Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM ADENOVIRUS DNA PCR

Facility

$50.27

Service Code	CPT 87798 90
Hospital Charge Code	900912712
Hospital Revenue Code	300
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$37.70
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	$22.62
Rate for Payer: Health Smart Auto/Commercial	$30.16
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 Beech St/Commercial/PHCS	$37.70

HC SOM ADENOVIRUS DNA PCR NON-BLOOD

Facility

$50.27

Service Code	CPT 87798 90
Hospital Charge Code	900910713
Hospital Revenue Code	306
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$37.70
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	$22.62
Rate for Payer: Health Smart Auto/Commercial	$30.16
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 Beech St/Commercial/PHCS	$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	$22.62
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$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	$37.70
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	$22.62
Rate for Payer: Health Smart Auto/Commercial	$30.16
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 Beech St/Commercial/PHCS	$37.70

HC SOM ADENOVIRUS DNA PCR NON-BLOOD

Facility

$50.27

Service Code	CPT 87798 90
Hospital Charge Code	900910713
Hospital Revenue Code	306
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$40.22
Rate for Payer: Cash Price	$22.62
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$37.70

HC SOM ADENOVIRUS DNA PCR QUANT

Facility

$374.90

Service Code	CPT 87799
Hospital Charge Code	900912781
Hospital Revenue Code	306
Min. Negotiated Rate	$206.20
Max. Negotiated Rate	$281.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$224.94
Rate for Payer: Aetna of CA Government/Medicare	$224.94
Rate for Payer: Cash Price	$168.71
Rate for Payer: Health Smart Auto/Commercial	$224.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$224.94
Rate for Payer: LLUH Dept of Risk Management WC	$206.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$281.18

HC SOM ADENOVIRUS DNA PCR QUANT

Facility

$374.90

Service Code	CPT 87799 90
Hospital Charge Code	900912781
Hospital Revenue Code	306
Min. Negotiated Rate	$206.20
Max. Negotiated Rate	$281.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$224.94
Rate for Payer: Aetna of CA Government/Medicare	$224.94
Rate for Payer: Cash Price	$168.71
Rate for Payer: Health Smart Auto/Commercial	$224.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$224.94
Rate for Payer: LLUH Dept of Risk Management WC	$206.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$281.18

HC SOM ADENOVIRUS DNA PCR QUANT

Facility

$374.90

Service Code	CPT 87799
Hospital Charge Code	900912781
Hospital Revenue Code	306
Min. Negotiated Rate	$206.20
Max. Negotiated Rate	$299.92
Rate for Payer: Cash Price	$168.71
Rate for Payer: Cigna of CA HMO/PPO	$299.92
Rate for Payer: Health Smart Auto/Commercial	$224.94
Rate for Payer: LLUH Dept of Risk Management WC	$206.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$281.18

HC SOM ADENOVIRUS DNA PCR QUANT

Facility

$374.90

Service Code	CPT 87799 90
Hospital Charge Code	900912781
Hospital Revenue Code	306
Min. Negotiated Rate	$206.20
Max. Negotiated Rate	$299.92
Rate for Payer: Cash Price	$168.71
Rate for Payer: Cigna of CA HMO/PPO	$299.92
Rate for Payer: Health Smart Auto/Commercial	$224.94
Rate for Payer: LLUH Dept of Risk Management WC	$206.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$281.18

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	$56.25
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$93.75

HC SOM AFP & TOTAL AFT, SERUM

Facility

$125.00

Service Code	CPT 82107 90
Hospital Charge Code	900913812
Hospital Revenue Code	301
Min. Negotiated Rate	$68.75
Max. Negotiated Rate	$93.75
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	$56.25
Rate for Payer: Health Smart Auto/Commercial	$75.00
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 Beech St/Commercial/PHCS	$93.75

HC SOM AFP & TOTAL AFT, SERUM

Facility

$125.00

Service Code	CPT 82107 90
Hospital Charge Code	900913812
Hospital Revenue Code	301
Min. Negotiated Rate	$68.75
Max. Negotiated Rate	$100.00
Rate for Payer: Cash Price	$56.25
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$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	$93.75
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	$56.25
Rate for Payer: Health Smart Auto/Commercial	$75.00
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 Beech St/Commercial/PHCS	$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	$7.50
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	$4.50
Rate for Payer: Health Smart Auto/Commercial	$6.00
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 Beech St/Commercial/PHCS	$7.50

HC SOM ALBUMIN LEVEL BODY FLUID

Facility

$10.00

Service Code	CPT 82042 90
Hospital Charge Code	900914481
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$7.50

HC SOM ALBUMIN LEVEL BODY FLUID

Facility

$10.00

Service Code	CPT 82042 90
Hospital Charge Code	900914481
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$7.50
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	$4.50
Rate for Payer: Health Smart Auto/Commercial	$6.00
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 Beech St/Commercial/PHCS	$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: Cash Price	$4.50
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$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	$7.20
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: Cash Price	$4.05
Rate for Payer: Cigna of CA HMO/PPO	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.75

HC SOM ALDOLASE

Facility

$9.00

Service Code	CPT 82085 90
Hospital Charge Code	900910218
Hospital Revenue Code	301
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.20
Rate for Payer: Cash Price	$4.05
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$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	$6.75
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	$4.05
Rate for Payer: Health Smart Auto/Commercial	$5.40
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 Beech St/Commercial/PHCS	$6.75

HC SOM ALDOLASE

Facility

$9.00

Service Code	CPT 82085 90
Hospital Charge Code	900910218
Hospital Revenue Code	301
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$6.75
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	$4.05
Rate for Payer: Health Smart Auto/Commercial	$5.40
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 Beech St/Commercial/PHCS	$6.75

HC SOM ALDOSTERONE

Facility

$19.50

Service Code	CPT 82088 90
Hospital Charge Code	900910965
Hospital Revenue Code	301
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$15.60
Rate for Payer: Cash Price	$8.78
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$14.62

HC SOM ALDOSTERONE

Facility

$19.50

Service Code	CPT 82088 90
Hospital Charge Code	900910965
Hospital Revenue Code	301
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$14.62
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	$8.78
Rate for Payer: Health Smart Auto/Commercial	$11.70
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 Beech St/Commercial/PHCS	$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	$8.78
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$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	$14.62
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	$8.78
Rate for Payer: Health Smart Auto/Commercial	$11.70
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 Beech St/Commercial/PHCS	$14.62

Know your out-of-pocket cost for care.

All Charges