Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC CHLORAMPHENICOL E TEST

Facility

$85.00

Service Code	CPT 87181
Hospital Charge Code	900912442
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 CHLORAMPHENICOL E TEST

Facility

$19.00

Service Code	CPT 87181
Hospital Charge Code	900912442
Hospital Revenue Code	306
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$15.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.40
Rate for Payer: Aetna of CA Government/Medicare	$11.40
Rate for Payer: Cash Price	$8.55
Rate for Payer: Cash Price	$8.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$15.20
Rate for Payer: Health Smart Auto/Commercial	$11.40
Rate for Payer: Intervalley Health Plan Commercial	$4.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.40
Rate for Payer: LLUH Dept of Risk Management WC	$10.45
Rate for Payer: Multiplan Commercial	$14.25

HC CHLORIDE

Facility

$98.00

Service Code	CPT 82435
Hospital Charge Code	900910256
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 CHLORIDE

Facility

$17.00

Service Code	CPT 82435
Hospital Charge Code	900910256
Hospital Revenue Code	301
Min. Negotiated Rate	$4.60
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	$4.60
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 CHLORIDE INDIVIDUAL

Facility

$50.00

Service Code	CPT 82435
Hospital Charge Code	900910489
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 CHLORIDE INDIVIDUAL

Facility

$50.00

Service Code	CPT 82435
Hospital Charge Code	900910489
Hospital Revenue Code	301
Min. Negotiated Rate	$4.60
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	$4.60
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 CHLORIDE STOOL

Facility

$26.00

Service Code	CPT 82438
Hospital Charge Code	900910420
Hospital Revenue Code	301
Min. Negotiated Rate	$5.00
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	$5.00
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 CHLORIDE STOOL

Facility

$198.00

Service Code	CPT 82438
Hospital Charge Code	900910420
Hospital Revenue Code	301
Min. Negotiated Rate	$108.90
Max. Negotiated Rate	$158.40
Rate for Payer: Cash Price	$89.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$158.40
Rate for Payer: Health Smart Auto/Commercial	$118.80
Rate for Payer: LLUH Dept of Risk Management WC	$108.90
Rate for Payer: Multiplan Commercial	$148.50

HC CHLORIDE URINE

Facility

$34.00

Service Code	CPT 82436
Hospital Charge Code	900910268
Hospital Revenue Code	301
Min. Negotiated Rate	$5.75
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	$5.75
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 CHLORIDE URINE

Facility

$117.00

Service Code	CPT 82436
Hospital Charge Code	900910268
Hospital Revenue Code	301
Min. Negotiated Rate	$64.35
Max. Negotiated Rate	$93.60
Rate for Payer: Cash Price	$52.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$93.60
Rate for Payer: Health Smart Auto/Commercial	$70.20
Rate for Payer: LLUH Dept of Risk Management WC	$64.35
Rate for Payer: Multiplan Commercial	$87.75

HC CHOLESTEROL BODY FLUID

Facility

$27.00

Service Code	CPT 84311
Hospital Charge Code	900912242
Hospital Revenue Code	301
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.20
Rate for Payer: Aetna of CA Government/Medicare	$16.20
Rate for Payer: Cash Price	$12.15
Rate for Payer: Cash Price	$12.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$21.60
Rate for Payer: Health Smart Auto/Commercial	$16.20
Rate for Payer: Intervalley Health Plan Commercial	$8.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.20
Rate for Payer: LLUH Dept of Risk Management WC	$14.85
Rate for Payer: Multiplan Commercial	$20.25

HC CHOLESTEROL BODY FLUID

Facility

$28.00

Service Code	CPT 84311
Hospital Charge Code	900912242
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

HC CHOLESTEROL HDL DIRECT

Facility

$153.00

Service Code	CPT 83718
Hospital Charge Code	900910528
Hospital Revenue Code	301
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$122.40
Rate for Payer: Cash Price	$68.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$122.40
Rate for Payer: Health Smart Auto/Commercial	$91.80
Rate for Payer: LLUH Dept of Risk Management WC	$84.15
Rate for Payer: Multiplan Commercial	$114.75

HC CHOLESTEROL HDL DIRECT

Facility

$27.00

Service Code	CPT 83718
Hospital Charge Code	900910528
Hospital Revenue Code	301
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.20
Rate for Payer: Aetna of CA Government/Medicare	$16.20
Rate for Payer: Cash Price	$12.15
Rate for Payer: Cash Price	$12.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$21.60
Rate for Payer: Health Smart Auto/Commercial	$16.20
Rate for Payer: Intervalley Health Plan Commercial	$8.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.20
Rate for Payer: LLUH Dept of Risk Management WC	$14.85
Rate for Payer: Multiplan Commercial	$20.25

HC CHOLESTEROL HDL-DIRECT INDIV

Facility

$27.00

Service Code	CPT 83718
Hospital Charge Code	900910527
Hospital Revenue Code	301
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.20
Rate for Payer: Aetna of CA Government/Medicare	$16.20
Rate for Payer: Cash Price	$12.15
Rate for Payer: Cash Price	$12.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$21.60
Rate for Payer: Health Smart Auto/Commercial	$16.20
Rate for Payer: Intervalley Health Plan Commercial	$8.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.20
Rate for Payer: LLUH Dept of Risk Management WC	$14.85
Rate for Payer: Multiplan Commercial	$20.25

HC CHOLESTEROL HDL-DIRECT INDIV

Facility

$153.00

Service Code	CPT 83718
Hospital Charge Code	900910527
Hospital Revenue Code	301
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$122.40
Rate for Payer: Cash Price	$68.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$122.40
Rate for Payer: Health Smart Auto/Commercial	$91.80
Rate for Payer: LLUH Dept of Risk Management WC	$84.15
Rate for Payer: Multiplan Commercial	$114.75

HC CHOLESTEROL LDL-DIRECT

Facility

$68.00

Service Code	CPT 83721
Hospital Charge Code	900910529
Hospital Revenue Code	301
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$54.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$40.80
Rate for Payer: Aetna of CA Government/Medicare	$40.80
Rate for Payer: Cash Price	$30.60
Rate for Payer: Cash Price	$30.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$54.40
Rate for Payer: Health Smart Auto/Commercial	$40.80
Rate for Payer: Intervalley Health Plan Commercial	$10.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$40.80
Rate for Payer: LLUH Dept of Risk Management WC	$37.40
Rate for Payer: Multiplan Commercial	$51.00

HC CHOLESTEROL LDL-DIRECT

Facility

$179.00

Service Code	CPT 83721
Hospital Charge Code	900910529
Hospital Revenue Code	301
Min. Negotiated Rate	$98.45
Max. Negotiated Rate	$143.20
Rate for Payer: Cash Price	$80.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$143.20
Rate for Payer: Health Smart Auto/Commercial	$107.40
Rate for Payer: LLUH Dept of Risk Management WC	$98.45
Rate for Payer: Multiplan Commercial	$134.25

HC CHOLESTEROL TOTAL

Facility

$98.00

Service Code	CPT 82465
Hospital Charge Code	900910221
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 CHOLESTEROL TOTAL

Facility

$47.00

Service Code	CPT 82465
Hospital Charge Code	900910221
Hospital Revenue Code	301
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$37.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$28.20
Rate for Payer: Aetna of CA Government/Medicare	$28.20
Rate for Payer: Cash Price	$21.15
Rate for Payer: Cash Price	$21.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$37.60
Rate for Payer: Health Smart Auto/Commercial	$28.20
Rate for Payer: Intervalley Health Plan Commercial	$4.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$28.20
Rate for Payer: LLUH Dept of Risk Management WC	$25.85
Rate for Payer: Multiplan Commercial	$35.25

HC CHOLESTEROL TOTAL INDIVIDUAL

Facility

$98.00

Service Code	CPT 82465
Hospital Charge Code	900910525
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 CHOLESTEROL TOTAL INDIVIDUAL

Facility

$47.00

Service Code	CPT 82465
Hospital Charge Code	900910525
Hospital Revenue Code	301
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$37.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$28.20
Rate for Payer: Aetna of CA Government/Medicare	$28.20
Rate for Payer: Cash Price	$21.15
Rate for Payer: Cash Price	$21.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$37.60
Rate for Payer: Health Smart Auto/Commercial	$28.20
Rate for Payer: Intervalley Health Plan Commercial	$4.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$28.20
Rate for Payer: LLUH Dept of Risk Management WC	$25.85
Rate for Payer: Multiplan Commercial	$35.25

HC CHROM ADDL CELL COUNT EA

Facility

$78.00

Service Code	CPT 88285
Hospital Charge Code	900918013
Hospital Revenue Code	310
Min. Negotiated Rate	$26.91
Max. Negotiated Rate	$62.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$46.80
Rate for Payer: Aetna of CA Government/Medicare	$46.80
Rate for Payer: Cash Price	$35.10
Rate for Payer: Cash Price	$35.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$62.40
Rate for Payer: Health Smart Auto/Commercial	$46.80
Rate for Payer: Intervalley Health Plan Commercial	$26.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$46.80
Rate for Payer: LLUH Dept of Risk Management WC	$42.90
Rate for Payer: Multiplan Commercial	$58.50

HC CHROM ADDL CELL COUNT EA

Facility

$120.00

Service Code	CPT 88285
Hospital Charge Code	900918013
Hospital Revenue Code	310
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$96.00
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: LLUH Dept of Risk Management WC	$66.00
Rate for Payer: Multiplan Commercial	$90.00

HC CHROM ADDL SPEC BANDING

Facility

$133.00

Service Code	CPT 88283
Hospital Charge Code	900918012
Hospital Revenue Code	310
Min. Negotiated Rate	$73.15
Max. Negotiated Rate	$106.40
Rate for Payer: Cash Price	$59.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$106.40
Rate for Payer: Health Smart Auto/Commercial	$79.80
Rate for Payer: LLUH Dept of Risk Management WC	$73.15
Rate for Payer: Multiplan Commercial	$99.75

Know your out-of-pocket cost for care.

All Charges