Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC GROUP PSYCHOTHERAPY-MOTIVATION

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804018
Hospital Revenue Code	912
Min. Negotiated Rate	$178.75
Max. Negotiated Rate	$644.00
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cigna of CA HMO/PPO	$260.00
Rate for Payer: Health Smart Auto/Commercial	$195.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Mary Free Bed Workers' Compensation	$644.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC GROUP PSYCHOTHERAPY-MOTIVATION

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804018
Hospital Revenue Code	915
Min. Negotiated Rate	$178.75
Max. Negotiated Rate	$260.00
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cigna of CA HMO/PPO	$260.00
Rate for Payer: Health Smart Auto/Commercial	$195.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC GROUP PSYCHOTHERAPY-MOTIVATION

Facility

$325.00

Service Code	CPT G0411
Hospital Charge Code	907804018
Hospital Revenue Code	915
Min. Negotiated Rate	$178.75
Max. Negotiated Rate	$260.00
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cigna of CA HMO/PPO	$260.00
Rate for Payer: Health Smart Auto/Commercial	$195.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC GROUP PSYCHOTHERAPY-MOTIVATION

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804018
Hospital Revenue Code	915
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$55.76
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Health Smart Auto/Commercial	$195.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$195.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Mary Free Bed Workers' Compensation	$41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC GROUP THERAPY 60 MIN

Facility

$439.00

Service Code	CPT 90853
Hospital Charge Code	903100090
Hospital Revenue Code	905
Min. Negotiated Rate	$241.45
Max. Negotiated Rate	$469.00
Rate for Payer: Cash Price	$197.55
Rate for Payer: Cash Price	$197.55
Rate for Payer: Cigna of CA HMO/PPO	$351.20
Rate for Payer: Health Smart Auto/Commercial	$263.40
Rate for Payer: LLUH Dept of Risk Management WC	$241.45
Rate for Payer: Mary Free Bed Workers' Compensation	$469.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$329.25

HC GROUP THERAPY 60 MIN

Facility

$439.00

Service Code	CPT 90853
Hospital Charge Code	903100090
Hospital Revenue Code	905
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$475.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Cash Price	$197.55
Rate for Payer: Cash Price	$197.55
Rate for Payer: Cash Price	$197.55
Rate for Payer: Cigna of CA HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Heritage Provider Network Commercial	$281.00
Rate for Payer: Heritage Provider Network Senior	$281.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$293.00
Rate for Payer: LLUH Dept of Risk Management WC	$241.45
Rate for Payer: Magellan Commercial	$406.00
Rate for Payer: Managed Health Network (MHN) Commercial	$434.00
Rate for Payer: Managed Health Network (MHN) Medicare	$111.37
Rate for Payer: Mary Free Bed Workers' Compensation	$41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$329.25
Rate for Payer: US Behavioral Health Commercial/Medicare	$397.33

HC HAND COMPLETE MIN 3 VIEWS

Facility

$972.00

Service Code	CPT 73130 TC
Hospital Charge Code	909001520
Hospital Revenue Code	320
Min. Negotiated Rate	$534.60
Max. Negotiated Rate	$729.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$583.20
Rate for Payer: Aetna of CA Government/Medicare	$583.20
Rate for Payer: Cash Price	$437.40
Rate for Payer: Health Smart Auto/Commercial	$583.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$583.20
Rate for Payer: LLUH Dept of Risk Management WC	$534.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$729.00

HC HAND COMPLETE MIN 3 VIEWS

Facility

$972.00

Service Code	CPT 73130
Hospital Charge Code	909001520
Hospital Revenue Code	320
Min. Negotiated Rate	$534.60
Max. Negotiated Rate	$777.60
Rate for Payer: Health Smart Auto/Commercial	$583.20
Rate for Payer: Cash Price	$437.40
Rate for Payer: Cigna of CA HMO/PPO	$777.60
Rate for Payer: LLUH Dept of Risk Management WC	$534.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$729.00

HC HAND COMPLETE MIN 3 VIEWS

Facility

$972.00

Service Code	CPT 73130
Hospital Charge Code	909001520
Hospital Revenue Code	320
Min. Negotiated Rate	$534.60
Max. Negotiated Rate	$729.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$583.20
Rate for Payer: Aetna of CA Government/Medicare	$583.20
Rate for Payer: Cash Price	$437.40
Rate for Payer: Health Smart Auto/Commercial	$583.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$583.20
Rate for Payer: LLUH Dept of Risk Management WC	$534.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$729.00

HC HAND COMPLETE MIN 3 VIEWS

Facility

$972.00

Service Code	CPT 73130 TC
Hospital Charge Code	909001520
Hospital Revenue Code	320
Min. Negotiated Rate	$534.60
Max. Negotiated Rate	$777.60
Rate for Payer: Cash Price	$437.40
Rate for Payer: Cigna of CA HMO/PPO	$777.60
Rate for Payer: Health Smart Auto/Commercial	$583.20
Rate for Payer: LLUH Dept of Risk Management WC	$534.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$729.00

HC HAND LIMITED 2 VIEWS

Facility

$969.00

Service Code	CPT 73120 TC
Hospital Charge Code	909001518
Hospital Revenue Code	320
Min. Negotiated Rate	$532.95
Max. Negotiated Rate	$775.20
Rate for Payer: Cash Price	$436.05
Rate for Payer: Cigna of CA HMO/PPO	$775.20
Rate for Payer: Health Smart Auto/Commercial	$581.40
Rate for Payer: LLUH Dept of Risk Management WC	$532.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$726.75

HC HAND LIMITED 2 VIEWS

Facility

$969.00

Service Code	CPT 73120
Hospital Charge Code	909001518
Hospital Revenue Code	320
Min. Negotiated Rate	$532.95
Max. Negotiated Rate	$775.20
Rate for Payer: Cash Price	$436.05
Rate for Payer: Cigna of CA HMO/PPO	$775.20
Rate for Payer: Health Smart Auto/Commercial	$581.40
Rate for Payer: LLUH Dept of Risk Management WC	$532.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$726.75

HC HAND LIMITED 2 VIEWS

Facility

$969.00

Service Code	CPT 73120 TC
Hospital Charge Code	909001518
Hospital Revenue Code	320
Min. Negotiated Rate	$532.95
Max. Negotiated Rate	$726.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$581.40
Rate for Payer: Aetna of CA Government/Medicare	$581.40
Rate for Payer: Cash Price	$436.05
Rate for Payer: Health Smart Auto/Commercial	$581.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$581.40
Rate for Payer: LLUH Dept of Risk Management WC	$532.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$726.75

HC HAND LIMITED 2 VIEWS

Facility

$969.00

Service Code	CPT 73120
Hospital Charge Code	909001518
Hospital Revenue Code	320
Min. Negotiated Rate	$532.95
Max. Negotiated Rate	$726.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$581.40
Rate for Payer: Aetna of CA Government/Medicare	$581.40
Rate for Payer: Cash Price	$436.05
Rate for Payer: Health Smart Auto/Commercial	$581.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$581.40
Rate for Payer: LLUH Dept of Risk Management WC	$532.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$726.75

HC HAPTOGLOBIN

Facility

$48.00

Service Code	CPT 83010
Hospital Charge Code	900910844
Hospital Revenue Code	301
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$28.80
Rate for Payer: Aetna of CA Government/Medicare	$28.80
Rate for Payer: Cash Price	$21.60
Rate for Payer: Health Smart Auto/Commercial	$28.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$28.80
Rate for Payer: LLUH Dept of Risk Management WC	$26.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.00

HC HAPTOGLOBIN

Facility

$190.00

Service Code	CPT 83010
Hospital Charge Code	900910844
Hospital Revenue Code	301
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 HCV RNA QUANT

Facility

$231.00

Service Code	CPT 87522
Hospital Charge Code	900913610
Hospital Revenue Code	306
Min. Negotiated Rate	$127.05
Max. Negotiated Rate	$173.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$138.60
Rate for Payer: Aetna of CA Government/Medicare	$138.60
Rate for Payer: Cash Price	$103.95
Rate for Payer: Health Smart Auto/Commercial	$138.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$138.60
Rate for Payer: LLUH Dept of Risk Management WC	$127.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$173.25

HC HCV RNA QUANT

Facility

$812.00

Service Code	CPT 87522
Hospital Charge Code	900913610
Hospital Revenue Code	306
Min. Negotiated Rate	$446.60
Max. Negotiated Rate	$649.60
Rate for Payer: Cash Price	$365.40
Rate for Payer: Cigna of CA HMO/PPO	$649.60
Rate for Payer: Health Smart Auto/Commercial	$487.20
Rate for Payer: LLUH Dept of Risk Management WC	$446.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$609.00

HC HEMATOCRIT HCT POC

Facility

$140.00

Service Code	CPT 85014
Hospital Charge Code	900912115
Hospital Revenue Code	301
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 HEMATOCRIT HCT POC

Facility

$140.00

Service Code	CPT 85014
Hospital Charge Code	900912115
Hospital Revenue Code	301
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 HEMECH-EPINEPHRINE

Facility

$82.00

Service Code	CPT 85576
Hospital Charge Code	900910197
Hospital Revenue Code	305
Min. Negotiated Rate	$45.10
Max. Negotiated Rate	$61.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$49.20
Rate for Payer: Aetna of CA Government/Medicare	$49.20
Rate for Payer: Cash Price	$36.90
Rate for Payer: Health Smart Auto/Commercial	$49.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$49.20
Rate for Payer: LLUH Dept of Risk Management WC	$45.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$61.50

HC HEMECH-EPINEPHRINE

Facility

$468.00

Service Code	CPT 85576
Hospital Charge Code	900910197
Hospital Revenue Code	305
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$374.40
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cigna of CA HMO/PPO	$374.40
Rate for Payer: Health Smart Auto/Commercial	$280.80
Rate for Payer: LLUH Dept of Risk Management WC	$257.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$351.00

HC HEMECH SCRN-ARACHEDONIC ACID A

Facility

$389.00

Service Code	CPT 85576
Hospital Charge Code	900912002
Hospital Revenue Code	305
Min. Negotiated Rate	$213.95
Max. Negotiated Rate	$311.20
Rate for Payer: Cash Price	$175.05
Rate for Payer: Cigna of CA HMO/PPO	$311.20
Rate for Payer: Health Smart Auto/Commercial	$233.40
Rate for Payer: LLUH Dept of Risk Management WC	$213.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$291.75

HC HEMECH SCRN-ARACHEDONIC ACID A

Facility

$82.00

Service Code	CPT 85576
Hospital Charge Code	900912002
Hospital Revenue Code	305
Min. Negotiated Rate	$45.10
Max. Negotiated Rate	$61.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$49.20
Rate for Payer: Aetna of CA Government/Medicare	$49.20
Rate for Payer: Cash Price	$36.90
Rate for Payer: Health Smart Auto/Commercial	$49.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$49.20
Rate for Payer: LLUH Dept of Risk Management WC	$45.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$61.50

HC HEMOGLOBIN A1C

Facility

$30.00

Service Code	CPT 83036
Hospital Charge Code	900912128
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.00
Rate for Payer: Aetna of CA Government/Medicare	$18.00
Rate for Payer: Cash Price	$13.50
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$22.50

Know your out-of-pocket cost for care.

All Charges