Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM ENC NEUROCHONDRIN IFA

Facility

$38.07

Service Code	CPT 86255
Hospital Charge Code	900915479
Hospital Revenue Code	300
Min. Negotiated Rate	$20.94
Max. Negotiated Rate	$30.46
Rate for Payer: Cash Price	$38.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.46
Rate for Payer: Health Smart Auto/Commercial	$22.84
Rate for Payer: LLUH Dept of Risk Management WC	$20.94
Rate for Payer: Multiplan Commercial	$28.55

HC SOM ENC NEUROCHONDRIN IFA

Facility

$38.07

Service Code	CPT 86255
Hospital Charge Code	900915479
Hospital Revenue Code	300
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$30.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.84
Rate for Payer: Aetna of CA Government/Medicare	$22.84
Rate for Payer: Cash Price	$38.07
Rate for Payer: Cash Price	$38.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.46
Rate for Payer: Health Smart Auto/Commercial	$22.84
Rate for Payer: Intervalley Health Plan Commercial	$12.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.84
Rate for Payer: LLUH Dept of Risk Management WC	$20.94
Rate for Payer: Multiplan Commercial	$28.55

HC SOM ENC PDE10A IFA

Facility

$38.07

Service Code	CPT 86255
Hospital Charge Code	900915482
Hospital Revenue Code	300
Min. Negotiated Rate	$20.94
Max. Negotiated Rate	$30.46
Rate for Payer: Cash Price	$38.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.46
Rate for Payer: Health Smart Auto/Commercial	$22.84
Rate for Payer: LLUH Dept of Risk Management WC	$20.94
Rate for Payer: Multiplan Commercial	$28.55

HC SOM ENC PDE10A IFA

Facility

$38.07

Service Code	CPT 86255
Hospital Charge Code	900915482
Hospital Revenue Code	300
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$30.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.84
Rate for Payer: Aetna of CA Government/Medicare	$22.84
Rate for Payer: Cash Price	$38.07
Rate for Payer: Cash Price	$38.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.46
Rate for Payer: Health Smart Auto/Commercial	$22.84
Rate for Payer: Intervalley Health Plan Commercial	$12.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.84
Rate for Payer: LLUH Dept of Risk Management WC	$20.94
Rate for Payer: Multiplan Commercial	$28.55

HC SOM ENC SEPTIN7 IFA

Facility

$38.07

Service Code	CPT 86255
Hospital Charge Code	900915480
Hospital Revenue Code	300
Min. Negotiated Rate	$20.94
Max. Negotiated Rate	$30.46
Rate for Payer: Cash Price	$38.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.46
Rate for Payer: Health Smart Auto/Commercial	$22.84
Rate for Payer: LLUH Dept of Risk Management WC	$20.94
Rate for Payer: Multiplan Commercial	$28.55

HC SOM ENC SEPTIN7 IFA

Facility

$38.07

Service Code	CPT 86255
Hospital Charge Code	900915480
Hospital Revenue Code	300
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$30.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.84
Rate for Payer: Aetna of CA Government/Medicare	$22.84
Rate for Payer: Cash Price	$38.07
Rate for Payer: Cash Price	$38.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.46
Rate for Payer: Health Smart Auto/Commercial	$22.84
Rate for Payer: Intervalley Health Plan Commercial	$12.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.84
Rate for Payer: LLUH Dept of Risk Management WC	$20.94
Rate for Payer: Multiplan Commercial	$28.55

HC SOM ENC TRIM46 IFA

Facility

$38.06

Service Code	CPT 86255
Hospital Charge Code	900915481
Hospital Revenue Code	300
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$30.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.84
Rate for Payer: Aetna of CA Government/Medicare	$22.84
Rate for Payer: Cash Price	$38.06
Rate for Payer: Cash Price	$38.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.45
Rate for Payer: Health Smart Auto/Commercial	$22.84
Rate for Payer: Intervalley Health Plan Commercial	$12.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.84
Rate for Payer: LLUH Dept of Risk Management WC	$20.93
Rate for Payer: Multiplan Commercial	$28.55

HC SOM ENC TRIM46 IFA

Facility

$38.06

Service Code	CPT 86255
Hospital Charge Code	900915481
Hospital Revenue Code	300
Min. Negotiated Rate	$20.93
Max. Negotiated Rate	$30.45
Rate for Payer: Cash Price	$38.06
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$30.45
Rate for Payer: Health Smart Auto/Commercial	$22.84
Rate for Payer: LLUH Dept of Risk Management WC	$20.93
Rate for Payer: Multiplan Commercial	$28.55

HC SOM ENDOMYSIAL IGA AB

Facility

$25.00

Service Code	CPT 86231
Hospital Charge Code	900911423
Hospital Revenue Code	302
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 ENDOMYSIAL IGA AB

Facility

$25.00

Service Code	CPT 86231
Hospital Charge Code	900911423
Hospital Revenue Code	302
Min. Negotiated Rate	$12.09
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	$12.09
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 ENS DPPX CBA

Facility

$44.08

Service Code	CPT 86255
Hospital Charge Code	900915472
Hospital Revenue Code	300
Min. Negotiated Rate	$24.24
Max. Negotiated Rate	$35.26
Rate for Payer: Cash Price	$44.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$35.26
Rate for Payer: Health Smart Auto/Commercial	$26.45
Rate for Payer: LLUH Dept of Risk Management WC	$24.24
Rate for Payer: Multiplan Commercial	$33.06

HC SOM ENS DPPX CBA

Facility

$44.08

Service Code	CPT 86255
Hospital Charge Code	900915472
Hospital Revenue Code	300
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$35.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$26.45
Rate for Payer: Aetna of CA Government/Medicare	$26.45
Rate for Payer: Cash Price	$44.08
Rate for Payer: Cash Price	$44.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$35.26
Rate for Payer: Health Smart Auto/Commercial	$26.45
Rate for Payer: Intervalley Health Plan Commercial	$12.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$26.45
Rate for Payer: LLUH Dept of Risk Management WC	$24.24
Rate for Payer: Multiplan Commercial	$33.06

HC SOM ENS IGLON5 CBA

Facility

$44.08

Service Code	CPT 86255
Hospital Charge Code	900915473
Hospital Revenue Code	300
Min. Negotiated Rate	$24.24
Max. Negotiated Rate	$35.26
Rate for Payer: Cash Price	$44.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$35.26
Rate for Payer: Health Smart Auto/Commercial	$26.45
Rate for Payer: LLUH Dept of Risk Management WC	$24.24
Rate for Payer: Multiplan Commercial	$33.06

HC SOM ENS IGLON5 CBA

Facility

$44.08

Service Code	CPT 86255
Hospital Charge Code	900915473
Hospital Revenue Code	300
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$35.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$26.45
Rate for Payer: Aetna of CA Government/Medicare	$26.45
Rate for Payer: Cash Price	$44.08
Rate for Payer: Cash Price	$44.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$35.26
Rate for Payer: Health Smart Auto/Commercial	$26.45
Rate for Payer: Intervalley Health Plan Commercial	$12.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$26.45
Rate for Payer: LLUH Dept of Risk Management WC	$24.24
Rate for Payer: Multiplan Commercial	$33.06

HC SOM ENS NEUROCHONDRIN IFA

Facility

$44.08

Service Code	CPT 86255
Hospital Charge Code	900915476
Hospital Revenue Code	300
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$35.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$26.45
Rate for Payer: Aetna of CA Government/Medicare	$26.45
Rate for Payer: Cash Price	$44.08
Rate for Payer: Cash Price	$44.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$35.26
Rate for Payer: Health Smart Auto/Commercial	$26.45
Rate for Payer: Intervalley Health Plan Commercial	$12.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$26.45
Rate for Payer: LLUH Dept of Risk Management WC	$24.24
Rate for Payer: Multiplan Commercial	$33.06

HC SOM ENS NEUROCHONDRIN IFA

Facility

$44.08

Service Code	CPT 86255
Hospital Charge Code	900915476
Hospital Revenue Code	300
Min. Negotiated Rate	$24.24
Max. Negotiated Rate	$35.26
Rate for Payer: Cash Price	$44.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$35.26
Rate for Payer: Health Smart Auto/Commercial	$26.45
Rate for Payer: LLUH Dept of Risk Management WC	$24.24
Rate for Payer: Multiplan Commercial	$33.06

HC SOM ENS PDE10A IFA

Facility

$44.08

Service Code	CPT 86255
Hospital Charge Code	900915475
Hospital Revenue Code	300
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$35.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$26.45
Rate for Payer: Aetna of CA Government/Medicare	$26.45
Rate for Payer: Cash Price	$44.08
Rate for Payer: Cash Price	$44.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$35.26
Rate for Payer: Health Smart Auto/Commercial	$26.45
Rate for Payer: Intervalley Health Plan Commercial	$12.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$26.45
Rate for Payer: LLUH Dept of Risk Management WC	$24.24
Rate for Payer: Multiplan Commercial	$33.06

HC SOM ENS PDE10A IFA

Facility

$44.08

Service Code	CPT 86255
Hospital Charge Code	900915475
Hospital Revenue Code	300
Min. Negotiated Rate	$24.24
Max. Negotiated Rate	$35.26
Rate for Payer: Cash Price	$44.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$35.26
Rate for Payer: Health Smart Auto/Commercial	$26.45
Rate for Payer: LLUH Dept of Risk Management WC	$24.24
Rate for Payer: Multiplan Commercial	$33.06

HC SOM ENS SEPTIN7 IFA

Facility

$44.07

Service Code	CPT 86255
Hospital Charge Code	900915477
Hospital Revenue Code	300
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$35.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$26.44
Rate for Payer: Aetna of CA Government/Medicare	$26.44
Rate for Payer: Cash Price	$44.07
Rate for Payer: Cash Price	$44.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$35.26
Rate for Payer: Health Smart Auto/Commercial	$26.44
Rate for Payer: Intervalley Health Plan Commercial	$12.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$26.44
Rate for Payer: LLUH Dept of Risk Management WC	$24.24
Rate for Payer: Multiplan Commercial	$33.05

HC SOM ENS SEPTIN7 IFA

Facility

$44.07

Service Code	CPT 86255
Hospital Charge Code	900915477
Hospital Revenue Code	300
Min. Negotiated Rate	$24.24
Max. Negotiated Rate	$35.26
Rate for Payer: Cash Price	$44.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$35.26
Rate for Payer: Health Smart Auto/Commercial	$26.44
Rate for Payer: LLUH Dept of Risk Management WC	$24.24
Rate for Payer: Multiplan Commercial	$33.05

HC SOM ENS TRIM46 IFA

Facility

$44.08

Service Code	CPT 86255
Hospital Charge Code	900915474
Hospital Revenue Code	300
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$35.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$26.45
Rate for Payer: Aetna of CA Government/Medicare	$26.45
Rate for Payer: Cash Price	$44.08
Rate for Payer: Cash Price	$44.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$35.26
Rate for Payer: Health Smart Auto/Commercial	$26.45
Rate for Payer: Intervalley Health Plan Commercial	$12.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$26.45
Rate for Payer: LLUH Dept of Risk Management WC	$24.24
Rate for Payer: Multiplan Commercial	$33.06

HC SOM ENS TRIM46 IFA

Facility

$44.08

Service Code	CPT 86255
Hospital Charge Code	900915474
Hospital Revenue Code	300
Min. Negotiated Rate	$24.24
Max. Negotiated Rate	$35.26
Rate for Payer: Cash Price	$44.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$35.26
Rate for Payer: Health Smart Auto/Commercial	$26.45
Rate for Payer: LLUH Dept of Risk Management WC	$24.24
Rate for Payer: Multiplan Commercial	$33.06

HC SOM ENTEROVIRUS PCR, BLOOD

Facility

$39.23

Service Code	CPT 87498
Hospital Charge Code	900910691
Hospital Revenue Code	306
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$35.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.54
Rate for Payer: Aetna of CA Government/Medicare	$23.54
Rate for Payer: Cash Price	$39.23
Rate for Payer: Cash Price	$39.23
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$31.38
Rate for Payer: Health Smart Auto/Commercial	$23.54
Rate for Payer: Intervalley Health Plan Commercial	$35.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.54
Rate for Payer: LLUH Dept of Risk Management WC	$21.58
Rate for Payer: Multiplan Commercial	$29.42

HC SOM ENTEROVIRUS PCR, BLOOD

Facility

$39.23

Service Code	CPT 87498
Hospital Charge Code	900910691
Hospital Revenue Code	306
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$31.38
Rate for Payer: Cash Price	$39.23
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$31.38
Rate for Payer: Health Smart Auto/Commercial	$23.54
Rate for Payer: LLUH Dept of Risk Management WC	$21.58
Rate for Payer: Multiplan Commercial	$29.42

HC SOM ENTEROVIRUS PCR CSF

Facility

$39.23

Service Code	CPT 87498
Hospital Charge Code	900910771
Hospital Revenue Code	301
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$31.38
Rate for Payer: Cash Price	$39.23
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$31.38
Rate for Payer: Health Smart Auto/Commercial	$23.54
Rate for Payer: LLUH Dept of Risk Management WC	$21.58
Rate for Payer: Multiplan Commercial	$29.42

Know your out-of-pocket cost for care.

All Charges