Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC POTASSIUM

Facility

$34.00

Service Code	CPT 84132
Hospital Charge Code	900910488
Hospital Revenue Code	301
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$27.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.40
Rate for Payer: Aetna of CA Government/Medicare	$20.40
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cash Price	$15.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$27.20
Rate for Payer: Health Smart Auto/Commercial	$20.40
Rate for Payer: Intervalley Health Plan Commercial	$4.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.40
Rate for Payer: LLUH Dept of Risk Management WC	$18.70
Rate for Payer: Multiplan Commercial	$25.50

HC POTASSIUM

Facility

$98.00

Service Code	CPT 84132
Hospital Charge Code	900910488
Hospital Revenue Code	301
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$78.40
Rate for Payer: Cash Price	$44.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$78.40
Rate for Payer: Health Smart Auto/Commercial	$58.80
Rate for Payer: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Commercial	$73.50

HC POTASSIUM

Facility

$34.00

Service Code	CPT 84132
Hospital Charge Code	900910266
Hospital Revenue Code	301
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$27.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.40
Rate for Payer: Aetna of CA Government/Medicare	$20.40
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cash Price	$15.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$27.20
Rate for Payer: Health Smart Auto/Commercial	$20.40
Rate for Payer: Intervalley Health Plan Commercial	$4.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.40
Rate for Payer: LLUH Dept of Risk Management WC	$18.70
Rate for Payer: Multiplan Commercial	$25.50

HC POTASSIUM

Facility

$98.00

Service Code	CPT 84132
Hospital Charge Code	900910266
Hospital Revenue Code	301
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$78.40
Rate for Payer: Cash Price	$44.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$78.40
Rate for Payer: Health Smart Auto/Commercial	$58.80
Rate for Payer: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Commercial	$73.50

HC POTASSIUM BODY FLUID

Facility

$27.00

Service Code	CPT 84999
Hospital Charge Code	900912245
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.20
Rate for Payer: Aetna of CA Government/Medicare	$16.20
Rate for Payer: Cash Price	$12.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$21.60
Rate for Payer: Health Smart Auto/Commercial	$16.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.20
Rate for Payer: LLUH Dept of Risk Management WC	$14.85
Rate for Payer: Multiplan Commercial	$20.25

HC POTASSIUM BODY FLUID

Facility

$28.00

Service Code	CPT 84999
Hospital Charge Code	900912245
Hospital Revenue Code	301
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$22.40
Rate for Payer: Cash Price	$12.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$22.40
Rate for Payer: Health Smart Auto/Commercial	$16.80
Rate for Payer: LLUH Dept of Risk Management WC	$15.40
Rate for Payer: Multiplan Commercial	$21.00

HC POTASSIUM POC

Facility

$91.00

Service Code	CPT 84132
Hospital Charge Code	900912117
Hospital Revenue Code	301
Min. Negotiated Rate	$4.76
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	$4.76
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 POTASSIUM POC

Facility

$91.00

Service Code	CPT 84132
Hospital Charge Code	900912117
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 POTASSIUM STOOL

Facility

$198.00

Service Code	CPT 84133
Hospital Charge Code	900910416
Hospital Revenue Code	301
Min. Negotiated Rate	$108.90
Max. Negotiated Rate	$158.40
Rate for Payer: Cash Price	$89.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$158.40
Rate for Payer: Health Smart Auto/Commercial	$118.80
Rate for Payer: LLUH Dept of Risk Management WC	$108.90
Rate for Payer: Multiplan Commercial	$148.50

HC POTASSIUM STOOL

Facility

$36.00

Service Code	CPT 84133
Hospital Charge Code	900910416
Hospital Revenue Code	301
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$28.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.60
Rate for Payer: Aetna of CA Government/Medicare	$21.60
Rate for Payer: Cash Price	$16.20
Rate for Payer: Cash Price	$16.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$28.80
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: Intervalley Health Plan Commercial	$4.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Commercial	$27.00

HC POTASSIUM URINE

Facility

$34.00

Service Code	CPT 84133
Hospital Charge Code	900910267
Hospital Revenue Code	301
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$27.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.40
Rate for Payer: Aetna of CA Government/Medicare	$20.40
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cash Price	$15.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$27.20
Rate for Payer: Health Smart Auto/Commercial	$20.40
Rate for Payer: Intervalley Health Plan Commercial	$4.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.40
Rate for Payer: LLUH Dept of Risk Management WC	$18.70
Rate for Payer: Multiplan Commercial	$25.50

HC POTASSIUM URINE

Facility

$117.00

Service Code	CPT 84133
Hospital Charge Code	900910267
Hospital Revenue Code	301
Min. Negotiated Rate	$64.35
Max. Negotiated Rate	$93.60
Rate for Payer: Cash Price	$52.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$93.60
Rate for Payer: Health Smart Auto/Commercial	$70.20
Rate for Payer: LLUH Dept of Risk Management WC	$64.35
Rate for Payer: Multiplan Commercial	$87.75

HC PROB-NATRIURETIC PEPTIDE

Facility

$210.00

Service Code	CPT 83880
Hospital Charge Code	900912306
Hospital Revenue Code	301
Min. Negotiated Rate	$39.26
Max. Negotiated Rate	$168.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$126.00
Rate for Payer: Aetna of CA Government/Medicare	$126.00
Rate for Payer: Cash Price	$94.50
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: Intervalley Health Plan Commercial	$39.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$126.00
Rate for Payer: LLUH Dept of Risk Management WC	$115.50
Rate for Payer: Multiplan Commercial	$157.50

HC PROB-NATRIURETIC PEPTIDE

Facility

$655.00

Service Code	CPT 83880
Hospital Charge Code	900912306
Hospital Revenue Code	301
Min. Negotiated Rate	$360.25
Max. Negotiated Rate	$524.00
Rate for Payer: Cash Price	$294.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$524.00
Rate for Payer: Health Smart Auto/Commercial	$393.00
Rate for Payer: LLUH Dept of Risk Management WC	$360.25
Rate for Payer: Multiplan Commercial	$491.25

HC PROGESTERONE

Facility

$250.00

Service Code	CPT 84144
Hospital Charge Code	900912132
Hospital Revenue Code	301
Min. Negotiated Rate	$137.50
Max. Negotiated Rate	$200.00
Rate for Payer: Cash Price	$112.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$200.00
Rate for Payer: Health Smart Auto/Commercial	$150.00
Rate for Payer: LLUH Dept of Risk Management WC	$137.50
Rate for Payer: Multiplan Commercial	$187.50

HC PROGESTERONE

Facility

$106.00

Service Code	CPT 84144
Hospital Charge Code	900912132
Hospital Revenue Code	301
Min. Negotiated Rate	$20.86
Max. Negotiated Rate	$84.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$63.60
Rate for Payer: Aetna of CA Government/Medicare	$63.60
Rate for Payer: Cash Price	$47.70
Rate for Payer: Cash Price	$47.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$84.80
Rate for Payer: Health Smart Auto/Commercial	$63.60
Rate for Payer: Intervalley Health Plan Commercial	$20.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$63.60
Rate for Payer: LLUH Dept of Risk Management WC	$58.30
Rate for Payer: Multiplan Commercial	$79.50

HC PROLACTIN

Facility

$440.00

Service Code	CPT 84146
Hospital Charge Code	900910808
Hospital Revenue Code	301
Min. Negotiated Rate	$242.00
Max. Negotiated Rate	$352.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$352.00
Rate for Payer: Health Smart Auto/Commercial	$264.00
Rate for Payer: LLUH Dept of Risk Management WC	$242.00
Rate for Payer: Multiplan Commercial	$330.00

HC PROLACTIN

Facility

$84.00

Service Code	CPT 84146
Hospital Charge Code	900910808
Hospital Revenue Code	301
Min. Negotiated Rate	$19.38
Max. Negotiated Rate	$67.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$50.40
Rate for Payer: Aetna of CA Government/Medicare	$50.40
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cash Price	$37.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$67.20
Rate for Payer: Health Smart Auto/Commercial	$50.40
Rate for Payer: Intervalley Health Plan Commercial	$19.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$50.40
Rate for Payer: LLUH Dept of Risk Management WC	$46.20
Rate for Payer: Multiplan Commercial	$63.00

HC PROSTATE CANCER SCREEN (PSA)

Facility

$64.00

Service Code	CPT 84153
Hospital Charge Code	900912101
Hospital Revenue Code	301
Min. Negotiated Rate	$18.39
Max. Negotiated Rate	$51.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$38.40
Rate for Payer: Aetna of CA Government/Medicare	$38.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$51.20
Rate for Payer: Health Smart Auto/Commercial	$38.40
Rate for Payer: Intervalley Health Plan Commercial	$18.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$38.40
Rate for Payer: LLUH Dept of Risk Management WC	$35.20
Rate for Payer: Multiplan Commercial	$48.00

HC PROSTATE CANCER SCREEN (PSA)

Facility

$235.00

Service Code	CPT 84153
Hospital Charge Code	900912101
Hospital Revenue Code	301
Min. Negotiated Rate	$129.25
Max. Negotiated Rate	$188.00
Rate for Payer: Cash Price	$105.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$188.00
Rate for Payer: Health Smart Auto/Commercial	$141.00
Rate for Payer: LLUH Dept of Risk Management WC	$129.25
Rate for Payer: Multiplan Commercial	$176.25

HC PROSTATE SPECIFIC AG. FREE

Facility

$190.00

Service Code	CPT 84154
Hospital Charge Code	900912133
Hospital Revenue Code	301
Min. Negotiated Rate	$104.50
Max. Negotiated Rate	$152.00
Rate for Payer: Cash Price	$85.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$152.00
Rate for Payer: Health Smart Auto/Commercial	$114.00
Rate for Payer: LLUH Dept of Risk Management WC	$104.50
Rate for Payer: Multiplan Commercial	$142.50

HC PROSTATE SPECIFIC AG. FREE

Facility

$102.70

Service Code	CPT 84154
Hospital Charge Code	900912133
Hospital Revenue Code	301
Min. Negotiated Rate	$18.39
Max. Negotiated Rate	$82.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$61.62
Rate for Payer: Aetna of CA Government/Medicare	$61.62
Rate for Payer: Cash Price	$46.22
Rate for Payer: Cash Price	$46.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$82.16
Rate for Payer: Health Smart Auto/Commercial	$61.62
Rate for Payer: Intervalley Health Plan Commercial	$18.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$61.62
Rate for Payer: LLUH Dept of Risk Management WC	$56.48
Rate for Payer: Multiplan Commercial	$77.03

HC PROSTATE SPECIFIC ANTIGEN

Facility

$270.00

Service Code	CPT 84153
Hospital Charge Code	900910879
Hospital Revenue Code	301
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$216.00
Rate for Payer: Cash Price	$121.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$216.00
Rate for Payer: Health Smart Auto/Commercial	$162.00
Rate for Payer: LLUH Dept of Risk Management WC	$148.50
Rate for Payer: Multiplan Commercial	$202.50

HC PROSTATE SPECIFIC ANTIGEN

Facility

$102.70

Service Code	CPT 84153
Hospital Charge Code	900910879
Hospital Revenue Code	301
Min. Negotiated Rate	$18.39
Max. Negotiated Rate	$82.16
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$61.62
Rate for Payer: Aetna of CA Government/Medicare	$61.62
Rate for Payer: Cash Price	$46.22
Rate for Payer: Cash Price	$46.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$82.16
Rate for Payer: Health Smart Auto/Commercial	$61.62
Rate for Payer: Intervalley Health Plan Commercial	$18.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$61.62
Rate for Payer: LLUH Dept of Risk Management WC	$56.48
Rate for Payer: Multiplan Commercial	$77.03

HC PROTEIN BODY FLUID

Facility

$30.00

Service Code	CPT 84157
Hospital Charge Code	900910248
Hospital Revenue Code	301
Min. Negotiated Rate	$4.00
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	$4.00
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

Know your out-of-pocket cost for care.

All Charges