Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM SECOBARBITAL

Facility

$228.60

Service Code	CPT G0480
Hospital Charge Code	900910552
Hospital Revenue Code	301
Min. Negotiated Rate	$125.73
Max. Negotiated Rate	$171.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$137.16
Rate for Payer: Aetna of CA Government/Medicare	$137.16
Rate for Payer: Cash Price	$102.87
Rate for Payer: Health Smart Auto/Commercial	$137.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$137.16
Rate for Payer: LLUH Dept of Risk Management WC	$125.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$171.45

HC SOM SECOBARBITAL

Facility

$228.60

Service Code	CPT G0480 90
Hospital Charge Code	900910552
Hospital Revenue Code	301
Min. Negotiated Rate	$125.73
Max. Negotiated Rate	$182.88
Rate for Payer: Cash Price	$102.87
Rate for Payer: Cigna of CA HMO/PPO	$182.88
Rate for Payer: Health Smart Auto/Commercial	$137.16
Rate for Payer: LLUH Dept of Risk Management WC	$125.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$171.45

HC SOM SELENIUM URINE

Facility

$25.62

Service Code	CPT 84255 90
Hospital Charge Code	900911019
Hospital Revenue Code	301
Min. Negotiated Rate	$14.09
Max. Negotiated Rate	$19.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.37
Rate for Payer: Aetna of CA Government/Medicare	$15.37
Rate for Payer: Cash Price	$11.53
Rate for Payer: Health Smart Auto/Commercial	$15.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.37
Rate for Payer: LLUH Dept of Risk Management WC	$14.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$19.22

HC SOM SELENIUM URINE

Facility

$25.62

Service Code	CPT 84255
Hospital Charge Code	900911019
Hospital Revenue Code	301
Min. Negotiated Rate	$14.09
Max. Negotiated Rate	$19.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.37
Rate for Payer: Aetna of CA Government/Medicare	$15.37
Rate for Payer: Cash Price	$11.53
Rate for Payer: Health Smart Auto/Commercial	$15.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.37
Rate for Payer: LLUH Dept of Risk Management WC	$14.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$19.22

HC SOM SELENIUM URINE

Facility

$25.62

Service Code	CPT 84255
Hospital Charge Code	900911019
Hospital Revenue Code	301
Min. Negotiated Rate	$14.09
Max. Negotiated Rate	$20.50
Rate for Payer: Cash Price	$11.53
Rate for Payer: Cigna of CA HMO/PPO	$20.50
Rate for Payer: Health Smart Auto/Commercial	$15.37
Rate for Payer: LLUH Dept of Risk Management WC	$14.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$19.22

HC SOM SELENIUM URINE

Facility

$25.62

Service Code	CPT 84255 90
Hospital Charge Code	900911019
Hospital Revenue Code	301
Min. Negotiated Rate	$14.09
Max. Negotiated Rate	$20.50
Rate for Payer: Cash Price	$11.53
Rate for Payer: Cigna of CA HMO/PPO	$20.50
Rate for Payer: Health Smart Auto/Commercial	$15.37
Rate for Payer: LLUH Dept of Risk Management WC	$14.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$19.22

HC SOM SEROTONIN BLOOD

Facility

$30.00

Service Code	CPT 84260 90
Hospital Charge Code	900911033
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.00
Rate for Payer: Aetna of CA Government/Medicare	$18.00
Rate for Payer: Cash Price	$13.50
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.50

HC SOM SEROTONIN BLOOD

Facility

$30.00

Service Code	CPT 84260 90
Hospital Charge Code	900911033
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$24.00
Rate for Payer: Cash Price	$13.50
Rate for Payer: Cigna of CA HMO/PPO	$24.00
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.50

HC SOM SEROTONIN BLOOD

Facility

$30.00

Service Code	CPT 84260
Hospital Charge Code	900911033
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$24.00
Rate for Payer: Cash Price	$13.50
Rate for Payer: Cigna of CA HMO/PPO	$24.00
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.50

HC SOM SEROTONIN BLOOD

Facility

$30.00

Service Code	CPT 84260
Hospital Charge Code	900911033
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$22.50
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: Cash Price	$13.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.00
Rate for Payer: Aetna of CA Government/Medicare	$18.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.50

HC SOM SEX HORMN BINDNG GLOBU SER

Facility

$13.00

Service Code	CPT 84270
Hospital Charge Code	900913804
Hospital Revenue Code	301
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$10.40
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cigna of CA HMO/PPO	$10.40
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC SOM SEX HORMN BINDNG GLOBU SER

Facility

$13.00

Service Code	CPT 84270 90
Hospital Charge Code	900913804
Hospital Revenue Code	301
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.80
Rate for Payer: Aetna of CA Government/Medicare	$7.80
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC SOM SEX HORMN BINDNG GLOBU SER

Facility

$13.00

Service Code	CPT 84270
Hospital Charge Code	900913804
Hospital Revenue Code	301
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.80
Rate for Payer: Aetna of CA Government/Medicare	$7.80
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC SOM SEX HORMN BINDNG GLOBU SER

Facility

$13.00

Service Code	CPT 84270 90
Hospital Charge Code	900913804
Hospital Revenue Code	301
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$10.40
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cigna of CA HMO/PPO	$10.40
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC SOM SMOOTH MUSCLE AB TITER REFLEX

Facility

$16.93

Service Code	CPT 86015
Hospital Charge Code	900915437
Hospital Revenue Code	300
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$12.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.16
Rate for Payer: Aetna of CA Government/Medicare	$10.16
Rate for Payer: Cash Price	$7.62
Rate for Payer: Health Smart Auto/Commercial	$10.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.16
Rate for Payer: LLUH Dept of Risk Management WC	$9.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.70

HC SOM SMOOTH MUSCLE AB TITER REFLEX

Facility

$16.93

Service Code	CPT 86015
Hospital Charge Code	900915437
Hospital Revenue Code	300
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$13.54
Rate for Payer: Cash Price	$7.62
Rate for Payer: Cigna of CA HMO/PPO	$13.54
Rate for Payer: Health Smart Auto/Commercial	$10.16
Rate for Payer: LLUH Dept of Risk Management WC	$9.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.70

HC SOM SMOOTH MUSCLE AB TITER REFLEX

Facility

$16.93

Service Code	CPT 86015 90
Hospital Charge Code	900915437
Hospital Revenue Code	300
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$13.54
Rate for Payer: Cash Price	$7.62
Rate for Payer: Cigna of CA HMO/PPO	$13.54
Rate for Payer: Health Smart Auto/Commercial	$10.16
Rate for Payer: LLUH Dept of Risk Management WC	$9.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.70

HC SOM SMOOTH MUSCLE AB TITER REFLEX

Facility

$16.93

Service Code	CPT 86015 90
Hospital Charge Code	900915437
Hospital Revenue Code	300
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$12.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.16
Rate for Payer: Aetna of CA Government/Medicare	$10.16
Rate for Payer: Cash Price	$7.62
Rate for Payer: Health Smart Auto/Commercial	$10.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.16
Rate for Payer: LLUH Dept of Risk Management WC	$9.31
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.70

HC SOM SOMATOSTATIN

Facility

$245.00

Service Code	CPT 84307
Hospital Charge Code	900911327
Hospital Revenue Code	301
Min. Negotiated Rate	$134.75
Max. Negotiated Rate	$183.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$147.00
Rate for Payer: Aetna of CA Government/Medicare	$147.00
Rate for Payer: Cash Price	$110.25
Rate for Payer: Health Smart Auto/Commercial	$147.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$147.00
Rate for Payer: LLUH Dept of Risk Management WC	$134.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$183.75

HC SOM SOMATOSTATIN

Facility

$245.00

Service Code	CPT 84307
Hospital Charge Code	900911327
Hospital Revenue Code	301
Min. Negotiated Rate	$134.75
Max. Negotiated Rate	$196.00
Rate for Payer: Cash Price	$110.25
Rate for Payer: Cigna of CA HMO/PPO	$196.00
Rate for Payer: Health Smart Auto/Commercial	$147.00
Rate for Payer: LLUH Dept of Risk Management WC	$134.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$183.75

HC SOM SOMATOSTATIN

Facility

$245.00

Service Code	CPT 84307 90
Hospital Charge Code	900911327
Hospital Revenue Code	301
Min. Negotiated Rate	$134.75
Max. Negotiated Rate	$196.00
Rate for Payer: Cash Price	$110.25
Rate for Payer: Cigna of CA HMO/PPO	$196.00
Rate for Payer: Health Smart Auto/Commercial	$147.00
Rate for Payer: LLUH Dept of Risk Management WC	$134.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$183.75

HC SOM SOMATOSTATIN

Facility

$245.00

Service Code	CPT 84307 90
Hospital Charge Code	900911327
Hospital Revenue Code	301
Min. Negotiated Rate	$134.75
Max. Negotiated Rate	$183.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$147.00
Rate for Payer: Aetna of CA Government/Medicare	$147.00
Rate for Payer: Cash Price	$110.25
Rate for Payer: Health Smart Auto/Commercial	$147.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$147.00
Rate for Payer: LLUH Dept of Risk Management WC	$134.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$183.75

HC SOM SOTALOL

Facility

$82.23

Service Code	CPT 80299
Hospital Charge Code	900910789
Hospital Revenue Code	301
Min. Negotiated Rate	$45.23
Max. Negotiated Rate	$65.78
Rate for Payer: Cash Price	$37.00
Rate for Payer: Cigna of CA HMO/PPO	$65.78
Rate for Payer: Health Smart Auto/Commercial	$49.34
Rate for Payer: LLUH Dept of Risk Management WC	$45.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$61.67

HC SOM SOTALOL

Facility

$82.23

Service Code	CPT 80299 90
Hospital Charge Code	900910789
Hospital Revenue Code	301
Min. Negotiated Rate	$45.23
Max. Negotiated Rate	$61.67
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$49.34
Rate for Payer: Aetna of CA Government/Medicare	$49.34
Rate for Payer: Cash Price	$37.00
Rate for Payer: Health Smart Auto/Commercial	$49.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$49.34
Rate for Payer: LLUH Dept of Risk Management WC	$45.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$61.67

HC SOM SOTALOL

Facility

$82.23

Service Code	CPT 80299 90
Hospital Charge Code	900910789
Hospital Revenue Code	301
Min. Negotiated Rate	$45.23
Max. Negotiated Rate	$65.78
Rate for Payer: Cash Price	$37.00
Rate for Payer: Cigna of CA HMO/PPO	$65.78
Rate for Payer: Health Smart Auto/Commercial	$49.34
Rate for Payer: LLUH Dept of Risk Management WC	$45.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$61.67

Know your out-of-pocket cost for care.

All Charges