Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC OCA1 81479 SOUMN

Facility

$1,181.68

Service Code	CPT 81479
Hospital Charge Code	900914802
Hospital Revenue Code	309
Min. Negotiated Rate	$649.92
Max. Negotiated Rate	$886.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$709.01
Rate for Payer: Aetna of CA Government/Medicare	$709.01
Rate for Payer: Cash Price	$531.76
Rate for Payer: Health Smart Auto/Commercial	$709.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$709.01
Rate for Payer: LLUH Dept of Risk Management WC	$649.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$886.26

HC OCA1 81479 SOUMN

Facility

$1,181.68

Service Code	CPT 81479
Hospital Charge Code	900914802
Hospital Revenue Code	309
Min. Negotiated Rate	$649.92
Max. Negotiated Rate	$945.34
Rate for Payer: Cash Price	$531.76
Rate for Payer: Cigna of CA HMO/PPO	$945.34
Rate for Payer: Health Smart Auto/Commercial	$709.01
Rate for Payer: LLUH Dept of Risk Management WC	$649.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$886.26

HC OCCULT BLOOD GASTRIC

Facility

$7.00

Service Code	CPT 82271
Hospital Charge Code	900912329
Hospital Revenue Code	301
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.20
Rate for Payer: Aetna of CA Government/Medicare	$4.20
Rate for Payer: Cash Price	$3.15
Rate for Payer: Health Smart Auto/Commercial	$4.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.25

HC OCCULT BLOOD GASTRIC

Facility

$122.00

Service Code	CPT 82271
Hospital Charge Code	900912329
Hospital Revenue Code	301
Min. Negotiated Rate	$67.10
Max. Negotiated Rate	$97.60
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cigna of CA HMO/PPO	$97.60
Rate for Payer: Health Smart Auto/Commercial	$73.20
Rate for Payer: LLUH Dept of Risk Management WC	$67.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$91.50

HC OCCULT BLOOD OTHR SOURCE

Facility

$122.00

Service Code	CPT 82271
Hospital Charge Code	900911536
Hospital Revenue Code	301
Min. Negotiated Rate	$67.10
Max. Negotiated Rate	$97.60
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cigna of CA HMO/PPO	$97.60
Rate for Payer: Health Smart Auto/Commercial	$73.20
Rate for Payer: LLUH Dept of Risk Management WC	$67.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$91.50

HC OCCULT BLOOD OTHR SOURCE

Facility

$9.00

Service Code	CPT 82271
Hospital Charge Code	900911536
Hospital Revenue Code	301
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$6.75
Rate for Payer: Health Smart Auto/Commercial	$5.40
Rate for Payer: Cash Price	$4.05
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.40
Rate for Payer: Aetna of CA Government/Medicare	$5.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.40
Rate for Payer: LLUH Dept of Risk Management WC	$4.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$6.75

HC OPIATES CONF & ID

Facility

$225.00

Service Code	CPT 80361
Hospital Charge Code	900910516
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 OPIATES CONF & ID

Facility

$225.00

Service Code	CPT G0480
Hospital Charge Code	900910516
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 OPIATES CONF & ID

Facility

$271.00

Service Code	CPT G0480
Hospital Charge Code	900910516
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 OPIATES CONF & ID

Facility

$271.00

Service Code	CPT 80361
Hospital Charge Code	900910516
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 ORBITS

Facility

$1,444.00

Service Code	CPT 70200
Hospital Charge Code	909001111
Hospital Revenue Code	320
Min. Negotiated Rate	$794.20
Max. Negotiated Rate	$1,155.20
Rate for Payer: Cash Price	$649.80
Rate for Payer: Cigna of CA HMO/PPO	$1,155.20
Rate for Payer: Health Smart Auto/Commercial	$866.40
Rate for Payer: LLUH Dept of Risk Management WC	$794.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,083.00

HC ORBITS

Facility

$1,444.00

Service Code	CPT 70200 TC
Hospital Charge Code	909001111
Hospital Revenue Code	320
Min. Negotiated Rate	$794.20
Max. Negotiated Rate	$1,155.20
Rate for Payer: Cash Price	$649.80
Rate for Payer: Cigna of CA HMO/PPO	$1,155.20
Rate for Payer: Health Smart Auto/Commercial	$866.40
Rate for Payer: LLUH Dept of Risk Management WC	$794.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,083.00

HC ORBITS

Facility

$1,444.00

Service Code	CPT 70200 TC
Hospital Charge Code	909001111
Hospital Revenue Code	320
Min. Negotiated Rate	$794.20
Max. Negotiated Rate	$1,083.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$866.40
Rate for Payer: Aetna of CA Government/Medicare	$866.40
Rate for Payer: Cash Price	$649.80
Rate for Payer: Health Smart Auto/Commercial	$866.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$866.40
Rate for Payer: LLUH Dept of Risk Management WC	$794.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,083.00

HC ORBITS

Facility

$1,444.00

Service Code	CPT 70200
Hospital Charge Code	909001111
Hospital Revenue Code	320
Min. Negotiated Rate	$794.20
Max. Negotiated Rate	$1,083.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$866.40
Rate for Payer: Aetna of CA Government/Medicare	$866.40
Rate for Payer: Cash Price	$649.80
Rate for Payer: Health Smart Auto/Commercial	$866.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$866.40
Rate for Payer: LLUH Dept of Risk Management WC	$794.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,083.00

HC OSMOLALITY SERUM

Facility

$224.00

Service Code	CPT 83930
Hospital Charge Code	900910264
Hospital Revenue Code	301
Min. Negotiated Rate	$123.20
Max. Negotiated Rate	$179.20
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna of CA HMO/PPO	$179.20
Rate for Payer: Health Smart Auto/Commercial	$134.40
Rate for Payer: LLUH Dept of Risk Management WC	$123.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$168.00

HC OSMOLALITY SERUM

Facility

$224.00

Service Code	CPT 83930
Hospital Charge Code	900910264
Hospital Revenue Code	301
Min. Negotiated Rate	$123.20
Max. Negotiated Rate	$168.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$134.40
Rate for Payer: Aetna of CA Government/Medicare	$134.40
Rate for Payer: Cash Price	$100.80
Rate for Payer: Health Smart Auto/Commercial	$134.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$134.40
Rate for Payer: LLUH Dept of Risk Management WC	$123.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$168.00

HC OSMOLALITY STOOL

Facility

$26.00

Service Code	CPT 83935
Hospital Charge Code	900910358
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 OSMOLALITY STOOL

Facility

$259.00

Service Code	CPT 83935
Hospital Charge Code	900910358
Hospital Revenue Code	301
Min. Negotiated Rate	$142.45
Max. Negotiated Rate	$207.20
Rate for Payer: Cash Price	$116.55
Rate for Payer: Cigna of CA HMO/PPO	$207.20
Rate for Payer: Health Smart Auto/Commercial	$155.40
Rate for Payer: LLUH Dept of Risk Management WC	$142.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$194.25

HC OSMOLALITY URINE

Facility

$236.00

Service Code	CPT 83935
Hospital Charge Code	900910214
Hospital Revenue Code	301
Min. Negotiated Rate	$129.80
Max. Negotiated Rate	$188.80
Rate for Payer: Cash Price	$106.20
Rate for Payer: Cigna of CA HMO/PPO	$188.80
Rate for Payer: Health Smart Auto/Commercial	$141.60
Rate for Payer: LLUH Dept of Risk Management WC	$129.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$177.00

HC OSMOLALITY URINE

Facility

$26.00

Service Code	CPT 83935
Hospital Charge Code	900910214
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 OSMOTIC FRAGILITY

Facility

$54.00

Service Code	CPT 85555
Hospital Charge Code	900910039
Hospital Revenue Code	305
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 OSMOTIC FRAGILITY

Facility

$244.00

Service Code	CPT 85555
Hospital Charge Code	900910039
Hospital Revenue Code	305
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$195.20
Rate for Payer: Cash Price	$109.80
Rate for Payer: Cigna of CA HMO/PPO	$195.20
Rate for Payer: Health Smart Auto/Commercial	$146.40
Rate for Payer: LLUH Dept of Risk Management WC	$134.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$183.00

HC OSMOTIC FRAGILITY (INC)

Facility

$52.00

Service Code	CPT 85557
Hospital Charge Code	900910077
Hospital Revenue Code	305
Min. Negotiated Rate	$28.60
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.20
Rate for Payer: Aetna of CA Government/Medicare	$31.20
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Smart Auto/Commercial	$31.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.20
Rate for Payer: LLUH Dept of Risk Management WC	$28.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.00

HC OSMOTIC FRAGILITY (INC)

Facility

$398.00

Service Code	CPT 85557
Hospital Charge Code	900910077
Hospital Revenue Code	305
Min. Negotiated Rate	$218.90
Max. Negotiated Rate	$318.40
Rate for Payer: Cash Price	$179.10
Rate for Payer: Cigna of CA HMO/PPO	$318.40
Rate for Payer: Health Smart Auto/Commercial	$238.80
Rate for Payer: LLUH Dept of Risk Management WC	$218.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$298.50

HC OT TASK GROUP

Facility

$325.00

Service Code	CPT G0177
Hospital Charge Code	907804025
Hospital Revenue Code	942
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

Know your out-of-pocket cost for care.

All Charges