Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM INSULIN ANTIBODIES QUANTITATIV

Facility

$32.21

Service Code	CPT 86337
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

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	$24.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.33
Rate for Payer: Aetna of CA Government/Medicare	$19.33
Rate for Payer: Cash Price	$14.49
Rate for Payer: Health Smart Auto/Commercial	$19.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.33
Rate for Payer: LLUH Dept of Risk Management WC	$17.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.16

HC SOM INSULIN ANTIBODIES QUANTITATIV

Facility

$32.21

Service Code	CPT 86337
Hospital Charge Code	900911061
Hospital Revenue Code	302
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$24.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.33
Rate for Payer: Aetna of CA Government/Medicare	$19.33
Rate for Payer: Cash Price	$14.49
Rate for Payer: Health Smart Auto/Commercial	$19.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.33
Rate for Payer: LLUH Dept of Risk Management WC	$17.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.16

HC SOM INSULIN-LIKE GROWTH FACTOR I

Facility

$20.20

Service Code	CPT 84305
Hospital Charge Code	900911132
Hospital Revenue Code	301
Min. Negotiated Rate	$11.11
Max. Negotiated Rate	$16.16
Rate for Payer: Cash Price	$9.09
Rate for Payer: Cigna of CA HMO/PPO	$16.16
Rate for Payer: Health Smart Auto/Commercial	$12.12
Rate for Payer: LLUH Dept of Risk Management WC	$11.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.15

HC SOM INSULIN-LIKE GROWTH FACTOR I

Facility

$20.20

Service Code	CPT 84305 90
Hospital Charge Code	900911132
Hospital Revenue Code	301
Min. Negotiated Rate	$11.11
Max. Negotiated Rate	$16.16
Rate for Payer: Cash Price	$9.09
Rate for Payer: Cigna of CA HMO/PPO	$16.16
Rate for Payer: Health Smart Auto/Commercial	$12.12
Rate for Payer: LLUH Dept of Risk Management WC	$11.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.15

HC SOM INSULIN-LIKE GROWTH FACTOR I

Facility

$20.20

Service Code	CPT 84305 90
Hospital Charge Code	900911132
Hospital Revenue Code	301
Min. Negotiated Rate	$11.11
Max. Negotiated Rate	$15.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.12
Rate for Payer: Aetna of CA Government/Medicare	$12.12
Rate for Payer: Cash Price	$9.09
Rate for Payer: Health Smart Auto/Commercial	$12.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.12
Rate for Payer: LLUH Dept of Risk Management WC	$11.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.15

HC SOM INSULIN-LIKE GROWTH FACTOR I

Facility

$20.20

Service Code	CPT 84305
Hospital Charge Code	900911132
Hospital Revenue Code	301
Min. Negotiated Rate	$11.11
Max. Negotiated Rate	$15.15
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.12
Rate for Payer: Aetna of CA Government/Medicare	$12.12
Rate for Payer: Cash Price	$9.09
Rate for Payer: Health Smart Auto/Commercial	$12.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.12
Rate for Payer: LLUH Dept of Risk Management WC	$11.11
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.15

HC SOM INTRINSIC FACTOR BLOCKING AB

Facility

$25.00

Service Code	CPT 86340
Hospital Charge Code	900911094
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 INTRINSIC FACTOR BLOCKING AB

Facility

$25.00

Service Code	CPT 86340 90
Hospital Charge Code	900911094
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 INTRINSIC FACTOR BLOCKING AB

Facility

$25.00

Service Code	CPT 86340
Hospital Charge Code	900911094
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 INTRINSIC FACTOR BLOCKING AB

Facility

$25.00

Service Code	CPT 86340 90
Hospital Charge Code	900911094
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 IRON LIVER TISSUE

Facility

$9.28

Service Code	CPT 83540
Hospital Charge Code	900914805
Hospital Revenue Code	301
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$7.42
Rate for Payer: Cash Price	$4.18
Rate for Payer: Cigna of CA HMO/PPO	$7.42
Rate for Payer: Health Smart Auto/Commercial	$5.57
Rate for Payer: LLUH Dept of Risk Management WC	$5.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.96

HC SOM IRON LIVER TISSUE

Facility

$9.28

Service Code	CPT 83540 90
Hospital Charge Code	900914805
Hospital Revenue Code	300
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$7.42
Rate for Payer: Health Smart Auto/Commercial	$5.57
Rate for Payer: Cash Price	$4.18
Rate for Payer: Cigna of CA HMO/PPO	$7.42
Rate for Payer: LLUH Dept of Risk Management WC	$5.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.96

HC SOM IRON LIVER TISSUE

Facility

$9.28

Service Code	CPT 83540 90
Hospital Charge Code	900914805
Hospital Revenue Code	300
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$6.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.57
Rate for Payer: Aetna of CA Government/Medicare	$5.57
Rate for Payer: Cash Price	$4.18
Rate for Payer: Health Smart Auto/Commercial	$5.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.57
Rate for Payer: LLUH Dept of Risk Management WC	$5.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.96

HC SOM IRON LIVER TISSUE

Facility

$9.28

Service Code	CPT 83540
Hospital Charge Code	900914805
Hospital Revenue Code	301
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$6.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.57
Rate for Payer: Aetna of CA Government/Medicare	$5.57
Rate for Payer: Cash Price	$4.18
Rate for Payer: Health Smart Auto/Commercial	$5.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.57
Rate for Payer: LLUH Dept of Risk Management WC	$5.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.96

HC SOM ITRACONAZOLE LEVEL

Facility

$40.00

Service Code	CPT 80189 90
Hospital Charge Code	900911379
Hospital Revenue Code	301
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$32.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cigna of CA HMO/PPO	$32.00
Rate for Payer: Health Smart Auto/Commercial	$24.00
Rate for Payer: LLUH Dept of Risk Management WC	$22.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.00

HC SOM ITRACONAZOLE LEVEL

Facility

$40.00

Service Code	CPT 80189 90
Hospital Charge Code	900911379
Hospital Revenue Code	301
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.00
Rate for Payer: Aetna of CA Government/Medicare	$24.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Smart Auto/Commercial	$24.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.00
Rate for Payer: LLUH Dept of Risk Management WC	$22.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.00

HC SOM ITRACONAZOLE LEVEL

Facility

$40.00

Service Code	CPT 80189
Hospital Charge Code	900911379
Hospital Revenue Code	301
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.00
Rate for Payer: Aetna of CA Government/Medicare	$24.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Smart Auto/Commercial	$24.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.00
Rate for Payer: LLUH Dept of Risk Management WC	$22.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.00

HC SOM ITRACONAZOLE LEVEL

Facility

$40.00

Service Code	CPT 80189
Hospital Charge Code	900911379
Hospital Revenue Code	301
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$32.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cigna of CA HMO/PPO	$32.00
Rate for Payer: Health Smart Auto/Commercial	$24.00
Rate for Payer: LLUH Dept of Risk Management WC	$22.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.00

HC SOM JAK 2 V617F MUTATION

Facility

$101.66

Service Code	CPT 81270
Hospital Charge Code	900912994
Hospital Revenue Code	309
Min. Negotiated Rate	$55.91
Max. Negotiated Rate	$76.24
Rate for Payer: Health Smart Auto/Commercial	$61.00
Rate for Payer: Cash Price	$45.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$61.00
Rate for Payer: Aetna of CA Government/Medicare	$61.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$61.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.91
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$76.24

HC SOM JAK 2 V617F MUTATION

Facility

$101.66

Service Code	CPT 81270
Hospital Charge Code	900912994
Hospital Revenue Code	309
Min. Negotiated Rate	$55.91
Max. Negotiated Rate	$81.33
Rate for Payer: Cash Price	$45.75
Rate for Payer: Cigna of CA HMO/PPO	$81.33
Rate for Payer: Health Smart Auto/Commercial	$61.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.91
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$76.24

HC SOM JAK 2 V617F MUTATION

Facility

$101.66

Service Code	CPT 81270 90
Hospital Charge Code	900912994
Hospital Revenue Code	300
Min. Negotiated Rate	$55.91
Max. Negotiated Rate	$76.24
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$61.00
Rate for Payer: Aetna of CA Government/Medicare	$61.00
Rate for Payer: Cash Price	$45.75
Rate for Payer: Health Smart Auto/Commercial	$61.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$61.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.91
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$76.24

HC SOM JAK 2 V617F MUTATION

Facility

$101.66

Service Code	CPT 81270 90
Hospital Charge Code	900912994
Hospital Revenue Code	300
Min. Negotiated Rate	$55.91
Max. Negotiated Rate	$81.33
Rate for Payer: Cash Price	$45.75
Rate for Payer: Cigna of CA HMO/PPO	$81.33
Rate for Payer: Health Smart Auto/Commercial	$61.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.91
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$76.24

HC SOM JC VIRUS BY PCR

Facility

$65.00

Service Code	CPT 87798 90
Hospital Charge Code	900912607
Hospital Revenue Code	306
Min. Negotiated Rate	$35.75
Max. Negotiated Rate	$52.00
Rate for Payer: Cash Price	$29.25
Rate for Payer: Cigna of CA HMO/PPO	$52.00
Rate for Payer: Health Smart Auto/Commercial	$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 JC VIRUS BY PCR

Facility

$65.00

Service Code	CPT 87798 90
Hospital Charge Code	900912607
Hospital Revenue Code	306
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

Know your out-of-pocket cost for care.

All Charges