Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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	$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 BETA GLYCOPROTEIN AB IGA

Facility

$20.00

Service Code	CPT 86146
Hospital Charge Code	900912615
Hospital Revenue Code	302
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 BETA GLYCOPROTEIN AB IGA

Facility

$20.00

Service Code	CPT 86146
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

HC SOM BETA GLYCOPROTEIN AB IGG

Facility

$20.00

Service Code	CPT 86146
Hospital Charge Code	900910565
Hospital Revenue Code	302
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 BETA GLYCOPROTEIN AB IGG

Facility

$20.00

Service Code	CPT 86146
Hospital Charge Code	900910565
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

HC SOM BETA GLYCOPROTEIN AB IGG

Facility

$20.00

Service Code	CPT 86146 90
Hospital Charge Code	900910565
Hospital Revenue Code	302
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 BETA GLYCOPROTEIN AB IGG

Facility

$20.00

Service Code	CPT 86146 90
Hospital Charge Code	900910565
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

HC SOM BETA GLYCOPROTEIN AB IGM

Facility

$20.00

Service Code	CPT 86146 90
Hospital Charge Code	900912616
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

HC SOM BETA GLYCOPROTEIN AB IGM

Facility

$20.00

Service Code	CPT 86146 90
Hospital Charge Code	900912616
Hospital Revenue Code	302
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 BETA GLYCOPROTEIN AB IGM

Facility

$20.00

Service Code	CPT 86146
Hospital Charge Code	900912616
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

HC SOM BETA GLYCOPROTEIN AB IGM

Facility

$20.00

Service Code	CPT 86146
Hospital Charge Code	900912616
Hospital Revenue Code	302
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 BETA HCG CSF

Facility

$35.00

Service Code	CPT 84702 90
Hospital Charge Code	900910726
Hospital Revenue Code	301
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$28.00
Rate for Payer: Cash Price	$15.75
Rate for Payer: Cigna of CA HMO/PPO	$28.00
Rate for Payer: Health Smart Auto/Commercial	$21.00
Rate for Payer: LLUH Dept of Risk Management WC	$19.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$26.25

HC SOM BETA HCG CSF

Facility

$35.00

Service Code	CPT 84702 90
Hospital Charge Code	900910726
Hospital Revenue Code	301
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.00
Rate for Payer: Aetna of CA Government/Medicare	$21.00
Rate for Payer: Cash Price	$15.75
Rate for Payer: Health Smart Auto/Commercial	$21.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.00
Rate for Payer: LLUH Dept of Risk Management WC	$19.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$26.25

HC SOM BETA HCG CSF

Facility

$35.00

Service Code	CPT 84702
Hospital Charge Code	900910726
Hospital Revenue Code	301
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.00
Rate for Payer: Aetna of CA Government/Medicare	$21.00
Rate for Payer: Cash Price	$15.75
Rate for Payer: Health Smart Auto/Commercial	$21.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.00
Rate for Payer: LLUH Dept of Risk Management WC	$19.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$26.25

HC SOM BETA HCG CSF

Facility

$35.00

Service Code	CPT 84702
Hospital Charge Code	900910726
Hospital Revenue Code	301
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$28.00
Rate for Payer: Cash Price	$15.75
Rate for Payer: Cigna of CA HMO/PPO	$28.00
Rate for Payer: Health Smart Auto/Commercial	$21.00
Rate for Payer: LLUH Dept of Risk Management WC	$19.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$26.25

HC SOM BICARBONATE URINE

Facility

$83.00

Service Code	CPT 82374
Hospital Charge Code	900910363
Hospital Revenue Code	301
Min. Negotiated Rate	$45.65
Max. Negotiated Rate	$66.40
Rate for Payer: Cash Price	$37.35
Rate for Payer: Cigna of CA HMO/PPO	$66.40
Rate for Payer: Health Smart Auto/Commercial	$49.80
Rate for Payer: LLUH Dept of Risk Management WC	$45.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$62.25

HC SOM BICARBONATE URINE

Facility

$83.00

Service Code	CPT 82374 90
Hospital Charge Code	900910363
Hospital Revenue Code	301
Min. Negotiated Rate	$45.65
Max. Negotiated Rate	$66.40
Rate for Payer: Cash Price	$37.35
Rate for Payer: Cigna of CA HMO/PPO	$66.40
Rate for Payer: Health Smart Auto/Commercial	$49.80
Rate for Payer: LLUH Dept of Risk Management WC	$45.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$62.25

HC SOM BICARBONATE URINE

Facility

$83.00

Service Code	CPT 82374
Hospital Charge Code	900910363
Hospital Revenue Code	301
Min. Negotiated Rate	$45.65
Max. Negotiated Rate	$62.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$49.80
Rate for Payer: Aetna of CA Government/Medicare	$49.80
Rate for Payer: Cash Price	$37.35
Rate for Payer: Health Smart Auto/Commercial	$49.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$49.80
Rate for Payer: LLUH Dept of Risk Management WC	$45.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$62.25

HC SOM BICARBONATE URINE

Facility

$83.00

Service Code	CPT 82374 90
Hospital Charge Code	900910363
Hospital Revenue Code	301
Min. Negotiated Rate	$45.65
Max. Negotiated Rate	$62.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$49.80
Rate for Payer: Aetna of CA Government/Medicare	$49.80
Rate for Payer: Cash Price	$37.35
Rate for Payer: Health Smart Auto/Commercial	$49.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$49.80
Rate for Payer: LLUH Dept of Risk Management WC	$45.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$62.25

HC SOM BILE ACIDS TOTAL

Facility

$30.00

Service Code	CPT 82239 90
Hospital Charge Code	900911123
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

HC SOM BILE ACIDS TOTAL

Facility

$30.00

Service Code	CPT 82239
Hospital Charge Code	900911123
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$24.00
Rate for Payer: Cash Price	$13.50
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$22.50

HC SOM BILE ACIDS TOTAL

Facility

$30.00

Service Code	CPT 82239 90
Hospital Charge Code	900911123
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$24.00
Rate for Payer: Cash Price	$13.50
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$22.50

HC SOM BILE ACIDS TOTAL

Facility

$30.00

Service Code	CPT 82239
Hospital Charge Code	900911123
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

HC SOM BK VIRUS DNA QUANT PCR

Facility

$65.90

Service Code	CPT 87799
Hospital Charge Code	900912559
Hospital Revenue Code	301
Min. Negotiated Rate	$36.24
Max. Negotiated Rate	$49.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$39.54
Rate for Payer: Aetna of CA Government/Medicare	$39.54
Rate for Payer: Cash Price	$29.66
Rate for Payer: Health Smart Auto/Commercial	$39.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$39.54
Rate for Payer: LLUH Dept of Risk Management WC	$36.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$49.42

HC SOM BK VIRUS DNA QUANT PCR

Facility

$65.90

Service Code	CPT 87799 90
Hospital Charge Code	900912559
Hospital Revenue Code	301
Min. Negotiated Rate	$36.24
Max. Negotiated Rate	$49.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$39.54
Rate for Payer: Aetna of CA Government/Medicare	$39.54
Rate for Payer: Cash Price	$29.66
Rate for Payer: Health Smart Auto/Commercial	$39.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$39.54
Rate for Payer: LLUH Dept of Risk Management WC	$36.24
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$49.42

Know your out-of-pocket cost for care.

All Charges