Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC COCAINE METABOLITE CONF

Facility

$225.00

Service Code	CPT 80353
Hospital Charge Code	900910518
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 COCAINE METABOLITE CONF

Facility

$225.00

Service Code	CPT G0480
Hospital Charge Code	900910518
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 COCAINE METABOLITE CONF

Facility

$271.00

Service Code	CPT 80353
Hospital Charge Code	900910518
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 COCAINE METABOLITE CONF

Facility

$271.00

Service Code	CPT G0480
Hospital Charge Code	900910518
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 COLON W SNGL CONTRAST ENEMA

Facility

$1,436.00

Service Code	CPT 74270
Hospital Charge Code	909001806
Hospital Revenue Code	320
Min. Negotiated Rate	$789.80
Max. Negotiated Rate	$1,077.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$861.60
Rate for Payer: Aetna of CA Government/Medicare	$861.60
Rate for Payer: Cash Price	$646.20
Rate for Payer: Health Smart Auto/Commercial	$861.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$861.60
Rate for Payer: LLUH Dept of Risk Management WC	$789.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,077.00

HC COLON W SNGL CONTRAST ENEMA

Facility

$1,436.00

Service Code	CPT 74270 TC
Hospital Charge Code	909001806
Hospital Revenue Code	320
Min. Negotiated Rate	$789.80
Max. Negotiated Rate	$1,148.80
Rate for Payer: Cash Price	$646.20
Rate for Payer: Cigna of CA HMO/PPO	$1,148.80
Rate for Payer: Health Smart Auto/Commercial	$861.60
Rate for Payer: LLUH Dept of Risk Management WC	$789.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,077.00

HC COLON W SNGL CONTRAST ENEMA

Facility

$1,436.00

Service Code	CPT 74270 TC
Hospital Charge Code	909001806
Hospital Revenue Code	320
Min. Negotiated Rate	$789.80
Max. Negotiated Rate	$1,077.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$861.60
Rate for Payer: Aetna of CA Government/Medicare	$861.60
Rate for Payer: Cash Price	$646.20
Rate for Payer: Health Smart Auto/Commercial	$861.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$861.60
Rate for Payer: LLUH Dept of Risk Management WC	$789.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,077.00

HC COLON W SNGL CONTRAST ENEMA

Facility

$1,436.00

Service Code	CPT 74270
Hospital Charge Code	909001806
Hospital Revenue Code	320
Min. Negotiated Rate	$789.80
Max. Negotiated Rate	$1,148.80
Rate for Payer: Cash Price	$646.20
Rate for Payer: Cigna of CA HMO/PPO	$1,148.80
Rate for Payer: Health Smart Auto/Commercial	$861.60
Rate for Payer: LLUH Dept of Risk Management WC	$789.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,077.00

HC COMPLEMENT C-3

Facility

$190.00

Service Code	CPT 86160
Hospital Charge Code	900910841
Hospital Revenue Code	302
Min. Negotiated Rate	$104.50
Max. Negotiated Rate	$152.00
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cigna of CA HMO/PPO	$152.00
Rate for Payer: Health Smart Auto/Commercial	$114.00
Rate for Payer: LLUH Dept of Risk Management WC	$104.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$142.50

HC COMPLEMENT C-3

Facility

$36.00

Service Code	CPT 86160
Hospital Charge Code	900910841
Hospital Revenue Code	302
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.60
Rate for Payer: Aetna of CA Government/Medicare	$21.60
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.00

HC COMPLEMENT TOTAL

Facility

$273.00

Service Code	CPT 86162
Hospital Charge Code	900910842
Hospital Revenue Code	302
Min. Negotiated Rate	$150.15
Max. Negotiated Rate	$218.40
Rate for Payer: Cash Price	$122.85
Rate for Payer: Cigna of CA HMO/PPO	$218.40
Rate for Payer: Health Smart Auto/Commercial	$163.80
Rate for Payer: LLUH Dept of Risk Management WC	$150.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$204.75

HC COMPLEMENT TOTAL

Facility

$60.00

Service Code	CPT 86162
Hospital Charge Code	900910842
Hospital Revenue Code	302
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$36.00
Rate for Payer: Aetna of CA Government/Medicare	$36.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Health Smart Auto/Commercial	$36.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$36.00
Rate for Payer: LLUH Dept of Risk Management WC	$33.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$45.00

HC COMPREHENSIVE METABOLIC PANEL

Facility

$25.00

Service Code	CPT 80053
Hospital Charge Code	900910423
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$18.75
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: Health Smart Auto/Commercial	$15.00
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 Beech St/Commercial/PHCS	$18.75

HC COMPREHENSIVE METABOLIC PANEL

Facility

$850.00

Service Code	CPT 80053
Hospital Charge Code	900910423
Hospital Revenue Code	301
Min. Negotiated Rate	$467.50
Max. Negotiated Rate	$680.00
Rate for Payer: Health Smart Auto/Commercial	$510.00
Rate for Payer: Cash Price	$382.50
Rate for Payer: Cigna of CA HMO/PPO	$680.00
Rate for Payer: LLUH Dept of Risk Management WC	$467.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$637.50

HC CORTISOL

Facility

$54.00

Service Code	CPT 82533
Hospital Charge Code	900912125
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 CORTISOL

Facility

$268.00

Service Code	CPT 82533
Hospital Charge Code	900912125
Hospital Revenue Code	301
Min. Negotiated Rate	$147.40
Max. Negotiated Rate	$214.40
Rate for Payer: Cash Price	$120.60
Rate for Payer: Cigna of CA HMO/PPO	$214.40
Rate for Payer: Health Smart Auto/Commercial	$160.80
Rate for Payer: LLUH Dept of Risk Management WC	$147.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$201.00

HC C-REACTIVE PROTEIN

Facility

$18.00

Service Code	CPT 86140
Hospital Charge Code	900910887
Hospital Revenue Code	302
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.80
Rate for Payer: Aetna of CA Government/Medicare	$10.80
Rate for Payer: Cash Price	$8.10
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.80
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.50

HC C-REACTIVE PROTEIN

Facility

$190.00

Service Code	CPT 86140
Hospital Charge Code	900910887
Hospital Revenue Code	302
Min. Negotiated Rate	$104.50
Max. Negotiated Rate	$152.00
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cigna of CA HMO/PPO	$152.00
Rate for Payer: Health Smart Auto/Commercial	$114.00
Rate for Payer: LLUH Dept of Risk Management WC	$104.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$142.50

HC C-REACTIVE PROTEIN HI SENSITIVITY

Facility

$36.00

Service Code	CPT 86141
Hospital Charge Code	900912102
Hospital Revenue Code	302
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$27.00
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: Cash Price	$16.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.60
Rate for Payer: Aetna of CA Government/Medicare	$21.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.00

HC C-REACTIVE PROTEIN HI SENSITIVITY

Facility

$268.00

Service Code	CPT 86141
Hospital Charge Code	900912102
Hospital Revenue Code	302
Min. Negotiated Rate	$147.40
Max. Negotiated Rate	$214.40
Rate for Payer: Cash Price	$120.60
Rate for Payer: Cigna of CA HMO/PPO	$214.40
Rate for Payer: Health Smart Auto/Commercial	$160.80
Rate for Payer: LLUH Dept of Risk Management WC	$147.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$201.00

HC CREATINE KINASE

Facility

$138.00

Service Code	CPT 82550
Hospital Charge Code	900910222
Hospital Revenue Code	301
Min. Negotiated Rate	$75.90
Max. Negotiated Rate	$110.40
Rate for Payer: Cash Price	$62.10
Rate for Payer: Cigna of CA HMO/PPO	$110.40
Rate for Payer: Health Smart Auto/Commercial	$82.80
Rate for Payer: LLUH Dept of Risk Management WC	$75.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$103.50

HC CREATINE KINASE

Facility

$24.00

Service Code	CPT 82550
Hospital Charge Code	900910222
Hospital Revenue Code	301
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.40
Rate for Payer: Aetna of CA Government/Medicare	$14.40
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.00

HC CREATININE

Facility

$15.00

Service Code	CPT 82565
Hospital Charge Code	900910247
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 CREATININE

Facility

$89.00

Service Code	CPT 82565
Hospital Charge Code	900910247
Hospital Revenue Code	301
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$71.20
Rate for Payer: Health Smart Auto/Commercial	$53.40
Rate for Payer: Cash Price	$40.05
Rate for Payer: Cigna of CA HMO/PPO	$71.20
Rate for Payer: LLUH Dept of Risk Management WC	$48.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$66.75

HC CREATININE BODY FLUID

Facility

$15.00

Service Code	CPT 82570
Hospital Charge Code	900910377
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

Know your out-of-pocket cost for care.

All Charges