Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM CAH 11-DESOXYCORTISOL

Facility

$76.96

Service Code	CPT 82634
Hospital Charge Code	900912775
Hospital Revenue Code	301
Min. Negotiated Rate	$42.33
Max. Negotiated Rate	$61.57
Rate for Payer: Cash Price	$34.63
Rate for Payer: Cigna of CA HMO/PPO	$61.57
Rate for Payer: Health Smart Auto/Commercial	$46.18
Rate for Payer: LLUH Dept of Risk Management WC	$42.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$57.72

HC SOM CAH 11-DESOXYCORTISOL

Facility

$76.96

Service Code	CPT 82634 90
Hospital Charge Code	900912775
Hospital Revenue Code	301
Min. Negotiated Rate	$42.33
Max. Negotiated Rate	$61.57
Rate for Payer: Cash Price	$34.63
Rate for Payer: Cigna of CA HMO/PPO	$61.57
Rate for Payer: Health Smart Auto/Commercial	$46.18
Rate for Payer: LLUH Dept of Risk Management WC	$42.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$57.72

HC SOM CAH 11-DESOXYCORTISOL

Facility

$76.96

Service Code	CPT 82634 90
Hospital Charge Code	900912775
Hospital Revenue Code	301
Min. Negotiated Rate	$42.33
Max. Negotiated Rate	$57.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$46.18
Rate for Payer: Aetna of CA Government/Medicare	$46.18
Rate for Payer: Cash Price	$34.63
Rate for Payer: Health Smart Auto/Commercial	$46.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$46.18
Rate for Payer: LLUH Dept of Risk Management WC	$42.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$57.72

HC SOM CAH 11-DESOXYCORTISOL

Facility

$76.96

Service Code	CPT 82634
Hospital Charge Code	900912775
Hospital Revenue Code	301
Min. Negotiated Rate	$42.33
Max. Negotiated Rate	$57.72
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$46.18
Rate for Payer: Aetna of CA Government/Medicare	$46.18
Rate for Payer: Cash Price	$34.63
Rate for Payer: Health Smart Auto/Commercial	$46.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$46.18
Rate for Payer: LLUH Dept of Risk Management WC	$42.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$57.72

HC SOM CAH 17-ALPHA-OH PROGESTERONE

Facility

$71.41

Service Code	CPT 83498 90
Hospital Charge Code	900912778
Hospital Revenue Code	301
Min. Negotiated Rate	$39.28
Max. Negotiated Rate	$53.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$42.85
Rate for Payer: Aetna of CA Government/Medicare	$42.85
Rate for Payer: Cash Price	$32.13
Rate for Payer: Health Smart Auto/Commercial	$42.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$42.85
Rate for Payer: LLUH Dept of Risk Management WC	$39.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$53.56

HC SOM CAH 17-ALPHA-OH PROGESTERONE

Facility

$71.41

Service Code	CPT 83498
Hospital Charge Code	900912778
Hospital Revenue Code	301
Min. Negotiated Rate	$39.28
Max. Negotiated Rate	$57.13
Rate for Payer: Cash Price	$32.13
Rate for Payer: Cigna of CA HMO/PPO	$57.13
Rate for Payer: Health Smart Auto/Commercial	$42.85
Rate for Payer: LLUH Dept of Risk Management WC	$39.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$53.56

HC SOM CAH 17-ALPHA-OH PROGESTERONE

Facility

$71.41

Service Code	CPT 83498 90
Hospital Charge Code	900912778
Hospital Revenue Code	301
Min. Negotiated Rate	$39.28
Max. Negotiated Rate	$57.13
Rate for Payer: Cash Price	$32.13
Rate for Payer: Cigna of CA HMO/PPO	$57.13
Rate for Payer: Health Smart Auto/Commercial	$42.85
Rate for Payer: LLUH Dept of Risk Management WC	$39.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$53.56

HC SOM CAH 17-ALPHA-OH PROGESTERONE

Facility

$71.41

Service Code	CPT 83498
Hospital Charge Code	900912778
Hospital Revenue Code	301
Min. Negotiated Rate	$39.28
Max. Negotiated Rate	$53.56
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$42.85
Rate for Payer: Aetna of CA Government/Medicare	$42.85
Rate for Payer: Cash Price	$32.13
Rate for Payer: Health Smart Auto/Commercial	$42.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$42.85
Rate for Payer: LLUH Dept of Risk Management WC	$39.28
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$53.56

HC SOM CAH 17-OH PREGNENOLONE

Facility

$59.95

Service Code	CPT 84143 90
Hospital Charge Code	900912776
Hospital Revenue Code	301
Min. Negotiated Rate	$32.97
Max. Negotiated Rate	$47.96
Rate for Payer: Cash Price	$26.98
Rate for Payer: Cigna of CA HMO/PPO	$47.96
Rate for Payer: Health Smart Auto/Commercial	$35.97
Rate for Payer: LLUH Dept of Risk Management WC	$32.97
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$44.96

HC SOM CAH 17-OH PREGNENOLONE

Facility

$59.95

Service Code	CPT 84143
Hospital Charge Code	900912776
Hospital Revenue Code	301
Min. Negotiated Rate	$32.97
Max. Negotiated Rate	$44.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$35.97
Rate for Payer: Aetna of CA Government/Medicare	$35.97
Rate for Payer: Cash Price	$26.98
Rate for Payer: Health Smart Auto/Commercial	$35.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$35.97
Rate for Payer: LLUH Dept of Risk Management WC	$32.97
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$44.96

HC SOM CAH 17-OH PREGNENOLONE

Facility

$59.95

Service Code	CPT 84143 90
Hospital Charge Code	900912776
Hospital Revenue Code	301
Min. Negotiated Rate	$32.97
Max. Negotiated Rate	$44.96
Rate for Payer: Health Smart Auto/Commercial	$35.97
Rate for Payer: Cash Price	$26.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$35.97
Rate for Payer: Aetna of CA Government/Medicare	$35.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$35.97
Rate for Payer: LLUH Dept of Risk Management WC	$32.97
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$44.96

HC SOM CAH 17-OH PREGNENOLONE

Facility

$59.95

Service Code	CPT 84143
Hospital Charge Code	900912776
Hospital Revenue Code	301
Min. Negotiated Rate	$32.97
Max. Negotiated Rate	$47.96
Rate for Payer: Cash Price	$26.98
Rate for Payer: Cigna of CA HMO/PPO	$47.96
Rate for Payer: Health Smart Auto/Commercial	$35.97
Rate for Payer: LLUH Dept of Risk Management WC	$32.97
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$44.96

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	$34.63
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$57.71

HC SOM CAH ANDROSTENEDIONE

Facility

$76.95

Service Code	CPT 82157 90
Hospital Charge Code	900912771
Hospital Revenue Code	301
Min. Negotiated Rate	$42.32
Max. Negotiated Rate	$57.71
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	$34.63
Rate for Payer: Health Smart Auto/Commercial	$46.17
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 Beech St/Commercial/PHCS	$57.71

HC SOM CAH ANDROSTENEDIONE

Facility

$76.95

Service Code	CPT 82157 90
Hospital Charge Code	900912771
Hospital Revenue Code	301
Min. Negotiated Rate	$42.32
Max. Negotiated Rate	$61.56
Rate for Payer: Cash Price	$34.63
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$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	$57.71
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	$34.63
Rate for Payer: Health Smart Auto/Commercial	$46.17
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 Beech St/Commercial/PHCS	$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	$19.28
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$32.13

HC SOM CAH CORTISOL

Facility

$42.84

Service Code	CPT 82533 90
Hospital Charge Code	900912772
Hospital Revenue Code	301
Min. Negotiated Rate	$23.56
Max. Negotiated Rate	$34.27
Rate for Payer: Cash Price	$19.28
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$32.13

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	$32.13
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	$19.28
Rate for Payer: Health Smart Auto/Commercial	$25.70
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 Beech St/Commercial/PHCS	$32.13

HC SOM CAH CORTISOL

Facility

$42.84

Service Code	CPT 82533 90
Hospital Charge Code	900912772
Hospital Revenue Code	301
Min. Negotiated Rate	$23.56
Max. Negotiated Rate	$32.13
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	$19.28
Rate for Payer: Health Smart Auto/Commercial	$25.70
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 Beech St/Commercial/PHCS	$32.13

HC SOM CAH DEHYDROEPIANDROSTERONE

Facility

$66.41

Service Code	CPT 82626 90
Hospital Charge Code	900912774
Hospital Revenue Code	301
Min. Negotiated Rate	$36.53
Max. Negotiated Rate	$49.81
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	$29.88
Rate for Payer: Health Smart Auto/Commercial	$39.85
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 Beech St/Commercial/PHCS	$49.81

HC SOM CAH DEHYDROEPIANDROSTERONE

Facility

$66.41

Service Code	CPT 82626 90
Hospital Charge Code	900912774
Hospital Revenue Code	301
Min. Negotiated Rate	$36.53
Max. Negotiated Rate	$53.13
Rate for Payer: Cash Price	$29.88
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$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	$29.88
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$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	$49.81
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	$29.88
Rate for Payer: Health Smart Auto/Commercial	$39.85
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 Beech St/Commercial/PHCS	$49.81

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	$61.06
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	$36.64
Rate for Payer: Health Smart Auto/Commercial	$48.85
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 Beech St/Commercial/PHCS	$61.06

Know your out-of-pocket cost for care.

All Charges