Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM THALLIUM URINE

Facility

$204.00

Service Code	CPT 83018 90
Hospital Charge Code	900911102
Hospital Revenue Code	301
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$122.40
Rate for Payer: Aetna of CA Government/Medicare	$122.40
Rate for Payer: Cash Price	$91.80
Rate for Payer: Health Smart Auto/Commercial	$122.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$122.40
Rate for Payer: LLUH Dept of Risk Management WC	$112.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$153.00

HC SOM THALLIUM URINE

Facility

$204.00

Service Code	CPT 83018
Hospital Charge Code	900911102
Hospital Revenue Code	301
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$122.40
Rate for Payer: Aetna of CA Government/Medicare	$122.40
Rate for Payer: Cash Price	$91.80
Rate for Payer: Health Smart Auto/Commercial	$122.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$122.40
Rate for Payer: LLUH Dept of Risk Management WC	$112.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$153.00

HC SOM THALLIUM URINE

Facility

$204.00

Service Code	CPT 83018 90
Hospital Charge Code	900911102
Hospital Revenue Code	301
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$163.20
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna of CA HMO/PPO	$163.20
Rate for Payer: Health Smart Auto/Commercial	$122.40
Rate for Payer: LLUH Dept of Risk Management WC	$112.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$153.00

HC SOM THC CONFIRMATION, U

Facility

$31.60

Service Code	CPT G0480 90
Hospital Charge Code	900912921
Hospital Revenue Code	301
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$25.28
Rate for Payer: Cash Price	$14.22
Rate for Payer: Cigna of CA HMO/PPO	$25.28
Rate for Payer: Health Smart Auto/Commercial	$18.96
Rate for Payer: LLUH Dept of Risk Management WC	$17.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$23.70

HC SOM THC CONFIRMATION, U

Facility

$31.60

Service Code	CPT G0480
Hospital Charge Code	900912921
Hospital Revenue Code	301
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$25.28
Rate for Payer: Cash Price	$14.22
Rate for Payer: Cigna of CA HMO/PPO	$25.28
Rate for Payer: Health Smart Auto/Commercial	$18.96
Rate for Payer: LLUH Dept of Risk Management WC	$17.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$23.70

HC SOM THC CONFIRMATION, U

Facility

$31.60

Service Code	CPT G0480
Hospital Charge Code	900912921
Hospital Revenue Code	301
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$23.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.96
Rate for Payer: Aetna of CA Government/Medicare	$18.96
Rate for Payer: Cash Price	$14.22
Rate for Payer: Health Smart Auto/Commercial	$18.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.96
Rate for Payer: LLUH Dept of Risk Management WC	$17.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$23.70

HC SOM THC CONFIRMATION, U

Facility

$31.60

Service Code	CPT 80349
Hospital Charge Code	900912921
Hospital Revenue Code	301
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$25.28
Rate for Payer: Cash Price	$14.22
Rate for Payer: Cigna of CA HMO/PPO	$25.28
Rate for Payer: Health Smart Auto/Commercial	$18.96
Rate for Payer: LLUH Dept of Risk Management WC	$17.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$23.70

HC SOM THC CONFIRMATION, U

Facility

$31.60

Service Code	CPT G0480 90
Hospital Charge Code	900912921
Hospital Revenue Code	301
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$23.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.96
Rate for Payer: Aetna of CA Government/Medicare	$18.96
Rate for Payer: Cash Price	$14.22
Rate for Payer: Health Smart Auto/Commercial	$18.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.96
Rate for Payer: LLUH Dept of Risk Management WC	$17.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$23.70

HC SOM THC CONFIRMATION, U

Facility

$31.60

Service Code	CPT 80349
Hospital Charge Code	900912921
Hospital Revenue Code	301
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$23.70
Rate for Payer: Health Smart Auto/Commercial	$18.96
Rate for Payer: Cash Price	$14.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.96
Rate for Payer: Aetna of CA Government/Medicare	$18.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.96
Rate for Payer: LLUH Dept of Risk Management WC	$17.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$23.70

HC SOM THIOPURINE METAB

Facility

$178.00

Service Code	CPT 80299
Hospital Charge Code	900914912
Hospital Revenue Code	309
Min. Negotiated Rate	$97.90
Max. Negotiated Rate	$133.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$106.80
Rate for Payer: Aetna of CA Government/Medicare	$106.80
Rate for Payer: Cash Price	$80.10
Rate for Payer: Health Smart Auto/Commercial	$106.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$106.80
Rate for Payer: LLUH Dept of Risk Management WC	$97.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$133.50

HC SOM THIOPURINE METAB

Facility

$178.00

Service Code	CPT 80299
Hospital Charge Code	900914912
Hospital Revenue Code	309
Min. Negotiated Rate	$97.90
Max. Negotiated Rate	$142.40
Rate for Payer: Cash Price	$80.10
Rate for Payer: Cigna of CA HMO/PPO	$142.40
Rate for Payer: Health Smart Auto/Commercial	$106.80
Rate for Payer: LLUH Dept of Risk Management WC	$97.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$133.50

HC SOM THIOPURINE METAB

Facility

$178.00

Service Code	CPT 80299 90
Hospital Charge Code	900914912
Hospital Revenue Code	300
Min. Negotiated Rate	$97.90
Max. Negotiated Rate	$133.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$106.80
Rate for Payer: Aetna of CA Government/Medicare	$106.80
Rate for Payer: Cash Price	$80.10
Rate for Payer: Health Smart Auto/Commercial	$106.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$106.80
Rate for Payer: LLUH Dept of Risk Management WC	$97.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$133.50

HC SOM THIOPURINE METAB

Facility

$178.00

Service Code	CPT 80299 90
Hospital Charge Code	900914912
Hospital Revenue Code	300
Min. Negotiated Rate	$97.90
Max. Negotiated Rate	$142.40
Rate for Payer: Cash Price	$80.10
Rate for Payer: Cigna of CA HMO/PPO	$142.40
Rate for Payer: Health Smart Auto/Commercial	$106.80
Rate for Payer: LLUH Dept of Risk Management WC	$97.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$133.50

HC SOM THYROBLUBULIN AB

Facility

$15.00

Service Code	CPT 86800
Hospital Charge Code	900910558
Hospital Revenue Code	302
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$12.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Cigna of CA HMO/PPO	$12.00
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC SOM THYROBLUBULIN AB

Facility

$15.00

Service Code	CPT 86800 90
Hospital Charge Code	900910558
Hospital Revenue Code	302
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$12.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Cigna of CA HMO/PPO	$12.00
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC SOM THYROBLUBULIN AB

Facility

$15.00

Service Code	CPT 86800
Hospital Charge Code	900910558
Hospital Revenue Code	302
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$11.25
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.00
Rate for Payer: Aetna of CA Government/Medicare	$9.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC SOM THYROBLUBULIN AB

Facility

$15.00

Service Code	CPT 86800 90
Hospital Charge Code	900910558
Hospital Revenue Code	302
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.00
Rate for Payer: Aetna of CA Government/Medicare	$9.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC SOM THYROGLOBULIN TUMOR MARKER TM

Facility

$10.20

Service Code	CPT 84432 90
Hospital Charge Code	900912645
Hospital Revenue Code	302
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$8.16
Rate for Payer: Cash Price	$4.59
Rate for Payer: Cigna of CA HMO/PPO	$8.16
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.65

HC SOM THYROGLOBULIN TUMOR MARKER TM

Facility

$10.20

Service Code	CPT 84432 90
Hospital Charge Code	900912645
Hospital Revenue Code	302
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$7.65
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: Cash Price	$4.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.12
Rate for Payer: Aetna of CA Government/Medicare	$6.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.65

HC SOM THYROGLOBULIN TUMOR MARKER TM

Facility

$10.20

Service Code	CPT 84432
Hospital Charge Code	900912645
Hospital Revenue Code	302
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$7.65
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.12
Rate for Payer: Aetna of CA Government/Medicare	$6.12
Rate for Payer: Cash Price	$4.59
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.65

HC SOM THYROGLOBULIN TUMOR MARKER TM

Facility

$10.20

Service Code	CPT 84432
Hospital Charge Code	900912645
Hospital Revenue Code	302
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$8.16
Rate for Payer: Cash Price	$4.59
Rate for Payer: Cigna of CA HMO/PPO	$8.16
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: LLUH Dept of Risk Management WC	$5.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.65

HC SOM THYROID BINDING GLOBULIN

Facility

$20.00

Service Code	CPT 84442 90
Hospital Charge Code	900911006
Hospital Revenue Code	301
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.00
Rate for Payer: Aetna of CA Government/Medicare	$12.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.00

HC SOM THYROID BINDING GLOBULIN

Facility

$20.00

Service Code	CPT 84442 90
Hospital Charge Code	900911006
Hospital Revenue Code	301
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$16.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cigna of CA HMO/PPO	$16.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.00

HC SOM THYROID BINDING GLOBULIN

Facility

$20.00

Service Code	CPT 84442
Hospital Charge Code	900911006
Hospital Revenue Code	301
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.00
Rate for Payer: Aetna of CA Government/Medicare	$12.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.00

HC SOM THYROID BINDING GLOBULIN

Facility

$20.00

Service Code	CPT 84442
Hospital Charge Code	900911006
Hospital Revenue Code	301
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$16.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cigna of CA HMO/PPO	$16.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.00

Know your out-of-pocket cost for care.

All Charges