Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM ALDOSTERONE URINE

Facility

$45.00

Service Code	CPT 82088
Hospital Charge Code	900910945
Hospital Revenue Code	301
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$36.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Cigna of CA HMO/PPO	$36.00
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC SOM ALDOSTERONE URINE

Facility

$45.00

Service Code	CPT 82088 90
Hospital Charge Code	900910945
Hospital Revenue Code	301
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.00
Rate for Payer: Aetna of CA Government/Medicare	$27.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC SOM ALDOSTERONE URINE

Facility

$45.00

Service Code	CPT 82088
Hospital Charge Code	900910945
Hospital Revenue Code	301
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.00
Rate for Payer: Aetna of CA Government/Medicare	$27.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC SOM ALDOSTERONE URINE

Facility

$45.00

Service Code	CPT 82088 90
Hospital Charge Code	900910945
Hospital Revenue Code	301
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$36.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Cigna of CA HMO/PPO	$36.00
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC SOM ALKALINE PHOSPHATSE ISO

Facility

$16.34

Service Code	CPT 84080
Hospital Charge Code	900911249
Hospital Revenue Code	301
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$12.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.80
Rate for Payer: Aetna of CA Government/Medicare	$9.80
Rate for Payer: Cash Price	$7.35
Rate for Payer: Health Smart Auto/Commercial	$9.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.80
Rate for Payer: LLUH Dept of Risk Management WC	$8.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.26

HC SOM ALKALINE PHOSPHATSE ISO

Facility

$16.34

Service Code	CPT 84080 90
Hospital Charge Code	900911249
Hospital Revenue Code	301
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$12.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.80
Rate for Payer: Aetna of CA Government/Medicare	$9.80
Rate for Payer: Cash Price	$7.35
Rate for Payer: Health Smart Auto/Commercial	$9.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.80
Rate for Payer: LLUH Dept of Risk Management WC	$8.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.26

HC SOM ALKALINE PHOSPHATSE ISO

Facility

$16.34

Service Code	CPT 84080 90
Hospital Charge Code	900911249
Hospital Revenue Code	301
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$13.07
Rate for Payer: Cash Price	$7.35
Rate for Payer: Cigna of CA HMO/PPO	$13.07
Rate for Payer: Health Smart Auto/Commercial	$9.80
Rate for Payer: LLUH Dept of Risk Management WC	$8.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.26

HC SOM ALKALINE PHOSPHATSE ISO

Facility

$16.34

Service Code	CPT 84080
Hospital Charge Code	900911249
Hospital Revenue Code	301
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$13.07
Rate for Payer: Cash Price	$7.35
Rate for Payer: Cigna of CA HMO/PPO	$13.07
Rate for Payer: Health Smart Auto/Commercial	$9.80
Rate for Payer: LLUH Dept of Risk Management WC	$8.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.26

HC SOM ALK PHOS TOTAL (SO)

Facility

$5.73

Service Code	CPT 84075
Hospital Charge Code	900912824
Hospital Revenue Code	301
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$4.58
Rate for Payer: Cash Price	$2.58
Rate for Payer: Cigna of CA HMO/PPO	$4.58
Rate for Payer: Health Smart Auto/Commercial	$3.44
Rate for Payer: LLUH Dept of Risk Management WC	$3.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.30

HC SOM ALK PHOS TOTAL (SO)

Facility

$5.73

Service Code	CPT 84075 90
Hospital Charge Code	900912824
Hospital Revenue Code	301
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$4.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.44
Rate for Payer: Aetna of CA Government/Medicare	$3.44
Rate for Payer: Cash Price	$2.58
Rate for Payer: Health Smart Auto/Commercial	$3.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.44
Rate for Payer: LLUH Dept of Risk Management WC	$3.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.30

HC SOM ALK PHOS TOTAL (SO)

Facility

$5.73

Service Code	CPT 84075 90
Hospital Charge Code	900912824
Hospital Revenue Code	301
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$4.58
Rate for Payer: Cash Price	$2.58
Rate for Payer: Cigna of CA HMO/PPO	$4.58
Rate for Payer: Health Smart Auto/Commercial	$3.44
Rate for Payer: LLUH Dept of Risk Management WC	$3.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.30

HC SOM ALK PHOS TOTAL (SO)

Facility

$5.73

Service Code	CPT 84075
Hospital Charge Code	900912824
Hospital Revenue Code	301
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$4.30
Rate for Payer: Health Smart Auto/Commercial	$3.44
Rate for Payer: Cash Price	$2.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.44
Rate for Payer: Aetna of CA Government/Medicare	$3.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.44
Rate for Payer: LLUH Dept of Risk Management WC	$3.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.30

HC SOM ALPHA-1-ANTITRYPSIN PHENO A1AT

Facility

$12.77

Service Code	CPT 82103
Hospital Charge Code	900912818
Hospital Revenue Code	301
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$10.22
Rate for Payer: Cash Price	$5.75
Rate for Payer: Cigna of CA HMO/PPO	$10.22
Rate for Payer: Health Smart Auto/Commercial	$7.66
Rate for Payer: LLUH Dept of Risk Management WC	$7.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.58

HC SOM ALPHA-1-ANTITRYPSIN PHENO A1AT

Facility

$12.77

Service Code	CPT 82103 90
Hospital Charge Code	900912818
Hospital Revenue Code	301
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$10.22
Rate for Payer: Cash Price	$5.75
Rate for Payer: Cigna of CA HMO/PPO	$10.22
Rate for Payer: Health Smart Auto/Commercial	$7.66
Rate for Payer: LLUH Dept of Risk Management WC	$7.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.58

HC SOM ALPHA-1-ANTITRYPSIN PHENO A1AT

Facility

$12.77

Service Code	CPT 82103 90
Hospital Charge Code	900912818
Hospital Revenue Code	301
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$9.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.66
Rate for Payer: Aetna of CA Government/Medicare	$7.66
Rate for Payer: Cash Price	$5.75
Rate for Payer: Health Smart Auto/Commercial	$7.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.66
Rate for Payer: LLUH Dept of Risk Management WC	$7.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.58

HC SOM ALPHA-1-ANTITRYPSIN PHENO A1AT

Facility

$12.77

Service Code	CPT 82103
Hospital Charge Code	900912818
Hospital Revenue Code	301
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$9.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.66
Rate for Payer: Aetna of CA Government/Medicare	$7.66
Rate for Payer: Cash Price	$5.75
Rate for Payer: Health Smart Auto/Commercial	$7.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.66
Rate for Payer: LLUH Dept of Risk Management WC	$7.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.58

HC SOM ALPHA 1-ANTITRYPSIN PHENOTYPE

Facility

$12.77

Service Code	CPT 82104 90
Hospital Charge Code	900911068
Hospital Revenue Code	301
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$10.22
Rate for Payer: Cash Price	$5.75
Rate for Payer: Cigna of CA HMO/PPO	$10.22
Rate for Payer: Health Smart Auto/Commercial	$7.66
Rate for Payer: LLUH Dept of Risk Management WC	$7.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.58

HC SOM ALPHA 1-ANTITRYPSIN PHENOTYPE

Facility

$12.77

Service Code	CPT 82104
Hospital Charge Code	900911068
Hospital Revenue Code	301
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$9.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.66
Rate for Payer: Aetna of CA Government/Medicare	$7.66
Rate for Payer: Cash Price	$5.75
Rate for Payer: Health Smart Auto/Commercial	$7.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.66
Rate for Payer: LLUH Dept of Risk Management WC	$7.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.58

HC SOM ALPHA 1-ANTITRYPSIN PHENOTYPE

Facility

$12.77

Service Code	CPT 82104 90
Hospital Charge Code	900911068
Hospital Revenue Code	301
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$9.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.66
Rate for Payer: Aetna of CA Government/Medicare	$7.66
Rate for Payer: Cash Price	$5.75
Rate for Payer: Health Smart Auto/Commercial	$7.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.66
Rate for Payer: LLUH Dept of Risk Management WC	$7.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.58

HC SOM ALPHA 1-ANTITRYPSIN PHENOTYPE

Facility

$12.77

Service Code	CPT 82104
Hospital Charge Code	900911068
Hospital Revenue Code	301
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$10.22
Rate for Payer: Cash Price	$5.75
Rate for Payer: Cigna of CA HMO/PPO	$10.22
Rate for Payer: Health Smart Auto/Commercial	$7.66
Rate for Payer: LLUH Dept of Risk Management WC	$7.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.58

HC SOM ALPHA-1-ANTITRYPSIN, STOOL

Facility

$20.00

Service Code	CPT 82103
Hospital Charge Code	900910858
Hospital Revenue Code	301
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$16.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$15.00

HC SOM ALPHA-1-ANTITRYPSIN, STOOL

Facility

$20.00

Service Code	CPT 82103 90
Hospital Charge Code	900910858
Hospital Revenue Code	301
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$15.00
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	$9.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
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 Beech St/Commercial/PHCS	$15.00

HC SOM ALPHA-1-ANTITRYPSIN, STOOL

Facility

$20.00

Service Code	CPT 82103 90
Hospital Charge Code	900910858
Hospital Revenue Code	301
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$16.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$15.00

HC SOM ALPHA-1-ANTITRYPSIN, STOOL

Facility

$20.00

Service Code	CPT 82103
Hospital Charge Code	900910858
Hospital Revenue Code	301
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$15.00
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	$9.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
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 Beech St/Commercial/PHCS	$15.00

HC SOM ALPHA-2-MACROGLOBULIN

Facility

$30.00

Service Code	CPT 83883
Hospital Charge Code	900911487
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$22.50
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	$13.50
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 Beech St/Commercial/PHCS	$22.50

Know your out-of-pocket cost for care.

All Charges