Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM NORDOXEPIN LEVEL

Facility

$35.00

Service Code	CPT 80335
Hospital Charge Code	900912562
Hospital Revenue Code	301
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$28.00
Rate for Payer: Cash Price	$15.75
Rate for Payer: Cigna of CA HMO/PPO	$28.00
Rate for Payer: Health Smart Auto/Commercial	$21.00
Rate for Payer: LLUH Dept of Risk Management WC	$19.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$26.25

HC SOM NORDOXEPIN LEVEL

Facility

$35.00

Service Code	CPT 80335 90
Hospital Charge Code	900912562
Hospital Revenue Code	301
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$28.00
Rate for Payer: Cash Price	$15.75
Rate for Payer: Cigna of CA HMO/PPO	$28.00
Rate for Payer: Health Smart Auto/Commercial	$21.00
Rate for Payer: LLUH Dept of Risk Management WC	$19.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$26.25

HC SOM NOROVIRUS AG

Facility

$126.00

Service Code	CPT 87449
Hospital Charge Code	900914127
Hospital Revenue Code	306
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$94.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$75.60
Rate for Payer: Aetna of CA Government/Medicare	$75.60
Rate for Payer: Cash Price	$56.70
Rate for Payer: Health Smart Auto/Commercial	$75.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$75.60
Rate for Payer: LLUH Dept of Risk Management WC	$69.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$94.50

HC SOM NOROVIRUS AG

Facility

$126.00

Service Code	CPT 87449 90
Hospital Charge Code	900914127
Hospital Revenue Code	306
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$94.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$75.60
Rate for Payer: Aetna of CA Government/Medicare	$75.60
Rate for Payer: Cash Price	$56.70
Rate for Payer: Health Smart Auto/Commercial	$75.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$75.60
Rate for Payer: LLUH Dept of Risk Management WC	$69.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$94.50

HC SOM NOROVIRUS AG

Facility

$126.00

Service Code	CPT 87449
Hospital Charge Code	900914127
Hospital Revenue Code	306
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$100.80
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cigna of CA HMO/PPO	$100.80
Rate for Payer: Health Smart Auto/Commercial	$75.60
Rate for Payer: LLUH Dept of Risk Management WC	$69.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$94.50

HC SOM NOROVIRUS AG

Facility

$126.00

Service Code	CPT 87449 90
Hospital Charge Code	900914127
Hospital Revenue Code	306
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$100.80
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cigna of CA HMO/PPO	$100.80
Rate for Payer: Health Smart Auto/Commercial	$75.60
Rate for Payer: LLUH Dept of Risk Management WC	$69.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$94.50

HC SOM NOROVIRUS RNA

Facility

$245.52

Service Code	CPT 87798 90
Hospital Charge Code	900913809
Hospital Revenue Code	300
Min. Negotiated Rate	$135.04
Max. Negotiated Rate	$196.42
Rate for Payer: Cash Price	$110.48
Rate for Payer: Cigna of CA HMO/PPO	$196.42
Rate for Payer: Health Smart Auto/Commercial	$147.31
Rate for Payer: LLUH Dept of Risk Management WC	$135.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$184.14

HC SOM NOROVIRUS RNA

Facility

$245.52

Service Code	CPT 87798
Hospital Charge Code	900913809
Hospital Revenue Code	309
Min. Negotiated Rate	$135.04
Max. Negotiated Rate	$184.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$147.31
Rate for Payer: Aetna of CA Government/Medicare	$147.31
Rate for Payer: Cash Price	$110.48
Rate for Payer: Health Smart Auto/Commercial	$147.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$147.31
Rate for Payer: LLUH Dept of Risk Management WC	$135.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$184.14

HC SOM NOROVIRUS RNA

Facility

$245.52

Service Code	CPT 87798
Hospital Charge Code	900913809
Hospital Revenue Code	309
Min. Negotiated Rate	$135.04
Max. Negotiated Rate	$196.42
Rate for Payer: Cash Price	$110.48
Rate for Payer: Cigna of CA HMO/PPO	$196.42
Rate for Payer: Health Smart Auto/Commercial	$147.31
Rate for Payer: LLUH Dept of Risk Management WC	$135.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$184.14

HC SOM NOROVIRUS RNA

Facility

$245.52

Service Code	CPT 87798 90
Hospital Charge Code	900913809
Hospital Revenue Code	300
Min. Negotiated Rate	$135.04
Max. Negotiated Rate	$184.14
Rate for Payer: Health Smart Auto/Commercial	$147.31
Rate for Payer: Cash Price	$110.48
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$147.31
Rate for Payer: Aetna of CA Government/Medicare	$147.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$147.31
Rate for Payer: LLUH Dept of Risk Management WC	$135.04
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$184.14

HC SOM N-TELOPEPTIDE, CROSS LINKED

Facility

$90.00

Service Code	CPT 82523 90
Hospital Charge Code	900912632
Hospital Revenue Code	301
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$54.00
Rate for Payer: Aetna of CA Government/Medicare	$54.00
Rate for Payer: Cash Price	$40.50
Rate for Payer: Health Smart Auto/Commercial	$54.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$54.00
Rate for Payer: LLUH Dept of Risk Management WC	$49.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$67.50

HC SOM N-TELOPEPTIDE, CROSS LINKED

Facility

$90.00

Service Code	CPT 82523
Hospital Charge Code	900912632
Hospital Revenue Code	301
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$54.00
Rate for Payer: Aetna of CA Government/Medicare	$54.00
Rate for Payer: Cash Price	$40.50
Rate for Payer: Health Smart Auto/Commercial	$54.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$54.00
Rate for Payer: LLUH Dept of Risk Management WC	$49.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$67.50

HC SOM N-TELOPEPTIDE, CROSS LINKED

Facility

$90.00

Service Code	CPT 82523 90
Hospital Charge Code	900912632
Hospital Revenue Code	301
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$72.00
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cigna of CA HMO/PPO	$72.00
Rate for Payer: Health Smart Auto/Commercial	$54.00
Rate for Payer: LLUH Dept of Risk Management WC	$49.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$67.50

HC SOM N-TELOPEPTIDE, CROSS LINKED

Facility

$90.00

Service Code	CPT 82523
Hospital Charge Code	900912632
Hospital Revenue Code	301
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$72.00
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cigna of CA HMO/PPO	$72.00
Rate for Payer: Health Smart Auto/Commercial	$54.00
Rate for Payer: LLUH Dept of Risk Management WC	$49.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$67.50

HC SOM N-TELOPEPTIDE URINE

Facility

$19.23

Service Code	CPT 82523 90
Hospital Charge Code	900911412
Hospital Revenue Code	301
Min. Negotiated Rate	$10.58
Max. Negotiated Rate	$15.38
Rate for Payer: Cash Price	$8.65
Rate for Payer: Cigna of CA HMO/PPO	$15.38
Rate for Payer: Health Smart Auto/Commercial	$11.54
Rate for Payer: LLUH Dept of Risk Management WC	$10.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.42

HC SOM N-TELOPEPTIDE URINE

Facility

$19.23

Service Code	CPT 82523 90
Hospital Charge Code	900911412
Hospital Revenue Code	301
Min. Negotiated Rate	$10.58
Max. Negotiated Rate	$14.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.54
Rate for Payer: Aetna of CA Government/Medicare	$11.54
Rate for Payer: Cash Price	$8.65
Rate for Payer: Health Smart Auto/Commercial	$11.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.54
Rate for Payer: LLUH Dept of Risk Management WC	$10.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.42

HC SOM N-TELOPEPTIDE URINE

Facility

$19.23

Service Code	CPT 82523
Hospital Charge Code	900911412
Hospital Revenue Code	301
Min. Negotiated Rate	$10.58
Max. Negotiated Rate	$14.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.54
Rate for Payer: Aetna of CA Government/Medicare	$11.54
Rate for Payer: Cash Price	$8.65
Rate for Payer: Health Smart Auto/Commercial	$11.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.54
Rate for Payer: LLUH Dept of Risk Management WC	$10.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.42

HC SOM N-TELOPEPTIDE URINE

Facility

$19.23

Service Code	CPT 82523
Hospital Charge Code	900911412
Hospital Revenue Code	301
Min. Negotiated Rate	$10.58
Max. Negotiated Rate	$15.38
Rate for Payer: Cash Price	$8.65
Rate for Payer: Cigna of CA HMO/PPO	$15.38
Rate for Payer: Health Smart Auto/Commercial	$11.54
Rate for Payer: LLUH Dept of Risk Management WC	$10.58
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.42

HC SOM NUCLEOPHOSMIN MUTAT ANAL

Facility

$350.00

Service Code	CPT 81310
Hospital Charge Code	900914001
Hospital Revenue Code	309
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$280.00
Rate for Payer: Cash Price	$157.50
Rate for Payer: Cigna of CA HMO/PPO	$280.00
Rate for Payer: Health Smart Auto/Commercial	$210.00
Rate for Payer: LLUH Dept of Risk Management WC	$192.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$262.50

HC SOM NUCLEOPHOSMIN MUTAT ANAL

Facility

$350.00

Service Code	CPT 81310 90
Hospital Charge Code	900914001
Hospital Revenue Code	301
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$280.00
Rate for Payer: Cash Price	$157.50
Rate for Payer: Cigna of CA HMO/PPO	$280.00
Rate for Payer: Health Smart Auto/Commercial	$210.00
Rate for Payer: LLUH Dept of Risk Management WC	$192.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$262.50

HC SOM NUCLEOPHOSMIN MUTAT ANAL

Facility

$350.00

Service Code	CPT 81310
Hospital Charge Code	900914001
Hospital Revenue Code	309
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$210.00
Rate for Payer: Aetna of CA Government/Medicare	$210.00
Rate for Payer: Cash Price	$157.50
Rate for Payer: Health Smart Auto/Commercial	$210.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$210.00
Rate for Payer: LLUH Dept of Risk Management WC	$192.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$262.50

HC SOM NUCLEOPHOSMIN MUTAT ANAL

Facility

$350.00

Service Code	CPT 81310 90
Hospital Charge Code	900914001
Hospital Revenue Code	301
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$210.00
Rate for Payer: Aetna of CA Government/Medicare	$210.00
Rate for Payer: Cash Price	$157.50
Rate for Payer: Health Smart Auto/Commercial	$210.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$210.00
Rate for Payer: LLUH Dept of Risk Management WC	$192.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$262.50

HC SOM OLANZAPINE

Facility

$93.80

Service Code	CPT 80299 90
Hospital Charge Code	900910772
Hospital Revenue Code	301
Min. Negotiated Rate	$51.59
Max. Negotiated Rate	$70.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$56.28
Rate for Payer: Aetna of CA Government/Medicare	$56.28
Rate for Payer: Cash Price	$42.21
Rate for Payer: Health Smart Auto/Commercial	$56.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$56.28
Rate for Payer: LLUH Dept of Risk Management WC	$51.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$70.35

HC SOM OLANZAPINE

Facility

$93.80

Service Code	CPT 80299 90
Hospital Charge Code	900910772
Hospital Revenue Code	301
Min. Negotiated Rate	$51.59
Max. Negotiated Rate	$75.04
Rate for Payer: Cash Price	$42.21
Rate for Payer: Cigna of CA HMO/PPO	$75.04
Rate for Payer: Health Smart Auto/Commercial	$56.28
Rate for Payer: LLUH Dept of Risk Management WC	$51.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$70.35

HC SOM OLANZAPINE

Facility

$93.80

Service Code	CPT 80299
Hospital Charge Code	900910772
Hospital Revenue Code	301
Min. Negotiated Rate	$51.59
Max. Negotiated Rate	$70.35
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$56.28
Rate for Payer: Aetna of CA Government/Medicare	$56.28
Rate for Payer: Cash Price	$42.21
Rate for Payer: Health Smart Auto/Commercial	$56.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$56.28
Rate for Payer: LLUH Dept of Risk Management WC	$51.59
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$70.35

Know your out-of-pocket cost for care.

All Charges