Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM BETA 2 MICROGLOBULIN URINE

Facility

$27.00

Service Code	CPT 82232
Hospital Charge Code	900911370
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.20
Rate for Payer: Aetna of CA Government/Medicare	$16.20
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$21.60
Rate for Payer: Health Smart Auto/Commercial	$16.20
Rate for Payer: Intervalley Health Plan Commercial	$16.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.20
Rate for Payer: LLUH Dept of Risk Management WC	$14.85
Rate for Payer: Multiplan Commercial	$20.25

HC SOM BETA 2 MICROGLOBULIN URINE

Facility

$27.00

Service Code	CPT 82232
Hospital Charge Code	900911370
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$21.60
Rate for Payer: Cash Price	$27.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$21.60
Rate for Payer: Health Smart Auto/Commercial	$16.20
Rate for Payer: LLUH Dept of Risk Management WC	$14.85
Rate for Payer: Multiplan Commercial	$20.25

HC SOM BETA 2 TRANSFERRIN (TAU)

Facility

$78.02

Service Code	CPT 86335
Hospital Charge Code	900911443
Hospital Revenue Code	301
Min. Negotiated Rate	$29.35
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$46.81
Rate for Payer: Aetna of CA Government/Medicare	$46.81
Rate for Payer: Cash Price	$78.02
Rate for Payer: Cash Price	$78.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$62.42
Rate for Payer: Health Smart Auto/Commercial	$46.81
Rate for Payer: Intervalley Health Plan Commercial	$29.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$46.81
Rate for Payer: LLUH Dept of Risk Management WC	$42.91
Rate for Payer: Multiplan Commercial	$58.52

HC SOM BETA 2 TRANSFERRIN (TAU)

Facility

$78.02

Service Code	CPT 86335
Hospital Charge Code	900911443
Hospital Revenue Code	301
Min. Negotiated Rate	$42.91
Max. Negotiated Rate	$62.42
Rate for Payer: Cash Price	$78.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$62.42
Rate for Payer: Health Smart Auto/Commercial	$46.81
Rate for Payer: LLUH Dept of Risk Management WC	$42.91
Rate for Payer: Multiplan Commercial	$58.52

HC SOM BETA GALACTOSIDASE

Facility

$573.70

Service Code	CPT 82657
Hospital Charge Code	900912511
Hospital Revenue Code	301
Min. Negotiated Rate	$22.17
Max. Negotiated Rate	$458.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$344.22
Rate for Payer: Aetna of CA Government/Medicare	$344.22
Rate for Payer: Cash Price	$573.70
Rate for Payer: Cash Price	$573.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$458.96
Rate for Payer: Health Smart Auto/Commercial	$344.22
Rate for Payer: Intervalley Health Plan Commercial	$22.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$344.22
Rate for Payer: LLUH Dept of Risk Management WC	$315.54
Rate for Payer: Multiplan Commercial	$430.27

HC SOM BETA GALACTOSIDASE

Facility

$573.70

Service Code	CPT 82657
Hospital Charge Code	900912511
Hospital Revenue Code	301
Min. Negotiated Rate	$315.54
Max. Negotiated Rate	$458.96
Rate for Payer: Cash Price	$573.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$458.96
Rate for Payer: Health Smart Auto/Commercial	$344.22
Rate for Payer: LLUH Dept of Risk Management WC	$315.54
Rate for Payer: Multiplan Commercial	$430.27

HC SOM BETA GLYCOPROTEIN AB IGA

Facility

$20.00

Service Code	CPT 86146
Hospital Charge Code	900912615
Hospital Revenue Code	302
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$25.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.00
Rate for Payer: Aetna of CA Government/Medicare	$12.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: Intervalley Health Plan Commercial	$25.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Commercial	$15.00

HC SOM BETA GLYCOPROTEIN AB IGA

Facility

$20.00

Service Code	CPT 86146
Hospital Charge Code	900912615
Hospital Revenue Code	302
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$16.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Commercial	$15.00

HC SOM BETA GLYCOPROTEIN AB IGG

Facility

$20.00

Service Code	CPT 86146
Hospital Charge Code	900910565
Hospital Revenue Code	302
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$25.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.00
Rate for Payer: Aetna of CA Government/Medicare	$12.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: Intervalley Health Plan Commercial	$25.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Commercial	$15.00

HC SOM BETA GLYCOPROTEIN AB IGG

Facility

$20.00

Service Code	CPT 86146
Hospital Charge Code	900910565
Hospital Revenue Code	302
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$16.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Commercial	$15.00

HC SOM BETA GLYCOPROTEIN AB IGM

Facility

$20.00

Service Code	CPT 86146
Hospital Charge Code	900912616
Hospital Revenue Code	302
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$16.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Commercial	$15.00

HC SOM BETA GLYCOPROTEIN AB IGM

Facility

$20.00

Service Code	CPT 86146
Hospital Charge Code	900912616
Hospital Revenue Code	302
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$25.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.00
Rate for Payer: Aetna of CA Government/Medicare	$12.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: Intervalley Health Plan Commercial	$25.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Commercial	$15.00

HC SOM BETA HCG CSF

Facility

$35.00

Service Code	CPT 84702
Hospital Charge Code	900910726
Hospital Revenue Code	301
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 BETA HCG CSF

Facility

$35.00

Service Code	CPT 84702
Hospital Charge Code	900910726
Hospital Revenue Code	301
Min. Negotiated Rate	$15.05
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	$15.05
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 BICARBONATE URINE

Facility

$83.00

Service Code	CPT 82374
Hospital Charge Code	900910363
Hospital Revenue Code	301
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$66.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$49.80
Rate for Payer: Aetna of CA Government/Medicare	$49.80
Rate for Payer: Cash Price	$83.00
Rate for Payer: Cash Price	$83.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$66.40
Rate for Payer: Health Smart Auto/Commercial	$49.80
Rate for Payer: Intervalley Health Plan Commercial	$4.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$49.80
Rate for Payer: LLUH Dept of Risk Management WC	$45.65
Rate for Payer: Multiplan Commercial	$62.25

HC SOM BICARBONATE URINE

Facility

$83.00

Service Code	CPT 82374
Hospital Charge Code	900910363
Hospital Revenue Code	301
Min. Negotiated Rate	$45.65
Max. Negotiated Rate	$66.40
Rate for Payer: Cash Price	$83.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$66.40
Rate for Payer: Health Smart Auto/Commercial	$49.80
Rate for Payer: LLUH Dept of Risk Management WC	$45.65
Rate for Payer: Multiplan Commercial	$62.25

HC SOM BILE ACIDS TOTAL

Facility

$30.00

Service Code	CPT 82239
Hospital Charge Code	900911123
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$24.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$24.00
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Commercial	$22.50

HC SOM BILE ACIDS TOTAL

Facility

$30.00

Service Code	CPT 82239
Hospital Charge Code	900911123
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.00
Rate for Payer: Aetna of CA Government/Medicare	$18.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$24.00
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: Intervalley Health Plan Commercial	$17.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Commercial	$22.50

HC SOM BK VIRUS DNA QUANT PCR

Facility

$65.90

Service Code	CPT 87799
Hospital Charge Code	900912559
Hospital Revenue Code	301
Min. Negotiated Rate	$36.24
Max. Negotiated Rate	$52.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$39.54
Rate for Payer: Aetna of CA Government/Medicare	$39.54
Rate for Payer: Cash Price	$65.90
Rate for Payer: Cash Price	$65.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$52.72
Rate for Payer: Health Smart Auto/Commercial	$39.54
Rate for Payer: Intervalley Health Plan Commercial	$42.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$39.54
Rate for Payer: LLUH Dept of Risk Management WC	$36.24
Rate for Payer: Multiplan Commercial	$49.42

HC SOM BK VIRUS DNA QUANT PCR

Facility

$65.90

Service Code	CPT 87799
Hospital Charge Code	900912559
Hospital Revenue Code	301
Min. Negotiated Rate	$36.24
Max. Negotiated Rate	$52.72
Rate for Payer: Cash Price	$65.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$52.72
Rate for Payer: Health Smart Auto/Commercial	$39.54
Rate for Payer: LLUH Dept of Risk Management WC	$36.24
Rate for Payer: Multiplan Commercial	$49.42

HC SOM BLASTOMYCES AB IMMUNODIFFUSION

Facility

$21.51

Service Code	CPT 86612
Hospital Charge Code	900912686
Hospital Revenue Code	302
Min. Negotiated Rate	$11.83
Max. Negotiated Rate	$17.21
Rate for Payer: Cash Price	$21.51
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$17.21
Rate for Payer: Health Smart Auto/Commercial	$12.91
Rate for Payer: LLUH Dept of Risk Management WC	$11.83
Rate for Payer: Multiplan Commercial	$16.13

HC SOM BLASTOMYCES AB IMMUNODIFFUSION

Facility

$21.51

Service Code	CPT 86612
Hospital Charge Code	900912686
Hospital Revenue Code	302
Min. Negotiated Rate	$11.83
Max. Negotiated Rate	$17.21
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.91
Rate for Payer: Aetna of CA Government/Medicare	$12.91
Rate for Payer: Cash Price	$21.51
Rate for Payer: Cash Price	$21.51
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$17.21
Rate for Payer: Health Smart Auto/Commercial	$12.91
Rate for Payer: Intervalley Health Plan Commercial	$12.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.91
Rate for Payer: LLUH Dept of Risk Management WC	$11.83
Rate for Payer: Multiplan Commercial	$16.13

HC SOM BORDETELLA PCR

Facility

$38.80

Service Code	CPT 87798
Hospital Charge Code	900914165
Hospital Revenue Code	306
Min. Negotiated Rate	$21.34
Max. Negotiated Rate	$35.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.28
Rate for Payer: Aetna of CA Government/Medicare	$23.28
Rate for Payer: Cash Price	$38.80
Rate for Payer: Cash Price	$38.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$31.04
Rate for Payer: Health Smart Auto/Commercial	$23.28
Rate for Payer: Intervalley Health Plan Commercial	$35.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.28
Rate for Payer: LLUH Dept of Risk Management WC	$21.34
Rate for Payer: Multiplan Commercial	$29.10

HC SOM BORDETELLA PCR

Facility

$38.80

Service Code	CPT 87798
Hospital Charge Code	900914165
Hospital Revenue Code	306
Min. Negotiated Rate	$21.34
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$38.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$31.04
Rate for Payer: Health Smart Auto/Commercial	$23.28
Rate for Payer: LLUH Dept of Risk Management WC	$21.34
Rate for Payer: Multiplan Commercial	$29.10

HC SOM BORIC ACID

Facility

$85.00

Service Code	CPT 83018
Hospital Charge Code	900911050
Hospital Revenue Code	301
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$68.00
Rate for Payer: Cash Price	$85.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$68.00
Rate for Payer: Health Smart Auto/Commercial	$51.00
Rate for Payer: LLUH Dept of Risk Management WC	$46.75
Rate for Payer: Multiplan Commercial	$63.75

Know your out-of-pocket cost for care.

All Charges