Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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	$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
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

HC SOM HEPARIN-PF4 AB

Facility

$25.00

Service Code	CPT 86022 90
Hospital Charge Code	900912527
Hospital Revenue Code	305
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 HEPARIN-PF4 AB

Facility

$25.00

Service Code	CPT 86022
Hospital Charge Code	900912527
Hospital Revenue Code	305
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 HEPARIN-PF4 AB

Facility

$25.00

Service Code	CPT 86022
Hospital Charge Code	900912527
Hospital Revenue Code	305
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 HEPARIN-PF4 AB

Facility

$25.00

Service Code	CPT 86022 90
Hospital Charge Code	900912527
Hospital Revenue Code	305
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 HEPATITIS B DNA (QUANT)

Facility

$79.33

Service Code	CPT 87517 90
Hospital Charge Code	900911402
Hospital Revenue Code	306
Min. Negotiated Rate	$43.63
Max. Negotiated Rate	$59.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$47.60
Rate for Payer: Aetna of CA Government/Medicare	$47.60
Rate for Payer: Cash Price	$35.70
Rate for Payer: Health Smart Auto/Commercial	$47.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$47.60
Rate for Payer: LLUH Dept of Risk Management WC	$43.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$59.50

HC SOM HEPATITIS B DNA (QUANT)

Facility

$79.33

Service Code	CPT 87517
Hospital Charge Code	900911402
Hospital Revenue Code	306
Min. Negotiated Rate	$43.63
Max. Negotiated Rate	$59.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$47.60
Rate for Payer: Aetna of CA Government/Medicare	$47.60
Rate for Payer: Cash Price	$35.70
Rate for Payer: Health Smart Auto/Commercial	$47.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$47.60
Rate for Payer: LLUH Dept of Risk Management WC	$43.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$59.50

HC SOM HEPATITIS B DNA (QUANT)

Facility

$79.33

Service Code	CPT 87517
Hospital Charge Code	900911402
Hospital Revenue Code	306
Min. Negotiated Rate	$43.63
Max. Negotiated Rate	$63.46
Rate for Payer: Cash Price	$35.70
Rate for Payer: Cigna of CA HMO/PPO	$63.46
Rate for Payer: Health Smart Auto/Commercial	$47.60
Rate for Payer: LLUH Dept of Risk Management WC	$43.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$59.50

HC SOM HEPATITIS B DNA (QUANT)

Facility

$79.33

Service Code	CPT 87517 90
Hospital Charge Code	900911402
Hospital Revenue Code	306
Min. Negotiated Rate	$43.63
Max. Negotiated Rate	$63.46
Rate for Payer: Cash Price	$35.70
Rate for Payer: Cigna of CA HMO/PPO	$63.46
Rate for Payer: Health Smart Auto/Commercial	$47.60
Rate for Payer: LLUH Dept of Risk Management WC	$43.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$59.50

HC SOM HEPATITIS BE AB

Facility

$12.00

Service Code	CPT 86707
Hospital Charge Code	900911195
Hospital Revenue Code	302
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.20
Rate for Payer: Aetna of CA Government/Medicare	$7.20
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

HC SOM HEPATITIS BE AB

Facility

$12.00

Service Code	CPT 86707 90
Hospital Charge Code	900911195
Hospital Revenue Code	302
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.60
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cigna of CA HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

HC SOM HEPATITIS BE AB

Facility

$12.00

Service Code	CPT 86707 90
Hospital Charge Code	900911195
Hospital Revenue Code	302
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.20
Rate for Payer: Aetna of CA Government/Medicare	$7.20
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

HC SOM HEPATITIS BE AB

Facility

$12.00

Service Code	CPT 86707
Hospital Charge Code	900911195
Hospital Revenue Code	302
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.60
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cigna of CA HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

HC SOM HEPATITIS D ANTIBODY

Facility

$60.00

Service Code	CPT 86692
Hospital Charge Code	900910354
Hospital Revenue Code	302
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$36.00
Rate for Payer: Aetna of CA Government/Medicare	$36.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.00

HC SOM HEPATITIS D ANTIBODY

Facility

$60.00

Service Code	CPT 86692 90
Hospital Charge Code	900910354
Hospital Revenue Code	302
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$48.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna of CA HMO/PPO	$48.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.00

HC SOM HEPATITIS D ANTIBODY

Facility

$60.00

Service Code	CPT 86692 90
Hospital Charge Code	900910354
Hospital Revenue Code	302
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$36.00
Rate for Payer: Aetna of CA Government/Medicare	$36.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.00

HC SOM HEPATITIS D ANTIBODY

Facility

$60.00

Service Code	CPT 86692
Hospital Charge Code	900910354
Hospital Revenue Code	302
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$48.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna of CA HMO/PPO	$48.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.00

HC SOM HHEMO 81256

Facility

$70.98

Service Code	CPT 81256
Hospital Charge Code	900914875
Hospital Revenue Code	309
Min. Negotiated Rate	$39.04
Max. Negotiated Rate	$53.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$42.59
Rate for Payer: Aetna of CA Government/Medicare	$42.59
Rate for Payer: Cash Price	$31.94
Rate for Payer: Health Smart Auto/Commercial	$42.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$42.59
Rate for Payer: LLUH Dept of Risk Management WC	$39.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$53.24

HC SOM HHEMO 81256

Facility

$70.98

Service Code	CPT 81256
Hospital Charge Code	900914875
Hospital Revenue Code	309
Min. Negotiated Rate	$39.04
Max. Negotiated Rate	$56.78
Rate for Payer: Cash Price	$31.94
Rate for Payer: Cigna of CA HMO/PPO	$56.78
Rate for Payer: Health Smart Auto/Commercial	$42.59
Rate for Payer: LLUH Dept of Risk Management WC	$39.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$53.24

HC SOM HHEMO 81256

Facility

$70.98

Service Code	CPT 81256 90
Hospital Charge Code	900914875
Hospital Revenue Code	310
Min. Negotiated Rate	$39.04
Max. Negotiated Rate	$56.78
Rate for Payer: Cash Price	$31.94
Rate for Payer: Cigna of CA HMO/PPO	$56.78
Rate for Payer: Health Smart Auto/Commercial	$42.59
Rate for Payer: LLUH Dept of Risk Management WC	$39.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$53.24

HC SOM HHEMO 81256

Facility

$70.98

Service Code	CPT 81256 90
Hospital Charge Code	900914875
Hospital Revenue Code	310
Min. Negotiated Rate	$39.04
Max. Negotiated Rate	$53.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$42.59
Rate for Payer: Aetna of CA Government/Medicare	$42.59
Rate for Payer: Cash Price	$31.94
Rate for Payer: Health Smart Auto/Commercial	$42.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$42.59
Rate for Payer: LLUH Dept of Risk Management WC	$39.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$53.24

HC SOM HISTOPLASMA AB IMMUNODIFFUSION

Facility

$8.52

Service Code	CPT 86698
Hospital Charge Code	900912643
Hospital Revenue Code	302
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$6.82
Rate for Payer: Cash Price	$3.83
Rate for Payer: Cigna of CA HMO/PPO	$6.82
Rate for Payer: Health Smart Auto/Commercial	$5.11
Rate for Payer: LLUH Dept of Risk Management WC	$4.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.39

HC SOM HISTOPLASMA AB IMMUNODIFFUSION

Facility

$8.52

Service Code	CPT 86698 90
Hospital Charge Code	900912643
Hospital Revenue Code	302
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$6.39
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.11
Rate for Payer: Aetna of CA Government/Medicare	$5.11
Rate for Payer: Cash Price	$3.83
Rate for Payer: Health Smart Auto/Commercial	$5.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.11
Rate for Payer: LLUH Dept of Risk Management WC	$4.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.39

HC SOM HISTOPLASMA AB IMMUNODIFFUSION

Facility

$8.52

Service Code	CPT 86698
Hospital Charge Code	900912643
Hospital Revenue Code	302
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$6.39
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.11
Rate for Payer: Aetna of CA Government/Medicare	$5.11
Rate for Payer: Cash Price	$3.83
Rate for Payer: Health Smart Auto/Commercial	$5.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.11
Rate for Payer: LLUH Dept of Risk Management WC	$4.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.39

Know your out-of-pocket cost for care.

All Charges