Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM CHOLINESTERASE PSEUDO

Facility

$107.03

Service Code	CPT 82480
Hospital Charge Code	900911160
Hospital Revenue Code	301
Min. Negotiated Rate	$58.87
Max. Negotiated Rate	$85.62
Rate for Payer: Cash Price	$48.16
Rate for Payer: Cigna of CA HMO/PPO	$85.62
Rate for Payer: Health Smart Auto/Commercial	$64.22
Rate for Payer: LLUH Dept of Risk Management WC	$58.87
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$80.27

HC SOM CHOLINESTERASE PSEUDO

Facility

$107.03

Service Code	CPT 82480 90
Hospital Charge Code	900911160
Hospital Revenue Code	301
Min. Negotiated Rate	$58.87
Max. Negotiated Rate	$85.62
Rate for Payer: Cash Price	$48.16
Rate for Payer: Cigna of CA HMO/PPO	$85.62
Rate for Payer: Health Smart Auto/Commercial	$64.22
Rate for Payer: LLUH Dept of Risk Management WC	$58.87
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$80.27

HC SOM CHROMIUM

Facility

$25.00

Service Code	CPT 82495
Hospital Charge Code	900911190
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 CHROMIUM

Facility

$25.00

Service Code	CPT 82495
Hospital Charge Code	900911190
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 CHROMIUM

Facility

$25.00

Service Code	CPT 82495 90
Hospital Charge Code	900911190
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 CHROMIUM

Facility

$25.00

Service Code	CPT 82495 90
Hospital Charge Code	900911190
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 CHROMIUM URINE

Facility

$214.60

Service Code	CPT 82495 90
Hospital Charge Code	900910731
Hospital Revenue Code	301
Min. Negotiated Rate	$118.03
Max. Negotiated Rate	$160.95
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$128.76
Rate for Payer: Aetna of CA Government/Medicare	$128.76
Rate for Payer: Cash Price	$96.57
Rate for Payer: Health Smart Auto/Commercial	$128.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$128.76
Rate for Payer: LLUH Dept of Risk Management WC	$118.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$160.95

HC SOM CHROMIUM URINE

Facility

$214.60

Service Code	CPT 82495
Hospital Charge Code	900910731
Hospital Revenue Code	301
Min. Negotiated Rate	$118.03
Max. Negotiated Rate	$171.68
Rate for Payer: Cash Price	$96.57
Rate for Payer: Cigna of CA HMO/PPO	$171.68
Rate for Payer: Health Smart Auto/Commercial	$128.76
Rate for Payer: LLUH Dept of Risk Management WC	$118.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$160.95

HC SOM CHROMIUM URINE

Facility

$214.60

Service Code	CPT 82495 90
Hospital Charge Code	900910731
Hospital Revenue Code	301
Min. Negotiated Rate	$118.03
Max. Negotiated Rate	$171.68
Rate for Payer: Cash Price	$96.57
Rate for Payer: Cigna of CA HMO/PPO	$171.68
Rate for Payer: Health Smart Auto/Commercial	$128.76
Rate for Payer: LLUH Dept of Risk Management WC	$118.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$160.95

HC SOM CHROMIUM URINE

Facility

$214.60

Service Code	CPT 82495
Hospital Charge Code	900910731
Hospital Revenue Code	301
Min. Negotiated Rate	$118.03
Max. Negotiated Rate	$160.95
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$128.76
Rate for Payer: Aetna of CA Government/Medicare	$128.76
Rate for Payer: Cash Price	$96.57
Rate for Payer: Health Smart Auto/Commercial	$128.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$128.76
Rate for Payer: LLUH Dept of Risk Management WC	$118.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$160.95

HC SOM CHROMOGRANIN A

Facility

$17.65

Service Code	CPT 86316 90
Hospital Charge Code	900911458
Hospital Revenue Code	301
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$13.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.59
Rate for Payer: Aetna of CA Government/Medicare	$10.59
Rate for Payer: Cash Price	$7.94
Rate for Payer: Health Smart Auto/Commercial	$10.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.59
Rate for Payer: LLUH Dept of Risk Management WC	$9.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.24

HC SOM CHROMOGRANIN A

Facility

$17.65

Service Code	CPT 86316
Hospital Charge Code	900911458
Hospital Revenue Code	301
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$13.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.59
Rate for Payer: Aetna of CA Government/Medicare	$10.59
Rate for Payer: Cash Price	$7.94
Rate for Payer: Health Smart Auto/Commercial	$10.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.59
Rate for Payer: LLUH Dept of Risk Management WC	$9.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.24

HC SOM CHROMOGRANIN A

Facility

$17.65

Service Code	CPT 86316
Hospital Charge Code	900911458
Hospital Revenue Code	301
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$14.12
Rate for Payer: Cash Price	$7.94
Rate for Payer: Cigna of CA HMO/PPO	$14.12
Rate for Payer: Health Smart Auto/Commercial	$10.59
Rate for Payer: LLUH Dept of Risk Management WC	$9.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.24

HC SOM CHROMOGRANIN A

Facility

$17.65

Service Code	CPT 86316 90
Hospital Charge Code	900911458
Hospital Revenue Code	301
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$14.12
Rate for Payer: Cash Price	$7.94
Rate for Payer: Cigna of CA HMO/PPO	$14.12
Rate for Payer: Health Smart Auto/Commercial	$10.59
Rate for Payer: LLUH Dept of Risk Management WC	$9.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.24

HC SOM CHROMOSOME ANALYSIS BREAKAGE

Facility

$243.11

Service Code	CPT 88291
Hospital Charge Code	900912554
Hospital Revenue Code	310
Min. Negotiated Rate	$133.71
Max. Negotiated Rate	$194.49
Rate for Payer: Cash Price	$109.40
Rate for Payer: Cigna of CA HMO/PPO	$194.49
Rate for Payer: Health Smart Auto/Commercial	$145.87
Rate for Payer: LLUH Dept of Risk Management WC	$133.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$182.33

HC SOM CHROMOSOME ANALYSIS BREAKAGE

Facility

$243.11

Service Code	CPT 88291
Hospital Charge Code	900912554
Hospital Revenue Code	310
Min. Negotiated Rate	$133.71
Max. Negotiated Rate	$182.33
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$145.87
Rate for Payer: Aetna of CA Government/Medicare	$145.87
Rate for Payer: Cash Price	$109.40
Rate for Payer: Health Smart Auto/Commercial	$145.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$145.87
Rate for Payer: LLUH Dept of Risk Management WC	$133.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$182.33

HC SOM CHROMOSOME ANALYSIS MARROW

Facility

$950.00

Service Code	CPT 88291 90
Hospital Charge Code	900910601
Hospital Revenue Code	310
Min. Negotiated Rate	$522.50
Max. Negotiated Rate	$760.00
Rate for Payer: Cash Price	$427.50
Rate for Payer: Cigna of CA HMO/PPO	$760.00
Rate for Payer: Health Smart Auto/Commercial	$570.00
Rate for Payer: LLUH Dept of Risk Management WC	$522.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$712.50

HC SOM CHROMOSOME ANALYSIS MARROW

Facility

$950.00

Service Code	CPT 88291
Hospital Charge Code	900910601
Hospital Revenue Code	310
Min. Negotiated Rate	$522.50
Max. Negotiated Rate	$760.00
Rate for Payer: Cash Price	$427.50
Rate for Payer: Cigna of CA HMO/PPO	$760.00
Rate for Payer: Health Smart Auto/Commercial	$570.00
Rate for Payer: LLUH Dept of Risk Management WC	$522.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$712.50

HC SOM CHROMOSOME ANALYSIS MARROW

Facility

$950.00

Service Code	CPT 88291 90
Hospital Charge Code	900910601
Hospital Revenue Code	310
Min. Negotiated Rate	$522.50
Max. Negotiated Rate	$712.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$570.00
Rate for Payer: Aetna of CA Government/Medicare	$570.00
Rate for Payer: Cash Price	$427.50
Rate for Payer: Health Smart Auto/Commercial	$570.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$570.00
Rate for Payer: LLUH Dept of Risk Management WC	$522.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$712.50

HC SOM CHROMOSOME ANALYSIS MARROW

Facility

$950.00

Service Code	CPT 88291
Hospital Charge Code	900910601
Hospital Revenue Code	310
Min. Negotiated Rate	$522.50
Max. Negotiated Rate	$712.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$570.00
Rate for Payer: Aetna of CA Government/Medicare	$570.00
Rate for Payer: Cash Price	$427.50
Rate for Payer: Health Smart Auto/Commercial	$570.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$570.00
Rate for Payer: LLUH Dept of Risk Management WC	$522.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$712.50

HC SOM CHROMOSOME ANALYSIS WHOLE BLOOD

Facility

$391.00

Service Code	CPT 88291
Hospital Charge Code	900910752
Hospital Revenue Code	310
Min. Negotiated Rate	$215.05
Max. Negotiated Rate	$312.80
Rate for Payer: Cash Price	$175.95
Rate for Payer: Cigna of CA HMO/PPO	$312.80
Rate for Payer: Health Smart Auto/Commercial	$234.60
Rate for Payer: LLUH Dept of Risk Management WC	$215.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$293.25

HC SOM CHROMOSOME ANALYSIS WHOLE BLOOD

Facility

$391.00

Service Code	CPT 88291 90
Hospital Charge Code	900910752
Hospital Revenue Code	310
Min. Negotiated Rate	$215.05
Max. Negotiated Rate	$312.80
Rate for Payer: Cash Price	$175.95
Rate for Payer: Cigna of CA HMO/PPO	$312.80
Rate for Payer: Health Smart Auto/Commercial	$234.60
Rate for Payer: LLUH Dept of Risk Management WC	$215.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$293.25

HC SOM CHROMOSOME ANALYSIS WHOLE BLOOD

Facility

$391.00

Service Code	CPT 88291
Hospital Charge Code	900910752
Hospital Revenue Code	310
Min. Negotiated Rate	$215.05
Max. Negotiated Rate	$293.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$234.60
Rate for Payer: Aetna of CA Government/Medicare	$234.60
Rate for Payer: Cash Price	$175.95
Rate for Payer: Health Smart Auto/Commercial	$234.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$234.60
Rate for Payer: LLUH Dept of Risk Management WC	$215.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$293.25

HC SOM CHROMOSOME ANALYSIS WHOLE BLOOD

Facility

$391.00

Service Code	CPT 88291 90
Hospital Charge Code	900910752
Hospital Revenue Code	310
Min. Negotiated Rate	$215.05
Max. Negotiated Rate	$293.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$234.60
Rate for Payer: Aetna of CA Government/Medicare	$234.60
Rate for Payer: Cash Price	$175.95
Rate for Payer: Health Smart Auto/Commercial	$234.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$234.60
Rate for Payer: LLUH Dept of Risk Management WC	$215.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$293.25

HC SOM CHROMOSOMES CHORIONIC VILLUS

Facility

$400.00

Service Code	CPT 88291
Hospital Charge Code	900912549
Hospital Revenue Code	310
Min. Negotiated Rate	$220.00
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$240.00
Rate for Payer: Aetna of CA Government/Medicare	$240.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Health Smart Auto/Commercial	$240.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$240.00
Rate for Payer: LLUH Dept of Risk Management WC	$220.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$300.00

Know your out-of-pocket cost for care.

All Charges