Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC IMMUNOGLOBULIN E

Facility

$98.00

Service Code	CPT 82785
Hospital Charge Code	900912129
Hospital Revenue Code	301
Min. Negotiated Rate	$16.46
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	$16.46
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 IMMUNOGLOBULIN E

Facility

$179.00

Service Code	CPT 82785
Hospital Charge Code	900912129
Hospital Revenue Code	301
Min. Negotiated Rate	$98.45
Max. Negotiated Rate	$143.20
Rate for Payer: Cash Price	$80.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$143.20
Rate for Payer: Health Smart Auto/Commercial	$107.40
Rate for Payer: LLUH Dept of Risk Management WC	$98.45
Rate for Payer: Multiplan Commercial	$134.25

HC IMMUNOGLOBULINS IGA

Facility

$210.00

Service Code	CPT 82784
Hospital Charge Code	900910855
Hospital Revenue Code	301
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$168.00
Rate for Payer: Cash Price	$94.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$168.00
Rate for Payer: Health Smart Auto/Commercial	$126.00
Rate for Payer: LLUH Dept of Risk Management WC	$115.50
Rate for Payer: Multiplan Commercial	$157.50

HC IMMUNOGLOBULINS IGA

Facility

$78.00

Service Code	CPT 82784
Hospital Charge Code	900910855
Hospital Revenue Code	301
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$62.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$46.80
Rate for Payer: Aetna of CA Government/Medicare	$46.80
Rate for Payer: Cash Price	$35.10
Rate for Payer: Cash Price	$35.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$62.40
Rate for Payer: Health Smart Auto/Commercial	$46.80
Rate for Payer: Intervalley Health Plan Commercial	$9.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$46.80
Rate for Payer: LLUH Dept of Risk Management WC	$42.90
Rate for Payer: Multiplan Commercial	$58.50

HC IMMUNOGLOBULINS IGG

Facility

$178.00

Service Code	CPT 82784
Hospital Charge Code	900910857
Hospital Revenue Code	301
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 IMMUNOGLOBULINS IGG

Facility

$78.00

Service Code	CPT 82784
Hospital Charge Code	900910857
Hospital Revenue Code	301
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$62.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$46.80
Rate for Payer: Aetna of CA Government/Medicare	$46.80
Rate for Payer: Cash Price	$35.10
Rate for Payer: Cash Price	$35.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$62.40
Rate for Payer: Health Smart Auto/Commercial	$46.80
Rate for Payer: Intervalley Health Plan Commercial	$9.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$46.80
Rate for Payer: LLUH Dept of Risk Management WC	$42.90
Rate for Payer: Multiplan Commercial	$58.50

HC IMMUNOGLOBULINS IGM

Facility

$210.00

Service Code	CPT 82784
Hospital Charge Code	900910856
Hospital Revenue Code	301
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$168.00
Rate for Payer: Cash Price	$94.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$168.00
Rate for Payer: Health Smart Auto/Commercial	$126.00
Rate for Payer: LLUH Dept of Risk Management WC	$115.50
Rate for Payer: Multiplan Commercial	$157.50

HC IMMUNOGLOBULINS IGM

Facility

$78.00

Service Code	CPT 82784
Hospital Charge Code	900910856
Hospital Revenue Code	301
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$62.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$46.80
Rate for Payer: Aetna of CA Government/Medicare	$46.80
Rate for Payer: Cash Price	$35.10
Rate for Payer: Cash Price	$35.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$62.40
Rate for Payer: Health Smart Auto/Commercial	$46.80
Rate for Payer: Intervalley Health Plan Commercial	$9.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$46.80
Rate for Payer: LLUH Dept of Risk Management WC	$42.90
Rate for Payer: Multiplan Commercial	$58.50

HC IMMUNOTYPING ELECTROPHORESIS

Facility

$196.00

Service Code	CPT 86334
Hospital Charge Code	900913611
Hospital Revenue Code	301
Min. Negotiated Rate	$22.34
Max. Negotiated Rate	$156.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$117.60
Rate for Payer: Aetna of CA Government/Medicare	$117.60
Rate for Payer: Cash Price	$88.20
Rate for Payer: Cash Price	$88.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$156.80
Rate for Payer: Health Smart Auto/Commercial	$117.60
Rate for Payer: Intervalley Health Plan Commercial	$22.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$117.60
Rate for Payer: LLUH Dept of Risk Management WC	$107.80
Rate for Payer: Multiplan Commercial	$147.00

HC IMMUNOTYPING ELECTROPHORESIS

Facility

$337.00

Service Code	CPT 86334
Hospital Charge Code	900913611
Hospital Revenue Code	301
Min. Negotiated Rate	$185.35
Max. Negotiated Rate	$269.60
Rate for Payer: Cash Price	$151.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$269.60
Rate for Payer: Health Smart Auto/Commercial	$202.20
Rate for Payer: LLUH Dept of Risk Management WC	$185.35
Rate for Payer: Multiplan Commercial	$252.75

HC INDIV BRIEF THERAPY

Facility

$391.00

Service Code	CPT 90832
Hospital Charge Code	907804005
Hospital Revenue Code	914
Min. Negotiated Rate	$81.95
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$102.00
Rate for Payer: Aetna of CA Government/Medicare	$102.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Cash Price	$175.95
Rate for Payer: Cash Price	$175.95
Rate for Payer: Cash Price	$175.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$312.80
Rate for Payer: Health Smart Auto/Commercial	$234.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$234.60
Rate for Payer: LLUH Dept of Risk Management WC	$215.05
Rate for Payer: Mary Free Bed Workers' Compensation	$81.95
Rate for Payer: Multiplan Commercial	$293.25

HC INDIV BRIEF THERAPY

Facility

$391.00

Service Code	CPT 90832
Hospital Charge Code	907804005
Hospital Revenue Code	914
Min. Negotiated Rate	$215.05
Max. Negotiated Rate	$312.80
Rate for Payer: Cash Price	$175.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$312.80
Rate for Payer: Health Smart Auto/Commercial	$234.60
Rate for Payer: LLUH Dept of Risk Management WC	$215.05
Rate for Payer: Multiplan Commercial	$293.25

HC INDIV THERAPY

Facility

$391.00

Service Code	CPT 90853
Hospital Charge Code	907804007
Hospital Revenue Code	912
Min. Negotiated Rate	$215.05
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$175.95
Rate for Payer: Cash Price	$175.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$312.80
Rate for Payer: Health Smart Auto/Commercial	$234.60
Rate for Payer: LLUH Dept of Risk Management WC	$215.05
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$293.25

HC INDIV THERAPY

Facility

$391.00

Service Code	CPT 90853
Hospital Charge Code	907804007
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
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	$55.76
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	$175.95
Rate for Payer: Cash Price	$175.95
Rate for Payer: Cash Price	$175.95
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: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
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	$215.05
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$293.25
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC INFLUENZA A ANTIGEN

Facility

$42.00

Service Code	CPT 87400
Hospital Charge Code	900911778
Hospital Revenue Code	306
Min. Negotiated Rate	$14.13
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	$14.13
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 INFLUENZA A ANTIGEN

Facility

$200.00

Service Code	CPT 87400
Hospital Charge Code	900911778
Hospital Revenue Code	306
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$160.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$160.00
Rate for Payer: Health Smart Auto/Commercial	$120.00
Rate for Payer: LLUH Dept of Risk Management WC	$110.00
Rate for Payer: Multiplan Commercial	$150.00

HC INSULIN

Facility

$179.00

Service Code	CPT 83525
Hospital Charge Code	900912130
Hospital Revenue Code	301
Min. Negotiated Rate	$98.45
Max. Negotiated Rate	$143.20
Rate for Payer: Cash Price	$80.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$143.20
Rate for Payer: Health Smart Auto/Commercial	$107.40
Rate for Payer: LLUH Dept of Risk Management WC	$98.45
Rate for Payer: Multiplan Commercial	$134.25

HC INSULIN

Facility

$41.08

Service Code	CPT 83525
Hospital Charge Code	900912130
Hospital Revenue Code	301
Min. Negotiated Rate	$11.43
Max. Negotiated Rate	$32.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.65
Rate for Payer: Aetna of CA Government/Medicare	$24.65
Rate for Payer: Cash Price	$18.49
Rate for Payer: Cash Price	$18.49
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$32.86
Rate for Payer: Health Smart Auto/Commercial	$24.65
Rate for Payer: Intervalley Health Plan Commercial	$11.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.65
Rate for Payer: LLUH Dept of Risk Management WC	$22.59
Rate for Payer: Multiplan Commercial	$30.81

HC INTACT PTH

Facility

$763.00

Service Code	CPT 83970
Hospital Charge Code	900910942
Hospital Revenue Code	301
Min. Negotiated Rate	$419.65
Max. Negotiated Rate	$610.40
Rate for Payer: Cash Price	$343.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$610.40
Rate for Payer: Health Smart Auto/Commercial	$457.80
Rate for Payer: LLUH Dept of Risk Management WC	$419.65
Rate for Payer: Multiplan Commercial	$572.25

HC INTACT PTH

Facility

$236.47

Service Code	CPT 83970
Hospital Charge Code	900910942
Hospital Revenue Code	301
Min. Negotiated Rate	$41.28
Max. Negotiated Rate	$189.18
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$141.88
Rate for Payer: Aetna of CA Government/Medicare	$141.88
Rate for Payer: Cash Price	$106.41
Rate for Payer: Cash Price	$106.41
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$189.18
Rate for Payer: Health Smart Auto/Commercial	$141.88
Rate for Payer: Intervalley Health Plan Commercial	$41.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$141.88
Rate for Payer: LLUH Dept of Risk Management WC	$130.06
Rate for Payer: Multiplan Commercial	$177.35

HC INTENSIVE OP SHIELD/ADOL/CHILD

Facility

$784.00

Service Code	CPT 90853
Hospital Charge Code	907300010
Hospital Revenue Code	905
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$588.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Cash Price	$352.80
Rate for Payer: Cash Price	$352.80
Rate for Payer: Cash Price	$352.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$364.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$431.20
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$588.00
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC INTENSIVE OP SHIELD/ADOL/CHILD

Facility

$784.00

Service Code	CPT 90853
Hospital Charge Code	907300010
Hospital Revenue Code	905
Min. Negotiated Rate	$431.20
Max. Negotiated Rate	$652.36
Rate for Payer: Cash Price	$352.80
Rate for Payer: Cash Price	$352.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$627.20
Rate for Payer: Health Smart Auto/Commercial	$470.40
Rate for Payer: LLUH Dept of Risk Management WC	$431.20
Rate for Payer: Mary Free Bed Workers' Compensation	$652.36
Rate for Payer: Multiplan Commercial	$588.00

HC INTERACTIVE GROUP THERAPY

Facility

$430.00

Service Code	CPT 90853
Hospital Charge Code	907804000
Hospital Revenue Code	912
Min. Negotiated Rate	$236.50
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$344.00
Rate for Payer: Health Smart Auto/Commercial	$258.00
Rate for Payer: LLUH Dept of Risk Management WC	$236.50
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$322.50

HC INTERACTIVE GROUP THERAPY

Facility

$430.00

Service Code	CPT 90853
Hospital Charge Code	907804000
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
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	$55.76
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	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
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: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
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	$236.50
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$322.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC IOP COGNITIVE THERAPY

Facility

$430.00

Service Code	CPT 90853
Hospital Charge Code	907804061
Hospital Revenue Code	905
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$364.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$236.50
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$322.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

Know your out-of-pocket cost for care.

All Charges