Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SKULL COMPLETE

Facility

$1,568.00

Service Code	CPT 70260
Hospital Charge Code	909001143
Hospital Revenue Code	320
Min. Negotiated Rate	$862.40
Max. Negotiated Rate	$1,254.40
Rate for Payer: Cash Price	$705.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,254.40
Rate for Payer: Health Smart Auto/Commercial	$940.80
Rate for Payer: LLUH Dept of Risk Management WC	$862.40
Rate for Payer: Multiplan Commercial	$1,176.00

HC SKULL LIMITED

Facility

$1,173.00

Service Code	CPT 70250
Hospital Charge Code	909001144
Hospital Revenue Code	320
Min. Negotiated Rate	$645.15
Max. Negotiated Rate	$938.40
Rate for Payer: Cash Price	$527.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$938.40
Rate for Payer: Health Smart Auto/Commercial	$703.80
Rate for Payer: LLUH Dept of Risk Management WC	$645.15
Rate for Payer: Multiplan Commercial	$879.75

HC SKULL LIMITED

Facility

$1,173.00

Service Code	CPT 70250
Hospital Charge Code	909001144
Hospital Revenue Code	320
Min. Negotiated Rate	$645.15
Max. Negotiated Rate	$938.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$703.80
Rate for Payer: Aetna of CA Government/Medicare	$703.80
Rate for Payer: Cash Price	$527.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$938.40
Rate for Payer: Health Smart Auto/Commercial	$703.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$703.80
Rate for Payer: LLUH Dept of Risk Management WC	$645.15
Rate for Payer: Multiplan Commercial	$879.75

HC SLOW ACTIVATION

Facility

$162.00

Service Code	CPT 85730
Hospital Charge Code	900910078
Hospital Revenue Code	305
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$129.60
Rate for Payer: Cash Price	$72.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$129.60
Rate for Payer: Health Smart Auto/Commercial	$97.20
Rate for Payer: LLUH Dept of Risk Management WC	$89.10
Rate for Payer: Multiplan Commercial	$121.50

HC SLOW ACTIVATION

Facility

$64.00

Service Code	CPT 85730
Hospital Charge Code	900910078
Hospital Revenue Code	305
Min. Negotiated Rate	$6.01
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	$6.01
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 SM (SMITH) ANTIBODY

Facility

$171.00

Service Code	CPT 86235
Hospital Charge Code	900913523
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 SM (SMITH) ANTIBODY

Facility

$44.00

Service Code	CPT 86235
Hospital Charge Code	900913523
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 SOA 55284 CYSTICER AB IGG

Facility

$59.10

Service Code	CPT 86682
Hospital Charge Code	900914796
Hospital Revenue Code	302
Min. Negotiated Rate	$13.01
Max. Negotiated Rate	$47.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$35.46
Rate for Payer: Aetna of CA Government/Medicare	$35.46
Rate for Payer: Cash Price	$26.60
Rate for Payer: Cash Price	$26.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$47.28
Rate for Payer: Health Smart Auto/Commercial	$35.46
Rate for Payer: Intervalley Health Plan Commercial	$13.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$35.46
Rate for Payer: LLUH Dept of Risk Management WC	$32.51
Rate for Payer: Multiplan Commercial	$44.33

HC SOA 55284 CYSTICER AB IGG

Facility

$59.10

Service Code	CPT 86682
Hospital Charge Code	900914796
Hospital Revenue Code	302
Min. Negotiated Rate	$32.51
Max. Negotiated Rate	$47.28
Rate for Payer: Cash Price	$26.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$47.28
Rate for Payer: Health Smart Auto/Commercial	$35.46
Rate for Payer: LLUH Dept of Risk Management WC	$32.51
Rate for Payer: Multiplan Commercial	$44.33

HC SOCIDEM PDC 82657

Facility

$150.00

Service Code	CPT 82657
Hospital Charge Code	900915254
Hospital Revenue Code	309
Min. Negotiated Rate	$22.17
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.00
Rate for Payer: Aetna of CA Government/Medicare	$90.00
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	$120.00
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: Intervalley Health Plan Commercial	$22.17
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: Multiplan Commercial	$112.50

HC SOCIDEM PDC 82657

Facility

$150.00

Service Code	CPT 82657
Hospital Charge Code	900915254
Hospital Revenue Code	309
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 SOCIDEM PDC 82658

Facility

$150.00

Service Code	CPT 82658
Hospital Charge Code	900915255
Hospital Revenue Code	309
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 SOCIDEM PDC 82658

Facility

$150.00

Service Code	CPT 82658
Hospital Charge Code	900915255
Hospital Revenue Code	309
Min. Negotiated Rate	$44.03
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.00
Rate for Payer: Aetna of CA Government/Medicare	$90.00
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	$120.00
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: Intervalley Health Plan Commercial	$44.03
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: Multiplan Commercial	$112.50

HC SOCIDEM PDC 84157

Facility

$150.00

Service Code	CPT 84157
Hospital Charge Code	900915256
Hospital Revenue Code	301
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 SOCIDEM PDC 84157

Facility

$150.00

Service Code	CPT 84157
Hospital Charge Code	900915256
Hospital Revenue Code	301
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.00
Rate for Payer: Aetna of CA Government/Medicare	$90.00
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	$120.00
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: Intervalley Health Plan Commercial	$4.00
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: Multiplan Commercial	$112.50

HC SOCIDEM PDC 84999

Facility

$120.00

Service Code	CPT 84999
Hospital Charge Code	900915253
Hospital Revenue Code	309
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$96.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$72.00
Rate for Payer: Aetna of CA Government/Medicare	$72.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$96.00
Rate for Payer: Health Smart Auto/Commercial	$72.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$72.00
Rate for Payer: LLUH Dept of Risk Management WC	$66.00
Rate for Payer: Multiplan Commercial	$90.00

HC SOCIDEM PDC 84999

Facility

$120.00

Service Code	CPT 84999
Hospital Charge Code	900915253
Hospital Revenue Code	309
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$96.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$96.00
Rate for Payer: Health Smart Auto/Commercial	$72.00
Rate for Payer: LLUH Dept of Risk Management WC	$66.00
Rate for Payer: Multiplan Commercial	$90.00

HC SODIUM

Facility

$89.00

Service Code	CPT 84295
Hospital Charge Code	900910269
Hospital Revenue Code	301
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$71.20
Rate for Payer: Cash Price	$40.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$71.20
Rate for Payer: Health Smart Auto/Commercial	$53.40
Rate for Payer: LLUH Dept of Risk Management WC	$48.95
Rate for Payer: Multiplan Commercial	$66.75

HC SODIUM

Facility

$15.00

Service Code	CPT 84295
Hospital Charge Code	900910269
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.00
Rate for Payer: Aetna of CA Government/Medicare	$9.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Cash Price	$6.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.00
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Intervalley Health Plan Commercial	$4.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Commercial	$11.25

HC SODIUM BODY FLUID

Facility

$25.00

Service Code	CPT 84302
Hospital Charge Code	900912246
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$20.00
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Commercial	$18.75

HC SODIUM BODY FLUID

Facility

$20.31

Service Code	CPT 84302
Hospital Charge Code	900912246
Hospital Revenue Code	301
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$16.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.19
Rate for Payer: Aetna of CA Government/Medicare	$12.19
Rate for Payer: Cash Price	$9.14
Rate for Payer: Cash Price	$9.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.25
Rate for Payer: Health Smart Auto/Commercial	$12.19
Rate for Payer: Intervalley Health Plan Commercial	$4.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.19
Rate for Payer: LLUH Dept of Risk Management WC	$11.17
Rate for Payer: Multiplan Commercial	$15.23

HC SODIUM INDIVIDUAL

Facility

$50.00

Service Code	CPT 84295
Hospital Charge Code	900910487
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
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	$4.81
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 SODIUM INDIVIDUAL

Facility

$50.00

Service Code	CPT 84295
Hospital Charge Code	900910487
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 SODIUM STOOL

Facility

$179.00

Service Code	CPT 84302
Hospital Charge Code	900910418
Hospital Revenue Code	301
Min. Negotiated Rate	$98.45
Max. Negotiated Rate	$143.20
Rate for Payer: Cash Price	$80.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$143.20
Rate for Payer: Health Smart Auto/Commercial	$107.40
Rate for Payer: LLUH Dept of Risk Management WC	$98.45
Rate for Payer: Multiplan Commercial	$134.25

HC SODIUM STOOL

Facility

$20.31

Service Code	CPT 84302
Hospital Charge Code	900910418
Hospital Revenue Code	301
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$16.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.19
Rate for Payer: Aetna of CA Government/Medicare	$12.19
Rate for Payer: Cash Price	$9.14
Rate for Payer: Cash Price	$9.14
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.25
Rate for Payer: Health Smart Auto/Commercial	$12.19
Rate for Payer: Intervalley Health Plan Commercial	$4.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.19
Rate for Payer: LLUH Dept of Risk Management WC	$11.17
Rate for Payer: Multiplan Commercial	$15.23

Know your out-of-pocket cost for care.

All Charges