Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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	$16.04
Rate for Payer: Cash Price	$9.02
Rate for Payer: Cigna of CA HMO/PPO	$16.04
Rate for Payer: Health Smart Auto/Commercial	$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 90
Hospital Charge Code	900912891
Hospital Revenue Code	301
Min. Negotiated Rate	$11.03
Max. Negotiated Rate	$16.04
Rate for Payer: Cash Price	$9.02
Rate for Payer: Cigna of CA HMO/PPO	$16.04
Rate for Payer: Health Smart Auto/Commercial	$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 ENDOMYSIAL IGA AB

Facility

$25.00

Service Code	CPT 86231
Hospital Charge Code	900911423
Hospital Revenue Code	302
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 ENDOMYSIAL IGA AB

Facility

$25.00

Service Code	CPT 86231
Hospital Charge Code	900911423
Hospital Revenue Code	302
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 ENDOMYSIAL IGA AB

Facility

$25.00

Service Code	CPT 86231 90
Hospital Charge Code	900911423
Hospital Revenue Code	302
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 ENDOMYSIAL IGA AB

Facility

$25.00

Service Code	CPT 86231 90
Hospital Charge Code	900911423
Hospital Revenue Code	302
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 ENTEROVIRUS PCR, BLOOD

Facility

$39.23

Service Code	CPT 87498
Hospital Charge Code	900910691
Hospital Revenue Code	306
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$29.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.54
Rate for Payer: Aetna of CA Government/Medicare	$23.54
Rate for Payer: Cash Price	$17.65
Rate for Payer: Health Smart Auto/Commercial	$23.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.54
Rate for Payer: LLUH Dept of Risk Management WC	$21.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.42

HC SOM ENTEROVIRUS PCR, BLOOD

Facility

$39.23

Service Code	CPT 87498
Hospital Charge Code	900910691
Hospital Revenue Code	306
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$31.38
Rate for Payer: Cash Price	$17.65
Rate for Payer: Cigna of CA HMO/PPO	$31.38
Rate for Payer: Health Smart Auto/Commercial	$23.54
Rate for Payer: LLUH Dept of Risk Management WC	$21.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.42

HC SOM ENTEROVIRUS PCR, BLOOD

Facility

$39.23

Service Code	CPT 87498 90
Hospital Charge Code	900910691
Hospital Revenue Code	306
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$31.38
Rate for Payer: Cash Price	$17.65
Rate for Payer: Cigna of CA HMO/PPO	$31.38
Rate for Payer: Health Smart Auto/Commercial	$23.54
Rate for Payer: LLUH Dept of Risk Management WC	$21.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.42

HC SOM ENTEROVIRUS PCR, BLOOD

Facility

$39.23

Service Code	CPT 87498 90
Hospital Charge Code	900910691
Hospital Revenue Code	306
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$29.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.54
Rate for Payer: Aetna of CA Government/Medicare	$23.54
Rate for Payer: Cash Price	$17.65
Rate for Payer: Health Smart Auto/Commercial	$23.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.54
Rate for Payer: LLUH Dept of Risk Management WC	$21.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.42

HC SOM ENTEROVIRUS PCR CSF

Facility

$39.23

Service Code	CPT 87498
Hospital Charge Code	900910771
Hospital Revenue Code	301
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$31.38
Rate for Payer: Cash Price	$17.65
Rate for Payer: Cigna of CA HMO/PPO	$31.38
Rate for Payer: Health Smart Auto/Commercial	$23.54
Rate for Payer: LLUH Dept of Risk Management WC	$21.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.42

HC SOM ENTEROVIRUS PCR CSF

Facility

$39.23

Service Code	CPT 87498
Hospital Charge Code	900910771
Hospital Revenue Code	301
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$29.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.54
Rate for Payer: Aetna of CA Government/Medicare	$23.54
Rate for Payer: Cash Price	$17.65
Rate for Payer: Health Smart Auto/Commercial	$23.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.54
Rate for Payer: LLUH Dept of Risk Management WC	$21.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.42

HC SOM ENTEROVIRUS PCR CSF

Facility

$39.23

Service Code	CPT 87498 90
Hospital Charge Code	900910771
Hospital Revenue Code	301
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$29.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.54
Rate for Payer: Aetna of CA Government/Medicare	$23.54
Rate for Payer: Cash Price	$17.65
Rate for Payer: Health Smart Auto/Commercial	$23.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.54
Rate for Payer: LLUH Dept of Risk Management WC	$21.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.42

HC SOM ENTEROVIRUS PCR CSF

Facility

$39.23

Service Code	CPT 87498 90
Hospital Charge Code	900910771
Hospital Revenue Code	301
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$31.38
Rate for Payer: Cash Price	$17.65
Rate for Payer: Cigna of CA HMO/PPO	$31.38
Rate for Payer: Health Smart Auto/Commercial	$23.54
Rate for Payer: LLUH Dept of Risk Management WC	$21.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.42

HC SOM ERYTHROPOIETIN

Facility

$15.68

Service Code	CPT 82668 90
Hospital Charge Code	900911227
Hospital Revenue Code	301
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$12.54
Rate for Payer: Cash Price	$7.06
Rate for Payer: Cigna of CA HMO/PPO	$12.54
Rate for Payer: Health Smart Auto/Commercial	$9.41
Rate for Payer: LLUH Dept of Risk Management WC	$8.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.76

HC SOM ERYTHROPOIETIN

Facility

$15.68

Service Code	CPT 82668
Hospital Charge Code	900911227
Hospital Revenue Code	301
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$11.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.41
Rate for Payer: Aetna of CA Government/Medicare	$9.41
Rate for Payer: Cash Price	$7.06
Rate for Payer: Health Smart Auto/Commercial	$9.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.41
Rate for Payer: LLUH Dept of Risk Management WC	$8.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.76

HC SOM ERYTHROPOIETIN

Facility

$15.68

Service Code	CPT 82668
Hospital Charge Code	900911227
Hospital Revenue Code	301
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$12.54
Rate for Payer: Cash Price	$7.06
Rate for Payer: Cigna of CA HMO/PPO	$12.54
Rate for Payer: Health Smart Auto/Commercial	$9.41
Rate for Payer: LLUH Dept of Risk Management WC	$8.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.76

HC SOM ERYTHROPOIETIN

Facility

$15.68

Service Code	CPT 82668 90
Hospital Charge Code	900911227
Hospital Revenue Code	301
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$11.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.41
Rate for Payer: Aetna of CA Government/Medicare	$9.41
Rate for Payer: Cash Price	$7.06
Rate for Payer: Health Smart Auto/Commercial	$9.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.41
Rate for Payer: LLUH Dept of Risk Management WC	$8.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.76

HC SOM ESTRADIOL

Facility

$23.80

Service Code	CPT 82671
Hospital Charge Code	900911014
Hospital Revenue Code	301
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$17.85
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.28
Rate for Payer: Aetna of CA Government/Medicare	$14.28
Rate for Payer: Cash Price	$10.71
Rate for Payer: Health Smart Auto/Commercial	$14.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.28
Rate for Payer: LLUH Dept of Risk Management WC	$13.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.85

HC SOM ESTRADIOL

Facility

$23.80

Service Code	CPT 82671 90
Hospital Charge Code	900911014
Hospital Revenue Code	301
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$17.85
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.28
Rate for Payer: Aetna of CA Government/Medicare	$14.28
Rate for Payer: Cash Price	$10.71
Rate for Payer: Health Smart Auto/Commercial	$14.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.28
Rate for Payer: LLUH Dept of Risk Management WC	$13.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.85

HC SOM ESTRADIOL

Facility

$23.80

Service Code	CPT 82671
Hospital Charge Code	900911014
Hospital Revenue Code	301
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$19.04
Rate for Payer: Cash Price	$10.71
Rate for Payer: Cigna of CA HMO/PPO	$19.04
Rate for Payer: Health Smart Auto/Commercial	$14.28
Rate for Payer: LLUH Dept of Risk Management WC	$13.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.85

HC SOM ESTRADIOL

Facility

$23.80

Service Code	CPT 82671 90
Hospital Charge Code	900911014
Hospital Revenue Code	301
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$19.04
Rate for Payer: Cash Price	$10.71
Rate for Payer: Cigna of CA HMO/PPO	$19.04
Rate for Payer: Health Smart Auto/Commercial	$14.28
Rate for Payer: LLUH Dept of Risk Management WC	$13.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.85

HC SOM ESTRIOL

Facility

$202.56

Service Code	CPT 82677 90
Hospital Charge Code	900911036
Hospital Revenue Code	301
Min. Negotiated Rate	$111.41
Max. Negotiated Rate	$162.05
Rate for Payer: Cash Price	$91.15
Rate for Payer: Cigna of CA HMO/PPO	$162.05
Rate for Payer: Health Smart Auto/Commercial	$121.54
Rate for Payer: LLUH Dept of Risk Management WC	$111.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$151.92

HC SOM ESTRIOL

Facility

$202.56

Service Code	CPT 82677
Hospital Charge Code	900911036
Hospital Revenue Code	301
Min. Negotiated Rate	$111.41
Max. Negotiated Rate	$151.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$121.54
Rate for Payer: Aetna of CA Government/Medicare	$121.54
Rate for Payer: Cash Price	$91.15
Rate for Payer: Health Smart Auto/Commercial	$121.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$121.54
Rate for Payer: LLUH Dept of Risk Management WC	$111.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$151.92

HC SOM ESTRIOL

Facility

$202.56

Service Code	CPT 82677 90
Hospital Charge Code	900911036
Hospital Revenue Code	301
Min. Negotiated Rate	$111.41
Max. Negotiated Rate	$151.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$121.54
Rate for Payer: Aetna of CA Government/Medicare	$121.54
Rate for Payer: Cash Price	$91.15
Rate for Payer: Health Smart Auto/Commercial	$121.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$121.54
Rate for Payer: LLUH Dept of Risk Management WC	$111.41
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$151.92

Know your out-of-pocket cost for care.

All Charges