Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC TRANSGLUTAMINASE IGA AB

Facility

$78.00

Service Code	CPT 83516
Hospital Charge Code	900913555
Hospital Revenue Code	302
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$62.40
Rate for Payer: Cash Price	$35.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$62.40
Rate for Payer: Health Smart Auto/Commercial	$46.80
Rate for Payer: LLUH Dept of Risk Management WC	$42.90
Rate for Payer: Multiplan Commercial	$58.50

HC TRANSTHYRETIN

Facility

$110.00

Service Code	CPT 84134
Hospital Charge Code	900910925
Hospital Revenue Code	301
Min. Negotiated Rate	$14.59
Max. Negotiated Rate	$88.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$66.00
Rate for Payer: Aetna of CA Government/Medicare	$66.00
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$88.00
Rate for Payer: Health Smart Auto/Commercial	$66.00
Rate for Payer: Intervalley Health Plan Commercial	$14.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$66.00
Rate for Payer: LLUH Dept of Risk Management WC	$60.50
Rate for Payer: Multiplan Commercial	$82.50

HC TRANSTHYRETIN

Facility

$367.00

Service Code	CPT 84134
Hospital Charge Code	900910925
Hospital Revenue Code	301
Min. Negotiated Rate	$201.85
Max. Negotiated Rate	$293.60
Rate for Payer: Cash Price	$165.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$293.60
Rate for Payer: Health Smart Auto/Commercial	$220.20
Rate for Payer: LLUH Dept of Risk Management WC	$201.85
Rate for Payer: Multiplan Commercial	$275.25

HC TRICHROME TEST

Facility

$97.00

Service Code	CPT 88313
Hospital Charge Code	900911728
Hospital Revenue Code	306
Min. Negotiated Rate	$53.35
Max. Negotiated Rate	$77.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$58.20
Rate for Payer: Aetna of CA Government/Medicare	$58.20
Rate for Payer: Cash Price	$43.65
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$77.60
Rate for Payer: Health Smart Auto/Commercial	$58.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$58.20
Rate for Payer: LLUH Dept of Risk Management WC	$53.35
Rate for Payer: Multiplan Commercial	$72.75

HC TRICHROME TEST

Facility

$552.00

Service Code	CPT 88313
Hospital Charge Code	900911728
Hospital Revenue Code	306
Min. Negotiated Rate	$303.60
Max. Negotiated Rate	$441.60
Rate for Payer: Cash Price	$248.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$441.60
Rate for Payer: Health Smart Auto/Commercial	$331.20
Rate for Payer: LLUH Dept of Risk Management WC	$303.60
Rate for Payer: Multiplan Commercial	$414.00

HC TRIGLYCERIDES

Facility

$98.00

Service Code	CPT 84478
Hospital Charge Code	900910234
Hospital Revenue Code	301
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$78.40
Rate for Payer: Cash Price	$44.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$78.40
Rate for Payer: Health Smart Auto/Commercial	$58.80
Rate for Payer: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Commercial	$73.50

HC TRIGLYCERIDES

Facility

$42.00

Service Code	CPT 84478
Hospital Charge Code	900910234
Hospital Revenue Code	301
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$33.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$25.20
Rate for Payer: Aetna of CA Government/Medicare	$25.20
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$33.60
Rate for Payer: Health Smart Auto/Commercial	$25.20
Rate for Payer: Intervalley Health Plan Commercial	$5.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$25.20
Rate for Payer: LLUH Dept of Risk Management WC	$23.10
Rate for Payer: Multiplan Commercial	$31.50

HC TRIGLYCERIDES BODY FLUID

Facility

$56.00

Service Code	CPT 84478
Hospital Charge Code	900912247
Hospital Revenue Code	301
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$44.80
Rate for Payer: Cash Price	$25.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$44.80
Rate for Payer: Health Smart Auto/Commercial	$33.60
Rate for Payer: LLUH Dept of Risk Management WC	$30.80
Rate for Payer: Multiplan Commercial	$42.00

HC TRIGLYCERIDES BODY FLUID

Facility

$54.00

Service Code	CPT 84478
Hospital Charge Code	900912247
Hospital Revenue Code	301
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$32.40
Rate for Payer: Aetna of CA Government/Medicare	$32.40
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cash Price	$24.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$43.20
Rate for Payer: Health Smart Auto/Commercial	$32.40
Rate for Payer: Intervalley Health Plan Commercial	$5.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$32.40
Rate for Payer: LLUH Dept of Risk Management WC	$29.70
Rate for Payer: Multiplan Commercial	$40.50

HC TRIGLYCERIDES INDIVIDUAL

Facility

$42.00

Service Code	CPT 84478
Hospital Charge Code	900910526
Hospital Revenue Code	301
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$33.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$25.20
Rate for Payer: Aetna of CA Government/Medicare	$25.20
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$33.60
Rate for Payer: Health Smart Auto/Commercial	$25.20
Rate for Payer: Intervalley Health Plan Commercial	$5.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$25.20
Rate for Payer: LLUH Dept of Risk Management WC	$23.10
Rate for Payer: Multiplan Commercial	$31.50

HC TRIGLYCERIDES INDIVIDUAL

Facility

$98.00

Service Code	CPT 84478
Hospital Charge Code	900910526
Hospital Revenue Code	301
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$78.40
Rate for Payer: Cash Price	$44.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$78.40
Rate for Payer: Health Smart Auto/Commercial	$58.80
Rate for Payer: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Commercial	$73.50

HC TRIIODOTHYRONINE, FREE

Facility

$305.00

Service Code	CPT 84481
Hospital Charge Code	900912135
Hospital Revenue Code	301
Min. Negotiated Rate	$167.75
Max. Negotiated Rate	$244.00
Rate for Payer: Cash Price	$137.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$244.00
Rate for Payer: Health Smart Auto/Commercial	$183.00
Rate for Payer: LLUH Dept of Risk Management WC	$167.75
Rate for Payer: Multiplan Commercial	$228.75

HC TRIIODOTHYRONINE, FREE

Facility

$173.03

Service Code	CPT 84481
Hospital Charge Code	900912135
Hospital Revenue Code	301
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$138.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$103.82
Rate for Payer: Aetna of CA Government/Medicare	$103.82
Rate for Payer: Cash Price	$77.86
Rate for Payer: Cash Price	$77.86
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$138.42
Rate for Payer: Health Smart Auto/Commercial	$103.82
Rate for Payer: Intervalley Health Plan Commercial	$16.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$103.82
Rate for Payer: LLUH Dept of Risk Management WC	$95.17
Rate for Payer: Multiplan Commercial	$129.77

HC TRMNT ANGER-PROBLEM SOLVING

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804064
Hospital Revenue Code	905
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
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	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$364.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
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	$318.08

HC TRMNT ANGER-PROBLEM SOLVING

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804064
Hospital Revenue Code	905
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$652.36
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	$652.36
Rate for Payer: Multiplan Commercial	$280.50

HC TRMNT ED HEALTH EDUCATION

Facility

$385.00

Service Code	CPT 90853
Hospital Charge Code	907804147
Hospital Revenue Code	905
Min. Negotiated Rate	$211.75
Max. Negotiated Rate	$652.36
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	$652.36
Rate for Payer: Multiplan Commercial	$288.75

HC TRMNT ED HEALTH EDUCATION

Facility

$385.00

Service Code	CPT 90853
Hospital Charge Code	907804147
Hospital Revenue Code	905
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
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	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$364.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$211.75
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
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	$318.08

HC TRMNT ED MENTAL HEALTH EDUCATION

Facility

$385.00

Service Code	CPT 90853
Hospital Charge Code	907804146
Hospital Revenue Code	905
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
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	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$364.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$211.75
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
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	$318.08

HC TRMNT ED MENTAL HEALTH EDUCATION

Facility

$385.00

Service Code	CPT 90853
Hospital Charge Code	907804146
Hospital Revenue Code	905
Min. Negotiated Rate	$211.75
Max. Negotiated Rate	$652.36
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	$652.36
Rate for Payer: Multiplan Commercial	$288.75

HC TRMNT ED STRESS MANAGEMENT

Facility

$402.00

Service Code	CPT 90834
Hospital Charge Code	907804148
Hospital Revenue Code	905
Min. Negotiated Rate	$221.10
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
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	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$221.10
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Multiplan Commercial	$301.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC TRMNT ED STRESS MANAGEMENT

Facility

$402.00

Service Code	CPT 90834
Hospital Charge Code	907804148
Hospital Revenue Code	905
Min. Negotiated Rate	$221.10
Max. Negotiated Rate	$652.36
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	$652.36
Rate for Payer: Multiplan Commercial	$301.50

HC TRMNT MENTAL HEALTH EDUCATION

Facility

$385.00

Service Code	CPT 90853
Hospital Charge Code	907804063
Hospital Revenue Code	905
Min. Negotiated Rate	$211.75
Max. Negotiated Rate	$652.36
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	$652.36
Rate for Payer: Multiplan Commercial	$288.75

HC TRMNT MENTAL HEALTH EDUCATION

Facility

$385.00

Service Code	CPT 90853
Hospital Charge Code	907804063
Hospital Revenue Code	905
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
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	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$364.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$211.75
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
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	$318.08

HC TRMNT STRESS MANAGEMENT

Facility

$402.00

Service Code	CPT 90834
Hospital Charge Code	907804066
Hospital Revenue Code	905
Min. Negotiated Rate	$221.10
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$504.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
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	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: LLUH Dept of Risk Management WC	$221.10
Rate for Payer: Magellan Commercial	$500.00
Rate for Payer: Managed Health Network (MHN) Commercial	$456.00
Rate for Payer: Multiplan Commercial	$301.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$318.08

HC TRMNT STRESS MANAGEMENT

Facility

$402.00

Service Code	CPT 90834
Hospital Charge Code	907804066
Hospital Revenue Code	905
Min. Negotiated Rate	$221.10
Max. Negotiated Rate	$652.36
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	$652.36
Rate for Payer: Multiplan Commercial	$301.50

Know your out-of-pocket cost for care.

All Charges