Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM DNA EXTRACTION

Facility

$203.61

Service Code	CPT 81401
Hospital Charge Code	900910721
Hospital Revenue Code	301
Min. Negotiated Rate	$111.99
Max. Negotiated Rate	$152.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$122.17
Rate for Payer: Aetna of CA Government/Medicare	$122.17
Rate for Payer: Cash Price	$91.62
Rate for Payer: Health Smart Auto/Commercial	$122.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$122.17
Rate for Payer: LLUH Dept of Risk Management WC	$111.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$152.71

HC SOM DNA EXTRACTION

Facility

$203.61

Service Code	CPT 81401
Hospital Charge Code	900910721
Hospital Revenue Code	301
Min. Negotiated Rate	$111.99
Max. Negotiated Rate	$162.89
Rate for Payer: Cash Price	$91.62
Rate for Payer: Cigna of CA HMO/PPO	$162.89
Rate for Payer: Health Smart Auto/Commercial	$122.17
Rate for Payer: LLUH Dept of Risk Management WC	$111.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$152.71

HC SOM DNA EXTRACTION

Facility

$203.61

Service Code	CPT 81401 90
Hospital Charge Code	900910721
Hospital Revenue Code	301
Min. Negotiated Rate	$111.99
Max. Negotiated Rate	$162.89
Rate for Payer: Cash Price	$91.62
Rate for Payer: Cigna of CA HMO/PPO	$162.89
Rate for Payer: Health Smart Auto/Commercial	$122.17
Rate for Payer: LLUH Dept of Risk Management WC	$111.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$152.71

HC SOM DRUG SCREEN PRESCRIPTION/OTC U

Facility

$47.95

Service Code	CPT 80307 90
Hospital Charge Code	900912877
Hospital Revenue Code	301
Min. Negotiated Rate	$26.37
Max. Negotiated Rate	$38.36
Rate for Payer: Cash Price	$21.58
Rate for Payer: Cigna of CA HMO/PPO	$38.36
Rate for Payer: Health Smart Auto/Commercial	$28.77
Rate for Payer: LLUH Dept of Risk Management WC	$26.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$35.96

HC SOM DRUG SCREEN PRESCRIPTION/OTC U

Facility

$47.95

Service Code	CPT 80307
Hospital Charge Code	900912877
Hospital Revenue Code	301
Min. Negotiated Rate	$26.37
Max. Negotiated Rate	$35.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$28.77
Rate for Payer: Aetna of CA Government/Medicare	$28.77
Rate for Payer: Cash Price	$21.58
Rate for Payer: Health Smart Auto/Commercial	$28.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$28.77
Rate for Payer: LLUH Dept of Risk Management WC	$26.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$35.96

HC SOM DRUG SCREEN PRESCRIPTION/OTC U

Facility

$47.95

Service Code	CPT 80307
Hospital Charge Code	900912877
Hospital Revenue Code	301
Min. Negotiated Rate	$26.37
Max. Negotiated Rate	$38.36
Rate for Payer: Cash Price	$21.58
Rate for Payer: Cigna of CA HMO/PPO	$38.36
Rate for Payer: Health Smart Auto/Commercial	$28.77
Rate for Payer: LLUH Dept of Risk Management WC	$26.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$35.96

HC SOM DRUG SCREEN PRESCRIPTION/OTC U

Facility

$47.95

Service Code	CPT 80307 90
Hospital Charge Code	900912877
Hospital Revenue Code	301
Min. Negotiated Rate	$26.37
Max. Negotiated Rate	$35.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$28.77
Rate for Payer: Aetna of CA Government/Medicare	$28.77
Rate for Payer: Cash Price	$21.58
Rate for Payer: Health Smart Auto/Commercial	$28.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$28.77
Rate for Payer: LLUH Dept of Risk Management WC	$26.37
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$35.96

HC SOM DRUG SCRN MECONIUM AMPHETAMINE

Facility

$50.00

Service Code	CPT 80307 90
Hospital Charge Code	900911008
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$40.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cigna of CA HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.50

HC SOM DRUG SCRN MECONIUM AMPHETAMINE

Facility

$50.00

Service Code	CPT 80307
Hospital Charge Code	900911008
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.50

HC SOM DRUG SCRN MECONIUM AMPHETAMINE

Facility

$50.00

Service Code	CPT 80307
Hospital Charge Code	900911008
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$40.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cigna of CA HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.50

HC SOM DRUG SCRN MECONIUM AMPHETAMINE

Facility

$50.00

Service Code	CPT 80307 90
Hospital Charge Code	900911008
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.50

HC SOM EBV PCR QUANT

Facility

$50.27

Service Code	CPT 87798 90
Hospital Charge Code	900911395
Hospital Revenue Code	301
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$37.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.16
Rate for Payer: Aetna of CA Government/Medicare	$30.16
Rate for Payer: Cash Price	$22.62
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.70

HC SOM EBV PCR QUANT

Facility

$50.27

Service Code	CPT 87798
Hospital Charge Code	900911395
Hospital Revenue Code	301
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$37.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.16
Rate for Payer: Aetna of CA Government/Medicare	$30.16
Rate for Payer: Cash Price	$22.62
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.70

HC SOM EBV PCR QUANT

Facility

$50.27

Service Code	CPT 87798
Hospital Charge Code	900911395
Hospital Revenue Code	301
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$40.22
Rate for Payer: Cash Price	$22.62
Rate for Payer: Cigna of CA HMO/PPO	$40.22
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.70

HC SOM EBV PCR QUANT

Facility

$50.27

Service Code	CPT 87798 90
Hospital Charge Code	900911395
Hospital Revenue Code	301
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$40.22
Rate for Payer: Cash Price	$22.62
Rate for Payer: Cigna of CA HMO/PPO	$40.22
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.70

HC SOM ECHINOCOCCUS AB

Facility

$30.00

Service Code	CPT 86682
Hospital Charge Code	900911392
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 ECHINOCOCCUS AB

Facility

$30.00

Service Code	CPT 86682 90
Hospital Charge Code	900911392
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 ECHINOCOCCUS AB

Facility

$30.00

Service Code	CPT 86682 90
Hospital Charge Code	900911392
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 ECHINOCOCCUS AB

Facility

$30.00

Service Code	CPT 86682
Hospital Charge Code	900911392
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 EHRLICHOSIS

Facility

$35.00

Service Code	CPT 86666 90
Hospital Charge Code	900911388
Hospital Revenue Code	302
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 EHRLICHOSIS

Facility

$35.00

Service Code	CPT 86666
Hospital Charge Code	900911388
Hospital Revenue Code	302
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 EHRLICHOSIS

Facility

$35.00

Service Code	CPT 86666
Hospital Charge Code	900911388
Hospital Revenue Code	302
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 EHRLICHOSIS

Facility

$35.00

Service Code	CPT 86666 90
Hospital Charge Code	900911388
Hospital Revenue Code	302
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 ELECTROPHORES,PROTEN,RANDM

Facility

$20.05

Service Code	CPT 84166 90
Hospital Charge Code	900912891
Hospital Revenue Code	301
Min. Negotiated Rate	$11.03
Max. Negotiated Rate	$15.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.03
Rate for Payer: Aetna of CA Government/Medicare	$12.03
Rate for Payer: Cash Price	$9.02
Rate for Payer: Health Smart Auto/Commercial	$12.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.03
Rate for Payer: LLUH Dept of Risk Management WC	$11.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.04

HC SOM ELECTROPHORES,PROTEN,RANDM

Facility

$20.05

Service Code	CPT 84166
Hospital Charge Code	900912891
Hospital Revenue Code	301
Min. Negotiated Rate	$11.03
Max. Negotiated Rate	$15.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.03
Rate for Payer: Aetna of CA Government/Medicare	$12.03
Rate for Payer: Cash Price	$9.02
Rate for Payer: Health Smart Auto/Commercial	$12.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.03
Rate for Payer: LLUH Dept of Risk Management WC	$11.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.04

Know your out-of-pocket cost for care.

All Charges