Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SKULL LIMITED

Facility

$1,057.00

Service Code	CPT 70250
Hospital Charge Code	909001144
Hospital Revenue Code	320
Min. Negotiated Rate	$581.35
Max. Negotiated Rate	$845.60
Rate for Payer: Cash Price	$475.65
Rate for Payer: Cigna of CA HMO/PPO	$845.60
Rate for Payer: Health Smart Auto/Commercial	$634.20
Rate for Payer: LLUH Dept of Risk Management WC	$581.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$792.75

HC SKULL LIMITED

Facility

$1,057.00

Service Code	CPT 70250 TC
Hospital Charge Code	909001144
Hospital Revenue Code	320
Min. Negotiated Rate	$581.35
Max. Negotiated Rate	$845.60
Rate for Payer: Cash Price	$475.65
Rate for Payer: Cigna of CA HMO/PPO	$845.60
Rate for Payer: Health Smart Auto/Commercial	$634.20
Rate for Payer: LLUH Dept of Risk Management WC	$581.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$792.75

HC SKULL LIMITED

Facility

$1,057.00

Service Code	CPT 70250
Hospital Charge Code	909001144
Hospital Revenue Code	320
Min. Negotiated Rate	$581.35
Max. Negotiated Rate	$792.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$634.20
Rate for Payer: Aetna of CA Government/Medicare	$634.20
Rate for Payer: Cash Price	$475.65
Rate for Payer: Health Smart Auto/Commercial	$634.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$634.20
Rate for Payer: LLUH Dept of Risk Management WC	$581.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$792.75

HC SKULL LIMITED

Facility

$1,057.00

Service Code	CPT 70250 TC
Hospital Charge Code	909001144
Hospital Revenue Code	320
Min. Negotiated Rate	$581.35
Max. Negotiated Rate	$792.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$634.20
Rate for Payer: Aetna of CA Government/Medicare	$634.20
Rate for Payer: Cash Price	$475.65
Rate for Payer: Health Smart Auto/Commercial	$634.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$634.20
Rate for Payer: LLUH Dept of Risk Management WC	$581.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$792.75

HC SLOW ACTIVATION

Facility

$171.00

Service Code	CPT 85730
Hospital Charge Code	900910078
Hospital Revenue Code	305
Min. Negotiated Rate	$94.05
Max. Negotiated Rate	$136.80
Rate for Payer: Health Smart Auto/Commercial	$102.60
Rate for Payer: Cash Price	$76.95
Rate for Payer: Cigna of CA HMO/PPO	$136.80
Rate for Payer: LLUH Dept of Risk Management WC	$94.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$128.25

HC SLOW ACTIVATION

Facility

$22.00

Service Code	CPT 85730
Hospital Charge Code	900910078
Hospital Revenue Code	305
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.20
Rate for Payer: Aetna of CA Government/Medicare	$13.20
Rate for Payer: Cash Price	$9.90
Rate for Payer: Health Smart Auto/Commercial	$13.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.20
Rate for Payer: LLUH Dept of Risk Management WC	$12.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.50

HC SM (SMITH) ANTIBODY

Facility

$162.00

Service Code	CPT 86235
Hospital Charge Code	900913523
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 SM (SMITH) ANTIBODY

Facility

$28.00

Service Code	CPT 86235
Hospital Charge Code	900913523
Hospital Revenue Code	302
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.80
Rate for Payer: Aetna of CA Government/Medicare	$16.80
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Smart Auto/Commercial	$16.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.80
Rate for Payer: LLUH Dept of Risk Management WC	$15.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$21.00

HC SOA 55284 CYSTICER AB IGG

Facility

$59.10

Service Code	CPT 86682
Hospital Charge Code	900914796
Hospital Revenue Code	302
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$44.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$35.46
Rate for Payer: Aetna of CA Government/Medicare	$35.46
Rate for Payer: Cash Price	$26.60
Rate for Payer: Health Smart Auto/Commercial	$35.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$35.46
Rate for Payer: LLUH Dept of Risk Management WC	$32.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$44.32

HC SOA 55284 CYSTICER AB IGG

Facility

$59.10

Service Code	CPT 86682 90
Hospital Charge Code	900914796
Hospital Revenue Code	300
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$44.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$35.46
Rate for Payer: Aetna of CA Government/Medicare	$35.46
Rate for Payer: Cash Price	$26.60
Rate for Payer: Health Smart Auto/Commercial	$35.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$35.46
Rate for Payer: LLUH Dept of Risk Management WC	$32.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$44.32

HC SOA 55284 CYSTICER AB IGG

Facility

$59.10

Service Code	CPT 86682
Hospital Charge Code	900914796
Hospital Revenue Code	302
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$47.28
Rate for Payer: Cash Price	$26.60
Rate for Payer: Cigna of CA HMO/PPO	$47.28
Rate for Payer: Health Smart Auto/Commercial	$35.46
Rate for Payer: LLUH Dept of Risk Management WC	$32.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$44.32

HC SOA 55284 CYSTICER AB IGG

Facility

$59.10

Service Code	CPT 86682 90
Hospital Charge Code	900914796
Hospital Revenue Code	300
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$47.28
Rate for Payer: Cash Price	$26.60
Rate for Payer: Cigna of CA HMO/PPO	$47.28
Rate for Payer: Health Smart Auto/Commercial	$35.46
Rate for Payer: LLUH Dept of Risk Management WC	$32.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$44.32

HC SOCIDEM PDC 82657

Facility

$150.00

Service Code	CPT 82657 90
Hospital Charge Code	900915254
Hospital Revenue Code	300
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$120.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna of CA HMO/PPO	$120.00
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOCIDEM PDC 82657

Facility

$150.00

Service Code	CPT 82657 90
Hospital Charge Code	900915254
Hospital Revenue Code	300
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.00
Rate for Payer: Aetna of CA Government/Medicare	$90.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOCIDEM PDC 82657

Facility

$150.00

Service Code	CPT 82657
Hospital Charge Code	900915254
Hospital Revenue Code	309
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.00
Rate for Payer: Aetna of CA Government/Medicare	$90.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOCIDEM PDC 82657

Facility

$150.00

Service Code	CPT 82657
Hospital Charge Code	900915254
Hospital Revenue Code	309
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$120.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna of CA HMO/PPO	$120.00
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOCIDEM PDC 82658

Facility

$150.00

Service Code	CPT 82658
Hospital Charge Code	900915255
Hospital Revenue Code	309
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.00
Rate for Payer: Aetna of CA Government/Medicare	$90.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOCIDEM PDC 82658

Facility

$150.00

Service Code	CPT 82658 90
Hospital Charge Code	900915255
Hospital Revenue Code	300
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.00
Rate for Payer: Aetna of CA Government/Medicare	$90.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOCIDEM PDC 82658

Facility

$150.00

Service Code	CPT 82658 90
Hospital Charge Code	900915255
Hospital Revenue Code	300
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$120.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna of CA HMO/PPO	$120.00
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOCIDEM PDC 82658

Facility

$150.00

Service Code	CPT 82658
Hospital Charge Code	900915255
Hospital Revenue Code	309
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$120.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna of CA HMO/PPO	$120.00
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOCIDEM PDC 84157

Facility

$150.00

Service Code	CPT 84157
Hospital Charge Code	900915256
Hospital Revenue Code	301
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$120.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna of CA HMO/PPO	$120.00
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOCIDEM PDC 84157

Facility

$150.00

Service Code	CPT 84157 90
Hospital Charge Code	900915256
Hospital Revenue Code	301
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$120.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna of CA HMO/PPO	$120.00
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOCIDEM PDC 84157

Facility

$150.00

Service Code	CPT 84157 90
Hospital Charge Code	900915256
Hospital Revenue Code	301
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.00
Rate for Payer: Aetna of CA Government/Medicare	$90.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOCIDEM PDC 84157

Facility

$150.00

Service Code	CPT 84157
Hospital Charge Code	900915256
Hospital Revenue Code	301
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$90.00
Rate for Payer: Aetna of CA Government/Medicare	$90.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Health Smart Auto/Commercial	$90.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$90.00
Rate for Payer: LLUH Dept of Risk Management WC	$82.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$112.50

HC SOCIDEM PDC 84999

Facility

$120.00

Service Code	CPT 84999
Hospital Charge Code	900915253
Hospital Revenue Code	309
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$96.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna of CA HMO/PPO	$96.00
Rate for Payer: Health Smart Auto/Commercial	$72.00
Rate for Payer: LLUH Dept of Risk Management WC	$66.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$90.00

Know your out-of-pocket cost for care.

All Charges