Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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	$52.72
Rate for Payer: Cash Price	$29.66
Rate for Payer: Cigna of CA HMO/PPO	$52.72
Rate for Payer: Health Smart Auto/Commercial	$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	$52.72
Rate for Payer: Cash Price	$29.66
Rate for Payer: Cigna of CA HMO/PPO	$52.72
Rate for Payer: Health Smart Auto/Commercial	$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 BLASTOMYCES AB IMMUNODIFFUSION

Facility

$45.00

Service Code	CPT 86612 90
Hospital Charge Code	900912686
Hospital Revenue Code	302
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 BLASTOMYCES AB IMMUNODIFFUSION

Facility

$45.00

Service Code	CPT 86612
Hospital Charge Code	900912686
Hospital Revenue Code	302
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 BLASTOMYCES AB IMMUNODIFFUSION

Facility

$45.00

Service Code	CPT 86612
Hospital Charge Code	900912686
Hospital Revenue Code	302
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 BLASTOMYCES AB IMMUNODIFFUSION

Facility

$45.00

Service Code	CPT 86612 90
Hospital Charge Code	900912686
Hospital Revenue Code	302
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 BORDETELLA PCR

Facility

$38.80

Service Code	CPT 87798
Hospital Charge Code	900914165
Hospital Revenue Code	306
Min. Negotiated Rate	$21.34
Max. Negotiated Rate	$29.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.28
Rate for Payer: Aetna of CA Government/Medicare	$23.28
Rate for Payer: Cash Price	$17.46
Rate for Payer: Health Smart Auto/Commercial	$23.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.28
Rate for Payer: LLUH Dept of Risk Management WC	$21.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.10

HC SOM BORDETELLA PCR

Facility

$38.80

Service Code	CPT 87798
Hospital Charge Code	900914165
Hospital Revenue Code	306
Min. Negotiated Rate	$21.34
Max. Negotiated Rate	$31.04
Rate for Payer: Health Smart Auto/Commercial	$23.28
Rate for Payer: Cash Price	$17.46
Rate for Payer: Cigna of CA HMO/PPO	$31.04
Rate for Payer: LLUH Dept of Risk Management WC	$21.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.10

HC SOM BORDETELLA PCR

Facility

$38.80

Service Code	CPT 87798 90
Hospital Charge Code	900914165
Hospital Revenue Code	306
Min. Negotiated Rate	$21.34
Max. Negotiated Rate	$29.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.28
Rate for Payer: Aetna of CA Government/Medicare	$23.28
Rate for Payer: Cash Price	$17.46
Rate for Payer: Health Smart Auto/Commercial	$23.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.28
Rate for Payer: LLUH Dept of Risk Management WC	$21.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.10

HC SOM BORDETELLA PCR

Facility

$38.80

Service Code	CPT 87798 90
Hospital Charge Code	900914165
Hospital Revenue Code	306
Min. Negotiated Rate	$21.34
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$17.46
Rate for Payer: Cigna of CA HMO/PPO	$31.04
Rate for Payer: Health Smart Auto/Commercial	$23.28
Rate for Payer: LLUH Dept of Risk Management WC	$21.34
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.10

HC SOM BORIC ACID

Facility

$85.00

Service Code	CPT 83018
Hospital Charge Code	900911050
Hospital Revenue Code	301
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$63.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$51.00
Rate for Payer: Aetna of CA Government/Medicare	$51.00
Rate for Payer: Cash Price	$38.25
Rate for Payer: Health Smart Auto/Commercial	$51.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$51.00
Rate for Payer: LLUH Dept of Risk Management WC	$46.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$63.75

HC SOM BORIC ACID

Facility

$85.00

Service Code	CPT 83018 90
Hospital Charge Code	900911050
Hospital Revenue Code	301
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$68.00
Rate for Payer: Cash Price	$38.25
Rate for Payer: Cigna of CA HMO/PPO	$68.00
Rate for Payer: Health Smart Auto/Commercial	$51.00
Rate for Payer: LLUH Dept of Risk Management WC	$46.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$63.75

HC SOM BORIC ACID

Facility

$85.00

Service Code	CPT 83018
Hospital Charge Code	900911050
Hospital Revenue Code	301
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$68.00
Rate for Payer: Cash Price	$38.25
Rate for Payer: Cigna of CA HMO/PPO	$68.00
Rate for Payer: Health Smart Auto/Commercial	$51.00
Rate for Payer: LLUH Dept of Risk Management WC	$46.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$63.75

HC SOM BORIC ACID

Facility

$85.00

Service Code	CPT 83018 90
Hospital Charge Code	900911050
Hospital Revenue Code	301
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$63.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$51.00
Rate for Payer: Aetna of CA Government/Medicare	$51.00
Rate for Payer: Cash Price	$38.25
Rate for Payer: Health Smart Auto/Commercial	$51.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$51.00
Rate for Payer: LLUH Dept of Risk Management WC	$46.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$63.75

HC SOM BORON

Facility

$73.00

Service Code	CPT 83018
Hospital Charge Code	900914503
Hospital Revenue Code	301
Min. Negotiated Rate	$40.15
Max. Negotiated Rate	$54.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$43.80
Rate for Payer: Aetna of CA Government/Medicare	$43.80
Rate for Payer: Cash Price	$32.85
Rate for Payer: Health Smart Auto/Commercial	$43.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$43.80
Rate for Payer: LLUH Dept of Risk Management WC	$40.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$54.75

HC SOM BORON

Facility

$73.00

Service Code	CPT 83018 90
Hospital Charge Code	900914503
Hospital Revenue Code	301
Min. Negotiated Rate	$40.15
Max. Negotiated Rate	$54.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$43.80
Rate for Payer: Aetna of CA Government/Medicare	$43.80
Rate for Payer: Cash Price	$32.85
Rate for Payer: Health Smart Auto/Commercial	$43.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$43.80
Rate for Payer: LLUH Dept of Risk Management WC	$40.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$54.75

HC SOM BORON

Facility

$73.00

Service Code	CPT 83018 90
Hospital Charge Code	900914503
Hospital Revenue Code	301
Min. Negotiated Rate	$40.15
Max. Negotiated Rate	$58.40
Rate for Payer: Cash Price	$32.85
Rate for Payer: Cigna of CA HMO/PPO	$58.40
Rate for Payer: Health Smart Auto/Commercial	$43.80
Rate for Payer: LLUH Dept of Risk Management WC	$40.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$54.75

HC SOM BORON

Facility

$73.00

Service Code	CPT 83018
Hospital Charge Code	900914503
Hospital Revenue Code	301
Min. Negotiated Rate	$40.15
Max. Negotiated Rate	$58.40
Rate for Payer: Cash Price	$32.85
Rate for Payer: Cigna of CA HMO/PPO	$58.40
Rate for Payer: Health Smart Auto/Commercial	$43.80
Rate for Payer: LLUH Dept of Risk Management WC	$40.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$54.75

HC SOM BORRELIA BURGDORFERI PCR PROBE

Facility

$26.66

Service Code	CPT 87476
Hospital Charge Code	900912513
Hospital Revenue Code	306
Min. Negotiated Rate	$14.66
Max. Negotiated Rate	$21.33
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cigna of CA HMO/PPO	$21.33
Rate for Payer: Health Smart Auto/Commercial	$16.00
Rate for Payer: LLUH Dept of Risk Management WC	$14.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.00

HC SOM BORRELIA BURGDORFERI PCR PROBE

Facility

$26.66

Service Code	CPT 87476
Hospital Charge Code	900912513
Hospital Revenue Code	306
Min. Negotiated Rate	$14.66
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.00
Rate for Payer: Aetna of CA Government/Medicare	$16.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Smart Auto/Commercial	$16.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.00
Rate for Payer: LLUH Dept of Risk Management WC	$14.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.00

HC SOM BORRELIA BURGDORFERI PCR PROBE

Facility

$26.66

Service Code	CPT 87476 90
Hospital Charge Code	900912513
Hospital Revenue Code	306
Min. Negotiated Rate	$14.66
Max. Negotiated Rate	$21.33
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cigna of CA HMO/PPO	$21.33
Rate for Payer: Health Smart Auto/Commercial	$16.00
Rate for Payer: LLUH Dept of Risk Management WC	$14.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.00

HC SOM BORRELIA BURGDORFERI PCR PROBE

Facility

$26.66

Service Code	CPT 87476 90
Hospital Charge Code	900912513
Hospital Revenue Code	306
Min. Negotiated Rate	$14.66
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.00
Rate for Payer: Aetna of CA Government/Medicare	$16.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Smart Auto/Commercial	$16.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.00
Rate for Payer: LLUH Dept of Risk Management WC	$14.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.00

HC SOM BRUCELLA AB CONFIRMATION

Facility

$116.41

Service Code	CPT 86622
Hospital Charge Code	900912841
Hospital Revenue Code	302
Min. Negotiated Rate	$64.03
Max. Negotiated Rate	$93.13
Rate for Payer: Cash Price	$52.38
Rate for Payer: Cigna of CA HMO/PPO	$93.13
Rate for Payer: Health Smart Auto/Commercial	$69.85
Rate for Payer: LLUH Dept of Risk Management WC	$64.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$87.31

HC SOM BRUCELLA AB CONFIRMATION

Facility

$116.41

Service Code	CPT 86622 90
Hospital Charge Code	900912841
Hospital Revenue Code	302
Min. Negotiated Rate	$64.03
Max. Negotiated Rate	$93.13
Rate for Payer: Cash Price	$52.38
Rate for Payer: Cigna of CA HMO/PPO	$93.13
Rate for Payer: Health Smart Auto/Commercial	$69.85
Rate for Payer: LLUH Dept of Risk Management WC	$64.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$87.31

HC SOM BRUCELLA AB CONFIRMATION

Facility

$116.41

Service Code	CPT 86622 90
Hospital Charge Code	900912841
Hospital Revenue Code	302
Min. Negotiated Rate	$64.03
Max. Negotiated Rate	$87.31
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$69.85
Rate for Payer: Aetna of CA Government/Medicare	$69.85
Rate for Payer: Cash Price	$52.38
Rate for Payer: Health Smart Auto/Commercial	$69.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$69.85
Rate for Payer: LLUH Dept of Risk Management WC	$64.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$87.31

Know your out-of-pocket cost for care.

All Charges