Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM WEST NILE VIRUS PCR (CSF)

Facility

$84.00

Service Code	CPT 87798
Hospital Charge Code	900912764
Hospital Revenue Code	306
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$50.40
Rate for Payer: Aetna of CA Government/Medicare	$50.40
Rate for Payer: Cash Price	$37.80
Rate for Payer: Health Smart Auto/Commercial	$50.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$50.40
Rate for Payer: LLUH Dept of Risk Management WC	$46.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$63.00

HC SOM WEST NILE VIRUS PCR (CSF)

Facility

$84.00

Service Code	CPT 87798
Hospital Charge Code	900912764
Hospital Revenue Code	306
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$67.20
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cigna of CA HMO/PPO	$67.20
Rate for Payer: Health Smart Auto/Commercial	$50.40
Rate for Payer: LLUH Dept of Risk Management WC	$46.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$63.00

HC SOM WEST NILE VIRUS PCR (CSF)

Facility

$84.00

Service Code	CPT 87798 90
Hospital Charge Code	900912764
Hospital Revenue Code	306
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$67.20
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cigna of CA HMO/PPO	$67.20
Rate for Payer: Health Smart Auto/Commercial	$50.40
Rate for Payer: LLUH Dept of Risk Management WC	$46.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$63.00

HC SOM ZINC

Facility

$12.17

Service Code	CPT 84630
Hospital Charge Code	900911152
Hospital Revenue Code	301
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$9.74
Rate for Payer: Cash Price	$5.48
Rate for Payer: Cigna of CA HMO/PPO	$9.74
Rate for Payer: Health Smart Auto/Commercial	$7.30
Rate for Payer: LLUH Dept of Risk Management WC	$6.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.13

HC SOM ZINC

Facility

$12.17

Service Code	CPT 84630 90
Hospital Charge Code	900911152
Hospital Revenue Code	301
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$9.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.30
Rate for Payer: Aetna of CA Government/Medicare	$7.30
Rate for Payer: Cash Price	$5.48
Rate for Payer: Health Smart Auto/Commercial	$7.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.30
Rate for Payer: LLUH Dept of Risk Management WC	$6.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.13

HC SOM ZINC

Facility

$12.17

Service Code	CPT 84630
Hospital Charge Code	900911152
Hospital Revenue Code	301
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$9.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.30
Rate for Payer: Aetna of CA Government/Medicare	$7.30
Rate for Payer: Cash Price	$5.48
Rate for Payer: Health Smart Auto/Commercial	$7.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.30
Rate for Payer: LLUH Dept of Risk Management WC	$6.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.13

HC SOM ZINC

Facility

$12.17

Service Code	CPT 84630 90
Hospital Charge Code	900911152
Hospital Revenue Code	301
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$9.74
Rate for Payer: Cash Price	$5.48
Rate for Payer: Cigna of CA HMO/PPO	$9.74
Rate for Payer: Health Smart Auto/Commercial	$7.30
Rate for Payer: LLUH Dept of Risk Management WC	$6.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.13

HC SOM ZINC TRANSPORTER 8 AUTOAB

Facility

$150.00

Service Code	CPT 86341
Hospital Charge Code	900915260
Hospital Revenue Code	302
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 ZINC TRANSPORTER 8 AUTOAB

Facility

$150.00

Service Code	CPT 86341
Hospital Charge Code	900915260
Hospital Revenue Code	302
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 ZONISAMIDE LEVEL

Facility

$39.85

Service Code	CPT 80203 90
Hospital Charge Code	900912714
Hospital Revenue Code	301
Min. Negotiated Rate	$21.92
Max. Negotiated Rate	$29.89
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.91
Rate for Payer: Aetna of CA Government/Medicare	$23.91
Rate for Payer: Cash Price	$17.93
Rate for Payer: Health Smart Auto/Commercial	$23.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.91
Rate for Payer: LLUH Dept of Risk Management WC	$21.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.89

HC SOM ZONISAMIDE LEVEL

Facility

$39.85

Service Code	CPT 80203
Hospital Charge Code	900912714
Hospital Revenue Code	301
Min. Negotiated Rate	$21.92
Max. Negotiated Rate	$31.88
Rate for Payer: Cash Price	$17.93
Rate for Payer: Cigna of CA HMO/PPO	$31.88
Rate for Payer: Health Smart Auto/Commercial	$23.91
Rate for Payer: LLUH Dept of Risk Management WC	$21.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.89

HC SOM ZONISAMIDE LEVEL

Facility

$39.85

Service Code	CPT 80203 90
Hospital Charge Code	900912714
Hospital Revenue Code	301
Min. Negotiated Rate	$21.92
Max. Negotiated Rate	$31.88
Rate for Payer: Cash Price	$17.93
Rate for Payer: Cigna of CA HMO/PPO	$31.88
Rate for Payer: Health Smart Auto/Commercial	$23.91
Rate for Payer: LLUH Dept of Risk Management WC	$21.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.89

HC SOM ZONISAMIDE LEVEL

Facility

$39.85

Service Code	CPT 80203
Hospital Charge Code	900912714
Hospital Revenue Code	301
Min. Negotiated Rate	$21.92
Max. Negotiated Rate	$29.89
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.91
Rate for Payer: Aetna of CA Government/Medicare	$23.91
Rate for Payer: Cash Price	$17.93
Rate for Payer: Health Smart Auto/Commercial	$23.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.91
Rate for Payer: LLUH Dept of Risk Management WC	$21.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.89

HC SOP CELIAC PLUS

Facility

$127.50

Service Code	CPT 88346
Hospital Charge Code	900914910
Hospital Revenue Code	309
Min. Negotiated Rate	$70.12
Max. Negotiated Rate	$102.00
Rate for Payer: Cash Price	$57.38
Rate for Payer: Cigna of CA HMO/PPO	$102.00
Rate for Payer: Health Smart Auto/Commercial	$76.50
Rate for Payer: LLUH Dept of Risk Management WC	$70.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$95.62

HC SOP CELIAC PLUS

Facility

$127.50

Service Code	CPT 88346
Hospital Charge Code	900914910
Hospital Revenue Code	309
Min. Negotiated Rate	$70.12
Max. Negotiated Rate	$95.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$76.50
Rate for Payer: Aetna of CA Government/Medicare	$76.50
Rate for Payer: Cash Price	$57.38
Rate for Payer: Health Smart Auto/Commercial	$76.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$76.50
Rate for Payer: LLUH Dept of Risk Management WC	$70.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$95.62

HC SOP CELIAC PLUS

Facility

$127.50

Service Code	CPT 88346 90
Hospital Charge Code	900914910
Hospital Revenue Code	300
Min. Negotiated Rate	$70.12
Max. Negotiated Rate	$95.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$76.50
Rate for Payer: Aetna of CA Government/Medicare	$76.50
Rate for Payer: Cash Price	$57.38
Rate for Payer: Health Smart Auto/Commercial	$76.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$76.50
Rate for Payer: LLUH Dept of Risk Management WC	$70.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$95.62

HC SOP CELIAC PLUS

Facility

$127.50

Service Code	CPT 88346 90
Hospital Charge Code	900914910
Hospital Revenue Code	300
Min. Negotiated Rate	$70.12
Max. Negotiated Rate	$102.00
Rate for Payer: Cash Price	$57.38
Rate for Payer: Cigna of CA HMO/PPO	$102.00
Rate for Payer: Health Smart Auto/Commercial	$76.50
Rate for Payer: LLUH Dept of Risk Management WC	$70.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$95.62

HC SOP CELIAC SEROLOGY

Facility

$127.50

Service Code	CPT 88346 90
Hospital Charge Code	900914914
Hospital Revenue Code	300
Min. Negotiated Rate	$70.12
Max. Negotiated Rate	$102.00
Rate for Payer: Cash Price	$57.38
Rate for Payer: Cigna of CA HMO/PPO	$102.00
Rate for Payer: Health Smart Auto/Commercial	$76.50
Rate for Payer: LLUH Dept of Risk Management WC	$70.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$95.62

HC SOP CELIAC SEROLOGY

Facility

$127.50

Service Code	CPT 88346
Hospital Charge Code	900914914
Hospital Revenue Code	309
Min. Negotiated Rate	$70.12
Max. Negotiated Rate	$95.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$76.50
Rate for Payer: Aetna of CA Government/Medicare	$76.50
Rate for Payer: Cash Price	$57.38
Rate for Payer: Health Smart Auto/Commercial	$76.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$76.50
Rate for Payer: LLUH Dept of Risk Management WC	$70.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$95.62

HC SOP CELIAC SEROLOGY

Facility

$127.50

Service Code	CPT 88346
Hospital Charge Code	900914914
Hospital Revenue Code	309
Min. Negotiated Rate	$70.12
Max. Negotiated Rate	$102.00
Rate for Payer: Cash Price	$57.38
Rate for Payer: Cigna of CA HMO/PPO	$102.00
Rate for Payer: Health Smart Auto/Commercial	$76.50
Rate for Payer: LLUH Dept of Risk Management WC	$70.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$95.62

HC SOP CELIAC SEROLOGY

Facility

$127.50

Service Code	CPT 88346 90
Hospital Charge Code	900914914
Hospital Revenue Code	300
Min. Negotiated Rate	$70.12
Max. Negotiated Rate	$95.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$76.50
Rate for Payer: Aetna of CA Government/Medicare	$76.50
Rate for Payer: Cash Price	$57.38
Rate for Payer: Health Smart Auto/Commercial	$76.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$76.50
Rate for Payer: LLUH Dept of Risk Management WC	$70.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$95.62

HC SOP TPMT ENZYME

Facility

$93.50

Service Code	CPT 82542
Hospital Charge Code	900914906
Hospital Revenue Code	309
Min. Negotiated Rate	$51.42
Max. Negotiated Rate	$70.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$56.10
Rate for Payer: Aetna of CA Government/Medicare	$56.10
Rate for Payer: Cash Price	$42.08
Rate for Payer: Health Smart Auto/Commercial	$56.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$56.10
Rate for Payer: LLUH Dept of Risk Management WC	$51.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$70.12

HC SOP TPMT ENZYME

Facility

$93.50

Service Code	CPT 82542 90
Hospital Charge Code	900914906
Hospital Revenue Code	300
Min. Negotiated Rate	$51.42
Max. Negotiated Rate	$70.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$56.10
Rate for Payer: Aetna of CA Government/Medicare	$56.10
Rate for Payer: Cash Price	$42.08
Rate for Payer: Health Smart Auto/Commercial	$56.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$56.10
Rate for Payer: LLUH Dept of Risk Management WC	$51.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$70.12

HC SOP TPMT ENZYME

Facility

$93.50

Service Code	CPT 82542 90
Hospital Charge Code	900914906
Hospital Revenue Code	300
Min. Negotiated Rate	$51.42
Max. Negotiated Rate	$74.80
Rate for Payer: Health Smart Auto/Commercial	$56.10
Rate for Payer: Cash Price	$42.08
Rate for Payer: Cigna of CA HMO/PPO	$74.80
Rate for Payer: LLUH Dept of Risk Management WC	$51.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$70.12

HC SOP TPMT ENZYME

Facility

$93.50

Service Code	CPT 82542
Hospital Charge Code	900914906
Hospital Revenue Code	309
Min. Negotiated Rate	$51.42
Max. Negotiated Rate	$74.80
Rate for Payer: Cash Price	$42.08
Rate for Payer: Cigna of CA HMO/PPO	$74.80
Rate for Payer: Health Smart Auto/Commercial	$56.10
Rate for Payer: LLUH Dept of Risk Management WC	$51.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$70.12

Know your out-of-pocket cost for care.

All Charges