Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM PSA ULTRASENSITIVE

Facility

$123.40

Service Code	CPT 84153
Hospital Charge Code	900913953
Hospital Revenue Code	301
Min. Negotiated Rate	$18.39
Max. Negotiated Rate	$98.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$74.04
Rate for Payer: Aetna of CA Government/Medicare	$74.04
Rate for Payer: Cash Price	$123.40
Rate for Payer: Cash Price	$123.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$98.72
Rate for Payer: Health Smart Auto/Commercial	$74.04
Rate for Payer: Intervalley Health Plan Commercial	$18.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$74.04
Rate for Payer: LLUH Dept of Risk Management WC	$67.87
Rate for Payer: Multiplan Commercial	$92.55

HC SOM PSA ULTRASENSITIVE

Facility

$123.40

Service Code	CPT 84153
Hospital Charge Code	900913953
Hospital Revenue Code	301
Min. Negotiated Rate	$67.87
Max. Negotiated Rate	$98.72
Rate for Payer: Cash Price	$123.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$98.72
Rate for Payer: Health Smart Auto/Commercial	$74.04
Rate for Payer: LLUH Dept of Risk Management WC	$67.87
Rate for Payer: Multiplan Commercial	$92.55

HC SOM PTH RELATED PROTEIN

Facility

$15.62

Service Code	CPT 82397
Hospital Charge Code	900911417
Hospital Revenue Code	301
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$14.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.37
Rate for Payer: Aetna of CA Government/Medicare	$9.37
Rate for Payer: Cash Price	$15.62
Rate for Payer: Cash Price	$15.62
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.50
Rate for Payer: Health Smart Auto/Commercial	$9.37
Rate for Payer: Intervalley Health Plan Commercial	$14.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.37
Rate for Payer: LLUH Dept of Risk Management WC	$8.59
Rate for Payer: Multiplan Commercial	$11.71

HC SOM PTH RELATED PROTEIN

Facility

$15.62

Service Code	CPT 82397
Hospital Charge Code	900911417
Hospital Revenue Code	301
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$12.50
Rate for Payer: Cash Price	$15.62
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.50
Rate for Payer: Health Smart Auto/Commercial	$9.37
Rate for Payer: LLUH Dept of Risk Management WC	$8.59
Rate for Payer: Multiplan Commercial	$11.71

HC SOM PWDNA 81331

Facility

$561.17

Service Code	CPT 81331
Hospital Charge Code	900914888
Hospital Revenue Code	309
Min. Negotiated Rate	$51.07
Max. Negotiated Rate	$448.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$336.70
Rate for Payer: Aetna of CA Government/Medicare	$336.70
Rate for Payer: Cash Price	$561.17
Rate for Payer: Cash Price	$561.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$448.94
Rate for Payer: Health Smart Auto/Commercial	$336.70
Rate for Payer: Intervalley Health Plan Commercial	$51.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$336.70
Rate for Payer: LLUH Dept of Risk Management WC	$308.64
Rate for Payer: Multiplan Commercial	$420.88

HC SOM PWDNA 81331

Facility

$561.17

Service Code	CPT 81331
Hospital Charge Code	900914888
Hospital Revenue Code	309
Min. Negotiated Rate	$308.64
Max. Negotiated Rate	$448.94
Rate for Payer: Cash Price	$561.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$448.94
Rate for Payer: Health Smart Auto/Commercial	$336.70
Rate for Payer: LLUH Dept of Risk Management WC	$308.64
Rate for Payer: Multiplan Commercial	$420.88

HC SOM PYRUVATE KINASE

Facility

$65.00

Service Code	CPT 84220
Hospital Charge Code	900911491
Hospital Revenue Code	301
Min. Negotiated Rate	$35.75
Max. Negotiated Rate	$52.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$52.00
Rate for Payer: Health Smart Auto/Commercial	$39.00
Rate for Payer: LLUH Dept of Risk Management WC	$35.75
Rate for Payer: Multiplan Commercial	$48.75

HC SOM PYRUVATE KINASE

Facility

$65.00

Service Code	CPT 84220
Hospital Charge Code	900911491
Hospital Revenue Code	301
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$39.00
Rate for Payer: Aetna of CA Government/Medicare	$39.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$52.00
Rate for Payer: Health Smart Auto/Commercial	$39.00
Rate for Payer: Intervalley Health Plan Commercial	$9.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$39.00
Rate for Payer: LLUH Dept of Risk Management WC	$35.75
Rate for Payer: Multiplan Commercial	$48.75

HC SOM Q FEVER IGG PHAS I

Facility

$10.02

Service Code	CPT 86638
Hospital Charge Code	900914336
Hospital Revenue Code	302
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$12.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.01
Rate for Payer: Aetna of CA Government/Medicare	$6.01
Rate for Payer: Cash Price	$10.02
Rate for Payer: Cash Price	$10.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.02
Rate for Payer: Health Smart Auto/Commercial	$6.01
Rate for Payer: Intervalley Health Plan Commercial	$12.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.01
Rate for Payer: LLUH Dept of Risk Management WC	$5.51
Rate for Payer: Multiplan Commercial	$7.51

HC SOM Q FEVER IGG PHAS I

Facility

$10.02

Service Code	CPT 86638
Hospital Charge Code	900914336
Hospital Revenue Code	302
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$8.02
Rate for Payer: Cash Price	$10.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.02
Rate for Payer: Health Smart Auto/Commercial	$6.01
Rate for Payer: LLUH Dept of Risk Management WC	$5.51
Rate for Payer: Multiplan Commercial	$7.51

HC SOM Q FEVER IGG PHAS II

Facility

$10.02

Service Code	CPT 86638
Hospital Charge Code	900914334
Hospital Revenue Code	302
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$8.02
Rate for Payer: Cash Price	$10.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.02
Rate for Payer: Health Smart Auto/Commercial	$6.01
Rate for Payer: LLUH Dept of Risk Management WC	$5.51
Rate for Payer: Multiplan Commercial	$7.51

HC SOM Q FEVER IGG PHAS II

Facility

$10.02

Service Code	CPT 86638
Hospital Charge Code	900914334
Hospital Revenue Code	302
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$12.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.01
Rate for Payer: Aetna of CA Government/Medicare	$6.01
Rate for Payer: Cash Price	$10.02
Rate for Payer: Cash Price	$10.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.02
Rate for Payer: Health Smart Auto/Commercial	$6.01
Rate for Payer: Intervalley Health Plan Commercial	$12.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.01
Rate for Payer: LLUH Dept of Risk Management WC	$5.51
Rate for Payer: Multiplan Commercial	$7.51

HC SOM Q FEVER IGM PHAS I

Facility

$10.03

Service Code	CPT 86638
Hospital Charge Code	900914337
Hospital Revenue Code	302
Min. Negotiated Rate	$5.52
Max. Negotiated Rate	$8.02
Rate for Payer: Cash Price	$10.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.02
Rate for Payer: Health Smart Auto/Commercial	$6.02
Rate for Payer: LLUH Dept of Risk Management WC	$5.52
Rate for Payer: Multiplan Commercial	$7.52

HC SOM Q FEVER IGM PHAS I

Facility

$10.03

Service Code	CPT 86638
Hospital Charge Code	900914337
Hospital Revenue Code	302
Min. Negotiated Rate	$5.52
Max. Negotiated Rate	$12.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.02
Rate for Payer: Aetna of CA Government/Medicare	$6.02
Rate for Payer: Cash Price	$10.03
Rate for Payer: Cash Price	$10.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.02
Rate for Payer: Health Smart Auto/Commercial	$6.02
Rate for Payer: Intervalley Health Plan Commercial	$12.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.02
Rate for Payer: LLUH Dept of Risk Management WC	$5.52
Rate for Payer: Multiplan Commercial	$7.52

HC SOM Q FEVER IGM PHAS II

Facility

$10.03

Service Code	CPT 86638
Hospital Charge Code	900914335
Hospital Revenue Code	302
Min. Negotiated Rate	$5.52
Max. Negotiated Rate	$12.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.02
Rate for Payer: Aetna of CA Government/Medicare	$6.02
Rate for Payer: Cash Price	$10.03
Rate for Payer: Cash Price	$10.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.02
Rate for Payer: Health Smart Auto/Commercial	$6.02
Rate for Payer: Intervalley Health Plan Commercial	$12.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.02
Rate for Payer: LLUH Dept of Risk Management WC	$5.52
Rate for Payer: Multiplan Commercial	$7.52

HC SOM Q FEVER IGM PHAS II

Facility

$10.03

Service Code	CPT 86638
Hospital Charge Code	900914335
Hospital Revenue Code	302
Min. Negotiated Rate	$5.52
Max. Negotiated Rate	$8.02
Rate for Payer: Cash Price	$10.03
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.02
Rate for Payer: Health Smart Auto/Commercial	$6.02
Rate for Payer: LLUH Dept of Risk Management WC	$5.52
Rate for Payer: Multiplan Commercial	$7.52

HC SOM QUANTIFERON TB GOLD

Facility

$40.00

Service Code	CPT 86480
Hospital Charge Code	900912882
Hospital Revenue Code	306
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$32.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$32.00
Rate for Payer: Health Smart Auto/Commercial	$24.00
Rate for Payer: LLUH Dept of Risk Management WC	$22.00
Rate for Payer: Multiplan Commercial	$30.00

HC SOM QUANTIFERON TB GOLD

Facility

$40.00

Service Code	CPT 86480
Hospital Charge Code	900912882
Hospital Revenue Code	306
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$61.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.00
Rate for Payer: Aetna of CA Government/Medicare	$24.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$32.00
Rate for Payer: Health Smart Auto/Commercial	$24.00
Rate for Payer: Intervalley Health Plan Commercial	$61.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.00
Rate for Payer: LLUH Dept of Risk Management WC	$22.00
Rate for Payer: Multiplan Commercial	$30.00

HC SOM RENIN ACT PLASMA

Facility

$13.72

Service Code	CPT 84244
Hospital Charge Code	900910955
Hospital Revenue Code	301
Min. Negotiated Rate	$7.55
Max. Negotiated Rate	$21.99
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.23
Rate for Payer: Aetna of CA Government/Medicare	$8.23
Rate for Payer: Cash Price	$13.72
Rate for Payer: Cash Price	$13.72
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.98
Rate for Payer: Health Smart Auto/Commercial	$8.23
Rate for Payer: Intervalley Health Plan Commercial	$21.99
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.23
Rate for Payer: LLUH Dept of Risk Management WC	$7.55
Rate for Payer: Multiplan Commercial	$10.29

HC SOM RENIN ACT PLASMA

Facility

$13.72

Service Code	CPT 84244
Hospital Charge Code	900910955
Hospital Revenue Code	301
Min. Negotiated Rate	$7.55
Max. Negotiated Rate	$10.98
Rate for Payer: Cash Price	$13.72
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.98
Rate for Payer: Health Smart Auto/Commercial	$8.23
Rate for Payer: LLUH Dept of Risk Management WC	$7.55
Rate for Payer: Multiplan Commercial	$10.29

HC SOM REPTILASE TIME

Facility

$40.00

Service Code	CPT 85635
Hospital Charge Code	900910114
Hospital Revenue Code	305
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.00
Rate for Payer: Aetna of CA Government/Medicare	$24.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$32.00
Rate for Payer: Health Smart Auto/Commercial	$24.00
Rate for Payer: Intervalley Health Plan Commercial	$9.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.00
Rate for Payer: LLUH Dept of Risk Management WC	$22.00
Rate for Payer: Multiplan Commercial	$30.00

HC SOM REPTILASE TIME

Facility

$40.00

Service Code	CPT 85635
Hospital Charge Code	900910114
Hospital Revenue Code	305
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$32.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$32.00
Rate for Payer: Health Smart Auto/Commercial	$24.00
Rate for Payer: LLUH Dept of Risk Management WC	$22.00
Rate for Payer: Multiplan Commercial	$30.00

HC SOM RESPIRATORY PANEL VARIES

Facility

$350.00

Service Code	CPT 0202U
Hospital Charge Code	900915466
Hospital Revenue Code	300
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$416.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$210.00
Rate for Payer: Aetna of CA Government/Medicare	$210.00
Rate for Payer: Cash Price	$350.00
Rate for Payer: Cash Price	$350.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$280.00
Rate for Payer: Health Smart Auto/Commercial	$210.00
Rate for Payer: Intervalley Health Plan Commercial	$416.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$210.00
Rate for Payer: LLUH Dept of Risk Management WC	$192.50
Rate for Payer: Multiplan Commercial	$262.50

HC SOM RESPIRATORY PANEL VARIES

Facility

$350.00

Service Code	CPT 0202U
Hospital Charge Code	900915466
Hospital Revenue Code	300
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$280.00
Rate for Payer: Cash Price	$350.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$280.00
Rate for Payer: Health Smart Auto/Commercial	$210.00
Rate for Payer: LLUH Dept of Risk Management WC	$192.50
Rate for Payer: Multiplan Commercial	$262.50

HC SOM RIBOSOMAL P AB

Facility

$30.00

Service Code	CPT 83516
Hospital Charge Code	900911367
Hospital Revenue Code	301
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

Know your out-of-pocket cost for care.

All Charges