Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM C-PEPTIDE

Facility

$12.00

Service Code	CPT 84681
Hospital Charge Code	900911116
Hospital Revenue Code	301
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.60
Rate for Payer: Cash Price	$12.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$9.60
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Commercial	$9.00

HC SOM C PNEUMONIA IGG

Facility

$9.65

Service Code	CPT 86631
Hospital Charge Code	900911125
Hospital Revenue Code	301
Min. Negotiated Rate	$5.31
Max. Negotiated Rate	$7.72
Rate for Payer: Cash Price	$9.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.72
Rate for Payer: Health Smart Auto/Commercial	$5.79
Rate for Payer: LLUH Dept of Risk Management WC	$5.31
Rate for Payer: Multiplan Commercial	$7.24

HC SOM C PNEUMONIA IGG

Facility

$9.65

Service Code	CPT 86631
Hospital Charge Code	900911125
Hospital Revenue Code	301
Min. Negotiated Rate	$5.31
Max. Negotiated Rate	$11.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.79
Rate for Payer: Aetna of CA Government/Medicare	$5.79
Rate for Payer: Cash Price	$9.65
Rate for Payer: Cash Price	$9.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.72
Rate for Payer: Health Smart Auto/Commercial	$5.79
Rate for Payer: Intervalley Health Plan Commercial	$11.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.79
Rate for Payer: LLUH Dept of Risk Management WC	$5.31
Rate for Payer: Multiplan Commercial	$7.24

HC SOM C. PNEUMONIA IGM

Facility

$10.35

Service Code	CPT 86632
Hospital Charge Code	900912797
Hospital Revenue Code	302
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$8.28
Rate for Payer: Cash Price	$10.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.28
Rate for Payer: Health Smart Auto/Commercial	$6.21
Rate for Payer: LLUH Dept of Risk Management WC	$5.69
Rate for Payer: Multiplan Commercial	$7.76

HC SOM C. PNEUMONIA IGM

Facility

$10.35

Service Code	CPT 86632
Hospital Charge Code	900912797
Hospital Revenue Code	302
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$12.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.21
Rate for Payer: Aetna of CA Government/Medicare	$6.21
Rate for Payer: Cash Price	$10.35
Rate for Payer: Cash Price	$10.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.28
Rate for Payer: Health Smart Auto/Commercial	$6.21
Rate for Payer: Intervalley Health Plan Commercial	$12.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.21
Rate for Payer: LLUH Dept of Risk Management WC	$5.69
Rate for Payer: Multiplan Commercial	$7.76

HC SOM C. PSITTACI IGG

Facility

$9.65

Service Code	CPT 86631
Hospital Charge Code	900912800
Hospital Revenue Code	302
Min. Negotiated Rate	$5.31
Max. Negotiated Rate	$11.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.79
Rate for Payer: Aetna of CA Government/Medicare	$5.79
Rate for Payer: Cash Price	$9.65
Rate for Payer: Cash Price	$9.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.72
Rate for Payer: Health Smart Auto/Commercial	$5.79
Rate for Payer: Intervalley Health Plan Commercial	$11.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.79
Rate for Payer: LLUH Dept of Risk Management WC	$5.31
Rate for Payer: Multiplan Commercial	$7.24

HC SOM C. PSITTACI IGG

Facility

$9.65

Service Code	CPT 86631
Hospital Charge Code	900912800
Hospital Revenue Code	302
Min. Negotiated Rate	$5.31
Max. Negotiated Rate	$7.72
Rate for Payer: Cash Price	$9.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.72
Rate for Payer: Health Smart Auto/Commercial	$5.79
Rate for Payer: LLUH Dept of Risk Management WC	$5.31
Rate for Payer: Multiplan Commercial	$7.24

HC SOM C. PSITTACI IGM

Facility

$10.35

Service Code	CPT 86632
Hospital Charge Code	900912798
Hospital Revenue Code	302
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$8.28
Rate for Payer: Cash Price	$10.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.28
Rate for Payer: Health Smart Auto/Commercial	$6.21
Rate for Payer: LLUH Dept of Risk Management WC	$5.69
Rate for Payer: Multiplan Commercial	$7.76

HC SOM C. PSITTACI IGM

Facility

$10.35

Service Code	CPT 86632
Hospital Charge Code	900912798
Hospital Revenue Code	302
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$12.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.21
Rate for Payer: Aetna of CA Government/Medicare	$6.21
Rate for Payer: Cash Price	$10.35
Rate for Payer: Cash Price	$10.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.28
Rate for Payer: Health Smart Auto/Commercial	$6.21
Rate for Payer: Intervalley Health Plan Commercial	$12.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.21
Rate for Payer: LLUH Dept of Risk Management WC	$5.69
Rate for Payer: Multiplan Commercial	$7.76

HC SOM CRYOFIBRINOGEN

Facility

$10.00

Service Code	CPT 82585
Hospital Charge Code	900911373
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$14.14
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	$10.00
Rate for Payer: Cash Price	$10.00
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	$14.14
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 SOM CRYOFIBRINOGEN

Facility

$10.00

Service Code	CPT 82585
Hospital Charge Code	900911373
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
Rate for Payer: Cash Price	$10.00
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: LLUH Dept of Risk Management WC	$5.50
Rate for Payer: Multiplan Commercial	$7.50

HC SOM CRYOFIBRINOGEN CRYOGLOBULIN

Facility

$10.00

Service Code	CPT 82595
Hospital Charge Code	900912819
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
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	$10.00
Rate for Payer: Cash Price	$10.00
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	$6.47
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 SOM CRYOFIBRINOGEN CRYOGLOBULIN

Facility

$10.00

Service Code	CPT 82595
Hospital Charge Code	900912819
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
Rate for Payer: Cash Price	$10.00
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: LLUH Dept of Risk Management WC	$5.50
Rate for Payer: Multiplan Commercial	$7.50

HC SOM CRYPTOSPORIDIUM AG, F

Facility

$40.00

Service Code	CPT 87328
Hospital Charge Code	900912939
Hospital Revenue Code	301
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$32.00
Rate for Payer: Cash Price	$40.00
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: LLUH Dept of Risk Management WC	$22.00
Rate for Payer: Multiplan Commercial	$30.00

HC SOM CRYPTOSPORIDIUM AG, F

Facility

$40.00

Service Code	CPT 87328
Hospital Charge Code	900912939
Hospital Revenue Code	301
Min. Negotiated Rate	$13.82
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	$40.00
Rate for Payer: Cash Price	$40.00
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	$13.82
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 SOM CSF IGG INDEX ALB CSF

Facility

$8.66

Service Code	CPT 82042
Hospital Charge Code	900914411
Hospital Revenue Code	302
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$7.78
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.20
Rate for Payer: Aetna of CA Government/Medicare	$5.20
Rate for Payer: Cash Price	$8.66
Rate for Payer: Cash Price	$8.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.93
Rate for Payer: Health Smart Auto/Commercial	$5.20
Rate for Payer: Intervalley Health Plan Commercial	$7.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.20
Rate for Payer: LLUH Dept of Risk Management WC	$4.76
Rate for Payer: Multiplan Commercial	$6.50

HC SOM CSF IGG INDEX ALB CSF

Facility

$8.66

Service Code	CPT 82042
Hospital Charge Code	900914411
Hospital Revenue Code	302
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$6.93
Rate for Payer: Cash Price	$8.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.93
Rate for Payer: Health Smart Auto/Commercial	$5.20
Rate for Payer: LLUH Dept of Risk Management WC	$4.76
Rate for Payer: Multiplan Commercial	$6.50

HC SOM CSF IGG INDEX ALB S

Facility

$5.51

Service Code	CPT 82040
Hospital Charge Code	900914410
Hospital Revenue Code	302
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$4.95
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.31
Rate for Payer: Aetna of CA Government/Medicare	$3.31
Rate for Payer: Cash Price	$5.51
Rate for Payer: Cash Price	$5.51
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.41
Rate for Payer: Health Smart Auto/Commercial	$3.31
Rate for Payer: Intervalley Health Plan Commercial	$4.95
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.31
Rate for Payer: LLUH Dept of Risk Management WC	$3.03
Rate for Payer: Multiplan Commercial	$4.13

HC SOM CSF IGG INDEX ALB S

Facility

$5.51

Service Code	CPT 82040
Hospital Charge Code	900914410
Hospital Revenue Code	302
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$4.41
Rate for Payer: Cash Price	$5.51
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$4.41
Rate for Payer: Health Smart Auto/Commercial	$3.31
Rate for Payer: LLUH Dept of Risk Management WC	$3.03
Rate for Payer: Multiplan Commercial	$4.13

HC SOM CSF IGG INDEX IGG, S

Facility

$10.35

Service Code	CPT 82784
Hospital Charge Code	900914409
Hospital Revenue Code	302
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$8.28
Rate for Payer: Cash Price	$10.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.28
Rate for Payer: Health Smart Auto/Commercial	$6.21
Rate for Payer: LLUH Dept of Risk Management WC	$5.69
Rate for Payer: Multiplan Commercial	$7.76

HC SOM CSF IGG INDEX IGG, S

Facility

$10.35

Service Code	CPT 82784
Hospital Charge Code	900914409
Hospital Revenue Code	302
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$9.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.21
Rate for Payer: Aetna of CA Government/Medicare	$6.21
Rate for Payer: Cash Price	$10.35
Rate for Payer: Cash Price	$10.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.28
Rate for Payer: Health Smart Auto/Commercial	$6.21
Rate for Payer: Intervalley Health Plan Commercial	$9.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.21
Rate for Payer: LLUH Dept of Risk Management WC	$5.69
Rate for Payer: Multiplan Commercial	$7.76

HC SOM C-TELOPEPTIDE

Facility

$19.34

Service Code	CPT 82523
Hospital Charge Code	900912783
Hospital Revenue Code	301
Min. Negotiated Rate	$10.64
Max. Negotiated Rate	$15.47
Rate for Payer: Cash Price	$19.34
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$15.47
Rate for Payer: Health Smart Auto/Commercial	$11.60
Rate for Payer: LLUH Dept of Risk Management WC	$10.64
Rate for Payer: Multiplan Commercial	$14.51

HC SOM C-TELOPEPTIDE

Facility

$19.34

Service Code	CPT 82523
Hospital Charge Code	900912783
Hospital Revenue Code	301
Min. Negotiated Rate	$10.64
Max. Negotiated Rate	$18.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.60
Rate for Payer: Aetna of CA Government/Medicare	$11.60
Rate for Payer: Cash Price	$19.34
Rate for Payer: Cash Price	$19.34
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$15.47
Rate for Payer: Health Smart Auto/Commercial	$11.60
Rate for Payer: Intervalley Health Plan Commercial	$18.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.60
Rate for Payer: LLUH Dept of Risk Management WC	$10.64
Rate for Payer: Multiplan Commercial	$14.51

HC SOM C. TRACHOMATIS, IGG

Facility

$7.00

Service Code	CPT 86631
Hospital Charge Code	900912801
Hospital Revenue Code	302
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$5.60
Rate for Payer: Cash Price	$7.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.60
Rate for Payer: Health Smart Auto/Commercial	$4.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.85
Rate for Payer: Multiplan Commercial	$5.25

HC SOM C. TRACHOMATIS, IGG

Facility

$7.00

Service Code	CPT 86631
Hospital Charge Code	900912801
Hospital Revenue Code	302
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$11.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.20
Rate for Payer: Aetna of CA Government/Medicare	$4.20
Rate for Payer: Cash Price	$7.00
Rate for Payer: Cash Price	$7.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$5.60
Rate for Payer: Health Smart Auto/Commercial	$4.20
Rate for Payer: Intervalley Health Plan Commercial	$11.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.85
Rate for Payer: Multiplan Commercial	$5.25

Know your out-of-pocket cost for care.

All Charges