Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC STAPHAUREX MRSA NON-BILLABLE

Facility

$50.00

Service Code	CPT 87147
Hospital Charge Code	900912440
Hospital Revenue Code	306
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$40.00
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: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC STAT CHARGE

Facility

$74.00

Hospital Charge Code	909001100
Hospital Revenue Code	320
Min. Negotiated Rate	$40.70
Max. Negotiated Rate	$59.20
Rate for Payer: Cash Price	$33.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$59.20
Rate for Payer: Health Smart Auto/Commercial	$44.40
Rate for Payer: LLUH Dept of Risk Management WC	$40.70
Rate for Payer: Multiplan Commercial	$55.50

HC STAT CHARGE

Facility

$74.00

Hospital Charge Code	909001100
Hospital Revenue Code	320
Min. Negotiated Rate	$40.70
Max. Negotiated Rate	$59.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$44.40
Rate for Payer: Aetna of CA Government/Medicare	$44.40
Rate for Payer: Cash Price	$33.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$59.20
Rate for Payer: Health Smart Auto/Commercial	$44.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$44.40
Rate for Payer: LLUH Dept of Risk Management WC	$40.70
Rate for Payer: Multiplan Commercial	$55.50

HC STREPTOZYME TEST

Facility

$23.00

Service Code	CPT 86063
Hospital Charge Code	900910870
Hospital Revenue Code	302
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$18.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.80
Rate for Payer: Aetna of CA Government/Medicare	$13.80
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	$18.40
Rate for Payer: Health Smart Auto/Commercial	$13.80
Rate for Payer: Intervalley Health Plan Commercial	$5.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.80
Rate for Payer: LLUH Dept of Risk Management WC	$12.65
Rate for Payer: Multiplan Commercial	$17.25

HC STREPTOZYME TEST

Facility

$170.00

Service Code	CPT 86063
Hospital Charge Code	900910870
Hospital Revenue Code	302
Min. Negotiated Rate	$93.50
Max. Negotiated Rate	$136.00
Rate for Payer: Cash Price	$76.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$136.00
Rate for Payer: Health Smart Auto/Commercial	$102.00
Rate for Payer: LLUH Dept of Risk Management WC	$93.50
Rate for Payer: Multiplan Commercial	$127.50

HC SUDAN BLACK B

Facility

$634.00

Service Code	CPT 88313
Hospital Charge Code	900910057
Hospital Revenue Code	310
Min. Negotiated Rate	$348.70
Max. Negotiated Rate	$507.20
Rate for Payer: Cash Price	$285.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$507.20
Rate for Payer: Health Smart Auto/Commercial	$380.40
Rate for Payer: LLUH Dept of Risk Management WC	$348.70
Rate for Payer: Multiplan Commercial	$475.50

HC SUDAN BLACK B

Facility

$136.00

Service Code	CPT 88313
Hospital Charge Code	900910057
Hospital Revenue Code	310
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$108.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$81.60
Rate for Payer: Aetna of CA Government/Medicare	$81.60
Rate for Payer: Cash Price	$61.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$108.80
Rate for Payer: Health Smart Auto/Commercial	$81.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$81.60
Rate for Payer: LLUH Dept of Risk Management WC	$74.80
Rate for Payer: Multiplan Commercial	$102.00

HC SUSCEPTIBILITY PANEL YEAST

Facility

$106.00

Service Code	CPT 87186
Hospital Charge Code	900914672
Hospital Revenue Code	300
Min. Negotiated Rate	$58.30
Max. Negotiated Rate	$84.80
Rate for Payer: Cash Price	$47.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$84.80
Rate for Payer: Health Smart Auto/Commercial	$63.60
Rate for Payer: LLUH Dept of Risk Management WC	$58.30
Rate for Payer: Multiplan Commercial	$79.50

HC SUSCEPTIBILITY PANEL YEAST

Facility

$76.00

Service Code	CPT 87186
Hospital Charge Code	900914672
Hospital Revenue Code	300
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$60.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$45.60
Rate for Payer: Aetna of CA Government/Medicare	$45.60
Rate for Payer: Cash Price	$34.20
Rate for Payer: Cash Price	$34.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$60.80
Rate for Payer: Health Smart Auto/Commercial	$45.60
Rate for Payer: Intervalley Health Plan Commercial	$8.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$45.60
Rate for Payer: LLUH Dept of Risk Management WC	$41.80
Rate for Payer: Multiplan Commercial	$57.00

HC SVC ANGER-PROBLEM SOLVING

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804017
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$280.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC SVC ANGER-PROBLEM SOLVING

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804017
Hospital Revenue Code	912
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$299.20
Rate for Payer: Health Smart Auto/Commercial	$224.40
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$280.50

HC SVC COPING SKILLS

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804014
Hospital Revenue Code	912
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$299.20
Rate for Payer: Health Smart Auto/Commercial	$224.40
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$280.50

HC SVC COPING SKILLS

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804014
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$280.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC SVC ED HEALTH EDUCATION

Facility

$385.00

Service Code	CPT 90853
Hospital Charge Code	907804107
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$173.25
Rate for Payer: Cash Price	$173.25
Rate for Payer: Cash Price	$173.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$211.75
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$288.75
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC SVC ED HEALTH EDUCATION

Facility

$385.00

Service Code	CPT 90853
Hospital Charge Code	907804107
Hospital Revenue Code	912
Min. Negotiated Rate	$211.75
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$173.25
Rate for Payer: Cash Price	$173.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$308.00
Rate for Payer: Health Smart Auto/Commercial	$231.00
Rate for Payer: LLUH Dept of Risk Management WC	$211.75
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$288.75

HC SVC ED MENTAL HEALTH EDUCATION

Facility

$385.00

Service Code	CPT 90853
Hospital Charge Code	907804106
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$173.25
Rate for Payer: Cash Price	$173.25
Rate for Payer: Cash Price	$173.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$211.75
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$288.75
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC SVC ED MENTAL HEALTH EDUCATION

Facility

$385.00

Service Code	CPT 90853
Hospital Charge Code	907804106
Hospital Revenue Code	912
Min. Negotiated Rate	$211.75
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$173.25
Rate for Payer: Cash Price	$173.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$308.00
Rate for Payer: Health Smart Auto/Commercial	$231.00
Rate for Payer: LLUH Dept of Risk Management WC	$211.75
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$288.75

HC SVC ED STRESS MANAGEMENT

Facility

$402.00

Service Code	CPT 90834
Hospital Charge Code	907804108
Hospital Revenue Code	912
Min. Negotiated Rate	$149.60
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$149.60
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$180.90
Rate for Payer: Cash Price	$180.90
Rate for Payer: Cash Price	$180.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$221.10
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Multiplan Commercial	$301.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC SVC ED STRESS MANAGEMENT

Facility

$402.00

Service Code	CPT 90834
Hospital Charge Code	907804108
Hospital Revenue Code	912
Min. Negotiated Rate	$221.10
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$180.90
Rate for Payer: Cash Price	$180.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$321.60
Rate for Payer: Health Smart Auto/Commercial	$241.20
Rate for Payer: LLUH Dept of Risk Management WC	$221.10
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$301.50

HC SVC HEALTH EDUCATION

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804013
Hospital Revenue Code	912
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$299.20
Rate for Payer: Health Smart Auto/Commercial	$224.40
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$280.50

HC SVC HEALTH EDUCATION

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804013
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$280.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC SVC LIFE-PROBLEM SOLVING

Facility

$262.00

Service Code	CPT 90834
Hospital Charge Code	907804016
Hospital Revenue Code	912
Min. Negotiated Rate	$144.10
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$209.60
Rate for Payer: Health Smart Auto/Commercial	$157.20
Rate for Payer: LLUH Dept of Risk Management WC	$144.10
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$196.50

HC SVC LIFE-PROBLEM SOLVING

Facility

$262.00

Service Code	CPT 90834
Hospital Charge Code	907804016
Hospital Revenue Code	912
Min. Negotiated Rate	$144.10
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$149.60
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$144.10
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Multiplan Commercial	$196.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC SVC MENTAL HEALTH EDUCATION

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804035
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$280.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC SVC MENTAL HEALTH EDUCATION

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804035
Hospital Revenue Code	912
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$299.20
Rate for Payer: Health Smart Auto/Commercial	$224.40
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$280.50

Know your out-of-pocket cost for care.

All Charges