Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM COPPER SERUM

Facility

$14.32

Service Code	CPT 82525 90
Hospital Charge Code	900911099
Hospital Revenue Code	301
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$11.46
Rate for Payer: Cash Price	$6.44
Rate for Payer: Cigna of CA HMO/PPO	$11.46
Rate for Payer: Health Smart Auto/Commercial	$8.59
Rate for Payer: LLUH Dept of Risk Management WC	$7.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$10.74

HC SOM COPPER URINE

Facility

$45.00

Service Code	CPT 82525
Hospital Charge Code	900911134
Hospital Revenue Code	301
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$36.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Cigna of CA HMO/PPO	$36.00
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC SOM COPPER URINE

Facility

$45.00

Service Code	CPT 82525 90
Hospital Charge Code	900911134
Hospital Revenue Code	301
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$36.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Cigna of CA HMO/PPO	$36.00
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC SOM COPPER URINE

Facility

$45.00

Service Code	CPT 82525
Hospital Charge Code	900911134
Hospital Revenue Code	301
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.00
Rate for Payer: Aetna of CA Government/Medicare	$27.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC SOM COPPER URINE

Facility

$45.00

Service Code	CPT 82525 90
Hospital Charge Code	900911134
Hospital Revenue Code	301
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.00
Rate for Payer: Aetna of CA Government/Medicare	$27.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC SOM CORTISOL FREE RANDOM UR

Facility

$25.00

Service Code	CPT 82530
Hospital Charge Code	900912608
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 CORTISOL FREE RANDOM UR

Facility

$25.00

Service Code	CPT 82530 90
Hospital Charge Code	900912608
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 CORTISOL FREE RANDOM UR

Facility

$25.00

Service Code	CPT 82530 90
Hospital Charge Code	900912608
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 CORTISOL FREE RANDOM UR

Facility

$25.00

Service Code	CPT 82530
Hospital Charge Code	900912608
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 CORTISOL FREE SERUM

Facility

$38.00

Service Code	CPT 82530 90
Hospital Charge Code	900910672
Hospital Revenue Code	301
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$28.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.80
Rate for Payer: Aetna of CA Government/Medicare	$22.80
Rate for Payer: Cash Price	$17.10
Rate for Payer: Health Smart Auto/Commercial	$22.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.80
Rate for Payer: LLUH Dept of Risk Management WC	$20.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.50

HC SOM CORTISOL FREE SERUM

Facility

$38.00

Service Code	CPT 82530
Hospital Charge Code	900910672
Hospital Revenue Code	301
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$30.40
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cigna of CA HMO/PPO	$30.40
Rate for Payer: Health Smart Auto/Commercial	$22.80
Rate for Payer: LLUH Dept of Risk Management WC	$20.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.50

HC SOM CORTISOL FREE SERUM

Facility

$38.00

Service Code	CPT 82530 90
Hospital Charge Code	900910672
Hospital Revenue Code	301
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$30.40
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cigna of CA HMO/PPO	$30.40
Rate for Payer: Health Smart Auto/Commercial	$22.80
Rate for Payer: LLUH Dept of Risk Management WC	$20.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.50

HC SOM CORTISOL FREE SERUM

Facility

$38.00

Service Code	CPT 82530
Hospital Charge Code	900910672
Hospital Revenue Code	301
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$28.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.80
Rate for Payer: Aetna of CA Government/Medicare	$22.80
Rate for Payer: Cash Price	$17.10
Rate for Payer: Health Smart Auto/Commercial	$22.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.80
Rate for Payer: LLUH Dept of Risk Management WC	$20.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$28.50

HC SOM CORTISOL FREE UR

Facility

$25.00

Service Code	CPT 82530 90
Hospital Charge Code	900914673
Hospital Revenue Code	300
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 CORTISOL FREE UR

Facility

$25.00

Service Code	CPT 82530 90
Hospital Charge Code	900914673
Hospital Revenue Code	300
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 CORTISOL FREE UR

Facility

$25.00

Service Code	CPT 82530
Hospital Charge Code	900914673
Hospital Revenue Code	300
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 CORTISOL FREE UR

Facility

$25.00

Service Code	CPT 82530
Hospital Charge Code	900914673
Hospital Revenue Code	300
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 CORTISOL FREE URINE

Facility

$25.00

Service Code	CPT 82530
Hospital Charge Code	900911026
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 CORTISOL FREE URINE

Facility

$25.00

Service Code	CPT 82530
Hospital Charge Code	900911026
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 CORTISOL FREE URINE

Facility

$25.00

Service Code	CPT 82530 90
Hospital Charge Code	900911026
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 CORTISOL FREE URINE

Facility

$25.00

Service Code	CPT 82530 90
Hospital Charge Code	900911026
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 COUMADIN LEVEL

Facility

$109.00

Service Code	CPT 80375
Hospital Charge Code	900911161
Hospital Revenue Code	301
Min. Negotiated Rate	$59.95
Max. Negotiated Rate	$87.20
Rate for Payer: Cash Price	$49.05
Rate for Payer: Cigna of CA HMO/PPO	$87.20
Rate for Payer: Health Smart Auto/Commercial	$65.40
Rate for Payer: LLUH Dept of Risk Management WC	$59.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$81.75

HC SOM COUMADIN LEVEL

Facility

$109.00

Service Code	CPT 80375 90
Hospital Charge Code	900911161
Hospital Revenue Code	301
Min. Negotiated Rate	$59.95
Max. Negotiated Rate	$87.20
Rate for Payer: Cash Price	$49.05
Rate for Payer: Cigna of CA HMO/PPO	$87.20
Rate for Payer: Health Smart Auto/Commercial	$65.40
Rate for Payer: LLUH Dept of Risk Management WC	$59.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$81.75

HC SOM COUMADIN LEVEL

Facility

$109.00

Service Code	CPT 80375 90
Hospital Charge Code	900911161
Hospital Revenue Code	301
Min. Negotiated Rate	$59.95
Max. Negotiated Rate	$81.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$65.40
Rate for Payer: Aetna of CA Government/Medicare	$65.40
Rate for Payer: Cash Price	$49.05
Rate for Payer: Health Smart Auto/Commercial	$65.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$65.40
Rate for Payer: LLUH Dept of Risk Management WC	$59.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$81.75

HC SOM COUMADIN LEVEL

Facility

$109.00

Service Code	CPT 80375
Hospital Charge Code	900911161
Hospital Revenue Code	301
Min. Negotiated Rate	$59.95
Max. Negotiated Rate	$81.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$65.40
Rate for Payer: Aetna of CA Government/Medicare	$65.40
Rate for Payer: Cash Price	$49.05
Rate for Payer: Health Smart Auto/Commercial	$65.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$65.40
Rate for Payer: LLUH Dept of Risk Management WC	$59.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$81.75

Know your out-of-pocket cost for care.

All Charges