Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC DNA AB DBL STRANDED

Facility

$36.00

Service Code	CPT 86225
Hospital Charge Code	900913520
Hospital Revenue Code	302
Min. Negotiated Rate	$13.74
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.60
Rate for Payer: Aetna of CA Government/Medicare	$21.60
Rate for Payer: Cash Price	$16.20
Rate for Payer: Cash Price	$16.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$28.80
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: Intervalley Health Plan Commercial	$13.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Commercial	$27.00

HC DRUGS ABUSE SCREEN,URINE(7)COC

Facility

$242.00

Service Code	CPT 80307
Hospital Charge Code	900912159
Hospital Revenue Code	301
Min. Negotiated Rate	$62.14
Max. Negotiated Rate	$193.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$145.20
Rate for Payer: Aetna of CA Government/Medicare	$145.20
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$193.60
Rate for Payer: Health Smart Auto/Commercial	$145.20
Rate for Payer: Intervalley Health Plan Commercial	$62.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$145.20
Rate for Payer: LLUH Dept of Risk Management WC	$133.10
Rate for Payer: Multiplan Commercial	$181.50

HC DRUGS ABUSE SCREEN,URINE(7)COC

Facility

$1,126.00

Service Code	CPT 80307
Hospital Charge Code	900912159
Hospital Revenue Code	301
Min. Negotiated Rate	$619.30
Max. Negotiated Rate	$900.80
Rate for Payer: Cash Price	$506.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$900.80
Rate for Payer: Health Smart Auto/Commercial	$675.60
Rate for Payer: LLUH Dept of Risk Management WC	$619.30
Rate for Payer: Multiplan Commercial	$844.50

HC DRUG SCREEN BARBITUATES

Facility

$278.00

Service Code	CPT 80307
Hospital Charge Code	900910325
Hospital Revenue Code	301
Min. Negotiated Rate	$152.90
Max. Negotiated Rate	$222.40
Rate for Payer: Cash Price	$125.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$222.40
Rate for Payer: Health Smart Auto/Commercial	$166.80
Rate for Payer: LLUH Dept of Risk Management WC	$152.90
Rate for Payer: Multiplan Commercial	$208.50

HC DRUG SCREEN BARBITUATES

Facility

$242.00

Service Code	CPT 80307
Hospital Charge Code	900910325
Hospital Revenue Code	301
Min. Negotiated Rate	$62.14
Max. Negotiated Rate	$193.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$145.20
Rate for Payer: Aetna of CA Government/Medicare	$145.20
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$193.60
Rate for Payer: Health Smart Auto/Commercial	$145.20
Rate for Payer: Intervalley Health Plan Commercial	$62.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$145.20
Rate for Payer: LLUH Dept of Risk Management WC	$133.10
Rate for Payer: Multiplan Commercial	$181.50

HC DRUG SCREEN BENZODIAZPINES

Facility

$242.00

Service Code	CPT 80307
Hospital Charge Code	900911101
Hospital Revenue Code	301
Min. Negotiated Rate	$62.14
Max. Negotiated Rate	$193.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$145.20
Rate for Payer: Aetna of CA Government/Medicare	$145.20
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$193.60
Rate for Payer: Health Smart Auto/Commercial	$145.20
Rate for Payer: Intervalley Health Plan Commercial	$62.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$145.20
Rate for Payer: LLUH Dept of Risk Management WC	$133.10
Rate for Payer: Multiplan Commercial	$181.50

HC DRUG SCREEN BENZODIAZPINES

Facility

$278.00

Service Code	CPT 80307
Hospital Charge Code	900911101
Hospital Revenue Code	301
Min. Negotiated Rate	$152.90
Max. Negotiated Rate	$222.40
Rate for Payer: Cash Price	$125.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$222.40
Rate for Payer: Health Smart Auto/Commercial	$166.80
Rate for Payer: LLUH Dept of Risk Management WC	$152.90
Rate for Payer: Multiplan Commercial	$208.50

HC DRUG SCREEN CANNABINOIDS

Facility

$278.00

Service Code	CPT 80307
Hospital Charge Code	900911238
Hospital Revenue Code	301
Min. Negotiated Rate	$152.90
Max. Negotiated Rate	$222.40
Rate for Payer: Cash Price	$125.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$222.40
Rate for Payer: Health Smart Auto/Commercial	$166.80
Rate for Payer: LLUH Dept of Risk Management WC	$152.90
Rate for Payer: Multiplan Commercial	$208.50

HC DRUG SCREEN CANNABINOIDS

Facility

$242.00

Service Code	CPT 80307
Hospital Charge Code	900911238
Hospital Revenue Code	301
Min. Negotiated Rate	$62.14
Max. Negotiated Rate	$193.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$145.20
Rate for Payer: Aetna of CA Government/Medicare	$145.20
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$193.60
Rate for Payer: Health Smart Auto/Commercial	$145.20
Rate for Payer: Intervalley Health Plan Commercial	$62.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$145.20
Rate for Payer: LLUH Dept of Risk Management WC	$133.10
Rate for Payer: Multiplan Commercial	$181.50

HC DRUG SCREEN COCAINE

Facility

$242.00

Service Code	CPT 80307
Hospital Charge Code	900910390
Hospital Revenue Code	301
Min. Negotiated Rate	$62.14
Max. Negotiated Rate	$193.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$145.20
Rate for Payer: Aetna of CA Government/Medicare	$145.20
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$193.60
Rate for Payer: Health Smart Auto/Commercial	$145.20
Rate for Payer: Intervalley Health Plan Commercial	$62.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$145.20
Rate for Payer: LLUH Dept of Risk Management WC	$133.10
Rate for Payer: Multiplan Commercial	$181.50

HC DRUG SCREEN COCAINE

Facility

$278.00

Service Code	CPT 80307
Hospital Charge Code	900910390
Hospital Revenue Code	301
Min. Negotiated Rate	$152.90
Max. Negotiated Rate	$222.40
Rate for Payer: Cash Price	$125.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$222.40
Rate for Payer: Health Smart Auto/Commercial	$166.80
Rate for Payer: LLUH Dept of Risk Management WC	$152.90
Rate for Payer: Multiplan Commercial	$208.50

HC DRUG SCREEN OPIATES

Facility

$242.00

Service Code	CPT 80307
Hospital Charge Code	900911145
Hospital Revenue Code	301
Min. Negotiated Rate	$62.14
Max. Negotiated Rate	$193.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$145.20
Rate for Payer: Aetna of CA Government/Medicare	$145.20
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$193.60
Rate for Payer: Health Smart Auto/Commercial	$145.20
Rate for Payer: Intervalley Health Plan Commercial	$62.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$145.20
Rate for Payer: LLUH Dept of Risk Management WC	$133.10
Rate for Payer: Multiplan Commercial	$181.50

HC DRUG SCREEN OPIATES

Facility

$278.00

Service Code	CPT 80307
Hospital Charge Code	900911145
Hospital Revenue Code	301
Min. Negotiated Rate	$152.90
Max. Negotiated Rate	$222.40
Rate for Payer: Cash Price	$125.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$222.40
Rate for Payer: Health Smart Auto/Commercial	$166.80
Rate for Payer: LLUH Dept of Risk Management WC	$152.90
Rate for Payer: Multiplan Commercial	$208.50

HC DRUG SCREEN PHENCYCLIDINE

Facility

$242.00

Service Code	CPT 80307
Hospital Charge Code	900911147
Hospital Revenue Code	301
Min. Negotiated Rate	$62.14
Max. Negotiated Rate	$193.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$145.20
Rate for Payer: Aetna of CA Government/Medicare	$145.20
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$193.60
Rate for Payer: Health Smart Auto/Commercial	$145.20
Rate for Payer: Intervalley Health Plan Commercial	$62.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$145.20
Rate for Payer: LLUH Dept of Risk Management WC	$133.10
Rate for Payer: Multiplan Commercial	$181.50

HC DRUG SCREEN PHENCYCLIDINE

Facility

$278.00

Service Code	CPT 80307
Hospital Charge Code	900911147
Hospital Revenue Code	301
Min. Negotiated Rate	$152.90
Max. Negotiated Rate	$222.40
Rate for Payer: Cash Price	$125.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$222.40
Rate for Payer: Health Smart Auto/Commercial	$166.80
Rate for Payer: LLUH Dept of Risk Management WC	$152.90
Rate for Payer: Multiplan Commercial	$208.50

HC DRUG SCREEN, PRE-EMPLOYMENT

Facility

$242.00

Service Code	CPT 80307
Hospital Charge Code	900912158
Hospital Revenue Code	301
Min. Negotiated Rate	$62.14
Max. Negotiated Rate	$193.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$145.20
Rate for Payer: Aetna of CA Government/Medicare	$145.20
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$193.60
Rate for Payer: Health Smart Auto/Commercial	$145.20
Rate for Payer: Intervalley Health Plan Commercial	$62.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$145.20
Rate for Payer: LLUH Dept of Risk Management WC	$133.10
Rate for Payer: Multiplan Commercial	$181.50

HC DRUG SCREEN, PRE-EMPLOYMENT

Facility

$1,126.00

Service Code	CPT 80307
Hospital Charge Code	900912158
Hospital Revenue Code	301
Min. Negotiated Rate	$619.30
Max. Negotiated Rate	$900.80
Rate for Payer: Cash Price	$506.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$900.80
Rate for Payer: Health Smart Auto/Commercial	$675.60
Rate for Payer: LLUH Dept of Risk Management WC	$619.30
Rate for Payer: Multiplan Commercial	$844.50

HC DRUGS OF ABUSE SCREEN,URINE(5)

Facility

$310.00

Service Code	CPT 80307
Hospital Charge Code	900912160
Hospital Revenue Code	301
Min. Negotiated Rate	$170.50
Max. Negotiated Rate	$248.00
Rate for Payer: Cash Price	$139.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$248.00
Rate for Payer: Health Smart Auto/Commercial	$186.00
Rate for Payer: LLUH Dept of Risk Management WC	$170.50
Rate for Payer: Multiplan Commercial	$232.50

HC DRUGS OF ABUSE SCREEN,URINE(5)

Facility

$242.00

Service Code	CPT 80307
Hospital Charge Code	900912160
Hospital Revenue Code	301
Min. Negotiated Rate	$62.14
Max. Negotiated Rate	$193.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$145.20
Rate for Payer: Aetna of CA Government/Medicare	$145.20
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$193.60
Rate for Payer: Health Smart Auto/Commercial	$145.20
Rate for Payer: Intervalley Health Plan Commercial	$62.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$145.20
Rate for Payer: LLUH Dept of Risk Management WC	$133.10
Rate for Payer: Multiplan Commercial	$181.50

HC DRUGS OF ABUSE SCREEN,URINE(7)

Facility

$1,126.00

Service Code	CPT 80307
Hospital Charge Code	900912161
Hospital Revenue Code	301
Min. Negotiated Rate	$619.30
Max. Negotiated Rate	$900.80
Rate for Payer: Cash Price	$506.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$900.80
Rate for Payer: Health Smart Auto/Commercial	$675.60
Rate for Payer: LLUH Dept of Risk Management WC	$619.30
Rate for Payer: Multiplan Commercial	$844.50

HC DRUGS OF ABUSE SCREEN,URINE(7)

Facility

$242.00

Service Code	CPT 80307
Hospital Charge Code	900912161
Hospital Revenue Code	301
Min. Negotiated Rate	$62.14
Max. Negotiated Rate	$193.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$145.20
Rate for Payer: Aetna of CA Government/Medicare	$145.20
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$193.60
Rate for Payer: Health Smart Auto/Commercial	$145.20
Rate for Payer: Intervalley Health Plan Commercial	$62.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$145.20
Rate for Payer: LLUH Dept of Risk Management WC	$133.10
Rate for Payer: Multiplan Commercial	$181.50

HC DRVVT

Facility

$94.00

Service Code	CPT 85613
Hospital Charge Code	900912008
Hospital Revenue Code	305
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$75.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$56.40
Rate for Payer: Aetna of CA Government/Medicare	$56.40
Rate for Payer: Cash Price	$42.30
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: Intervalley Health Plan Commercial	$9.58
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$56.40
Rate for Payer: LLUH Dept of Risk Management WC	$51.70
Rate for Payer: Multiplan Commercial	$70.50

HC DRVVT

Facility

$178.00

Service Code	CPT 85613
Hospital Charge Code	900912008
Hospital Revenue Code	305
Min. Negotiated Rate	$97.90
Max. Negotiated Rate	$142.40
Rate for Payer: Cash Price	$80.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$142.40
Rate for Payer: Health Smart Auto/Commercial	$106.80
Rate for Payer: LLUH Dept of Risk Management WC	$97.90
Rate for Payer: Multiplan Commercial	$133.50

HC D TEST

Facility

$72.00

Service Code	CPT 87184
Hospital Charge Code	900912427
Hospital Revenue Code	306
Min. Negotiated Rate	$7.48
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$43.20
Rate for Payer: Aetna of CA Government/Medicare	$43.20
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$57.60
Rate for Payer: Health Smart Auto/Commercial	$43.20
Rate for Payer: Intervalley Health Plan Commercial	$7.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$43.20
Rate for Payer: LLUH Dept of Risk Management WC	$39.60
Rate for Payer: Multiplan Commercial	$54.00

HC D TEST

Facility

$156.00

Service Code	CPT 87184
Hospital Charge Code	900912427
Hospital Revenue Code	306
Min. Negotiated Rate	$85.80
Max. Negotiated Rate	$124.80
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: LLUH Dept of Risk Management WC	$85.80
Rate for Payer: Multiplan Commercial	$117.00

Know your out-of-pocket cost for care.

All Charges