Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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	$6.82
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 HIV-1 PROVIRAL DNA

Facility

$50.27

Service Code	CPT 87535 90
Hospital Charge Code	900914170
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 HIV-1 PROVIRAL DNA

Facility

$50.27

Service Code	CPT 87535
Hospital Charge Code	900914170
Hospital Revenue Code	309
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 HIV-1 PROVIRAL DNA

Facility

$50.27

Service Code	CPT 87535
Hospital Charge Code	900914170
Hospital Revenue Code	309
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 HIV-1 PROVIRAL DNA

Facility

$50.27

Service Code	CPT 87535 90
Hospital Charge Code	900914170
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 HIV 2 CONFIRM

Facility

$57.80

Service Code	CPT 86702
Hospital Charge Code	900911352
Hospital Revenue Code	302
Min. Negotiated Rate	$31.79
Max. Negotiated Rate	$46.24
Rate for Payer: Cash Price	$26.01
Rate for Payer: Cigna of CA HMO/PPO	$46.24
Rate for Payer: Health Smart Auto/Commercial	$34.68
Rate for Payer: LLUH Dept of Risk Management WC	$31.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$43.35

HC SOM HIV 2 CONFIRM

Facility

$57.80

Service Code	CPT 86702 90
Hospital Charge Code	900911352
Hospital Revenue Code	302
Min. Negotiated Rate	$31.79
Max. Negotiated Rate	$46.24
Rate for Payer: Cash Price	$26.01
Rate for Payer: Cigna of CA HMO/PPO	$46.24
Rate for Payer: Health Smart Auto/Commercial	$34.68
Rate for Payer: LLUH Dept of Risk Management WC	$31.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$43.35

HC SOM HIV 2 CONFIRM

Facility

$65.00

Service Code	CPT 86702
Hospital Charge Code	900911352
Hospital Revenue Code	302
Min. Negotiated Rate	$35.75
Max. Negotiated Rate	$48.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$39.00
Rate for Payer: Aetna of CA Government/Medicare	$39.00
Rate for Payer: Cash Price	$29.25
Rate for Payer: Health Smart Auto/Commercial	$39.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$39.00
Rate for Payer: LLUH Dept of Risk Management WC	$35.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$48.75

HC SOM HIV DNA (PCR)

Facility

$85.00

Service Code	CPT 87536
Hospital Charge Code	900911055
Hospital Revenue Code	306
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$68.00
Rate for Payer: Cash Price	$38.25
Rate for Payer: Cigna of CA HMO/PPO	$68.00
Rate for Payer: Health Smart Auto/Commercial	$51.00
Rate for Payer: LLUH Dept of Risk Management WC	$46.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$63.75

HC SOM HIV DNA (PCR)

Facility

$85.00

Service Code	CPT 87536 90
Hospital Charge Code	900911055
Hospital Revenue Code	306
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$68.00
Rate for Payer: Cash Price	$38.25
Rate for Payer: Cigna of CA HMO/PPO	$68.00
Rate for Payer: Health Smart Auto/Commercial	$51.00
Rate for Payer: LLUH Dept of Risk Management WC	$46.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$63.75

HC SOM HIV DNA (PCR)

Facility

$85.00

Service Code	CPT 87536
Hospital Charge Code	900911055
Hospital Revenue Code	306
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$63.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$51.00
Rate for Payer: Aetna of CA Government/Medicare	$51.00
Rate for Payer: Cash Price	$38.25
Rate for Payer: Health Smart Auto/Commercial	$51.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$51.00
Rate for Payer: LLUH Dept of Risk Management WC	$46.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$63.75

HC SOM HIV DNA (PCR)

Facility

$85.00

Service Code	CPT 87536 90
Hospital Charge Code	900911055
Hospital Revenue Code	306
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$63.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$51.00
Rate for Payer: Aetna of CA Government/Medicare	$51.00
Rate for Payer: Cash Price	$38.25
Rate for Payer: Health Smart Auto/Commercial	$51.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$51.00
Rate for Payer: LLUH Dept of Risk Management WC	$46.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$63.75

HC SOM HOMOCYSTEINE

Facility

$17.92

Service Code	CPT 83090 90
Hospital Charge Code	900911404
Hospital Revenue Code	301
Min. Negotiated Rate	$9.86
Max. Negotiated Rate	$14.34
Rate for Payer: Cash Price	$8.06
Rate for Payer: Cigna of CA HMO/PPO	$14.34
Rate for Payer: Health Smart Auto/Commercial	$10.75
Rate for Payer: LLUH Dept of Risk Management WC	$9.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.44

HC SOM HOMOCYSTEINE

Facility

$17.92

Service Code	CPT 83090 90
Hospital Charge Code	900911404
Hospital Revenue Code	301
Min. Negotiated Rate	$9.86
Max. Negotiated Rate	$13.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.75
Rate for Payer: Aetna of CA Government/Medicare	$10.75
Rate for Payer: Cash Price	$8.06
Rate for Payer: Health Smart Auto/Commercial	$10.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.75
Rate for Payer: LLUH Dept of Risk Management WC	$9.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.44

HC SOM HOMOCYSTEINE

Facility

$17.92

Service Code	CPT 83090
Hospital Charge Code	900911404
Hospital Revenue Code	301
Min. Negotiated Rate	$9.86
Max. Negotiated Rate	$14.34
Rate for Payer: Cash Price	$8.06
Rate for Payer: Cigna of CA HMO/PPO	$14.34
Rate for Payer: Health Smart Auto/Commercial	$10.75
Rate for Payer: LLUH Dept of Risk Management WC	$9.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.44

HC SOM HOMOCYSTEINE

Facility

$17.92

Service Code	CPT 83090
Hospital Charge Code	900911404
Hospital Revenue Code	301
Min. Negotiated Rate	$9.86
Max. Negotiated Rate	$13.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.75
Rate for Payer: Aetna of CA Government/Medicare	$10.75
Rate for Payer: Cash Price	$8.06
Rate for Payer: Health Smart Auto/Commercial	$10.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.75
Rate for Payer: LLUH Dept of Risk Management WC	$9.86
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.44

HC SOM HPV

Facility

$45.00

Service Code	CPT 87624
Hospital Charge Code	900915272
Hospital Revenue Code	306
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.00
Rate for Payer: Aetna of CA Government/Medicare	$27.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC SOM HPV

Facility

$45.00

Service Code	CPT 87624 90
Hospital Charge Code	900915272
Hospital Revenue Code	306
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.00
Rate for Payer: Aetna of CA Government/Medicare	$27.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC SOM HPV

Facility

$45.00

Service Code	CPT 87624
Hospital Charge Code	900915272
Hospital Revenue Code	306
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$36.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Cigna of CA HMO/PPO	$36.00
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC SOM HPV

Facility

$45.00

Service Code	CPT 87624 90
Hospital Charge Code	900915272
Hospital Revenue Code	306
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$36.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Cigna of CA HMO/PPO	$36.00
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC SOM HROMOSOME ANALYSIS AMNIO

Facility

$400.00

Service Code	CPT 88291
Hospital Charge Code	900910739
Hospital Revenue Code	310
Min. Negotiated Rate	$220.00
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$240.00
Rate for Payer: Aetna of CA Government/Medicare	$240.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Health Smart Auto/Commercial	$240.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$240.00
Rate for Payer: LLUH Dept of Risk Management WC	$220.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$300.00

HC SOM HROMOSOME ANALYSIS AMNIO

Facility

$400.00

Service Code	CPT 88291 90
Hospital Charge Code	900910739
Hospital Revenue Code	310
Min. Negotiated Rate	$220.00
Max. Negotiated Rate	$320.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cigna of CA HMO/PPO	$320.00
Rate for Payer: Health Smart Auto/Commercial	$240.00
Rate for Payer: LLUH Dept of Risk Management WC	$220.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$300.00

HC SOM HROMOSOME ANALYSIS AMNIO

Facility

$400.00

Service Code	CPT 88291
Hospital Charge Code	900910739
Hospital Revenue Code	310
Min. Negotiated Rate	$220.00
Max. Negotiated Rate	$320.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cigna of CA HMO/PPO	$320.00
Rate for Payer: Health Smart Auto/Commercial	$240.00
Rate for Payer: LLUH Dept of Risk Management WC	$220.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$300.00

HC SOM HROMOSOME ANALYSIS AMNIO

Facility

$400.00

Service Code	CPT 88291 90
Hospital Charge Code	900910739
Hospital Revenue Code	310
Min. Negotiated Rate	$220.00
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$240.00
Rate for Payer: Aetna of CA Government/Medicare	$240.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Health Smart Auto/Commercial	$240.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$240.00
Rate for Payer: LLUH Dept of Risk Management WC	$220.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$300.00

HC SOM HSV TYPE 1 AB, IGG, S

Facility

$11.75

Service Code	CPT 86695
Hospital Charge Code	900914085
Hospital Revenue Code	302
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$8.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.05
Rate for Payer: Aetna of CA Government/Medicare	$7.05
Rate for Payer: Cash Price	$5.29
Rate for Payer: Health Smart Auto/Commercial	$7.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.05
Rate for Payer: LLUH Dept of Risk Management WC	$6.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.81

Know your out-of-pocket cost for care.

All Charges