Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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 OLIGOCLONAL BANDS CSF

Facility

$22.86

Service Code	CPT 83916 90
Hospital Charge Code	900911235
Hospital Revenue Code	301
Min. Negotiated Rate	$12.57
Max. Negotiated Rate	$17.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.72
Rate for Payer: Aetna of CA Government/Medicare	$13.72
Rate for Payer: Cash Price	$10.29
Rate for Payer: Health Smart Auto/Commercial	$13.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.72
Rate for Payer: LLUH Dept of Risk Management WC	$12.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.14

HC SOM OLIGOCLONAL BANDS CSF

Facility

$22.86

Service Code	CPT 83916 90
Hospital Charge Code	900911235
Hospital Revenue Code	301
Min. Negotiated Rate	$12.57
Max. Negotiated Rate	$18.29
Rate for Payer: Cash Price	$10.29
Rate for Payer: Cigna of CA HMO/PPO	$18.29
Rate for Payer: Health Smart Auto/Commercial	$13.72
Rate for Payer: LLUH Dept of Risk Management WC	$12.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.14

HC SOM OLIGOCLONAL BANDS CSF

Facility

$22.86

Service Code	CPT 83916
Hospital Charge Code	900911235
Hospital Revenue Code	301
Min. Negotiated Rate	$12.57
Max. Negotiated Rate	$17.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.72
Rate for Payer: Aetna of CA Government/Medicare	$13.72
Rate for Payer: Cash Price	$10.29
Rate for Payer: Health Smart Auto/Commercial	$13.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.72
Rate for Payer: LLUH Dept of Risk Management WC	$12.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.14

HC SOM OLIGOCLONAL BANDS CSF

Facility

$22.86

Service Code	CPT 83916
Hospital Charge Code	900911235
Hospital Revenue Code	301
Min. Negotiated Rate	$12.57
Max. Negotiated Rate	$18.29
Rate for Payer: Cash Price	$10.29
Rate for Payer: Cigna of CA HMO/PPO	$18.29
Rate for Payer: Health Smart Auto/Commercial	$13.72
Rate for Payer: LLUH Dept of Risk Management WC	$12.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.14

HC SOM OLIGOCLONAL BANDS SERUM

Facility

$22.86

Service Code	CPT 83916 90
Hospital Charge Code	900912657
Hospital Revenue Code	301
Min. Negotiated Rate	$12.57
Max. Negotiated Rate	$18.29
Rate for Payer: Cash Price	$10.29
Rate for Payer: Cigna of CA HMO/PPO	$18.29
Rate for Payer: Health Smart Auto/Commercial	$13.72
Rate for Payer: LLUH Dept of Risk Management WC	$12.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.14

HC SOM OLIGOCLONAL BANDS SERUM

Facility

$22.86

Service Code	CPT 83916 90
Hospital Charge Code	900912657
Hospital Revenue Code	301
Min. Negotiated Rate	$12.57
Max. Negotiated Rate	$17.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.72
Rate for Payer: Aetna of CA Government/Medicare	$13.72
Rate for Payer: Cash Price	$10.29
Rate for Payer: Health Smart Auto/Commercial	$13.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.72
Rate for Payer: LLUH Dept of Risk Management WC	$12.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.14

HC SOM OLIGOCLONAL BANDS SERUM

Facility

$22.86

Service Code	CPT 83916
Hospital Charge Code	900912657
Hospital Revenue Code	301
Min. Negotiated Rate	$12.57
Max. Negotiated Rate	$18.29
Rate for Payer: Cash Price	$10.29
Rate for Payer: Cigna of CA HMO/PPO	$18.29
Rate for Payer: Health Smart Auto/Commercial	$13.72
Rate for Payer: LLUH Dept of Risk Management WC	$12.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.14

HC SOM OLIGOCLONAL BANDS SERUM

Facility

$22.86

Service Code	CPT 83916
Hospital Charge Code	900912657
Hospital Revenue Code	301
Min. Negotiated Rate	$12.57
Max. Negotiated Rate	$17.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.72
Rate for Payer: Aetna of CA Government/Medicare	$13.72
Rate for Payer: Cash Price	$10.29
Rate for Payer: Health Smart Auto/Commercial	$13.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.72
Rate for Payer: LLUH Dept of Risk Management WC	$12.57
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.14

HC SOM ORGANIC ACID SCREEN

Facility

$40.00

Service Code	CPT 83919 90
Hospital Charge Code	900911179
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 ORGANIC ACID SCREEN

Facility

$40.00

Service Code	CPT 83919
Hospital Charge Code	900911179
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 ORGANIC ACID SCREEN

Facility

$40.00

Service Code	CPT 83919 90
Hospital Charge Code	900911179
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 ORGANIC ACID SCREEN

Facility

$40.00

Service Code	CPT 83919
Hospital Charge Code	900911179
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 ORG REFER FOR ID, AEROBIC

Facility

$17.20

Service Code	CPT 87077
Hospital Charge Code	900912887
Hospital Revenue Code	306
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$12.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.32
Rate for Payer: Aetna of CA Government/Medicare	$10.32
Rate for Payer: Cash Price	$7.74
Rate for Payer: Health Smart Auto/Commercial	$10.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.32
Rate for Payer: LLUH Dept of Risk Management WC	$9.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.90

HC SOM ORG REFER FOR ID, AEROBIC

Facility

$17.20

Service Code	CPT 87077 90
Hospital Charge Code	900912887
Hospital Revenue Code	306
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$13.76
Rate for Payer: Cash Price	$7.74
Rate for Payer: Cigna of CA HMO/PPO	$13.76
Rate for Payer: Health Smart Auto/Commercial	$10.32
Rate for Payer: LLUH Dept of Risk Management WC	$9.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.90

HC SOM ORG REFER FOR ID, AEROBIC

Facility

$17.20

Service Code	CPT 87077 90
Hospital Charge Code	900912887
Hospital Revenue Code	306
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$12.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.32
Rate for Payer: Aetna of CA Government/Medicare	$10.32
Rate for Payer: Cash Price	$7.74
Rate for Payer: Health Smart Auto/Commercial	$10.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.32
Rate for Payer: LLUH Dept of Risk Management WC	$9.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.90

HC SOM ORG REFER FOR ID, AEROBIC

Facility

$17.20

Service Code	CPT 87077
Hospital Charge Code	900912887
Hospital Revenue Code	306
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$13.76
Rate for Payer: Cash Price	$7.74
Rate for Payer: Cigna of CA HMO/PPO	$13.76
Rate for Payer: Health Smart Auto/Commercial	$10.32
Rate for Payer: LLUH Dept of Risk Management WC	$9.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.90

HC SOM ORG REFER FOR ID, ANAEROB

Facility

$23.74

Service Code	CPT 87076 90
Hospital Charge Code	900912889
Hospital Revenue Code	306
Min. Negotiated Rate	$13.06
Max. Negotiated Rate	$17.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.24
Rate for Payer: Aetna of CA Government/Medicare	$14.24
Rate for Payer: Cash Price	$10.68
Rate for Payer: Health Smart Auto/Commercial	$14.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.24
Rate for Payer: LLUH Dept of Risk Management WC	$13.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.80

HC SOM ORG REFER FOR ID, ANAEROB

Facility

$23.74

Service Code	CPT 87076
Hospital Charge Code	900912889
Hospital Revenue Code	306
Min. Negotiated Rate	$13.06
Max. Negotiated Rate	$18.99
Rate for Payer: Cash Price	$10.68
Rate for Payer: Cigna of CA HMO/PPO	$18.99
Rate for Payer: Health Smart Auto/Commercial	$14.24
Rate for Payer: LLUH Dept of Risk Management WC	$13.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.80

HC SOM ORG REFER FOR ID, ANAEROB

Facility

$23.74

Service Code	CPT 87076 90
Hospital Charge Code	900912889
Hospital Revenue Code	306
Min. Negotiated Rate	$13.06
Max. Negotiated Rate	$18.99
Rate for Payer: Cash Price	$10.68
Rate for Payer: Cigna of CA HMO/PPO	$18.99
Rate for Payer: Health Smart Auto/Commercial	$14.24
Rate for Payer: LLUH Dept of Risk Management WC	$13.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.80

HC SOM ORG REFER FOR ID, ANAEROB

Facility

$23.74

Service Code	CPT 87076
Hospital Charge Code	900912889
Hospital Revenue Code	306
Min. Negotiated Rate	$13.06
Max. Negotiated Rate	$17.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.24
Rate for Payer: Aetna of CA Government/Medicare	$14.24
Rate for Payer: Cash Price	$10.68
Rate for Payer: Health Smart Auto/Commercial	$14.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.24
Rate for Payer: LLUH Dept of Risk Management WC	$13.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$17.80

HC SOM OSTEOCALCIN

Facility

$41.00

Service Code	CPT 83937
Hospital Charge Code	900911399
Hospital Revenue Code	301
Min. Negotiated Rate	$22.55
Max. Negotiated Rate	$30.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.60
Rate for Payer: Aetna of CA Government/Medicare	$24.60
Rate for Payer: Cash Price	$18.45
Rate for Payer: Health Smart Auto/Commercial	$24.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.60
Rate for Payer: LLUH Dept of Risk Management WC	$22.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.75

HC SOM OSTEOCALCIN

Facility

$41.00

Service Code	CPT 83937 90
Hospital Charge Code	900911399
Hospital Revenue Code	301
Min. Negotiated Rate	$22.55
Max. Negotiated Rate	$32.80
Rate for Payer: Cash Price	$18.45
Rate for Payer: Cigna of CA HMO/PPO	$32.80
Rate for Payer: Health Smart Auto/Commercial	$24.60
Rate for Payer: LLUH Dept of Risk Management WC	$22.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.75

HC SOM OSTEOCALCIN

Facility

$41.00

Service Code	CPT 83937 90
Hospital Charge Code	900911399
Hospital Revenue Code	301
Min. Negotiated Rate	$22.55
Max. Negotiated Rate	$30.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.60
Rate for Payer: Aetna of CA Government/Medicare	$24.60
Rate for Payer: Cash Price	$18.45
Rate for Payer: Health Smart Auto/Commercial	$24.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.60
Rate for Payer: LLUH Dept of Risk Management WC	$22.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.75

HC SOM OSTEOCALCIN

Facility

$41.00

Service Code	CPT 83937
Hospital Charge Code	900911399
Hospital Revenue Code	301
Min. Negotiated Rate	$22.55
Max. Negotiated Rate	$32.80
Rate for Payer: Cash Price	$18.45
Rate for Payer: Cigna of CA HMO/PPO	$32.80
Rate for Payer: Health Smart Auto/Commercial	$24.60
Rate for Payer: LLUH Dept of Risk Management WC	$22.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.75

Know your out-of-pocket cost for care.

All Charges