Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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: Aetna of CA EPO/HMO/POS/PPO	$728.40
Rate for Payer: Aetna of CA Government/Medicare	$728.40
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: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$728.40
Rate for Payer: LLUH Dept of Risk Management WC	$667.70
Rate for Payer: Multiplan Commercial	$910.50

HC LUMBAR SPINE LIMITED

Facility

$241.00

Service Code	CPT 72100
Hospital Charge Code	909001136
Hospital Revenue Code	320
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$192.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$144.60
Rate for Payer: Aetna of CA Government/Medicare	$144.60
Rate for Payer: Cash Price	$108.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$192.80
Rate for Payer: Health Smart Auto/Commercial	$144.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$144.60
Rate for Payer: LLUH Dept of Risk Management WC	$132.55
Rate for Payer: Multiplan Commercial	$180.75

HC LUMBAR SPINE LIMITED

Facility

$241.00

Service Code	CPT 72100
Hospital Charge Code	909001136
Hospital Revenue Code	320
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$192.80
Rate for Payer: Cash Price	$108.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$192.80
Rate for Payer: Health Smart Auto/Commercial	$144.60
Rate for Payer: LLUH Dept of Risk Management WC	$132.55
Rate for Payer: Multiplan Commercial	$180.75

HC LUM SPINE W/OBLIQUES

Facility

$1,600.00

Service Code	CPT 72110
Hospital Charge Code	909001317
Hospital Revenue Code	320
Min. Negotiated Rate	$880.00
Max. Negotiated Rate	$1,280.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,280.00
Rate for Payer: Health Smart Auto/Commercial	$960.00
Rate for Payer: LLUH Dept of Risk Management WC	$880.00
Rate for Payer: Multiplan Commercial	$1,200.00

HC LUM SPINE W/OBLIQUES

Facility

$1,600.00

Service Code	CPT 72110
Hospital Charge Code	909001317
Hospital Revenue Code	320
Min. Negotiated Rate	$880.00
Max. Negotiated Rate	$1,280.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$960.00
Rate for Payer: Aetna of CA Government/Medicare	$960.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,280.00
Rate for Payer: Health Smart Auto/Commercial	$960.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$960.00
Rate for Payer: LLUH Dept of Risk Management WC	$880.00
Rate for Payer: Multiplan Commercial	$1,200.00

HC LUPUS SCREEN PTT

Facility

$184.00

Service Code	CPT 85730
Hospital Charge Code	900912006
Hospital Revenue Code	305
Min. Negotiated Rate	$101.20
Max. Negotiated Rate	$147.20
Rate for Payer: Cash Price	$82.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$147.20
Rate for Payer: Health Smart Auto/Commercial	$110.40
Rate for Payer: LLUH Dept of Risk Management WC	$101.20
Rate for Payer: Multiplan Commercial	$138.00

HC LUPUS SCREEN PTT

Facility

$60.00

Service Code	CPT 85730
Hospital Charge Code	900912006
Hospital Revenue Code	305
Min. Negotiated Rate	$6.01
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	$6.01
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 LUTEINIZING HORMON

Facility

$92.00

Service Code	CPT 83002
Hospital Charge Code	900910886
Hospital Revenue Code	301
Min. Negotiated Rate	$18.52
Max. Negotiated Rate	$73.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$55.20
Rate for Payer: Aetna of CA Government/Medicare	$55.20
Rate for Payer: Cash Price	$41.40
Rate for Payer: Cash Price	$41.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$73.60
Rate for Payer: Health Smart Auto/Commercial	$55.20
Rate for Payer: Intervalley Health Plan Commercial	$18.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$55.20
Rate for Payer: LLUH Dept of Risk Management WC	$50.60
Rate for Payer: Multiplan Commercial	$69.00

HC LUTEINIZING HORMON

Facility

$302.00

Service Code	CPT 83002
Hospital Charge Code	900910886
Hospital Revenue Code	301
Min. Negotiated Rate	$166.10
Max. Negotiated Rate	$241.60
Rate for Payer: Cash Price	$135.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$241.60
Rate for Payer: Health Smart Auto/Commercial	$181.20
Rate for Payer: LLUH Dept of Risk Management WC	$166.10
Rate for Payer: Multiplan Commercial	$226.50

HC MAGNESIUM

Facility

$39.66

Service Code	CPT 83735
Hospital Charge Code	900910230
Hospital Revenue Code	301
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$31.73
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.80
Rate for Payer: Aetna of CA Government/Medicare	$23.80
Rate for Payer: Cash Price	$17.85
Rate for Payer: Cash Price	$17.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$31.73
Rate for Payer: Health Smart Auto/Commercial	$23.80
Rate for Payer: Intervalley Health Plan Commercial	$6.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.80
Rate for Payer: LLUH Dept of Risk Management WC	$21.81
Rate for Payer: Multiplan Commercial	$29.75

HC MAGNESIUM

Facility

$152.00

Service Code	CPT 83735
Hospital Charge Code	900910230
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 MALARIA QUANTITAT

Facility

$42.00

Service Code	CPT 87207
Hospital Charge Code	900911640
Hospital Revenue Code	306
Min. Negotiated Rate	$5.99
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	$5.99
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 MALARIA QUANTITAT

Facility

$196.00

Service Code	CPT 87207
Hospital Charge Code	900911640
Hospital Revenue Code	306
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$156.80
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: LLUH Dept of Risk Management WC	$107.80
Rate for Payer: Multiplan Commercial	$147.00

HC MALARIA SCREEN AG TEST

Facility

$196.00

Service Code	CPT 87899
Hospital Charge Code	900912441
Hospital Revenue Code	306
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$156.80
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: LLUH Dept of Risk Management WC	$107.80
Rate for Payer: Multiplan Commercial	$147.00

HC MALARIA SCREEN AG TEST

Facility

$38.00

Service Code	CPT 87899
Hospital Charge Code	900912441
Hospital Revenue Code	306
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$30.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.80
Rate for Payer: Aetna of CA Government/Medicare	$22.80
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cash Price	$17.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.40
Rate for Payer: Health Smart Auto/Commercial	$22.80
Rate for Payer: Intervalley Health Plan Commercial	$16.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.80
Rate for Payer: LLUH Dept of Risk Management WC	$20.90
Rate for Payer: Multiplan Commercial	$28.50

HC MALARIA SMEARS

Facility

$196.00

Service Code	CPT 87207
Hospital Charge Code	900911686
Hospital Revenue Code	306
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$156.80
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: LLUH Dept of Risk Management WC	$107.80
Rate for Payer: Multiplan Commercial	$147.00

HC MALARIA SMEARS

Facility

$42.00

Service Code	CPT 87207
Hospital Charge Code	900911686
Hospital Revenue Code	306
Min. Negotiated Rate	$5.99
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	$5.99
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 MANDIBLE-COMPLETE

Facility

$1,790.00

Service Code	CPT 70110
Hospital Charge Code	909001122
Hospital Revenue Code	320
Min. Negotiated Rate	$984.50
Max. Negotiated Rate	$1,432.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,074.00
Rate for Payer: Aetna of CA Government/Medicare	$1,074.00
Rate for Payer: Cash Price	$805.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,432.00
Rate for Payer: Health Smart Auto/Commercial	$1,074.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,074.00
Rate for Payer: LLUH Dept of Risk Management WC	$984.50
Rate for Payer: Multiplan Commercial	$1,342.50

HC MANDIBLE-COMPLETE

Facility

$1,790.00

Service Code	CPT 70110
Hospital Charge Code	909001122
Hospital Revenue Code	320
Min. Negotiated Rate	$984.50
Max. Negotiated Rate	$1,432.00
Rate for Payer: Cash Price	$805.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,432.00
Rate for Payer: Health Smart Auto/Commercial	$1,074.00
Rate for Payer: LLUH Dept of Risk Management WC	$984.50
Rate for Payer: Multiplan Commercial	$1,342.50

HC MEASLES AB

Facility

$74.00

Service Code	CPT 86765
Hospital Charge Code	900913530
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$59.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$44.40
Rate for Payer: Aetna of CA Government/Medicare	$44.40
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cash Price	$33.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$59.20
Rate for Payer: Health Smart Auto/Commercial	$44.40
Rate for Payer: Intervalley Health Plan Commercial	$12.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$44.40
Rate for Payer: LLUH Dept of Risk Management WC	$40.70
Rate for Payer: Multiplan Commercial	$55.50

HC MEASLES AB

Facility

$210.00

Service Code	CPT 86765
Hospital Charge Code	900913530
Hospital Revenue Code	302
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 MENINGITIS PANEL NUCLEIC ACID

Facility

$1,482.00

Service Code	CPT 87483
Hospital Charge Code	900913643
Hospital Revenue Code	300
Min. Negotiated Rate	$416.78
Max. Negotiated Rate	$1,185.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$889.20
Rate for Payer: Aetna of CA Government/Medicare	$889.20
Rate for Payer: Cash Price	$666.90
Rate for Payer: Cash Price	$666.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,185.60
Rate for Payer: Health Smart Auto/Commercial	$889.20
Rate for Payer: Intervalley Health Plan Commercial	$416.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$889.20
Rate for Payer: LLUH Dept of Risk Management WC	$815.10
Rate for Payer: Multiplan Commercial	$1,111.50

HC MENINGITIS PANEL NUCLEIC ACID

Facility

$1,762.00

Service Code	CPT 87483
Hospital Charge Code	900913643
Hospital Revenue Code	300
Min. Negotiated Rate	$969.10
Max. Negotiated Rate	$1,409.60
Rate for Payer: Cash Price	$792.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,409.60
Rate for Payer: Health Smart Auto/Commercial	$1,057.20
Rate for Payer: LLUH Dept of Risk Management WC	$969.10
Rate for Payer: Multiplan Commercial	$1,321.50

HC METANEPHRINES FRACTIONATED UR

Facility

$70.00

Service Code	CPT 83835
Hospital Charge Code	900910288
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 METANEPHRINES FRACTIONATED UR

Facility

$68.00

Service Code	CPT 83835
Hospital Charge Code	900910288
Hospital Revenue Code	301
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$54.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$40.80
Rate for Payer: Aetna of CA Government/Medicare	$40.80
Rate for Payer: Cash Price	$30.60
Rate for Payer: Cash Price	$30.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$54.40
Rate for Payer: Health Smart Auto/Commercial	$40.80
Rate for Payer: Intervalley Health Plan Commercial	$16.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$40.80
Rate for Payer: LLUH Dept of Risk Management WC	$37.40
Rate for Payer: Multiplan Commercial	$51.00

Know your out-of-pocket cost for care.

All Charges