Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM BCR ABL MUTAT ASPE

Facility

$435.08

Service Code	CPT 81403 90
Hospital Charge Code	900914536
Hospital Revenue Code	301
Min. Negotiated Rate	$239.29
Max. Negotiated Rate	$348.06
Rate for Payer: Cash Price	$195.79
Rate for Payer: Cigna of CA HMO/PPO	$348.06
Rate for Payer: Health Smart Auto/Commercial	$261.05
Rate for Payer: LLUH Dept of Risk Management WC	$239.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$326.31

HC SOM BCR ABL MUTAT ASPE

Facility

$435.08

Service Code	CPT 81403
Hospital Charge Code	900914536
Hospital Revenue Code	309
Min. Negotiated Rate	$239.29
Max. Negotiated Rate	$348.06
Rate for Payer: Cash Price	$195.79
Rate for Payer: Cigna of CA HMO/PPO	$348.06
Rate for Payer: Health Smart Auto/Commercial	$261.05
Rate for Payer: LLUH Dept of Risk Management WC	$239.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$326.31

HC SOM BENZODIAZEPINE CONFIRM, U

Facility

$36.96

Service Code	CPT 80346
Hospital Charge Code	900912915
Hospital Revenue Code	301
Min. Negotiated Rate	$20.33
Max. Negotiated Rate	$27.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.18
Rate for Payer: Aetna of CA Government/Medicare	$22.18
Rate for Payer: Cash Price	$16.63
Rate for Payer: Health Smart Auto/Commercial	$22.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.18
Rate for Payer: LLUH Dept of Risk Management WC	$20.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.72

HC SOM BENZODIAZEPINE CONFIRM, U

Facility

$36.96

Service Code	CPT G0480 90
Hospital Charge Code	900912915
Hospital Revenue Code	301
Min. Negotiated Rate	$20.33
Max. Negotiated Rate	$27.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.18
Rate for Payer: Aetna of CA Government/Medicare	$22.18
Rate for Payer: Cash Price	$16.63
Rate for Payer: Health Smart Auto/Commercial	$22.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.18
Rate for Payer: LLUH Dept of Risk Management WC	$20.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.72

HC SOM BENZODIAZEPINE CONFIRM, U

Facility

$36.96

Service Code	CPT 80346
Hospital Charge Code	900912915
Hospital Revenue Code	301
Min. Negotiated Rate	$20.33
Max. Negotiated Rate	$29.57
Rate for Payer: Cash Price	$16.63
Rate for Payer: Cigna of CA HMO/PPO	$29.57
Rate for Payer: Health Smart Auto/Commercial	$22.18
Rate for Payer: LLUH Dept of Risk Management WC	$20.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.72

HC SOM BENZODIAZEPINE CONFIRM, U

Facility

$36.96

Service Code	CPT G0480
Hospital Charge Code	900912915
Hospital Revenue Code	301
Min. Negotiated Rate	$20.33
Max. Negotiated Rate	$27.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.18
Rate for Payer: Aetna of CA Government/Medicare	$22.18
Rate for Payer: Cash Price	$16.63
Rate for Payer: Health Smart Auto/Commercial	$22.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.18
Rate for Payer: LLUH Dept of Risk Management WC	$20.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.72

HC SOM BENZODIAZEPINE CONFIRM, U

Facility

$36.96

Service Code	CPT G0480
Hospital Charge Code	900912915
Hospital Revenue Code	301
Min. Negotiated Rate	$20.33
Max. Negotiated Rate	$29.57
Rate for Payer: Cash Price	$16.63
Rate for Payer: Cigna of CA HMO/PPO	$29.57
Rate for Payer: Health Smart Auto/Commercial	$22.18
Rate for Payer: LLUH Dept of Risk Management WC	$20.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.72

HC SOM BENZODIAZEPINE CONFIRM, U

Facility

$36.96

Service Code	CPT G0480 90
Hospital Charge Code	900912915
Hospital Revenue Code	301
Min. Negotiated Rate	$20.33
Max. Negotiated Rate	$29.57
Rate for Payer: Cash Price	$16.63
Rate for Payer: Cigna of CA HMO/PPO	$29.57
Rate for Payer: Health Smart Auto/Commercial	$22.18
Rate for Payer: LLUH Dept of Risk Management WC	$20.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.72

HC SOM BETA 2 MICROGLOBULIN CSF

Facility

$220.67

Service Code	CPT 82232
Hospital Charge Code	900911369
Hospital Revenue Code	301
Min. Negotiated Rate	$121.37
Max. Negotiated Rate	$165.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$132.40
Rate for Payer: Aetna of CA Government/Medicare	$132.40
Rate for Payer: Cash Price	$99.30
Rate for Payer: Health Smart Auto/Commercial	$132.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$132.40
Rate for Payer: LLUH Dept of Risk Management WC	$121.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$165.50

HC SOM BETA 2 MICROGLOBULIN CSF

Facility

$220.67

Service Code	CPT 82232
Hospital Charge Code	900911369
Hospital Revenue Code	301
Min. Negotiated Rate	$121.37
Max. Negotiated Rate	$176.54
Rate for Payer: Cash Price	$99.30
Rate for Payer: Cigna of CA HMO/PPO	$176.54
Rate for Payer: Health Smart Auto/Commercial	$132.40
Rate for Payer: LLUH Dept of Risk Management WC	$121.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$165.50

HC SOM BETA 2 MICROGLOBULIN CSF

Facility

$220.67

Service Code	CPT 82232 90
Hospital Charge Code	900911369
Hospital Revenue Code	301
Min. Negotiated Rate	$121.37
Max. Negotiated Rate	$165.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$132.40
Rate for Payer: Aetna of CA Government/Medicare	$132.40
Rate for Payer: Cash Price	$99.30
Rate for Payer: Health Smart Auto/Commercial	$132.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$132.40
Rate for Payer: LLUH Dept of Risk Management WC	$121.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$165.50

HC SOM BETA 2 MICROGLOBULIN CSF

Facility

$220.67

Service Code	CPT 82232 90
Hospital Charge Code	900911369
Hospital Revenue Code	301
Min. Negotiated Rate	$121.37
Max. Negotiated Rate	$176.54
Rate for Payer: Cash Price	$99.30
Rate for Payer: Cigna of CA HMO/PPO	$176.54
Rate for Payer: Health Smart Auto/Commercial	$132.40
Rate for Payer: LLUH Dept of Risk Management WC	$121.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$165.50

HC SOM BETA 2 MICROGLOBULIN URINE

Facility

$27.00

Service Code	CPT 82232
Hospital Charge Code	900911370
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$21.60
Rate for Payer: Cash Price	$12.15
Rate for Payer: Cigna of CA HMO/PPO	$21.60
Rate for Payer: Health Smart Auto/Commercial	$16.20
Rate for Payer: LLUH Dept of Risk Management WC	$14.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.25

HC SOM BETA 2 MICROGLOBULIN URINE

Facility

$27.00

Service Code	CPT 82232 90
Hospital Charge Code	900911370
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$21.60
Rate for Payer: Cash Price	$12.15
Rate for Payer: Cigna of CA HMO/PPO	$21.60
Rate for Payer: Health Smart Auto/Commercial	$16.20
Rate for Payer: LLUH Dept of Risk Management WC	$14.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.25

HC SOM BETA 2 MICROGLOBULIN URINE

Facility

$27.00

Service Code	CPT 82232 90
Hospital Charge Code	900911370
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.20
Rate for Payer: Aetna of CA Government/Medicare	$16.20
Rate for Payer: Cash Price	$12.15
Rate for Payer: Health Smart Auto/Commercial	$16.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.20
Rate for Payer: LLUH Dept of Risk Management WC	$14.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.25

HC SOM BETA 2 MICROGLOBULIN URINE

Facility

$27.00

Service Code	CPT 82232
Hospital Charge Code	900911370
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.20
Rate for Payer: Aetna of CA Government/Medicare	$16.20
Rate for Payer: Cash Price	$12.15
Rate for Payer: Health Smart Auto/Commercial	$16.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.20
Rate for Payer: LLUH Dept of Risk Management WC	$14.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.25

HC SOM BETA 2 TRANSFERRIN (TAU)

Facility

$78.02

Service Code	CPT 86335
Hospital Charge Code	900911443
Hospital Revenue Code	301
Min. Negotiated Rate	$42.91
Max. Negotiated Rate	$62.42
Rate for Payer: Cash Price	$35.11
Rate for Payer: Cigna of CA HMO/PPO	$62.42
Rate for Payer: Health Smart Auto/Commercial	$46.81
Rate for Payer: LLUH Dept of Risk Management WC	$42.91
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$58.52

HC SOM BETA 2 TRANSFERRIN (TAU)

Facility

$78.02

Service Code	CPT 86335 90
Hospital Charge Code	900911443
Hospital Revenue Code	301
Min. Negotiated Rate	$42.91
Max. Negotiated Rate	$62.42
Rate for Payer: Cash Price	$35.11
Rate for Payer: Cigna of CA HMO/PPO	$62.42
Rate for Payer: Health Smart Auto/Commercial	$46.81
Rate for Payer: LLUH Dept of Risk Management WC	$42.91
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$58.52

HC SOM BETA 2 TRANSFERRIN (TAU)

Facility

$78.02

Service Code	CPT 86335 90
Hospital Charge Code	900911443
Hospital Revenue Code	301
Min. Negotiated Rate	$42.91
Max. Negotiated Rate	$58.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$46.81
Rate for Payer: Aetna of CA Government/Medicare	$46.81
Rate for Payer: Cash Price	$35.11
Rate for Payer: Health Smart Auto/Commercial	$46.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$46.81
Rate for Payer: LLUH Dept of Risk Management WC	$42.91
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$58.52

HC SOM BETA 2 TRANSFERRIN (TAU)

Facility

$78.02

Service Code	CPT 86335
Hospital Charge Code	900911443
Hospital Revenue Code	301
Min. Negotiated Rate	$42.91
Max. Negotiated Rate	$58.52
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$46.81
Rate for Payer: Aetna of CA Government/Medicare	$46.81
Rate for Payer: Cash Price	$35.11
Rate for Payer: Health Smart Auto/Commercial	$46.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$46.81
Rate for Payer: LLUH Dept of Risk Management WC	$42.91
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$58.52

HC SOM BETA GALACTOSIDASE

Facility

$546.35

Service Code	CPT 82657 90
Hospital Charge Code	900912511
Hospital Revenue Code	301
Min. Negotiated Rate	$300.49
Max. Negotiated Rate	$409.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$327.81
Rate for Payer: Aetna of CA Government/Medicare	$327.81
Rate for Payer: Cash Price	$245.86
Rate for Payer: Health Smart Auto/Commercial	$327.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$327.81
Rate for Payer: LLUH Dept of Risk Management WC	$300.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$409.76

HC SOM BETA GALACTOSIDASE

Facility

$546.35

Service Code	CPT 82657 90
Hospital Charge Code	900912511
Hospital Revenue Code	301
Min. Negotiated Rate	$300.49
Max. Negotiated Rate	$437.08
Rate for Payer: Cash Price	$245.86
Rate for Payer: Cigna of CA HMO/PPO	$437.08
Rate for Payer: Health Smart Auto/Commercial	$327.81
Rate for Payer: LLUH Dept of Risk Management WC	$300.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$409.76

HC SOM BETA GALACTOSIDASE

Facility

$546.35

Service Code	CPT 82657
Hospital Charge Code	900912511
Hospital Revenue Code	301
Min. Negotiated Rate	$300.49
Max. Negotiated Rate	$437.08
Rate for Payer: Cash Price	$245.86
Rate for Payer: Cigna of CA HMO/PPO	$437.08
Rate for Payer: Health Smart Auto/Commercial	$327.81
Rate for Payer: LLUH Dept of Risk Management WC	$300.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$409.76

HC SOM BETA GALACTOSIDASE

Facility

$546.35

Service Code	CPT 82657
Hospital Charge Code	900912511
Hospital Revenue Code	301
Min. Negotiated Rate	$300.49
Max. Negotiated Rate	$409.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$327.81
Rate for Payer: Aetna of CA Government/Medicare	$327.81
Rate for Payer: Cash Price	$245.86
Rate for Payer: Health Smart Auto/Commercial	$327.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$327.81
Rate for Payer: LLUH Dept of Risk Management WC	$300.49
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$409.76

HC SOM BETA GLYCOPROTEIN AB IGA

Facility

$20.00

Service Code	CPT 86146 90
Hospital Charge Code	900912615
Hospital Revenue Code	302
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

Know your out-of-pocket cost for care.

All Charges