Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM ACYLCARNITINE PROFILE(PKU CARD

Facility

$41.20

Service Code	CPT 82017
Hospital Charge Code	900911486
Hospital Revenue Code	301
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$32.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.72
Rate for Payer: Aetna of CA Government/Medicare	$24.72
Rate for Payer: Cash Price	$41.20
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: Intervalley Health Plan Commercial	$16.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.72
Rate for Payer: LLUH Dept of Risk Management WC	$22.66
Rate for Payer: Multiplan Commercial	$30.90

HC SOM ACYLGLYCINE

Facility

$175.00

Service Code	CPT 82542
Hospital Charge Code	900910712
Hospital Revenue Code	301
Min. Negotiated Rate	$96.25
Max. Negotiated Rate	$140.00
Rate for Payer: Cash Price	$175.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$140.00
Rate for Payer: Health Smart Auto/Commercial	$105.00
Rate for Payer: LLUH Dept of Risk Management WC	$96.25
Rate for Payer: Multiplan Commercial	$131.25

HC SOM ACYLGLYCINE

Facility

$175.00

Service Code	CPT 82542
Hospital Charge Code	900910712
Hospital Revenue Code	301
Min. Negotiated Rate	$24.09
Max. Negotiated Rate	$140.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$105.00
Rate for Payer: Aetna of CA Government/Medicare	$105.00
Rate for Payer: Cash Price	$175.00
Rate for Payer: Cash Price	$175.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$140.00
Rate for Payer: Health Smart Auto/Commercial	$105.00
Rate for Payer: Intervalley Health Plan Commercial	$24.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$105.00
Rate for Payer: LLUH Dept of Risk Management WC	$96.25
Rate for Payer: Multiplan Commercial	$131.25

HC SOM ADALIMUMAB AB REFLEX

Facility

$120.00

Service Code	CPT 83520
Hospital Charge Code	900915465
Hospital Revenue Code	300
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$96.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$96.00
Rate for Payer: Health Smart Auto/Commercial	$72.00
Rate for Payer: LLUH Dept of Risk Management WC	$66.00
Rate for Payer: Multiplan Commercial	$90.00

HC SOM ADALIMUMAB AB REFLEX

Facility

$120.00

Service Code	CPT 83520
Hospital Charge Code	900915465
Hospital Revenue Code	300
Min. Negotiated Rate	$17.27
Max. Negotiated Rate	$96.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$72.00
Rate for Payer: Aetna of CA Government/Medicare	$72.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$96.00
Rate for Payer: Health Smart Auto/Commercial	$72.00
Rate for Payer: Intervalley Health Plan Commercial	$17.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$72.00
Rate for Payer: LLUH Dept of Risk Management WC	$66.00
Rate for Payer: Multiplan Commercial	$90.00

HC SOM ADENOSINE DEAMINASE

Facility

$145.00

Service Code	CPT 84311
Hospital Charge Code	900911409
Hospital Revenue Code	301
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$116.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$87.00
Rate for Payer: Aetna of CA Government/Medicare	$87.00
Rate for Payer: Cash Price	$145.00
Rate for Payer: Cash Price	$145.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$116.00
Rate for Payer: Health Smart Auto/Commercial	$87.00
Rate for Payer: Intervalley Health Plan Commercial	$8.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$87.00
Rate for Payer: LLUH Dept of Risk Management WC	$79.75
Rate for Payer: Multiplan Commercial	$108.75

HC SOM ADENOSINE DEAMINASE

Facility

$145.00

Service Code	CPT 84311
Hospital Charge Code	900911409
Hospital Revenue Code	301
Min. Negotiated Rate	$79.75
Max. Negotiated Rate	$116.00
Rate for Payer: Cash Price	$145.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$116.00
Rate for Payer: Health Smart Auto/Commercial	$87.00
Rate for Payer: LLUH Dept of Risk Management WC	$79.75
Rate for Payer: Multiplan Commercial	$108.75

HC SOM ADENOVIRUS DNA PCR

Facility

$50.27

Service Code	CPT 87798
Hospital Charge Code	900912712
Hospital Revenue Code	306
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$40.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.16
Rate for Payer: Aetna of CA Government/Medicare	$30.16
Rate for Payer: Cash Price	$50.27
Rate for Payer: Cash Price	$50.27
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.22
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: Intervalley Health Plan Commercial	$35.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Commercial	$37.70

HC SOM ADENOVIRUS DNA PCR

Facility

$50.27

Service Code	CPT 87798
Hospital Charge Code	900912712
Hospital Revenue Code	306
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$40.22
Rate for Payer: Cash Price	$50.27
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.22
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Commercial	$37.70

HC SOM ADENOVIRUS DNA PCR NON-BLOOD

Facility

$50.27

Service Code	CPT 87798
Hospital Charge Code	900910713
Hospital Revenue Code	306
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$40.22
Rate for Payer: Cash Price	$50.27
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.22
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Commercial	$37.70

HC SOM ADENOVIRUS DNA PCR NON-BLOOD

Facility

$50.27

Service Code	CPT 87798
Hospital Charge Code	900910713
Hospital Revenue Code	306
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$40.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.16
Rate for Payer: Aetna of CA Government/Medicare	$30.16
Rate for Payer: Cash Price	$50.27
Rate for Payer: Cash Price	$50.27
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.22
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: Intervalley Health Plan Commercial	$35.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Commercial	$37.70

HC SOM ADENOVIRUS DNA PCR QUANT

Facility

$125.00

Service Code	CPT 87799
Hospital Charge Code	900912781
Hospital Revenue Code	306
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$75.00
Rate for Payer: Aetna of CA Government/Medicare	$75.00
Rate for Payer: Cash Price	$125.00
Rate for Payer: Cash Price	$125.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$100.00
Rate for Payer: Health Smart Auto/Commercial	$75.00
Rate for Payer: Intervalley Health Plan Commercial	$42.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$75.00
Rate for Payer: LLUH Dept of Risk Management WC	$68.75
Rate for Payer: Multiplan Commercial	$93.75

HC SOM ADENOVIRUS DNA PCR QUANT

Facility

$125.00

Service Code	CPT 87799
Hospital Charge Code	900912781
Hospital Revenue Code	306
Min. Negotiated Rate	$68.75
Max. Negotiated Rate	$100.00
Rate for Payer: Cash Price	$125.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$100.00
Rate for Payer: Health Smart Auto/Commercial	$75.00
Rate for Payer: LLUH Dept of Risk Management WC	$68.75
Rate for Payer: Multiplan Commercial	$93.75

HC SOM AFP & TOTAL AFT, SERUM

Facility

$125.00

Service Code	CPT 82107
Hospital Charge Code	900913812
Hospital Revenue Code	301
Min. Negotiated Rate	$68.75
Max. Negotiated Rate	$100.00
Rate for Payer: Cash Price	$125.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$100.00
Rate for Payer: Health Smart Auto/Commercial	$75.00
Rate for Payer: LLUH Dept of Risk Management WC	$68.75
Rate for Payer: Multiplan Commercial	$93.75

HC SOM AFP & TOTAL AFT, SERUM

Facility

$125.00

Service Code	CPT 82107
Hospital Charge Code	900913812
Hospital Revenue Code	301
Min. Negotiated Rate	$64.41
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$75.00
Rate for Payer: Aetna of CA Government/Medicare	$75.00
Rate for Payer: Cash Price	$125.00
Rate for Payer: Cash Price	$125.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$100.00
Rate for Payer: Health Smart Auto/Commercial	$75.00
Rate for Payer: Intervalley Health Plan Commercial	$64.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$75.00
Rate for Payer: LLUH Dept of Risk Management WC	$68.75
Rate for Payer: Multiplan Commercial	$93.75

HC SOM ALBUMIN LEVEL BODY FLUID

Facility

$10.00

Service Code	CPT 82042
Hospital Charge Code	900914481
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
Rate for Payer: Cash Price	$10.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.00
Rate for Payer: Health Smart Auto/Commercial	$6.00
Rate for Payer: LLUH Dept of Risk Management WC	$5.50
Rate for Payer: Multiplan Commercial	$7.50

HC SOM ALBUMIN LEVEL BODY FLUID

Facility

$10.00

Service Code	CPT 82042
Hospital Charge Code	900914481
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.00
Rate for Payer: Aetna of CA Government/Medicare	$6.00
Rate for Payer: Cash Price	$10.00
Rate for Payer: Cash Price	$10.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.00
Rate for Payer: Health Smart Auto/Commercial	$6.00
Rate for Payer: Intervalley Health Plan Commercial	$7.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.00
Rate for Payer: LLUH Dept of Risk Management WC	$5.50
Rate for Payer: Multiplan Commercial	$7.50

HC SOM ALDOLASE

Facility

$9.00

Service Code	CPT 82085
Hospital Charge Code	900910218
Hospital Revenue Code	301
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$9.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.40
Rate for Payer: Aetna of CA Government/Medicare	$5.40
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: Intervalley Health Plan Commercial	$9.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

HC SOM ALDOLASE

Facility

$9.00

Service Code	CPT 82085
Hospital Charge Code	900910218
Hospital Revenue Code	301
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Cash Price	$9.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Commercial	$6.75

HC SOM ALDOSTERONE

Facility

$19.50

Service Code	CPT 82088
Hospital Charge Code	900910965
Hospital Revenue Code	301
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$40.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.70
Rate for Payer: Aetna of CA Government/Medicare	$11.70
Rate for Payer: Cash Price	$19.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$15.60
Rate for Payer: Health Smart Auto/Commercial	$11.70
Rate for Payer: Intervalley Health Plan Commercial	$40.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.70
Rate for Payer: LLUH Dept of Risk Management WC	$10.72
Rate for Payer: Multiplan Commercial	$14.62

HC SOM ALDOSTERONE

Facility

$19.50

Service Code	CPT 82088
Hospital Charge Code	900910965
Hospital Revenue Code	301
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$15.60
Rate for Payer: Cash Price	$19.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$15.60
Rate for Payer: Health Smart Auto/Commercial	$11.70
Rate for Payer: LLUH Dept of Risk Management WC	$10.72
Rate for Payer: Multiplan Commercial	$14.62

HC SOM ALDOSTERONE URINE

Facility

$45.00

Service Code	CPT 82088
Hospital Charge Code	900910945
Hospital Revenue Code	301
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$36.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$36.00
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Commercial	$33.75

HC SOM ALDOSTERONE URINE

Facility

$45.00

Service Code	CPT 82088
Hospital Charge Code	900910945
Hospital Revenue Code	301
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$40.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.00
Rate for Payer: Aetna of CA Government/Medicare	$27.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$36.00
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: Intervalley Health Plan Commercial	$40.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Commercial	$33.75

HC SOM ALKALINE PHOSPHATSE ISO

Facility

$16.34

Service Code	CPT 84080
Hospital Charge Code	900911249
Hospital Revenue Code	301
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$13.07
Rate for Payer: Cash Price	$16.34
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.07
Rate for Payer: Health Smart Auto/Commercial	$9.80
Rate for Payer: LLUH Dept of Risk Management WC	$8.99
Rate for Payer: Multiplan Commercial	$12.26

HC SOM ALKALINE PHOSPHATSE ISO

Facility

$16.34

Service Code	CPT 84080
Hospital Charge Code	900911249
Hospital Revenue Code	301
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$14.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.80
Rate for Payer: Aetna of CA Government/Medicare	$9.80
Rate for Payer: Cash Price	$16.34
Rate for Payer: Cash Price	$16.34
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.07
Rate for Payer: Health Smart Auto/Commercial	$9.80
Rate for Payer: Intervalley Health Plan Commercial	$14.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.80
Rate for Payer: LLUH Dept of Risk Management WC	$8.99
Rate for Payer: Multiplan Commercial	$12.26

Know your out-of-pocket cost for care.

All Charges