Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM CHROMOGRANIN A

Facility

$17.65

Service Code	CPT 86316
Hospital Charge Code	900911458
Hospital Revenue Code	301
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$14.12
Rate for Payer: Cash Price	$17.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.12
Rate for Payer: Health Smart Auto/Commercial	$10.59
Rate for Payer: LLUH Dept of Risk Management WC	$9.71
Rate for Payer: Multiplan Commercial	$13.24

HC SOM CHROMOGRANIN A

Facility

$17.65

Service Code	CPT 86316
Hospital Charge Code	900911458
Hospital Revenue Code	301
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$20.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.59
Rate for Payer: Aetna of CA Government/Medicare	$10.59
Rate for Payer: Cash Price	$17.65
Rate for Payer: Cash Price	$17.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.12
Rate for Payer: Health Smart Auto/Commercial	$10.59
Rate for Payer: Intervalley Health Plan Commercial	$20.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.59
Rate for Payer: LLUH Dept of Risk Management WC	$9.71
Rate for Payer: Multiplan Commercial	$13.24

HC SOM CHROMOSOME ANALYSIS BREAKAGE

Facility

$243.11

Service Code	CPT 88291
Hospital Charge Code	900912554
Hospital Revenue Code	310
Min. Negotiated Rate	$133.71
Max. Negotiated Rate	$194.49
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$145.87
Rate for Payer: Aetna of CA Government/Medicare	$145.87
Rate for Payer: Cash Price	$243.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$194.49
Rate for Payer: Health Smart Auto/Commercial	$145.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$145.87
Rate for Payer: LLUH Dept of Risk Management WC	$133.71
Rate for Payer: Multiplan Commercial	$182.33

HC SOM CHROMOSOME ANALYSIS BREAKAGE

Facility

$243.11

Service Code	CPT 88291
Hospital Charge Code	900912554
Hospital Revenue Code	310
Min. Negotiated Rate	$133.71
Max. Negotiated Rate	$194.49
Rate for Payer: Cash Price	$243.11
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$194.49
Rate for Payer: Health Smart Auto/Commercial	$145.87
Rate for Payer: LLUH Dept of Risk Management WC	$133.71
Rate for Payer: Multiplan Commercial	$182.33

HC SOM CHROMOSOME ANALYSIS MARROW

Facility

$950.00

Service Code	CPT 88291
Hospital Charge Code	900910601
Hospital Revenue Code	310
Min. Negotiated Rate	$522.50
Max. Negotiated Rate	$760.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$570.00
Rate for Payer: Aetna of CA Government/Medicare	$570.00
Rate for Payer: Cash Price	$950.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$760.00
Rate for Payer: Health Smart Auto/Commercial	$570.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$570.00
Rate for Payer: LLUH Dept of Risk Management WC	$522.50
Rate for Payer: Multiplan Commercial	$712.50

HC SOM CHROMOSOME ANALYSIS MARROW

Facility

$950.00

Service Code	CPT 88291
Hospital Charge Code	900910601
Hospital Revenue Code	310
Min. Negotiated Rate	$522.50
Max. Negotiated Rate	$760.00
Rate for Payer: Cash Price	$950.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$760.00
Rate for Payer: Health Smart Auto/Commercial	$570.00
Rate for Payer: LLUH Dept of Risk Management WC	$522.50
Rate for Payer: Multiplan Commercial	$712.50

HC SOM CHROMOSOME ANALYSIS WHOLE BLOOD

Facility

$391.00

Service Code	CPT 88291
Hospital Charge Code	900910752
Hospital Revenue Code	310
Min. Negotiated Rate	$215.05
Max. Negotiated Rate	$312.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$234.60
Rate for Payer: Aetna of CA Government/Medicare	$234.60
Rate for Payer: Cash Price	$391.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$312.80
Rate for Payer: Health Smart Auto/Commercial	$234.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$234.60
Rate for Payer: LLUH Dept of Risk Management WC	$215.05
Rate for Payer: Multiplan Commercial	$293.25

HC SOM CHROMOSOME ANALYSIS WHOLE BLOOD

Facility

$391.00

Service Code	CPT 88291
Hospital Charge Code	900910752
Hospital Revenue Code	310
Min. Negotiated Rate	$215.05
Max. Negotiated Rate	$312.80
Rate for Payer: Cash Price	$391.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$312.80
Rate for Payer: Health Smart Auto/Commercial	$234.60
Rate for Payer: LLUH Dept of Risk Management WC	$215.05
Rate for Payer: Multiplan Commercial	$293.25

HC SOM CHROMOSOMES CHORIONIC VILLUS

Facility

$400.00

Service Code	CPT 88291
Hospital Charge Code	900912549
Hospital Revenue Code	310
Min. Negotiated Rate	$220.00
Max. Negotiated Rate	$320.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$320.00
Rate for Payer: Health Smart Auto/Commercial	$240.00
Rate for Payer: LLUH Dept of Risk Management WC	$220.00
Rate for Payer: Multiplan Commercial	$300.00

HC SOM CHROMOSOMES CHORIONIC VILLUS

Facility

$400.00

Service Code	CPT 88291
Hospital Charge Code	900912549
Hospital Revenue Code	310
Min. Negotiated Rate	$220.00
Max. Negotiated Rate	$320.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$240.00
Rate for Payer: Aetna of CA Government/Medicare	$240.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$320.00
Rate for Payer: Health Smart Auto/Commercial	$240.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$240.00
Rate for Payer: LLUH Dept of Risk Management WC	$220.00
Rate for Payer: Multiplan Commercial	$300.00

HC SOM CHROMOSOMES LYMPHOID

Facility

$36.56

Service Code	CPT 88291
Hospital Charge Code	900912548
Hospital Revenue Code	310
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.94
Rate for Payer: Aetna of CA Government/Medicare	$21.94
Rate for Payer: Cash Price	$36.56
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$29.25
Rate for Payer: Health Smart Auto/Commercial	$21.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.94
Rate for Payer: LLUH Dept of Risk Management WC	$20.11
Rate for Payer: Multiplan Commercial	$27.42

HC SOM CHROMOSOMES LYMPHOID

Facility

$36.56

Service Code	CPT 88291
Hospital Charge Code	900912548
Hospital Revenue Code	310
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$29.25
Rate for Payer: Cash Price	$36.56
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$29.25
Rate for Payer: Health Smart Auto/Commercial	$21.94
Rate for Payer: LLUH Dept of Risk Management WC	$20.11
Rate for Payer: Multiplan Commercial	$27.42

HC SOM CHROMOSOMES SKIN BIOPSY

Facility

$276.95

Service Code	CPT 88291
Hospital Charge Code	900912547
Hospital Revenue Code	310
Min. Negotiated Rate	$152.32
Max. Negotiated Rate	$221.56
Rate for Payer: Cash Price	$276.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$221.56
Rate for Payer: Health Smart Auto/Commercial	$166.17
Rate for Payer: LLUH Dept of Risk Management WC	$152.32
Rate for Payer: Multiplan Commercial	$207.71

HC SOM CHROMOSOMES SKIN BIOPSY

Facility

$276.95

Service Code	CPT 88291
Hospital Charge Code	900912547
Hospital Revenue Code	310
Min. Negotiated Rate	$152.32
Max. Negotiated Rate	$221.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$166.17
Rate for Payer: Aetna of CA Government/Medicare	$166.17
Rate for Payer: Cash Price	$276.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$221.56
Rate for Payer: Health Smart Auto/Commercial	$166.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$166.17
Rate for Payer: LLUH Dept of Risk Management WC	$152.32
Rate for Payer: Multiplan Commercial	$207.71

HC SOM CHRONIC URTICARIA INDEX

Facility

$160.00

Service Code	CPT 86343
Hospital Charge Code	900912840
Hospital Revenue Code	302
Min. Negotiated Rate	$88.00
Max. Negotiated Rate	$128.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$128.00
Rate for Payer: Health Smart Auto/Commercial	$96.00
Rate for Payer: LLUH Dept of Risk Management WC	$88.00
Rate for Payer: Multiplan Commercial	$120.00

HC SOM CHRONIC URTICARIA INDEX

Facility

$160.00

Service Code	CPT 86343
Hospital Charge Code	900912840
Hospital Revenue Code	302
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$128.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$96.00
Rate for Payer: Aetna of CA Government/Medicare	$96.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$128.00
Rate for Payer: Health Smart Auto/Commercial	$96.00
Rate for Payer: Intervalley Health Plan Commercial	$12.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$96.00
Rate for Payer: LLUH Dept of Risk Management WC	$88.00
Rate for Payer: Multiplan Commercial	$120.00

HC SOM CIRC TUMOR PROS FLOW

Facility

$325.24

Service Code	CPT 86152
Hospital Charge Code	900914391
Hospital Revenue Code	309
Min. Negotiated Rate	$178.88
Max. Negotiated Rate	$260.19
Rate for Payer: Cash Price	$325.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$260.19
Rate for Payer: Health Smart Auto/Commercial	$195.14
Rate for Payer: LLUH Dept of Risk Management WC	$178.88
Rate for Payer: Multiplan Commercial	$243.93

HC SOM CIRC TUMOR PROS FLOW

Facility

$325.24

Service Code	CPT 86152
Hospital Charge Code	900914391
Hospital Revenue Code	309
Min. Negotiated Rate	$178.88
Max. Negotiated Rate	$260.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$195.14
Rate for Payer: Aetna of CA Government/Medicare	$195.14
Rate for Payer: Cash Price	$325.24
Rate for Payer: Cash Price	$325.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$260.19
Rate for Payer: Health Smart Auto/Commercial	$195.14
Rate for Payer: Intervalley Health Plan Commercial	$250.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$195.14
Rate for Payer: LLUH Dept of Risk Management WC	$178.88
Rate for Payer: Multiplan Commercial	$243.93

HC SOM CIRC TUMOR PROS MARK

Facility

$325.24

Service Code	CPT 86153
Hospital Charge Code	900914392
Hospital Revenue Code	309
Min. Negotiated Rate	$178.88
Max. Negotiated Rate	$260.19
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$195.14
Rate for Payer: Aetna of CA Government/Medicare	$195.14
Rate for Payer: Cash Price	$325.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$260.19
Rate for Payer: Health Smart Auto/Commercial	$195.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$195.14
Rate for Payer: LLUH Dept of Risk Management WC	$178.88
Rate for Payer: Multiplan Commercial	$243.93

HC SOM CIRC TUMOR PROS MARK

Facility

$325.24

Service Code	CPT 86153
Hospital Charge Code	900914392
Hospital Revenue Code	309
Min. Negotiated Rate	$178.88
Max. Negotiated Rate	$260.19
Rate for Payer: Cash Price	$325.24
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$260.19
Rate for Payer: Health Smart Auto/Commercial	$195.14
Rate for Payer: LLUH Dept of Risk Management WC	$178.88
Rate for Payer: Multiplan Commercial	$243.93

HC SOM CITRIC ACID URINE

Facility

$20.00

Service Code	CPT 82507
Hospital Charge Code	900911053
Hospital Revenue Code	301
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 CITRIC ACID URINE

Facility

$20.00

Service Code	CPT 82507
Hospital Charge Code	900911053
Hospital Revenue Code	301
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$27.80
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	$27.80
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 CLONAZEPAM (CLONOPIN)

Facility

$30.00

Service Code	CPT 80346
Hospital Charge Code	900911228
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 CLONAZEPAM (CLONOPIN)

Facility

$30.00

Service Code	CPT 80346
Hospital Charge Code	900911228
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: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$24.00
Rate for Payer: Health Smart Auto/Commercial	$18.00
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 CLOZAPINE LEVEL

Facility

$31.59

Service Code	CPT 80159
Hospital Charge Code	900911438
Hospital Revenue Code	301
Min. Negotiated Rate	$17.37
Max. Negotiated Rate	$25.27
Rate for Payer: Cash Price	$31.59
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$25.27
Rate for Payer: Health Smart Auto/Commercial	$18.95
Rate for Payer: LLUH Dept of Risk Management WC	$17.37
Rate for Payer: Multiplan Commercial	$23.69

Know your out-of-pocket cost for care.

All Charges