Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM MYCOPLASMA PNEUMONIAE AB IGG

Facility

$10.40

Service Code	CPT 86738
Hospital Charge Code	900911589
Hospital Revenue Code	302
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$13.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.24
Rate for Payer: Aetna of CA Government/Medicare	$6.24
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cash Price	$10.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.32
Rate for Payer: Health Smart Auto/Commercial	$6.24
Rate for Payer: Intervalley Health Plan Commercial	$13.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.24
Rate for Payer: LLUH Dept of Risk Management WC	$5.72
Rate for Payer: Multiplan Commercial	$7.80

HC SOM MYCOPLASMA PNEUMONIAE AB IGM

Facility

$10.41

Service Code	CPT 86738
Hospital Charge Code	900912639
Hospital Revenue Code	302
Min. Negotiated Rate	$5.73
Max. Negotiated Rate	$13.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.25
Rate for Payer: Aetna of CA Government/Medicare	$6.25
Rate for Payer: Cash Price	$10.41
Rate for Payer: Cash Price	$10.41
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.33
Rate for Payer: Health Smart Auto/Commercial	$6.25
Rate for Payer: Intervalley Health Plan Commercial	$13.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.25
Rate for Payer: LLUH Dept of Risk Management WC	$5.73
Rate for Payer: Multiplan Commercial	$7.81

HC SOM MYCOPLASMA PNEUMONIAE AB IGM

Facility

$10.41

Service Code	CPT 86738
Hospital Charge Code	900912639
Hospital Revenue Code	302
Min. Negotiated Rate	$5.73
Max. Negotiated Rate	$8.33
Rate for Payer: Cash Price	$10.41
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.33
Rate for Payer: Health Smart Auto/Commercial	$6.25
Rate for Payer: LLUH Dept of Risk Management WC	$5.73
Rate for Payer: Multiplan Commercial	$7.81

HC SOM MYCO PNEUM DNA PCR

Facility

$175.00

Service Code	CPT 87581
Hospital Charge Code	900914442
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
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	$35.09
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 MYCO PNEUM DNA PCR

Facility

$175.00

Service Code	CPT 87581
Hospital Charge Code	900914442
Hospital Revenue Code	306
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 MYELOID NEOPLASM NGS

Facility

$1,989.23

Service Code	CPT 81450
Hospital Charge Code	900915522
Hospital Revenue Code	310
Min. Negotiated Rate	$1,094.08
Max. Negotiated Rate	$1,591.38
Rate for Payer: Cash Price	$1,989.23
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,591.38
Rate for Payer: Health Smart Auto/Commercial	$1,193.54
Rate for Payer: LLUH Dept of Risk Management WC	$1,094.08
Rate for Payer: Multiplan Commercial	$1,491.92

HC SOM MYELOID NEOPLASM NGS

Facility

$1,989.23

Service Code	CPT 81450
Hospital Charge Code	900915522
Hospital Revenue Code	310
Min. Negotiated Rate	$759.53
Max. Negotiated Rate	$1,591.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,193.54
Rate for Payer: Aetna of CA Government/Medicare	$1,193.54
Rate for Payer: Cash Price	$1,989.23
Rate for Payer: Cash Price	$1,989.23
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,591.38
Rate for Payer: Health Smart Auto/Commercial	$1,193.54
Rate for Payer: Intervalley Health Plan Commercial	$759.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,193.54
Rate for Payer: LLUH Dept of Risk Management WC	$1,094.08
Rate for Payer: Multiplan Commercial	$1,491.92

HC SOM MYELOPEROXIDASE

Facility

$27.90

Service Code	CPT 83516
Hospital Charge Code	900910578
Hospital Revenue Code	302
Min. Negotiated Rate	$15.35
Max. Negotiated Rate	$22.32
Rate for Payer: Cash Price	$27.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.32
Rate for Payer: Health Smart Auto/Commercial	$16.74
Rate for Payer: LLUH Dept of Risk Management WC	$15.35
Rate for Payer: Multiplan Commercial	$20.93

HC SOM MYELOPEROXIDASE

Facility

$27.90

Service Code	CPT 83516
Hospital Charge Code	900910578
Hospital Revenue Code	302
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$22.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.74
Rate for Payer: Aetna of CA Government/Medicare	$16.74
Rate for Payer: Cash Price	$27.90
Rate for Payer: Cash Price	$27.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.32
Rate for Payer: Health Smart Auto/Commercial	$16.74
Rate for Payer: Intervalley Health Plan Commercial	$11.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.74
Rate for Payer: LLUH Dept of Risk Management WC	$15.35
Rate for Payer: Multiplan Commercial	$20.93

HC SOM MYOGLOBIN URINE

Facility

$18.00

Service Code	CPT 83874
Hospital Charge Code	900910762
Hospital Revenue Code	301
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$14.40
Rate for Payer: Cash Price	$18.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.40
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: Multiplan Commercial	$13.50

HC SOM MYOGLOBIN URINE

Facility

$18.00

Service Code	CPT 83874
Hospital Charge Code	900910762
Hospital Revenue Code	301
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.80
Rate for Payer: Aetna of CA Government/Medicare	$10.80
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.40
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: Intervalley Health Plan Commercial	$12.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.80
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: Multiplan Commercial	$13.50

HC SOM MYOMARKER3 NONANTIBODY

Facility

$169.02

Service Code	CPT 83516
Hospital Charge Code	900915484
Hospital Revenue Code	300
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$135.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$101.41
Rate for Payer: Aetna of CA Government/Medicare	$101.41
Rate for Payer: Cash Price	$169.02
Rate for Payer: Cash Price	$169.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$135.22
Rate for Payer: Health Smart Auto/Commercial	$101.41
Rate for Payer: Intervalley Health Plan Commercial	$11.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$101.41
Rate for Payer: LLUH Dept of Risk Management WC	$92.96
Rate for Payer: Multiplan Commercial	$126.77

HC SOM MYOMARKER3 NONANTIBODY

Facility

$169.02

Service Code	CPT 83516
Hospital Charge Code	900915484
Hospital Revenue Code	300
Min. Negotiated Rate	$92.96
Max. Negotiated Rate	$135.22
Rate for Payer: Cash Price	$169.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$135.22
Rate for Payer: Health Smart Auto/Commercial	$101.41
Rate for Payer: LLUH Dept of Risk Management WC	$92.96
Rate for Payer: Multiplan Commercial	$126.77

HC SOM MYOMARKER3 NUCLEAR AG AB

Facility

$183.98

Service Code	CPT 86235
Hospital Charge Code	900915485
Hospital Revenue Code	300
Min. Negotiated Rate	$101.19
Max. Negotiated Rate	$147.18
Rate for Payer: Cash Price	$183.98
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$147.18
Rate for Payer: Health Smart Auto/Commercial	$110.39
Rate for Payer: LLUH Dept of Risk Management WC	$101.19
Rate for Payer: Multiplan Commercial	$137.99

HC SOM MYOMARKER3 NUCLEAR AG AB

Facility

$183.98

Service Code	CPT 86235
Hospital Charge Code	900915485
Hospital Revenue Code	300
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$147.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$110.39
Rate for Payer: Aetna of CA Government/Medicare	$110.39
Rate for Payer: Cash Price	$183.98
Rate for Payer: Cash Price	$183.98
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$147.18
Rate for Payer: Health Smart Auto/Commercial	$110.39
Rate for Payer: Intervalley Health Plan Commercial	$17.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$110.39
Rate for Payer: LLUH Dept of Risk Management WC	$101.19
Rate for Payer: Multiplan Commercial	$137.99

HC SOM NEOPTERIN

Facility

$179.25

Service Code	CPT 83520
Hospital Charge Code	900913946
Hospital Revenue Code	301
Min. Negotiated Rate	$17.27
Max. Negotiated Rate	$143.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$107.55
Rate for Payer: Aetna of CA Government/Medicare	$107.55
Rate for Payer: Cash Price	$179.25
Rate for Payer: Cash Price	$179.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$143.40
Rate for Payer: Health Smart Auto/Commercial	$107.55
Rate for Payer: Intervalley Health Plan Commercial	$17.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$107.55
Rate for Payer: LLUH Dept of Risk Management WC	$98.59
Rate for Payer: Multiplan Commercial	$134.44

HC SOM NEOPTERIN

Facility

$179.25

Service Code	CPT 83520
Hospital Charge Code	900913946
Hospital Revenue Code	301
Min. Negotiated Rate	$98.59
Max. Negotiated Rate	$143.40
Rate for Payer: Cash Price	$179.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$143.40
Rate for Payer: Health Smart Auto/Commercial	$107.55
Rate for Payer: LLUH Dept of Risk Management WC	$98.59
Rate for Payer: Multiplan Commercial	$134.44

HC SOM NEURON SPECIFIC ENOLASE CSF

Facility

$30.00

Service Code	CPT 83520
Hospital Charge Code	900910766
Hospital Revenue Code	302
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	$17.27
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 NEURON SPECIFIC ENOLASE CSF

Facility

$30.00

Service Code	CPT 83520
Hospital Charge Code	900910766
Hospital Revenue Code	302
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 NEURON SPECIFIC ENOLASE SERUM

Facility

$25.00

Service Code	CPT 83520
Hospital Charge Code	900910767
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.00
Rate for Payer: Aetna of CA Government/Medicare	$15.00
Rate for Payer: Cash Price	$25.00
Rate for Payer: Cash Price	$25.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$20.00
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: Intervalley Health Plan Commercial	$17.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Commercial	$18.75

HC SOM NEURON SPECIFIC ENOLASE SERUM

Facility

$25.00

Service Code	CPT 83520
Hospital Charge Code	900910767
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.00
Rate for Payer: Cash Price	$25.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$20.00
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Commercial	$18.75

HC SOM NEUROTENSIN

Facility

$270.00

Service Code	CPT 83519
Hospital Charge Code	900910768
Hospital Revenue Code	301
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$216.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$162.00
Rate for Payer: Aetna of CA Government/Medicare	$162.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$216.00
Rate for Payer: Health Smart Auto/Commercial	$162.00
Rate for Payer: Intervalley Health Plan Commercial	$18.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$162.00
Rate for Payer: LLUH Dept of Risk Management WC	$148.50
Rate for Payer: Multiplan Commercial	$202.50

HC SOM NEUROTENSIN

Facility

$270.00

Service Code	CPT 83519
Hospital Charge Code	900910768
Hospital Revenue Code	301
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$216.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$216.00
Rate for Payer: Health Smart Auto/Commercial	$162.00
Rate for Payer: LLUH Dept of Risk Management WC	$148.50
Rate for Payer: Multiplan Commercial	$202.50

HC SOM N.GONORRHOEAE AMP DNA FEMALE U

Facility

$194.68

Service Code	CPT 87591
Hospital Charge Code	900912876
Hospital Revenue Code	306
Min. Negotiated Rate	$107.07
Max. Negotiated Rate	$155.74
Rate for Payer: Cash Price	$194.68
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$155.74
Rate for Payer: Health Smart Auto/Commercial	$116.81
Rate for Payer: LLUH Dept of Risk Management WC	$107.07
Rate for Payer: Multiplan Commercial	$146.01

HC SOM N.GONORRHOEAE AMP DNA FEMALE U

Facility

$194.68

Service Code	CPT 87591
Hospital Charge Code	900912876
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$155.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$116.81
Rate for Payer: Aetna of CA Government/Medicare	$116.81
Rate for Payer: Cash Price	$194.68
Rate for Payer: Cash Price	$194.68
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$155.74
Rate for Payer: Health Smart Auto/Commercial	$116.81
Rate for Payer: Intervalley Health Plan Commercial	$35.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$116.81
Rate for Payer: LLUH Dept of Risk Management WC	$107.07
Rate for Payer: Multiplan Commercial	$146.01

Know your out-of-pocket cost for care.

All Charges