96
Rate for Payer: Health Smart Auto/Commercial	$24.72
Rate for Payer: LLUH Dept of Risk Management WC	$22.66
Rate for Payer: Multiplan Commercial	$30.90

Know your out-of-pocket cost for care.

All Charges