Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC COMPLEMENT C-3

Facility

$92.00

Service Code	CPT 86160
Hospital Charge Code	900910841
Hospital Revenue Code	302
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$73.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$55.20
Rate for Payer: Aetna of CA Government/Medicare	$55.20
Rate for Payer: Cash Price	$41.40
Rate for Payer: Cash Price	$41.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$73.60
Rate for Payer: Health Smart Auto/Commercial	$55.20
Rate for Payer: Intervalley Health Plan Commercial	$12.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$55.20
Rate for Payer: LLUH Dept of Risk Management WC	$50.60
Rate for Payer: Multiplan Commercial	$69.00

HC COMPLEMENT TOTAL

Facility

$109.00

Service Code	CPT 86162
Hospital Charge Code	900910842
Hospital Revenue Code	302
Min. Negotiated Rate	$59.95
Max. Negotiated Rate	$87.20
Rate for Payer: Cash Price	$49.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$87.20
Rate for Payer: Health Smart Auto/Commercial	$65.40
Rate for Payer: LLUH Dept of Risk Management WC	$59.95
Rate for Payer: Multiplan Commercial	$81.75

HC COMPLEMENT TOTAL

Facility

$80.00

Service Code	CPT 86162
Hospital Charge Code	900910842
Hospital Revenue Code	302
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$64.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$48.00
Rate for Payer: Aetna of CA Government/Medicare	$48.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$64.00
Rate for Payer: Health Smart Auto/Commercial	$48.00
Rate for Payer: Intervalley Health Plan Commercial	$20.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$48.00
Rate for Payer: LLUH Dept of Risk Management WC	$44.00
Rate for Payer: Multiplan Commercial	$60.00

HC COMPREHENSIVE METABOLIC PANEL

Facility

$70.00

Service Code	CPT 80053
Hospital Charge Code	900910423
Hospital Revenue Code	301
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$56.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$42.00
Rate for Payer: Aetna of CA Government/Medicare	$42.00
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$56.00
Rate for Payer: Health Smart Auto/Commercial	$42.00
Rate for Payer: Intervalley Health Plan Commercial	$10.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$42.00
Rate for Payer: LLUH Dept of Risk Management WC	$38.50
Rate for Payer: Multiplan Commercial	$52.50

HC COMPREHENSIVE METABOLIC PANEL

Facility

$795.00

Service Code	CPT 80053
Hospital Charge Code	900910423
Hospital Revenue Code	301
Min. Negotiated Rate	$437.25
Max. Negotiated Rate	$636.00
Rate for Payer: Cash Price	$357.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$636.00
Rate for Payer: Health Smart Auto/Commercial	$477.00
Rate for Payer: LLUH Dept of Risk Management WC	$437.25
Rate for Payer: Multiplan Commercial	$596.25

HC CORTISOL

Facility

$296.00

Service Code	CPT 82533
Hospital Charge Code	900912125
Hospital Revenue Code	301
Min. Negotiated Rate	$162.80
Max. Negotiated Rate	$236.80
Rate for Payer: Cash Price	$133.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$236.80
Rate for Payer: Health Smart Auto/Commercial	$177.60
Rate for Payer: LLUH Dept of Risk Management WC	$162.80
Rate for Payer: Multiplan Commercial	$222.00

HC CORTISOL

Facility

$128.00

Service Code	CPT 82533
Hospital Charge Code	900912125
Hospital Revenue Code	301
Min. Negotiated Rate	$16.30
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	$16.30
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 C-REACTIVE PROTEIN

Facility

$100.00

Service Code	CPT 86140
Hospital Charge Code	900910887
Hospital Revenue Code	302
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$80.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$80.00
Rate for Payer: Health Smart Auto/Commercial	$60.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.00
Rate for Payer: Multiplan Commercial	$75.00

HC C-REACTIVE PROTEIN

Facility

$55.00

Service Code	CPT 86140
Hospital Charge Code	900910887
Hospital Revenue Code	302
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$44.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.00
Rate for Payer: Aetna of CA Government/Medicare	$33.00
Rate for Payer: Cash Price	$24.75
Rate for Payer: Cash Price	$24.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$44.00
Rate for Payer: Health Smart Auto/Commercial	$33.00
Rate for Payer: Intervalley Health Plan Commercial	$5.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.00
Rate for Payer: LLUH Dept of Risk Management WC	$30.25
Rate for Payer: Multiplan Commercial	$41.25

HC C-REACTIVE PROTEIN HI SENSITIVITY

Facility

$315.00

Service Code	CPT 86141
Hospital Charge Code	900912102
Hospital Revenue Code	302
Min. Negotiated Rate	$173.25
Max. Negotiated Rate	$252.00
Rate for Payer: Cash Price	$141.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$252.00
Rate for Payer: Health Smart Auto/Commercial	$189.00
Rate for Payer: LLUH Dept of Risk Management WC	$173.25
Rate for Payer: Multiplan Commercial	$236.25

HC C-REACTIVE PROTEIN HI SENSITIVITY

Facility

$82.00

Service Code	CPT 86141
Hospital Charge Code	900912102
Hospital Revenue Code	302
Min. Negotiated Rate	$12.95
Max. Negotiated Rate	$65.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$49.20
Rate for Payer: Aetna of CA Government/Medicare	$49.20
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cash Price	$36.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$65.60
Rate for Payer: Health Smart Auto/Commercial	$49.20
Rate for Payer: Intervalley Health Plan Commercial	$12.95
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$49.20
Rate for Payer: LLUH Dept of Risk Management WC	$45.10
Rate for Payer: Multiplan Commercial	$61.50

HC CREATINE KINASE

Facility

$55.09

Service Code	CPT 82550
Hospital Charge Code	900910222
Hospital Revenue Code	301
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$44.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.05
Rate for Payer: Aetna of CA Government/Medicare	$33.05
Rate for Payer: Cash Price	$24.79
Rate for Payer: Cash Price	$24.79
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$44.07
Rate for Payer: Health Smart Auto/Commercial	$33.05
Rate for Payer: Intervalley Health Plan Commercial	$6.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.05
Rate for Payer: LLUH Dept of Risk Management WC	$30.30
Rate for Payer: Multiplan Commercial	$41.32

HC CREATINE KINASE

Facility

$153.00

Service Code	CPT 82550
Hospital Charge Code	900910222
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 CREATININE

Facility

$98.00

Service Code	CPT 82565
Hospital Charge Code	900910247
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 CREATININE

Facility

$34.00

Service Code	CPT 82565
Hospital Charge Code	900910247
Hospital Revenue Code	301
Min. Negotiated Rate	$5.12
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	$5.12
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 CREATININE BODY FLUID

Facility

$50.00

Service Code	CPT 82570
Hospital Charge Code	900910377
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 CREATININE BODY FLUID

Facility

$127.00

Service Code	CPT 82570
Hospital Charge Code	900910377
Hospital Revenue Code	301
Min. Negotiated Rate	$69.85
Max. Negotiated Rate	$101.60
Rate for Payer: Cash Price	$57.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$101.60
Rate for Payer: Health Smart Auto/Commercial	$76.20
Rate for Payer: LLUH Dept of Risk Management WC	$69.85
Rate for Payer: Multiplan Commercial	$95.25

HC CREATININE CLEARAN

Facility

$261.00

Service Code	CPT 82575
Hospital Charge Code	900910260
Hospital Revenue Code	301
Min. Negotiated Rate	$143.55
Max. Negotiated Rate	$208.80
Rate for Payer: Cash Price	$117.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$208.80
Rate for Payer: Health Smart Auto/Commercial	$156.60
Rate for Payer: LLUH Dept of Risk Management WC	$143.55
Rate for Payer: Multiplan Commercial	$195.75

HC CREATININE CLEARAN

Facility

$92.00

Service Code	CPT 82575
Hospital Charge Code	900910260
Hospital Revenue Code	301
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$73.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$55.20
Rate for Payer: Aetna of CA Government/Medicare	$55.20
Rate for Payer: Cash Price	$41.40
Rate for Payer: Cash Price	$41.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$73.60
Rate for Payer: Health Smart Auto/Commercial	$55.20
Rate for Payer: Intervalley Health Plan Commercial	$9.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$55.20
Rate for Payer: LLUH Dept of Risk Management WC	$50.60
Rate for Payer: Multiplan Commercial	$69.00

HC CREATININE INDIVIDUAL

Facility

$34.00

Service Code	CPT 82565
Hospital Charge Code	900910493
Hospital Revenue Code	301
Min. Negotiated Rate	$5.12
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	$5.12
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 CREATININE INDIVIDUAL

Facility

$98.00

Service Code	CPT 82565
Hospital Charge Code	900910493
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 CRYOGLOBULINS QUAL

Facility

$62.00

Service Code	CPT 82595
Hospital Charge Code	900910978
Hospital Revenue Code	301
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$49.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$37.20
Rate for Payer: Aetna of CA Government/Medicare	$37.20
Rate for Payer: Cash Price	$27.90
Rate for Payer: Cash Price	$27.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$49.60
Rate for Payer: Health Smart Auto/Commercial	$37.20
Rate for Payer: Intervalley Health Plan Commercial	$6.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$37.20
Rate for Payer: LLUH Dept of Risk Management WC	$34.10
Rate for Payer: Multiplan Commercial	$46.50

HC CRYOGLOBULINS QUAL

Facility

$153.00

Service Code	CPT 82595
Hospital Charge Code	900910978
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 CT ABDOMEN & PELVIS W & W/O CO

Facility

$7,670.00

Service Code	CPT 74178
Hospital Charge Code	909202003
Hospital Revenue Code	352
Min. Negotiated Rate	$4,218.50
Max. Negotiated Rate	$6,136.00
Rate for Payer: Cash Price	$3,451.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6,136.00
Rate for Payer: Health Smart Auto/Commercial	$4,602.00
Rate for Payer: LLUH Dept of Risk Management WC	$4,218.50
Rate for Payer: Multiplan Commercial	$5,752.50

HC CT ABDOMEN & PELVIS W & W/O CO

Facility

$4,306.00

Service Code	CPT 74178
Hospital Charge Code	909202003
Hospital Revenue Code	352
Min. Negotiated Rate	$2,368.30
Max. Negotiated Rate	$3,444.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2,583.60
Rate for Payer: Aetna of CA Government/Medicare	$2,583.60
Rate for Payer: Cash Price	$1,937.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$3,444.80
Rate for Payer: Health Smart Auto/Commercial	$2,583.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2,583.60
Rate for Payer: LLUH Dept of Risk Management WC	$2,368.30
Rate for Payer: Multiplan Commercial	$3,229.50

Know your out-of-pocket cost for care.

All Charges