Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC BLEEDING TIME TEMPLATE

Facility

$16.00

Service Code	CPT 85002
Hospital Charge Code	900910065
Hospital Revenue Code	305
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$12.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.60
Rate for Payer: Aetna of CA Government/Medicare	$9.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.80
Rate for Payer: Health Smart Auto/Commercial	$9.60
Rate for Payer: Intervalley Health Plan Commercial	$4.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.60
Rate for Payer: LLUH Dept of Risk Management WC	$8.80
Rate for Payer: Multiplan Commercial	$12.00

HC BLOOD OCCULT FECES

Facility

$135.00

Service Code	CPT 82274
Hospital Charge Code	900911638
Hospital Revenue Code	301
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$108.00
Rate for Payer: Cash Price	$60.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$108.00
Rate for Payer: Health Smart Auto/Commercial	$81.00
Rate for Payer: LLUH Dept of Risk Management WC	$74.25
Rate for Payer: Multiplan Commercial	$101.25

HC BLOOD OCCULT FECES

Facility

$60.00

Service Code	CPT 82274
Hospital Charge Code	900911638
Hospital Revenue Code	301
Min. Negotiated Rate	$15.92
Max. Negotiated Rate	$48.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$36.00
Rate for Payer: Aetna of CA Government/Medicare	$36.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$48.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: Intervalley Health Plan Commercial	$15.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Commercial	$45.00

HC BLOOD PH PCO2 P02 (POC)

Facility

$251.00

Service Code	CPT 82803
Hospital Charge Code	900912112
Hospital Revenue Code	301
Min. Negotiated Rate	$26.07
Max. Negotiated Rate	$200.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$150.60
Rate for Payer: Aetna of CA Government/Medicare	$150.60
Rate for Payer: Cash Price	$112.95
Rate for Payer: Cash Price	$112.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$200.80
Rate for Payer: Health Smart Auto/Commercial	$150.60
Rate for Payer: Intervalley Health Plan Commercial	$26.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$150.60
Rate for Payer: LLUH Dept of Risk Management WC	$138.05
Rate for Payer: Multiplan Commercial	$188.25

HC BLOOD PH PCO2 P02 (POC)

Facility

$251.00

Service Code	CPT 82803
Hospital Charge Code	900912112
Hospital Revenue Code	301
Min. Negotiated Rate	$138.05
Max. Negotiated Rate	$200.80
Rate for Payer: Cash Price	$112.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$200.80
Rate for Payer: Health Smart Auto/Commercial	$150.60
Rate for Payer: LLUH Dept of Risk Management WC	$138.05
Rate for Payer: Multiplan Commercial	$188.25

HC BONE MARROW ASP/AT TIME OF BX

Facility

$4,855.00

Service Code	CPT 38222
Hospital Charge Code	911800314
Hospital Revenue Code	361
Min. Negotiated Rate	$2,670.25
Max. Negotiated Rate	$3,884.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2,913.00
Rate for Payer: Aetna of CA Government/Medicare	$2,913.00
Rate for Payer: Cash Price	$2,184.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3,884.00
Rate for Payer: Health Smart Auto/Commercial	$2,913.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2,913.00
Rate for Payer: LLUH Dept of Risk Management WC	$2,670.25
Rate for Payer: Multiplan Commercial	$3,641.25

HC BONE MARROW ASP/AT TIME OF BX

Facility

$4,855.00

Service Code	CPT 38222
Hospital Charge Code	911800314
Hospital Revenue Code	361
Min. Negotiated Rate	$2,670.25
Max. Negotiated Rate	$3,884.00
Rate for Payer: Cash Price	$2,184.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3,884.00
Rate for Payer: Health Smart Auto/Commercial	$2,913.00
Rate for Payer: LLUH Dept of Risk Management WC	$2,670.25
Rate for Payer: Multiplan Commercial	$3,641.25

HC BONE MARROW BX ONLY

Facility

$4,855.00

Service Code	CPT 38221
Hospital Charge Code	909020057
Hospital Revenue Code	361
Min. Negotiated Rate	$2,670.25
Max. Negotiated Rate	$3,884.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2,913.00
Rate for Payer: Aetna of CA Government/Medicare	$2,913.00
Rate for Payer: Cash Price	$2,184.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3,884.00
Rate for Payer: Health Smart Auto/Commercial	$2,913.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2,913.00
Rate for Payer: LLUH Dept of Risk Management WC	$2,670.25
Rate for Payer: Multiplan Commercial	$3,641.25

HC BONE MARROW BX ONLY

Facility

$4,855.00

Service Code	CPT 38221
Hospital Charge Code	909020057
Hospital Revenue Code	361
Min. Negotiated Rate	$2,670.25
Max. Negotiated Rate	$3,884.00
Rate for Payer: Cash Price	$2,184.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3,884.00
Rate for Payer: Health Smart Auto/Commercial	$2,913.00
Rate for Payer: LLUH Dept of Risk Management WC	$2,670.25
Rate for Payer: Multiplan Commercial	$3,641.25

HC BRISK PROFILE

Facility

$445.00

Service Code	CPT 85576
Hospital Charge Code	900912001
Hospital Revenue Code	305
Min. Negotiated Rate	$244.75
Max. Negotiated Rate	$356.00
Rate for Payer: Cash Price	$200.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$356.00
Rate for Payer: Health Smart Auto/Commercial	$267.00
Rate for Payer: LLUH Dept of Risk Management WC	$244.75
Rate for Payer: Multiplan Commercial	$333.75

HC BRISK PROFILE

Facility

$156.00

Service Code	CPT 85576
Hospital Charge Code	900912001
Hospital Revenue Code	305
Min. Negotiated Rate	$24.91
Max. Negotiated Rate	$124.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$93.60
Rate for Payer: Aetna of CA Government/Medicare	$93.60
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cash Price	$70.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$124.80
Rate for Payer: Health Smart Auto/Commercial	$93.60
Rate for Payer: Intervalley Health Plan Commercial	$24.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$93.60
Rate for Payer: LLUH Dept of Risk Management WC	$85.80
Rate for Payer: Multiplan Commercial	$117.00

HC BUFFY COAT EXAM

Facility

$265.00

Service Code	CPT 85009
Hospital Charge Code	900910196
Hospital Revenue Code	305
Min. Negotiated Rate	$145.75
Max. Negotiated Rate	$212.00
Rate for Payer: Cash Price	$119.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$212.00
Rate for Payer: Health Smart Auto/Commercial	$159.00
Rate for Payer: LLUH Dept of Risk Management WC	$145.75
Rate for Payer: Multiplan Commercial	$198.75

HC BUFFY COAT EXAM

Facility

$14.00

Service Code	CPT 85009
Hospital Charge Code	900910196
Hospital Revenue Code	305
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$11.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.40
Rate for Payer: Aetna of CA Government/Medicare	$8.40
Rate for Payer: Cash Price	$6.30
Rate for Payer: Cash Price	$6.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$11.20
Rate for Payer: Health Smart Auto/Commercial	$8.40
Rate for Payer: Intervalley Health Plan Commercial	$5.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.40
Rate for Payer: LLUH Dept of Risk Management WC	$7.70
Rate for Payer: Multiplan Commercial	$10.50

HC BUN

Facility

$34.00

Service Code	CPT 84520
Hospital Charge Code	900910253
Hospital Revenue Code	301
Min. Negotiated Rate	$3.95
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	$3.95
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 BUN

Facility

$98.00

Service Code	CPT 84520
Hospital Charge Code	900910253
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 BUN BODY FLUID

Facility

$38.00

Service Code	CPT 84520
Hospital Charge Code	900912241
Hospital Revenue Code	301
Min. Negotiated Rate	$3.95
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	$3.95
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 BUN BODY FLUID

Facility

$42.00

Service Code	CPT 84520
Hospital Charge Code	900912241
Hospital Revenue Code	301
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$33.60
Rate for Payer: Cash Price	$18.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$33.60
Rate for Payer: Health Smart Auto/Commercial	$25.20
Rate for Payer: LLUH Dept of Risk Management WC	$23.10
Rate for Payer: Multiplan Commercial	$31.50

HC BUN INDIVIDUAL

Facility

$50.00

Service Code	CPT 84520
Hospital Charge Code	900910492
Hospital Revenue Code	301
Min. Negotiated Rate	$3.95
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	$3.95
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 BUN INDIVIDUAL

Facility

$50.00

Service Code	CPT 84520
Hospital Charge Code	900910492
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$40.00
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: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC CAFFEINE SERUM

Facility

$158.00

Service Code	CPT 80299
Hospital Charge Code	900910538
Hospital Revenue Code	301
Min. Negotiated Rate	$86.90
Max. Negotiated Rate	$126.40
Rate for Payer: Cash Price	$71.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$126.40
Rate for Payer: Health Smart Auto/Commercial	$94.80
Rate for Payer: LLUH Dept of Risk Management WC	$86.90
Rate for Payer: Multiplan Commercial	$118.50

HC CAFFEINE SERUM

Facility

$46.00

Service Code	CPT 80299
Hospital Charge Code	900910538
Hospital Revenue Code	301
Min. Negotiated Rate	$18.64
Max. Negotiated Rate	$36.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.60
Rate for Payer: Aetna of CA Government/Medicare	$27.60
Rate for Payer: Cash Price	$20.70
Rate for Payer: Cash Price	$20.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$36.80
Rate for Payer: Health Smart Auto/Commercial	$27.60
Rate for Payer: Intervalley Health Plan Commercial	$18.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.60
Rate for Payer: LLUH Dept of Risk Management WC	$25.30
Rate for Payer: Multiplan Commercial	$34.50

HC CA IONIZED (POC)

Facility

$323.00

Service Code	CPT 82330
Hospital Charge Code	900912118
Hospital Revenue Code	301
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$258.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$193.80
Rate for Payer: Aetna of CA Government/Medicare	$193.80
Rate for Payer: Cash Price	$145.35
Rate for Payer: Cash Price	$145.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$258.40
Rate for Payer: Health Smart Auto/Commercial	$193.80
Rate for Payer: Intervalley Health Plan Commercial	$13.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$193.80
Rate for Payer: LLUH Dept of Risk Management WC	$177.65
Rate for Payer: Multiplan Commercial	$242.25

HC CA IONIZED (POC)

Facility

$323.00

Service Code	CPT 82330
Hospital Charge Code	900912118
Hospital Revenue Code	301
Min. Negotiated Rate	$177.65
Max. Negotiated Rate	$258.40
Rate for Payer: Cash Price	$145.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$258.40
Rate for Payer: Health Smart Auto/Commercial	$193.80
Rate for Payer: LLUH Dept of Risk Management WC	$177.65
Rate for Payer: Multiplan Commercial	$242.25

HC CALCIUM TOTAL

Facility

$34.00

Service Code	CPT 82310
Hospital Charge Code	900910239
Hospital Revenue Code	301
Min. Negotiated Rate	$5.16
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	$5.16
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 CALCIUM TOTAL

Facility

$98.00

Service Code	CPT 82310
Hospital Charge Code	900910239
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

Know your out-of-pocket cost for care.

All Charges