Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM CAH DEOXYCORTICOSTERONE

Facility

$81.42

Service Code	CPT 82633 90
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

HC SOM CAH DEOXYCORTICOSTERONE

Facility

$81.42

Service Code	CPT 82633 90
Hospital Charge Code	900912773
Hospital Revenue Code	301
Min. Negotiated Rate	$44.78
Max. Negotiated Rate	$65.14
Rate for Payer: Cash Price	$36.64
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$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	$36.64
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$61.06

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	$41.12
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	$24.67
Rate for Payer: Health Smart Auto/Commercial	$32.90
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 Beech St/Commercial/PHCS	$41.12

HC SOM CAH PROGESTERONE

Facility

$54.83

Service Code	CPT 84144 90
Hospital Charge Code	900912777
Hospital Revenue Code	301
Min. Negotiated Rate	$30.16
Max. Negotiated Rate	$43.86
Rate for Payer: Cash Price	$24.67
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$41.12

HC SOM CAH PROGESTERONE

Facility

$54.83

Service Code	CPT 84144 90
Hospital Charge Code	900912777
Hospital Revenue Code	301
Min. Negotiated Rate	$30.16
Max. Negotiated Rate	$41.12
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	$24.67
Rate for Payer: Health Smart Auto/Commercial	$32.90
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 Beech St/Commercial/PHCS	$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	$24.67
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$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	$50.87
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	$30.52
Rate for Payer: Health Smart Auto/Commercial	$40.70
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 Beech St/Commercial/PHCS	$50.87

HC SOM CAH TESTOSTERONE

Facility

$67.83

Service Code	CPT 84403 90
Hospital Charge Code	900912779
Hospital Revenue Code	301
Min. Negotiated Rate	$37.31
Max. Negotiated Rate	$50.87
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	$30.52
Rate for Payer: Health Smart Auto/Commercial	$40.70
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 Beech St/Commercial/PHCS	$50.87

HC SOM CAH TESTOSTERONE

Facility

$67.83

Service Code	CPT 84403 90
Hospital Charge Code	900912779
Hospital Revenue Code	301
Min. Negotiated Rate	$37.31
Max. Negotiated Rate	$54.26
Rate for Payer: Cash Price	$30.52
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$50.87

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	$30.52
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$50.87

HC SOM CALCITONIN

Facility

$20.00

Service Code	CPT 82308 90
Hospital Charge Code	900911003
Hospital Revenue Code	301
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$15.00
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	$9.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
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 Beech St/Commercial/PHCS	$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	$15.00
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	$9.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
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 Beech St/Commercial/PHCS	$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	$16.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$15.00

HC SOM CALCITONIN

Facility

$20.00

Service Code	CPT 82308 90
Hospital Charge Code	900911003
Hospital Revenue Code	301
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$16.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$15.00

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	$40.50
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$67.50

HC SOM CALPROTECTIN

Facility

$90.00

Service Code	CPT 83993 90
Hospital Charge Code	900912938
Hospital Revenue Code	301
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$67.50
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	$40.50
Rate for Payer: Health Smart Auto/Commercial	$54.00
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 Beech St/Commercial/PHCS	$67.50

HC SOM CALPROTECTIN

Facility

$90.00

Service Code	CPT 83993 90
Hospital Charge Code	900912938
Hospital Revenue Code	301
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$72.00
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$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	$67.50
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	$40.50
Rate for Payer: Health Smart Auto/Commercial	$54.00
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 Beech St/Commercial/PHCS	$67.50

HC SOM CARBAPEN MOD HODGE TEST

Facility

$164.70

Service Code	CPT 87185 90
Hospital Charge Code	900914208
Hospital Revenue Code	306
Min. Negotiated Rate	$90.58
Max. Negotiated Rate	$131.76
Rate for Payer: Cash Price	$74.12
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$123.52

HC SOM CARBAPEN MOD HODGE TEST

Facility

$164.70

Service Code	CPT 87185 90
Hospital Charge Code	900914208
Hospital Revenue Code	306
Min. Negotiated Rate	$90.58
Max. Negotiated Rate	$123.52
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	$74.12
Rate for Payer: Health Smart Auto/Commercial	$98.82
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 Beech St/Commercial/PHCS	$123.52

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	$123.52
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	$74.12
Rate for Payer: Health Smart Auto/Commercial	$98.82
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 Beech St/Commercial/PHCS	$123.52

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	$74.12
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$123.52

HC SOM CARB DEF TRANS CONGENITAL

Facility

$200.00

Service Code	CPT 82373 90
Hospital Charge Code	900912514
Hospital Revenue Code	301
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$150.00
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	$90.00
Rate for Payer: Health Smart Auto/Commercial	$120.00
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 Beech St/Commercial/PHCS	$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	$110.00
Max. Negotiated Rate	$160.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$150.00

Know your out-of-pocket cost for care.

All Charges