Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM ANTINUCLEAR AB,HEP-2 SUB,S

Facility

$10.00

Service Code	CPT 86039
Hospital Charge Code	900912903
Hospital Revenue Code	302
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 ANTI-SMOOTH MUSCLE

Facility

$12.90

Service Code	CPT 86015
Hospital Charge Code	900911176
Hospital Revenue Code	302
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$10.32
Rate for Payer: Cash Price	$5.81
Rate for Payer: Cigna of CA HMO/PPO	$10.32
Rate for Payer: Health Smart Auto/Commercial	$7.74
Rate for Payer: LLUH Dept of Risk Management WC	$7.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.68

HC SOM ANTI-SMOOTH MUSCLE

Facility

$12.90

Service Code	CPT 86015
Hospital Charge Code	900911176
Hospital Revenue Code	302
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$9.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.74
Rate for Payer: Aetna of CA Government/Medicare	$7.74
Rate for Payer: Cash Price	$5.81
Rate for Payer: Health Smart Auto/Commercial	$7.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.74
Rate for Payer: LLUH Dept of Risk Management WC	$7.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.68

HC SOM ANTI-SMOOTH MUSCLE

Facility

$12.90

Service Code	CPT 86015 90
Hospital Charge Code	900911176
Hospital Revenue Code	302
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$10.32
Rate for Payer: Cash Price	$5.81
Rate for Payer: Cigna of CA HMO/PPO	$10.32
Rate for Payer: Health Smart Auto/Commercial	$7.74
Rate for Payer: LLUH Dept of Risk Management WC	$7.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.68

HC SOM ANTI-SMOOTH MUSCLE

Facility

$12.90

Service Code	CPT 86015 90
Hospital Charge Code	900911176
Hospital Revenue Code	302
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$9.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.74
Rate for Payer: Aetna of CA Government/Medicare	$7.74
Rate for Payer: Cash Price	$5.81
Rate for Payer: Health Smart Auto/Commercial	$7.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.74
Rate for Payer: LLUH Dept of Risk Management WC	$7.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.68

HC SOM ANTI-STRIATED MUSCLE AB

Facility

$24.00

Service Code	CPT 83520
Hospital Charge Code	900911368
Hospital Revenue Code	302
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$19.20
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cigna of CA HMO/PPO	$19.20
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.00

HC SOM ANTI-STRIATED MUSCLE AB

Facility

$24.00

Service Code	CPT 83520 90
Hospital Charge Code	900911368
Hospital Revenue Code	302
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$19.20
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cigna of CA HMO/PPO	$19.20
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.00

HC SOM ANTI-STRIATED MUSCLE AB

Facility

$24.00

Service Code	CPT 83520
Hospital Charge Code	900911368
Hospital Revenue Code	302
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.40
Rate for Payer: Aetna of CA Government/Medicare	$14.40
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.00

HC SOM ANTI-STRIATED MUSCLE AB

Facility

$24.00

Service Code	CPT 83520 90
Hospital Charge Code	900911368
Hospital Revenue Code	302
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.40
Rate for Payer: Aetna of CA Government/Medicare	$14.40
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.00

HC SOM APOLIPOPROTEIN A-1

Facility

$20.00

Service Code	CPT 82172 90
Hospital Charge Code	900910800
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 APOLIPOPROTEIN A-1

Facility

$20.00

Service Code	CPT 82172
Hospital Charge Code	900910800
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 APOLIPOPROTEIN A-1

Facility

$20.00

Service Code	CPT 82172
Hospital Charge Code	900910800
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 APOLIPOPROTEIN A-1

Facility

$20.00

Service Code	CPT 82172 90
Hospital Charge Code	900910800
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 APOLIPOPROTEIN B

Facility

$16.77

Service Code	CPT 82172 90
Hospital Charge Code	900910801
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$13.42
Rate for Payer: Cash Price	$7.55
Rate for Payer: Cigna of CA HMO/PPO	$13.42
Rate for Payer: Health Smart Auto/Commercial	$10.06
Rate for Payer: LLUH Dept of Risk Management WC	$9.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.58

HC SOM APOLIPOPROTEIN B

Facility

$16.77

Service Code	CPT 82172 90
Hospital Charge Code	900910801
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$12.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.06
Rate for Payer: Aetna of CA Government/Medicare	$10.06
Rate for Payer: Cash Price	$7.55
Rate for Payer: Health Smart Auto/Commercial	$10.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.06
Rate for Payer: LLUH Dept of Risk Management WC	$9.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.58

HC SOM APOLIPOPROTEIN B

Facility

$16.77

Service Code	CPT 82172
Hospital Charge Code	900910801
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$13.42
Rate for Payer: Cash Price	$7.55
Rate for Payer: Cigna of CA HMO/PPO	$13.42
Rate for Payer: Health Smart Auto/Commercial	$10.06
Rate for Payer: LLUH Dept of Risk Management WC	$9.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.58

HC SOM APOLIPOPROTEIN B

Facility

$16.77

Service Code	CPT 82172
Hospital Charge Code	900910801
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$12.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.06
Rate for Payer: Aetna of CA Government/Medicare	$10.06
Rate for Payer: Cash Price	$7.55
Rate for Payer: Health Smart Auto/Commercial	$10.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.06
Rate for Payer: LLUH Dept of Risk Management WC	$9.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.58

HC SOM APOLIPOPROTEIN E GENOTYPING

Facility

$203.61

Service Code	CPT 81401 90
Hospital Charge Code	900914646
Hospital Revenue Code	310
Min. Negotiated Rate	$111.99
Max. Negotiated Rate	$162.89
Rate for Payer: Cash Price	$91.62
Rate for Payer: Cigna of CA HMO/PPO	$162.89
Rate for Payer: Health Smart Auto/Commercial	$122.17
Rate for Payer: LLUH Dept of Risk Management WC	$111.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$152.71

HC SOM APOLIPOPROTEIN E GENOTYPING

Facility

$203.61

Service Code	CPT 81401
Hospital Charge Code	900914646
Hospital Revenue Code	310
Min. Negotiated Rate	$111.99
Max. Negotiated Rate	$152.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$122.17
Rate for Payer: Aetna of CA Government/Medicare	$122.17
Rate for Payer: Cash Price	$91.62
Rate for Payer: Health Smart Auto/Commercial	$122.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$122.17
Rate for Payer: LLUH Dept of Risk Management WC	$111.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$152.71

HC SOM APOLIPOPROTEIN E GENOTYPING

Facility

$203.61

Service Code	CPT 81401
Hospital Charge Code	900914646
Hospital Revenue Code	310
Min. Negotiated Rate	$111.99
Max. Negotiated Rate	$162.89
Rate for Payer: Cash Price	$91.62
Rate for Payer: Cigna of CA HMO/PPO	$162.89
Rate for Payer: Health Smart Auto/Commercial	$122.17
Rate for Payer: LLUH Dept of Risk Management WC	$111.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$152.71

HC SOM APOLIPOPROTEIN E GENOTYPING

Facility

$203.61

Service Code	CPT 81401 90
Hospital Charge Code	900914646
Hospital Revenue Code	310
Min. Negotiated Rate	$111.99
Max. Negotiated Rate	$152.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$122.17
Rate for Payer: Aetna of CA Government/Medicare	$122.17
Rate for Payer: Cash Price	$91.62
Rate for Payer: Health Smart Auto/Commercial	$122.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$122.17
Rate for Payer: LLUH Dept of Risk Management WC	$111.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$152.71

HC SOM ARSENIC BLOOD

Facility

$25.00

Service Code	CPT 82175
Hospital Charge Code	900910563
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$18.75
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	$11.25
Rate for Payer: Health Smart Auto/Commercial	$15.00
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 Beech St/Commercial/PHCS	$18.75

HC SOM ARSENIC BLOOD

Facility

$25.00

Service Code	CPT 82175
Hospital Charge Code	900910563
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$18.75

HC SOM ARSENIC BLOOD

Facility

$25.00

Service Code	CPT 82175 90
Hospital Charge Code	900910563
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$18.75
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	$11.25
Rate for Payer: Health Smart Auto/Commercial	$15.00
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 Beech St/Commercial/PHCS	$18.75

HC SOM ARSENIC BLOOD

Facility

$25.00

Service Code	CPT 82175 90
Hospital Charge Code	900910563
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$18.75

Know your out-of-pocket cost for care.

All Charges