Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM TCP 88184

Facility

$199.38

Service Code	CPT 88184
Hospital Charge Code	900914882
Hospital Revenue Code	309
Min. Negotiated Rate	$109.66
Max. Negotiated Rate	$159.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$119.63
Rate for Payer: Aetna of CA Government/Medicare	$119.63
Rate for Payer: Cash Price	$199.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$159.50
Rate for Payer: Health Smart Auto/Commercial	$119.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$119.63
Rate for Payer: LLUH Dept of Risk Management WC	$109.66
Rate for Payer: Multiplan Commercial	$149.53

HC SOM TESTOSTERONE FREE

Facility

$8.94

Service Code	CPT 84402
Hospital Charge Code	900911131
Hospital Revenue Code	300
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$7.15
Rate for Payer: Cash Price	$8.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.15
Rate for Payer: Health Smart Auto/Commercial	$5.36
Rate for Payer: LLUH Dept of Risk Management WC	$4.92
Rate for Payer: Multiplan Commercial	$6.71

HC SOM TESTOSTERONE FREE

Facility

$8.94

Service Code	CPT 84402
Hospital Charge Code	900911131
Hospital Revenue Code	300
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$25.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.36
Rate for Payer: Aetna of CA Government/Medicare	$5.36
Rate for Payer: Cash Price	$8.94
Rate for Payer: Cash Price	$8.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.15
Rate for Payer: Health Smart Auto/Commercial	$5.36
Rate for Payer: Intervalley Health Plan Commercial	$25.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.36
Rate for Payer: LLUH Dept of Risk Management WC	$4.92
Rate for Payer: Multiplan Commercial	$6.71

HC SOM TETANUS ANTITOXOID (ELISA)

Facility

$20.42

Service Code	CPT 86317
Hospital Charge Code	900911757
Hospital Revenue Code	302
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$16.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.25
Rate for Payer: Aetna of CA Government/Medicare	$12.25
Rate for Payer: Cash Price	$20.42
Rate for Payer: Cash Price	$20.42
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.34
Rate for Payer: Health Smart Auto/Commercial	$12.25
Rate for Payer: Intervalley Health Plan Commercial	$14.99
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.25
Rate for Payer: LLUH Dept of Risk Management WC	$11.23
Rate for Payer: Multiplan Commercial	$15.31

HC SOM TETANUS ANTITOXOID (ELISA)

Facility

$20.42

Service Code	CPT 86317
Hospital Charge Code	900911757
Hospital Revenue Code	302
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$16.34
Rate for Payer: Cash Price	$20.42
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.34
Rate for Payer: Health Smart Auto/Commercial	$12.25
Rate for Payer: LLUH Dept of Risk Management WC	$11.23
Rate for Payer: Multiplan Commercial	$15.31

HC SOM THALLIUM URINE

Facility

$217.26

Service Code	CPT 83018
Hospital Charge Code	900911102
Hospital Revenue Code	301
Min. Negotiated Rate	$119.49
Max. Negotiated Rate	$173.81
Rate for Payer: Cash Price	$217.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$173.81
Rate for Payer: Health Smart Auto/Commercial	$130.36
Rate for Payer: LLUH Dept of Risk Management WC	$119.49
Rate for Payer: Multiplan Commercial	$162.94

HC SOM THALLIUM URINE

Facility

$217.26

Service Code	CPT 83018
Hospital Charge Code	900911102
Hospital Revenue Code	301
Min. Negotiated Rate	$21.96
Max. Negotiated Rate	$173.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$130.36
Rate for Payer: Aetna of CA Government/Medicare	$130.36
Rate for Payer: Cash Price	$217.26
Rate for Payer: Cash Price	$217.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$173.81
Rate for Payer: Health Smart Auto/Commercial	$130.36
Rate for Payer: Intervalley Health Plan Commercial	$21.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$130.36
Rate for Payer: LLUH Dept of Risk Management WC	$119.49
Rate for Payer: Multiplan Commercial	$162.94

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: Aetna of CA EPO/HMO/POS/PPO	$18.96
Rate for Payer: Aetna of CA Government/Medicare	$18.96
Rate for Payer: Cash Price	$31.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$25.28
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 Commercial	$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	$31.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$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	$142.40
Rate for Payer: Cash Price	$178.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$133.50

HC SOM THIOPURINE METAB

Facility

$178.00

Service Code	CPT 80299
Hospital Charge Code	900914912
Hospital Revenue Code	309
Min. Negotiated Rate	$18.64
Max. Negotiated Rate	$142.40
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	$178.00
Rate for Payer: Cash Price	$178.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$142.40
Rate for Payer: Health Smart Auto/Commercial	$106.80
Rate for Payer: Intervalley Health Plan Commercial	$18.64
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 Commercial	$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	$15.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$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	$15.91
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	$15.00
Rate for Payer: Cash Price	$15.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.00
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Intervalley Health Plan Commercial	$15.91
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 Commercial	$11.25

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	$10.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$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	$16.06
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	$10.20
Rate for Payer: Cash Price	$10.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.16
Rate for Payer: Health Smart Auto/Commercial	$6.12
Rate for Payer: Intervalley Health Plan Commercial	$16.06
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 Commercial	$7.65

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	$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 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: 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	$14.78
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 THYROPEROXIDASE AB

Facility

$11.90

Service Code	CPT 86376
Hospital Charge Code	900911315
Hospital Revenue Code	302
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$9.52
Rate for Payer: Cash Price	$11.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$9.52
Rate for Payer: Health Smart Auto/Commercial	$7.14
Rate for Payer: LLUH Dept of Risk Management WC	$6.54
Rate for Payer: Multiplan Commercial	$8.93

HC SOM THYROPEROXIDASE AB

Facility

$11.90

Service Code	CPT 86376
Hospital Charge Code	900911315
Hospital Revenue Code	302
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$14.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.14
Rate for Payer: Aetna of CA Government/Medicare	$7.14
Rate for Payer: Cash Price	$11.90
Rate for Payer: Cash Price	$11.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$9.52
Rate for Payer: Health Smart Auto/Commercial	$7.14
Rate for Payer: Intervalley Health Plan Commercial	$14.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.14
Rate for Payer: LLUH Dept of Risk Management WC	$6.54
Rate for Payer: Multiplan Commercial	$8.93

HC SOM THYROTROPIN RECEPTOR

Facility

$17.27

Service Code	CPT 83520
Hospital Charge Code	900912541
Hospital Revenue Code	301
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$17.27
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.36
Rate for Payer: Aetna of CA Government/Medicare	$10.36
Rate for Payer: Cash Price	$17.27
Rate for Payer: Cash Price	$17.27
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.82
Rate for Payer: Health Smart Auto/Commercial	$10.36
Rate for Payer: Intervalley Health Plan Commercial	$17.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.36
Rate for Payer: LLUH Dept of Risk Management WC	$9.50
Rate for Payer: Multiplan Commercial	$12.95

HC SOM THYROTROPIN RECEPTOR

Facility

$17.27

Service Code	CPT 83520
Hospital Charge Code	900912541
Hospital Revenue Code	301
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$13.82
Rate for Payer: Cash Price	$17.27
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.82
Rate for Payer: Health Smart Auto/Commercial	$10.36
Rate for Payer: LLUH Dept of Risk Management WC	$9.50
Rate for Payer: Multiplan Commercial	$12.95

HC SOM THYROXINE (T4), FREE

Facility

$63.10

Service Code	CPT 84439
Hospital Charge Code	900911005
Hospital Revenue Code	301
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$50.48
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$37.86
Rate for Payer: Aetna of CA Government/Medicare	$37.86
Rate for Payer: Cash Price	$63.10
Rate for Payer: Cash Price	$63.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$50.48
Rate for Payer: Health Smart Auto/Commercial	$37.86
Rate for Payer: Intervalley Health Plan Commercial	$9.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$37.86
Rate for Payer: LLUH Dept of Risk Management WC	$34.70
Rate for Payer: Multiplan Commercial	$47.33

HC SOM THYROXINE (T4), FREE

Facility

$63.10

Service Code	CPT 84439
Hospital Charge Code	900911005
Hospital Revenue Code	301
Min. Negotiated Rate	$34.70
Max. Negotiated Rate	$50.48
Rate for Payer: Cash Price	$63.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$50.48
Rate for Payer: Health Smart Auto/Commercial	$37.86
Rate for Payer: LLUH Dept of Risk Management WC	$34.70
Rate for Payer: Multiplan Commercial	$47.33

HC SOM THYROXIN TOTAL

Facility

$9.84

Service Code	CPT 84436
Hospital Charge Code	900912522
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$7.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.90
Rate for Payer: Aetna of CA Government/Medicare	$5.90
Rate for Payer: Cash Price	$9.84
Rate for Payer: Cash Price	$9.84
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.87
Rate for Payer: Health Smart Auto/Commercial	$5.90
Rate for Payer: Intervalley Health Plan Commercial	$6.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.90
Rate for Payer: LLUH Dept of Risk Management WC	$5.41
Rate for Payer: Multiplan Commercial	$7.38

HC SOM THYROXIN TOTAL

Facility

$9.84

Service Code	CPT 84436
Hospital Charge Code	900912522
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$7.87
Rate for Payer: Cash Price	$9.84
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.87
Rate for Payer: Health Smart Auto/Commercial	$5.90
Rate for Payer: LLUH Dept of Risk Management WC	$5.41
Rate for Payer: Multiplan Commercial	$7.38

Know your out-of-pocket cost for care.

All Charges