Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC PROTEIN CSF

Facility

$20.00

Service Code	CPT 84157
Hospital Charge Code	900912250
Hospital Revenue Code	301
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$16.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cigna of CA HMO/PPO	$16.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.00

HC PROTEIN CSF

Facility

$11.00

Service Code	CPT 84157
Hospital Charge Code	900912250
Hospital Revenue Code	301
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.60
Rate for Payer: Aetna of CA Government/Medicare	$6.60
Rate for Payer: Cash Price	$4.95
Rate for Payer: Health Smart Auto/Commercial	$6.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.60
Rate for Payer: LLUH Dept of Risk Management WC	$6.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.25

HC PROTEIN ELECT CSF/URINE

Facility

$230.00

Service Code	CPT 84166
Hospital Charge Code	900910849
Hospital Revenue Code	301
Min. Negotiated Rate	$126.50
Max. Negotiated Rate	$184.00
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cigna of CA HMO/PPO	$184.00
Rate for Payer: Health Smart Auto/Commercial	$138.00
Rate for Payer: LLUH Dept of Risk Management WC	$126.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$172.50

HC PROTEIN ELECT CSF/URINE

Facility

$68.00

Service Code	CPT 84166
Hospital Charge Code	900910849
Hospital Revenue Code	301
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$40.80
Rate for Payer: Aetna of CA Government/Medicare	$40.80
Rate for Payer: Cash Price	$30.60
Rate for Payer: Health Smart Auto/Commercial	$40.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$40.80
Rate for Payer: LLUH Dept of Risk Management WC	$37.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$51.00

HC PROTEIN ELECT SERUM

Facility

$31.00

Service Code	CPT 84165
Hospital Charge Code	900910850
Hospital Revenue Code	301
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 PROTEIN ELECT SERUM

Facility

$230.00

Service Code	CPT 84165 TC
Hospital Charge Code	900910850
Hospital Revenue Code	301
Min. Negotiated Rate	$126.50
Max. Negotiated Rate	$184.00
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cigna of CA HMO/PPO	$184.00
Rate for Payer: Health Smart Auto/Commercial	$138.00
Rate for Payer: LLUH Dept of Risk Management WC	$126.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$172.50

HC PROTEIN ELECT SERUM

Facility

$230.00

Service Code	CPT 84165
Hospital Charge Code	900910850
Hospital Revenue Code	301
Min. Negotiated Rate	$126.50
Max. Negotiated Rate	$184.00
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cigna of CA HMO/PPO	$184.00
Rate for Payer: Health Smart Auto/Commercial	$138.00
Rate for Payer: LLUH Dept of Risk Management WC	$126.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$172.50

HC PROTEIN TOTAL

Facility

$89.00

Service Code	CPT 84155
Hospital Charge Code	900910249
Hospital Revenue Code	301
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$71.20
Rate for Payer: Cash Price	$40.05
Rate for Payer: Cigna of CA HMO/PPO	$71.20
Rate for Payer: Health Smart Auto/Commercial	$53.40
Rate for Payer: LLUH Dept of Risk Management WC	$48.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$66.75

HC PROTEIN TOTAL

Facility

$15.00

Service Code	CPT 84155
Hospital Charge Code	900910249
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 PROTEIN TOTAL SPE ONLY

Facility

$89.00

Service Code	CPT 84155
Hospital Charge Code	900912163
Hospital Revenue Code	301
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$71.20
Rate for Payer: Cash Price	$40.05
Rate for Payer: Cigna of CA HMO/PPO	$71.20
Rate for Payer: Health Smart Auto/Commercial	$53.40
Rate for Payer: LLUH Dept of Risk Management WC	$48.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$66.75

HC PROTEIN TOTAL SPE ONLY

Facility

$15.00

Service Code	CPT 84155
Hospital Charge Code	900912163
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$11.25
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Cash Price	$6.75
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: 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 PROTEIN URINE

Facility

$15.00

Service Code	CPT 84156
Hospital Charge Code	900910290
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 PROTEIN URINE

Facility

$106.00

Service Code	CPT 84156
Hospital Charge Code	900910290
Hospital Revenue Code	301
Min. Negotiated Rate	$58.30
Max. Negotiated Rate	$84.80
Rate for Payer: Cash Price	$47.70
Rate for Payer: Cigna of CA HMO/PPO	$84.80
Rate for Payer: Health Smart Auto/Commercial	$63.60
Rate for Payer: LLUH Dept of Risk Management WC	$58.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$79.50

HC PROTHROMBIN G20210A MUTATION

Facility

$168.00

Service Code	CPT 81240
Hospital Charge Code	900912324
Hospital Revenue Code	310
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$126.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$100.80
Rate for Payer: Aetna of CA Government/Medicare	$100.80
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Smart Auto/Commercial	$100.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$100.80
Rate for Payer: LLUH Dept of Risk Management WC	$92.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$126.00

HC PROTHROMBIN G20210A MUTATION

Facility

$632.00

Service Code	CPT 81240
Hospital Charge Code	900912324
Hospital Revenue Code	310
Min. Negotiated Rate	$347.60
Max. Negotiated Rate	$505.60
Rate for Payer: Cash Price	$284.40
Rate for Payer: Cigna of CA HMO/PPO	$505.60
Rate for Payer: Health Smart Auto/Commercial	$379.20
Rate for Payer: LLUH Dept of Risk Management WC	$347.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$474.00

HC PROTHROMBIN TIME (POC)

Facility

$128.00

Service Code	CPT 85610
Hospital Charge Code	900912025
Hospital Revenue Code	305
Min. Negotiated Rate	$70.40
Max. Negotiated Rate	$102.40
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cigna of CA HMO/PPO	$102.40
Rate for Payer: Health Smart Auto/Commercial	$76.80
Rate for Payer: LLUH Dept of Risk Management WC	$70.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$96.00

HC PROTHROMBIN TIME (POC)

Facility

$128.00

Service Code	CPT 85610
Hospital Charge Code	900912025
Hospital Revenue Code	305
Min. Negotiated Rate	$70.40
Max. Negotiated Rate	$96.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$76.80
Rate for Payer: Aetna of CA Government/Medicare	$76.80
Rate for Payer: Cash Price	$57.60
Rate for Payer: Health Smart Auto/Commercial	$76.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$76.80
Rate for Payer: LLUH Dept of Risk Management WC	$70.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$96.00

HC PROTHROMBIN TIME QUICK

Facility

$13.00

Service Code	CPT 85610
Hospital Charge Code	900910040
Hospital Revenue Code	305
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.80
Rate for Payer: Aetna of CA Government/Medicare	$7.80
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC PROTHROMBIN TIME QUICK

Facility

$128.00

Service Code	CPT 85610
Hospital Charge Code	900910040
Hospital Revenue Code	305
Min. Negotiated Rate	$70.40
Max. Negotiated Rate	$102.40
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cigna of CA HMO/PPO	$102.40
Rate for Payer: Health Smart Auto/Commercial	$76.80
Rate for Payer: LLUH Dept of Risk Management WC	$70.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$96.00

HC PSYCH DIAGNOSTIC EVALUATION

Facility

$124.00

Service Code	CPT 90791
Hospital Charge Code	950900000
Hospital Revenue Code	900
Min. Negotiated Rate	$68.20
Max. Negotiated Rate	$99.20
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cigna of CA HMO/PPO	$99.20
Rate for Payer: Health Smart Auto/Commercial	$74.40
Rate for Payer: LLUH Dept of Risk Management WC	$68.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$93.00

HC PSYCH DIAGNOSTIC EVALUATION

Facility

$124.00

Service Code	CPT 90791
Hospital Charge Code	950900000
Hospital Revenue Code	900
Min. Negotiated Rate	$68.20
Max. Negotiated Rate	$224.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$224.40
Rate for Payer: Aetna of CA Government/Medicare	$224.40
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cash Price	$55.80
Rate for Payer: Health Smart Auto/Commercial	$74.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$74.40
Rate for Payer: LLUH Dept of Risk Management WC	$68.20
Rate for Payer: Mary Free Bed Workers' Compensation	$165.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$93.00

HC PSYCH TESTING

Facility

$153.00

Service Code	CPT 96100
Hospital Charge Code	907804040
Hospital Revenue Code	918
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$122.40
Rate for Payer: Cash Price	$68.85
Rate for Payer: Cigna of CA HMO/PPO	$122.40
Rate for Payer: Health Smart Auto/Commercial	$91.80
Rate for Payer: LLUH Dept of Risk Management WC	$84.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$114.75

HC PSYCH TESTING

Facility

$153.00

Service Code	CPT 96100
Hospital Charge Code	907804040
Hospital Revenue Code	912
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$644.00
Rate for Payer: Cash Price	$68.85
Rate for Payer: Cash Price	$68.85
Rate for Payer: Cigna of CA HMO/PPO	$122.40
Rate for Payer: Health Smart Auto/Commercial	$91.80
Rate for Payer: LLUH Dept of Risk Management WC	$84.15
Rate for Payer: Mary Free Bed Workers' Compensation	$644.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$114.75

HC PSYCH TESTING

Facility

$153.00

Service Code	CPT 96100
Hospital Charge Code	907804040
Hospital Revenue Code	918
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$114.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$91.80
Rate for Payer: Aetna of CA Government/Medicare	$91.80
Rate for Payer: Cash Price	$68.85
Rate for Payer: Health Smart Auto/Commercial	$91.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$91.80
Rate for Payer: LLUH Dept of Risk Management WC	$84.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$114.75

HC PSYCH TESTING

Facility

$153.00

Service Code	CPT 96100
Hospital Charge Code	907804040
Hospital Revenue Code	912
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$725.00
Rate for Payer: Aetna of CA Government/Medicare	$91.80
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$68.85
Rate for Payer: Cash Price	$68.85
Rate for Payer: Cigna of CA HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Heritage Provider Network Commercial	$472.00
Rate for Payer: Heritage Provider Network Senior	$472.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$522.00
Rate for Payer: LLUH Dept of Risk Management WC	$84.15
Rate for Payer: Magellan Commercial	$637.00
Rate for Payer: Managed Health Network (MHN) Commercial	$682.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$114.75
Rate for Payer: US Behavioral Health Commercial/Medicare	$498.68

Know your out-of-pocket cost for care.

All Charges