Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC CITRULLINATED PEPTIDE AB

Facility

$162.00

Service Code	CPT 86200
Hospital Charge Code	900913554
Hospital Revenue Code	302
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 CK-MB

Facility

$32.00

Service Code	CPT 82553
Hospital Charge Code	900910805
Hospital Revenue Code	301
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.20
Rate for Payer: Aetna of CA Government/Medicare	$19.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.00

HC CK-MB

Facility

$269.00

Service Code	CPT 82553
Hospital Charge Code	900910805
Hospital Revenue Code	301
Min. Negotiated Rate	$147.95
Max. Negotiated Rate	$215.20
Rate for Payer: Cash Price	$121.05
Rate for Payer: Cigna of CA HMO/PPO	$215.20
Rate for Payer: Health Smart Auto/Commercial	$161.40
Rate for Payer: LLUH Dept of Risk Management WC	$147.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$201.75

HC CLOSTRIDIUM DIFFICILE GDH

Facility

$46.00

Service Code	CPT 87449
Hospital Charge Code	900913622
Hospital Revenue Code	306
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.60
Rate for Payer: Aetna of CA Government/Medicare	$27.60
Rate for Payer: Cash Price	$20.70
Rate for Payer: Health Smart Auto/Commercial	$27.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.60
Rate for Payer: LLUH Dept of Risk Management WC	$25.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$34.50

HC CLOSTRIDIUM DIFFICILE GDH

Facility

$60.00

Service Code	CPT 87449
Hospital Charge Code	900913622
Hospital Revenue Code	306
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$48.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna of CA HMO/PPO	$48.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.00

HC CLOSTRIDIUM DIFFICILE TOXIN

Facility

$46.00

Service Code	CPT 87324
Hospital Charge Code	900913623
Hospital Revenue Code	306
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.60
Rate for Payer: Aetna of CA Government/Medicare	$27.60
Rate for Payer: Cash Price	$20.70
Rate for Payer: Health Smart Auto/Commercial	$27.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.60
Rate for Payer: LLUH Dept of Risk Management WC	$25.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$34.50

HC CLOSTRIDIUM DIFFICILE TOXIN

Facility

$60.00

Service Code	CPT 87324
Hospital Charge Code	900913623
Hospital Revenue Code	306
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$48.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna of CA HMO/PPO	$48.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.00

HC CM SVCS BH AT LST 20 MIN CLIN PSYCH OR CLIN SW PER MNTH

Facility

$87.00

Service Code	CPT G0323
Hospital Charge Code	907800323
Hospital Revenue Code	914
Min. Negotiated Rate	$47.85
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$52.20
Rate for Payer: Aetna of CA Government/Medicare	$52.20
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Cash Price	$39.15
Rate for Payer: Cash Price	$39.15
Rate for Payer: Health Smart Auto/Commercial	$52.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$52.20
Rate for Payer: LLUH Dept of Risk Management WC	$47.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$65.25

HC CM SVCS BH AT LST 20 MIN CLIN PSYCH OR CLIN SW PER MNTH

Facility

$87.00

Service Code	CPT G0323
Hospital Charge Code	907800323
Hospital Revenue Code	914
Min. Negotiated Rate	$47.85
Max. Negotiated Rate	$69.60
Rate for Payer: Cash Price	$39.15
Rate for Payer: Cigna of CA HMO/PPO	$69.60
Rate for Payer: Health Smart Auto/Commercial	$52.20
Rate for Payer: LLUH Dept of Risk Management WC	$47.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$65.25

HC CMV AB IGG

Facility

$237.00

Service Code	CPT 86644
Hospital Charge Code	900910987
Hospital Revenue Code	302
Min. Negotiated Rate	$130.35
Max. Negotiated Rate	$189.60
Rate for Payer: Cash Price	$106.65
Rate for Payer: Cigna of CA HMO/PPO	$189.60
Rate for Payer: Health Smart Auto/Commercial	$142.20
Rate for Payer: LLUH Dept of Risk Management WC	$130.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$177.75

HC CMV AB IGG

Facility

$39.00

Service Code	CPT 86644
Hospital Charge Code	900910987
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 CMV AB IGM

Facility

$50.00

Service Code	CPT 86645
Hospital Charge Code	900910959
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 CMV AB IGM

Facility

$237.00

Service Code	CPT 86645
Hospital Charge Code	900910959
Hospital Revenue Code	302
Min. Negotiated Rate	$130.35
Max. Negotiated Rate	$189.60
Rate for Payer: Cash Price	$106.65
Rate for Payer: Cigna of CA HMO/PPO	$189.60
Rate for Payer: Health Smart Auto/Commercial	$142.20
Rate for Payer: LLUH Dept of Risk Management WC	$130.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$177.75

HC CMV ANTIBODY IGG

Facility

$39.00

Service Code	CPT 86644
Hospital Charge Code	900913650
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 CMV ANTIBODY IGG

Facility

$58.00

Service Code	CPT 86644
Hospital Charge Code	900913650
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 CMV ANTIBODY IGM

Facility

$58.00

Service Code	CPT 86645
Hospital Charge Code	900913651
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 CMV ANTIBODY IGM

Facility

$39.00

Service Code	CPT 86645
Hospital Charge Code	900913651
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 CO2

Facility

$89.00

Service Code	CPT 82374
Hospital Charge Code	900910258
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 CO2

Facility

$15.00

Service Code	CPT 82374
Hospital Charge Code	900910258
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 COAG FVIII INHIB EVAL BTHSDA U

Facility

$140.00

Service Code	CPT 85335
Hospital Charge Code	900913970
Hospital Revenue Code	305
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$112.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna of CA HMO/PPO	$112.00
Rate for Payer: Health Smart Auto/Commercial	$84.00
Rate for Payer: LLUH Dept of Risk Management WC	$77.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$105.00

HC COAG FVIII INHIB EVAL BTHSDA U

Facility

$140.00

Service Code	CPT 85335 90
Hospital Charge Code	900913970
Hospital Revenue Code	305
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$84.00
Rate for Payer: Aetna of CA Government/Medicare	$84.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Health Smart Auto/Commercial	$84.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$84.00
Rate for Payer: LLUH Dept of Risk Management WC	$77.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$105.00

HC COAG FVIII INHIB EVAL BTHSDA U

Facility

$140.00

Service Code	CPT 85335
Hospital Charge Code	900913970
Hospital Revenue Code	305
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$84.00
Rate for Payer: Aetna of CA Government/Medicare	$84.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Health Smart Auto/Commercial	$84.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$84.00
Rate for Payer: LLUH Dept of Risk Management WC	$77.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$105.00

HC COAG FVIII INHIB EVAL BTHSDA U

Facility

$140.00

Service Code	CPT 85335 90
Hospital Charge Code	900913970
Hospital Revenue Code	305
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$112.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna of CA HMO/PPO	$112.00
Rate for Payer: Health Smart Auto/Commercial	$84.00
Rate for Payer: LLUH Dept of Risk Management WC	$77.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$105.00

HC COAG TIME ACTIVATED

Facility

$299.00

Service Code	CPT 85347
Hospital Charge Code	900910011
Hospital Revenue Code	305
Min. Negotiated Rate	$164.45
Max. Negotiated Rate	$239.20
Rate for Payer: Cash Price	$134.55
Rate for Payer: Cigna of CA HMO/PPO	$239.20
Rate for Payer: Health Smart Auto/Commercial	$179.40
Rate for Payer: LLUH Dept of Risk Management WC	$164.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$224.25

HC COAG TIME ACTIVATED

Facility

$26.00

Service Code	CPT 85347
Hospital Charge Code	900910011
Hospital Revenue Code	305
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$19.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.60
Rate for Payer: Aetna of CA Government/Medicare	$15.60
Rate for Payer: Cash Price	$11.70
Rate for Payer: Health Smart Auto/Commercial	$15.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.60
Rate for Payer: LLUH Dept of Risk Management WC	$14.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$19.50

Know your out-of-pocket cost for care.

All Charges