Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC CLOSTRIDIUM DIFFICILE TOXIN

Facility

$96.00

Service Code	CPT 87324
Hospital Charge Code	900913623
Hospital Revenue Code	306
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$76.80
Rate for Payer: Cash Price	$43.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$76.80
Rate for Payer: Health Smart Auto/Commercial	$57.60
Rate for Payer: LLUH Dept of Risk Management WC	$52.80
Rate for Payer: Multiplan Commercial	$72.00

HC CLOSTRIDIUM DIFFICILE TOXIN

Facility

$83.00

Service Code	CPT 87324
Hospital Charge Code	900913623
Hospital Revenue Code	306
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$66.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$49.80
Rate for Payer: Aetna of CA Government/Medicare	$49.80
Rate for Payer: Cash Price	$37.35
Rate for Payer: Cash Price	$37.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$66.40
Rate for Payer: Health Smart Auto/Commercial	$49.80
Rate for Payer: Intervalley Health Plan Commercial	$11.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$49.80
Rate for Payer: LLUH Dept of Risk Management WC	$45.65
Rate for Payer: Multiplan Commercial	$62.25

HC CM SVCS BH AT LST 20 MIN CLIN PSYCH OR CLIN SW PER MNTH

Facility

$87.00

Service Code	CPT G0323
Hospital Charge Code	907800323
Hospital Revenue Code	914
Min. Negotiated Rate	$47.85
Max. Negotiated Rate	$69.60
Rate for Payer: Cash Price	$39.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$69.60
Rate for Payer: Health Smart Auto/Commercial	$52.20
Rate for Payer: LLUH Dept of Risk Management WC	$47.85
Rate for Payer: Multiplan Commercial	$65.25

HC CM SVCS BH AT LST 20 MIN CLIN PSYCH OR CLIN SW PER MNTH

Facility

$87.00

Service Code	CPT G0323
Hospital Charge Code	907800323
Hospital Revenue Code	914
Min. Negotiated Rate	$47.85
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$52.20
Rate for Payer: Aetna of CA Government/Medicare	$52.20
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Cash Price	$39.15
Rate for Payer: Cash Price	$39.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$69.60
Rate for Payer: Health Smart Auto/Commercial	$52.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$52.20
Rate for Payer: LLUH Dept of Risk Management WC	$47.85
Rate for Payer: Multiplan Commercial	$65.25

HC CMV AB IGG

Facility

$273.00

Service Code	CPT 86644
Hospital Charge Code	900910987
Hospital Revenue Code	302
Min. Negotiated Rate	$150.15
Max. Negotiated Rate	$218.40
Rate for Payer: Cash Price	$122.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$218.40
Rate for Payer: Health Smart Auto/Commercial	$163.80
Rate for Payer: LLUH Dept of Risk Management WC	$150.15
Rate for Payer: Multiplan Commercial	$204.75

HC CMV AB IGG

Facility

$98.00

Service Code	CPT 86644
Hospital Charge Code	900910987
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
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	$14.39
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 CMV AB IGM

Facility

$120.00

Service Code	CPT 86645
Hospital Charge Code	900910959
Hospital Revenue Code	302
Min. Negotiated Rate	$16.85
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	$16.85
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 CMV AB IGM

Facility

$314.00

Service Code	CPT 86645
Hospital Charge Code	900910959
Hospital Revenue Code	302
Min. Negotiated Rate	$172.70
Max. Negotiated Rate	$251.20
Rate for Payer: Cash Price	$141.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$251.20
Rate for Payer: Health Smart Auto/Commercial	$188.40
Rate for Payer: LLUH Dept of Risk Management WC	$172.70
Rate for Payer: Multiplan Commercial	$235.50

HC CMV ANTIBODY IGG

Facility

$98.00

Service Code	CPT 86644
Hospital Charge Code	900913650
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
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	$14.39
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 CMV ANTIBODY IGG

Facility

$134.00

Service Code	CPT 86644
Hospital Charge Code	900913650
Hospital Revenue Code	302
Min. Negotiated Rate	$73.70
Max. Negotiated Rate	$107.20
Rate for Payer: Cash Price	$60.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$107.20
Rate for Payer: Health Smart Auto/Commercial	$80.40
Rate for Payer: LLUH Dept of Risk Management WC	$73.70
Rate for Payer: Multiplan Commercial	$100.50

HC CMV ANTIBODY IGM

Facility

$134.00

Service Code	CPT 86645
Hospital Charge Code	900913651
Hospital Revenue Code	302
Min. Negotiated Rate	$73.70
Max. Negotiated Rate	$107.20
Rate for Payer: Cash Price	$60.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$107.20
Rate for Payer: Health Smart Auto/Commercial	$80.40
Rate for Payer: LLUH Dept of Risk Management WC	$73.70
Rate for Payer: Multiplan Commercial	$100.50

HC CMV ANTIBODY IGM

Facility

$98.00

Service Code	CPT 86645
Hospital Charge Code	900913651
Hospital Revenue Code	302
Min. Negotiated Rate	$16.85
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	$16.85
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 CO2

Facility

$98.00

Service Code	CPT 82374
Hospital Charge Code	900910258
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 CO2

Facility

$17.00

Service Code	CPT 82374
Hospital Charge Code	900910258
Hospital Revenue Code	301
Min. Negotiated Rate	$4.88
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	$4.88
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 CO2 INDIVIDUAL

Facility

$50.00

Service Code	CPT 82374
Hospital Charge Code	900910491
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 CO2 INDIVIDUAL

Facility

$50.00

Service Code	CPT 82374
Hospital Charge Code	900910491
Hospital Revenue Code	301
Min. Negotiated Rate	$4.88
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	$4.88
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 COAG FVIII INHIB EVAL BTHSDA U

Facility

$133.00

Service Code	CPT 85335
Hospital Charge Code	900913970
Hospital Revenue Code	305
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$106.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$79.80
Rate for Payer: Aetna of CA Government/Medicare	$79.80
Rate for Payer: Cash Price	$59.85
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: Intervalley Health Plan Commercial	$12.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$79.80
Rate for Payer: LLUH Dept of Risk Management WC	$73.15
Rate for Payer: Multiplan Commercial	$99.75

HC COAG FVIII INHIB EVAL BTHSDA U

Facility

$133.00

Service Code	CPT 85335
Hospital Charge Code	900913970
Hospital Revenue Code	305
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

HC COAG TIME ACTIVATED

Facility

$284.00

Service Code	CPT 85347
Hospital Charge Code	900910011
Hospital Revenue Code	305
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$227.20
Rate for Payer: Cash Price	$127.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$227.20
Rate for Payer: Health Smart Auto/Commercial	$170.40
Rate for Payer: LLUH Dept of Risk Management WC	$156.20
Rate for Payer: Multiplan Commercial	$213.00

HC COAG TIME ACTIVATED

Facility

$25.00

Service Code	CPT 85347
Hospital Charge Code	900910011
Hospital Revenue Code	305
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.00
Rate for Payer: Aetna of CA Government/Medicare	$15.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Cash Price	$11.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$20.00
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: Intervalley Health Plan Commercial	$4.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Commercial	$18.75

HC COCAINE METABOLITE CONF

Facility

$298.00

Service Code	CPT 80353
Hospital Charge Code	900910518
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 COCAINE METABOLITE CONF

Facility

$359.00

Service Code	CPT 80353
Hospital Charge Code	900910518
Hospital Revenue Code	301
Min. Negotiated Rate	$197.45
Max. Negotiated Rate	$287.20
Rate for Payer: Cash Price	$161.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$287.20
Rate for Payer: Health Smart Auto/Commercial	$215.40
Rate for Payer: LLUH Dept of Risk Management WC	$197.45
Rate for Payer: Multiplan Commercial	$269.25

HC COLON W SNGL CONTRAST ENEMA

Facility

$1,436.00

Service Code	CPT 74270
Hospital Charge Code	909001806
Hospital Revenue Code	320
Min. Negotiated Rate	$789.80
Max. Negotiated Rate	$1,148.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$861.60
Rate for Payer: Aetna of CA Government/Medicare	$861.60
Rate for Payer: Cash Price	$646.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,148.80
Rate for Payer: Health Smart Auto/Commercial	$861.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$861.60
Rate for Payer: LLUH Dept of Risk Management WC	$789.80
Rate for Payer: Multiplan Commercial	$1,077.00

HC COLON W SNGL CONTRAST ENEMA

Facility

$1,436.00

Service Code	CPT 74270
Hospital Charge Code	909001806
Hospital Revenue Code	320
Min. Negotiated Rate	$789.80
Max. Negotiated Rate	$1,148.80
Rate for Payer: Cash Price	$646.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,148.80
Rate for Payer: Health Smart Auto/Commercial	$861.60
Rate for Payer: LLUH Dept of Risk Management WC	$789.80
Rate for Payer: Multiplan Commercial	$1,077.00

HC COMPLEMENT C-3

Facility

$218.00

Service Code	CPT 86160
Hospital Charge Code	900910841
Hospital Revenue Code	302
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$174.40
Rate for Payer: Cash Price	$98.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$174.40
Rate for Payer: Health Smart Auto/Commercial	$130.80
Rate for Payer: LLUH Dept of Risk Management WC	$119.90
Rate for Payer: Multiplan Commercial	$163.50

Know your out-of-pocket cost for care.

All Charges