Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM PRIMIDONE LEVEL

Facility

$26.01

Service Code	CPT 80188
Hospital Charge Code	900911489
Hospital Revenue Code	301
Min. Negotiated Rate	$14.31
Max. Negotiated Rate	$20.81
Rate for Payer: Cash Price	$11.70
Rate for Payer: Cigna of CA HMO/PPO	$20.81
Rate for Payer: Health Smart Auto/Commercial	$15.61
Rate for Payer: LLUH Dept of Risk Management WC	$14.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$19.51

HC SOM PRIMIDONE LEVEL

Facility

$26.01

Service Code	CPT 80188
Hospital Charge Code	900911489
Hospital Revenue Code	301
Min. Negotiated Rate	$14.31
Max. Negotiated Rate	$19.51
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.61
Rate for Payer: Aetna of CA Government/Medicare	$15.61
Rate for Payer: Cash Price	$11.70
Rate for Payer: Health Smart Auto/Commercial	$15.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.61
Rate for Payer: LLUH Dept of Risk Management WC	$14.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$19.51

HC SOM PRIMIDONE LEVEL

Facility

$26.01

Service Code	CPT 80188 90
Hospital Charge Code	900911489
Hospital Revenue Code	301
Min. Negotiated Rate	$14.31
Max. Negotiated Rate	$20.81
Rate for Payer: Cash Price	$11.70
Rate for Payer: Cigna of CA HMO/PPO	$20.81
Rate for Payer: Health Smart Auto/Commercial	$15.61
Rate for Payer: LLUH Dept of Risk Management WC	$14.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$19.51

HC SOM PRIMIDONE LEVEL

Facility

$26.01

Service Code	CPT 80188 90
Hospital Charge Code	900911489
Hospital Revenue Code	301
Min. Negotiated Rate	$14.31
Max. Negotiated Rate	$19.51
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.61
Rate for Payer: Aetna of CA Government/Medicare	$15.61
Rate for Payer: Cash Price	$11.70
Rate for Payer: Health Smart Auto/Commercial	$15.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.61
Rate for Payer: LLUH Dept of Risk Management WC	$14.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$19.51

HC SOM PROINSULIN

Facility

$26.69

Service Code	CPT 84206 90
Hospital Charge Code	900911398
Hospital Revenue Code	301
Min. Negotiated Rate	$14.68
Max. Negotiated Rate	$20.02
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.01
Rate for Payer: Aetna of CA Government/Medicare	$16.01
Rate for Payer: Cash Price	$12.01
Rate for Payer: Health Smart Auto/Commercial	$16.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.01
Rate for Payer: LLUH Dept of Risk Management WC	$14.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.02

HC SOM PROINSULIN

Facility

$26.69

Service Code	CPT 84206
Hospital Charge Code	900911398
Hospital Revenue Code	301
Min. Negotiated Rate	$14.68
Max. Negotiated Rate	$20.02
Rate for Payer: Health Smart Auto/Commercial	$16.01
Rate for Payer: Cash Price	$12.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.01
Rate for Payer: Aetna of CA Government/Medicare	$16.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.01
Rate for Payer: LLUH Dept of Risk Management WC	$14.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.02

HC SOM PROINSULIN

Facility

$26.69

Service Code	CPT 84206
Hospital Charge Code	900911398
Hospital Revenue Code	301
Min. Negotiated Rate	$14.68
Max. Negotiated Rate	$21.35
Rate for Payer: Cash Price	$12.01
Rate for Payer: Cigna of CA HMO/PPO	$21.35
Rate for Payer: Health Smart Auto/Commercial	$16.01
Rate for Payer: LLUH Dept of Risk Management WC	$14.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.02

HC SOM PROINSULIN

Facility

$26.69

Service Code	CPT 84206 90
Hospital Charge Code	900911398
Hospital Revenue Code	301
Min. Negotiated Rate	$14.68
Max. Negotiated Rate	$21.35
Rate for Payer: Cash Price	$12.01
Rate for Payer: Cigna of CA HMO/PPO	$21.35
Rate for Payer: Health Smart Auto/Commercial	$16.01
Rate for Payer: LLUH Dept of Risk Management WC	$14.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.02

HC SOM PROTEINASE 3 AB

Facility

$19.01

Service Code	CPT 83516 90
Hospital Charge Code	900912701
Hospital Revenue Code	302
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$15.21
Rate for Payer: Cash Price	$8.55
Rate for Payer: Cigna of CA HMO/PPO	$15.21
Rate for Payer: Health Smart Auto/Commercial	$11.41
Rate for Payer: LLUH Dept of Risk Management WC	$10.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.26

HC SOM PROTEINASE 3 AB

Facility

$19.01

Service Code	CPT 83516
Hospital Charge Code	900912701
Hospital Revenue Code	302
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$14.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.41
Rate for Payer: Aetna of CA Government/Medicare	$11.41
Rate for Payer: Cash Price	$8.55
Rate for Payer: Health Smart Auto/Commercial	$11.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.41
Rate for Payer: LLUH Dept of Risk Management WC	$10.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.26

HC SOM PROTEINASE 3 AB

Facility

$19.01

Service Code	CPT 83516 90
Hospital Charge Code	900912701
Hospital Revenue Code	302
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$14.26
Rate for Payer: Health Smart Auto/Commercial	$11.41
Rate for Payer: Cash Price	$8.55
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.41
Rate for Payer: Aetna of CA Government/Medicare	$11.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.41
Rate for Payer: LLUH Dept of Risk Management WC	$10.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.26

HC SOM PROTEINASE 3 AB

Facility

$19.01

Service Code	CPT 83516
Hospital Charge Code	900912701
Hospital Revenue Code	302
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$15.21
Rate for Payer: Cash Price	$8.55
Rate for Payer: Cigna of CA HMO/PPO	$15.21
Rate for Payer: Health Smart Auto/Commercial	$11.41
Rate for Payer: LLUH Dept of Risk Management WC	$10.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.26

HC SOM PROTEIN C AG

Facility

$223.58

Service Code	CPT 85302
Hospital Charge Code	900913801
Hospital Revenue Code	305
Min. Negotiated Rate	$122.97
Max. Negotiated Rate	$167.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$134.15
Rate for Payer: Aetna of CA Government/Medicare	$134.15
Rate for Payer: Cash Price	$100.61
Rate for Payer: Health Smart Auto/Commercial	$134.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$134.15
Rate for Payer: LLUH Dept of Risk Management WC	$122.97
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$167.68

HC SOM PROTEIN C AG

Facility

$223.58

Service Code	CPT 85302
Hospital Charge Code	900913801
Hospital Revenue Code	305
Min. Negotiated Rate	$122.97
Max. Negotiated Rate	$178.86
Rate for Payer: Cash Price	$100.61
Rate for Payer: Cigna of CA HMO/PPO	$178.86
Rate for Payer: Health Smart Auto/Commercial	$134.15
Rate for Payer: LLUH Dept of Risk Management WC	$122.97
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$167.68

HC SOM PROTEIN C AG

Facility

$223.58

Service Code	CPT 85302 90
Hospital Charge Code	900913801
Hospital Revenue Code	305
Min. Negotiated Rate	$122.97
Max. Negotiated Rate	$178.86
Rate for Payer: Cash Price	$100.61
Rate for Payer: Cigna of CA HMO/PPO	$178.86
Rate for Payer: Health Smart Auto/Commercial	$134.15
Rate for Payer: LLUH Dept of Risk Management WC	$122.97
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$167.68

HC SOM PROTEIN C AG

Facility

$223.58

Service Code	CPT 85302 90
Hospital Charge Code	900913801
Hospital Revenue Code	305
Min. Negotiated Rate	$122.97
Max. Negotiated Rate	$167.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$134.15
Rate for Payer: Aetna of CA Government/Medicare	$134.15
Rate for Payer: Cash Price	$100.61
Rate for Payer: Health Smart Auto/Commercial	$134.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$134.15
Rate for Payer: LLUH Dept of Risk Management WC	$122.97
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$167.68

HC SOM PROTEIN ELECT URINE

Facility

$24.88

Service Code	CPT 84166 90
Hospital Charge Code	900912721
Hospital Revenue Code	301
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$19.90
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cigna of CA HMO/PPO	$19.90
Rate for Payer: Health Smart Auto/Commercial	$14.93
Rate for Payer: LLUH Dept of Risk Management WC	$13.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.66

HC SOM PROTEIN ELECT URINE

Facility

$24.88

Service Code	CPT 84166
Hospital Charge Code	900912721
Hospital Revenue Code	301
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$18.66
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.93
Rate for Payer: Aetna of CA Government/Medicare	$14.93
Rate for Payer: Cash Price	$11.20
Rate for Payer: Health Smart Auto/Commercial	$14.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.93
Rate for Payer: LLUH Dept of Risk Management WC	$13.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.66

HC SOM PROTEIN ELECT URINE

Facility

$24.88

Service Code	CPT 84166
Hospital Charge Code	900912721
Hospital Revenue Code	301
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$19.90
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cigna of CA HMO/PPO	$19.90
Rate for Payer: Health Smart Auto/Commercial	$14.93
Rate for Payer: LLUH Dept of Risk Management WC	$13.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.66

HC SOM PROTEIN ELECT URINE

Facility

$24.88

Service Code	CPT 84166 90
Hospital Charge Code	900912721
Hospital Revenue Code	301
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$18.66
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.93
Rate for Payer: Aetna of CA Government/Medicare	$14.93
Rate for Payer: Cash Price	$11.20
Rate for Payer: Health Smart Auto/Commercial	$14.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.93
Rate for Payer: LLUH Dept of Risk Management WC	$13.68
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.66

HC SOM PROTEIN S AG

Facility

$21.95

Service Code	CPT 85306
Hospital Charge Code	900913807
Hospital Revenue Code	305
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$17.56
Rate for Payer: Cash Price	$9.88
Rate for Payer: Cigna of CA HMO/PPO	$17.56
Rate for Payer: Health Smart Auto/Commercial	$13.17
Rate for Payer: LLUH Dept of Risk Management WC	$12.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.46

HC SOM PROTEIN S AG

Facility

$21.95

Service Code	CPT 85306 90
Hospital Charge Code	900913807
Hospital Revenue Code	305
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$16.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.17
Rate for Payer: Aetna of CA Government/Medicare	$13.17
Rate for Payer: Cash Price	$9.88
Rate for Payer: Health Smart Auto/Commercial	$13.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.17
Rate for Payer: LLUH Dept of Risk Management WC	$12.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.46

HC SOM PROTEIN S AG

Facility

$21.95

Service Code	CPT 85306 90
Hospital Charge Code	900913807
Hospital Revenue Code	305
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$17.56
Rate for Payer: Cash Price	$9.88
Rate for Payer: Cigna of CA HMO/PPO	$17.56
Rate for Payer: Health Smart Auto/Commercial	$13.17
Rate for Payer: LLUH Dept of Risk Management WC	$12.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.46

HC SOM PROTEIN S AG

Facility

$21.95

Service Code	CPT 85306
Hospital Charge Code	900913807
Hospital Revenue Code	305
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$16.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.17
Rate for Payer: Aetna of CA Government/Medicare	$13.17
Rate for Payer: Cash Price	$9.88
Rate for Payer: Health Smart Auto/Commercial	$13.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.17
Rate for Payer: LLUH Dept of Risk Management WC	$12.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.46

HC SOM PROTEIN S PLASMA

Facility

$28.63

Service Code	CPT 85306 90
Hospital Charge Code	900911277
Hospital Revenue Code	305
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$22.90
Rate for Payer: Cash Price	$12.88
Rate for Payer: Cigna of CA HMO/PPO	$22.90
Rate for Payer: Health Smart Auto/Commercial	$17.18
Rate for Payer: LLUH Dept of Risk Management WC	$15.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21.47

Know your out-of-pocket cost for care.

All Charges