Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM IMMUNOGLOBULINS,IGG SUBCLASS 2

Facility

$6.00

Service Code	CPT 82787
Hospital Charge Code	900911272
Hospital Revenue Code	301
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

HC SOM IMMUNOGLOBULINS,IGG SUBCLASS 2

Facility

$6.00

Service Code	CPT 82787
Hospital Charge Code	900911272
Hospital Revenue Code	301
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

HC SOM IMMUNOGLOBULINS,IGG SUBCLASS 2

Facility

$6.00

Service Code	CPT 82787 90
Hospital Charge Code	900911272
Hospital Revenue Code	301
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

HC SOM IMMUNOGLOBULINS,IGG SUBCLASS 2

Facility

$6.00

Service Code	CPT 82787 90
Hospital Charge Code	900911272
Hospital Revenue Code	301
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

HC SOM IMMUNOGLOBULINS IGG SUBCLASS 3

Facility

$7.24

Service Code	CPT 82787 90
Hospital Charge Code	900911273
Hospital Revenue Code	301
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$5.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.34
Rate for Payer: Aetna of CA Government/Medicare	$4.34
Rate for Payer: Cash Price	$3.26
Rate for Payer: Health Smart Auto/Commercial	$4.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.34
Rate for Payer: LLUH Dept of Risk Management WC	$3.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.43

HC SOM IMMUNOGLOBULINS IGG SUBCLASS 3

Facility

$7.24

Service Code	CPT 82787
Hospital Charge Code	900911273
Hospital Revenue Code	301
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$5.79
Rate for Payer: Cash Price	$3.26
Rate for Payer: Cigna of CA HMO/PPO	$5.79
Rate for Payer: Health Smart Auto/Commercial	$4.34
Rate for Payer: LLUH Dept of Risk Management WC	$3.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.43

HC SOM IMMUNOGLOBULINS IGG SUBCLASS 3

Facility

$7.24

Service Code	CPT 82787
Hospital Charge Code	900911273
Hospital Revenue Code	301
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$5.43
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.34
Rate for Payer: Aetna of CA Government/Medicare	$4.34
Rate for Payer: Cash Price	$3.26
Rate for Payer: Health Smart Auto/Commercial	$4.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.34
Rate for Payer: LLUH Dept of Risk Management WC	$3.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.43

HC SOM IMMUNOGLOBULINS IGG SUBCLASS 3

Facility

$7.24

Service Code	CPT 82787 90
Hospital Charge Code	900911273
Hospital Revenue Code	301
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$5.79
Rate for Payer: Cash Price	$3.26
Rate for Payer: Cigna of CA HMO/PPO	$5.79
Rate for Payer: Health Smart Auto/Commercial	$4.34
Rate for Payer: LLUH Dept of Risk Management WC	$3.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.43

HC SOM IMMUNOGLOBULINS IGG SUBCLASS 4

Facility

$7.25

Service Code	CPT 82787
Hospital Charge Code	900910440
Hospital Revenue Code	301
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$5.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.35
Rate for Payer: Aetna of CA Government/Medicare	$4.35
Rate for Payer: Cash Price	$3.26
Rate for Payer: Health Smart Auto/Commercial	$4.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.35
Rate for Payer: LLUH Dept of Risk Management WC	$3.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.44

HC SOM IMMUNOGLOBULINS IGG SUBCLASS 4

Facility

$7.25

Service Code	CPT 82787 90
Hospital Charge Code	900910440
Hospital Revenue Code	301
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$5.80
Rate for Payer: Cash Price	$3.26
Rate for Payer: Cigna of CA HMO/PPO	$5.80
Rate for Payer: Health Smart Auto/Commercial	$4.35
Rate for Payer: LLUH Dept of Risk Management WC	$3.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.44

HC SOM IMMUNOGLOBULINS IGG SUBCLASS 4

Facility

$7.25

Service Code	CPT 82787 90
Hospital Charge Code	900910440
Hospital Revenue Code	301
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$5.44
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.35
Rate for Payer: Aetna of CA Government/Medicare	$4.35
Rate for Payer: Cash Price	$3.26
Rate for Payer: Health Smart Auto/Commercial	$4.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.35
Rate for Payer: LLUH Dept of Risk Management WC	$3.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.44

HC SOM IMMUNOGLOBULINS IGG SUBCLASS 4

Facility

$7.25

Service Code	CPT 82787
Hospital Charge Code	900910440
Hospital Revenue Code	301
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$5.80
Rate for Payer: Cash Price	$3.26
Rate for Payer: Cigna of CA HMO/PPO	$5.80
Rate for Payer: Health Smart Auto/Commercial	$4.35
Rate for Payer: LLUH Dept of Risk Management WC	$3.99
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.44

HC SOM INFLUENZA A AB TITER (CF)

Facility

$14.75

Service Code	CPT 86710 90
Hospital Charge Code	900911771
Hospital Revenue Code	302
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$11.80
Rate for Payer: Cash Price	$6.64
Rate for Payer: Cigna of CA HMO/PPO	$11.80
Rate for Payer: Health Smart Auto/Commercial	$8.85
Rate for Payer: LLUH Dept of Risk Management WC	$8.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.06

HC SOM INFLUENZA A AB TITER (CF)

Facility

$14.75

Service Code	CPT 86710 90
Hospital Charge Code	900911771
Hospital Revenue Code	302
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$11.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.85
Rate for Payer: Aetna of CA Government/Medicare	$8.85
Rate for Payer: Cash Price	$6.64
Rate for Payer: Health Smart Auto/Commercial	$8.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.85
Rate for Payer: LLUH Dept of Risk Management WC	$8.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.06

HC SOM INFLUENZA A AB TITER (CF)

Facility

$14.75

Service Code	CPT 86710
Hospital Charge Code	900911771
Hospital Revenue Code	302
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$11.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.85
Rate for Payer: Aetna of CA Government/Medicare	$8.85
Rate for Payer: Cash Price	$6.64
Rate for Payer: Health Smart Auto/Commercial	$8.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.85
Rate for Payer: LLUH Dept of Risk Management WC	$8.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.06

HC SOM INFLUENZA A AB TITER (CF)

Facility

$14.75

Service Code	CPT 86710
Hospital Charge Code	900911771
Hospital Revenue Code	302
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$11.80
Rate for Payer: Cash Price	$6.64
Rate for Payer: Cigna of CA HMO/PPO	$11.80
Rate for Payer: Health Smart Auto/Commercial	$8.85
Rate for Payer: LLUH Dept of Risk Management WC	$8.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.06

HC SOM INFLUENZA B AB TITER (CF)

Facility

$7.50

Service Code	CPT 86710
Hospital Charge Code	900911772
Hospital Revenue Code	302
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$6.00
Rate for Payer: Cash Price	$3.38
Rate for Payer: Cigna of CA HMO/PPO	$6.00
Rate for Payer: Health Smart Auto/Commercial	$4.50
Rate for Payer: LLUH Dept of Risk Management WC	$4.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.62

HC SOM INFLUENZA B AB TITER (CF)

Facility

$7.50

Service Code	CPT 86710 90
Hospital Charge Code	900911772
Hospital Revenue Code	302
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.50
Rate for Payer: Aetna of CA Government/Medicare	$4.50
Rate for Payer: Cash Price	$3.38
Rate for Payer: Health Smart Auto/Commercial	$4.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.50
Rate for Payer: LLUH Dept of Risk Management WC	$4.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.62

HC SOM INFLUENZA B AB TITER (CF)

Facility

$7.50

Service Code	CPT 86710
Hospital Charge Code	900911772
Hospital Revenue Code	302
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.50
Rate for Payer: Aetna of CA Government/Medicare	$4.50
Rate for Payer: Cash Price	$3.38
Rate for Payer: Health Smart Auto/Commercial	$4.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.50
Rate for Payer: LLUH Dept of Risk Management WC	$4.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.62

HC SOM INFLUENZA B AB TITER (CF)

Facility

$7.50

Service Code	CPT 86710 90
Hospital Charge Code	900911772
Hospital Revenue Code	302
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$6.00
Rate for Payer: Cash Price	$3.38
Rate for Payer: Cigna of CA HMO/PPO	$6.00
Rate for Payer: Health Smart Auto/Commercial	$4.50
Rate for Payer: LLUH Dept of Risk Management WC	$4.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.62

HC SOM INHIBIN B

Facility

$50.00

Service Code	CPT 83520 90
Hospital Charge Code	900913934
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 INHIBIN B

Facility

$50.00

Service Code	CPT 83520
Hospital Charge Code	900913934
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 INHIBIN B

Facility

$50.00

Service Code	CPT 83520 90
Hospital Charge Code	900913934
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 INHIBIN B

Facility

$50.00

Service Code	CPT 83520
Hospital Charge Code	900913934
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 INSULIN ANTIBODIES QUANTITATIV

Facility

$32.21

Service Code	CPT 86337 90
Hospital Charge Code	900911061
Hospital Revenue Code	302
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$25.77
Rate for Payer: Cash Price	$14.49
Rate for Payer: Cigna of CA HMO/PPO	$25.77
Rate for Payer: Health Smart Auto/Commercial	$19.33
Rate for Payer: LLUH Dept of Risk Management WC	$17.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.16

Know your out-of-pocket cost for care.

All Charges