Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC MRI LOWER EXTREM JOINT WO CONT

Facility

$8,287.00

Service Code	CPT 73721
Hospital Charge Code	908801441
Hospital Revenue Code	610
Min. Negotiated Rate	$4,557.85
Max. Negotiated Rate	$6,629.60
Rate for Payer: Cash Price	$3,729.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6,629.60
Rate for Payer: Health Smart Auto/Commercial	$4,972.20
Rate for Payer: LLUH Dept of Risk Management WC	$4,557.85
Rate for Payer: Multiplan Commercial	$6,215.25

HC MRSA DNA

Facility

$100.00

Service Code	CPT 87641
Hospital Charge Code	900912328
Hospital Revenue Code	301
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$60.00
Rate for Payer: Aetna of CA Government/Medicare	$60.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$80.00
Rate for Payer: Health Smart Auto/Commercial	$60.00
Rate for Payer: Intervalley Health Plan Commercial	$35.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$60.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.00
Rate for Payer: Multiplan Commercial	$75.00

HC MRSA DNA

Facility

$184.00

Service Code	CPT 87641
Hospital Charge Code	900912328
Hospital Revenue Code	301
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 MULTI FAMILY GRP BHVR MGMT MOD TRNG EA ADD 15 MIN

Facility

$57.00

Service Code	CPT 96203
Hospital Charge Code	907806203
Hospital Revenue Code	916
Min. Negotiated Rate	$31.35
Max. Negotiated Rate	$45.60
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: LLUH Dept of Risk Management WC	$31.35
Rate for Payer: Multiplan Commercial	$42.75

HC MULTI FAMILY GRP BHVR MGMT MOD TRNG EA ADD 15 MIN

Facility

$57.00

Service Code	CPT 96203
Hospital Charge Code	907806203
Hospital Revenue Code	916
Min. Negotiated Rate	$31.35
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: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$45.60
Rate for Payer: Health Smart Auto/Commercial	$34.20
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 MULTI FAMILY GRP BHVR MGMT MOD TRNG INITIAL 60 MIN

Facility

$262.00

Service Code	CPT 96202
Hospital Charge Code	907806202
Hospital Revenue Code	916
Min. Negotiated Rate	$144.10
Max. Negotiated Rate	$209.60
Rate for Payer: Cash Price	$117.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$209.60
Rate for Payer: Health Smart Auto/Commercial	$157.20
Rate for Payer: LLUH Dept of Risk Management WC	$144.10
Rate for Payer: Multiplan Commercial	$196.50

HC MULTI FAMILY GRP BHVR MGMT MOD TRNG INITIAL 60 MIN

Facility

$262.00

Service Code	CPT 96202
Hospital Charge Code	907806202
Hospital Revenue Code	916
Min. Negotiated Rate	$144.10
Max. Negotiated Rate	$209.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$157.20
Rate for Payer: Aetna of CA Government/Medicare	$157.20
Rate for Payer: Cash Price	$117.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$209.60
Rate for Payer: Health Smart Auto/Commercial	$157.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$157.20
Rate for Payer: LLUH Dept of Risk Management WC	$144.10
Rate for Payer: Multiplan Commercial	$196.50

HC MULTI-PLANAR RECON

Facility

$1,768.00

Service Code	CPT 76376
Hospital Charge Code	909201350
Hospital Revenue Code	359
Min. Negotiated Rate	$972.40
Max. Negotiated Rate	$1,414.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,060.80
Rate for Payer: Aetna of CA Government/Medicare	$1,060.80
Rate for Payer: Cash Price	$795.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,414.40
Rate for Payer: Health Smart Auto/Commercial	$1,060.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,060.80
Rate for Payer: LLUH Dept of Risk Management WC	$972.40
Rate for Payer: Multiplan Commercial	$1,326.00

HC MULTI-PLANAR RECON

Facility

$1,768.00

Service Code	CPT 76376
Hospital Charge Code	909201350
Hospital Revenue Code	359
Min. Negotiated Rate	$972.40
Max. Negotiated Rate	$1,414.40
Rate for Payer: Cash Price	$795.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,414.40
Rate for Payer: Health Smart Auto/Commercial	$1,060.80
Rate for Payer: LLUH Dept of Risk Management WC	$972.40
Rate for Payer: Multiplan Commercial	$1,326.00

HC MUMPS AB

Facility

$200.00

Service Code	CPT 86735
Hospital Charge Code	900913533
Hospital Revenue Code	302
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 MUMPS AB

Facility

$74.00

Service Code	CPT 86735
Hospital Charge Code	900913533
Hospital Revenue Code	302
Min. Negotiated Rate	$13.05
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	$13.05
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 MUMPS ANTIBODY

Facility

$128.12

Service Code	CPT 86735
Hospital Charge Code	900913663
Hospital Revenue Code	302
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$102.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$76.87
Rate for Payer: Aetna of CA Government/Medicare	$76.87
Rate for Payer: Cash Price	$57.65
Rate for Payer: Cash Price	$57.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$102.50
Rate for Payer: Health Smart Auto/Commercial	$76.87
Rate for Payer: Intervalley Health Plan Commercial	$13.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$76.87
Rate for Payer: LLUH Dept of Risk Management WC	$70.47
Rate for Payer: Multiplan Commercial	$96.09

HC MUMPS ANTIBODY

Facility

$134.00

Service Code	CPT 86735
Hospital Charge Code	900913663
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 MYOGLOBIN SCREEN

Facility

$96.00

Service Code	CPT 81003
Hospital Charge Code	900910387
Hospital Revenue Code	307
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 MYOGLOBIN SCREEN

Facility

$18.00

Service Code	CPT 81003
Hospital Charge Code	900910387
Hospital Revenue Code	307
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.80
Rate for Payer: Aetna of CA Government/Medicare	$10.80
Rate for Payer: Cash Price	$8.10
Rate for Payer: Cash Price	$8.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.40
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: Intervalley Health Plan Commercial	$2.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.80
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: Multiplan Commercial	$13.50

HC MYOGLOBIN (SERUM)

Facility

$143.00

Service Code	CPT 83874
Hospital Charge Code	900910825
Hospital Revenue Code	301
Min. Negotiated Rate	$78.65
Max. Negotiated Rate	$114.40
Rate for Payer: Cash Price	$64.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$114.40
Rate for Payer: Health Smart Auto/Commercial	$85.80
Rate for Payer: LLUH Dept of Risk Management WC	$78.65
Rate for Payer: Multiplan Commercial	$107.25

HC MYOGLOBIN (SERUM)

Facility

$30.00

Service Code	CPT 83874
Hospital Charge Code	900910825
Hospital Revenue Code	301
Min. Negotiated Rate	$12.92
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.00
Rate for Payer: Aetna of CA Government/Medicare	$18.00
Rate for Payer: Cash Price	$13.50
Rate for Payer: Cash Price	$13.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$24.00
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: Intervalley Health Plan Commercial	$12.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Commercial	$22.50

HC NA (POC)

Facility

$91.00

Service Code	CPT 84295
Hospital Charge Code	900912116
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$72.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$54.60
Rate for Payer: Aetna of CA Government/Medicare	$54.60
Rate for Payer: Cash Price	$40.95
Rate for Payer: Cash Price	$40.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$72.80
Rate for Payer: Health Smart Auto/Commercial	$54.60
Rate for Payer: Intervalley Health Plan Commercial	$4.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$54.60
Rate for Payer: LLUH Dept of Risk Management WC	$50.05
Rate for Payer: Multiplan Commercial	$68.25

HC NA (POC)

Facility

$91.00

Service Code	CPT 84295
Hospital Charge Code	900912116
Hospital Revenue Code	301
Min. Negotiated Rate	$50.05
Max. Negotiated Rate	$72.80
Rate for Payer: Cash Price	$40.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$72.80
Rate for Payer: Health Smart Auto/Commercial	$54.60
Rate for Payer: LLUH Dept of Risk Management WC	$50.05
Rate for Payer: Multiplan Commercial	$68.25

HC NASAL BONES

Facility

$1,173.00

Service Code	CPT 70160
Hospital Charge Code	909001104
Hospital Revenue Code	320
Min. Negotiated Rate	$645.15
Max. Negotiated Rate	$938.40
Rate for Payer: Cash Price	$527.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$938.40
Rate for Payer: Health Smart Auto/Commercial	$703.80
Rate for Payer: LLUH Dept of Risk Management WC	$645.15
Rate for Payer: Multiplan Commercial	$879.75

HC NASAL BONES

Facility

$1,173.00

Service Code	CPT 70160
Hospital Charge Code	909001104
Hospital Revenue Code	320
Min. Negotiated Rate	$645.15
Max. Negotiated Rate	$938.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$703.80
Rate for Payer: Aetna of CA Government/Medicare	$703.80
Rate for Payer: Cash Price	$527.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$938.40
Rate for Payer: Health Smart Auto/Commercial	$703.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$703.80
Rate for Payer: LLUH Dept of Risk Management WC	$645.15
Rate for Payer: Multiplan Commercial	$879.75

HC NEGATIVE URINE COMBO PANEL 61

Facility

$218.00

Service Code	CPT 87077
Hospital Charge Code	900912450
Hospital Revenue Code	306
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$174.40
Rate for Payer: Cash Price	$98.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$174.40
Rate for Payer: Health Smart Auto/Commercial	$130.80
Rate for Payer: LLUH Dept of Risk Management WC	$119.90
Rate for Payer: Multiplan Commercial	$163.50

HC NEGATIVE URINE COMBO PANEL 61

Facility

$181.00

Service Code	CPT 87077
Hospital Charge Code	900912450
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$144.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$108.60
Rate for Payer: Aetna of CA Government/Medicare	$108.60
Rate for Payer: Cash Price	$81.45
Rate for Payer: Cash Price	$81.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$144.80
Rate for Payer: Health Smart Auto/Commercial	$108.60
Rate for Payer: Intervalley Health Plan Commercial	$8.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$108.60
Rate for Payer: LLUH Dept of Risk Management WC	$99.55
Rate for Payer: Multiplan Commercial	$135.75

HC N GONNORHOEAE AMPLIFICATION

Facility

$220.00

Service Code	CPT 87591
Hospital Charge Code	900912305
Hospital Revenue Code	306
Min. Negotiated Rate	$121.00
Max. Negotiated Rate	$176.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$176.00
Rate for Payer: Health Smart Auto/Commercial	$132.00
Rate for Payer: LLUH Dept of Risk Management WC	$121.00
Rate for Payer: Multiplan Commercial	$165.00

HC N GONNORHOEAE AMPLIFICATION

Facility

$115.04

Service Code	CPT 87591
Hospital Charge Code	900912305
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$92.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$69.02
Rate for Payer: Aetna of CA Government/Medicare	$69.02
Rate for Payer: Cash Price	$51.77
Rate for Payer: Cash Price	$51.77
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$92.03
Rate for Payer: Health Smart Auto/Commercial	$69.02
Rate for Payer: Intervalley Health Plan Commercial	$35.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$69.02
Rate for Payer: LLUH Dept of Risk Management WC	$63.27
Rate for Payer: Multiplan Commercial	$86.28

Know your out-of-pocket cost for care.

All Charges