Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM HANDLING FEE

Facility

$35.00

Service Code	CPT 99001 90
Hospital Charge Code	900913932
Hospital Revenue Code	300
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 HANDLING FEE

Facility

$39.00

Service Code	CPT 99001
Hospital Charge Code	900913932
Hospital Revenue Code	300
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.40
Rate for Payer: Aetna of CA Government/Medicare	$23.40
Rate for Payer: Cash Price	$17.55
Rate for Payer: Health Smart Auto/Commercial	$23.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.40
Rate for Payer: LLUH Dept of Risk Management WC	$21.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.25

HC SOM HANDLING FEE

Facility

$35.00

Service Code	CPT 99001
Hospital Charge Code	900913932
Hospital Revenue Code	300
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 HCG HIGH SENSITIVITY

Facility

$16.77

Service Code	CPT 84702 90
Hospital Charge Code	900914546
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$12.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.06
Rate for Payer: Aetna of CA Government/Medicare	$10.06
Rate for Payer: Cash Price	$7.55
Rate for Payer: Health Smart Auto/Commercial	$10.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.06
Rate for Payer: LLUH Dept of Risk Management WC	$9.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.58

HC SOM HCG HIGH SENSITIVITY

Facility

$16.77

Service Code	CPT 84702
Hospital Charge Code	900914546
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$13.42
Rate for Payer: Cash Price	$7.55
Rate for Payer: Cigna of CA HMO/PPO	$13.42
Rate for Payer: Health Smart Auto/Commercial	$10.06
Rate for Payer: LLUH Dept of Risk Management WC	$9.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.58

HC SOM HCG HIGH SENSITIVITY

Facility

$16.77

Service Code	CPT 84702
Hospital Charge Code	900914546
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$12.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.06
Rate for Payer: Aetna of CA Government/Medicare	$10.06
Rate for Payer: Cash Price	$7.55
Rate for Payer: Health Smart Auto/Commercial	$10.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.06
Rate for Payer: LLUH Dept of Risk Management WC	$9.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.58

HC SOM HCG HIGH SENSITIVITY

Facility

$16.77

Service Code	CPT 84702 90
Hospital Charge Code	900914546
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$13.42
Rate for Payer: Cash Price	$7.55
Rate for Payer: Cigna of CA HMO/PPO	$13.42
Rate for Payer: Health Smart Auto/Commercial	$10.06
Rate for Payer: LLUH Dept of Risk Management WC	$9.22
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.58

HC SOM HCV GENOTYPING

Facility

$125.55

Service Code	CPT 87902
Hospital Charge Code	900911374
Hospital Revenue Code	301
Min. Negotiated Rate	$69.05
Max. Negotiated Rate	$100.44
Rate for Payer: Cash Price	$56.50
Rate for Payer: Cigna of CA HMO/PPO	$100.44
Rate for Payer: Health Smart Auto/Commercial	$75.33
Rate for Payer: LLUH Dept of Risk Management WC	$69.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$94.16

HC SOM HCV GENOTYPING

Facility

$125.55

Service Code	CPT 87902 90
Hospital Charge Code	900911374
Hospital Revenue Code	301
Min. Negotiated Rate	$69.05
Max. Negotiated Rate	$100.44
Rate for Payer: Cash Price	$56.50
Rate for Payer: Cigna of CA HMO/PPO	$100.44
Rate for Payer: Health Smart Auto/Commercial	$75.33
Rate for Payer: LLUH Dept of Risk Management WC	$69.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$94.16

HC SOM HCV GENOTYPING

Facility

$125.55

Service Code	CPT 87902
Hospital Charge Code	900911374
Hospital Revenue Code	301
Min. Negotiated Rate	$69.05
Max. Negotiated Rate	$94.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$75.33
Rate for Payer: Aetna of CA Government/Medicare	$75.33
Rate for Payer: Cash Price	$56.50
Rate for Payer: Health Smart Auto/Commercial	$75.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$75.33
Rate for Payer: LLUH Dept of Risk Management WC	$69.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$94.16

HC SOM HCV GENOTYPING

Facility

$125.55

Service Code	CPT 87902 90
Hospital Charge Code	900911374
Hospital Revenue Code	301
Min. Negotiated Rate	$69.05
Max. Negotiated Rate	$94.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$75.33
Rate for Payer: Aetna of CA Government/Medicare	$75.33
Rate for Payer: Cash Price	$56.50
Rate for Payer: Health Smart Auto/Commercial	$75.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$75.33
Rate for Payer: LLUH Dept of Risk Management WC	$69.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$94.16

HC SOM HEMO A INV INTERP

Facility

$553.05

Service Code	CPT 81403 90
Hospital Charge Code	900914242
Hospital Revenue Code	301
Min. Negotiated Rate	$304.18
Max. Negotiated Rate	$442.44
Rate for Payer: Cash Price	$248.87
Rate for Payer: Cigna of CA HMO/PPO	$442.44
Rate for Payer: Health Smart Auto/Commercial	$331.83
Rate for Payer: LLUH Dept of Risk Management WC	$304.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$414.79

HC SOM HEMO A INV INTERP

Facility

$553.05

Service Code	CPT 81403 90
Hospital Charge Code	900914242
Hospital Revenue Code	301
Min. Negotiated Rate	$304.18
Max. Negotiated Rate	$414.79
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$331.83
Rate for Payer: Aetna of CA Government/Medicare	$331.83
Rate for Payer: Cash Price	$248.87
Rate for Payer: Health Smart Auto/Commercial	$331.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$331.83
Rate for Payer: LLUH Dept of Risk Management WC	$304.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$414.79

HC SOM HEMO A INV INTERP

Facility

$553.05

Service Code	CPT 81403
Hospital Charge Code	900914242
Hospital Revenue Code	309
Min. Negotiated Rate	$304.18
Max. Negotiated Rate	$414.79
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$331.83
Rate for Payer: Aetna of CA Government/Medicare	$331.83
Rate for Payer: Cash Price	$248.87
Rate for Payer: Health Smart Auto/Commercial	$331.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$331.83
Rate for Payer: LLUH Dept of Risk Management WC	$304.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$414.79

HC SOM HEMO A INV INTERP

Facility

$553.05

Service Code	CPT 81403
Hospital Charge Code	900914242
Hospital Revenue Code	309
Min. Negotiated Rate	$304.18
Max. Negotiated Rate	$442.44
Rate for Payer: Cash Price	$248.87
Rate for Payer: Cigna of CA HMO/PPO	$442.44
Rate for Payer: Health Smart Auto/Commercial	$331.83
Rate for Payer: LLUH Dept of Risk Management WC	$304.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$414.79

HC SOM HEMOCHROMATOSIS GENE PCR

Facility

$95.84

Service Code	CPT 81256
Hospital Charge Code	900910606
Hospital Revenue Code	301
Min. Negotiated Rate	$52.71
Max. Negotiated Rate	$76.67
Rate for Payer: Cash Price	$43.13
Rate for Payer: Cigna of CA HMO/PPO	$76.67
Rate for Payer: Health Smart Auto/Commercial	$57.50
Rate for Payer: LLUH Dept of Risk Management WC	$52.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$71.88

HC SOM HEMOCHROMATOSIS GENE PCR

Facility

$95.84

Service Code	CPT 81256
Hospital Charge Code	900910606
Hospital Revenue Code	301
Min. Negotiated Rate	$52.71
Max. Negotiated Rate	$71.88
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$57.50
Rate for Payer: Aetna of CA Government/Medicare	$57.50
Rate for Payer: Cash Price	$43.13
Rate for Payer: Health Smart Auto/Commercial	$57.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$57.50
Rate for Payer: LLUH Dept of Risk Management WC	$52.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$71.88

HC SOM HEMOCHROMATOSIS GENE PCR

Facility

$95.84

Service Code	CPT 81256 90
Hospital Charge Code	900910606
Hospital Revenue Code	301
Min. Negotiated Rate	$52.71
Max. Negotiated Rate	$76.67
Rate for Payer: Cash Price	$43.13
Rate for Payer: Cigna of CA HMO/PPO	$76.67
Rate for Payer: Health Smart Auto/Commercial	$57.50
Rate for Payer: LLUH Dept of Risk Management WC	$52.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$71.88

HC SOM HEMOCHROMATOSIS GENE PCR

Facility

$95.84

Service Code	CPT 81256 90
Hospital Charge Code	900910606
Hospital Revenue Code	301
Min. Negotiated Rate	$52.71
Max. Negotiated Rate	$71.88
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$57.50
Rate for Payer: Aetna of CA Government/Medicare	$57.50
Rate for Payer: Cash Price	$43.13
Rate for Payer: Health Smart Auto/Commercial	$57.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$57.50
Rate for Payer: LLUH Dept of Risk Management WC	$52.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$71.88

HC SOM HEMOGLOBIN QUAL URINE

Facility

$15.00

Service Code	CPT 81002 90
Hospital Charge Code	900912526
Hospital Revenue Code	307
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$12.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Cigna of CA HMO/PPO	$12.00
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC SOM HEMOGLOBIN QUAL URINE

Facility

$15.00

Service Code	CPT 81002
Hospital Charge Code	900912526
Hospital Revenue Code	307
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.00
Rate for Payer: Aetna of CA Government/Medicare	$9.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC SOM HEMOGLOBIN QUAL URINE

Facility

$15.00

Service Code	CPT 81002 90
Hospital Charge Code	900912526
Hospital Revenue Code	307
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.00
Rate for Payer: Aetna of CA Government/Medicare	$9.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC SOM HEMOGLOBIN QUAL URINE

Facility

$15.00

Service Code	CPT 81002
Hospital Charge Code	900912526
Hospital Revenue Code	307
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$12.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Cigna of CA HMO/PPO	$12.00
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC SOM HEMOSIDERIN, URINE

Facility

$125.67

Service Code	CPT 83070
Hospital Charge Code	900910748
Hospital Revenue Code	301
Min. Negotiated Rate	$69.12
Max. Negotiated Rate	$100.54
Rate for Payer: Cash Price	$56.55
Rate for Payer: Cigna of CA HMO/PPO	$100.54
Rate for Payer: Health Smart Auto/Commercial	$75.40
Rate for Payer: LLUH Dept of Risk Management WC	$69.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$94.25

HC SOM HEMOSIDERIN, URINE

Facility

$125.67

Service Code	CPT 83070 90
Hospital Charge Code	900910748
Hospital Revenue Code	301
Min. Negotiated Rate	$69.12
Max. Negotiated Rate	$94.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$75.40
Rate for Payer: Aetna of CA Government/Medicare	$75.40
Rate for Payer: Cash Price	$56.55
Rate for Payer: Health Smart Auto/Commercial	$75.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$75.40
Rate for Payer: LLUH Dept of Risk Management WC	$69.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$94.25

Know your out-of-pocket cost for care.

All Charges