Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM LD ACTIVITY TOTAL

Facility

$11.23

Service Code	CPT 83615
Hospital Charge Code	900912823
Hospital Revenue Code	301
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$8.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.74
Rate for Payer: Aetna of CA Government/Medicare	$6.74
Rate for Payer: Cash Price	$5.05
Rate for Payer: Health Smart Auto/Commercial	$6.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.74
Rate for Payer: LLUH Dept of Risk Management WC	$6.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42

HC SOM LD ISOENZYMES

Facility

$11.22

Service Code	CPT 83625 90
Hospital Charge Code	900910804
Hospital Revenue Code	301
Min. Negotiated Rate	$6.17
Max. Negotiated Rate	$8.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.73
Rate for Payer: Aetna of CA Government/Medicare	$6.73
Rate for Payer: Cash Price	$5.05
Rate for Payer: Health Smart Auto/Commercial	$6.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.73
Rate for Payer: LLUH Dept of Risk Management WC	$6.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42

HC SOM LD ISOENZYMES

Facility

$11.22

Service Code	CPT 83625 90
Hospital Charge Code	900910804
Hospital Revenue Code	301
Min. Negotiated Rate	$6.17
Max. Negotiated Rate	$8.98
Rate for Payer: Cash Price	$5.05
Rate for Payer: Cigna of CA HMO/PPO	$8.98
Rate for Payer: Health Smart Auto/Commercial	$6.73
Rate for Payer: LLUH Dept of Risk Management WC	$6.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42

HC SOM LD ISOENZYMES

Facility

$11.22

Service Code	CPT 83625
Hospital Charge Code	900910804
Hospital Revenue Code	301
Min. Negotiated Rate	$6.17
Max. Negotiated Rate	$8.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.73
Rate for Payer: Aetna of CA Government/Medicare	$6.73
Rate for Payer: Cash Price	$5.05
Rate for Payer: Health Smart Auto/Commercial	$6.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.73
Rate for Payer: LLUH Dept of Risk Management WC	$6.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42

HC SOM LD ISOENZYMES

Facility

$11.22

Service Code	CPT 83625
Hospital Charge Code	900910804
Hospital Revenue Code	301
Min. Negotiated Rate	$6.17
Max. Negotiated Rate	$8.98
Rate for Payer: Cash Price	$5.05
Rate for Payer: Cigna of CA HMO/PPO	$8.98
Rate for Payer: Health Smart Auto/Commercial	$6.73
Rate for Payer: LLUH Dept of Risk Management WC	$6.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.42

HC SOM LEAD BLOOD

Facility

$9.10

Service Code	CPT 83655 90
Hospital Charge Code	900911201
Hospital Revenue Code	301
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$6.82
Rate for Payer: Health Smart Auto/Commercial	$5.46
Rate for Payer: Cash Price	$4.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.46
Rate for Payer: Aetna of CA Government/Medicare	$5.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.46
Rate for Payer: LLUH Dept of Risk Management WC	$5.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.82

HC SOM LEAD BLOOD

Facility

$9.10

Service Code	CPT 83655
Hospital Charge Code	900911201
Hospital Revenue Code	301
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$6.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.46
Rate for Payer: Aetna of CA Government/Medicare	$5.46
Rate for Payer: Cash Price	$4.10
Rate for Payer: Health Smart Auto/Commercial	$5.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.46
Rate for Payer: LLUH Dept of Risk Management WC	$5.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.82

HC SOM LEAD BLOOD

Facility

$9.10

Service Code	CPT 83655
Hospital Charge Code	900911201
Hospital Revenue Code	301
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$7.28
Rate for Payer: Cash Price	$4.10
Rate for Payer: Cigna of CA HMO/PPO	$7.28
Rate for Payer: Health Smart Auto/Commercial	$5.46
Rate for Payer: LLUH Dept of Risk Management WC	$5.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.82

HC SOM LEAD BLOOD

Facility

$9.10

Service Code	CPT 83655 90
Hospital Charge Code	900911201
Hospital Revenue Code	301
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$7.28
Rate for Payer: Cash Price	$4.10
Rate for Payer: Cigna of CA HMO/PPO	$7.28
Rate for Payer: Health Smart Auto/Commercial	$5.46
Rate for Payer: LLUH Dept of Risk Management WC	$5.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.82

HC SOM LEAD URINE

Facility

$150.80

Service Code	CPT 83655
Hospital Charge Code	900911141
Hospital Revenue Code	301
Min. Negotiated Rate	$82.94
Max. Negotiated Rate	$120.64
Rate for Payer: Cash Price	$67.86
Rate for Payer: Cigna of CA HMO/PPO	$120.64
Rate for Payer: Health Smart Auto/Commercial	$90.48
Rate for Payer: LLUH Dept of Risk Management WC	$82.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$113.10

HC SOM LEAD URINE

Facility

$150.80

Service Code	CPT 83655 90
Hospital Charge Code	900911141
Hospital Revenue Code	301
Min. Negotiated Rate	$82.94
Max. Negotiated Rate	$113.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.48
Rate for Payer: Aetna of CA Government/Medicare	$90.48
Rate for Payer: Cash Price	$67.86
Rate for Payer: Health Smart Auto/Commercial	$90.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$90.48
Rate for Payer: LLUH Dept of Risk Management WC	$82.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$113.10

HC SOM LEAD URINE

Facility

$150.80

Service Code	CPT 83655 90
Hospital Charge Code	900911141
Hospital Revenue Code	301
Min. Negotiated Rate	$82.94
Max. Negotiated Rate	$120.64
Rate for Payer: Cash Price	$67.86
Rate for Payer: Cigna of CA HMO/PPO	$120.64
Rate for Payer: Health Smart Auto/Commercial	$90.48
Rate for Payer: LLUH Dept of Risk Management WC	$82.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$113.10

HC SOM LEAD URINE

Facility

$150.80

Service Code	CPT 83655
Hospital Charge Code	900911141
Hospital Revenue Code	301
Min. Negotiated Rate	$82.94
Max. Negotiated Rate	$113.10
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.48
Rate for Payer: Aetna of CA Government/Medicare	$90.48
Rate for Payer: Cash Price	$67.86
Rate for Payer: Health Smart Auto/Commercial	$90.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$90.48
Rate for Payer: LLUH Dept of Risk Management WC	$82.94
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$113.10

HC SOM LEFLUNOMIDE METABOLITE

Facility

$150.00

Service Code	CPT 80193 90
Hospital Charge Code	900913937
Hospital Revenue Code	301
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$120.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna of CA HMO/PPO	$120.00
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOM LEFLUNOMIDE METABOLITE

Facility

$150.00

Service Code	CPT 80193
Hospital Charge Code	900913937
Hospital Revenue Code	301
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.00
Rate for Payer: Aetna of CA Government/Medicare	$90.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOM LEFLUNOMIDE METABOLITE

Facility

$150.00

Service Code	CPT 80193
Hospital Charge Code	900913937
Hospital Revenue Code	301
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$120.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna of CA HMO/PPO	$120.00
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOM LEFLUNOMIDE METABOLITE

Facility

$150.00

Service Code	CPT 80193 90
Hospital Charge Code	900913937
Hospital Revenue Code	301
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.00
Rate for Payer: Aetna of CA Government/Medicare	$90.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOM LEGIONELLA AB

Facility

$14.90

Service Code	CPT 86713
Hospital Charge Code	900912567
Hospital Revenue Code	302
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$11.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.94
Rate for Payer: Aetna of CA Government/Medicare	$8.94
Rate for Payer: Cash Price	$6.71
Rate for Payer: Health Smart Auto/Commercial	$8.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.94
Rate for Payer: LLUH Dept of Risk Management WC	$8.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.18

HC SOM LEGIONELLA AB

Facility

$14.90

Service Code	CPT 86713 90
Hospital Charge Code	900912567
Hospital Revenue Code	302
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$11.92
Rate for Payer: Cash Price	$6.71
Rate for Payer: Cigna of CA HMO/PPO	$11.92
Rate for Payer: Health Smart Auto/Commercial	$8.94
Rate for Payer: LLUH Dept of Risk Management WC	$8.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.18

HC SOM LEGIONELLA AB

Facility

$14.90

Service Code	CPT 86713
Hospital Charge Code	900912567
Hospital Revenue Code	302
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$11.92
Rate for Payer: Cash Price	$6.71
Rate for Payer: Cigna of CA HMO/PPO	$11.92
Rate for Payer: Health Smart Auto/Commercial	$8.94
Rate for Payer: LLUH Dept of Risk Management WC	$8.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.18

HC SOM LEGIONELLA AB

Facility

$14.90

Service Code	CPT 86713 90
Hospital Charge Code	900912567
Hospital Revenue Code	302
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$11.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.94
Rate for Payer: Aetna of CA Government/Medicare	$8.94
Rate for Payer: Cash Price	$6.71
Rate for Payer: Health Smart Auto/Commercial	$8.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.94
Rate for Payer: LLUH Dept of Risk Management WC	$8.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.18

HC SOM LEGIONELLA AG URINE

Facility

$16.07

Service Code	CPT 87899 90
Hospital Charge Code	900911293
Hospital Revenue Code	301
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$12.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.64
Rate for Payer: Aetna of CA Government/Medicare	$9.64
Rate for Payer: Cash Price	$7.23
Rate for Payer: Health Smart Auto/Commercial	$9.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.64
Rate for Payer: LLUH Dept of Risk Management WC	$8.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.05

HC SOM LEGIONELLA AG URINE

Facility

$16.07

Service Code	CPT 87899 90
Hospital Charge Code	900911293
Hospital Revenue Code	301
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$12.86
Rate for Payer: Cash Price	$7.23
Rate for Payer: Cigna of CA HMO/PPO	$12.86
Rate for Payer: Health Smart Auto/Commercial	$9.64
Rate for Payer: LLUH Dept of Risk Management WC	$8.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.05

HC SOM LEGIONELLA AG URINE

Facility

$16.07

Service Code	CPT 87899
Hospital Charge Code	900911293
Hospital Revenue Code	301
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$12.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.64
Rate for Payer: Aetna of CA Government/Medicare	$9.64
Rate for Payer: Cash Price	$7.23
Rate for Payer: Health Smart Auto/Commercial	$9.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.64
Rate for Payer: LLUH Dept of Risk Management WC	$8.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.05

HC SOM LEGIONELLA AG URINE

Facility

$16.07

Service Code	CPT 87899
Hospital Charge Code	900911293
Hospital Revenue Code	301
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$12.86
Rate for Payer: Cash Price	$7.23
Rate for Payer: Cigna of CA HMO/PPO	$12.86
Rate for Payer: Health Smart Auto/Commercial	$9.64
Rate for Payer: LLUH Dept of Risk Management WC	$8.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.05

Know your out-of-pocket cost for care.

All Charges