Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM CARBOXYHEMOGLOBIN

Facility

$35.00

Service Code	CPT 82375
Hospital Charge Code	900911041
Hospital Revenue Code	301
Min. Negotiated Rate	$12.32
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.00
Rate for Payer: Aetna of CA Government/Medicare	$21.00
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	$28.00
Rate for Payer: Health Smart Auto/Commercial	$21.00
Rate for Payer: Intervalley Health Plan Commercial	$12.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.00
Rate for Payer: LLUH Dept of Risk Management WC	$19.25
Rate for Payer: Multiplan Commercial	$26.25

HC SOM CARNITINE PLASMA

Facility

$25.00

Service Code	CPT 82379
Hospital Charge Code	900911103
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.00
Rate for Payer: Cash Price	$25.00
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 SOM CARNITINE PLASMA

Facility

$25.00

Service Code	CPT 82379
Hospital Charge Code	900911103
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.00
Rate for Payer: Aetna of CA Government/Medicare	$15.00
Rate for Payer: Cash Price	$25.00
Rate for Payer: Cash Price	$25.00
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: Intervalley Health Plan Commercial	$16.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Commercial	$18.75

HC SOM CARNITINE URINE

Facility

$60.00

Service Code	CPT 82379
Hospital Charge Code	900910730
Hospital Revenue Code	301
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$48.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$48.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Commercial	$45.00

HC SOM CARNITINE URINE

Facility

$60.00

Service Code	CPT 82379
Hospital Charge Code	900910730
Hospital Revenue Code	301
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$48.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$36.00
Rate for Payer: Aetna of CA Government/Medicare	$36.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$48.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: Intervalley Health Plan Commercial	$16.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Commercial	$45.00

HC SOM CAROTENE

Facility

$122.75

Service Code	CPT 82380
Hospital Charge Code	900911303
Hospital Revenue Code	301
Min. Negotiated Rate	$67.51
Max. Negotiated Rate	$98.20
Rate for Payer: Cash Price	$122.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$98.20
Rate for Payer: Health Smart Auto/Commercial	$73.65
Rate for Payer: LLUH Dept of Risk Management WC	$67.51
Rate for Payer: Multiplan Commercial	$92.06

HC SOM CAROTENE

Facility

$122.75

Service Code	CPT 82380
Hospital Charge Code	900911303
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$98.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$73.65
Rate for Payer: Aetna of CA Government/Medicare	$73.65
Rate for Payer: Cash Price	$122.75
Rate for Payer: Cash Price	$122.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$98.20
Rate for Payer: Health Smart Auto/Commercial	$73.65
Rate for Payer: Intervalley Health Plan Commercial	$9.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$73.65
Rate for Payer: LLUH Dept of Risk Management WC	$67.51
Rate for Payer: Multiplan Commercial	$92.06

HC SOM CATECHOLAMINE FRACT FREE UR

Facility

$30.00

Service Code	CPT 82384
Hospital Charge Code	900914081
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$25.25
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	$30.00
Rate for Payer: Cash Price	$30.00
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	$25.25
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 SOM CATECHOLAMINE FRACT FREE UR

Facility

$30.00

Service Code	CPT 82384
Hospital Charge Code	900914081
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$24.00
Rate for Payer: Cash Price	$30.00
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: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Commercial	$22.50

HC SOM CATECHOLAMINES PL

Facility

$30.00

Service Code	CPT 82384
Hospital Charge Code	900910483
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$24.00
Rate for Payer: Cash Price	$30.00
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: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Commercial	$22.50

HC SOM CATECHOLAMINES PL

Facility

$30.00

Service Code	CPT 82384
Hospital Charge Code	900910483
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$25.25
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	$30.00
Rate for Payer: Cash Price	$30.00
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	$25.25
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 SOM C DIFF PCR STOOL

Facility

$60.00

Service Code	CPT 87493
Hospital Charge Code	900914042
Hospital Revenue Code	306
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$48.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$36.00
Rate for Payer: Aetna of CA Government/Medicare	$36.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$48.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: Intervalley Health Plan Commercial	$37.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Commercial	$45.00

HC SOM C DIFF PCR STOOL

Facility

$60.00

Service Code	CPT 87493
Hospital Charge Code	900914042
Hospital Revenue Code	306
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$48.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$48.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Commercial	$45.00

HC SOM CEA PANCREATIC CYST

Facility

$45.00

Service Code	CPT 82378
Hospital Charge Code	900912997
Hospital Revenue Code	301
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$36.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$36.00
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Commercial	$33.75

HC SOM CEA PANCREATIC CYST

Facility

$45.00

Service Code	CPT 82378
Hospital Charge Code	900912997
Hospital Revenue Code	301
Min. Negotiated Rate	$18.96
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.00
Rate for Payer: Aetna of CA Government/Medicare	$27.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$36.00
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: Intervalley Health Plan Commercial	$18.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Commercial	$33.75

HC SOM CELIAC COMP IGA

Facility

$6.48

Service Code	CPT 82784
Hospital Charge Code	900914382
Hospital Revenue Code	302
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$9.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.89
Rate for Payer: Aetna of CA Government/Medicare	$3.89
Rate for Payer: Cash Price	$6.48
Rate for Payer: Cash Price	$6.48
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.18
Rate for Payer: Health Smart Auto/Commercial	$3.89
Rate for Payer: Intervalley Health Plan Commercial	$9.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.89
Rate for Payer: LLUH Dept of Risk Management WC	$3.56
Rate for Payer: Multiplan Commercial	$4.86

HC SOM CELIAC COMP IGA

Facility

$6.48

Service Code	CPT 82784
Hospital Charge Code	900914382
Hospital Revenue Code	302
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$5.18
Rate for Payer: Cash Price	$6.48
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.18
Rate for Payer: Health Smart Auto/Commercial	$3.89
Rate for Payer: LLUH Dept of Risk Management WC	$3.56
Rate for Payer: Multiplan Commercial	$4.86

HC SOM CHLORDIAZEPOXIDE (LIBRIUM)

Facility

$290.10

Service Code	CPT 80346
Hospital Charge Code	900911081
Hospital Revenue Code	301
Min. Negotiated Rate	$159.56
Max. Negotiated Rate	$232.08
Rate for Payer: Cash Price	$290.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$232.08
Rate for Payer: Health Smart Auto/Commercial	$174.06
Rate for Payer: LLUH Dept of Risk Management WC	$159.56
Rate for Payer: Multiplan Commercial	$217.57

HC SOM CHLORDIAZEPOXIDE (LIBRIUM)

Facility

$290.10

Service Code	CPT 80346
Hospital Charge Code	900911081
Hospital Revenue Code	301
Min. Negotiated Rate	$159.56
Max. Negotiated Rate	$232.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$174.06
Rate for Payer: Aetna of CA Government/Medicare	$174.06
Rate for Payer: Cash Price	$290.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$232.08
Rate for Payer: Health Smart Auto/Commercial	$174.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$174.06
Rate for Payer: LLUH Dept of Risk Management WC	$159.56
Rate for Payer: Multiplan Commercial	$217.57

HC SOM CHOLINESTERASE PSEUDO

Facility

$116.50

Service Code	CPT 82480
Hospital Charge Code	900911160
Hospital Revenue Code	301
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$93.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$69.90
Rate for Payer: Aetna of CA Government/Medicare	$69.90
Rate for Payer: Cash Price	$116.50
Rate for Payer: Cash Price	$116.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$93.20
Rate for Payer: Health Smart Auto/Commercial	$69.90
Rate for Payer: Intervalley Health Plan Commercial	$7.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$69.90
Rate for Payer: LLUH Dept of Risk Management WC	$64.08
Rate for Payer: Multiplan Commercial	$87.38

HC SOM CHOLINESTERASE PSEUDO

Facility

$116.50

Service Code	CPT 82480
Hospital Charge Code	900911160
Hospital Revenue Code	301
Min. Negotiated Rate	$64.08
Max. Negotiated Rate	$93.20
Rate for Payer: Cash Price	$116.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$93.20
Rate for Payer: Health Smart Auto/Commercial	$69.90
Rate for Payer: LLUH Dept of Risk Management WC	$64.08
Rate for Payer: Multiplan Commercial	$87.38

HC SOM CHROMIUM

Facility

$25.00

Service Code	CPT 82495
Hospital Charge Code	900911190
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.00
Rate for Payer: Aetna of CA Government/Medicare	$15.00
Rate for Payer: Cash Price	$25.00
Rate for Payer: Cash Price	$25.00
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: Intervalley Health Plan Commercial	$20.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Commercial	$18.75

HC SOM CHROMIUM

Facility

$25.00

Service Code	CPT 82495
Hospital Charge Code	900911190
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.00
Rate for Payer: Cash Price	$25.00
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 SOM CHROMIUM URINE

Facility

$320.00

Service Code	CPT 82495
Hospital Charge Code	900910731
Hospital Revenue Code	301
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$256.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$192.00
Rate for Payer: Aetna of CA Government/Medicare	$192.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$256.00
Rate for Payer: Health Smart Auto/Commercial	$192.00
Rate for Payer: Intervalley Health Plan Commercial	$20.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$192.00
Rate for Payer: LLUH Dept of Risk Management WC	$176.00
Rate for Payer: Multiplan Commercial	$240.00

HC SOM CHROMIUM URINE

Facility

$320.00

Service Code	CPT 82495
Hospital Charge Code	900910731
Hospital Revenue Code	301
Min. Negotiated Rate	$176.00
Max. Negotiated Rate	$256.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$256.00
Rate for Payer: Health Smart Auto/Commercial	$192.00
Rate for Payer: LLUH Dept of Risk Management WC	$176.00
Rate for Payer: Multiplan Commercial	$240.00

Know your out-of-pocket cost for care.

All Charges