Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC LIPASE

Facility

$233.00

Service Code	CPT 83690
Hospital Charge Code	900910334
Hospital Revenue Code	301
Min. Negotiated Rate	$128.15
Max. Negotiated Rate	$186.40
Rate for Payer: Cash Price	$104.85
Rate for Payer: Cigna of CA HMO/PPO	$186.40
Rate for Payer: Health Smart Auto/Commercial	$139.80
Rate for Payer: LLUH Dept of Risk Management WC	$128.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$174.75

HC LIPASE

Facility

$26.00

Service Code	CPT 83690
Hospital Charge Code	900910334
Hospital Revenue Code	301
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

HC LIPASE BODY FLUID

Facility

$17.00

Service Code	CPT 83690
Hospital Charge Code	900912244
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 LIPASE BODY FLUID

Facility

$32.00

Service Code	CPT 83690
Hospital Charge Code	900912244
Hospital Revenue Code	301
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$25.60
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna of CA HMO/PPO	$25.60
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.00

HC LITHIUM

Facility

$26.00

Service Code	CPT 80178
Hospital Charge Code	900910332
Hospital Revenue Code	301
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

HC LITHIUM

Facility

$117.00

Service Code	CPT 80178
Hospital Charge Code	900910332
Hospital Revenue Code	301
Min. Negotiated Rate	$64.35
Max. Negotiated Rate	$93.60
Rate for Payer: Cash Price	$52.65
Rate for Payer: Cigna of CA HMO/PPO	$93.60
Rate for Payer: Health Smart Auto/Commercial	$70.20
Rate for Payer: LLUH Dept of Risk Management WC	$64.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$87.75

HC LOW MIGRAT STAGE IV CONF & ID

Facility

$271.00

Service Code	CPT 80307
Hospital Charge Code	900910511
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 LOW MIGRAT STAGE IV CONF & ID

Facility

$225.00

Service Code	CPT G0480
Hospital Charge Code	900910511
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 LOW MIGRAT STAGE IV CONF & ID

Facility

$271.00

Service Code	CPT G0480
Hospital Charge Code	900910511
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 LOW MIGRAT STAGE IV CONF & ID

Facility

$225.00

Service Code	CPT 80307
Hospital Charge Code	900910511
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 LUMBAR SPINE AP AND LATERAL

Facility

$1,093.00

Service Code	CPT 72100
Hospital Charge Code	909001315
Hospital Revenue Code	320
Min. Negotiated Rate	$601.15
Max. Negotiated Rate	$874.40
Rate for Payer: Cash Price	$491.85
Rate for Payer: Cigna of CA HMO/PPO	$874.40
Rate for Payer: Health Smart Auto/Commercial	$655.80
Rate for Payer: LLUH Dept of Risk Management WC	$601.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$819.75

HC LUMBAR SPINE AP AND LATERAL

Facility

$1,093.00

Service Code	CPT 72100 TC
Hospital Charge Code	909001315
Hospital Revenue Code	320
Min. Negotiated Rate	$601.15
Max. Negotiated Rate	$819.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$655.80
Rate for Payer: Aetna of CA Government/Medicare	$655.80
Rate for Payer: Cash Price	$491.85
Rate for Payer: Health Smart Auto/Commercial	$655.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$655.80
Rate for Payer: LLUH Dept of Risk Management WC	$601.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$819.75

HC LUMBAR SPINE AP AND LATERAL

Facility

$1,093.00

Service Code	CPT 72100
Hospital Charge Code	909001315
Hospital Revenue Code	320
Min. Negotiated Rate	$601.15
Max. Negotiated Rate	$819.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$655.80
Rate for Payer: Aetna of CA Government/Medicare	$655.80
Rate for Payer: Cash Price	$491.85
Rate for Payer: Health Smart Auto/Commercial	$655.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$655.80
Rate for Payer: LLUH Dept of Risk Management WC	$601.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$819.75

HC LUMBAR SPINE AP AND LATERAL

Facility

$1,093.00

Service Code	CPT 72100 TC
Hospital Charge Code	909001315
Hospital Revenue Code	320
Min. Negotiated Rate	$601.15
Max. Negotiated Rate	$874.40
Rate for Payer: Cash Price	$491.85
Rate for Payer: Cigna of CA HMO/PPO	$874.40
Rate for Payer: Health Smart Auto/Commercial	$655.80
Rate for Payer: LLUH Dept of Risk Management WC	$601.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$819.75

HC LUMBAR SPINE LIMITED

Facility

$217.00

Service Code	CPT 72100 TC
Hospital Charge Code	909001136
Hospital Revenue Code	320
Min. Negotiated Rate	$119.35
Max. Negotiated Rate	$162.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$130.20
Rate for Payer: Aetna of CA Government/Medicare	$130.20
Rate for Payer: Cash Price	$97.65
Rate for Payer: Health Smart Auto/Commercial	$130.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$130.20
Rate for Payer: LLUH Dept of Risk Management WC	$119.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$162.75

HC LUMBAR SPINE LIMITED

Facility

$217.00

Service Code	CPT 72100
Hospital Charge Code	909001136
Hospital Revenue Code	320
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 LUMBAR SPINE LIMITED

Facility

$217.00

Service Code	CPT 72100 TC
Hospital Charge Code	909001136
Hospital Revenue Code	320
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 LUMBAR SPINE LIMITED

Facility

$217.00

Service Code	CPT 72100
Hospital Charge Code	909001136
Hospital Revenue Code	320
Min. Negotiated Rate	$119.35
Max. Negotiated Rate	$162.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$130.20
Rate for Payer: Aetna of CA Government/Medicare	$130.20
Rate for Payer: Cash Price	$97.65
Rate for Payer: Health Smart Auto/Commercial	$130.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$130.20
Rate for Payer: LLUH Dept of Risk Management WC	$119.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$162.75

HC LUM SPINE W/OBLIQUES

Facility

$1,441.00

Service Code	CPT 72110
Hospital Charge Code	909001317
Hospital Revenue Code	320
Min. Negotiated Rate	$792.55
Max. Negotiated Rate	$1,080.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$864.60
Rate for Payer: Aetna of CA Government/Medicare	$864.60
Rate for Payer: Cash Price	$648.45
Rate for Payer: Health Smart Auto/Commercial	$864.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$864.60
Rate for Payer: LLUH Dept of Risk Management WC	$792.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,080.75

HC LUM SPINE W/OBLIQUES

Facility

$1,441.00

Service Code	CPT 72110
Hospital Charge Code	909001317
Hospital Revenue Code	320
Min. Negotiated Rate	$792.55
Max. Negotiated Rate	$1,152.80
Rate for Payer: Cash Price	$648.45
Rate for Payer: Cigna of CA HMO/PPO	$1,152.80
Rate for Payer: Health Smart Auto/Commercial	$864.60
Rate for Payer: LLUH Dept of Risk Management WC	$792.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,080.75

HC LUM SPINE W/OBLIQUES

Facility

$1,441.00

Service Code	CPT 72110 TC
Hospital Charge Code	909001317
Hospital Revenue Code	320
Min. Negotiated Rate	$792.55
Max. Negotiated Rate	$1,152.80
Rate for Payer: Cash Price	$648.45
Rate for Payer: Cigna of CA HMO/PPO	$1,152.80
Rate for Payer: Health Smart Auto/Commercial	$864.60
Rate for Payer: LLUH Dept of Risk Management WC	$792.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,080.75

HC LUM SPINE W/OBLIQUES

Facility

$1,441.00

Service Code	CPT 72110 TC
Hospital Charge Code	909001317
Hospital Revenue Code	320
Min. Negotiated Rate	$792.55
Max. Negotiated Rate	$1,080.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$864.60
Rate for Payer: Aetna of CA Government/Medicare	$864.60
Rate for Payer: Cash Price	$648.45
Rate for Payer: Health Smart Auto/Commercial	$864.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$864.60
Rate for Payer: LLUH Dept of Risk Management WC	$792.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,080.75

HC LUPUS SCREEN PTT

Facility

$194.00

Service Code	CPT 85730
Hospital Charge Code	900912006
Hospital Revenue Code	305
Min. Negotiated Rate	$106.70
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$87.30
Rate for Payer: Cigna of CA HMO/PPO	$155.20
Rate for Payer: Health Smart Auto/Commercial	$116.40
Rate for Payer: LLUH Dept of Risk Management WC	$106.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$145.50

HC LUPUS SCREEN PTT

Facility

$20.00

Service Code	CPT 85730
Hospital Charge Code	900912006
Hospital Revenue Code	305
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$15.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.00
Rate for Payer: Aetna of CA Government/Medicare	$12.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.00

HC LUTEINIZING HORMON

Facility

$36.00

Service Code	CPT 83002
Hospital Charge Code	900910886
Hospital Revenue Code	301
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

Know your out-of-pocket cost for care.

All Charges