Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC ROUTINE URINALYSIS

Facility

$33.00

Service Code	CPT 81001
Hospital Charge Code	900910167
Hospital Revenue Code	307
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$26.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.80
Rate for Payer: Aetna of CA Government/Medicare	$19.80
Rate for Payer: Cash Price	$14.85
Rate for Payer: Cash Price	$14.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$26.40
Rate for Payer: Health Smart Auto/Commercial	$19.80
Rate for Payer: Intervalley Health Plan Commercial	$3.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.80
Rate for Payer: LLUH Dept of Risk Management WC	$18.15
Rate for Payer: Multiplan Commercial	$24.75

HC RPR

Facility

$56.96

Service Code	CPT 83520
Hospital Charge Code	900913675
Hospital Revenue Code	302
Min. Negotiated Rate	$17.27
Max. Negotiated Rate	$45.57
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$34.18
Rate for Payer: Aetna of CA Government/Medicare	$34.18
Rate for Payer: Cash Price	$25.63
Rate for Payer: Cash Price	$25.63
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$45.57
Rate for Payer: Health Smart Auto/Commercial	$34.18
Rate for Payer: Intervalley Health Plan Commercial	$17.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$34.18
Rate for Payer: LLUH Dept of Risk Management WC	$31.33
Rate for Payer: Multiplan Commercial	$42.72

HC RPR

Facility

$64.00

Service Code	CPT 83520
Hospital Charge Code	900913675
Hospital Revenue Code	302
Min. Negotiated Rate	$35.20
Max. Negotiated Rate	$51.20
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: LLUH Dept of Risk Management WC	$35.20
Rate for Payer: Multiplan Commercial	$48.00

HC RPR TITER

Facility

$182.00

Service Code	CPT 86593
Hospital Charge Code	900910929
Hospital Revenue Code	302
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$145.60
Rate for Payer: Cash Price	$81.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$145.60
Rate for Payer: Health Smart Auto/Commercial	$109.20
Rate for Payer: LLUH Dept of Risk Management WC	$100.10
Rate for Payer: Multiplan Commercial	$136.50

HC RPR TITER

Facility

$40.00

Service Code	CPT 86593
Hospital Charge Code	900910929
Hospital Revenue Code	302
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.00
Rate for Payer: Aetna of CA Government/Medicare	$24.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$32.00
Rate for Payer: Health Smart Auto/Commercial	$24.00
Rate for Payer: Intervalley Health Plan Commercial	$4.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.00
Rate for Payer: LLUH Dept of Risk Management WC	$22.00
Rate for Payer: Multiplan Commercial	$30.00

HC RSV AG

Facility

$184.00

Service Code	CPT 87420
Hospital Charge Code	900911613
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 RSV AG

Facility

$31.00

Service Code	CPT 87420
Hospital Charge Code	900911613
Hospital Revenue Code	306
Min. Negotiated Rate	$13.91
Max. Negotiated Rate	$24.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.60
Rate for Payer: Aetna of CA Government/Medicare	$18.60
Rate for Payer: Cash Price	$13.95
Rate for Payer: Cash Price	$13.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$24.80
Rate for Payer: Health Smart Auto/Commercial	$18.60
Rate for Payer: Intervalley Health Plan Commercial	$13.91
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.60
Rate for Payer: LLUH Dept of Risk Management WC	$17.05
Rate for Payer: Multiplan Commercial	$23.25

HC RSV DFA

Facility

$332.00

Service Code	CPT 87280
Hospital Charge Code	900911537
Hospital Revenue Code	306
Min. Negotiated Rate	$182.60
Max. Negotiated Rate	$265.60
Rate for Payer: Cash Price	$149.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$265.60
Rate for Payer: Health Smart Auto/Commercial	$199.20
Rate for Payer: LLUH Dept of Risk Management WC	$182.60
Rate for Payer: Multiplan Commercial	$249.00

HC RSV DFA

Facility

$39.00

Service Code	CPT 87280
Hospital Charge Code	900911537
Hospital Revenue Code	306
Min. Negotiated Rate	$13.42
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	$13.42
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 RUBELLA ANTIBODY

Facility

$121.82

Service Code	CPT 86762
Hospital Charge Code	900913664
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$97.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$73.09
Rate for Payer: Aetna of CA Government/Medicare	$73.09
Rate for Payer: Cash Price	$54.82
Rate for Payer: Cash Price	$54.82
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$97.46
Rate for Payer: Health Smart Auto/Commercial	$73.09
Rate for Payer: Intervalley Health Plan Commercial	$14.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$73.09
Rate for Payer: LLUH Dept of Risk Management WC	$67.00
Rate for Payer: Multiplan Commercial	$91.36

HC RUBELLA ANTIBODY

Facility

$134.00

Service Code	CPT 86762
Hospital Charge Code	900913664
Hospital Revenue Code	302
Min. Negotiated Rate	$73.70
Max. Negotiated Rate	$107.20
Rate for Payer: Cash Price	$60.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$107.20
Rate for Payer: Health Smart Auto/Commercial	$80.40
Rate for Payer: LLUH Dept of Risk Management WC	$73.70
Rate for Payer: Multiplan Commercial	$100.50

HC RUBELLA ANTIBODY IGG QUANT

Facility

$98.00

Service Code	CPT 86762
Hospital Charge Code	900913665
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$78.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$58.80
Rate for Payer: Aetna of CA Government/Medicare	$58.80
Rate for Payer: Cash Price	$44.10
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: Intervalley Health Plan Commercial	$14.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$58.80
Rate for Payer: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Commercial	$73.50

HC RUBELLA ANTIBODY IGG QUANT

Facility

$134.00

Service Code	CPT 86762
Hospital Charge Code	900913665
Hospital Revenue Code	302
Min. Negotiated Rate	$73.70
Max. Negotiated Rate	$107.20
Rate for Payer: Cash Price	$60.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$107.20
Rate for Payer: Health Smart Auto/Commercial	$80.40
Rate for Payer: LLUH Dept of Risk Management WC	$73.70
Rate for Payer: Multiplan Commercial	$100.50

HC RUBEOLA ANTIBODY

Facility

$144.06

Service Code	CPT 86765
Hospital Charge Code	900913666
Hospital Revenue Code	302
Min. Negotiated Rate	$79.23
Max. Negotiated Rate	$115.25
Rate for Payer: Cash Price	$64.83
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$115.25
Rate for Payer: Health Smart Auto/Commercial	$86.44
Rate for Payer: LLUH Dept of Risk Management WC	$79.23
Rate for Payer: Multiplan Commercial	$108.05

HC RUBEOLA ANTIBODY

Facility

$130.96

Service Code	CPT 86765
Hospital Charge Code	900913666
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$104.77
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$78.58
Rate for Payer: Aetna of CA Government/Medicare	$78.58
Rate for Payer: Cash Price	$58.93
Rate for Payer: Cash Price	$58.93
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$104.77
Rate for Payer: Health Smart Auto/Commercial	$78.58
Rate for Payer: Intervalley Health Plan Commercial	$12.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$78.58
Rate for Payer: LLUH Dept of Risk Management WC	$72.03
Rate for Payer: Multiplan Commercial	$98.22

HC SACRUM AND COCCYX

Facility

$1,151.00

Service Code	CPT 72220
Hospital Charge Code	909001343
Hospital Revenue Code	320
Min. Negotiated Rate	$633.05
Max. Negotiated Rate	$920.80
Rate for Payer: Cash Price	$517.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$920.80
Rate for Payer: Health Smart Auto/Commercial	$690.60
Rate for Payer: LLUH Dept of Risk Management WC	$633.05
Rate for Payer: Multiplan Commercial	$863.25

HC SACRUM AND COCCYX

Facility

$1,151.00

Service Code	CPT 72220
Hospital Charge Code	909001343
Hospital Revenue Code	320
Min. Negotiated Rate	$633.05
Max. Negotiated Rate	$920.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$690.60
Rate for Payer: Aetna of CA Government/Medicare	$690.60
Rate for Payer: Cash Price	$517.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$920.80
Rate for Payer: Health Smart Auto/Commercial	$690.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$690.60
Rate for Payer: LLUH Dept of Risk Management WC	$633.05
Rate for Payer: Multiplan Commercial	$863.25

HC SALICYLATES

Facility

$508.00

Service Code	CPT 80307
Hospital Charge Code	900910366
Hospital Revenue Code	301
Min. Negotiated Rate	$279.40
Max. Negotiated Rate	$406.40
Rate for Payer: Cash Price	$228.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$406.40
Rate for Payer: Health Smart Auto/Commercial	$304.80
Rate for Payer: LLUH Dept of Risk Management WC	$279.40
Rate for Payer: Multiplan Commercial	$381.00

HC SALICYLATES

Facility

$82.00

Service Code	CPT 80307
Hospital Charge Code	900910366
Hospital Revenue Code	301
Min. Negotiated Rate	$45.10
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	$62.14
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 SCAPULA

Facility

$1,202.00

Service Code	CPT 73010
Hospital Charge Code	909001479
Hospital Revenue Code	320
Min. Negotiated Rate	$661.10
Max. Negotiated Rate	$961.60
Rate for Payer: Cash Price	$540.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$961.60
Rate for Payer: Health Smart Auto/Commercial	$721.20
Rate for Payer: LLUH Dept of Risk Management WC	$661.10
Rate for Payer: Multiplan Commercial	$901.50

HC SCAPULA

Facility

$1,202.00

Service Code	CPT 73010
Hospital Charge Code	909001479
Hospital Revenue Code	320
Min. Negotiated Rate	$661.10
Max. Negotiated Rate	$961.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$721.20
Rate for Payer: Aetna of CA Government/Medicare	$721.20
Rate for Payer: Cash Price	$540.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$961.60
Rate for Payer: Health Smart Auto/Commercial	$721.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$721.20
Rate for Payer: LLUH Dept of Risk Management WC	$661.10
Rate for Payer: Multiplan Commercial	$901.50

HC SCL 70 AB

Facility

$171.00

Service Code	CPT 86235
Hospital Charge Code	900913525
Hospital Revenue Code	302
Min. Negotiated Rate	$94.05
Max. Negotiated Rate	$136.80
Rate for Payer: Cash Price	$76.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$136.80
Rate for Payer: Health Smart Auto/Commercial	$102.60
Rate for Payer: LLUH Dept of Risk Management WC	$94.05
Rate for Payer: Multiplan Commercial	$128.25

HC SCL 70 AB

Facility

$44.00

Service Code	CPT 86235
Hospital Charge Code	900913525
Hospital Revenue Code	302
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$26.40
Rate for Payer: Aetna of CA Government/Medicare	$26.40
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$35.20
Rate for Payer: Health Smart Auto/Commercial	$26.40
Rate for Payer: Intervalley Health Plan Commercial	$17.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$26.40
Rate for Payer: LLUH Dept of Risk Management WC	$24.20
Rate for Payer: Multiplan Commercial	$33.00

HC SED RATE WESTERGREN MANUAL

Facility

$148.00

Service Code	CPT 85651
Hospital Charge Code	900912022
Hospital Revenue Code	305
Min. Negotiated Rate	$81.40
Max. Negotiated Rate	$118.40
Rate for Payer: Cash Price	$66.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$118.40
Rate for Payer: Health Smart Auto/Commercial	$88.80
Rate for Payer: LLUH Dept of Risk Management WC	$81.40
Rate for Payer: Multiplan Commercial	$111.00

HC SED RATE WESTERGREN MANUAL

Facility

$22.00

Service Code	CPT 85651
Hospital Charge Code	900912022
Hospital Revenue Code	305
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$17.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.20
Rate for Payer: Aetna of CA Government/Medicare	$13.20
Rate for Payer: Cash Price	$9.90
Rate for Payer: Cash Price	$9.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$17.60
Rate for Payer: Health Smart Auto/Commercial	$13.20
Rate for Payer: Intervalley Health Plan Commercial	$4.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.20
Rate for Payer: LLUH Dept of Risk Management WC	$12.10
Rate for Payer: Multiplan Commercial	$16.50

Know your out-of-pocket cost for care.

All Charges