Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM MECONIUM OPIATE CONFIRM

Facility

$49.07

Service Code	CPT 80361
Hospital Charge Code	900912833
Hospital Revenue Code	301
Min. Negotiated Rate	$26.99
Max. Negotiated Rate	$39.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$29.44
Rate for Payer: Aetna of CA Government/Medicare	$29.44
Rate for Payer: Cash Price	$49.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$39.26
Rate for Payer: Health Smart Auto/Commercial	$29.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$29.44
Rate for Payer: LLUH Dept of Risk Management WC	$26.99
Rate for Payer: Multiplan Commercial	$36.80

HC SOM MECONIUM OPIATE CONFIRM

Facility

$49.07

Service Code	CPT 80361
Hospital Charge Code	900912833
Hospital Revenue Code	301
Min. Negotiated Rate	$26.99
Max. Negotiated Rate	$39.26
Rate for Payer: Cash Price	$49.07
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$39.26
Rate for Payer: Health Smart Auto/Commercial	$29.44
Rate for Payer: LLUH Dept of Risk Management WC	$26.99
Rate for Payer: Multiplan Commercial	$36.80

HC SOM MECONIUM PCP CONFIRM

Facility

$180.00

Service Code	CPT 83992
Hospital Charge Code	900912835
Hospital Revenue Code	301
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$144.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$144.00
Rate for Payer: Health Smart Auto/Commercial	$108.00
Rate for Payer: LLUH Dept of Risk Management WC	$99.00
Rate for Payer: Multiplan Commercial	$135.00

HC SOM MECONIUM PCP CONFIRM

Facility

$180.00

Service Code	CPT 83992
Hospital Charge Code	900912835
Hospital Revenue Code	301
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$108.00
Rate for Payer: Aetna of CA Government/Medicare	$108.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$144.00
Rate for Payer: Health Smart Auto/Commercial	$108.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$108.00
Rate for Payer: LLUH Dept of Risk Management WC	$99.00
Rate for Payer: Multiplan Commercial	$135.00

HC SOM MECONIUM THC LAB REF CONFIRM

Facility

$76.10

Service Code	CPT 80349
Hospital Charge Code	900912834
Hospital Revenue Code	301
Min. Negotiated Rate	$41.85
Max. Negotiated Rate	$60.88
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$45.66
Rate for Payer: Aetna of CA Government/Medicare	$45.66
Rate for Payer: Cash Price	$76.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$60.88
Rate for Payer: Health Smart Auto/Commercial	$45.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$45.66
Rate for Payer: LLUH Dept of Risk Management WC	$41.85
Rate for Payer: Multiplan Commercial	$57.08

HC SOM MECONIUM THC LAB REF CONFIRM

Facility

$76.10

Service Code	CPT 80349
Hospital Charge Code	900912834
Hospital Revenue Code	301
Min. Negotiated Rate	$41.85
Max. Negotiated Rate	$60.88
Rate for Payer: Cash Price	$76.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$60.88
Rate for Payer: Health Smart Auto/Commercial	$45.66
Rate for Payer: LLUH Dept of Risk Management WC	$41.85
Rate for Payer: Multiplan Commercial	$57.08

HC SOM MEPERIDINE

Facility

$98.28

Service Code	CPT 80362
Hospital Charge Code	900910758
Hospital Revenue Code	301
Min. Negotiated Rate	$54.05
Max. Negotiated Rate	$78.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$58.97
Rate for Payer: Aetna of CA Government/Medicare	$58.97
Rate for Payer: Cash Price	$98.28
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$78.62
Rate for Payer: Health Smart Auto/Commercial	$58.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$58.97
Rate for Payer: LLUH Dept of Risk Management WC	$54.05
Rate for Payer: Multiplan Commercial	$73.71

HC SOM MEPERIDINE

Facility

$98.28

Service Code	CPT 80362
Hospital Charge Code	900910758
Hospital Revenue Code	301
Min. Negotiated Rate	$54.05
Max. Negotiated Rate	$78.62
Rate for Payer: Cash Price	$98.28
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$78.62
Rate for Payer: Health Smart Auto/Commercial	$58.97
Rate for Payer: LLUH Dept of Risk Management WC	$54.05
Rate for Payer: Multiplan Commercial	$73.71

HC SOM MERCURY BLOOD

Facility

$22.00

Service Code	CPT 83825
Hospital Charge Code	900910759
Hospital Revenue Code	301
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$17.60
Rate for Payer: Cash Price	$22.00
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: LLUH Dept of Risk Management WC	$12.10
Rate for Payer: Multiplan Commercial	$16.50

HC SOM MERCURY BLOOD

Facility

$22.00

Service Code	CPT 83825
Hospital Charge Code	900910759
Hospital Revenue Code	301
Min. Negotiated Rate	$12.10
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	$22.00
Rate for Payer: Cash Price	$22.00
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	$16.26
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

HC SOM METANEPHRINES,FRACT,FREE,P

Facility

$24.26

Service Code	CPT 83835
Hospital Charge Code	900912922
Hospital Revenue Code	301
Min. Negotiated Rate	$13.34
Max. Negotiated Rate	$19.41
Rate for Payer: Cash Price	$24.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.41
Rate for Payer: Health Smart Auto/Commercial	$14.56
Rate for Payer: LLUH Dept of Risk Management WC	$13.34
Rate for Payer: Multiplan Commercial	$18.20

HC SOM METANEPHRINES,FRACT,FREE,P

Facility

$24.26

Service Code	CPT 83835
Hospital Charge Code	900912922
Hospital Revenue Code	301
Min. Negotiated Rate	$13.34
Max. Negotiated Rate	$19.41
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.56
Rate for Payer: Aetna of CA Government/Medicare	$14.56
Rate for Payer: Cash Price	$24.26
Rate for Payer: Cash Price	$24.26
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$19.41
Rate for Payer: Health Smart Auto/Commercial	$14.56
Rate for Payer: Intervalley Health Plan Commercial	$16.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.56
Rate for Payer: LLUH Dept of Risk Management WC	$13.34
Rate for Payer: Multiplan Commercial	$18.20

HC SOM METHADONE CONFIRMATION, U

Facility

$114.08

Service Code	CPT 80358
Hospital Charge Code	900912918
Hospital Revenue Code	301
Min. Negotiated Rate	$62.74
Max. Negotiated Rate	$91.26
Rate for Payer: Cash Price	$114.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$91.26
Rate for Payer: Health Smart Auto/Commercial	$68.45
Rate for Payer: LLUH Dept of Risk Management WC	$62.74
Rate for Payer: Multiplan Commercial	$85.56

HC SOM METHADONE CONFIRMATION, U

Facility

$114.08

Service Code	CPT 80358
Hospital Charge Code	900912918
Hospital Revenue Code	301
Min. Negotiated Rate	$62.74
Max. Negotiated Rate	$91.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$68.45
Rate for Payer: Aetna of CA Government/Medicare	$68.45
Rate for Payer: Cash Price	$114.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$91.26
Rate for Payer: Health Smart Auto/Commercial	$68.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$68.45
Rate for Payer: LLUH Dept of Risk Management WC	$62.74
Rate for Payer: Multiplan Commercial	$85.56

HC SOM METHANPHETAMINE QUANT

Facility

$16.18

Service Code	CPT 80359
Hospital Charge Code	900912822
Hospital Revenue Code	301
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$12.94
Rate for Payer: Cash Price	$16.18
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.94
Rate for Payer: Health Smart Auto/Commercial	$9.71
Rate for Payer: LLUH Dept of Risk Management WC	$8.90
Rate for Payer: Multiplan Commercial	$12.13

HC SOM METHANPHETAMINE QUANT

Facility

$16.18

Service Code	CPT 80359
Hospital Charge Code	900912822
Hospital Revenue Code	301
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$12.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.71
Rate for Payer: Aetna of CA Government/Medicare	$9.71
Rate for Payer: Cash Price	$16.18
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$12.94
Rate for Payer: Health Smart Auto/Commercial	$9.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.71
Rate for Payer: LLUH Dept of Risk Management WC	$8.90
Rate for Payer: Multiplan Commercial	$12.13

HC SOM METHYLMALONIC ACID

Facility

$22.00

Service Code	CPT 83921
Hospital Charge Code	900911265
Hospital Revenue Code	301
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$21.21
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	$22.00
Rate for Payer: Cash Price	$22.00
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	$21.21
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

HC SOM METHYLMALONIC ACID

Facility

$22.00

Service Code	CPT 83921
Hospital Charge Code	900911265
Hospital Revenue Code	301
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$17.60
Rate for Payer: Cash Price	$22.00
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: LLUH Dept of Risk Management WC	$12.10
Rate for Payer: Multiplan Commercial	$16.50

HC SOM METHYLMALONIC ACID URINE

Facility

$22.00

Service Code	CPT 83921
Hospital Charge Code	900910587
Hospital Revenue Code	301
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$21.21
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	$22.00
Rate for Payer: Cash Price	$22.00
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	$21.21
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

HC SOM METHYLMALONIC ACID URINE

Facility

$22.00

Service Code	CPT 83921
Hospital Charge Code	900910587
Hospital Revenue Code	301
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$17.60
Rate for Payer: Cash Price	$22.00
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: LLUH Dept of Risk Management WC	$12.10
Rate for Payer: Multiplan Commercial	$16.50

HC SOM MEXILETINE PLASMA

Facility

$289.80

Service Code	CPT 80299
Hospital Charge Code	900911280
Hospital Revenue Code	301
Min. Negotiated Rate	$18.64
Max. Negotiated Rate	$231.84
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$173.88
Rate for Payer: Aetna of CA Government/Medicare	$173.88
Rate for Payer: Cash Price	$289.80
Rate for Payer: Cash Price	$289.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$231.84
Rate for Payer: Health Smart Auto/Commercial	$173.88
Rate for Payer: Intervalley Health Plan Commercial	$18.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$173.88
Rate for Payer: LLUH Dept of Risk Management WC	$159.39
Rate for Payer: Multiplan Commercial	$217.35

HC SOM MEXILETINE PLASMA

Facility

$289.80

Service Code	CPT 80299
Hospital Charge Code	900911280
Hospital Revenue Code	301
Min. Negotiated Rate	$159.39
Max. Negotiated Rate	$231.84
Rate for Payer: Cash Price	$289.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$231.84
Rate for Payer: Health Smart Auto/Commercial	$173.88
Rate for Payer: LLUH Dept of Risk Management WC	$159.39
Rate for Payer: Multiplan Commercial	$217.35

HC SOM MGLE ACH RECEPTOR BINDING AB

Facility

$269.00

Service Code	CPT 83519
Hospital Charge Code	900911445
Hospital Revenue Code	300
Min. Negotiated Rate	$147.95
Max. Negotiated Rate	$215.20
Rate for Payer: Cash Price	$269.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$215.20
Rate for Payer: Health Smart Auto/Commercial	$161.40
Rate for Payer: LLUH Dept of Risk Management WC	$147.95
Rate for Payer: Multiplan Commercial	$201.75

HC SOM MGLE ACH RECEPTOR BINDING AB

Facility

$269.00

Service Code	CPT 83519
Hospital Charge Code	900911445
Hospital Revenue Code	300
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$215.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$161.40
Rate for Payer: Aetna of CA Government/Medicare	$161.40
Rate for Payer: Cash Price	$269.00
Rate for Payer: Cash Price	$269.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$215.20
Rate for Payer: Health Smart Auto/Commercial	$161.40
Rate for Payer: Intervalley Health Plan Commercial	$18.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$161.40
Rate for Payer: LLUH Dept of Risk Management WC	$147.95
Rate for Payer: Multiplan Commercial	$201.75

HC SOM MGLES 83519A

Facility

$126.40

Service Code	CPT 83519
Hospital Charge Code	900914809
Hospital Revenue Code	302
Min. Negotiated Rate	$69.52
Max. Negotiated Rate	$101.12
Rate for Payer: Cash Price	$126.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$101.12
Rate for Payer: Health Smart Auto/Commercial	$75.84
Rate for Payer: LLUH Dept of Risk Management WC	$69.52
Rate for Payer: Multiplan Commercial	$94.80

Know your out-of-pocket cost for care.

All Charges