Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM 199PC 86301

Facility

$29.81

Service Code	CPT 86301 90
Hospital Charge Code	900914879
Hospital Revenue Code	301
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$23.85
Rate for Payer: Health Smart Auto/Commercial	$17.89
Rate for Payer: Cash Price	$13.41
Rate for Payer: Cigna of CA HMO/PPO	$23.85
Rate for Payer: LLUH Dept of Risk Management WC	$16.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.36

HC SOM 199PC 86301

Facility

$29.81

Service Code	CPT 86301
Hospital Charge Code	900914879
Hospital Revenue Code	301
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$23.85
Rate for Payer: Cash Price	$13.41
Rate for Payer: Cigna of CA HMO/PPO	$23.85
Rate for Payer: Health Smart Auto/Commercial	$17.89
Rate for Payer: LLUH Dept of Risk Management WC	$16.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.36

HC SOM 199PC 86301

Facility

$29.81

Service Code	CPT 86301
Hospital Charge Code	900914879
Hospital Revenue Code	301
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$22.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$17.89
Rate for Payer: Aetna of CA Government/Medicare	$17.89
Rate for Payer: Cash Price	$13.41
Rate for Payer: Health Smart Auto/Commercial	$17.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$17.89
Rate for Payer: LLUH Dept of Risk Management WC	$16.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.36

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	$25.52
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	$15.31
Rate for Payer: Health Smart Auto/Commercial	$20.41
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 Beech St/Commercial/PHCS	$25.52

HC SOM 5-FLUOROCYTOSINE

Facility

$34.02

Service Code	CPT 80299 90
Hospital Charge Code	900911263
Hospital Revenue Code	301
Min. Negotiated Rate	$18.71
Max. Negotiated Rate	$27.22
Rate for Payer: Cash Price	$15.31
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$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	$15.31
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$25.52

HC SOM 5-FLUOROCYTOSINE

Facility

$34.02

Service Code	CPT 80299 90
Hospital Charge Code	900911263
Hospital Revenue Code	301
Min. Negotiated Rate	$18.71
Max. Negotiated Rate	$25.52
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	$15.31
Rate for Payer: Health Smart Auto/Commercial	$20.41
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 Beech St/Commercial/PHCS	$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	$45.00
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$75.00

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	$75.00
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	$45.00
Rate for Payer: Health Smart Auto/Commercial	$60.00
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 Beech St/Commercial/PHCS	$75.00

HC SOM 7-DEHYDROCHOLESTERL

Facility

$100.00

Service Code	CPT 82542 90
Hospital Charge Code	900910710
Hospital Revenue Code	301
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$75.00
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	$45.00
Rate for Payer: Health Smart Auto/Commercial	$60.00
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 Beech St/Commercial/PHCS	$75.00

HC SOM 7-DEHYDROCHOLESTERL

Facility

$100.00

Service Code	CPT 82542 90
Hospital Charge Code	900910710
Hospital Revenue Code	301
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$80.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$75.00

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	$29.81
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	$17.89
Rate for Payer: Health Smart Auto/Commercial	$23.85
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 Beech St/Commercial/PHCS	$29.81

HC SOM ACETYLCHOLINE RECPT AB BINDING

Facility

$39.75

Service Code	CPT 83519 90
Hospital Charge Code	900911205
Hospital Revenue Code	301
Min. Negotiated Rate	$21.86
Max. Negotiated Rate	$29.81
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	$17.89
Rate for Payer: Health Smart Auto/Commercial	$23.85
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 Beech St/Commercial/PHCS	$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	$17.89
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$29.81

HC SOM ACETYLCHOLINE RECPT AB BINDING

Facility

$39.75

Service Code	CPT 83519 90
Hospital Charge Code	900911205
Hospital Revenue Code	301
Min. Negotiated Rate	$21.86
Max. Negotiated Rate	$31.80
Rate for Payer: Cash Price	$17.89
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$29.81

HC SOM ACETYLCHOLINESTERASE

Facility

$38.00

Service Code	CPT 82482 90
Hospital Charge Code	900910948
Hospital Revenue Code	301
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$30.40
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$28.50

HC SOM ACETYLCHOLINESTERASE

Facility

$38.00

Service Code	CPT 82482 90
Hospital Charge Code	900910948
Hospital Revenue Code	301
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$28.50
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	$17.10
Rate for Payer: Health Smart Auto/Commercial	$22.80
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 Beech St/Commercial/PHCS	$28.50

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	$28.50
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	$17.10
Rate for Payer: Health Smart Auto/Commercial	$22.80
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 Beech St/Commercial/PHCS	$28.50

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	$17.10
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$28.50

HC SOM ACH RECEPTOR BINDING AB

Facility

$39.75

Service Code	CPT 83519 90
Hospital Charge Code	900912583
Hospital Revenue Code	301
Min. Negotiated Rate	$21.86
Max. Negotiated Rate	$29.81
Rate for Payer: Health Smart Auto/Commercial	$23.85
Rate for Payer: Cash Price	$17.89
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: 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 Beech St/Commercial/PHCS	$29.81

HC SOM ACH RECEPTOR BINDING AB

Facility

$39.75

Service Code	CPT 83519 90
Hospital Charge Code	900912583
Hospital Revenue Code	301
Min. Negotiated Rate	$21.86
Max. Negotiated Rate	$31.80
Rate for Payer: Cash Price	$17.89
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$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	$21.86
Max. Negotiated Rate	$31.80
Rate for Payer: Cash Price	$17.89
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$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	$21.86
Max. Negotiated Rate	$29.81
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	$17.89
Rate for Payer: Health Smart Auto/Commercial	$23.85
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 Beech St/Commercial/PHCS	$29.81

HC SOM ACID PHOSPHATASE TOTAL

Facility

$174.77

Service Code	CPT 84066 90
Hospital Charge Code	900910217
Hospital Revenue Code	301
Min. Negotiated Rate	$96.12
Max. Negotiated Rate	$139.82
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cigna of CA HMO/PPO	$139.82
Rate for Payer: Health Smart Auto/Commercial	$104.86
Rate for Payer: LLUH Dept of Risk Management WC	$96.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$131.08

HC SOM ACID PHOSPHATASE TOTAL

Facility

$174.77

Service Code	CPT 84066
Hospital Charge Code	900910217
Hospital Revenue Code	301
Min. Negotiated Rate	$96.12
Max. Negotiated Rate	$139.82
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cigna of CA HMO/PPO	$139.82
Rate for Payer: Health Smart Auto/Commercial	$104.86
Rate for Payer: LLUH Dept of Risk Management WC	$96.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$131.08

Know your out-of-pocket cost for care.

All Charges