Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC LACTATE (CSF/POC)

Facility

$82.00

Service Code	CPT 83605
Hospital Charge Code	900910245
Hospital Revenue Code	301
Min. Negotiated Rate	$11.57
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	$11.57
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 LACTATE (CSF/POC)

Facility

$308.00

Service Code	CPT 83605
Hospital Charge Code	900910245
Hospital Revenue Code	301
Min. Negotiated Rate	$169.40
Max. Negotiated Rate	$246.40
Rate for Payer: Cash Price	$138.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$246.40
Rate for Payer: Health Smart Auto/Commercial	$184.80
Rate for Payer: LLUH Dept of Risk Management WC	$169.40
Rate for Payer: Multiplan Commercial	$231.00

HC LACTATE DEHYDROGENASE

Facility

$60.00

Service Code	CPT 83615
Hospital Charge Code	900910229
Hospital Revenue Code	301
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$48.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$36.00
Rate for Payer: Aetna of CA Government/Medicare	$36.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$48.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: Intervalley Health Plan Commercial	$6.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Commercial	$45.00

HC LACTATE DEHYDROGENASE

Facility

$152.00

Service Code	CPT 83615
Hospital Charge Code	900910229
Hospital Revenue Code	301
Min. Negotiated Rate	$83.60
Max. Negotiated Rate	$121.60
Rate for Payer: Cash Price	$68.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$121.60
Rate for Payer: Health Smart Auto/Commercial	$91.20
Rate for Payer: LLUH Dept of Risk Management WC	$83.60
Rate for Payer: Multiplan Commercial	$114.00

HC LACTATE DEHYDROGENASE BODY FL

Facility

$56.00

Service Code	CPT 83615
Hospital Charge Code	900912243
Hospital Revenue Code	301
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$44.80
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: LLUH Dept of Risk Management WC	$30.80
Rate for Payer: Multiplan Commercial	$42.00

HC LACTATE DEHYDROGENASE BODY FL

Facility

$54.00

Service Code	CPT 83615
Hospital Charge Code	900912243
Hospital Revenue Code	301
Min. Negotiated Rate	$6.04
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	$6.04
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 LACTOSE TOLERANCE

Facility

$118.00

Service Code	CPT 82951
Hospital Charge Code	900910313
Hospital Revenue Code	301
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$94.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$70.80
Rate for Payer: Aetna of CA Government/Medicare	$70.80
Rate for Payer: Cash Price	$53.10
Rate for Payer: Cash Price	$53.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$94.40
Rate for Payer: Health Smart Auto/Commercial	$70.80
Rate for Payer: Intervalley Health Plan Commercial	$12.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$70.80
Rate for Payer: LLUH Dept of Risk Management WC	$64.90
Rate for Payer: Multiplan Commercial	$88.50

HC LACTOSE TOLERANCE

Facility

$226.00

Service Code	CPT 82951
Hospital Charge Code	900910313
Hospital Revenue Code	301
Min. Negotiated Rate	$124.30
Max. Negotiated Rate	$180.80
Rate for Payer: Cash Price	$101.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$180.80
Rate for Payer: Health Smart Auto/Commercial	$135.60
Rate for Payer: LLUH Dept of Risk Management WC	$124.30
Rate for Payer: Multiplan Commercial	$169.50

HC LAMELLAR BODY COUNT AMNIOTIC

Facility

$128.00

Service Code	CPT 83664
Hospital Charge Code	900912027
Hospital Revenue Code	305
Min. Negotiated Rate	$70.40
Max. Negotiated Rate	$102.40
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: LLUH Dept of Risk Management WC	$70.40
Rate for Payer: Multiplan Commercial	$96.00

HC LAMELLAR BODY COUNT AMNIOTIC

Facility

$81.00

Service Code	CPT 83664
Hospital Charge Code	900912027
Hospital Revenue Code	305
Min. Negotiated Rate	$19.32
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$48.60
Rate for Payer: Aetna of CA Government/Medicare	$48.60
Rate for Payer: Cash Price	$36.45
Rate for Payer: Cash Price	$36.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$64.80
Rate for Payer: Health Smart Auto/Commercial	$48.60
Rate for Payer: Intervalley Health Plan Commercial	$19.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$48.60
Rate for Payer: LLUH Dept of Risk Management WC	$44.55
Rate for Payer: Multiplan Commercial	$60.75

HC LEUK ACID PHOSP (TRAP STAIN)

Facility

$383.00

Service Code	CPT 88319
Hospital Charge Code	900910068
Hospital Revenue Code	310
Min. Negotiated Rate	$210.65
Max. Negotiated Rate	$306.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$229.80
Rate for Payer: Aetna of CA Government/Medicare	$229.80
Rate for Payer: Cash Price	$172.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$306.40
Rate for Payer: Health Smart Auto/Commercial	$229.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$229.80
Rate for Payer: LLUH Dept of Risk Management WC	$210.65
Rate for Payer: Multiplan Commercial	$287.25

HC LEUK ACID PHOSP (TRAP STAIN)

Facility

$1,056.00

Service Code	CPT 88319
Hospital Charge Code	900910068
Hospital Revenue Code	310
Min. Negotiated Rate	$580.80
Max. Negotiated Rate	$844.80
Rate for Payer: Cash Price	$475.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$844.80
Rate for Payer: Health Smart Auto/Commercial	$633.60
Rate for Payer: LLUH Dept of Risk Management WC	$580.80
Rate for Payer: Multiplan Commercial	$792.00

HC LEUK ALK PHOS

Facility

$494.00

Service Code	CPT 85540
Hospital Charge Code	900910059
Hospital Revenue Code	305
Min. Negotiated Rate	$271.70
Max. Negotiated Rate	$395.20
Rate for Payer: Cash Price	$222.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$395.20
Rate for Payer: Health Smart Auto/Commercial	$296.40
Rate for Payer: LLUH Dept of Risk Management WC	$271.70
Rate for Payer: Multiplan Commercial	$370.50

HC LEUK ALK PHOS

Facility

$42.00

Service Code	CPT 85540
Hospital Charge Code	900910059
Hospital Revenue Code	305
Min. Negotiated Rate	$8.60
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	$8.60
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 LEUKOCYTES FECAL

Facility

$170.00

Service Code	CPT 89055
Hospital Charge Code	900911641
Hospital Revenue Code	306
Min. Negotiated Rate	$93.50
Max. Negotiated Rate	$136.00
Rate for Payer: Cash Price	$76.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$136.00
Rate for Payer: Health Smart Auto/Commercial	$102.00
Rate for Payer: LLUH Dept of Risk Management WC	$93.50
Rate for Payer: Multiplan Commercial	$127.50

HC LEUKOCYTES FECAL

Facility

$46.00

Service Code	CPT 89055
Hospital Charge Code	900911641
Hospital Revenue Code	306
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$36.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.60
Rate for Payer: Aetna of CA Government/Medicare	$27.60
Rate for Payer: Cash Price	$20.70
Rate for Payer: Cash Price	$20.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$36.80
Rate for Payer: Health Smart Auto/Commercial	$27.60
Rate for Payer: Intervalley Health Plan Commercial	$4.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.60
Rate for Payer: LLUH Dept of Risk Management WC	$25.30
Rate for Payer: Multiplan Commercial	$34.50

HC LIPASE

Facility

$70.26

Service Code	CPT 83690
Hospital Charge Code	900910334
Hospital Revenue Code	301
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$56.21
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$42.16
Rate for Payer: Aetna of CA Government/Medicare	$42.16
Rate for Payer: Cash Price	$31.62
Rate for Payer: Cash Price	$31.62
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$56.21
Rate for Payer: Health Smart Auto/Commercial	$42.16
Rate for Payer: Intervalley Health Plan Commercial	$6.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$42.16
Rate for Payer: LLUH Dept of Risk Management WC	$38.64
Rate for Payer: Multiplan Commercial	$52.70

HC LIPASE

Facility

$206.40

Service Code	CPT 83690
Hospital Charge Code	900910334
Hospital Revenue Code	301
Min. Negotiated Rate	$113.52
Max. Negotiated Rate	$165.12
Rate for Payer: Cash Price	$92.88
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$165.12
Rate for Payer: Health Smart Auto/Commercial	$123.84
Rate for Payer: LLUH Dept of Risk Management WC	$113.52
Rate for Payer: Multiplan Commercial	$154.80

HC LIPASE BODY FLUID

Facility

$54.00

Service Code	CPT 83690
Hospital Charge Code	900912244
Hospital Revenue Code	301
Min. Negotiated Rate	$6.89
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	$6.89
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 LIPASE BODY FLUID

Facility

$70.00

Service Code	CPT 83690
Hospital Charge Code	900912244
Hospital Revenue Code	301
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$56.00
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: LLUH Dept of Risk Management WC	$38.50
Rate for Payer: Multiplan Commercial	$52.50

HC LITHIUM

Facility

$115.00

Service Code	CPT 80178
Hospital Charge Code	900910332
Hospital Revenue Code	301
Min. Negotiated Rate	$63.25
Max. Negotiated Rate	$92.00
Rate for Payer: Cash Price	$51.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$92.00
Rate for Payer: Health Smart Auto/Commercial	$69.00
Rate for Payer: LLUH Dept of Risk Management WC	$63.25
Rate for Payer: Multiplan Commercial	$86.25

HC LITHIUM

Facility

$71.00

Service Code	CPT 80178
Hospital Charge Code	900910332
Hospital Revenue Code	301
Min. Negotiated Rate	$6.61
Max. Negotiated Rate	$56.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$42.60
Rate for Payer: Aetna of CA Government/Medicare	$42.60
Rate for Payer: Cash Price	$31.95
Rate for Payer: Cash Price	$31.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$56.80
Rate for Payer: Health Smart Auto/Commercial	$42.60
Rate for Payer: Intervalley Health Plan Commercial	$6.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$42.60
Rate for Payer: LLUH Dept of Risk Management WC	$39.05
Rate for Payer: Multiplan Commercial	$53.25

HC LOW MIGRAT STAGE IV CONF & ID

Facility

$518.00

Service Code	CPT 80307
Hospital Charge Code	900910511
Hospital Revenue Code	301
Min. Negotiated Rate	$62.14
Max. Negotiated Rate	$414.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$310.80
Rate for Payer: Aetna of CA Government/Medicare	$310.80
Rate for Payer: Cash Price	$233.10
Rate for Payer: Cash Price	$233.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$414.40
Rate for Payer: Health Smart Auto/Commercial	$310.80
Rate for Payer: Intervalley Health Plan Commercial	$62.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$310.80
Rate for Payer: LLUH Dept of Risk Management WC	$284.90
Rate for Payer: Multiplan Commercial	$388.50

HC LOW MIGRAT STAGE IV CONF & ID

Facility

$624.00

Service Code	CPT 80307
Hospital Charge Code	900910511
Hospital Revenue Code	301
Min. Negotiated Rate	$343.20
Max. Negotiated Rate	$499.20
Rate for Payer: Cash Price	$280.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$499.20
Rate for Payer: Health Smart Auto/Commercial	$374.40
Rate for Payer: LLUH Dept of Risk Management WC	$343.20
Rate for Payer: Multiplan Commercial	$468.00

HC LUMBAR SPINE AP AND LATERAL

Facility

$1,214.00

Service Code	CPT 72100
Hospital Charge Code	909001315
Hospital Revenue Code	320
Min. Negotiated Rate	$667.70
Max. Negotiated Rate	$971.20
Rate for Payer: Cash Price	$546.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$971.20
Rate for Payer: Health Smart Auto/Commercial	$728.40
Rate for Payer: LLUH Dept of Risk Management WC	$667.70
Rate for Payer: Multiplan Commercial	$910.50

Know your out-of-pocket cost for care.

All Charges