Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC BUN BODY FLUID

Facility

$17.00

Service Code	CPT 84520
Hospital Charge Code	900912241
Hospital Revenue Code	301
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$12.75
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: Health Smart Auto/Commercial	$10.20
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 Beech St/Commercial/PHCS	$12.75

HC CAFFEINE SERUM

Facility

$162.00

Service Code	CPT 80299
Hospital Charge Code	900910538
Hospital Revenue Code	301
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$129.60
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cigna of CA HMO/PPO	$129.60
Rate for Payer: Health Smart Auto/Commercial	$97.20
Rate for Payer: LLUH Dept of Risk Management WC	$89.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$121.50

HC CAFFEINE SERUM

Facility

$44.00

Service Code	CPT 80299
Hospital Charge Code	900910538
Hospital Revenue Code	301
Min. Negotiated Rate	$24.20
Max. Negotiated Rate	$33.00
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: Health Smart Auto/Commercial	$26.40
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 Beech St/Commercial/PHCS	$33.00

HC CA IONIZED (POC)

Facility

$292.00

Service Code	CPT 82330
Hospital Charge Code	900912118
Hospital Revenue Code	301
Min. Negotiated Rate	$160.60
Max. Negotiated Rate	$219.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$175.20
Rate for Payer: Aetna of CA Government/Medicare	$175.20
Rate for Payer: Cash Price	$131.40
Rate for Payer: Health Smart Auto/Commercial	$175.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$175.20
Rate for Payer: LLUH Dept of Risk Management WC	$160.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$219.00

HC CA IONIZED (POC)

Facility

$292.00

Service Code	CPT 82330
Hospital Charge Code	900912118
Hospital Revenue Code	301
Min. Negotiated Rate	$160.60
Max. Negotiated Rate	$233.60
Rate for Payer: Cash Price	$131.40
Rate for Payer: Cigna of CA HMO/PPO	$233.60
Rate for Payer: Health Smart Auto/Commercial	$175.20
Rate for Payer: LLUH Dept of Risk Management WC	$160.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$219.00

HC CALCIUM TOTAL

Facility

$89.00

Service Code	CPT 82310
Hospital Charge Code	900910239
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 CALCIUM TOTAL

Facility

$15.00

Service Code	CPT 82310
Hospital Charge Code	900910239
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 CANNABINOIDS SEMI-QUANTITATIVE

Facility

$122.00

Service Code	CPT 80299
Hospital Charge Code	900910380
Hospital Revenue Code	301
Min. Negotiated Rate	$67.10
Max. Negotiated Rate	$97.60
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cigna of CA HMO/PPO	$97.60
Rate for Payer: Health Smart Auto/Commercial	$73.20
Rate for Payer: LLUH Dept of Risk Management WC	$67.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$91.50

HC CANNABINOIDS SEMI-QUANTITATIVE

Facility

$101.00

Service Code	CPT 80299
Hospital Charge Code	900910380
Hospital Revenue Code	301
Min. Negotiated Rate	$55.55
Max. Negotiated Rate	$75.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$60.60
Rate for Payer: Aetna of CA Government/Medicare	$60.60
Rate for Payer: Cash Price	$45.45
Rate for Payer: Health Smart Auto/Commercial	$60.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$60.60
Rate for Payer: LLUH Dept of Risk Management WC	$55.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$75.75

HC CARBAMATES CONF & ID

Facility

$271.00

Service Code	CPT 82482
Hospital Charge Code	900910513
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 CARBAMATES CONF & ID

Facility

$225.00

Service Code	CPT G0480
Hospital Charge Code	900910513
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 CARBAMATES CONF & ID

Facility

$271.00

Service Code	CPT G0480
Hospital Charge Code	900910513
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 CARBAMATES CONF & ID

Facility

$225.00

Service Code	CPT 82482
Hospital Charge Code	900910513
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 CARBAMAZEPINE

Facility

$247.00

Service Code	CPT 80156
Hospital Charge Code	900910396
Hospital Revenue Code	301
Min. Negotiated Rate	$135.85
Max. Negotiated Rate	$197.60
Rate for Payer: Cash Price	$111.15
Rate for Payer: Cigna of CA HMO/PPO	$197.60
Rate for Payer: Health Smart Auto/Commercial	$148.20
Rate for Payer: LLUH Dept of Risk Management WC	$135.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$185.25

HC CARBAMAZEPINE

Facility

$50.00

Service Code	CPT 80156
Hospital Charge Code	900910396
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$37.50
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: Health Smart Auto/Commercial	$30.00
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 Beech St/Commercial/PHCS	$37.50

HC CARCINOEMBRYONIC ANTIGEN (CEA)

Facility

$406.00

Service Code	CPT 82378
Hospital Charge Code	900910865
Hospital Revenue Code	301
Min. Negotiated Rate	$223.30
Max. Negotiated Rate	$324.80
Rate for Payer: Cash Price	$182.70
Rate for Payer: Cigna of CA HMO/PPO	$324.80
Rate for Payer: Health Smart Auto/Commercial	$243.60
Rate for Payer: LLUH Dept of Risk Management WC	$223.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$304.50

HC CARCINOEMBRYONIC ANTIGEN (CEA)

Facility

$54.00

Service Code	CPT 82378
Hospital Charge Code	900910865
Hospital Revenue Code	301
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$40.50
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: Health Smart Auto/Commercial	$32.40
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 Beech St/Commercial/PHCS	$40.50

HC CARDIOLIPIN AB EAC IG CLASS

Facility

$50.00

Service Code	CPT 86147
Hospital Charge Code	900913559
Hospital Revenue Code	302
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$37.50
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: Health Smart Auto/Commercial	$30.00
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 Beech St/Commercial/PHCS	$37.50

HC CARDIOLIPIN AB EAC IG CLASS

Facility

$192.00

Service Code	CPT 86147
Hospital Charge Code	900913559
Hospital Revenue Code	302
Min. Negotiated Rate	$105.60
Max. Negotiated Rate	$153.60
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cigna of CA HMO/PPO	$153.60
Rate for Payer: Health Smart Auto/Commercial	$115.20
Rate for Payer: LLUH Dept of Risk Management WC	$105.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$144.00

HC CATECHOLAMINES UR FRACTIONATED

Facility

$96.00

Service Code	CPT 82384
Hospital Charge Code	900910455
Hospital Revenue Code	301
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$57.60
Rate for Payer: Aetna of CA Government/Medicare	$57.60
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Smart Auto/Commercial	$57.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$57.60
Rate for Payer: LLUH Dept of Risk Management WC	$52.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$72.00

HC CATECHOLAMINES UR FRACTIONATED

Facility

$317.00

Service Code	CPT 82384
Hospital Charge Code	900910455
Hospital Revenue Code	301
Min. Negotiated Rate	$174.35
Max. Negotiated Rate	$253.60
Rate for Payer: Cash Price	$142.65
Rate for Payer: Cigna of CA HMO/PPO	$253.60
Rate for Payer: Health Smart Auto/Commercial	$190.20
Rate for Payer: LLUH Dept of Risk Management WC	$174.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$237.75

HC CBC W DIFFERENTIAL

Facility

$16.00

Service Code	CPT 85027
Hospital Charge Code	900910093
Hospital Revenue Code	305
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.60
Rate for Payer: Aetna of CA Government/Medicare	$9.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Smart Auto/Commercial	$9.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.60
Rate for Payer: LLUH Dept of Risk Management WC	$8.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.00

HC CBC W DIFFERENTIAL

Facility

$99.00

Service Code	CPT 85027
Hospital Charge Code	900910093
Hospital Revenue Code	305
Min. Negotiated Rate	$54.45
Max. Negotiated Rate	$79.20
Rate for Payer: Cash Price	$44.55
Rate for Payer: Cigna of CA HMO/PPO	$79.20
Rate for Payer: Health Smart Auto/Commercial	$59.40
Rate for Payer: LLUH Dept of Risk Management WC	$54.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$74.25

HC CBC WITHOUT DIFFERENTIAL

Facility

$16.00

Service Code	CPT 85027
Hospital Charge Code	900912020
Hospital Revenue Code	305
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.60
Rate for Payer: Aetna of CA Government/Medicare	$9.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Smart Auto/Commercial	$9.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.60
Rate for Payer: LLUH Dept of Risk Management WC	$8.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.00

HC CBC WITHOUT DIFFERENTIAL

Facility

$109.00

Service Code	CPT 85027
Hospital Charge Code	900912020
Hospital Revenue Code	305
Min. Negotiated Rate	$59.95
Max. Negotiated Rate	$87.20
Rate for Payer: Cash Price	$49.05
Rate for Payer: Cigna of CA HMO/PPO	$87.20
Rate for Payer: Health Smart Auto/Commercial	$65.40
Rate for Payer: LLUH Dept of Risk Management WC	$59.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$81.75

Know your out-of-pocket cost for care.

All Charges