Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOP CELIAC SEROLOGY

Facility

$127.50

Service Code	CPT 88346
Hospital Charge Code	900914914
Hospital Revenue Code	309
Min. Negotiated Rate	$70.12
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$76.50
Rate for Payer: Aetna of CA Government/Medicare	$76.50
Rate for Payer: Cash Price	$57.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$102.00
Rate for Payer: Health Smart Auto/Commercial	$76.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$76.50
Rate for Payer: LLUH Dept of Risk Management WC	$70.12
Rate for Payer: Multiplan Commercial	$95.62

HC SOP CELIAC SEROLOGY

Facility

$127.50

Service Code	CPT 88346
Hospital Charge Code	900914914
Hospital Revenue Code	309
Min. Negotiated Rate	$70.12
Max. Negotiated Rate	$102.00
Rate for Payer: Cash Price	$57.38
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$102.00
Rate for Payer: Health Smart Auto/Commercial	$76.50
Rate for Payer: LLUH Dept of Risk Management WC	$70.12
Rate for Payer: Multiplan Commercial	$95.62

HC SOP TPMT ENZYME

Facility

$93.50

Service Code	CPT 82542
Hospital Charge Code	900914906
Hospital Revenue Code	309
Min. Negotiated Rate	$24.09
Max. Negotiated Rate	$74.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$56.10
Rate for Payer: Aetna of CA Government/Medicare	$56.10
Rate for Payer: Cash Price	$42.08
Rate for Payer: Cash Price	$42.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$74.80
Rate for Payer: Health Smart Auto/Commercial	$56.10
Rate for Payer: Intervalley Health Plan Commercial	$24.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$56.10
Rate for Payer: LLUH Dept of Risk Management WC	$51.42
Rate for Payer: Multiplan Commercial	$70.12

HC SOP TPMT ENZYME

Facility

$93.50

Service Code	CPT 82542
Hospital Charge Code	900914906
Hospital Revenue Code	309
Min. Negotiated Rate	$51.42
Max. Negotiated Rate	$74.80
Rate for Payer: Cash Price	$42.08
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$74.80
Rate for Payer: Health Smart Auto/Commercial	$56.10
Rate for Payer: LLUH Dept of Risk Management WC	$51.42
Rate for Payer: Multiplan Commercial	$70.12

HC SOQ 26477 ASPERG IGM 86606

Facility

$173.00

Service Code	CPT 86606
Hospital Charge Code	900914876
Hospital Revenue Code	302
Min. Negotiated Rate	$15.05
Max. Negotiated Rate	$138.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$103.80
Rate for Payer: Aetna of CA Government/Medicare	$103.80
Rate for Payer: Cash Price	$77.85
Rate for Payer: Cash Price	$77.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$138.40
Rate for Payer: Health Smart Auto/Commercial	$103.80
Rate for Payer: Intervalley Health Plan Commercial	$15.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$103.80
Rate for Payer: LLUH Dept of Risk Management WC	$95.15
Rate for Payer: Multiplan Commercial	$129.75

HC SOQ 26477 ASPERG IGM 86606

Facility

$173.00

Service Code	CPT 86606
Hospital Charge Code	900914876
Hospital Revenue Code	302
Min. Negotiated Rate	$95.15
Max. Negotiated Rate	$138.40
Rate for Payer: Cash Price	$77.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$138.40
Rate for Payer: Health Smart Auto/Commercial	$103.80
Rate for Payer: LLUH Dept of Risk Management WC	$95.15
Rate for Payer: Multiplan Commercial	$129.75

HC SOSB MICRO ARTHROPOD EXAM

Facility

$10.00

Service Code	CPT 87220
Hospital Charge Code	900915252
Hospital Revenue Code	306
Min. Negotiated Rate	$4.27
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	$4.50
Rate for Payer: Cash Price	$4.50
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	$4.27
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 SOSB MICRO ARTHROPOD EXAM

Facility

$10.00

Service Code	CPT 87220
Hospital Charge Code	900915252
Hospital Revenue Code	306
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.00
Rate for Payer: Cash Price	$4.50
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 SOSPH MTB PCR SPUTUM

Facility

$100.00

Service Code	CPT 87556
Hospital Charge Code	900915436
Hospital Revenue Code	300
Min. Negotiated Rate	$41.68
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$60.00
Rate for Payer: Aetna of CA Government/Medicare	$60.00
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	$80.00
Rate for Payer: Health Smart Auto/Commercial	$60.00
Rate for Payer: Intervalley Health Plan Commercial	$41.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$60.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.00
Rate for Payer: Multiplan Commercial	$75.00

HC SOSPH MTB PCR SPUTUM

Facility

$100.00

Service Code	CPT 87556
Hospital Charge Code	900915436
Hospital Revenue Code	300
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$80.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$80.00
Rate for Payer: Health Smart Auto/Commercial	$60.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.00
Rate for Payer: Multiplan Commercial	$75.00

HC SOUCI METHOTREXATE

Facility

$55.00

Service Code	CPT 80229
Hospital Charge Code	900915251
Hospital Revenue Code	301
Min. Negotiated Rate	$30.25
Max. Negotiated Rate	$44.00
Rate for Payer: Cash Price	$24.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$44.00
Rate for Payer: Health Smart Auto/Commercial	$33.00
Rate for Payer: LLUH Dept of Risk Management WC	$30.25
Rate for Payer: Multiplan Commercial	$41.25

HC SOUCI METHOTREXATE

Facility

$55.00

Service Code	CPT 80229
Hospital Charge Code	900915251
Hospital Revenue Code	301
Min. Negotiated Rate	$30.25
Max. Negotiated Rate	$44.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.00
Rate for Payer: Aetna of CA Government/Medicare	$33.00
Rate for Payer: Cash Price	$24.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$44.00
Rate for Payer: Health Smart Auto/Commercial	$33.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.00
Rate for Payer: LLUH Dept of Risk Management WC	$30.25
Rate for Payer: Multiplan Commercial	$41.25

HC SOUMN OCA1 81479

Facility

$1,359.00

Service Code	CPT 81479
Hospital Charge Code	900914802
Hospital Revenue Code	309
Min. Negotiated Rate	$747.45
Max. Negotiated Rate	$1,087.20
Rate for Payer: Cash Price	$611.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,087.20
Rate for Payer: Health Smart Auto/Commercial	$815.40
Rate for Payer: LLUH Dept of Risk Management WC	$747.45
Rate for Payer: Multiplan Commercial	$1,019.25

HC SOUMN OCA1 81479

Facility

$1,359.00

Service Code	CPT 81479
Hospital Charge Code	900914802
Hospital Revenue Code	309
Min. Negotiated Rate	$747.45
Max. Negotiated Rate	$1,087.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$815.40
Rate for Payer: Aetna of CA Government/Medicare	$815.40
Rate for Payer: Cash Price	$611.55
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,087.20
Rate for Payer: Health Smart Auto/Commercial	$815.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$815.40
Rate for Payer: LLUH Dept of Risk Management WC	$747.45
Rate for Payer: Multiplan Commercial	$1,019.25

HC SPEC GRAVITY HEMATOLOGY

Facility

$12.00

Service Code	CPT 81002
Hospital Charge Code	900910178
Hospital Revenue Code	307
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$9.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.20
Rate for Payer: Aetna of CA Government/Medicare	$7.20
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cash Price	$5.40
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: Intervalley Health Plan Commercial	$3.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Commercial	$9.00

HC SPEC GRAVITY HEMATOLOGY

Facility

$80.00

Service Code	CPT 81002
Hospital Charge Code	900910178
Hospital Revenue Code	307
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$64.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$64.00
Rate for Payer: Health Smart Auto/Commercial	$48.00
Rate for Payer: LLUH Dept of Risk Management WC	$44.00
Rate for Payer: Multiplan Commercial	$60.00

HC SPECIMEN HANDLING

Facility

$32.00

Service Code	CPT 99001
Hospital Charge Code	900910091
Hospital Revenue Code	300
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$25.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.20
Rate for Payer: Aetna of CA Government/Medicare	$19.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$25.60
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Commercial	$24.00

HC SPECIMEN HANDLING

Facility

$87.00

Service Code	CPT 99001
Hospital Charge Code	900910091
Hospital Revenue Code	300
Min. Negotiated Rate	$47.85
Max. Negotiated Rate	$69.60
Rate for Payer: Cash Price	$39.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$69.60
Rate for Payer: Health Smart Auto/Commercial	$52.20
Rate for Payer: LLUH Dept of Risk Management WC	$47.85
Rate for Payer: Multiplan Commercial	$65.25

HC SPINE 2-3 VIEWS

Facility

$1,133.00

Service Code	CPT 72040
Hospital Charge Code	909001302
Hospital Revenue Code	320
Min. Negotiated Rate	$623.15
Max. Negotiated Rate	$906.40
Rate for Payer: Cash Price	$509.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$906.40
Rate for Payer: Health Smart Auto/Commercial	$679.80
Rate for Payer: LLUH Dept of Risk Management WC	$623.15
Rate for Payer: Multiplan Commercial	$849.75

HC SPINE 2-3 VIEWS

Facility

$1,133.00

Service Code	CPT 72040
Hospital Charge Code	909001302
Hospital Revenue Code	320
Min. Negotiated Rate	$623.15
Max. Negotiated Rate	$906.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$679.80
Rate for Payer: Aetna of CA Government/Medicare	$679.80
Rate for Payer: Cash Price	$509.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$906.40
Rate for Payer: Health Smart Auto/Commercial	$679.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$679.80
Rate for Payer: LLUH Dept of Risk Management WC	$623.15
Rate for Payer: Multiplan Commercial	$849.75

HC SPINE MINIMUM 4 VIEWS

Facility

$1,758.00

Service Code	CPT 72050
Hospital Charge Code	909001301
Hospital Revenue Code	320
Min. Negotiated Rate	$966.90
Max. Negotiated Rate	$1,406.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,054.80
Rate for Payer: Aetna of CA Government/Medicare	$1,054.80
Rate for Payer: Cash Price	$791.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,406.40
Rate for Payer: Health Smart Auto/Commercial	$1,054.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,054.80
Rate for Payer: LLUH Dept of Risk Management WC	$966.90
Rate for Payer: Multiplan Commercial	$1,318.50

HC SPINE MINIMUM 4 VIEWS

Facility

$1,758.00

Service Code	CPT 72050
Hospital Charge Code	909001301
Hospital Revenue Code	320
Min. Negotiated Rate	$966.90
Max. Negotiated Rate	$1,406.40
Rate for Payer: Cash Price	$791.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1,406.40
Rate for Payer: Health Smart Auto/Commercial	$1,054.80
Rate for Payer: LLUH Dept of Risk Management WC	$966.90
Rate for Payer: Multiplan Commercial	$1,318.50

HC SSA AB

Facility

$171.00

Service Code	CPT 86235
Hospital Charge Code	900913521
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 SSA AB

Facility

$44.00

Service Code	CPT 86235
Hospital Charge Code	900913521
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 STAPHAUREX MRSA NON-BILLABLE

Facility

$50.00

Service Code	CPT 87147
Hospital Charge Code	900912440
Hospital Revenue Code	306
Min. Negotiated Rate	$5.18
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	$5.18
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

Know your out-of-pocket cost for care.

All Charges