Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SENSITIVITY MIC

Facility

$320.00

Service Code	CPT 87186
Hospital Charge Code	900911558
Hospital Revenue Code	306
Min. Negotiated Rate	$176.00
Max. Negotiated Rate	$256.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna of CA HMO/PPO	$256.00
Rate for Payer: Health Smart Auto/Commercial	$192.00
Rate for Payer: LLUH Dept of Risk Management WC	$176.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$240.00

HC SENSITIVITY STREP MIC

Facility

$320.00

Service Code	CPT 87186
Hospital Charge Code	900912413
Hospital Revenue Code	306
Min. Negotiated Rate	$176.00
Max. Negotiated Rate	$256.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna of CA HMO/PPO	$256.00
Rate for Payer: Health Smart Auto/Commercial	$192.00
Rate for Payer: LLUH Dept of Risk Management WC	$176.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$240.00

HC SENSITIVITY STREP MIC

Facility

$34.00

Service Code	CPT 87186
Hospital Charge Code	900912413
Hospital Revenue Code	306
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$20.40
Rate for Payer: Aetna of CA Government/Medicare	$20.40
Rate for Payer: Cash Price	$15.30
Rate for Payer: Health Smart Auto/Commercial	$20.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$20.40
Rate for Payer: LLUH Dept of Risk Management WC	$18.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$25.50

HC SHIGATOXIN

Facility

$162.00

Service Code	CPT 87427
Hospital Charge Code	900912326
Hospital Revenue Code	302
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$129.60
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cigna of CA HMO/PPO	$129.60
Rate for Payer: Health Smart Auto/Commercial	$97.20
Rate for Payer: LLUH Dept of Risk Management WC	$89.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$121.50

HC SHIGATOXIN

Facility

$46.00

Service Code	CPT 87427
Hospital Charge Code	900912326
Hospital Revenue Code	302
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.60
Rate for Payer: Aetna of CA Government/Medicare	$27.60
Rate for Payer: Cash Price	$20.70
Rate for Payer: Health Smart Auto/Commercial	$27.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.60
Rate for Payer: LLUH Dept of Risk Management WC	$25.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$34.50

HC SHOULDER COMPLETE UNILAT

Facility

$1,039.00

Service Code	CPT 73030
Hospital Charge Code	909001504
Hospital Revenue Code	320
Min. Negotiated Rate	$571.45
Max. Negotiated Rate	$831.20
Rate for Payer: Cash Price	$467.55
Rate for Payer: Cigna of CA HMO/PPO	$831.20
Rate for Payer: Health Smart Auto/Commercial	$623.40
Rate for Payer: LLUH Dept of Risk Management WC	$571.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$779.25

HC SHOULDER COMPLETE UNILAT

Facility

$1,039.00

Service Code	CPT 73030 TC
Hospital Charge Code	909001504
Hospital Revenue Code	320
Min. Negotiated Rate	$571.45
Max. Negotiated Rate	$779.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$623.40
Rate for Payer: Aetna of CA Government/Medicare	$623.40
Rate for Payer: Cash Price	$467.55
Rate for Payer: Health Smart Auto/Commercial	$623.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$623.40
Rate for Payer: LLUH Dept of Risk Management WC	$571.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$779.25

HC SHOULDER COMPLETE UNILAT

Facility

$1,039.00

Service Code	CPT 73030
Hospital Charge Code	909001504
Hospital Revenue Code	320
Min. Negotiated Rate	$571.45
Max. Negotiated Rate	$779.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$623.40
Rate for Payer: Aetna of CA Government/Medicare	$623.40
Rate for Payer: Cash Price	$467.55
Rate for Payer: Health Smart Auto/Commercial	$623.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$623.40
Rate for Payer: LLUH Dept of Risk Management WC	$571.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$779.25

HC SHOULDER COMPLETE UNILAT

Facility

$1,039.00

Service Code	CPT 73030 TC
Hospital Charge Code	909001504
Hospital Revenue Code	320
Min. Negotiated Rate	$571.45
Max. Negotiated Rate	$831.20
Rate for Payer: Cash Price	$467.55
Rate for Payer: Cigna of CA HMO/PPO	$831.20
Rate for Payer: Health Smart Auto/Commercial	$623.40
Rate for Payer: LLUH Dept of Risk Management WC	$571.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$779.25

HC SHOULDER LIMITED

Facility

$876.00

Service Code	CPT 73020 TC
Hospital Charge Code	909001505
Hospital Revenue Code	320
Min. Negotiated Rate	$481.80
Max. Negotiated Rate	$700.80
Rate for Payer: Cash Price	$394.20
Rate for Payer: Cigna of CA HMO/PPO	$700.80
Rate for Payer: Health Smart Auto/Commercial	$525.60
Rate for Payer: LLUH Dept of Risk Management WC	$481.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$657.00

HC SHOULDER LIMITED

Facility

$876.00

Service Code	CPT 73020
Hospital Charge Code	909001505
Hospital Revenue Code	320
Min. Negotiated Rate	$481.80
Max. Negotiated Rate	$700.80
Rate for Payer: Cash Price	$394.20
Rate for Payer: Cigna of CA HMO/PPO	$700.80
Rate for Payer: Health Smart Auto/Commercial	$525.60
Rate for Payer: LLUH Dept of Risk Management WC	$481.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$657.00

HC SHOULDER LIMITED

Facility

$876.00

Service Code	CPT 73020 TC
Hospital Charge Code	909001505
Hospital Revenue Code	320
Min. Negotiated Rate	$481.80
Max. Negotiated Rate	$657.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$525.60
Rate for Payer: Aetna of CA Government/Medicare	$525.60
Rate for Payer: Cash Price	$394.20
Rate for Payer: Health Smart Auto/Commercial	$525.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$525.60
Rate for Payer: LLUH Dept of Risk Management WC	$481.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$657.00

HC SHOULDER LIMITED

Facility

$876.00

Service Code	CPT 73020
Hospital Charge Code	909001505
Hospital Revenue Code	320
Min. Negotiated Rate	$481.80
Max. Negotiated Rate	$657.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$525.60
Rate for Payer: Aetna of CA Government/Medicare	$525.60
Rate for Payer: Cash Price	$394.20
Rate for Payer: Health Smart Auto/Commercial	$525.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$525.60
Rate for Payer: LLUH Dept of Risk Management WC	$481.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$657.00

HC SICKLE CELL SCREEN

Facility

$21.00

Service Code	CPT 85660
Hospital Charge Code	900910034
Hospital Revenue Code	305
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$15.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.60
Rate for Payer: Aetna of CA Government/Medicare	$12.60
Rate for Payer: Cash Price	$9.45
Rate for Payer: Health Smart Auto/Commercial	$12.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.60
Rate for Payer: LLUH Dept of Risk Management WC	$11.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.75

HC SICKLE CELL SCREEN

Facility

$101.00

Service Code	CPT 85660
Hospital Charge Code	900910034
Hospital Revenue Code	305
Min. Negotiated Rate	$55.55
Max. Negotiated Rate	$80.80
Rate for Payer: Cash Price	$45.45
Rate for Payer: Cigna of CA HMO/PPO	$80.80
Rate for Payer: Health Smart Auto/Commercial	$60.60
Rate for Payer: LLUH Dept of Risk Management WC	$55.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$75.75

HC SINUS/ PARANASAL COMPLETE

Facility

$1,551.00

Service Code	CPT 70220
Hospital Charge Code	909001141
Hospital Revenue Code	320
Min. Negotiated Rate	$853.05
Max. Negotiated Rate	$1,163.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$930.60
Rate for Payer: Aetna of CA Government/Medicare	$930.60
Rate for Payer: Cash Price	$697.95
Rate for Payer: Health Smart Auto/Commercial	$930.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$930.60
Rate for Payer: LLUH Dept of Risk Management WC	$853.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,163.25

HC SINUS/ PARANASAL COMPLETE

Facility

$1,551.00

Service Code	CPT 70220 TC
Hospital Charge Code	909001141
Hospital Revenue Code	320
Min. Negotiated Rate	$853.05
Max. Negotiated Rate	$1,163.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$930.60
Rate for Payer: Aetna of CA Government/Medicare	$930.60
Rate for Payer: Cash Price	$697.95
Rate for Payer: Health Smart Auto/Commercial	$930.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$930.60
Rate for Payer: LLUH Dept of Risk Management WC	$853.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,163.25

HC SINUS/ PARANASAL COMPLETE

Facility

$1,551.00

Service Code	CPT 70220 TC
Hospital Charge Code	909001141
Hospital Revenue Code	320
Min. Negotiated Rate	$853.05
Max. Negotiated Rate	$1,240.80
Rate for Payer: Cash Price	$697.95
Rate for Payer: Cigna of CA HMO/PPO	$1,240.80
Rate for Payer: Health Smart Auto/Commercial	$930.60
Rate for Payer: LLUH Dept of Risk Management WC	$853.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,163.25

HC SINUS/ PARANASAL COMPLETE

Facility

$1,551.00

Service Code	CPT 70220
Hospital Charge Code	909001141
Hospital Revenue Code	320
Min. Negotiated Rate	$853.05
Max. Negotiated Rate	$1,240.80
Rate for Payer: Cash Price	$697.95
Rate for Payer: Cigna of CA HMO/PPO	$1,240.80
Rate for Payer: Health Smart Auto/Commercial	$930.60
Rate for Payer: LLUH Dept of Risk Management WC	$853.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,163.25

HC SIROLIMUS

Facility

$53.00

Service Code	CPT 80195
Hospital Charge Code	900912167
Hospital Revenue Code	301
Min. Negotiated Rate	$29.15
Max. Negotiated Rate	$39.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.80
Rate for Payer: Aetna of CA Government/Medicare	$31.80
Rate for Payer: Cash Price	$23.85
Rate for Payer: Health Smart Auto/Commercial	$31.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.80
Rate for Payer: LLUH Dept of Risk Management WC	$29.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.75

HC SIROLIMUS

Facility

$216.00

Service Code	CPT 80195
Hospital Charge Code	900912167
Hospital Revenue Code	301
Min. Negotiated Rate	$118.80
Max. Negotiated Rate	$172.80
Rate for Payer: Cash Price	$97.20
Rate for Payer: Cigna of CA HMO/PPO	$172.80
Rate for Payer: Health Smart Auto/Commercial	$129.60
Rate for Payer: LLUH Dept of Risk Management WC	$118.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$162.00

HC SKULL COMPLETE

Facility

$1,412.00

Service Code	CPT 70260
Hospital Charge Code	909001143
Hospital Revenue Code	320
Min. Negotiated Rate	$776.60
Max. Negotiated Rate	$1,129.60
Rate for Payer: Cash Price	$635.40
Rate for Payer: Cigna of CA HMO/PPO	$1,129.60
Rate for Payer: Health Smart Auto/Commercial	$847.20
Rate for Payer: LLUH Dept of Risk Management WC	$776.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,059.00

HC SKULL COMPLETE

Facility

$1,412.00

Service Code	CPT 70260
Hospital Charge Code	909001143
Hospital Revenue Code	320
Min. Negotiated Rate	$776.60
Max. Negotiated Rate	$1,059.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$847.20
Rate for Payer: Aetna of CA Government/Medicare	$847.20
Rate for Payer: Cash Price	$635.40
Rate for Payer: Health Smart Auto/Commercial	$847.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$847.20
Rate for Payer: LLUH Dept of Risk Management WC	$776.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,059.00

HC SKULL COMPLETE

Facility

$1,412.00

Service Code	CPT 70260 TC
Hospital Charge Code	909001143
Hospital Revenue Code	320
Min. Negotiated Rate	$776.60
Max. Negotiated Rate	$1,129.60
Rate for Payer: Cash Price	$635.40
Rate for Payer: Cigna of CA HMO/PPO	$1,129.60
Rate for Payer: Health Smart Auto/Commercial	$847.20
Rate for Payer: LLUH Dept of Risk Management WC	$776.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,059.00

HC SKULL COMPLETE

Facility

$1,412.00

Service Code	CPT 70260 TC
Hospital Charge Code	909001143
Hospital Revenue Code	320
Min. Negotiated Rate	$776.60
Max. Negotiated Rate	$1,059.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$847.20
Rate for Payer: Aetna of CA Government/Medicare	$847.20
Rate for Payer: Cash Price	$635.40
Rate for Payer: Health Smart Auto/Commercial	$847.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$847.20
Rate for Payer: LLUH Dept of Risk Management WC	$776.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,059.00

Know your out-of-pocket cost for care.

All Charges