Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC ACTH

Facility

$165.00

Service Code	CPT 82024
Hospital Charge Code	900912120
Hospital Revenue Code	301
Min. Negotiated Rate	$90.75
Max. Negotiated Rate	$132.00
Rate for Payer: Cash Price	$74.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$132.00
Rate for Payer: Health Smart Auto/Commercial	$99.00
Rate for Payer: LLUH Dept of Risk Management WC	$90.75
Rate for Payer: Multiplan Commercial	$123.75

HC ACTH

Facility

$124.00

Service Code	CPT 82024
Hospital Charge Code	900912120
Hospital Revenue Code	301
Min. Negotiated Rate	$38.62
Max. Negotiated Rate	$99.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$74.40
Rate for Payer: Aetna of CA Government/Medicare	$74.40
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cash Price	$55.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$99.20
Rate for Payer: Health Smart Auto/Commercial	$74.40
Rate for Payer: Intervalley Health Plan Commercial	$38.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$74.40
Rate for Payer: LLUH Dept of Risk Management WC	$68.20
Rate for Payer: Multiplan Commercial	$93.00

HC ACT LOW RANGE/PLUS (POC)

Facility

$214.00

Service Code	CPT 85347
Hospital Charge Code	900912013
Hospital Revenue Code	301
Min. Negotiated Rate	$117.70
Max. Negotiated Rate	$171.20
Rate for Payer: Cash Price	$96.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$171.20
Rate for Payer: Health Smart Auto/Commercial	$128.40
Rate for Payer: LLUH Dept of Risk Management WC	$117.70
Rate for Payer: Multiplan Commercial	$160.50

HC ACT LOW RANGE/PLUS (POC)

Facility

$214.00

Service Code	CPT 85347
Hospital Charge Code	900912013
Hospital Revenue Code	301
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$171.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$128.40
Rate for Payer: Aetna of CA Government/Medicare	$128.40
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$171.20
Rate for Payer: Health Smart Auto/Commercial	$128.40
Rate for Payer: Intervalley Health Plan Commercial	$4.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$128.40
Rate for Payer: LLUH Dept of Risk Management WC	$117.70
Rate for Payer: Multiplan Commercial	$160.50

HC ACUPUNCTURE/TENS

Facility

$150.00

Hospital Charge Code	901500002
Hospital Revenue Code	420
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$120.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$120.00
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Commercial	$112.50

HC ACUPUNCTURE/TENS

Facility

$150.00

Hospital Charge Code	901500002
Hospital Revenue Code	420
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.00
Rate for Payer: Aetna of CA Government/Medicare	$90.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$120.00
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Commercial	$112.50

HC ACUTE HEPATITIS PANEL

Facility

$168.00

Service Code	CPT 80074
Hospital Charge Code	900910701
Hospital Revenue Code	301
Min. Negotiated Rate	$47.63
Max. Negotiated Rate	$134.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$100.80
Rate for Payer: Aetna of CA Government/Medicare	$100.80
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cash Price	$75.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$134.40
Rate for Payer: Health Smart Auto/Commercial	$100.80
Rate for Payer: Intervalley Health Plan Commercial	$47.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$100.80
Rate for Payer: LLUH Dept of Risk Management WC	$92.40
Rate for Payer: Multiplan Commercial	$126.00

HC ACUTE HEPATITIS PANEL

Facility

$867.00

Service Code	CPT 80074
Hospital Charge Code	900910701
Hospital Revenue Code	301
Min. Negotiated Rate	$476.85
Max. Negotiated Rate	$693.60
Rate for Payer: Cash Price	$390.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$693.60
Rate for Payer: Health Smart Auto/Commercial	$520.20
Rate for Payer: LLUH Dept of Risk Management WC	$476.85
Rate for Payer: Multiplan Commercial	$650.25

HC ADENOVIRUS DNA QUANT

Facility

$274.00

Service Code	CPT 87799
Hospital Charge Code	900913624
Hospital Revenue Code	306
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$219.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$164.40
Rate for Payer: Aetna of CA Government/Medicare	$164.40
Rate for Payer: Cash Price	$123.30
Rate for Payer: Cash Price	$123.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$219.20
Rate for Payer: Health Smart Auto/Commercial	$164.40
Rate for Payer: Intervalley Health Plan Commercial	$42.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$164.40
Rate for Payer: LLUH Dept of Risk Management WC	$150.70
Rate for Payer: Multiplan Commercial	$205.50

HC ADENOVIRUS DNA QUANT

Facility

$332.00

Service Code	CPT 87799
Hospital Charge Code	900913624
Hospital Revenue Code	306
Min. Negotiated Rate	$182.60
Max. Negotiated Rate	$265.60
Rate for Payer: Cash Price	$149.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$265.60
Rate for Payer: Health Smart Auto/Commercial	$199.20
Rate for Payer: LLUH Dept of Risk Management WC	$182.60
Rate for Payer: Multiplan Commercial	$249.00

HC ADM FR HIGH A/D 2DATES/ HR

Facility

$269.00

Service Code	CPT G0378
Hospital Charge Code	902100006
Hospital Revenue Code	762
Min. Negotiated Rate	$147.95
Max. Negotiated Rate	$215.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$161.40
Rate for Payer: Aetna of CA Government/Medicare	$161.40
Rate for Payer: Cash Price	$121.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$215.20
Rate for Payer: Health Smart Auto/Commercial	$161.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$161.40
Rate for Payer: LLUH Dept of Risk Management WC	$147.95
Rate for Payer: Multiplan Commercial	$201.75

HC ADM FR HIGH A/D 2DATES/ HR

Facility

$269.00

Service Code	CPT G0378
Hospital Charge Code	902100006
Hospital Revenue Code	762
Min. Negotiated Rate	$147.95
Max. Negotiated Rate	$215.20
Rate for Payer: Cash Price	$121.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$215.20
Rate for Payer: Health Smart Auto/Commercial	$161.40
Rate for Payer: LLUH Dept of Risk Management WC	$147.95
Rate for Payer: Multiplan Commercial	$201.75

HC ADOLESCENT IOP MEND GROUP

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804372
Hospital Revenue Code	905
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$364.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$280.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC ADOLESCENT IOP MEND GROUP

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804372
Hospital Revenue Code	905
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$652.36
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$299.20
Rate for Payer: Health Smart Auto/Commercial	$224.40
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Mary Free Bed Workers' Compensation	$652.36
Rate for Payer: Multiplan Commercial	$280.50

HC ADULT IOP MEND GROUP

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804371
Hospital Revenue Code	905
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$364.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$280.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC ADULT IOP MEND GROUP

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804371
Hospital Revenue Code	905
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$652.36
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$299.20
Rate for Payer: Health Smart Auto/Commercial	$224.40
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Mary Free Bed Workers' Compensation	$652.36
Rate for Payer: Multiplan Commercial	$280.50

HC AFB FLUOROCHROME STAIN CONCEN

Facility

$138.00

Service Code	CPT 87206
Hospital Charge Code	900911546
Hospital Revenue Code	306
Min. Negotiated Rate	$75.90
Max. Negotiated Rate	$110.40
Rate for Payer: Cash Price	$62.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$110.40
Rate for Payer: Health Smart Auto/Commercial	$82.80
Rate for Payer: LLUH Dept of Risk Management WC	$75.90
Rate for Payer: Multiplan Commercial	$103.50

HC AFB FLUOROCHROME STAIN CONCEN

Facility

$57.00

Service Code	CPT 87206
Hospital Charge Code	900911546
Hospital Revenue Code	306
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$45.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$34.20
Rate for Payer: Aetna of CA Government/Medicare	$34.20
Rate for Payer: Cash Price	$25.65
Rate for Payer: Cash Price	$25.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$45.60
Rate for Payer: Health Smart Auto/Commercial	$34.20
Rate for Payer: Intervalley Health Plan Commercial	$5.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$34.20
Rate for Payer: LLUH Dept of Risk Management WC	$31.35
Rate for Payer: Multiplan Commercial	$42.75

HC AFB FLUOROCHROME STAIN DIRECT

Facility

$138.00

Service Code	CPT 87206
Hospital Charge Code	900911545
Hospital Revenue Code	306
Min. Negotiated Rate	$75.90
Max. Negotiated Rate	$110.40
Rate for Payer: Cash Price	$62.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$110.40
Rate for Payer: Health Smart Auto/Commercial	$82.80
Rate for Payer: LLUH Dept of Risk Management WC	$75.90
Rate for Payer: Multiplan Commercial	$103.50

HC AFB FLUOROCHROME STAIN DIRECT

Facility

$57.00

Service Code	CPT 87206
Hospital Charge Code	900911545
Hospital Revenue Code	306
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$45.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$34.20
Rate for Payer: Aetna of CA Government/Medicare	$34.20
Rate for Payer: Cash Price	$25.65
Rate for Payer: Cash Price	$25.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$45.60
Rate for Payer: Health Smart Auto/Commercial	$34.20
Rate for Payer: Intervalley Health Plan Commercial	$5.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$34.20
Rate for Payer: LLUH Dept of Risk Management WC	$31.35
Rate for Payer: Multiplan Commercial	$42.75

HC AFB ZIEHL-NEELSEN STAIN

Facility

$138.00

Service Code	CPT 87206
Hospital Charge Code	900911544
Hospital Revenue Code	306
Min. Negotiated Rate	$75.90
Max. Negotiated Rate	$110.40
Rate for Payer: Cash Price	$62.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$110.40
Rate for Payer: Health Smart Auto/Commercial	$82.80
Rate for Payer: LLUH Dept of Risk Management WC	$75.90
Rate for Payer: Multiplan Commercial	$103.50

HC AFB ZIEHL-NEELSEN STAIN

Facility

$57.00

Service Code	CPT 87206
Hospital Charge Code	900911544
Hospital Revenue Code	306
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$45.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$34.20
Rate for Payer: Aetna of CA Government/Medicare	$34.20
Rate for Payer: Cash Price	$25.65
Rate for Payer: Cash Price	$25.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$45.60
Rate for Payer: Health Smart Auto/Commercial	$34.20
Rate for Payer: Intervalley Health Plan Commercial	$5.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$34.20
Rate for Payer: LLUH Dept of Risk Management WC	$31.35
Rate for Payer: Multiplan Commercial	$42.75

HC ALBUMIN

Facility

$34.00

Service Code	CPT 82040
Hospital Charge Code	900910220
Hospital Revenue Code	301
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$27.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.40
Rate for Payer: Aetna of CA Government/Medicare	$20.40
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cash Price	$15.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$27.20
Rate for Payer: Health Smart Auto/Commercial	$20.40
Rate for Payer: Intervalley Health Plan Commercial	$4.95
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.40
Rate for Payer: LLUH Dept of Risk Management WC	$18.70
Rate for Payer: Multiplan Commercial	$25.50

HC ALBUMIN

Facility

$98.00

Service Code	CPT 82040
Hospital Charge Code	900910220
Hospital Revenue Code	301
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$78.40
Rate for Payer: Cash Price	$44.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$78.40
Rate for Payer: Health Smart Auto/Commercial	$58.80
Rate for Payer: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Commercial	$73.50

HC ALBUMIN BODY FLUID

Facility

$28.00

Service Code	CPT 82042
Hospital Charge Code	900910715
Hospital Revenue Code	301
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$22.40
Rate for Payer: Cash Price	$12.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.40
Rate for Payer: Health Smart Auto/Commercial	$16.80
Rate for Payer: LLUH Dept of Risk Management WC	$15.40
Rate for Payer: Multiplan Commercial	$21.00

Know your out-of-pocket cost for care.

All Charges