Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC ANTITHROMBIN III ANTIGEN

Facility

$41.00

Service Code	CPT 85301
Hospital Charge Code	900912011
Hospital Revenue Code	305
Min. Negotiated Rate	$22.55
Max. Negotiated Rate	$30.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.60
Rate for Payer: Aetna of CA Government/Medicare	$24.60
Rate for Payer: Cash Price	$18.45
Rate for Payer: Health Smart Auto/Commercial	$24.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.60
Rate for Payer: LLUH Dept of Risk Management WC	$22.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.75

HC ANTITHROMBIN III ANTIGEN

Facility

$330.00

Service Code	CPT 85301
Hospital Charge Code	900912011
Hospital Revenue Code	305
Min. Negotiated Rate	$181.50
Max. Negotiated Rate	$264.00
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cigna of CA HMO/PPO	$264.00
Rate for Payer: Health Smart Auto/Commercial	$198.00
Rate for Payer: LLUH Dept of Risk Management WC	$181.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$247.50

HC APLS IGA

Facility

$58.00

Service Code	CPT 86148
Hospital Charge Code	900913647
Hospital Revenue Code	302
Min. Negotiated Rate	$31.90
Max. Negotiated Rate	$46.40
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cigna of CA HMO/PPO	$46.40
Rate for Payer: Health Smart Auto/Commercial	$34.80
Rate for Payer: LLUH Dept of Risk Management WC	$31.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$43.50

HC APLS IGA

Facility

$39.00

Service Code	CPT 86148
Hospital Charge Code	900913647
Hospital Revenue Code	302
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.40
Rate for Payer: Aetna of CA Government/Medicare	$23.40
Rate for Payer: Cash Price	$17.55
Rate for Payer: Health Smart Auto/Commercial	$23.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.40
Rate for Payer: LLUH Dept of Risk Management WC	$21.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.25

HC APLS IGG

Facility

$39.00

Service Code	CPT 86147
Hospital Charge Code	900913648
Hospital Revenue Code	302
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.40
Rate for Payer: Aetna of CA Government/Medicare	$23.40
Rate for Payer: Cash Price	$17.55
Rate for Payer: Health Smart Auto/Commercial	$23.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.40
Rate for Payer: LLUH Dept of Risk Management WC	$21.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.25

HC APLS IGG

Facility

$58.00

Service Code	CPT 86147
Hospital Charge Code	900913648
Hospital Revenue Code	302
Min. Negotiated Rate	$31.90
Max. Negotiated Rate	$46.40
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cigna of CA HMO/PPO	$46.40
Rate for Payer: Health Smart Auto/Commercial	$34.80
Rate for Payer: LLUH Dept of Risk Management WC	$31.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$43.50

HC APLS IGM

Facility

$58.00

Service Code	CPT 86148
Hospital Charge Code	900913649
Hospital Revenue Code	302
Min. Negotiated Rate	$31.90
Max. Negotiated Rate	$46.40
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cigna of CA HMO/PPO	$46.40
Rate for Payer: Health Smart Auto/Commercial	$34.80
Rate for Payer: LLUH Dept of Risk Management WC	$31.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$43.50

HC APLS IGM

Facility

$39.00

Service Code	CPT 86148
Hospital Charge Code	900913649
Hospital Revenue Code	302
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.40
Rate for Payer: Aetna of CA Government/Medicare	$23.40
Rate for Payer: Cash Price	$17.55
Rate for Payer: Health Smart Auto/Commercial	$23.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.40
Rate for Payer: LLUH Dept of Risk Management WC	$21.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.25

HC AST

Facility

$15.00

Service Code	CPT 84450
Hospital Charge Code	900910509
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.00
Rate for Payer: Aetna of CA Government/Medicare	$9.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC AST

Facility

$89.00

Service Code	CPT 84450
Hospital Charge Code	900910509
Hospital Revenue Code	301
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$71.20
Rate for Payer: Cash Price	$40.05
Rate for Payer: Cigna of CA HMO/PPO	$71.20
Rate for Payer: Health Smart Auto/Commercial	$53.40
Rate for Payer: LLUH Dept of Risk Management WC	$48.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$66.75

HC AST INDIVIDUAL

Facility

$89.00

Service Code	CPT 84450
Hospital Charge Code	900910232
Hospital Revenue Code	301
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$71.20
Rate for Payer: Cash Price	$40.05
Rate for Payer: Cigna of CA HMO/PPO	$71.20
Rate for Payer: Health Smart Auto/Commercial	$53.40
Rate for Payer: LLUH Dept of Risk Management WC	$48.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$66.75

HC AST INDIVIDUAL

Facility

$15.00

Service Code	CPT 84450
Hospital Charge Code	900910232
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.00
Rate for Payer: Aetna of CA Government/Medicare	$9.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC B ABORTUS AB

Facility

$13.00

Service Code	CPT 86000
Hospital Charge Code	900911585
Hospital Revenue Code	302
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.80
Rate for Payer: Aetna of CA Government/Medicare	$7.80
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC B ABORTUS AB

Facility

$125.00

Service Code	CPT 86000
Hospital Charge Code	900911585
Hospital Revenue Code	302
Min. Negotiated Rate	$68.75
Max. Negotiated Rate	$100.00
Rate for Payer: Cash Price	$56.25
Rate for Payer: Cigna of CA HMO/PPO	$100.00
Rate for Payer: Health Smart Auto/Commercial	$75.00
Rate for Payer: LLUH Dept of Risk Management WC	$68.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$93.75

HC BARBITUATES CONF & ID

Facility

$271.00

Service Code	CPT G0480 90
Hospital Charge Code	900910519
Hospital Revenue Code	301
Min. Negotiated Rate	$149.05
Max. Negotiated Rate	$216.80
Rate for Payer: Cash Price	$121.95
Rate for Payer: Cigna of CA HMO/PPO	$216.80
Rate for Payer: Health Smart Auto/Commercial	$162.60
Rate for Payer: LLUH Dept of Risk Management WC	$149.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$203.25

HC BARBITUATES CONF & ID

Facility

$271.00

Service Code	CPT G0480
Hospital Charge Code	900910519
Hospital Revenue Code	301
Min. Negotiated Rate	$149.05
Max. Negotiated Rate	$216.80
Rate for Payer: Cash Price	$121.95
Rate for Payer: Cigna of CA HMO/PPO	$216.80
Rate for Payer: Health Smart Auto/Commercial	$162.60
Rate for Payer: LLUH Dept of Risk Management WC	$149.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$203.25

HC BARBITUATES CONF & ID

Facility

$271.00

Service Code	CPT 80345
Hospital Charge Code	900910519
Hospital Revenue Code	301
Min. Negotiated Rate	$149.05
Max. Negotiated Rate	$216.80
Rate for Payer: Cash Price	$121.95
Rate for Payer: Cigna of CA HMO/PPO	$216.80
Rate for Payer: Health Smart Auto/Commercial	$162.60
Rate for Payer: LLUH Dept of Risk Management WC	$149.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$203.25

HC BARBITUATES CONF & ID

Facility

$225.00

Service Code	CPT G0480
Hospital Charge Code	900910519
Hospital Revenue Code	301
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$168.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$135.00
Rate for Payer: Aetna of CA Government/Medicare	$135.00
Rate for Payer: Cash Price	$101.25
Rate for Payer: Health Smart Auto/Commercial	$135.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$135.00
Rate for Payer: LLUH Dept of Risk Management WC	$123.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$168.75

HC BARBITUATES CONF & ID

Facility

$225.00

Service Code	CPT 80345
Hospital Charge Code	900910519
Hospital Revenue Code	301
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$168.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$135.00
Rate for Payer: Aetna of CA Government/Medicare	$135.00
Rate for Payer: Cash Price	$101.25
Rate for Payer: Health Smart Auto/Commercial	$135.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$135.00
Rate for Payer: LLUH Dept of Risk Management WC	$123.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$168.75

HC BARTB 87798 SOM

Facility

$50.27

Service Code	CPT 87798 90
Hospital Charge Code	900914848
Hospital Revenue Code	306
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$37.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.16
Rate for Payer: Aetna of CA Government/Medicare	$30.16
Rate for Payer: Cash Price	$22.62
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.70

HC BARTB 87798 SOM

Facility

$50.27

Service Code	CPT 87798 90
Hospital Charge Code	900914848
Hospital Revenue Code	306
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$40.22
Rate for Payer: Cash Price	$22.62
Rate for Payer: Cigna of CA HMO/PPO	$40.22
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.70

HC BARTB 87798 SOM

Facility

$50.27

Service Code	CPT 87798
Hospital Charge Code	900914848
Hospital Revenue Code	306
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$37.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.16
Rate for Payer: Aetna of CA Government/Medicare	$30.16
Rate for Payer: Cash Price	$22.62
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.70

HC BARTB 87798 SOM

Facility

$50.27

Service Code	CPT 87798
Hospital Charge Code	900914848
Hospital Revenue Code	306
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$40.22
Rate for Payer: Cash Price	$22.62
Rate for Payer: Cigna of CA HMO/PPO	$40.22
Rate for Payer: Health Smart Auto/Commercial	$30.16
Rate for Payer: LLUH Dept of Risk Management WC	$27.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$37.70

HC BASIC METABOLIC PANEL

Facility

$20.00

Service Code	CPT 80048
Hospital Charge Code	900910421
Hospital Revenue Code	301
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.00
Rate for Payer: Aetna of CA Government/Medicare	$12.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.00

HC BASIC METABOLIC PANEL

Facility

$481.00

Service Code	CPT 80048
Hospital Charge Code	900910421
Hospital Revenue Code	301
Min. Negotiated Rate	$264.55
Max. Negotiated Rate	$384.80
Rate for Payer: Cash Price	$216.45
Rate for Payer: Cigna of CA HMO/PPO	$384.80
Rate for Payer: Health Smart Auto/Commercial	$288.60
Rate for Payer: LLUH Dept of Risk Management WC	$264.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$360.75

Know your out-of-pocket cost for care.

All Charges