Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC DRUGS ABUSE SCREEN,URINE(7)COC

Facility

$105.00

Service Code	CPT 80307
Hospital Charge Code	900912159
Hospital Revenue Code	301
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$63.00
Rate for Payer: Aetna of CA Government/Medicare	$63.00
Rate for Payer: Cash Price	$47.25
Rate for Payer: Health Smart Auto/Commercial	$63.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$63.00
Rate for Payer: LLUH Dept of Risk Management WC	$57.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$78.75

HC DRUGS ABUSE SCREEN,URINE(7)COC

Facility

$851.00

Service Code	CPT 80307
Hospital Charge Code	900912159
Hospital Revenue Code	301
Min. Negotiated Rate	$468.05
Max. Negotiated Rate	$680.80
Rate for Payer: Cash Price	$382.95
Rate for Payer: Cigna of CA HMO/PPO	$680.80
Rate for Payer: Health Smart Auto/Commercial	$510.60
Rate for Payer: LLUH Dept of Risk Management WC	$468.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$638.25

HC DRUG SCREEN BARBITUATES

Facility

$121.00

Service Code	CPT 80307
Hospital Charge Code	900910325
Hospital Revenue Code	301
Min. Negotiated Rate	$66.55
Max. Negotiated Rate	$96.80
Rate for Payer: Cash Price	$54.45
Rate for Payer: Cigna of CA HMO/PPO	$96.80
Rate for Payer: Health Smart Auto/Commercial	$72.60
Rate for Payer: LLUH Dept of Risk Management WC	$66.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$90.75

HC DRUG SCREEN BARBITUATES

Facility

$105.00

Service Code	CPT 80307
Hospital Charge Code	900910325
Hospital Revenue Code	301
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$63.00
Rate for Payer: Aetna of CA Government/Medicare	$63.00
Rate for Payer: Cash Price	$47.25
Rate for Payer: Health Smart Auto/Commercial	$63.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$63.00
Rate for Payer: LLUH Dept of Risk Management WC	$57.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$78.75

HC DRUG SCREEN BENZODIAZPINES

Facility

$121.00

Service Code	CPT 80307
Hospital Charge Code	900911101
Hospital Revenue Code	301
Min. Negotiated Rate	$66.55
Max. Negotiated Rate	$96.80
Rate for Payer: Cash Price	$54.45
Rate for Payer: Cigna of CA HMO/PPO	$96.80
Rate for Payer: Health Smart Auto/Commercial	$72.60
Rate for Payer: LLUH Dept of Risk Management WC	$66.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$90.75

HC DRUG SCREEN BENZODIAZPINES

Facility

$105.00

Service Code	CPT 80307
Hospital Charge Code	900911101
Hospital Revenue Code	301
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$63.00
Rate for Payer: Aetna of CA Government/Medicare	$63.00
Rate for Payer: Cash Price	$47.25
Rate for Payer: Health Smart Auto/Commercial	$63.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$63.00
Rate for Payer: LLUH Dept of Risk Management WC	$57.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$78.75

HC DRUG SCREEN CANNABINOIDS

Facility

$105.00

Service Code	CPT 80307
Hospital Charge Code	900911238
Hospital Revenue Code	301
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$63.00
Rate for Payer: Aetna of CA Government/Medicare	$63.00
Rate for Payer: Cash Price	$47.25
Rate for Payer: Health Smart Auto/Commercial	$63.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$63.00
Rate for Payer: LLUH Dept of Risk Management WC	$57.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$78.75

HC DRUG SCREEN CANNABINOIDS

Facility

$121.00

Service Code	CPT 80307
Hospital Charge Code	900911238
Hospital Revenue Code	301
Min. Negotiated Rate	$66.55
Max. Negotiated Rate	$96.80
Rate for Payer: Cash Price	$54.45
Rate for Payer: Cigna of CA HMO/PPO	$96.80
Rate for Payer: Health Smart Auto/Commercial	$72.60
Rate for Payer: LLUH Dept of Risk Management WC	$66.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$90.75

HC DRUG SCREEN COCAINE

Facility

$121.00

Service Code	CPT 80307
Hospital Charge Code	900910390
Hospital Revenue Code	301
Min. Negotiated Rate	$66.55
Max. Negotiated Rate	$96.80
Rate for Payer: Cash Price	$54.45
Rate for Payer: Cigna of CA HMO/PPO	$96.80
Rate for Payer: Health Smart Auto/Commercial	$72.60
Rate for Payer: LLUH Dept of Risk Management WC	$66.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$90.75

HC DRUG SCREEN COCAINE

Facility

$105.00

Service Code	CPT 80307
Hospital Charge Code	900910390
Hospital Revenue Code	301
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$63.00
Rate for Payer: Aetna of CA Government/Medicare	$63.00
Rate for Payer: Cash Price	$47.25
Rate for Payer: Health Smart Auto/Commercial	$63.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$63.00
Rate for Payer: LLUH Dept of Risk Management WC	$57.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$78.75

HC DRUG SCREEN OPIATES

Facility

$121.00

Service Code	CPT 80307
Hospital Charge Code	900911145
Hospital Revenue Code	301
Min. Negotiated Rate	$66.55
Max. Negotiated Rate	$96.80
Rate for Payer: Cash Price	$54.45
Rate for Payer: Cigna of CA HMO/PPO	$96.80
Rate for Payer: Health Smart Auto/Commercial	$72.60
Rate for Payer: LLUH Dept of Risk Management WC	$66.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$90.75

HC DRUG SCREEN OPIATES

Facility

$105.00

Service Code	CPT 80307
Hospital Charge Code	900911145
Hospital Revenue Code	301
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$63.00
Rate for Payer: Aetna of CA Government/Medicare	$63.00
Rate for Payer: Cash Price	$47.25
Rate for Payer: Health Smart Auto/Commercial	$63.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$63.00
Rate for Payer: LLUH Dept of Risk Management WC	$57.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$78.75

HC DRUG SCREEN PHENCYCLIDINE

Facility

$105.00

Service Code	CPT 80307
Hospital Charge Code	900911147
Hospital Revenue Code	301
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$63.00
Rate for Payer: Aetna of CA Government/Medicare	$63.00
Rate for Payer: Cash Price	$47.25
Rate for Payer: Health Smart Auto/Commercial	$63.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$63.00
Rate for Payer: LLUH Dept of Risk Management WC	$57.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$78.75

HC DRUG SCREEN PHENCYCLIDINE

Facility

$121.00

Service Code	CPT 80307
Hospital Charge Code	900911147
Hospital Revenue Code	301
Min. Negotiated Rate	$66.55
Max. Negotiated Rate	$96.80
Rate for Payer: Cash Price	$54.45
Rate for Payer: Cigna of CA HMO/PPO	$96.80
Rate for Payer: Health Smart Auto/Commercial	$72.60
Rate for Payer: LLUH Dept of Risk Management WC	$66.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$90.75

HC DRUG SCREEN, PRE-EMPLOYMENT

Facility

$105.00

Service Code	CPT 80307
Hospital Charge Code	900912158
Hospital Revenue Code	301
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$63.00
Rate for Payer: Aetna of CA Government/Medicare	$63.00
Rate for Payer: Cash Price	$47.25
Rate for Payer: Health Smart Auto/Commercial	$63.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$63.00
Rate for Payer: LLUH Dept of Risk Management WC	$57.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$78.75

HC DRUG SCREEN, PRE-EMPLOYMENT

Facility

$851.00

Service Code	CPT 80307
Hospital Charge Code	900912158
Hospital Revenue Code	301
Min. Negotiated Rate	$468.05
Max. Negotiated Rate	$680.80
Rate for Payer: Cash Price	$382.95
Rate for Payer: Cigna of CA HMO/PPO	$680.80
Rate for Payer: Health Smart Auto/Commercial	$510.60
Rate for Payer: LLUH Dept of Risk Management WC	$468.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$638.25

HC DRUGS OF ABUSE SCREEN,URINE(5)

Facility

$608.00

Service Code	CPT 80307
Hospital Charge Code	900912160
Hospital Revenue Code	301
Min. Negotiated Rate	$334.40
Max. Negotiated Rate	$486.40
Rate for Payer: Cash Price	$273.60
Rate for Payer: Cigna of CA HMO/PPO	$486.40
Rate for Payer: Health Smart Auto/Commercial	$364.80
Rate for Payer: LLUH Dept of Risk Management WC	$334.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$456.00

HC DRUGS OF ABUSE SCREEN,URINE(5)

Facility

$105.00

Service Code	CPT 80307
Hospital Charge Code	900912160
Hospital Revenue Code	301
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$63.00
Rate for Payer: Aetna of CA Government/Medicare	$63.00
Rate for Payer: Cash Price	$47.25
Rate for Payer: Health Smart Auto/Commercial	$63.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$63.00
Rate for Payer: LLUH Dept of Risk Management WC	$57.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$78.75

HC DRUGS OF ABUSE SCREEN,URINE(7)

Facility

$105.00

Service Code	CPT 80307
Hospital Charge Code	900912161
Hospital Revenue Code	301
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$63.00
Rate for Payer: Aetna of CA Government/Medicare	$63.00
Rate for Payer: Cash Price	$47.25
Rate for Payer: Health Smart Auto/Commercial	$63.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$63.00
Rate for Payer: LLUH Dept of Risk Management WC	$57.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$78.75

HC DRUGS OF ABUSE SCREEN,URINE(7)

Facility

$851.00

Service Code	CPT 80307
Hospital Charge Code	900912161
Hospital Revenue Code	301
Min. Negotiated Rate	$468.05
Max. Negotiated Rate	$680.80
Rate for Payer: Cash Price	$382.95
Rate for Payer: Cigna of CA HMO/PPO	$680.80
Rate for Payer: Health Smart Auto/Commercial	$510.60
Rate for Payer: LLUH Dept of Risk Management WC	$468.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$638.25

HC DRVVT

Facility

$37.00

Service Code	CPT 85613
Hospital Charge Code	900912008
Hospital Revenue Code	305
Min. Negotiated Rate	$20.35
Max. Negotiated Rate	$27.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$22.20
Rate for Payer: Aetna of CA Government/Medicare	$22.20
Rate for Payer: Cash Price	$16.65
Rate for Payer: Health Smart Auto/Commercial	$22.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$22.20
Rate for Payer: LLUH Dept of Risk Management WC	$20.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.75

HC DRVVT

Facility

$217.00

Service Code	CPT 85613
Hospital Charge Code	900912008
Hospital Revenue Code	305
Min. Negotiated Rate	$119.35
Max. Negotiated Rate	$173.60
Rate for Payer: Cash Price	$97.65
Rate for Payer: Cigna of CA HMO/PPO	$173.60
Rate for Payer: Health Smart Auto/Commercial	$130.20
Rate for Payer: LLUH Dept of Risk Management WC	$119.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$162.75

HC D TEST

Facility

$160.00

Service Code	CPT 87184
Hospital Charge Code	900912427
Hospital Revenue Code	306
Min. Negotiated Rate	$88.00
Max. Negotiated Rate	$128.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna of CA HMO/PPO	$128.00
Rate for Payer: Health Smart Auto/Commercial	$96.00
Rate for Payer: LLUH Dept of Risk Management WC	$88.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$120.00

HC D TEST

Facility

$31.00

Service Code	CPT 87184
Hospital Charge Code	900912427
Hospital Revenue Code	306
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.60
Rate for Payer: Aetna of CA Government/Medicare	$18.60
Rate for Payer: Cash Price	$13.95
Rate for Payer: Health Smart Auto/Commercial	$18.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.60
Rate for Payer: LLUH Dept of Risk Management WC	$17.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$23.25

HC EBNA IGG

Facility

$25.00

Service Code	CPT 86664
Hospital Charge Code	900913537
Hospital Revenue Code	302
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

Know your out-of-pocket cost for care.

All Charges