Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM C-TELOPEPTIDE

Facility

$19.34

Service Code	CPT 82523 90
Hospital Charge Code	900912783
Hospital Revenue Code	301
Min. Negotiated Rate	$10.64
Max. Negotiated Rate	$15.47
Rate for Payer: Cash Price	$8.70
Rate for Payer: Cigna of CA HMO/PPO	$15.47
Rate for Payer: Health Smart Auto/Commercial	$11.60
Rate for Payer: LLUH Dept of Risk Management WC	$10.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.50

HC SOM C-TELOPEPTIDE

Facility

$19.34

Service Code	CPT 82523
Hospital Charge Code	900912783
Hospital Revenue Code	301
Min. Negotiated Rate	$10.64
Max. Negotiated Rate	$14.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.60
Rate for Payer: Aetna of CA Government/Medicare	$11.60
Rate for Payer: Cash Price	$8.70
Rate for Payer: Health Smart Auto/Commercial	$11.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.60
Rate for Payer: LLUH Dept of Risk Management WC	$10.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.50

HC SOM C. TRACHOMATIS, IGG

Facility

$7.00

Service Code	CPT 86631
Hospital Charge Code	900912801
Hospital Revenue Code	302
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$5.60
Rate for Payer: Cash Price	$3.15
Rate for Payer: Cigna of CA HMO/PPO	$5.60
Rate for Payer: Health Smart Auto/Commercial	$4.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.25

HC SOM C. TRACHOMATIS, IGG

Facility

$7.00

Service Code	CPT 86631 90
Hospital Charge Code	900912801
Hospital Revenue Code	302
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.20
Rate for Payer: Aetna of CA Government/Medicare	$4.20
Rate for Payer: Cash Price	$3.15
Rate for Payer: Health Smart Auto/Commercial	$4.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.25

HC SOM C. TRACHOMATIS, IGG

Facility

$7.00

Service Code	CPT 86631 90
Hospital Charge Code	900912801
Hospital Revenue Code	302
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$5.60
Rate for Payer: Cash Price	$3.15
Rate for Payer: Cigna of CA HMO/PPO	$5.60
Rate for Payer: Health Smart Auto/Commercial	$4.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.25

HC SOM C. TRACHOMATIS, IGG

Facility

$7.00

Service Code	CPT 86631
Hospital Charge Code	900912801
Hospital Revenue Code	302
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.20
Rate for Payer: Aetna of CA Government/Medicare	$4.20
Rate for Payer: Cash Price	$3.15
Rate for Payer: Health Smart Auto/Commercial	$4.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.25

HC SOM C. TRACHOMATIS IGM

Facility

$7.00

Service Code	CPT 86632 90
Hospital Charge Code	900912799
Hospital Revenue Code	302
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$5.60
Rate for Payer: Cash Price	$3.15
Rate for Payer: Cigna of CA HMO/PPO	$5.60
Rate for Payer: Health Smart Auto/Commercial	$4.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.25

HC SOM C. TRACHOMATIS IGM

Facility

$7.00

Service Code	CPT 86632
Hospital Charge Code	900912799
Hospital Revenue Code	302
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.20
Rate for Payer: Aetna of CA Government/Medicare	$4.20
Rate for Payer: Cash Price	$3.15
Rate for Payer: Health Smart Auto/Commercial	$4.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.25

HC SOM C. TRACHOMATIS IGM

Facility

$7.00

Service Code	CPT 86632
Hospital Charge Code	900912799
Hospital Revenue Code	302
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$5.60
Rate for Payer: Cash Price	$3.15
Rate for Payer: Cigna of CA HMO/PPO	$5.60
Rate for Payer: Health Smart Auto/Commercial	$4.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.25

HC SOM C. TRACHOMATIS IGM

Facility

$7.00

Service Code	CPT 86632 90
Hospital Charge Code	900912799
Hospital Revenue Code	302
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.20
Rate for Payer: Aetna of CA Government/Medicare	$4.20
Rate for Payer: Cash Price	$3.15
Rate for Payer: Health Smart Auto/Commercial	$4.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.25

HC SOM CYANIDE

Facility

$89.00

Service Code	CPT 82600 90
Hospital Charge Code	900911136
Hospital Revenue Code	301
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$71.20
Rate for Payer: Cash Price	$40.05
Rate for Payer: Cigna of CA HMO/PPO	$71.20
Rate for Payer: Health Smart Auto/Commercial	$53.40
Rate for Payer: LLUH Dept of Risk Management WC	$48.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$66.75

HC SOM CYANIDE

Facility

$89.00

Service Code	CPT 82600
Hospital Charge Code	900911136
Hospital Revenue Code	301
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$66.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$53.40
Rate for Payer: Aetna of CA Government/Medicare	$53.40
Rate for Payer: Cash Price	$40.05
Rate for Payer: Health Smart Auto/Commercial	$53.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$53.40
Rate for Payer: LLUH Dept of Risk Management WC	$48.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$66.75

HC SOM CYANIDE

Facility

$89.00

Service Code	CPT 82600 90
Hospital Charge Code	900911136
Hospital Revenue Code	301
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$66.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$53.40
Rate for Payer: Aetna of CA Government/Medicare	$53.40
Rate for Payer: Cash Price	$40.05
Rate for Payer: Health Smart Auto/Commercial	$53.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$53.40
Rate for Payer: LLUH Dept of Risk Management WC	$48.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$66.75

HC SOM CYANIDE

Facility

$89.00

Service Code	CPT 82600
Hospital Charge Code	900911136
Hospital Revenue Code	301
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$71.20
Rate for Payer: Cash Price	$40.05
Rate for Payer: Cigna of CA HMO/PPO	$71.20
Rate for Payer: Health Smart Auto/Commercial	$53.40
Rate for Payer: LLUH Dept of Risk Management WC	$48.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$66.75

HC SOM CYSTATIN C WITH EGFR, S

Facility

$37.23

Service Code	CPT 82610 90
Hospital Charge Code	900915362
Hospital Revenue Code	301
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$27.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.34
Rate for Payer: Aetna of CA Government/Medicare	$22.34
Rate for Payer: Cash Price	$16.75
Rate for Payer: Health Smart Auto/Commercial	$22.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.34
Rate for Payer: LLUH Dept of Risk Management WC	$20.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.92

HC SOM CYSTATIN C WITH EGFR, S

Facility

$37.23

Service Code	CPT 82610
Hospital Charge Code	900915362
Hospital Revenue Code	301
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$29.78
Rate for Payer: Cash Price	$16.75
Rate for Payer: Cigna of CA HMO/PPO	$29.78
Rate for Payer: Health Smart Auto/Commercial	$22.34
Rate for Payer: LLUH Dept of Risk Management WC	$20.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.92

HC SOM CYSTATIN C WITH EGFR, S

Facility

$37.23

Service Code	CPT 82610
Hospital Charge Code	900915362
Hospital Revenue Code	301
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$27.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.34
Rate for Payer: Aetna of CA Government/Medicare	$22.34
Rate for Payer: Cash Price	$16.75
Rate for Payer: Health Smart Auto/Commercial	$22.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.34
Rate for Payer: LLUH Dept of Risk Management WC	$20.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.92

HC SOM CYSTATIN C WITH EGFR, S

Facility

$37.23

Service Code	CPT 82610 90
Hospital Charge Code	900915362
Hospital Revenue Code	301
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$29.78
Rate for Payer: Cash Price	$16.75
Rate for Payer: Cigna of CA HMO/PPO	$29.78
Rate for Payer: Health Smart Auto/Commercial	$22.34
Rate for Payer: LLUH Dept of Risk Management WC	$20.48
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.92

HC SOM CYSTICERCOSIS AB BLOOD

Facility

$30.00

Service Code	CPT 86682
Hospital Charge Code	900911763
Hospital Revenue Code	302
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 CYSTICERCOSIS AB BLOOD

Facility

$30.00

Service Code	CPT 86682
Hospital Charge Code	900911763
Hospital Revenue Code	302
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 CYSTICERCOSIS AB BLOOD

Facility

$30.00

Service Code	CPT 86682 90
Hospital Charge Code	900911763
Hospital Revenue Code	302
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 CYSTICERCOSIS AB BLOOD

Facility

$30.00

Service Code	CPT 86682 90
Hospital Charge Code	900911763
Hospital Revenue Code	302
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 CYSTIC FIBROSIS DNA

Facility

$168.38

Service Code	CPT 81220 90
Hospital Charge Code	900911481
Hospital Revenue Code	301
Min. Negotiated Rate	$92.61
Max. Negotiated Rate	$126.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$101.03
Rate for Payer: Aetna of CA Government/Medicare	$101.03
Rate for Payer: Cash Price	$75.77
Rate for Payer: Health Smart Auto/Commercial	$101.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$101.03
Rate for Payer: LLUH Dept of Risk Management WC	$92.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$126.28

HC SOM CYSTIC FIBROSIS DNA

Facility

$168.38

Service Code	CPT 81220
Hospital Charge Code	900911481
Hospital Revenue Code	301
Min. Negotiated Rate	$92.61
Max. Negotiated Rate	$134.70
Rate for Payer: Cash Price	$75.77
Rate for Payer: Cigna of CA HMO/PPO	$134.70
Rate for Payer: Health Smart Auto/Commercial	$101.03
Rate for Payer: LLUH Dept of Risk Management WC	$92.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$126.28

HC SOM CYSTIC FIBROSIS DNA

Facility

$168.38

Service Code	CPT 81220 90
Hospital Charge Code	900911481
Hospital Revenue Code	301
Min. Negotiated Rate	$92.61
Max. Negotiated Rate	$134.70
Rate for Payer: Cash Price	$75.77
Rate for Payer: Cigna of CA HMO/PPO	$134.70
Rate for Payer: Health Smart Auto/Commercial	$101.03
Rate for Payer: LLUH Dept of Risk Management WC	$92.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$126.28

Know your out-of-pocket cost for care.

All Charges