Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC FISH PROBE CYTOGEN 10-30 CELLS

Facility

$201.00

Service Code	CPT 88273
Hospital Charge Code	900918009
Hospital Revenue Code	310
Min. Negotiated Rate	$110.55
Max. Negotiated Rate	$160.80
Rate for Payer: Cash Price	$90.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$160.80
Rate for Payer: Health Smart Auto/Commercial	$120.60
Rate for Payer: LLUH Dept of Risk Management WC	$110.55
Rate for Payer: Multiplan Commercial	$150.75

HC FISH PROBE CYTOGEN 3-5 CELLS

Facility

$182.00

Service Code	CPT 88272
Hospital Charge Code	900918008
Hospital Revenue Code	310
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$145.60
Rate for Payer: Cash Price	$81.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$145.60
Rate for Payer: Health Smart Auto/Commercial	$109.20
Rate for Payer: LLUH Dept of Risk Management WC	$100.10
Rate for Payer: Multiplan Commercial	$136.50

HC FISH PROBE CYTOGEN 3-5 CELLS

Facility

$131.00

Service Code	CPT 88272
Hospital Charge Code	900918008
Hospital Revenue Code	310
Min. Negotiated Rate	$40.70
Max. Negotiated Rate	$104.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$78.60
Rate for Payer: Aetna of CA Government/Medicare	$78.60
Rate for Payer: Cash Price	$58.95
Rate for Payer: Cash Price	$58.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$104.80
Rate for Payer: Health Smart Auto/Commercial	$78.60
Rate for Payer: Intervalley Health Plan Commercial	$40.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$78.60
Rate for Payer: LLUH Dept of Risk Management WC	$72.05
Rate for Payer: Multiplan Commercial	$98.25

HC FISH PROBE CYTOGEN EA

Facility

$362.00

Service Code	CPT 88271
Hospital Charge Code	900918007
Hospital Revenue Code	310
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$289.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$217.20
Rate for Payer: Aetna of CA Government/Medicare	$217.20
Rate for Payer: Cash Price	$162.90
Rate for Payer: Cash Price	$162.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$289.60
Rate for Payer: Health Smart Auto/Commercial	$217.20
Rate for Payer: Intervalley Health Plan Commercial	$21.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$217.20
Rate for Payer: LLUH Dept of Risk Management WC	$199.10
Rate for Payer: Multiplan Commercial	$271.50

HC FISH PROBE CYTOGEN EA

Facility

$385.51

Service Code	CPT 88271
Hospital Charge Code	900918007
Hospital Revenue Code	310
Min. Negotiated Rate	$212.03
Max. Negotiated Rate	$308.41
Rate for Payer: Cash Price	$173.48
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$308.41
Rate for Payer: Health Smart Auto/Commercial	$231.31
Rate for Payer: LLUH Dept of Risk Management WC	$212.03
Rate for Payer: Multiplan Commercial	$289.13

HC FK 506 (TACROLIMUS)

Facility

$151.52

Service Code	CPT 80197
Hospital Charge Code	900911039
Hospital Revenue Code	301
Min. Negotiated Rate	$13.73
Max. Negotiated Rate	$121.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.91
Rate for Payer: Aetna of CA Government/Medicare	$90.91
Rate for Payer: Cash Price	$68.18
Rate for Payer: Cash Price	$68.18
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$121.22
Rate for Payer: Health Smart Auto/Commercial	$90.91
Rate for Payer: Intervalley Health Plan Commercial	$13.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$90.91
Rate for Payer: LLUH Dept of Risk Management WC	$83.34
Rate for Payer: Multiplan Commercial	$113.64

HC FK 506 (TACROLIMUS)

Facility

$211.00

Service Code	CPT 80197
Hospital Charge Code	900911039
Hospital Revenue Code	301
Min. Negotiated Rate	$116.05
Max. Negotiated Rate	$168.80
Rate for Payer: Cash Price	$94.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$168.80
Rate for Payer: Health Smart Auto/Commercial	$126.60
Rate for Payer: LLUH Dept of Risk Management WC	$116.05
Rate for Payer: Multiplan Commercial	$158.25

HC FLUORESCENT STAIN FUNGI

Facility

$156.00

Service Code	CPT 87206
Hospital Charge Code	900912418
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

HC FLUORESCENT STAIN FUNGI

Facility

$57.00

Service Code	CPT 87206
Hospital Charge Code	900912418
Hospital Revenue Code	306
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$45.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$34.20
Rate for Payer: Aetna of CA Government/Medicare	$34.20
Rate for Payer: Cash Price	$25.65
Rate for Payer: Cash Price	$25.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$45.60
Rate for Payer: Health Smart Auto/Commercial	$34.20
Rate for Payer: Intervalley Health Plan Commercial	$5.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$34.20
Rate for Payer: LLUH Dept of Risk Management WC	$31.35
Rate for Payer: Multiplan Commercial	$42.75

HC FOLIC ACID (SERUM)

Facility

$129.76

Service Code	CPT 82746
Hospital Charge Code	900910817
Hospital Revenue Code	301
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$103.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$77.86
Rate for Payer: Aetna of CA Government/Medicare	$77.86
Rate for Payer: Cash Price	$58.39
Rate for Payer: Cash Price	$58.39
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$103.81
Rate for Payer: Health Smart Auto/Commercial	$77.86
Rate for Payer: Intervalley Health Plan Commercial	$14.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$77.86
Rate for Payer: LLUH Dept of Risk Management WC	$71.37
Rate for Payer: Multiplan Commercial	$97.32

HC FOLIC ACID (SERUM)

Facility

$270.00

Service Code	CPT 82746
Hospital Charge Code	900910817
Hospital Revenue Code	301
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$216.00
Rate for Payer: Cash Price	$121.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$216.00
Rate for Payer: Health Smart Auto/Commercial	$162.00
Rate for Payer: LLUH Dept of Risk Management WC	$148.50
Rate for Payer: Multiplan Commercial	$202.50

HC FOOT COMPLETE

Facility

$1,098.00

Service Code	CPT 73630
Hospital Charge Code	909001631
Hospital Revenue Code	320
Min. Negotiated Rate	$603.90
Max. Negotiated Rate	$878.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$658.80
Rate for Payer: Aetna of CA Government/Medicare	$658.80
Rate for Payer: Cash Price	$494.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$878.40
Rate for Payer: Health Smart Auto/Commercial	$658.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$658.80
Rate for Payer: LLUH Dept of Risk Management WC	$603.90
Rate for Payer: Multiplan Commercial	$823.50

HC FOOT COMPLETE

Facility

$1,098.00

Service Code	CPT 73630
Hospital Charge Code	909001631
Hospital Revenue Code	320
Min. Negotiated Rate	$603.90
Max. Negotiated Rate	$878.40
Rate for Payer: Cash Price	$494.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$878.40
Rate for Payer: Health Smart Auto/Commercial	$658.80
Rate for Payer: LLUH Dept of Risk Management WC	$603.90
Rate for Payer: Multiplan Commercial	$823.50

HC FOOT LIMITED 2 VIEWS

Facility

$852.00

Service Code	CPT 73620
Hospital Charge Code	909001632
Hospital Revenue Code	320
Min. Negotiated Rate	$468.60
Max. Negotiated Rate	$681.60
Rate for Payer: Cash Price	$383.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$681.60
Rate for Payer: Health Smart Auto/Commercial	$511.20
Rate for Payer: LLUH Dept of Risk Management WC	$468.60
Rate for Payer: Multiplan Commercial	$639.00

HC FOOT LIMITED 2 VIEWS

Facility

$852.00

Service Code	CPT 73620
Hospital Charge Code	909001632
Hospital Revenue Code	320
Min. Negotiated Rate	$468.60
Max. Negotiated Rate	$681.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$511.20
Rate for Payer: Aetna of CA Government/Medicare	$511.20
Rate for Payer: Cash Price	$383.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$681.60
Rate for Payer: Health Smart Auto/Commercial	$511.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$511.20
Rate for Payer: LLUH Dept of Risk Management WC	$468.60
Rate for Payer: Multiplan Commercial	$639.00

HC FOREARM

Facility

$877.00

Service Code	CPT 73090
Hospital Charge Code	909001513
Hospital Revenue Code	320
Min. Negotiated Rate	$482.35
Max. Negotiated Rate	$701.60
Rate for Payer: Cash Price	$394.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$701.60
Rate for Payer: Health Smart Auto/Commercial	$526.20
Rate for Payer: LLUH Dept of Risk Management WC	$482.35
Rate for Payer: Multiplan Commercial	$657.75

HC FOREARM

Facility

$877.00

Service Code	CPT 73090
Hospital Charge Code	909001513
Hospital Revenue Code	320
Min. Negotiated Rate	$482.35
Max. Negotiated Rate	$701.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$526.20
Rate for Payer: Aetna of CA Government/Medicare	$526.20
Rate for Payer: Cash Price	$394.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$701.60
Rate for Payer: Health Smart Auto/Commercial	$526.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$526.20
Rate for Payer: LLUH Dept of Risk Management WC	$482.35
Rate for Payer: Multiplan Commercial	$657.75

HC FREE T4 BY EIA

Facility

$270.00

Service Code	CPT 84439
Hospital Charge Code	900912111
Hospital Revenue Code	301
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$216.00
Rate for Payer: Cash Price	$121.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$216.00
Rate for Payer: Health Smart Auto/Commercial	$162.00
Rate for Payer: LLUH Dept of Risk Management WC	$148.50
Rate for Payer: Multiplan Commercial	$202.50

HC FREE T4 BY EIA

Facility

$92.05

Service Code	CPT 84439
Hospital Charge Code	900912111
Hospital Revenue Code	301
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$73.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$55.23
Rate for Payer: Aetna of CA Government/Medicare	$55.23
Rate for Payer: Cash Price	$41.42
Rate for Payer: Cash Price	$41.42
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$73.64
Rate for Payer: Health Smart Auto/Commercial	$55.23
Rate for Payer: Intervalley Health Plan Commercial	$9.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$55.23
Rate for Payer: LLUH Dept of Risk Management WC	$50.63
Rate for Payer: Multiplan Commercial	$69.04

HC FSH

Facility

$148.72

Service Code	CPT 83001
Hospital Charge Code	900910818
Hospital Revenue Code	301
Min. Negotiated Rate	$18.58
Max. Negotiated Rate	$118.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$89.23
Rate for Payer: Aetna of CA Government/Medicare	$89.23
Rate for Payer: Cash Price	$66.92
Rate for Payer: Cash Price	$66.92
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$118.98
Rate for Payer: Health Smart Auto/Commercial	$89.23
Rate for Payer: Intervalley Health Plan Commercial	$18.58
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$89.23
Rate for Payer: LLUH Dept of Risk Management WC	$81.80
Rate for Payer: Multiplan Commercial	$111.54

HC FSH

Facility

$270.00

Service Code	CPT 83001
Hospital Charge Code	900910818
Hospital Revenue Code	301
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$216.00
Rate for Payer: Cash Price	$121.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$216.00
Rate for Payer: Health Smart Auto/Commercial	$162.00
Rate for Payer: LLUH Dept of Risk Management WC	$148.50
Rate for Payer: Multiplan Commercial	$202.50

HC FULL DAY ADOL/CHILD

Facility

$857.00

Service Code	CPT 90899
Hospital Charge Code	907803300
Hospital Revenue Code	912
Min. Negotiated Rate	$471.35
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$385.65
Rate for Payer: Cash Price	$385.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$685.60
Rate for Payer: Health Smart Auto/Commercial	$514.20
Rate for Payer: LLUH Dept of Risk Management WC	$471.35
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$642.75

HC FULL DAY ADOL/CHILD

Facility

$857.00

Service Code	CPT 90899
Hospital Charge Code	907803300
Hospital Revenue Code	912
Min. Negotiated Rate	$471.35
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$514.20
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$385.65
Rate for Payer: Cash Price	$385.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$471.35
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Multiplan Commercial	$642.75
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC FULL DAY ADOL EATING DISORDER

Facility

$1,837.00

Service Code	CPT 90899
Hospital Charge Code	907803315
Hospital Revenue Code	912
Min. Negotiated Rate	$516.13
Max. Negotiated Rate	$1,377.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$1,102.20
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$826.65
Rate for Payer: Cash Price	$826.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$1,010.35
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Multiplan Commercial	$1,377.75
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC FULL DAY ADOL EATING DISORDER

Facility

$1,837.00

Service Code	CPT 90899
Hospital Charge Code	907803315
Hospital Revenue Code	912
Min. Negotiated Rate	$703.72
Max. Negotiated Rate	$1,469.60
Rate for Payer: Cash Price	$826.65
Rate for Payer: Cash Price	$826.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,469.60
Rate for Payer: Health Smart Auto/Commercial	$1,102.20
Rate for Payer: LLUH Dept of Risk Management WC	$1,010.35
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$1,377.75

Know your out-of-pocket cost for care.

All Charges