Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC EEG,AWAKE/DROWSY

Facility

$2,957.00

Service Code	CPT 95816
Hospital Charge Code	900600228
Hospital Revenue Code	740
Min. Negotiated Rate	$1,626.35
Max. Negotiated Rate	$2,365.60
Rate for Payer: Cash Price	$1,330.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2,365.60
Rate for Payer: Health Smart Auto/Commercial	$1,774.20
Rate for Payer: LLUH Dept of Risk Management WC	$1,626.35
Rate for Payer: Multiplan Commercial	$2,217.75

HC ELBOW COMPLETE

Facility

$1,238.00

Service Code	CPT 73080
Hospital Charge Code	909001512
Hospital Revenue Code	320
Min. Negotiated Rate	$680.90
Max. Negotiated Rate	$990.40
Rate for Payer: Cash Price	$557.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$990.40
Rate for Payer: Health Smart Auto/Commercial	$742.80
Rate for Payer: LLUH Dept of Risk Management WC	$680.90
Rate for Payer: Multiplan Commercial	$928.50

HC ELBOW COMPLETE

Facility

$1,238.00

Service Code	CPT 73080
Hospital Charge Code	909001512
Hospital Revenue Code	320
Min. Negotiated Rate	$680.90
Max. Negotiated Rate	$990.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$742.80
Rate for Payer: Aetna of CA Government/Medicare	$742.80
Rate for Payer: Cash Price	$557.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$990.40
Rate for Payer: Health Smart Auto/Commercial	$742.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$742.80
Rate for Payer: LLUH Dept of Risk Management WC	$680.90
Rate for Payer: Multiplan Commercial	$928.50

HC ELBOW LIMITED 2 VIEW

Facility

$875.00

Service Code	CPT 73070
Hospital Charge Code	909001511
Hospital Revenue Code	320
Min. Negotiated Rate	$481.25
Max. Negotiated Rate	$700.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$525.00
Rate for Payer: Aetna of CA Government/Medicare	$525.00
Rate for Payer: Cash Price	$393.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$700.00
Rate for Payer: Health Smart Auto/Commercial	$525.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$525.00
Rate for Payer: LLUH Dept of Risk Management WC	$481.25
Rate for Payer: Multiplan Commercial	$656.25

HC ELBOW LIMITED 2 VIEW

Facility

$875.00

Service Code	CPT 73070
Hospital Charge Code	909001511
Hospital Revenue Code	320
Min. Negotiated Rate	$481.25
Max. Negotiated Rate	$700.00
Rate for Payer: Cash Price	$393.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$700.00
Rate for Payer: Health Smart Auto/Commercial	$525.00
Rate for Payer: LLUH Dept of Risk Management WC	$481.25
Rate for Payer: Multiplan Commercial	$656.25

HC ELECTROCARDIOGRAM

Facility

$660.00

Service Code	CPT 93005
Hospital Charge Code	907601600
Hospital Revenue Code	730
Min. Negotiated Rate	$363.00
Max. Negotiated Rate	$528.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$396.00
Rate for Payer: Aetna of CA Government/Medicare	$396.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$528.00
Rate for Payer: Health Smart Auto/Commercial	$396.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$396.00
Rate for Payer: LLUH Dept of Risk Management WC	$363.00
Rate for Payer: Multiplan Commercial	$495.00

HC ELECTROCARDIOGRAM

Facility

$660.00

Service Code	CPT 93005
Hospital Charge Code	907601600
Hospital Revenue Code	730
Min. Negotiated Rate	$363.00
Max. Negotiated Rate	$528.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$528.00
Rate for Payer: Health Smart Auto/Commercial	$396.00
Rate for Payer: LLUH Dept of Risk Management WC	$363.00
Rate for Payer: Multiplan Commercial	$495.00

HC ELECTROCONVULSIVE THERAPY

Facility

$2,886.00

Service Code	CPT 90870
Hospital Charge Code	907702200
Hospital Revenue Code	901
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$2,164.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,145.00
Rate for Payer: Aetna of CA Government/Medicare	$1,214.00
Rate for Payer: Anthem Blue Cross of CA Commercial/Medicare	$1,351.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$900.00
Rate for Payer: Cash Price	$1,298.70
Rate for Payer: Cash Price	$1,298.70
Rate for Payer: Cash Price	$1,298.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,011.00
Rate for Payer: Health Smart Auto/Commercial	$1,047.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$1,213.00
Rate for Payer: Intervalley Health Plan Commercial	$1,000.00
Rate for Payer: LLUH Dept of Risk Management WC	$1,587.30
Rate for Payer: Mary Free Bed Workers' Compensation	$1,350.61
Rate for Payer: Multiplan Commercial	$2,164.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$1,029.86

HC ELECTROCONVULSIVE THERAPY

Facility

$2,886.00

Service Code	CPT 90870
Hospital Charge Code	907702200
Hospital Revenue Code	901
Min. Negotiated Rate	$783.00
Max. Negotiated Rate	$2,164.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,214.00
Rate for Payer: Aetna of CA Government/Medicare	$1,145.00
Rate for Payer: Anthem Blue Cross of CA Commercial/Medicare	$1,330.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$900.00
Rate for Payer: Blue Shield of California Commercial	$783.00
Rate for Payer: Caremore Medicare Advantage	$1,067.00
Rate for Payer: Cash Price	$1,298.70
Rate for Payer: Cash Price	$1,298.70
Rate for Payer: Cash Price	$1,298.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,011.00
Rate for Payer: Health Smart Auto/Commercial	$1,047.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$1,213.00
Rate for Payer: Intervalley Health Plan Commercial	$1,000.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,034.00
Rate for Payer: LLUH Dept of Risk Management WC	$1,587.30
Rate for Payer: Magellan Commercial	$1,450.00
Rate for Payer: Managed Health Network (MHN) Commercial	$1,301.00
Rate for Payer: Multiplan Commercial	$2,164.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$1,029.86

HC ELECTROLYTE PANEL

Facility

$230.00

Service Code	CPT 80051
Hospital Charge Code	900912165
Hospital Revenue Code	301
Min. Negotiated Rate	$126.50
Max. Negotiated Rate	$184.00
Rate for Payer: Cash Price	$103.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$184.00
Rate for Payer: Health Smart Auto/Commercial	$138.00
Rate for Payer: LLUH Dept of Risk Management WC	$126.50
Rate for Payer: Multiplan Commercial	$172.50

HC ELECTROLYTE PANEL

Facility

$54.00

Service Code	CPT 80051
Hospital Charge Code	900912165
Hospital Revenue Code	301
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$32.40
Rate for Payer: Aetna of CA Government/Medicare	$32.40
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cash Price	$24.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$43.20
Rate for Payer: Health Smart Auto/Commercial	$32.40
Rate for Payer: Intervalley Health Plan Commercial	$7.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$32.40
Rate for Payer: LLUH Dept of Risk Management WC	$29.70
Rate for Payer: Multiplan Commercial	$40.50

HC EOSINOPHIL CT DIR

Facility

$20.00

Service Code	CPT 85048
Hospital Charge Code	900910031
Hospital Revenue Code	305
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.00
Rate for Payer: Aetna of CA Government/Medicare	$12.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: Intervalley Health Plan Commercial	$2.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Commercial	$15.00

HC EOSINOPHIL CT DIR

Facility

$96.00

Service Code	CPT 85048
Hospital Charge Code	900910031
Hospital Revenue Code	305
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 EOSINOPHIL SMEAR

Facility

$42.00

Service Code	CPT 89190
Hospital Charge Code	900910030
Hospital Revenue Code	300
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$33.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$25.20
Rate for Payer: Aetna of CA Government/Medicare	$25.20
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$33.60
Rate for Payer: Health Smart Auto/Commercial	$25.20
Rate for Payer: Intervalley Health Plan Commercial	$5.79
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$25.20
Rate for Payer: LLUH Dept of Risk Management WC	$23.10
Rate for Payer: Multiplan Commercial	$31.50

HC EOSINOPHIL SMEAR

Facility

$157.00

Service Code	CPT 89190
Hospital Charge Code	900910030
Hospital Revenue Code	300
Min. Negotiated Rate	$86.35
Max. Negotiated Rate	$125.60
Rate for Payer: Cash Price	$70.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$125.60
Rate for Payer: Health Smart Auto/Commercial	$94.20
Rate for Payer: LLUH Dept of Risk Management WC	$86.35
Rate for Payer: Multiplan Commercial	$117.75

HC EPSTEIN ANTIBODY SCREEN IGM

Facility

$77.00

Service Code	CPT 86308
Hospital Charge Code	900913657
Hospital Revenue Code	302
Min. Negotiated Rate	$42.35
Max. Negotiated Rate	$61.60
Rate for Payer: Cash Price	$34.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$61.60
Rate for Payer: Health Smart Auto/Commercial	$46.20
Rate for Payer: LLUH Dept of Risk Management WC	$42.35
Rate for Payer: Multiplan Commercial	$57.75

HC EPSTEIN ANTIBODY SCREEN IGM

Facility

$55.00

Service Code	CPT 86308
Hospital Charge Code	900913657
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 EPSTEIN BARR EARLY ANTIGEN IGG

Facility

$56.00

Service Code	CPT 86663
Hospital Charge Code	900913653
Hospital Revenue Code	302
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$44.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.60
Rate for Payer: Aetna of CA Government/Medicare	$33.60
Rate for Payer: Cash Price	$25.20
Rate for Payer: Cash Price	$25.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$44.80
Rate for Payer: Health Smart Auto/Commercial	$33.60
Rate for Payer: Intervalley Health Plan Commercial	$13.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.60
Rate for Payer: LLUH Dept of Risk Management WC	$30.80
Rate for Payer: Multiplan Commercial	$42.00

HC EPSTEIN BARR EARLY ANTIGEN IGG

Facility

$77.00

Service Code	CPT 86663
Hospital Charge Code	900913653
Hospital Revenue Code	302
Min. Negotiated Rate	$42.35
Max. Negotiated Rate	$61.60
Rate for Payer: Cash Price	$34.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$61.60
Rate for Payer: Health Smart Auto/Commercial	$46.20
Rate for Payer: LLUH Dept of Risk Management WC	$42.35
Rate for Payer: Multiplan Commercial	$57.75

HC EPSTEIN BARR NUCLEAR ANTIGEN IGG

Facility

$98.00

Service Code	CPT 86664
Hospital Charge Code	900913654
Hospital Revenue Code	302
Min. Negotiated Rate	$15.29
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	$15.29
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 EPSTEIN BARR NUCLEAR ANTIGEN IGG

Facility

$134.00

Service Code	CPT 86664
Hospital Charge Code	900913654
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 EPSTEIN BARR VIRAL CAPSID IGG

Facility

$134.00

Service Code	CPT 86665
Hospital Charge Code	900913655
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 EPSTEIN BARR VIRAL CAPSID IGG

Facility

$98.00

Service Code	CPT 86665
Hospital Charge Code	900913655
Hospital Revenue Code	302
Min. Negotiated Rate	$18.14
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	$18.14
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 EPSTEIN BARR VIRAL CAPSID IGM

Facility

$134.00

Service Code	CPT 86665
Hospital Charge Code	900913656
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 EPSTEIN BARR VIRAL CAPSID IGM

Facility

$98.00

Service Code	CPT 86665
Hospital Charge Code	900913656
Hospital Revenue Code	302
Min. Negotiated Rate	$18.14
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	$18.14
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

Know your out-of-pocket cost for care.

All Charges