Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC AMPHETAMINES CONF & ID

Facility

$298.00

Service Code	CPT 80324
Hospital Charge Code	900910520
Hospital Revenue Code	301
Min. Negotiated Rate	$163.90
Max. Negotiated Rate	$238.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$178.80
Rate for Payer: Aetna of CA Government/Medicare	$178.80
Rate for Payer: Cash Price	$134.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$238.40
Rate for Payer: Health Smart Auto/Commercial	$178.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$178.80
Rate for Payer: LLUH Dept of Risk Management WC	$163.90
Rate for Payer: Multiplan Commercial	$223.50

HC AMPICILLIN E TEST

Facility

$17.00

Service Code	CPT 87181
Hospital Charge Code	900912448
Hospital Revenue Code	306
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$13.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.20
Rate for Payer: Aetna of CA Government/Medicare	$10.20
Rate for Payer: Cash Price	$7.65
Rate for Payer: Cash Price	$7.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.60
Rate for Payer: Health Smart Auto/Commercial	$10.20
Rate for Payer: Intervalley Health Plan Commercial	$4.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.20
Rate for Payer: LLUH Dept of Risk Management WC	$9.35
Rate for Payer: Multiplan Commercial	$12.75

HC AMPICILLIN E TEST

Facility

$85.00

Service Code	CPT 87181
Hospital Charge Code	900912448
Hospital Revenue Code	306
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$68.00
Rate for Payer: Cash Price	$38.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$68.00
Rate for Payer: Health Smart Auto/Commercial	$51.00
Rate for Payer: LLUH Dept of Risk Management WC	$46.75
Rate for Payer: Multiplan Commercial	$63.75

HC AMYLASE

Facility

$258.00

Service Code	CPT 82150
Hospital Charge Code	900910236
Hospital Revenue Code	301
Min. Negotiated Rate	$141.90
Max. Negotiated Rate	$206.40
Rate for Payer: Cash Price	$116.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$206.40
Rate for Payer: Health Smart Auto/Commercial	$154.80
Rate for Payer: LLUH Dept of Risk Management WC	$141.90
Rate for Payer: Multiplan Commercial	$193.50

HC AMYLASE

Facility

$38.00

Service Code	CPT 82150
Hospital Charge Code	900910236
Hospital Revenue Code	301
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$30.40
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: Cash Price	$17.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.40
Rate for Payer: Health Smart Auto/Commercial	$22.80
Rate for Payer: Intervalley Health Plan Commercial	$6.48
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 Commercial	$28.50

HC AMYLASE BODY FLUID

Facility

$56.00

Service Code	CPT 82150
Hospital Charge Code	900910242
Hospital Revenue Code	301
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$44.80
Rate for Payer: Cash Price	$25.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$44.80
Rate for Payer: Health Smart Auto/Commercial	$33.60
Rate for Payer: LLUH Dept of Risk Management WC	$30.80
Rate for Payer: Multiplan Commercial	$42.00

HC AMYLASE BODY FLUID

Facility

$38.00

Service Code	CPT 82150
Hospital Charge Code	900910242
Hospital Revenue Code	301
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$30.40
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: Cash Price	$17.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.40
Rate for Payer: Health Smart Auto/Commercial	$22.80
Rate for Payer: Intervalley Health Plan Commercial	$6.48
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 Commercial	$28.50

HC AMYLASE URINE

Facility

$56.00

Service Code	CPT 82150
Hospital Charge Code	900910237
Hospital Revenue Code	301
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$44.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.60
Rate for Payer: Aetna of CA Government/Medicare	$33.60
Rate for Payer: Cash Price	$25.20
Rate for Payer: Cash Price	$25.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$44.80
Rate for Payer: Health Smart Auto/Commercial	$33.60
Rate for Payer: Intervalley Health Plan Commercial	$6.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.60
Rate for Payer: LLUH Dept of Risk Management WC	$30.80
Rate for Payer: Multiplan Commercial	$42.00

HC AMYLASE URINE

Facility

$258.00

Service Code	CPT 82150
Hospital Charge Code	900910237
Hospital Revenue Code	301
Min. Negotiated Rate	$141.90
Max. Negotiated Rate	$206.40
Rate for Payer: Cash Price	$116.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$206.40
Rate for Payer: Health Smart Auto/Commercial	$154.80
Rate for Payer: LLUH Dept of Risk Management WC	$141.90
Rate for Payer: Multiplan Commercial	$193.50

HC ANA PANEL

Facility

$171.00

Service Code	CPT 86235
Hospital Charge Code	900913646
Hospital Revenue Code	302
Min. Negotiated Rate	$94.05
Max. Negotiated Rate	$136.80
Rate for Payer: Cash Price	$76.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$136.80
Rate for Payer: Health Smart Auto/Commercial	$102.60
Rate for Payer: LLUH Dept of Risk Management WC	$94.05
Rate for Payer: Multiplan Commercial	$128.25

HC ANA PANEL

Facility

$154.00

Service Code	CPT 86235
Hospital Charge Code	900913646
Hospital Revenue Code	302
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$123.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$92.40
Rate for Payer: Aetna of CA Government/Medicare	$92.40
Rate for Payer: Cash Price	$69.30
Rate for Payer: Cash Price	$69.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$123.20
Rate for Payer: Health Smart Auto/Commercial	$92.40
Rate for Payer: Intervalley Health Plan Commercial	$17.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$92.40
Rate for Payer: LLUH Dept of Risk Management WC	$84.70
Rate for Payer: Multiplan Commercial	$115.50

HC ANKLE COMPLETE

Facility

$1,123.00

Service Code	CPT 73610
Hospital Charge Code	909001648
Hospital Revenue Code	320
Min. Negotiated Rate	$617.65
Max. Negotiated Rate	$898.40
Rate for Payer: Cash Price	$505.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$898.40
Rate for Payer: Health Smart Auto/Commercial	$673.80
Rate for Payer: LLUH Dept of Risk Management WC	$617.65
Rate for Payer: Multiplan Commercial	$842.25

HC ANKLE COMPLETE

Facility

$1,123.00

Service Code	CPT 73610
Hospital Charge Code	909001648
Hospital Revenue Code	320
Min. Negotiated Rate	$617.65
Max. Negotiated Rate	$898.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$673.80
Rate for Payer: Aetna of CA Government/Medicare	$673.80
Rate for Payer: Cash Price	$505.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$898.40
Rate for Payer: Health Smart Auto/Commercial	$673.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$673.80
Rate for Payer: LLUH Dept of Risk Management WC	$617.65
Rate for Payer: Multiplan Commercial	$842.25

HC ANKLE LIMITED

Facility

$959.00

Service Code	CPT 73600
Hospital Charge Code	909001642
Hospital Revenue Code	320
Min. Negotiated Rate	$527.45
Max. Negotiated Rate	$767.20
Rate for Payer: Cash Price	$431.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$767.20
Rate for Payer: Health Smart Auto/Commercial	$575.40
Rate for Payer: LLUH Dept of Risk Management WC	$527.45
Rate for Payer: Multiplan Commercial	$719.25

HC ANKLE LIMITED

Facility

$959.00

Service Code	CPT 73600
Hospital Charge Code	909001642
Hospital Revenue Code	320
Min. Negotiated Rate	$527.45
Max. Negotiated Rate	$767.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$575.40
Rate for Payer: Aetna of CA Government/Medicare	$575.40
Rate for Payer: Cash Price	$431.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$767.20
Rate for Payer: Health Smart Auto/Commercial	$575.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$575.40
Rate for Payer: LLUH Dept of Risk Management WC	$527.45
Rate for Payer: Multiplan Commercial	$719.25

HC ANTIMICROB SUSCEPTIBILITY TEST

Facility

$18.00

Service Code	CPT 87181
Hospital Charge Code	900911660
Hospital Revenue Code	306
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.80
Rate for Payer: Aetna of CA Government/Medicare	$10.80
Rate for Payer: Cash Price	$8.10
Rate for Payer: Cash Price	$8.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.40
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: Intervalley Health Plan Commercial	$4.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.80
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: Multiplan Commercial	$13.50

HC ANTIMICROB SUSCEPTIBILITY TEST

Facility

$210.00

Service Code	CPT 87181
Hospital Charge Code	900911660
Hospital Revenue Code	306
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$168.00
Rate for Payer: Cash Price	$94.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$168.00
Rate for Payer: Health Smart Auto/Commercial	$126.00
Rate for Payer: LLUH Dept of Risk Management WC	$115.50
Rate for Payer: Multiplan Commercial	$157.50

HC ANTINUCLEAR ANTIBODIES (ANA)

Facility

$223.00

Service Code	CPT 86038
Hospital Charge Code	900910969
Hospital Revenue Code	302
Min. Negotiated Rate	$122.65
Max. Negotiated Rate	$178.40
Rate for Payer: Cash Price	$100.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$178.40
Rate for Payer: Health Smart Auto/Commercial	$133.80
Rate for Payer: LLUH Dept of Risk Management WC	$122.65
Rate for Payer: Multiplan Commercial	$167.25

HC ANTINUCLEAR ANTIBODIES (ANA)

Facility

$53.00

Service Code	CPT 86038
Hospital Charge Code	900910969
Hospital Revenue Code	302
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$42.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.80
Rate for Payer: Aetna of CA Government/Medicare	$31.80
Rate for Payer: Cash Price	$23.85
Rate for Payer: Cash Price	$23.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$42.40
Rate for Payer: Health Smart Auto/Commercial	$31.80
Rate for Payer: Intervalley Health Plan Commercial	$12.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.80
Rate for Payer: LLUH Dept of Risk Management WC	$29.15
Rate for Payer: Multiplan Commercial	$39.75

HC ANTISTREPTOLYSIN O

Facility

$74.97

Service Code	CPT 83883
Hospital Charge Code	900910881
Hospital Revenue Code	301
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$59.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$44.98
Rate for Payer: Aetna of CA Government/Medicare	$44.98
Rate for Payer: Cash Price	$33.74
Rate for Payer: Cash Price	$33.74
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$59.98
Rate for Payer: Health Smart Auto/Commercial	$44.98
Rate for Payer: Intervalley Health Plan Commercial	$13.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$44.98
Rate for Payer: LLUH Dept of Risk Management WC	$41.23
Rate for Payer: Multiplan Commercial	$56.23

HC ANTISTREPTOLYSIN O

Facility

$186.00

Service Code	CPT 83883
Hospital Charge Code	900910881
Hospital Revenue Code	301
Min. Negotiated Rate	$102.30
Max. Negotiated Rate	$148.80
Rate for Payer: Cash Price	$83.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$148.80
Rate for Payer: Health Smart Auto/Commercial	$111.60
Rate for Payer: LLUH Dept of Risk Management WC	$102.30
Rate for Payer: Multiplan Commercial	$139.50

HC ANTITHROMBIN III ACTIVITY

Facility

$110.00

Service Code	CPT 85300
Hospital Charge Code	900912010
Hospital Revenue Code	305
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$88.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$66.00
Rate for Payer: Aetna of CA Government/Medicare	$66.00
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$88.00
Rate for Payer: Health Smart Auto/Commercial	$66.00
Rate for Payer: Intervalley Health Plan Commercial	$11.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$66.00
Rate for Payer: LLUH Dept of Risk Management WC	$60.50
Rate for Payer: Multiplan Commercial	$82.50

HC ANTITHROMBIN III ACTIVITY

Facility

$242.00

Service Code	CPT 85300
Hospital Charge Code	900912010
Hospital Revenue Code	305
Min. Negotiated Rate	$133.10
Max. Negotiated Rate	$193.60
Rate for Payer: Cash Price	$108.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$193.60
Rate for Payer: Health Smart Auto/Commercial	$145.20
Rate for Payer: LLUH Dept of Risk Management WC	$133.10
Rate for Payer: Multiplan Commercial	$181.50

HC ANTITHROMBIN III ANTIGEN

Facility

$163.00

Service Code	CPT 85301
Hospital Charge Code	900912011
Hospital Revenue Code	305
Min. Negotiated Rate	$89.65
Max. Negotiated Rate	$130.40
Rate for Payer: Cash Price	$73.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$130.40
Rate for Payer: Health Smart Auto/Commercial	$97.80
Rate for Payer: LLUH Dept of Risk Management WC	$89.65
Rate for Payer: Multiplan Commercial	$122.25

HC ANTITHROMBIN III ANTIGEN

Facility

$102.00

Service Code	CPT 85301
Hospital Charge Code	900912011
Hospital Revenue Code	305
Min. Negotiated Rate	$10.81
Max. Negotiated Rate	$81.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$61.20
Rate for Payer: Aetna of CA Government/Medicare	$61.20
Rate for Payer: Cash Price	$45.90
Rate for Payer: Cash Price	$45.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$81.60
Rate for Payer: Health Smart Auto/Commercial	$61.20
Rate for Payer: Intervalley Health Plan Commercial	$10.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$61.20
Rate for Payer: LLUH Dept of Risk Management WC	$56.10
Rate for Payer: Multiplan Commercial	$76.50

Know your out-of-pocket cost for care.

All Charges