Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM CAH ANDROSTENEDIONE

Facility

$76.95

Service Code	CPT 82157
Hospital Charge Code	900912771
Hospital Revenue Code	301
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$61.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$46.17
Rate for Payer: Aetna of CA Government/Medicare	$46.17
Rate for Payer: Cash Price	$76.95
Rate for Payer: Cash Price	$76.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$61.56
Rate for Payer: Health Smart Auto/Commercial	$46.17
Rate for Payer: Intervalley Health Plan Commercial	$29.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$46.17
Rate for Payer: LLUH Dept of Risk Management WC	$42.32
Rate for Payer: Multiplan Commercial	$57.71

HC SOM CAH ANDROSTENEDIONE

Facility

$76.95

Service Code	CPT 82157
Hospital Charge Code	900912771
Hospital Revenue Code	301
Min. Negotiated Rate	$42.32
Max. Negotiated Rate	$61.56
Rate for Payer: Cash Price	$76.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$61.56
Rate for Payer: Health Smart Auto/Commercial	$46.17
Rate for Payer: LLUH Dept of Risk Management WC	$42.32
Rate for Payer: Multiplan Commercial	$57.71

HC SOM CAH CORTISOL

Facility

$42.84

Service Code	CPT 82533
Hospital Charge Code	900912772
Hospital Revenue Code	301
Min. Negotiated Rate	$23.56
Max. Negotiated Rate	$34.27
Rate for Payer: Cash Price	$42.84
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$34.27
Rate for Payer: Health Smart Auto/Commercial	$25.70
Rate for Payer: LLUH Dept of Risk Management WC	$23.56
Rate for Payer: Multiplan Commercial	$32.13

HC SOM CAH CORTISOL

Facility

$42.84

Service Code	CPT 82533
Hospital Charge Code	900912772
Hospital Revenue Code	301
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$34.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$25.70
Rate for Payer: Aetna of CA Government/Medicare	$25.70
Rate for Payer: Cash Price	$42.84
Rate for Payer: Cash Price	$42.84
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$34.27
Rate for Payer: Health Smart Auto/Commercial	$25.70
Rate for Payer: Intervalley Health Plan Commercial	$16.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$25.70
Rate for Payer: LLUH Dept of Risk Management WC	$23.56
Rate for Payer: Multiplan Commercial	$32.13

HC SOM CAH DEHYDROEPIANDROSTERONE

Facility

$66.41

Service Code	CPT 82626
Hospital Charge Code	900912774
Hospital Revenue Code	301
Min. Negotiated Rate	$25.27
Max. Negotiated Rate	$53.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$39.85
Rate for Payer: Aetna of CA Government/Medicare	$39.85
Rate for Payer: Cash Price	$66.41
Rate for Payer: Cash Price	$66.41
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$53.13
Rate for Payer: Health Smart Auto/Commercial	$39.85
Rate for Payer: Intervalley Health Plan Commercial	$25.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$39.85
Rate for Payer: LLUH Dept of Risk Management WC	$36.53
Rate for Payer: Multiplan Commercial	$49.81

HC SOM CAH DEHYDROEPIANDROSTERONE

Facility

$66.41

Service Code	CPT 82626
Hospital Charge Code	900912774
Hospital Revenue Code	301
Min. Negotiated Rate	$36.53
Max. Negotiated Rate	$53.13
Rate for Payer: Cash Price	$66.41
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$53.13
Rate for Payer: Health Smart Auto/Commercial	$39.85
Rate for Payer: LLUH Dept of Risk Management WC	$36.53
Rate for Payer: Multiplan Commercial	$49.81

HC SOM CAH DEOXYCORTICOSTERONE

Facility

$81.42

Service Code	CPT 82633
Hospital Charge Code	900912773
Hospital Revenue Code	301
Min. Negotiated Rate	$30.98
Max. Negotiated Rate	$65.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$48.85
Rate for Payer: Aetna of CA Government/Medicare	$48.85
Rate for Payer: Cash Price	$81.42
Rate for Payer: Cash Price	$81.42
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$65.14
Rate for Payer: Health Smart Auto/Commercial	$48.85
Rate for Payer: Intervalley Health Plan Commercial	$30.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$48.85
Rate for Payer: LLUH Dept of Risk Management WC	$44.78
Rate for Payer: Multiplan Commercial	$61.06

HC SOM CAH DEOXYCORTICOSTERONE

Facility

$81.42

Service Code	CPT 82633
Hospital Charge Code	900912773
Hospital Revenue Code	301
Min. Negotiated Rate	$44.78
Max. Negotiated Rate	$65.14
Rate for Payer: Cash Price	$81.42
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$65.14
Rate for Payer: Health Smart Auto/Commercial	$48.85
Rate for Payer: LLUH Dept of Risk Management WC	$44.78
Rate for Payer: Multiplan Commercial	$61.06

HC SOM CAH PROGESTERONE

Facility

$54.83

Service Code	CPT 84144
Hospital Charge Code	900912777
Hospital Revenue Code	301
Min. Negotiated Rate	$20.86
Max. Negotiated Rate	$43.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$32.90
Rate for Payer: Aetna of CA Government/Medicare	$32.90
Rate for Payer: Cash Price	$54.83
Rate for Payer: Cash Price	$54.83
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$43.86
Rate for Payer: Health Smart Auto/Commercial	$32.90
Rate for Payer: Intervalley Health Plan Commercial	$20.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$32.90
Rate for Payer: LLUH Dept of Risk Management WC	$30.16
Rate for Payer: Multiplan Commercial	$41.12

HC SOM CAH PROGESTERONE

Facility

$54.83

Service Code	CPT 84144
Hospital Charge Code	900912777
Hospital Revenue Code	301
Min. Negotiated Rate	$30.16
Max. Negotiated Rate	$43.86
Rate for Payer: Cash Price	$54.83
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$43.86
Rate for Payer: Health Smart Auto/Commercial	$32.90
Rate for Payer: LLUH Dept of Risk Management WC	$30.16
Rate for Payer: Multiplan Commercial	$41.12

HC SOM CAH TESTOSTERONE

Facility

$67.83

Service Code	CPT 84403
Hospital Charge Code	900912779
Hospital Revenue Code	301
Min. Negotiated Rate	$37.31
Max. Negotiated Rate	$54.26
Rate for Payer: Cash Price	$67.83
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$54.26
Rate for Payer: Health Smart Auto/Commercial	$40.70
Rate for Payer: LLUH Dept of Risk Management WC	$37.31
Rate for Payer: Multiplan Commercial	$50.87

HC SOM CAH TESTOSTERONE

Facility

$67.83

Service Code	CPT 84403
Hospital Charge Code	900912779
Hospital Revenue Code	301
Min. Negotiated Rate	$25.81
Max. Negotiated Rate	$54.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$40.70
Rate for Payer: Aetna of CA Government/Medicare	$40.70
Rate for Payer: Cash Price	$67.83
Rate for Payer: Cash Price	$67.83
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$54.26
Rate for Payer: Health Smart Auto/Commercial	$40.70
Rate for Payer: Intervalley Health Plan Commercial	$25.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$40.70
Rate for Payer: LLUH Dept of Risk Management WC	$37.31
Rate for Payer: Multiplan Commercial	$50.87

HC SOM CALCITONIN

Facility

$20.00

Service Code	CPT 82308
Hospital Charge Code	900911003
Hospital Revenue Code	301
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$16.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$15.00

HC SOM CALCITONIN

Facility

$20.00

Service Code	CPT 82308
Hospital Charge Code	900911003
Hospital Revenue Code	301
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$26.79
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	$20.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: Intervalley Health Plan Commercial	$26.79
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 Commercial	$15.00

HC SOM CALPROTECTIN

Facility

$90.00

Service Code	CPT 83993
Hospital Charge Code	900912938
Hospital Revenue Code	301
Min. Negotiated Rate	$19.63
Max. Negotiated Rate	$72.00
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	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$72.00
Rate for Payer: Health Smart Auto/Commercial	$54.00
Rate for Payer: Intervalley Health Plan Commercial	$19.63
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 Commercial	$67.50

HC SOM CALPROTECTIN

Facility

$90.00

Service Code	CPT 83993
Hospital Charge Code	900912938
Hospital Revenue Code	301
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$72.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$67.50

HC SOM CANDIDA AURIS SURV PCR

Facility

$494.90

Service Code	CPT 87481
Hospital Charge Code	900915483
Hospital Revenue Code	300
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$395.92
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$296.94
Rate for Payer: Aetna of CA Government/Medicare	$296.94
Rate for Payer: Cash Price	$494.90
Rate for Payer: Cash Price	$494.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$395.92
Rate for Payer: Health Smart Auto/Commercial	$296.94
Rate for Payer: Intervalley Health Plan Commercial	$35.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$296.94
Rate for Payer: LLUH Dept of Risk Management WC	$272.19
Rate for Payer: Multiplan Commercial	$371.18

HC SOM CANDIDA AURIS SURV PCR

Facility

$494.90

Service Code	CPT 87481
Hospital Charge Code	900915483
Hospital Revenue Code	300
Min. Negotiated Rate	$272.19
Max. Negotiated Rate	$395.92
Rate for Payer: Cash Price	$494.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$395.92
Rate for Payer: Health Smart Auto/Commercial	$296.94
Rate for Payer: LLUH Dept of Risk Management WC	$272.19
Rate for Payer: Multiplan Commercial	$371.18

HC SOM CARBAPEN MOD HODGE TEST

Facility

$164.70

Service Code	CPT 87185
Hospital Charge Code	900914208
Hospital Revenue Code	306
Min. Negotiated Rate	$90.58
Max. Negotiated Rate	$131.76
Rate for Payer: Cash Price	$164.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$131.76
Rate for Payer: Health Smart Auto/Commercial	$98.82
Rate for Payer: LLUH Dept of Risk Management WC	$90.58
Rate for Payer: Multiplan Commercial	$123.53

HC SOM CARBAPEN MOD HODGE TEST

Facility

$164.70

Service Code	CPT 87185
Hospital Charge Code	900914208
Hospital Revenue Code	306
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$131.76
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$98.82
Rate for Payer: Aetna of CA Government/Medicare	$98.82
Rate for Payer: Cash Price	$164.70
Rate for Payer: Cash Price	$164.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$131.76
Rate for Payer: Health Smart Auto/Commercial	$98.82
Rate for Payer: Intervalley Health Plan Commercial	$4.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$98.82
Rate for Payer: LLUH Dept of Risk Management WC	$90.58
Rate for Payer: Multiplan Commercial	$123.53

HC SOM CARB DEF TRANS CONGENITAL

Facility

$200.00

Service Code	CPT 82373
Hospital Charge Code	900912514
Hospital Revenue Code	301
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$160.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$160.00
Rate for Payer: Health Smart Auto/Commercial	$120.00
Rate for Payer: LLUH Dept of Risk Management WC	$110.00
Rate for Payer: Multiplan Commercial	$150.00

HC SOM CARB DEF TRANS CONGENITAL

Facility

$200.00

Service Code	CPT 82373
Hospital Charge Code	900912514
Hospital Revenue Code	301
Min. Negotiated Rate	$18.06
Max. Negotiated Rate	$160.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$120.00
Rate for Payer: Aetna of CA Government/Medicare	$120.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$160.00
Rate for Payer: Health Smart Auto/Commercial	$120.00
Rate for Payer: Intervalley Health Plan Commercial	$18.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$120.00
Rate for Payer: LLUH Dept of Risk Management WC	$110.00
Rate for Payer: Multiplan Commercial	$150.00

HC SOM CARB DEF TRANSFERRIN ADULT

Facility

$354.50

Service Code	CPT 82373
Hospital Charge Code	900912717
Hospital Revenue Code	301
Min. Negotiated Rate	$194.97
Max. Negotiated Rate	$283.60
Rate for Payer: Cash Price	$354.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$283.60
Rate for Payer: Health Smart Auto/Commercial	$212.70
Rate for Payer: LLUH Dept of Risk Management WC	$194.97
Rate for Payer: Multiplan Commercial	$265.88

HC SOM CARB DEF TRANSFERRIN ADULT

Facility

$354.50

Service Code	CPT 82373
Hospital Charge Code	900912717
Hospital Revenue Code	301
Min. Negotiated Rate	$18.06
Max. Negotiated Rate	$283.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$212.70
Rate for Payer: Aetna of CA Government/Medicare	$212.70
Rate for Payer: Cash Price	$354.50
Rate for Payer: Cash Price	$354.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$283.60
Rate for Payer: Health Smart Auto/Commercial	$212.70
Rate for Payer: Intervalley Health Plan Commercial	$18.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$212.70
Rate for Payer: LLUH Dept of Risk Management WC	$194.97
Rate for Payer: Multiplan Commercial	$265.88

HC SOM CARBOXYHEMOGLOBIN

Facility

$35.00

Service Code	CPT 82375
Hospital Charge Code	900911041
Hospital Revenue Code	301
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$28.00
Rate for Payer: Cash Price	$35.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$26.25

Know your out-of-pocket cost for care.

All Charges