Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SVC STRESS MANAGEMENT

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804015
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 STRESS MANAGEMENT

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804015
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 SWEAT CHLORIDE, IONTOPHORESIS

Facility

$314.00

Service Code	CPT 89230
Hospital Charge Code	900910257
Hospital Revenue Code	300
Min. Negotiated Rate	$172.70
Max. Negotiated Rate	$251.20
Rate for Payer: Cash Price	$141.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$251.20
Rate for Payer: Health Smart Auto/Commercial	$188.40
Rate for Payer: LLUH Dept of Risk Management WC	$172.70
Rate for Payer: Multiplan Commercial	$235.50

HC SWEAT CHLORIDE, IONTOPHORESIS

Facility

$31.00

Service Code	CPT 89230
Hospital Charge Code	900910257
Hospital Revenue Code	300
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$24.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.60
Rate for Payer: Aetna of CA Government/Medicare	$18.60
Rate for Payer: Cash Price	$13.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$24.80
Rate for Payer: Health Smart Auto/Commercial	$18.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.60
Rate for Payer: LLUH Dept of Risk Management WC	$17.05
Rate for Payer: Multiplan Commercial	$23.25

HC SWEAT CHLORIDE MEASUREMENT

Facility

$206.00

Service Code	CPT 82438
Hospital Charge Code	900910680
Hospital Revenue Code	301
Min. Negotiated Rate	$113.30
Max. Negotiated Rate	$164.80
Rate for Payer: Cash Price	$92.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$164.80
Rate for Payer: Health Smart Auto/Commercial	$123.60
Rate for Payer: LLUH Dept of Risk Management WC	$113.30
Rate for Payer: Multiplan Commercial	$154.50

HC SWEAT CHLORIDE MEASUREMENT

Facility

$21.00

Service Code	CPT 82438
Hospital Charge Code	900910680
Hospital Revenue Code	301
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$16.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.60
Rate for Payer: Aetna of CA Government/Medicare	$12.60
Rate for Payer: Cash Price	$9.45
Rate for Payer: Cash Price	$9.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.80
Rate for Payer: Health Smart Auto/Commercial	$12.60
Rate for Payer: Intervalley Health Plan Commercial	$5.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.60
Rate for Payer: LLUH Dept of Risk Management WC	$11.55
Rate for Payer: Multiplan Commercial	$15.75

HC SYNERCID E TEST

Facility

$17.00

Service Code	CPT 87181
Hospital Charge Code	900912447
Hospital Revenue Code	306
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$13.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.20
Rate for Payer: Aetna of CA Government/Medicare	$10.20
Rate for Payer: Cash Price	$7.65
Rate for Payer: Cash Price	$7.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$13.60
Rate for Payer: Health Smart Auto/Commercial	$10.20
Rate for Payer: Intervalley Health Plan Commercial	$4.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.20
Rate for Payer: LLUH Dept of Risk Management WC	$9.35
Rate for Payer: Multiplan Commercial	$12.75

HC SYNERCID E TEST

Facility

$85.00

Service Code	CPT 87181
Hospital Charge Code	900912447
Hospital Revenue Code	306
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$68.00
Rate for Payer: Cash Price	$38.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$68.00
Rate for Payer: Health Smart Auto/Commercial	$51.00
Rate for Payer: LLUH Dept of Risk Management WC	$46.75
Rate for Payer: Multiplan Commercial	$63.75

HC SYPHILIS NON TREP QUAL RPR

Facility

$77.00

Service Code	CPT 86592
Hospital Charge Code	900913673
Hospital Revenue Code	302
Min. Negotiated Rate	$42.35
Max. Negotiated Rate	$61.60
Rate for Payer: Cash Price	$34.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$61.60
Rate for Payer: Health Smart Auto/Commercial	$46.20
Rate for Payer: LLUH Dept of Risk Management WC	$42.35
Rate for Payer: Multiplan Commercial	$57.75

HC SYPHILIS NON TREP QUAL RPR

Facility

$52.00

Service Code	CPT 86592
Hospital Charge Code	900913673
Hospital Revenue Code	302
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$41.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.20
Rate for Payer: Aetna of CA Government/Medicare	$31.20
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cash Price	$23.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$41.60
Rate for Payer: Health Smart Auto/Commercial	$31.20
Rate for Payer: Intervalley Health Plan Commercial	$4.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.20
Rate for Payer: LLUH Dept of Risk Management WC	$28.60
Rate for Payer: Multiplan Commercial	$39.00

HC SYPHILIS NON TREP QUANT

Facility

$42.06

Service Code	CPT 86593
Hospital Charge Code	900913672
Hospital Revenue Code	302
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$33.65
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$25.24
Rate for Payer: Aetna of CA Government/Medicare	$25.24
Rate for Payer: Cash Price	$18.93
Rate for Payer: Cash Price	$18.93
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$33.65
Rate for Payer: Health Smart Auto/Commercial	$25.24
Rate for Payer: Intervalley Health Plan Commercial	$4.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$25.24
Rate for Payer: LLUH Dept of Risk Management WC	$23.13
Rate for Payer: Multiplan Commercial	$31.55

HC SYPHILIS NON TREP QUANT

Facility

$77.00

Service Code	CPT 86593
Hospital Charge Code	900913672
Hospital Revenue Code	302
Min. Negotiated Rate	$42.35
Max. Negotiated Rate	$61.60
Rate for Payer: Cash Price	$34.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$61.60
Rate for Payer: Health Smart Auto/Commercial	$46.20
Rate for Payer: LLUH Dept of Risk Management WC	$42.35
Rate for Payer: Multiplan Commercial	$57.75

HC SYPHILIS TOTAL

Facility

$49.00

Service Code	CPT 83516
Hospital Charge Code	900913674
Hospital Revenue Code	302
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$39.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$29.40
Rate for Payer: Aetna of CA Government/Medicare	$29.40
Rate for Payer: Cash Price	$22.05
Rate for Payer: Cash Price	$22.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$39.20
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: Intervalley Health Plan Commercial	$11.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$29.40
Rate for Payer: LLUH Dept of Risk Management WC	$26.95
Rate for Payer: Multiplan Commercial	$36.75

HC SYPHILIS TOTAL

Facility

$64.00

Service Code	CPT 83516
Hospital Charge Code	900913674
Hospital Revenue Code	302
Min. Negotiated Rate	$35.20
Max. Negotiated Rate	$51.20
Rate for Payer: Cash Price	$28.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$51.20
Rate for Payer: Health Smart Auto/Commercial	$38.40
Rate for Payer: LLUH Dept of Risk Management WC	$35.20
Rate for Payer: Multiplan Commercial	$48.00

HC SYPHILLIS IGG

Facility

$72.00

Service Code	CPT 86780
Hospital Charge Code	900913561
Hospital Revenue Code	302
Min. Negotiated Rate	$13.24
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$43.20
Rate for Payer: Aetna of CA Government/Medicare	$43.20
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$57.60
Rate for Payer: Health Smart Auto/Commercial	$43.20
Rate for Payer: Intervalley Health Plan Commercial	$13.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$43.20
Rate for Payer: LLUH Dept of Risk Management WC	$39.60
Rate for Payer: Multiplan Commercial	$54.00

HC SYPHILLIS IGG

Facility

$186.00

Service Code	CPT 86780
Hospital Charge Code	900913561
Hospital Revenue Code	302
Min. Negotiated Rate	$102.30
Max. Negotiated Rate	$148.80
Rate for Payer: Cash Price	$83.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$148.80
Rate for Payer: Health Smart Auto/Commercial	$111.60
Rate for Payer: LLUH Dept of Risk Management WC	$102.30
Rate for Payer: Multiplan Commercial	$139.50

HC SYPHILLIS IGG INDIVIDUAL

Facility

$186.00

Service Code	CPT 86780
Hospital Charge Code	900913563
Hospital Revenue Code	302
Min. Negotiated Rate	$102.30
Max. Negotiated Rate	$148.80
Rate for Payer: Cash Price	$83.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$148.80
Rate for Payer: Health Smart Auto/Commercial	$111.60
Rate for Payer: LLUH Dept of Risk Management WC	$102.30
Rate for Payer: Multiplan Commercial	$139.50

HC SYPHILLIS IGG INDIVIDUAL

Facility

$186.00

Service Code	CPT 86780
Hospital Charge Code	900913563
Hospital Revenue Code	302
Min. Negotiated Rate	$13.24
Max. Negotiated Rate	$148.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$111.60
Rate for Payer: Aetna of CA Government/Medicare	$111.60
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cash Price	$83.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$148.80
Rate for Payer: Health Smart Auto/Commercial	$111.60
Rate for Payer: Intervalley Health Plan Commercial	$13.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$111.60
Rate for Payer: LLUH Dept of Risk Management WC	$102.30
Rate for Payer: Multiplan Commercial	$139.50

HC SYPHILLIS TEST RPR

Facility

$25.00

Service Code	CPT 86592
Hospital Charge Code	900910892
Hospital Revenue Code	302
Min. Negotiated Rate	$4.27
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	$11.25
Rate for Payer: Cash Price	$11.25
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	$4.27
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 SYPHILLIS TEST RPR

Facility

$182.00

Service Code	CPT 86592
Hospital Charge Code	900910892
Hospital Revenue Code	302
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$145.60
Rate for Payer: Cash Price	$81.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$145.60
Rate for Payer: Health Smart Auto/Commercial	$109.20
Rate for Payer: LLUH Dept of Risk Management WC	$100.10
Rate for Payer: Multiplan Commercial	$136.50

HC SYPHILLIS TEST RPR INDIVIDUAL

Facility

$25.00

Service Code	CPT 86592
Hospital Charge Code	900912331
Hospital Revenue Code	302
Min. Negotiated Rate	$4.27
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	$11.25
Rate for Payer: Cash Price	$11.25
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	$4.27
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 SYPHILLIS TEST RPR INDIVIDUAL

Facility

$182.00

Service Code	CPT 86592
Hospital Charge Code	900912331
Hospital Revenue Code	302
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$145.60
Rate for Payer: Cash Price	$81.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$145.60
Rate for Payer: Health Smart Auto/Commercial	$109.20
Rate for Payer: LLUH Dept of Risk Management WC	$100.10
Rate for Payer: Multiplan Commercial	$136.50

HC SYPHILLIS TEST VDRL/ CSF

Facility

$182.00

Service Code	CPT 86592
Hospital Charge Code	900910861
Hospital Revenue Code	302
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$145.60
Rate for Payer: Cash Price	$81.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$145.60
Rate for Payer: Health Smart Auto/Commercial	$109.20
Rate for Payer: LLUH Dept of Risk Management WC	$100.10
Rate for Payer: Multiplan Commercial	$136.50

HC SYPHILLIS TEST VDRL/ CSF

Facility

$31.00

Service Code	CPT 86592
Hospital Charge Code	900910861
Hospital Revenue Code	302
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$24.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.60
Rate for Payer: Aetna of CA Government/Medicare	$18.60
Rate for Payer: Cash Price	$13.95
Rate for Payer: Cash Price	$13.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$24.80
Rate for Payer: Health Smart Auto/Commercial	$18.60
Rate for Payer: Intervalley Health Plan Commercial	$4.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.60
Rate for Payer: LLUH Dept of Risk Management WC	$17.05
Rate for Payer: Multiplan Commercial	$23.25

HC TESTOSTERONE TOTAL

Facility

$120.00

Service Code	CPT 84403
Hospital Charge Code	900912134
Hospital Revenue Code	301
Min. Negotiated Rate	$25.81
Max. Negotiated Rate	$96.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$72.00
Rate for Payer: Aetna of CA Government/Medicare	$72.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$96.00
Rate for Payer: Health Smart Auto/Commercial	$72.00
Rate for Payer: Intervalley Health Plan Commercial	$25.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$72.00
Rate for Payer: LLUH Dept of Risk Management WC	$66.00
Rate for Payer: Multiplan Commercial	$90.00

Know your out-of-pocket cost for care.

All Charges