Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC NON SPECIFIC ESTERASE (NSE)

Facility

$383.00

Service Code	CPT 88319
Hospital Charge Code	900910067
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 NON SPECIFIC ESTERASE (NSE)

Facility

$1,056.00

Service Code	CPT 88319
Hospital Charge Code	900910067
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 OCCULT BLOOD GASTRIC

Facility

$135.00

Service Code	CPT 82271
Hospital Charge Code	900912329
Hospital Revenue Code	301
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$108.00
Rate for Payer: Cash Price	$60.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$108.00
Rate for Payer: Health Smart Auto/Commercial	$81.00
Rate for Payer: LLUH Dept of Risk Management WC	$74.25
Rate for Payer: Multiplan Commercial	$101.25

HC OCCULT BLOOD GASTRIC

Facility

$8.00

Service Code	CPT 82271
Hospital Charge Code	900912329
Hospital Revenue Code	301
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$6.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.80
Rate for Payer: Aetna of CA Government/Medicare	$4.80
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.40
Rate for Payer: Health Smart Auto/Commercial	$4.80
Rate for Payer: Intervalley Health Plan Commercial	$5.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.80
Rate for Payer: LLUH Dept of Risk Management WC	$4.40
Rate for Payer: Multiplan Commercial	$6.00

HC OCCULT BLOOD OTHR SOURCE

Facility

$10.00

Service Code	CPT 82271
Hospital Charge Code	900911536
Hospital Revenue Code	301
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.00
Rate for Payer: Aetna of CA Government/Medicare	$6.00
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cash Price	$4.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.00
Rate for Payer: Health Smart Auto/Commercial	$6.00
Rate for Payer: Intervalley Health Plan Commercial	$5.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.00
Rate for Payer: LLUH Dept of Risk Management WC	$5.50
Rate for Payer: Multiplan Commercial	$7.50

HC OCCULT BLOOD OTHR SOURCE

Facility

$135.00

Service Code	CPT 82271
Hospital Charge Code	900911536
Hospital Revenue Code	301
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$108.00
Rate for Payer: Cash Price	$60.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$108.00
Rate for Payer: Health Smart Auto/Commercial	$81.00
Rate for Payer: LLUH Dept of Risk Management WC	$74.25
Rate for Payer: Multiplan Commercial	$101.25

HC OPIATES CONF & ID

Facility

$359.00

Service Code	CPT 80361
Hospital Charge Code	900910516
Hospital Revenue Code	301
Min. Negotiated Rate	$197.45
Max. Negotiated Rate	$287.20
Rate for Payer: Cash Price	$161.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$287.20
Rate for Payer: Health Smart Auto/Commercial	$215.40
Rate for Payer: LLUH Dept of Risk Management WC	$197.45
Rate for Payer: Multiplan Commercial	$269.25

HC OPIATES CONF & ID

Facility

$298.00

Service Code	CPT 80361
Hospital Charge Code	900910516
Hospital Revenue Code	301
Min. Negotiated Rate	$163.90
Max. Negotiated Rate	$238.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$178.80
Rate for Payer: Aetna of CA Government/Medicare	$178.80
Rate for Payer: Cash Price	$134.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$238.40
Rate for Payer: Health Smart Auto/Commercial	$178.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$178.80
Rate for Payer: LLUH Dept of Risk Management WC	$163.90
Rate for Payer: Multiplan Commercial	$223.50

HC ORBITS

Facility

$1,603.00

Service Code	CPT 70200
Hospital Charge Code	909001111
Hospital Revenue Code	320
Min. Negotiated Rate	$881.65
Max. Negotiated Rate	$1,282.40
Rate for Payer: Cash Price	$721.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,282.40
Rate for Payer: Health Smart Auto/Commercial	$961.80
Rate for Payer: LLUH Dept of Risk Management WC	$881.65
Rate for Payer: Multiplan Commercial	$1,202.25

HC ORBITS

Facility

$1,603.00

Service Code	CPT 70200
Hospital Charge Code	909001111
Hospital Revenue Code	320
Min. Negotiated Rate	$881.65
Max. Negotiated Rate	$1,282.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$961.80
Rate for Payer: Aetna of CA Government/Medicare	$961.80
Rate for Payer: Cash Price	$721.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,282.40
Rate for Payer: Health Smart Auto/Commercial	$961.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$961.80
Rate for Payer: LLUH Dept of Risk Management WC	$881.65
Rate for Payer: Multiplan Commercial	$1,202.25

HC OSMOLALITY SERUM

Facility

$248.00

Service Code	CPT 83930
Hospital Charge Code	900910264
Hospital Revenue Code	301
Min. Negotiated Rate	$136.40
Max. Negotiated Rate	$198.40
Rate for Payer: Cash Price	$111.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$198.40
Rate for Payer: Health Smart Auto/Commercial	$148.80
Rate for Payer: LLUH Dept of Risk Management WC	$136.40
Rate for Payer: Multiplan Commercial	$186.00

HC OSMOLALITY SERUM

Facility

$248.00

Service Code	CPT 83930
Hospital Charge Code	900910264
Hospital Revenue Code	301
Min. Negotiated Rate	$6.61
Max. Negotiated Rate	$198.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$148.80
Rate for Payer: Aetna of CA Government/Medicare	$148.80
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$198.40
Rate for Payer: Health Smart Auto/Commercial	$148.80
Rate for Payer: Intervalley Health Plan Commercial	$6.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$148.80
Rate for Payer: LLUH Dept of Risk Management WC	$136.40
Rate for Payer: Multiplan Commercial	$186.00

HC OSMOLALITY STOOL

Facility

$72.00

Service Code	CPT 83935
Hospital Charge Code	900910358
Hospital Revenue Code	301
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$43.20
Rate for Payer: Aetna of CA Government/Medicare	$43.20
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$57.60
Rate for Payer: Health Smart Auto/Commercial	$43.20
Rate for Payer: Intervalley Health Plan Commercial	$6.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$43.20
Rate for Payer: LLUH Dept of Risk Management WC	$39.60
Rate for Payer: Multiplan Commercial	$54.00

HC OSMOLALITY STOOL

Facility

$287.00

Service Code	CPT 83935
Hospital Charge Code	900910358
Hospital Revenue Code	301
Min. Negotiated Rate	$157.85
Max. Negotiated Rate	$229.60
Rate for Payer: Cash Price	$129.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$229.60
Rate for Payer: Health Smart Auto/Commercial	$172.20
Rate for Payer: LLUH Dept of Risk Management WC	$157.85
Rate for Payer: Multiplan Commercial	$215.25

HC OSMOLALITY URINE

Facility

$72.00

Service Code	CPT 83935
Hospital Charge Code	900910214
Hospital Revenue Code	301
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$43.20
Rate for Payer: Aetna of CA Government/Medicare	$43.20
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$57.60
Rate for Payer: Health Smart Auto/Commercial	$43.20
Rate for Payer: Intervalley Health Plan Commercial	$6.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$43.20
Rate for Payer: LLUH Dept of Risk Management WC	$39.60
Rate for Payer: Multiplan Commercial	$54.00

HC OSMOLALITY URINE

Facility

$261.00

Service Code	CPT 83935
Hospital Charge Code	900910214
Hospital Revenue Code	301
Min. Negotiated Rate	$143.55
Max. Negotiated Rate	$208.80
Rate for Payer: Cash Price	$117.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$208.80
Rate for Payer: Health Smart Auto/Commercial	$156.60
Rate for Payer: LLUH Dept of Risk Management WC	$143.55
Rate for Payer: Multiplan Commercial	$195.75

HC OSMOTIC FRAGILITY

Facility

$51.00

Service Code	CPT 85555
Hospital Charge Code	900910039
Hospital Revenue Code	305
Min. Negotiated Rate	$7.47
Max. Negotiated Rate	$40.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.60
Rate for Payer: Aetna of CA Government/Medicare	$30.60
Rate for Payer: Cash Price	$22.95
Rate for Payer: Cash Price	$22.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.80
Rate for Payer: Health Smart Auto/Commercial	$30.60
Rate for Payer: Intervalley Health Plan Commercial	$7.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.60
Rate for Payer: LLUH Dept of Risk Management WC	$28.05
Rate for Payer: Multiplan Commercial	$38.25

HC OSMOTIC FRAGILITY

Facility

$141.00

Service Code	CPT 85555
Hospital Charge Code	900910039
Hospital Revenue Code	305
Min. Negotiated Rate	$77.55
Max. Negotiated Rate	$112.80
Rate for Payer: Cash Price	$63.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$112.80
Rate for Payer: Health Smart Auto/Commercial	$84.60
Rate for Payer: LLUH Dept of Risk Management WC	$77.55
Rate for Payer: Multiplan Commercial	$105.75

HC OSMOTIC FRAGILITY (INC)

Facility

$378.00

Service Code	CPT 85557
Hospital Charge Code	900910077
Hospital Revenue Code	305
Min. Negotiated Rate	$207.90
Max. Negotiated Rate	$302.40
Rate for Payer: Cash Price	$170.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$302.40
Rate for Payer: Health Smart Auto/Commercial	$226.80
Rate for Payer: LLUH Dept of Risk Management WC	$207.90
Rate for Payer: Multiplan Commercial	$283.50

HC OSMOTIC FRAGILITY (INC)

Facility

$49.00

Service Code	CPT 85557
Hospital Charge Code	900910077
Hospital Revenue Code	305
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$39.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$29.40
Rate for Payer: Aetna of CA Government/Medicare	$29.40
Rate for Payer: Cash Price	$22.05
Rate for Payer: Cash Price	$22.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$39.20
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: Intervalley Health Plan Commercial	$13.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$29.40
Rate for Payer: LLUH Dept of Risk Management WC	$26.95
Rate for Payer: Multiplan Commercial	$36.75

HC OT TASK GROUP

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804025
Hospital Revenue Code	912
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$299.20
Rate for Payer: Health Smart Auto/Commercial	$224.40
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$280.50

HC OT TASK GROUP

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804025
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	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
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	$205.70
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	$280.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC OVA & PARASITES, PRESERVED

Facility

$95.00

Service Code	CPT 87177
Hospital Charge Code	900911726
Hospital Revenue Code	306
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$76.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$57.00
Rate for Payer: Aetna of CA Government/Medicare	$57.00
Rate for Payer: Cash Price	$42.75
Rate for Payer: Cash Price	$42.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$76.00
Rate for Payer: Health Smart Auto/Commercial	$57.00
Rate for Payer: Intervalley Health Plan Commercial	$8.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$57.00
Rate for Payer: LLUH Dept of Risk Management WC	$52.25
Rate for Payer: Multiplan Commercial	$71.25

HC OVA & PARASITES, PRESERVED

Facility

$142.00

Service Code	CPT 87177
Hospital Charge Code	900911726
Hospital Revenue Code	306
Min. Negotiated Rate	$78.10
Max. Negotiated Rate	$113.60
Rate for Payer: Cash Price	$63.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$113.60
Rate for Payer: Health Smart Auto/Commercial	$85.20
Rate for Payer: LLUH Dept of Risk Management WC	$78.10
Rate for Payer: Multiplan Commercial	$106.50

HC PARASITE SCREEN

Facility

$45.00

Service Code	CPT 87272
Hospital Charge Code	900911729
Hospital Revenue Code	306
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.00
Rate for Payer: Aetna of CA Government/Medicare	$27.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Cash Price	$20.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$36.00
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: Intervalley Health Plan Commercial	$11.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Commercial	$33.75

Know your out-of-pocket cost for care.

All Charges