Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM UNIPARENTAL DISOMY AMP

Facility

$275.48

Service Code	CPT 81402
Hospital Charge Code	900914445
Hospital Revenue Code	309
Min. Negotiated Rate	$151.51
Max. Negotiated Rate	$220.38
Rate for Payer: Cash Price	$123.97
Rate for Payer: Cigna of CA HMO/PPO	$220.38
Rate for Payer: Health Smart Auto/Commercial	$165.29
Rate for Payer: LLUH Dept of Risk Management WC	$151.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$206.61

HC SOM UNIPARENTAL DISOMY AMP

Facility

$275.48

Service Code	CPT 81402 90
Hospital Charge Code	900914445
Hospital Revenue Code	301
Min. Negotiated Rate	$151.51
Max. Negotiated Rate	$206.61
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$165.29
Rate for Payer: Aetna of CA Government/Medicare	$165.29
Rate for Payer: Cash Price	$123.97
Rate for Payer: Health Smart Auto/Commercial	$165.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$165.29
Rate for Payer: LLUH Dept of Risk Management WC	$151.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$206.61

HC SOM UNIPARENTAL DISOMY AMP

Facility

$275.48

Service Code	CPT 81402
Hospital Charge Code	900914445
Hospital Revenue Code	309
Min. Negotiated Rate	$151.51
Max. Negotiated Rate	$206.61
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$165.29
Rate for Payer: Aetna of CA Government/Medicare	$165.29
Rate for Payer: Cash Price	$123.97
Rate for Payer: Health Smart Auto/Commercial	$165.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$165.29
Rate for Payer: LLUH Dept of Risk Management WC	$151.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$206.61

HC SOM UREAPLASMA PCR

Facility

$37.50

Service Code	CPT 87798
Hospital Charge Code	900912878
Hospital Revenue Code	306
Min. Negotiated Rate	$20.62
Max. Negotiated Rate	$28.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.50
Rate for Payer: Aetna of CA Government/Medicare	$22.50
Rate for Payer: Cash Price	$16.88
Rate for Payer: Health Smart Auto/Commercial	$22.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.50
Rate for Payer: LLUH Dept of Risk Management WC	$20.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.12

HC SOM UREAPLASMA PCR

Facility

$37.50

Service Code	CPT 87798 90
Hospital Charge Code	900912878
Hospital Revenue Code	306
Min. Negotiated Rate	$20.62
Max. Negotiated Rate	$30.00
Rate for Payer: Cash Price	$16.88
Rate for Payer: Cigna of CA HMO/PPO	$30.00
Rate for Payer: Health Smart Auto/Commercial	$22.50
Rate for Payer: LLUH Dept of Risk Management WC	$20.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.12

HC SOM UREAPLASMA PCR

Facility

$37.50

Service Code	CPT 87798 90
Hospital Charge Code	900912878
Hospital Revenue Code	306
Min. Negotiated Rate	$20.62
Max. Negotiated Rate	$28.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.50
Rate for Payer: Aetna of CA Government/Medicare	$22.50
Rate for Payer: Cash Price	$16.88
Rate for Payer: Health Smart Auto/Commercial	$22.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.50
Rate for Payer: LLUH Dept of Risk Management WC	$20.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.12

HC SOM UREAPLASMA PCR

Facility

$37.50

Service Code	CPT 87798
Hospital Charge Code	900912878
Hospital Revenue Code	306
Min. Negotiated Rate	$20.62
Max. Negotiated Rate	$30.00
Rate for Payer: Cash Price	$16.88
Rate for Payer: Cigna of CA HMO/PPO	$30.00
Rate for Payer: Health Smart Auto/Commercial	$22.50
Rate for Payer: LLUH Dept of Risk Management WC	$20.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.12

HC SOM VARICELLA ZOSTER ANTIBODY

Facility

$14.17

Service Code	CPT 86787
Hospital Charge Code	900912868
Hospital Revenue Code	302
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$10.63
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.50
Rate for Payer: Aetna of CA Government/Medicare	$8.50
Rate for Payer: Cash Price	$6.38
Rate for Payer: Health Smart Auto/Commercial	$8.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.50
Rate for Payer: LLUH Dept of Risk Management WC	$7.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.63

HC SOM VARICELLA ZOSTER ANTIBODY

Facility

$14.17

Service Code	CPT 86787 90
Hospital Charge Code	900912868
Hospital Revenue Code	302
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$11.34
Rate for Payer: Cash Price	$6.38
Rate for Payer: Cigna of CA HMO/PPO	$11.34
Rate for Payer: Health Smart Auto/Commercial	$8.50
Rate for Payer: LLUH Dept of Risk Management WC	$7.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.63

HC SOM VARICELLA ZOSTER ANTIBODY

Facility

$14.17

Service Code	CPT 86787 90
Hospital Charge Code	900912868
Hospital Revenue Code	302
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$10.63
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.50
Rate for Payer: Aetna of CA Government/Medicare	$8.50
Rate for Payer: Cash Price	$6.38
Rate for Payer: Health Smart Auto/Commercial	$8.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.50
Rate for Payer: LLUH Dept of Risk Management WC	$7.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.63

HC SOM VARICELLA ZOSTER ANTIBODY

Facility

$14.17

Service Code	CPT 86787
Hospital Charge Code	900912868
Hospital Revenue Code	302
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$11.34
Rate for Payer: Cash Price	$6.38
Rate for Payer: Cigna of CA HMO/PPO	$11.34
Rate for Payer: Health Smart Auto/Commercial	$8.50
Rate for Payer: LLUH Dept of Risk Management WC	$7.79
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.63

HC SOM VASCULITIS PANEL P3 AB

Facility

$17.50

Service Code	CPT 83516
Hospital Charge Code	900912702
Hospital Revenue Code	301
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$14.00
Rate for Payer: Cash Price	$7.88
Rate for Payer: Cigna of CA HMO/PPO	$14.00
Rate for Payer: Health Smart Auto/Commercial	$10.50
Rate for Payer: LLUH Dept of Risk Management WC	$9.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.12

HC SOM VASCULITIS PANEL P3 AB

Facility

$17.50

Service Code	CPT 83516
Hospital Charge Code	900912702
Hospital Revenue Code	301
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$13.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.50
Rate for Payer: Aetna of CA Government/Medicare	$10.50
Rate for Payer: Cash Price	$7.88
Rate for Payer: Health Smart Auto/Commercial	$10.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.50
Rate for Payer: LLUH Dept of Risk Management WC	$9.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.12

HC SOM VASCULITIS PANEL P3 AB

Facility

$17.50

Service Code	CPT 83516 90
Hospital Charge Code	900912702
Hospital Revenue Code	301
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$13.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.50
Rate for Payer: Aetna of CA Government/Medicare	$10.50
Rate for Payer: Cash Price	$7.88
Rate for Payer: Health Smart Auto/Commercial	$10.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.50
Rate for Payer: LLUH Dept of Risk Management WC	$9.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.12

HC SOM VASCULITIS PANEL P3 AB

Facility

$17.50

Service Code	CPT 83516 90
Hospital Charge Code	900912702
Hospital Revenue Code	301
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$14.00
Rate for Payer: Cash Price	$7.88
Rate for Payer: Cigna of CA HMO/PPO	$14.00
Rate for Payer: Health Smart Auto/Commercial	$10.50
Rate for Payer: LLUH Dept of Risk Management WC	$9.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.12

HC SOM VASOACTIVE INTESTINAL PEPTIDE

Facility

$50.00

Service Code	CPT 84586 90
Hospital Charge Code	900911186
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$40.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cigna of CA HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.50

HC SOM VASOACTIVE INTESTINAL PEPTIDE

Facility

$50.00

Service Code	CPT 84586
Hospital Charge Code	900911186
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$40.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cigna of CA HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.50

HC SOM VASOACTIVE INTESTINAL PEPTIDE

Facility

$50.00

Service Code	CPT 84586 90
Hospital Charge Code	900911186
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.50

HC SOM VASOACTIVE INTESTINAL PEPTIDE

Facility

$50.00

Service Code	CPT 84586
Hospital Charge Code	900911186
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.50

HC SOM VDER 87529

Facility

$50.27

Service Code	CPT 87529 90
Hospital Charge Code	900913965
Hospital Revenue Code	306
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$37.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.16
Rate for Payer: Aetna of CA Government/Medicare	$30.16
Rate for Payer: Cash Price	$22.62
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.70

HC SOM VDER 87529

Facility

$50.27

Service Code	CPT 87529
Hospital Charge Code	900913965
Hospital Revenue Code	306
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$40.22
Rate for Payer: Cash Price	$22.62
Rate for Payer: Cigna of CA HMO/PPO	$40.22
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.70

HC SOM VDER 87529

Facility

$50.27

Service Code	CPT 87529
Hospital Charge Code	900913965
Hospital Revenue Code	306
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$37.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.16
Rate for Payer: Aetna of CA Government/Medicare	$30.16
Rate for Payer: Cash Price	$22.62
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.70

HC SOM VDER 87529

Facility

$50.27

Service Code	CPT 87529 90
Hospital Charge Code	900913965
Hospital Revenue Code	306
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$40.22
Rate for Payer: Cash Price	$22.62
Rate for Payer: Cigna of CA HMO/PPO	$40.22
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.70

HC SOM VDER 87798

Facility

$50.27

Service Code	CPT 87798 90
Hospital Charge Code	900913966
Hospital Revenue Code	306
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$37.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.16
Rate for Payer: Aetna of CA Government/Medicare	$30.16
Rate for Payer: Cash Price	$22.62
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.70

HC SOM VDER 87798

Facility

$50.27

Service Code	CPT 87798
Hospital Charge Code	900913966
Hospital Revenue Code	306
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$37.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.16
Rate for Payer: Aetna of CA Government/Medicare	$30.16
Rate for Payer: Cash Price	$22.62
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.70

Know your out-of-pocket cost for care.

All Charges