Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC PHP YOUTH STRESS MANAGEMENT

Facility

$402.00

Service Code	CPT 90834
Hospital Charge Code	907804308
Hospital Revenue Code	912
Min. Negotiated Rate	$221.10
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$180.90
Rate for Payer: Cash Price	$180.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$321.60
Rate for Payer: Health Smart Auto/Commercial	$241.20
Rate for Payer: LLUH Dept of Risk Management WC	$221.10
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$301.50

HC PI-LINKD AG, FLOW 1ST MRKR WBC

Facility

$519.00

Service Code	CPT 88184
Hospital Charge Code	900914174
Hospital Revenue Code	309
Min. Negotiated Rate	$285.45
Max. Negotiated Rate	$415.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$311.40
Rate for Payer: Aetna of CA Government/Medicare	$311.40
Rate for Payer: Cash Price	$233.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$415.20
Rate for Payer: Health Smart Auto/Commercial	$311.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$311.40
Rate for Payer: LLUH Dept of Risk Management WC	$285.45
Rate for Payer: Multiplan Commercial	$389.25

HC PI-LINKD AG, FLOW 1ST MRKR WBC

Facility

$519.00

Service Code	CPT 88184
Hospital Charge Code	900914174
Hospital Revenue Code	309
Min. Negotiated Rate	$285.45
Max. Negotiated Rate	$415.20
Rate for Payer: Cash Price	$233.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$415.20
Rate for Payer: Health Smart Auto/Commercial	$311.40
Rate for Payer: LLUH Dept of Risk Management WC	$285.45
Rate for Payer: Multiplan Commercial	$389.25

HC PI-LINKD AG,FLOW ADD'L MRKR,WBC

Facility

$41.00

Service Code	CPT 88185
Hospital Charge Code	900914175
Hospital Revenue Code	309
Min. Negotiated Rate	$22.55
Max. Negotiated Rate	$32.80
Rate for Payer: Cash Price	$18.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$32.80
Rate for Payer: Health Smart Auto/Commercial	$24.60
Rate for Payer: LLUH Dept of Risk Management WC	$22.55
Rate for Payer: Multiplan Commercial	$30.75

HC PI-LINKD AG,FLOW ADD'L MRKR,WBC

Facility

$41.00

Service Code	CPT 88185
Hospital Charge Code	900914175
Hospital Revenue Code	309
Min. Negotiated Rate	$22.55
Max. Negotiated Rate	$32.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.60
Rate for Payer: Aetna of CA Government/Medicare	$24.60
Rate for Payer: Cash Price	$18.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$32.80
Rate for Payer: Health Smart Auto/Commercial	$24.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.60
Rate for Payer: LLUH Dept of Risk Management WC	$22.55
Rate for Payer: Multiplan Commercial	$30.75

HC PIN WORM PREP

Facility

$20.00

Service Code	CPT 87172
Hospital Charge Code	900911636
Hospital Revenue Code	306
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.00
Rate for Payer: Aetna of CA Government/Medicare	$12.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: Intervalley Health Plan Commercial	$4.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Commercial	$15.00

HC PIN WORM PREP

Facility

$112.00

Service Code	CPT 87172
Hospital Charge Code	900911636
Hospital Revenue Code	306
Min. Negotiated Rate	$61.60
Max. Negotiated Rate	$89.60
Rate for Payer: Cash Price	$50.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$89.60
Rate for Payer: Health Smart Auto/Commercial	$67.20
Rate for Payer: LLUH Dept of Risk Management WC	$61.60
Rate for Payer: Multiplan Commercial	$84.00

HC PIPERACILLIN/TAZOBACTAM E TEST

Facility

$18.00

Service Code	CPT 87181
Hospital Charge Code	900912422
Hospital Revenue Code	306
Min. Negotiated Rate	$4.75
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	$4.75
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 PIPERACILLIN/TAZOBACTAM E TEST

Facility

$103.00

Service Code	CPT 87181
Hospital Charge Code	900912422
Hospital Revenue Code	306
Min. Negotiated Rate	$56.65
Max. Negotiated Rate	$82.40
Rate for Payer: Cash Price	$46.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$82.40
Rate for Payer: Health Smart Auto/Commercial	$61.80
Rate for Payer: LLUH Dept of Risk Management WC	$56.65
Rate for Payer: Multiplan Commercial	$77.25

HC PLACENTAL ALPHA MICROGLOB-1POC

Facility

$272.00

Service Code	CPT 84112
Hospital Charge Code	900912139
Hospital Revenue Code	301
Min. Negotiated Rate	$98.11
Max. Negotiated Rate	$217.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$163.20
Rate for Payer: Aetna of CA Government/Medicare	$163.20
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$122.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$217.60
Rate for Payer: Health Smart Auto/Commercial	$163.20
Rate for Payer: Intervalley Health Plan Commercial	$98.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$163.20
Rate for Payer: LLUH Dept of Risk Management WC	$149.60
Rate for Payer: Multiplan Commercial	$204.00

HC PLACENTAL ALPHA MICROGLOB-1POC

Facility

$960.00

Service Code	CPT 84112
Hospital Charge Code	900912139
Hospital Revenue Code	301
Min. Negotiated Rate	$528.00
Max. Negotiated Rate	$768.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$768.00
Rate for Payer: Health Smart Auto/Commercial	$576.00
Rate for Payer: LLUH Dept of Risk Management WC	$528.00
Rate for Payer: Multiplan Commercial	$720.00

HC PLATELET COUNT

Facility

$32.00

Service Code	CPT 85049
Hospital Charge Code	900910101
Hospital Revenue Code	305
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$25.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.20
Rate for Payer: Aetna of CA Government/Medicare	$19.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$25.60
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: Intervalley Health Plan Commercial	$4.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Commercial	$24.00

HC PLATELET COUNT

Facility

$119.00

Service Code	CPT 85049
Hospital Charge Code	900910101
Hospital Revenue Code	305
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$95.20
Rate for Payer: Cash Price	$53.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$95.20
Rate for Payer: Health Smart Auto/Commercial	$71.40
Rate for Payer: LLUH Dept of Risk Management WC	$65.45
Rate for Payer: Multiplan Commercial	$89.25

HC PLATELET COUNT CITRATED

Facility

$119.00

Service Code	CPT 85049
Hospital Charge Code	900912026
Hospital Revenue Code	305
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$95.20
Rate for Payer: Cash Price	$53.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$95.20
Rate for Payer: Health Smart Auto/Commercial	$71.40
Rate for Payer: LLUH Dept of Risk Management WC	$65.45
Rate for Payer: Multiplan Commercial	$89.25

HC PLATELET COUNT CITRATED

Facility

$32.00

Service Code	CPT 85049
Hospital Charge Code	900912026
Hospital Revenue Code	305
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$25.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.20
Rate for Payer: Aetna of CA Government/Medicare	$19.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$25.60
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: Intervalley Health Plan Commercial	$4.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Commercial	$24.00

HC PLATELET NEUTRALIZATION

Facility

$350.00

Service Code	CPT 85597
Hospital Charge Code	900912007
Hospital Revenue Code	305
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$280.00
Rate for Payer: Cash Price	$157.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$280.00
Rate for Payer: Health Smart Auto/Commercial	$210.00
Rate for Payer: LLUH Dept of Risk Management WC	$192.50
Rate for Payer: Multiplan Commercial	$262.50

HC PLATELET NEUTRALIZATION

Facility

$65.00

Service Code	CPT 85597
Hospital Charge Code	900912007
Hospital Revenue Code	305
Min. Negotiated Rate	$17.98
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$39.00
Rate for Payer: Aetna of CA Government/Medicare	$39.00
Rate for Payer: Cash Price	$29.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$52.00
Rate for Payer: Health Smart Auto/Commercial	$39.00
Rate for Payer: Intervalley Health Plan Commercial	$17.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$39.00
Rate for Payer: LLUH Dept of Risk Management WC	$35.75
Rate for Payer: Multiplan Commercial	$48.75

HC PNEUMOCYSTIS STAIN

Facility

$184.00

Service Code	CPT 87205
Hospital Charge Code	900911625
Hospital Revenue Code	306
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 PNEUMOCYSTIS STAIN

Facility

$46.00

Service Code	CPT 87205
Hospital Charge Code	900911625
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 POLYS MICRO EXAM

Facility

$170.00

Service Code	CPT 89055
Hospital Charge Code	900910045
Hospital Revenue Code	300
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 POLYS MICRO EXAM

Facility

$46.00

Service Code	CPT 89055
Hospital Charge Code	900910045
Hospital Revenue Code	300
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 PORPHOBILINOGEN QUAL

Facility

$17.00

Service Code	CPT 84106
Hospital Charge Code	900910297
Hospital Revenue Code	301
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$13.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.20
Rate for Payer: Aetna of CA Government/Medicare	$10.20
Rate for Payer: Cash Price	$7.65
Rate for Payer: Cash Price	$7.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.60
Rate for Payer: Health Smart Auto/Commercial	$10.20
Rate for Payer: Intervalley Health Plan Commercial	$5.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.20
Rate for Payer: LLUH Dept of Risk Management WC	$9.35
Rate for Payer: Multiplan Commercial	$12.75

HC PORPHOBILINOGEN QUAL

Facility

$135.00

Service Code	CPT 84106
Hospital Charge Code	900910297
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 POS COMBO 43 PANEL ID

Facility

$50.00

Service Code	CPT 87077
Hospital Charge Code	900912490
Hospital Revenue Code	300
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Intervalley Health Plan Commercial	$8.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC POS COMBO 43 PANEL ID

Facility

$74.00

Service Code	CPT 87077
Hospital Charge Code	900912490
Hospital Revenue Code	300
Min. Negotiated Rate	$40.70
Max. Negotiated Rate	$59.20
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: LLUH Dept of Risk Management WC	$40.70
Rate for Payer: Multiplan Commercial	$55.50

Know your out-of-pocket cost for care.

All Charges