Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC CALCIUM TOTAL INDIVIDUAL

Facility

$50.00

Service Code	CPT 82310
Hospital Charge Code	900910494
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 CALCIUM TOTAL INDIVIDUAL

Facility

$50.00

Service Code	CPT 82310
Hospital Charge Code	900910494
Hospital Revenue Code	301
Min. Negotiated Rate	$5.16
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	$5.16
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 CANNABINOIDS SEMI-QUANTITATIVE

Facility

$99.00

Service Code	CPT 80299
Hospital Charge Code	900910380
Hospital Revenue Code	301
Min. Negotiated Rate	$18.64
Max. Negotiated Rate	$79.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$59.40
Rate for Payer: Aetna of CA Government/Medicare	$59.40
Rate for Payer: Cash Price	$44.55
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: Intervalley Health Plan Commercial	$18.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$59.40
Rate for Payer: LLUH Dept of Risk Management WC	$54.45
Rate for Payer: Multiplan Commercial	$74.25

HC CANNABINOIDS SEMI-QUANTITATIVE

Facility

$119.00

Service Code	CPT 80299
Hospital Charge Code	900910380
Hospital Revenue Code	301
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$95.20
Rate for Payer: Cash Price	$53.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$95.20
Rate for Payer: Health Smart Auto/Commercial	$71.40
Rate for Payer: LLUH Dept of Risk Management WC	$65.45
Rate for Payer: Multiplan Commercial	$89.25

HC CARBAMATES CONF & ID

Facility

$312.00

Service Code	CPT 82482
Hospital Charge Code	900910513
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 CARBAMATES CONF & ID

Facility

$259.00

Service Code	CPT 82482
Hospital Charge Code	900910513
Hospital Revenue Code	301
Min. Negotiated Rate	$9.81
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: 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: Intervalley Health Plan Commercial	$9.81
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 CARBAMAZEPINE

Facility

$241.00

Service Code	CPT 80156
Hospital Charge Code	900910396
Hospital Revenue Code	301
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$192.80
Rate for Payer: Cash Price	$108.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$192.80
Rate for Payer: Health Smart Auto/Commercial	$144.60
Rate for Payer: LLUH Dept of Risk Management WC	$132.55
Rate for Payer: Multiplan Commercial	$180.75

HC CARBAMAZEPINE

Facility

$120.00

Service Code	CPT 80156
Hospital Charge Code	900910396
Hospital Revenue Code	301
Min. Negotiated Rate	$14.57
Max. Negotiated Rate	$96.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$72.00
Rate for Payer: Aetna of CA Government/Medicare	$72.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$96.00
Rate for Payer: Health Smart Auto/Commercial	$72.00
Rate for Payer: Intervalley Health Plan Commercial	$14.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$72.00
Rate for Payer: LLUH Dept of Risk Management WC	$66.00
Rate for Payer: Multiplan Commercial	$90.00

HC CARCINOEMBRYONIC ANTIGEN (CEA)

Facility

$359.20

Service Code	CPT 82378
Hospital Charge Code	900910865
Hospital Revenue Code	301
Min. Negotiated Rate	$197.56
Max. Negotiated Rate	$287.36
Rate for Payer: Cash Price	$161.64
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$287.36
Rate for Payer: Health Smart Auto/Commercial	$215.52
Rate for Payer: LLUH Dept of Risk Management WC	$197.56
Rate for Payer: Multiplan Commercial	$269.40

HC CARCINOEMBRYONIC ANTIGEN (CEA)

Facility

$128.00

Service Code	CPT 82378
Hospital Charge Code	900910865
Hospital Revenue Code	301
Min. Negotiated Rate	$18.96
Max. Negotiated Rate	$102.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$76.80
Rate for Payer: Aetna of CA Government/Medicare	$76.80
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cash Price	$57.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$102.40
Rate for Payer: Health Smart Auto/Commercial	$76.80
Rate for Payer: Intervalley Health Plan Commercial	$18.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$76.80
Rate for Payer: LLUH Dept of Risk Management WC	$70.40
Rate for Payer: Multiplan Commercial	$96.00

HC CARDIOLIPIN AB EAC IG CLASS

Facility

$221.00

Service Code	CPT 86147
Hospital Charge Code	900913559
Hospital Revenue Code	302
Min. Negotiated Rate	$121.55
Max. Negotiated Rate	$176.80
Rate for Payer: Cash Price	$99.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$176.80
Rate for Payer: Health Smart Auto/Commercial	$132.60
Rate for Payer: LLUH Dept of Risk Management WC	$121.55
Rate for Payer: Multiplan Commercial	$165.75

HC CARDIOLIPIN AB EAC IG CLASS

Facility

$99.00

Service Code	CPT 86147
Hospital Charge Code	900913559
Hospital Revenue Code	302
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$79.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$59.40
Rate for Payer: Aetna of CA Government/Medicare	$59.40
Rate for Payer: Cash Price	$44.55
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: Intervalley Health Plan Commercial	$25.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$59.40
Rate for Payer: LLUH Dept of Risk Management WC	$54.45
Rate for Payer: Multiplan Commercial	$74.25

HC CATECHOLAMINES UR FRACTIONATED

Facility

$94.00

Service Code	CPT 82384
Hospital Charge Code	900910455
Hospital Revenue Code	301
Min. Negotiated Rate	$51.70
Max. Negotiated Rate	$75.20
Rate for Payer: Cash Price	$42.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$75.20
Rate for Payer: Health Smart Auto/Commercial	$56.40
Rate for Payer: LLUH Dept of Risk Management WC	$51.70
Rate for Payer: Multiplan Commercial	$70.50

HC CATECHOLAMINES UR FRACTIONATED

Facility

$85.00

Service Code	CPT 82384
Hospital Charge Code	900910455
Hospital Revenue Code	301
Min. Negotiated Rate	$25.25
Max. Negotiated Rate	$68.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$51.00
Rate for Payer: Aetna of CA Government/Medicare	$51.00
Rate for Payer: Cash Price	$38.25
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: Intervalley Health Plan Commercial	$25.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$51.00
Rate for Payer: LLUH Dept of Risk Management WC	$46.75
Rate for Payer: Multiplan Commercial	$63.75

HC CBC W DIFFERENTIAL

Facility

$52.00

Service Code	CPT 85027
Hospital Charge Code	900910093
Hospital Revenue Code	305
Min. Negotiated Rate	$6.47
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	$6.47
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 CBC W DIFFERENTIAL

Facility

$94.00

Service Code	CPT 85027
Hospital Charge Code	900910093
Hospital Revenue Code	305
Min. Negotiated Rate	$51.70
Max. Negotiated Rate	$75.20
Rate for Payer: Cash Price	$42.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$75.20
Rate for Payer: Health Smart Auto/Commercial	$56.40
Rate for Payer: LLUH Dept of Risk Management WC	$51.70
Rate for Payer: Multiplan Commercial	$70.50

HC CBC WITHOUT DIFFERENTIAL

Facility

$104.00

Service Code	CPT 85027
Hospital Charge Code	900912020
Hospital Revenue Code	305
Min. Negotiated Rate	$57.20
Max. Negotiated Rate	$83.20
Rate for Payer: Cash Price	$46.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$83.20
Rate for Payer: Health Smart Auto/Commercial	$62.40
Rate for Payer: LLUH Dept of Risk Management WC	$57.20
Rate for Payer: Multiplan Commercial	$78.00

HC CBC WITHOUT DIFFERENTIAL

Facility

$52.00

Service Code	CPT 85027
Hospital Charge Code	900912020
Hospital Revenue Code	305
Min. Negotiated Rate	$6.47
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	$6.47
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 CBC WO DIFFERENTIAL

Facility

$104.00

Service Code	CPT 85027
Hospital Charge Code	900910086
Hospital Revenue Code	305
Min. Negotiated Rate	$57.20
Max. Negotiated Rate	$83.20
Rate for Payer: Cash Price	$46.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$83.20
Rate for Payer: Health Smart Auto/Commercial	$62.40
Rate for Payer: LLUH Dept of Risk Management WC	$57.20
Rate for Payer: Multiplan Commercial	$78.00

HC CBC WO DIFFERENTIAL

Facility

$37.04

Service Code	CPT 85027
Hospital Charge Code	900910086
Hospital Revenue Code	305
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$29.63
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.22
Rate for Payer: Aetna of CA Government/Medicare	$22.22
Rate for Payer: Cash Price	$16.67
Rate for Payer: Cash Price	$16.67
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$29.63
Rate for Payer: Health Smart Auto/Commercial	$22.22
Rate for Payer: Intervalley Health Plan Commercial	$6.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.22
Rate for Payer: LLUH Dept of Risk Management WC	$20.37
Rate for Payer: Multiplan Commercial	$27.78

HC CBC W WBC AUTO DIFF

Facility

$52.00

Service Code	CPT 85025
Hospital Charge Code	900910092
Hospital Revenue Code	305
Min. Negotiated Rate	$7.77
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	$7.77
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 CBC W WBC AUTO DIFF

Facility

$145.80

Service Code	CPT 85025
Hospital Charge Code	900910092
Hospital Revenue Code	305
Min. Negotiated Rate	$80.19
Max. Negotiated Rate	$116.64
Rate for Payer: Cash Price	$65.61
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$116.64
Rate for Payer: Health Smart Auto/Commercial	$87.48
Rate for Payer: LLUH Dept of Risk Management WC	$80.19
Rate for Payer: Multiplan Commercial	$109.35

HC CBC W WBC AUTO DIFFERENTIAL INDIV

Facility

$52.00

Service Code	CPT 85025
Hospital Charge Code	900912018
Hospital Revenue Code	305
Min. Negotiated Rate	$7.77
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	$7.77
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 CBC W WBC AUTO DIFFERENTIAL INDIV

Facility

$145.00

Service Code	CPT 85025
Hospital Charge Code	900912018
Hospital Revenue Code	305
Min. Negotiated Rate	$79.75
Max. Negotiated Rate	$116.00
Rate for Payer: Cash Price	$65.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$116.00
Rate for Payer: Health Smart Auto/Commercial	$87.00
Rate for Payer: LLUH Dept of Risk Management WC	$79.75
Rate for Payer: Multiplan Commercial	$108.75

HC CBC W WO DIFFERENTIAL INDIVIDUAL

Facility

$94.00

Service Code	CPT 85027
Hospital Charge Code	900912019
Hospital Revenue Code	305
Min. Negotiated Rate	$51.70
Max. Negotiated Rate	$75.20
Rate for Payer: Cash Price	$42.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$75.20
Rate for Payer: Health Smart Auto/Commercial	$56.40
Rate for Payer: LLUH Dept of Risk Management WC	$51.70
Rate for Payer: Multiplan Commercial	$70.50

Know your out-of-pocket cost for care.

All Charges