Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM AMOXAPINE

Facility

$65.46

Service Code	CPT 80335 90
Hospital Charge Code	900911071
Hospital Revenue Code	301
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$52.37
Rate for Payer: Cash Price	$29.46
Rate for Payer: Cigna of CA HMO/PPO	$52.37
Rate for Payer: Health Smart Auto/Commercial	$39.28
Rate for Payer: LLUH Dept of Risk Management WC	$36.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$49.10

HC SOM AMPHETAMINE QUANT

Facility

$20.78

Service Code	CPT 80325
Hospital Charge Code	900910720
Hospital Revenue Code	301
Min. Negotiated Rate	$11.43
Max. Negotiated Rate	$15.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.47
Rate for Payer: Aetna of CA Government/Medicare	$12.47
Rate for Payer: Cash Price	$9.35
Rate for Payer: Health Smart Auto/Commercial	$12.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.47
Rate for Payer: LLUH Dept of Risk Management WC	$11.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.58

HC SOM AMPHETAMINE QUANT

Facility

$20.78

Service Code	CPT G0480
Hospital Charge Code	900910720
Hospital Revenue Code	301
Min. Negotiated Rate	$11.43
Max. Negotiated Rate	$15.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.47
Rate for Payer: Aetna of CA Government/Medicare	$12.47
Rate for Payer: Cash Price	$9.35
Rate for Payer: Health Smart Auto/Commercial	$12.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.47
Rate for Payer: LLUH Dept of Risk Management WC	$11.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.58

HC SOM AMPHETAMINE QUANT

Facility

$20.78

Service Code	CPT 80325
Hospital Charge Code	900910720
Hospital Revenue Code	301
Min. Negotiated Rate	$11.43
Max. Negotiated Rate	$16.62
Rate for Payer: Health Smart Auto/Commercial	$12.47
Rate for Payer: Cash Price	$9.35
Rate for Payer: Cigna of CA HMO/PPO	$16.62
Rate for Payer: LLUH Dept of Risk Management WC	$11.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.58

HC SOM AMPHETAMINE QUANT

Facility

$20.78

Service Code	CPT G0480 90
Hospital Charge Code	900910720
Hospital Revenue Code	301
Min. Negotiated Rate	$11.43
Max. Negotiated Rate	$16.62
Rate for Payer: Cash Price	$9.35
Rate for Payer: Cigna of CA HMO/PPO	$16.62
Rate for Payer: Health Smart Auto/Commercial	$12.47
Rate for Payer: LLUH Dept of Risk Management WC	$11.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.58

HC SOM AMPHETAMINE QUANT

Facility

$20.78

Service Code	CPT G0480
Hospital Charge Code	900910720
Hospital Revenue Code	301
Min. Negotiated Rate	$11.43
Max. Negotiated Rate	$16.62
Rate for Payer: Cash Price	$9.35
Rate for Payer: Cigna of CA HMO/PPO	$16.62
Rate for Payer: Health Smart Auto/Commercial	$12.47
Rate for Payer: LLUH Dept of Risk Management WC	$11.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.58

HC SOM AMPHETAMINE QUANT

Facility

$20.78

Service Code	CPT G0480 90
Hospital Charge Code	900910720
Hospital Revenue Code	301
Min. Negotiated Rate	$11.43
Max. Negotiated Rate	$15.58
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.47
Rate for Payer: Aetna of CA Government/Medicare	$12.47
Rate for Payer: Cash Price	$9.35
Rate for Payer: Health Smart Auto/Commercial	$12.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.47
Rate for Payer: LLUH Dept of Risk Management WC	$11.43
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.58

HC SOM AMYLASE ISOENZYMES

Facility

$25.00

Service Code	CPT 82150
Hospital Charge Code	900910241
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Cigna of CA HMO/PPO	$20.00
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.75

HC SOM AMYLASE ISOENZYMES

Facility

$25.00

Service Code	CPT 82150
Hospital Charge Code	900910241
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$18.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.00
Rate for Payer: Aetna of CA Government/Medicare	$15.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.75

HC SOM AMYLASE ISOENZYMES

Facility

$25.00

Service Code	CPT 82150 90
Hospital Charge Code	900910241
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$18.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.00
Rate for Payer: Aetna of CA Government/Medicare	$15.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.75

HC SOM AMYLASE ISOENZYMES

Facility

$25.00

Service Code	CPT 82150 90
Hospital Charge Code	900910241
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Cigna of CA HMO/PPO	$20.00
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.75

HC SOM ANDROSTENEDIONE

Facility

$24.00

Service Code	CPT 82157 90
Hospital Charge Code	900911011
Hospital Revenue Code	301
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$19.20
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cigna of CA HMO/PPO	$19.20
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.00

HC SOM ANDROSTENEDIONE

Facility

$24.00

Service Code	CPT 82157
Hospital Charge Code	900911011
Hospital Revenue Code	301
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$19.20
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cigna of CA HMO/PPO	$19.20
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.00

HC SOM ANDROSTENEDIONE

Facility

$24.00

Service Code	CPT 82157
Hospital Charge Code	900911011
Hospital Revenue Code	301
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.40
Rate for Payer: Aetna of CA Government/Medicare	$14.40
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.00

HC SOM ANDROSTENEDIONE

Facility

$24.00

Service Code	CPT 82157 90
Hospital Charge Code	900911011
Hospital Revenue Code	301
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.40
Rate for Payer: Aetna of CA Government/Medicare	$14.40
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.00

HC SOM ANGIOTENSIN 1 CONVERTING ENZYM

Facility

$12.00

Service Code	CPT 82164 90
Hospital Charge Code	900911119
Hospital Revenue Code	301
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.60
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cigna of CA HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

HC SOM ANGIOTENSIN 1 CONVERTING ENZYM

Facility

$12.00

Service Code	CPT 82164
Hospital Charge Code	900911119
Hospital Revenue Code	301
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.60
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cigna of CA HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

HC SOM ANGIOTENSIN 1 CONVERTING ENZYM

Facility

$12.00

Service Code	CPT 82164 90
Hospital Charge Code	900911119
Hospital Revenue Code	301
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.20
Rate for Payer: Aetna of CA Government/Medicare	$7.20
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

HC SOM ANGIOTENSIN 1 CONVERTING ENZYM

Facility

$12.00

Service Code	CPT 82164
Hospital Charge Code	900911119
Hospital Revenue Code	301
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.20
Rate for Payer: Aetna of CA Government/Medicare	$7.20
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

HC SOM ANGIOTENSIN CONVERT ENZ CS

Facility

$68.50

Service Code	CPT 82164 90
Hospital Charge Code	900913826
Hospital Revenue Code	301
Min. Negotiated Rate	$37.68
Max. Negotiated Rate	$54.80
Rate for Payer: Cash Price	$30.83
Rate for Payer: Cigna of CA HMO/PPO	$54.80
Rate for Payer: Health Smart Auto/Commercial	$41.10
Rate for Payer: LLUH Dept of Risk Management WC	$37.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$51.38

HC SOM ANGIOTENSIN CONVERT ENZ CS

Facility

$68.50

Service Code	CPT 82164
Hospital Charge Code	900913826
Hospital Revenue Code	301
Min. Negotiated Rate	$37.68
Max. Negotiated Rate	$54.80
Rate for Payer: Cash Price	$30.83
Rate for Payer: Cigna of CA HMO/PPO	$54.80
Rate for Payer: Health Smart Auto/Commercial	$41.10
Rate for Payer: LLUH Dept of Risk Management WC	$37.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$51.38

HC SOM ANGIOTENSIN CONVERT ENZ CS

Facility

$68.50

Service Code	CPT 82164 90
Hospital Charge Code	900913826
Hospital Revenue Code	301
Min. Negotiated Rate	$37.68
Max. Negotiated Rate	$51.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$41.10
Rate for Payer: Aetna of CA Government/Medicare	$41.10
Rate for Payer: Cash Price	$30.83
Rate for Payer: Health Smart Auto/Commercial	$41.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$41.10
Rate for Payer: LLUH Dept of Risk Management WC	$37.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$51.38

HC SOM ANGIOTENSIN CONVERT ENZ CS

Facility

$68.50

Service Code	CPT 82164
Hospital Charge Code	900913826
Hospital Revenue Code	301
Min. Negotiated Rate	$37.68
Max. Negotiated Rate	$51.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$41.10
Rate for Payer: Aetna of CA Government/Medicare	$41.10
Rate for Payer: Cash Price	$30.83
Rate for Payer: Health Smart Auto/Commercial	$41.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$41.10
Rate for Payer: LLUH Dept of Risk Management WC	$37.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$51.38

HC SOM ANTI-DIURETIC HORMONE

Facility

$80.00

Service Code	CPT 84588 90
Hospital Charge Code	900911035
Hospital Revenue Code	301
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$64.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna of CA HMO/PPO	$64.00
Rate for Payer: Health Smart Auto/Commercial	$48.00
Rate for Payer: LLUH Dept of Risk Management WC	$44.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$60.00

HC SOM ANTI-DIURETIC HORMONE

Facility

$80.00

Service Code	CPT 84588
Hospital Charge Code	900911035
Hospital Revenue Code	301
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$48.00
Rate for Payer: Aetna of CA Government/Medicare	$48.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Smart Auto/Commercial	$48.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$48.00
Rate for Payer: LLUH Dept of Risk Management WC	$44.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$60.00

Know your out-of-pocket cost for care.

All Charges