Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC APLS IGA

Facility

$77.00

Service Code	CPT 86148
Hospital Charge Code	900913647
Hospital Revenue Code	302
Min. Negotiated Rate	$42.35
Max. Negotiated Rate	$61.60
Rate for Payer: Cash Price	$34.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$61.60
Rate for Payer: Health Smart Auto/Commercial	$46.20
Rate for Payer: LLUH Dept of Risk Management WC	$42.35
Rate for Payer: Multiplan Commercial	$57.75

HC APLS IGA

Facility

$52.00

Service Code	CPT 86148
Hospital Charge Code	900913647
Hospital Revenue Code	302
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$41.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.20
Rate for Payer: Aetna of CA Government/Medicare	$31.20
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cash Price	$23.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$41.60
Rate for Payer: Health Smart Auto/Commercial	$31.20
Rate for Payer: Intervalley Health Plan Commercial	$16.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.20
Rate for Payer: LLUH Dept of Risk Management WC	$28.60
Rate for Payer: Multiplan Commercial	$39.00

HC APLS IGG

Facility

$99.00

Service Code	CPT 86147
Hospital Charge Code	900913648
Hospital Revenue Code	302
Min. Negotiated Rate	$54.45
Max. Negotiated Rate	$79.20
Rate for Payer: Cash Price	$44.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$79.20
Rate for Payer: Health Smart Auto/Commercial	$59.40
Rate for Payer: LLUH Dept of Risk Management WC	$54.45
Rate for Payer: Multiplan Commercial	$74.25

HC APLS IGG

Facility

$98.00

Service Code	CPT 86147
Hospital Charge Code	900913648
Hospital Revenue Code	302
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$78.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$58.80
Rate for Payer: Aetna of CA Government/Medicare	$58.80
Rate for Payer: Cash Price	$44.10
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: Intervalley Health Plan Commercial	$25.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$58.80
Rate for Payer: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Commercial	$73.50

HC APLS IGM

Facility

$52.00

Service Code	CPT 86148
Hospital Charge Code	900913649
Hospital Revenue Code	302
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$41.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.20
Rate for Payer: Aetna of CA Government/Medicare	$31.20
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cash Price	$23.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$41.60
Rate for Payer: Health Smart Auto/Commercial	$31.20
Rate for Payer: Intervalley Health Plan Commercial	$16.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.20
Rate for Payer: LLUH Dept of Risk Management WC	$28.60
Rate for Payer: Multiplan Commercial	$39.00

HC APLS IGM

Facility

$77.00

Service Code	CPT 86148
Hospital Charge Code	900913649
Hospital Revenue Code	302
Min. Negotiated Rate	$42.35
Max. Negotiated Rate	$61.60
Rate for Payer: Cash Price	$34.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$61.60
Rate for Payer: Health Smart Auto/Commercial	$46.20
Rate for Payer: LLUH Dept of Risk Management WC	$42.35
Rate for Payer: Multiplan Commercial	$57.75

HC AST

Facility

$50.00

Service Code	CPT 84450
Hospital Charge Code	900910509
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Intervalley Health Plan Commercial	$5.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC AST

Facility

$98.00

Service Code	CPT 84450
Hospital Charge Code	900910509
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 AST INDIVIDUAL

Facility

$98.00

Service Code	CPT 84450
Hospital Charge Code	900910232
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 AST INDIVIDUAL

Facility

$50.00

Service Code	CPT 84450
Hospital Charge Code	900910232
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Intervalley Health Plan Commercial	$5.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC AUTOIMMUNE PANEL

Facility

$38.00

Hospital Charge Code	900913519
Hospital Revenue Code	302
Min. Negotiated Rate	$20.90
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: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.40
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 Commercial	$28.50

HC B ABORTUS AB

Facility

$26.00

Service Code	CPT 86000
Hospital Charge Code	900911585
Hospital Revenue Code	302
Min. Negotiated Rate	$6.98
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.60
Rate for Payer: Aetna of CA Government/Medicare	$15.60
Rate for Payer: Cash Price	$11.70
Rate for Payer: Cash Price	$11.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$20.80
Rate for Payer: Health Smart Auto/Commercial	$15.60
Rate for Payer: Intervalley Health Plan Commercial	$6.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.60
Rate for Payer: LLUH Dept of Risk Management WC	$14.30
Rate for Payer: Multiplan Commercial	$19.50

HC B ABORTUS AB

Facility

$166.00

Service Code	CPT 86000
Hospital Charge Code	900911585
Hospital Revenue Code	302
Min. Negotiated Rate	$91.30
Max. Negotiated Rate	$132.80
Rate for Payer: Cash Price	$74.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$132.80
Rate for Payer: Health Smart Auto/Commercial	$99.60
Rate for Payer: LLUH Dept of Risk Management WC	$91.30
Rate for Payer: Multiplan Commercial	$124.50

HC BARBITUATES CONF & ID

Facility

$312.00

Service Code	CPT 80345
Hospital Charge Code	900910519
Hospital Revenue Code	301
Min. Negotiated Rate	$171.60
Max. Negotiated Rate	$249.60
Rate for Payer: Cash Price	$140.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$249.60
Rate for Payer: Health Smart Auto/Commercial	$187.20
Rate for Payer: LLUH Dept of Risk Management WC	$171.60
Rate for Payer: Multiplan Commercial	$234.00

HC BARBITUATES CONF & ID

Facility

$259.00

Service Code	CPT 80345
Hospital Charge Code	900910519
Hospital Revenue Code	301
Min. Negotiated Rate	$142.45
Max. Negotiated Rate	$207.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$155.40
Rate for Payer: Aetna of CA Government/Medicare	$155.40
Rate for Payer: Cash Price	$116.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$207.20
Rate for Payer: Health Smart Auto/Commercial	$155.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$155.40
Rate for Payer: LLUH Dept of Risk Management WC	$142.45
Rate for Payer: Multiplan Commercial	$194.25

HC BARTB 87798 SOM

Facility

$50.27

Service Code	CPT 87798
Hospital Charge Code	900914848
Hospital Revenue Code	306
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$40.22
Rate for Payer: Cash Price	$22.62
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.22
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Commercial	$37.70

HC BARTB 87798 SOM

Facility

$50.27

Service Code	CPT 87798
Hospital Charge Code	900914848
Hospital Revenue Code	306
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$40.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.16
Rate for Payer: Aetna of CA Government/Medicare	$30.16
Rate for Payer: Cash Price	$22.62
Rate for Payer: Cash Price	$22.62
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.22
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: Intervalley Health Plan Commercial	$35.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Commercial	$37.70

HC BASIC METABOLIC PANEL

Facility

$50.20

Service Code	CPT 80048
Hospital Charge Code	900910421
Hospital Revenue Code	301
Min. Negotiated Rate	$8.46
Max. Negotiated Rate	$40.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.12
Rate for Payer: Aetna of CA Government/Medicare	$30.12
Rate for Payer: Cash Price	$22.59
Rate for Payer: Cash Price	$22.59
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.16
Rate for Payer: Health Smart Auto/Commercial	$30.12
Rate for Payer: Intervalley Health Plan Commercial	$8.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.12
Rate for Payer: LLUH Dept of Risk Management WC	$27.61
Rate for Payer: Multiplan Commercial	$37.65

HC BASIC METABOLIC PANEL

Facility

$450.00

Service Code	CPT 80048
Hospital Charge Code	900910421
Hospital Revenue Code	301
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$360.00
Rate for Payer: Cash Price	$202.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$360.00
Rate for Payer: Health Smart Auto/Commercial	$270.00
Rate for Payer: LLUH Dept of Risk Management WC	$247.50
Rate for Payer: Multiplan Commercial	$337.50

HC B-CELL LYMPH FISH DNA PROBE SO

Facility

$86.00

Service Code	CPT 88271
Hospital Charge Code	900914114
Hospital Revenue Code	309
Min. Negotiated Rate	$47.30
Max. Negotiated Rate	$68.80
Rate for Payer: Cash Price	$38.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$68.80
Rate for Payer: Health Smart Auto/Commercial	$51.60
Rate for Payer: LLUH Dept of Risk Management WC	$47.30
Rate for Payer: Multiplan Commercial	$64.50

HC B-CELL LYMPH FISH DNA PROBE SO

Facility

$86.00

Service Code	CPT 88271
Hospital Charge Code	900914114
Hospital Revenue Code	309
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$68.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$51.60
Rate for Payer: Aetna of CA Government/Medicare	$51.60
Rate for Payer: Cash Price	$38.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$68.80
Rate for Payer: Health Smart Auto/Commercial	$51.60
Rate for Payer: Intervalley Health Plan Commercial	$21.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$51.60
Rate for Payer: LLUH Dept of Risk Management WC	$47.30
Rate for Payer: Multiplan Commercial	$64.50

HC B-CELL LYMPH FISH INTRPHAS IN

Facility

$186.00

Service Code	CPT 88275
Hospital Charge Code	900914115
Hospital Revenue Code	309
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 B-CELL LYMPH FISH INTRPHAS IN

Facility

$186.00

Service Code	CPT 88275
Hospital Charge Code	900914115
Hospital Revenue Code	309
Min. Negotiated Rate	$51.19
Max. Negotiated Rate	$148.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$111.60
Rate for Payer: Aetna of CA Government/Medicare	$111.60
Rate for Payer: Cash Price	$83.70
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: Intervalley Health Plan Commercial	$51.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$111.60
Rate for Payer: LLUH Dept of Risk Management WC	$102.30
Rate for Payer: Multiplan Commercial	$139.50

HC BENZODIAZPINES CONF

Facility

$259.00

Service Code	CPT 80346
Hospital Charge Code	900910515
Hospital Revenue Code	301
Min. Negotiated Rate	$142.45
Max. Negotiated Rate	$207.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$155.40
Rate for Payer: Aetna of CA Government/Medicare	$155.40
Rate for Payer: Cash Price	$116.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$207.20
Rate for Payer: Health Smart Auto/Commercial	$155.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$155.40
Rate for Payer: LLUH Dept of Risk Management WC	$142.45
Rate for Payer: Multiplan Commercial	$194.25

HC BENZODIAZPINES CONF

Facility

$312.00

Service Code	CPT 80346
Hospital Charge Code	900910515
Hospital Revenue Code	301
Min. Negotiated Rate	$171.60
Max. Negotiated Rate	$249.60
Rate for Payer: Cash Price	$140.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$249.60
Rate for Payer: Health Smart Auto/Commercial	$187.20
Rate for Payer: LLUH Dept of Risk Management WC	$171.60
Rate for Payer: Multiplan Commercial	$234.00

Know your out-of-pocket cost for care.

All Charges