Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC PSYCH DIAGNOSTIC EVALUATION

Facility

$150.00

Service Code	CPT 90791
Hospital Charge Code	950900000
Hospital Revenue Code	900
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$120.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$120.00
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Commercial	$112.50

HC PSYCH DIAGNOSTIC EVALUATION

Facility

$150.00

Service Code	CPT 90791
Hospital Charge Code	950900000
Hospital Revenue Code	900
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$224.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$224.40
Rate for Payer: Aetna of CA Government/Medicare	$224.40
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$120.00
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Mary Free Bed Workers' Compensation	$180.30
Rate for Payer: Multiplan Commercial	$112.50

HC PSYCH TESTING

Facility

$150.00

Service Code	CPT 96100
Hospital Charge Code	907804040
Hospital Revenue Code	912
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$120.00
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$112.50

HC PSYCH TESTING

Facility

$150.00

Service Code	CPT 96100
Hospital Charge Code	907804040
Hospital Revenue Code	912
Min. Negotiated Rate	$82.50
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	$90.00
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	$67.50
Rate for Payer: Cash Price	$67.50
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: 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	$82.50
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Multiplan Commercial	$112.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC PT SUBSTITUTION

Facility

$177.00

Service Code	CPT 85611
Hospital Charge Code	900910105
Hospital Revenue Code	305
Min. Negotiated Rate	$97.35
Max. Negotiated Rate	$141.60
Rate for Payer: Cash Price	$79.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$141.60
Rate for Payer: Health Smart Auto/Commercial	$106.20
Rate for Payer: LLUH Dept of Risk Management WC	$97.35
Rate for Payer: Multiplan Commercial	$132.75

HC PT SUBSTITUTION

Facility

$42.00

Service Code	CPT 85611
Hospital Charge Code	900910105
Hospital Revenue Code	305
Min. Negotiated Rate	$3.94
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	$3.94
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 PTT

Facility

$184.00

Service Code	CPT 85730
Hospital Charge Code	900910007
Hospital Revenue Code	305
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 PTT

Facility

$62.00

Service Code	CPT 85730
Hospital Charge Code	900910007
Hospital Revenue Code	305
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$49.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$37.20
Rate for Payer: Aetna of CA Government/Medicare	$37.20
Rate for Payer: Cash Price	$27.90
Rate for Payer: Cash Price	$27.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$49.60
Rate for Payer: Health Smart Auto/Commercial	$37.20
Rate for Payer: Intervalley Health Plan Commercial	$6.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$37.20
Rate for Payer: LLUH Dept of Risk Management WC	$34.10
Rate for Payer: Multiplan Commercial	$46.50

HC PTT SUBSTITUTION

Facility

$184.00

Service Code	CPT 85732
Hospital Charge Code	900910106
Hospital Revenue Code	305
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 PTT SUBSTITUTION

Facility

$58.00

Service Code	CPT 85732
Hospital Charge Code	900910106
Hospital Revenue Code	305
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$46.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$34.80
Rate for Payer: Aetna of CA Government/Medicare	$34.80
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cash Price	$26.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$46.40
Rate for Payer: Health Smart Auto/Commercial	$34.80
Rate for Payer: Intervalley Health Plan Commercial	$6.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$34.80
Rate for Payer: LLUH Dept of Risk Management WC	$31.90
Rate for Payer: Multiplan Commercial	$43.50

HC PYRUVATE

Facility

$110.00

Service Code	CPT 84210
Hospital Charge Code	900910251
Hospital Revenue Code	301
Min. Negotiated Rate	$60.50
Max. Negotiated Rate	$88.00
Rate for Payer: Cash Price	$49.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$88.00
Rate for Payer: Health Smart Auto/Commercial	$66.00
Rate for Payer: LLUH Dept of Risk Management WC	$60.50
Rate for Payer: Multiplan Commercial	$82.50

HC PYRUVATE

Facility

$51.00

Service Code	CPT 84210
Hospital Charge Code	900910251
Hospital Revenue Code	301
Min. Negotiated Rate	$14.48
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	$14.48
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 PYRUVATE CSF

Facility

$110.00

Service Code	CPT 84210
Hospital Charge Code	900910344
Hospital Revenue Code	301
Min. Negotiated Rate	$60.50
Max. Negotiated Rate	$88.00
Rate for Payer: Cash Price	$49.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$88.00
Rate for Payer: Health Smart Auto/Commercial	$66.00
Rate for Payer: LLUH Dept of Risk Management WC	$60.50
Rate for Payer: Multiplan Commercial	$82.50

HC PYRUVATE CSF

Facility

$51.00

Service Code	CPT 84210
Hospital Charge Code	900910344
Hospital Revenue Code	301
Min. Negotiated Rate	$14.48
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	$14.48
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 RDLGC SM INT FLW THRGH STDY

Facility

$954.00

Service Code	CPT 74248
Hospital Charge Code	909004248
Hospital Revenue Code	320
Min. Negotiated Rate	$524.70
Max. Negotiated Rate	$763.20
Rate for Payer: Cash Price	$429.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$763.20
Rate for Payer: Health Smart Auto/Commercial	$572.40
Rate for Payer: LLUH Dept of Risk Management WC	$524.70
Rate for Payer: Multiplan Commercial	$715.50

HC RDLGC SM INT FLW THRGH STDY

Facility

$954.00

Service Code	CPT 74248
Hospital Charge Code	909004248
Hospital Revenue Code	320
Min. Negotiated Rate	$524.70
Max. Negotiated Rate	$763.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$572.40
Rate for Payer: Aetna of CA Government/Medicare	$572.40
Rate for Payer: Cash Price	$429.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$763.20
Rate for Payer: Health Smart Auto/Commercial	$572.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$572.40
Rate for Payer: LLUH Dept of Risk Management WC	$524.70
Rate for Payer: Multiplan Commercial	$715.50

HC RECOVERY INTENSIVE OP

Facility

$1,110.00

Service Code	CPT 90853
Hospital Charge Code	901500010
Hospital Revenue Code	906
Min. Negotiated Rate	$478.61
Max. Negotiated Rate	$888.00
Rate for Payer: Cash Price	$499.50
Rate for Payer: Cash Price	$499.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$888.00
Rate for Payer: Health Smart Auto/Commercial	$666.00
Rate for Payer: LLUH Dept of Risk Management WC	$610.50
Rate for Payer: Mary Free Bed Workers' Compensation	$478.61
Rate for Payer: Multiplan Commercial	$832.50

HC RECOVERY INTENSIVE OP

Facility

$1,110.00

Service Code	CPT 90853
Hospital Charge Code	901500010
Hospital Revenue Code	906
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$832.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Caremore Medicare Advantage	$429.00
Rate for Payer: Cash Price	$499.50
Rate for Payer: Cash Price	$499.50
Rate for Payer: Cash Price	$499.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$610.50
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$832.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC RECOVERY PART HOSP-FULL(12HRS)

Facility

$1,852.00

Service Code	CPT 90853
Hospital Charge Code	901500012
Hospital Revenue Code	911
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$1,389.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$55.76
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	$833.40
Rate for Payer: Cash Price	$833.40
Rate for Payer: Cash Price	$833.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$756.00
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	$1,018.60
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	$1,389.00

HC RECOVERY PART HOSP-FULL(12HRS)

Facility

$1,852.00

Service Code	CPT 90853
Hospital Charge Code	901500012
Hospital Revenue Code	911
Min. Negotiated Rate	$703.72
Max. Negotiated Rate	$1,481.60
Rate for Payer: Cash Price	$833.40
Rate for Payer: Cash Price	$833.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,481.60
Rate for Payer: Health Smart Auto/Commercial	$1,111.20
Rate for Payer: LLUH Dept of Risk Management WC	$1,018.60
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$1,389.00

HC REDUCING SUBSTANCE

Facility

$87.00

Service Code	CPT 81005
Hospital Charge Code	900910318
Hospital Revenue Code	307
Min. Negotiated Rate	$47.85
Max. Negotiated Rate	$69.60
Rate for Payer: Cash Price	$39.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$69.60
Rate for Payer: Health Smart Auto/Commercial	$52.20
Rate for Payer: LLUH Dept of Risk Management WC	$47.85
Rate for Payer: Multiplan Commercial	$65.25

HC REDUCING SUBSTANCE

Facility

$10.00

Service Code	CPT 81005
Hospital Charge Code	900910318
Hospital Revenue Code	307
Min. Negotiated Rate	$2.17
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	$2.17
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 RENAL FUNCTION PANEL

Facility

$561.00

Service Code	CPT 80069
Hospital Charge Code	900912172
Hospital Revenue Code	301
Min. Negotiated Rate	$308.55
Max. Negotiated Rate	$448.80
Rate for Payer: Cash Price	$252.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$448.80
Rate for Payer: Health Smart Auto/Commercial	$336.60
Rate for Payer: LLUH Dept of Risk Management WC	$308.55
Rate for Payer: Multiplan Commercial	$420.75

HC RENAL FUNCTION PANEL

Facility

$561.00

Service Code	CPT 80069
Hospital Charge Code	900912172
Hospital Revenue Code	301
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$448.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$336.60
Rate for Payer: Aetna of CA Government/Medicare	$336.60
Rate for Payer: Cash Price	$252.45
Rate for Payer: Cash Price	$252.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$448.80
Rate for Payer: Health Smart Auto/Commercial	$336.60
Rate for Payer: Intervalley Health Plan Commercial	$8.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$336.60
Rate for Payer: LLUH Dept of Risk Management WC	$308.55
Rate for Payer: Multiplan Commercial	$420.75

HC RESP VIRUS PANEL NUCLEIC ACID

Facility

$1,540.69

Service Code	CPT 87633
Hospital Charge Code	900912337
Hospital Revenue Code	306
Min. Negotiated Rate	$847.38
Max. Negotiated Rate	$1,232.55
Rate for Payer: Cash Price	$693.31
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,232.55
Rate for Payer: Health Smart Auto/Commercial	$924.41
Rate for Payer: LLUH Dept of Risk Management WC	$847.38
Rate for Payer: Multiplan Commercial	$1,155.52

Know your out-of-pocket cost for care.

All Charges