Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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

HC PROTEIN C ACTIVITY

Facility

$126.00

Service Code	CPT 85303
Hospital Charge Code	900912012
Hospital Revenue Code	305
Min. Negotiated Rate	$13.84
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$75.60
Rate for Payer: Aetna of CA Government/Medicare	$75.60
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cash Price	$56.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$100.80
Rate for Payer: Health Smart Auto/Commercial	$75.60
Rate for Payer: Intervalley Health Plan Commercial	$13.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$75.60
Rate for Payer: LLUH Dept of Risk Management WC	$69.30
Rate for Payer: Multiplan Commercial	$94.50

HC PROTEIN C ACTIVITY

Facility

$308.00

Service Code	CPT 85303
Hospital Charge Code	900912012
Hospital Revenue Code	305
Min. Negotiated Rate	$169.40
Max. Negotiated Rate	$246.40
Rate for Payer: Cash Price	$138.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$246.40
Rate for Payer: Health Smart Auto/Commercial	$184.80
Rate for Payer: LLUH Dept of Risk Management WC	$169.40
Rate for Payer: Multiplan Commercial	$231.00

HC PROTEIN CSF

Facility

$39.00

Service Code	CPT 84157
Hospital Charge Code	900912250
Hospital Revenue Code	301
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$31.20
Rate for Payer: Cash Price	$17.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$31.20
Rate for Payer: Health Smart Auto/Commercial	$23.40
Rate for Payer: LLUH Dept of Risk Management WC	$21.45
Rate for Payer: Multiplan Commercial	$29.25

HC PROTEIN CSF

Facility

$34.00

Service Code	CPT 84157
Hospital Charge Code	900912250
Hospital Revenue Code	301
Min. Negotiated Rate	$4.00
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	$4.00
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 PROTEIN ELECT CSF/URINE

Facility

$75.00

Service Code	CPT 84166
Hospital Charge Code	900910849
Hospital Revenue Code	301
Min. Negotiated Rate	$17.83
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$45.00
Rate for Payer: Aetna of CA Government/Medicare	$45.00
Rate for Payer: Cash Price	$33.75
Rate for Payer: Cash Price	$33.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$60.00
Rate for Payer: Health Smart Auto/Commercial	$45.00
Rate for Payer: Intervalley Health Plan Commercial	$17.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$45.00
Rate for Payer: LLUH Dept of Risk Management WC	$41.25
Rate for Payer: Multiplan Commercial	$56.25

HC PROTEIN ELECT CSF/URINE

Facility

$254.00

Service Code	CPT 84166
Hospital Charge Code	900910849
Hospital Revenue Code	301
Min. Negotiated Rate	$139.70
Max. Negotiated Rate	$203.20
Rate for Payer: Cash Price	$114.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$203.20
Rate for Payer: Health Smart Auto/Commercial	$152.40
Rate for Payer: LLUH Dept of Risk Management WC	$139.70
Rate for Payer: Multiplan Commercial	$190.50

HC PROTEIN ELECT SERUM

Facility

$82.00

Service Code	CPT 84165
Hospital Charge Code	900910850
Hospital Revenue Code	301
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$65.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$49.20
Rate for Payer: Aetna of CA Government/Medicare	$49.20
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cash Price	$36.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$65.60
Rate for Payer: Health Smart Auto/Commercial	$49.20
Rate for Payer: Intervalley Health Plan Commercial	$10.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$49.20
Rate for Payer: LLUH Dept of Risk Management WC	$45.10
Rate for Payer: Multiplan Commercial	$61.50

HC PROTEIN ELECT SERUM

Facility

$254.00

Service Code	CPT 84165
Hospital Charge Code	900910850
Hospital Revenue Code	301
Min. Negotiated Rate	$139.70
Max. Negotiated Rate	$203.20
Rate for Payer: Cash Price	$114.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$203.20
Rate for Payer: Health Smart Auto/Commercial	$152.40
Rate for Payer: LLUH Dept of Risk Management WC	$139.70
Rate for Payer: Multiplan Commercial	$190.50

HC PROTEIN ELECT URINE

Facility

$77.78

Service Code	CPT 84165
Hospital Charge Code	900910851
Hospital Revenue Code	301
Min. Negotiated Rate	$42.78
Max. Negotiated Rate	$62.22
Rate for Payer: Cash Price	$35.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$62.22
Rate for Payer: Health Smart Auto/Commercial	$46.67
Rate for Payer: LLUH Dept of Risk Management WC	$42.78
Rate for Payer: Multiplan Commercial	$58.34

HC PROTEIN ELECT URINE

Facility

$77.78

Service Code	CPT 84165
Hospital Charge Code	900910851
Hospital Revenue Code	301
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$62.22
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$46.67
Rate for Payer: Aetna of CA Government/Medicare	$46.67
Rate for Payer: Cash Price	$35.00
Rate for Payer: Cash Price	$35.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$62.22
Rate for Payer: Health Smart Auto/Commercial	$46.67
Rate for Payer: Intervalley Health Plan Commercial	$10.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$46.67
Rate for Payer: LLUH Dept of Risk Management WC	$42.78
Rate for Payer: Multiplan Commercial	$58.34

HC PROTEIN TOTAL

Facility

$17.00

Service Code	CPT 84155
Hospital Charge Code	900910249
Hospital Revenue Code	301
Min. Negotiated Rate	$3.67
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	$3.67
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 PROTEIN TOTAL

Facility

$98.00

Service Code	CPT 84155
Hospital Charge Code	900910249
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 PROTEIN TOTAL INDIVIDUAL

Facility

$50.00

Service Code	CPT 84155
Hospital Charge Code	900910496
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$40.00
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: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC PROTEIN TOTAL INDIVIDUAL

Facility

$50.00

Service Code	CPT 84155
Hospital Charge Code	900910496
Hospital Revenue Code	301
Min. Negotiated Rate	$3.67
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	$3.67
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 PROTEIN TOTAL SPE ONLY

Facility

$17.00

Service Code	CPT 84155
Hospital Charge Code	900912163
Hospital Revenue Code	301
Min. Negotiated Rate	$3.67
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	$3.67
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 PROTEIN TOTAL SPE ONLY

Facility

$98.00

Service Code	CPT 84155
Hospital Charge Code	900912163
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 PROTEIN URINE

Facility

$117.00

Service Code	CPT 84156
Hospital Charge Code	900910290
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 PROTEIN URINE

Facility

$39.00

Service Code	CPT 84156
Hospital Charge Code	900910290
Hospital Revenue Code	301
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$31.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.40
Rate for Payer: Aetna of CA Government/Medicare	$23.40
Rate for Payer: Cash Price	$17.55
Rate for Payer: Cash Price	$17.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$31.20
Rate for Payer: Health Smart Auto/Commercial	$23.40
Rate for Payer: Intervalley Health Plan Commercial	$3.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.40
Rate for Payer: LLUH Dept of Risk Management WC	$21.45
Rate for Payer: Multiplan Commercial	$29.25

HC PROTHROMBIN G20210A MUTATION

Facility

$618.00

Service Code	CPT 81240
Hospital Charge Code	900912324
Hospital Revenue Code	310
Min. Negotiated Rate	$339.90
Max. Negotiated Rate	$494.40
Rate for Payer: Cash Price	$278.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$494.40
Rate for Payer: Health Smart Auto/Commercial	$370.80
Rate for Payer: LLUH Dept of Risk Management WC	$339.90
Rate for Payer: Multiplan Commercial	$463.50

HC PROTHROMBIN G20210A MUTATION

Facility

$164.00

Service Code	CPT 81240
Hospital Charge Code	900912324
Hospital Revenue Code	310
Min. Negotiated Rate	$65.69
Max. Negotiated Rate	$131.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$98.40
Rate for Payer: Aetna of CA Government/Medicare	$98.40
Rate for Payer: Cash Price	$73.80
Rate for Payer: Cash Price	$73.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$131.20
Rate for Payer: Health Smart Auto/Commercial	$98.40
Rate for Payer: Intervalley Health Plan Commercial	$65.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$98.40
Rate for Payer: LLUH Dept of Risk Management WC	$90.20
Rate for Payer: Multiplan Commercial	$123.00

HC PROTHROMBIN TIME (POC)

Facility

$97.60

Service Code	CPT 85610
Hospital Charge Code	900912025
Hospital Revenue Code	305
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$78.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$58.56
Rate for Payer: Aetna of CA Government/Medicare	$58.56
Rate for Payer: Cash Price	$43.92
Rate for Payer: Cash Price	$43.92
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$78.08
Rate for Payer: Health Smart Auto/Commercial	$58.56
Rate for Payer: Intervalley Health Plan Commercial	$4.29
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$58.56
Rate for Payer: LLUH Dept of Risk Management WC	$53.68
Rate for Payer: Multiplan Commercial	$73.20

HC PROTHROMBIN TIME (POC)

Facility

$97.60

Service Code	CPT 85610
Hospital Charge Code	900912025
Hospital Revenue Code	305
Min. Negotiated Rate	$53.68
Max. Negotiated Rate	$78.08
Rate for Payer: Cash Price	$43.92
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$78.08
Rate for Payer: Health Smart Auto/Commercial	$58.56
Rate for Payer: LLUH Dept of Risk Management WC	$53.68
Rate for Payer: Multiplan Commercial	$73.20

HC PROTHROMBIN TIME QUICK

Facility

$42.00

Service Code	CPT 85610
Hospital Charge Code	900910040
Hospital Revenue Code	305
Min. Negotiated Rate	$4.29
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	$4.29
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 PROTHROMBIN TIME QUICK

Facility

$122.00

Service Code	CPT 85610
Hospital Charge Code	900910040
Hospital Revenue Code	305
Min. Negotiated Rate	$67.10
Max. Negotiated Rate	$97.60
Rate for Payer: Cash Price	$54.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$97.60
Rate for Payer: Health Smart Auto/Commercial	$73.20
Rate for Payer: LLUH Dept of Risk Management WC	$67.10
Rate for Payer: Multiplan Commercial	$91.50

Know your out-of-pocket cost for care.

All Charges