Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SPINE 2-3 VIEWS

Facility

$1,020.00

Service Code	CPT 72040 TC
Hospital Charge Code	909001302
Hospital Revenue Code	320
Min. Negotiated Rate	$561.00
Max. Negotiated Rate	$816.00
Rate for Payer: Cash Price	$459.00
Rate for Payer: Cigna of CA HMO/PPO	$816.00
Rate for Payer: Health Smart Auto/Commercial	$612.00
Rate for Payer: LLUH Dept of Risk Management WC	$561.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$765.00

HC SPINE MINIMUM 4 VIEWS

Facility

$1,584.00

Service Code	CPT 72050 TC
Hospital Charge Code	909001301
Hospital Revenue Code	320
Min. Negotiated Rate	$871.20
Max. Negotiated Rate	$1,267.20
Rate for Payer: Cash Price	$712.80
Rate for Payer: Cigna of CA HMO/PPO	$1,267.20
Rate for Payer: Health Smart Auto/Commercial	$950.40
Rate for Payer: LLUH Dept of Risk Management WC	$871.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,188.00

HC SPINE MINIMUM 4 VIEWS

Facility

$1,584.00

Service Code	CPT 72050
Hospital Charge Code	909001301
Hospital Revenue Code	320
Min. Negotiated Rate	$871.20
Max. Negotiated Rate	$1,267.20
Rate for Payer: Health Smart Auto/Commercial	$950.40
Rate for Payer: Cash Price	$712.80
Rate for Payer: Cigna of CA HMO/PPO	$1,267.20
Rate for Payer: LLUH Dept of Risk Management WC	$871.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,188.00

HC SPINE MINIMUM 4 VIEWS

Facility

$1,584.00

Service Code	CPT 72050 TC
Hospital Charge Code	909001301
Hospital Revenue Code	320
Min. Negotiated Rate	$871.20
Max. Negotiated Rate	$1,188.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$950.40
Rate for Payer: Aetna of CA Government/Medicare	$950.40
Rate for Payer: Cash Price	$712.80
Rate for Payer: Health Smart Auto/Commercial	$950.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$950.40
Rate for Payer: LLUH Dept of Risk Management WC	$871.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,188.00

HC SPINE MINIMUM 4 VIEWS

Facility

$1,584.00

Service Code	CPT 72050
Hospital Charge Code	909001301
Hospital Revenue Code	320
Min. Negotiated Rate	$871.20
Max. Negotiated Rate	$1,188.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$950.40
Rate for Payer: Aetna of CA Government/Medicare	$950.40
Rate for Payer: Cash Price	$712.80
Rate for Payer: Health Smart Auto/Commercial	$950.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$950.40
Rate for Payer: LLUH Dept of Risk Management WC	$871.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,188.00

HC SSA AB

Facility

$162.00

Service Code	CPT 86235
Hospital Charge Code	900913521
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 SSA AB

Facility

$28.00

Service Code	CPT 86235
Hospital Charge Code	900913521
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 STREPTOZYME TEST

Facility

$17.00

Service Code	CPT 86063
Hospital Charge Code	900910870
Hospital Revenue Code	302
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 STREPTOZYME TEST

Facility

$129.00

Service Code	CPT 86063
Hospital Charge Code	900910870
Hospital Revenue Code	302
Min. Negotiated Rate	$70.95
Max. Negotiated Rate	$103.20
Rate for Payer: Cash Price	$58.05
Rate for Payer: Cigna of CA HMO/PPO	$103.20
Rate for Payer: Health Smart Auto/Commercial	$77.40
Rate for Payer: LLUH Dept of Risk Management WC	$70.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$96.75

HC SUDAN BLACK B

Facility

$118.00

Service Code	CPT 88313
Hospital Charge Code	900910057
Hospital Revenue Code	310
Min. Negotiated Rate	$64.90
Max. Negotiated Rate	$88.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$70.80
Rate for Payer: Aetna of CA Government/Medicare	$70.80
Rate for Payer: Cash Price	$53.10
Rate for Payer: Health Smart Auto/Commercial	$70.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$70.80
Rate for Payer: LLUH Dept of Risk Management WC	$64.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$88.50

HC SUDAN BLACK B

Facility

$551.00

Service Code	CPT 88313 90
Hospital Charge Code	900910057
Hospital Revenue Code	310
Min. Negotiated Rate	$303.05
Max. Negotiated Rate	$440.80
Rate for Payer: Cash Price	$247.95
Rate for Payer: Cigna of CA HMO/PPO	$440.80
Rate for Payer: Health Smart Auto/Commercial	$330.60
Rate for Payer: LLUH Dept of Risk Management WC	$303.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$413.25

HC SUDAN BLACK B

Facility

$551.00

Service Code	CPT 88313
Hospital Charge Code	900910057
Hospital Revenue Code	310
Min. Negotiated Rate	$303.05
Max. Negotiated Rate	$440.80
Rate for Payer: Cash Price	$247.95
Rate for Payer: Cigna of CA HMO/PPO	$440.80
Rate for Payer: Health Smart Auto/Commercial	$330.60
Rate for Payer: LLUH Dept of Risk Management WC	$303.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$413.25

HC SUSCEPTIBILITY PANEL YEAST

Facility

$109.00

Service Code	CPT 87186
Hospital Charge Code	900914672
Hospital Revenue Code	300
Min. Negotiated Rate	$59.95
Max. Negotiated Rate	$87.20
Rate for Payer: Cash Price	$49.05
Rate for Payer: Cigna of CA HMO/PPO	$87.20
Rate for Payer: Health Smart Auto/Commercial	$65.40
Rate for Payer: LLUH Dept of Risk Management WC	$59.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$81.75

HC SUSCEPTIBILITY PANEL YEAST

Facility

$78.00

Service Code	CPT 87186
Hospital Charge Code	900914672
Hospital Revenue Code	300
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$46.80
Rate for Payer: Aetna of CA Government/Medicare	$46.80
Rate for Payer: Cash Price	$35.10
Rate for Payer: Health Smart Auto/Commercial	$46.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$46.80
Rate for Payer: LLUH Dept of Risk Management WC	$42.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$58.50

HC SVC ANGER-PROBLEM SOLVING

Facility

$325.00

Service Code	CPT G0177
Hospital Charge Code	907804017
Hospital Revenue Code	942
Min. Negotiated Rate	$178.75
Max. Negotiated Rate	$243.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$195.00
Rate for Payer: Aetna of CA Government/Medicare	$195.00
Rate for Payer: Cash Price	$146.25
Rate for Payer: Health Smart Auto/Commercial	$195.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$195.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC SVC ANGER-PROBLEM SOLVING

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804017
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

HC SVC ANGER-PROBLEM SOLVING

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804017
Hospital Revenue Code	942
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$243.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$55.76
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Health Smart Auto/Commercial	$195.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$195.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Mary Free Bed Workers' Compensation	$41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC SVC ANGER-PROBLEM SOLVING

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804017
Hospital Revenue Code	912
Min. Negotiated Rate	$41.00
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	$55.76
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	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
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: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$463.00
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	$178.75
Rate for Payer: Magellan Commercial	$637.00
Rate for Payer: Managed Health Network (MHN) Commercial	$682.00
Rate for Payer: Managed Health Network (MHN) Medicare	$111.37
Rate for Payer: Mary Free Bed Workers' Compensation	$41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75
Rate for Payer: US Behavioral Health Commercial/Medicare	$498.68

HC SVC ANGER-PROBLEM SOLVING

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804017
Hospital Revenue Code	912
Min. Negotiated Rate	$178.75
Max. Negotiated Rate	$644.00
Rate for Payer: Cash Price	$146.25
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: Mary Free Bed Workers' Compensation	$644.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC SVC ANGER-PROBLEM SOLVING

Facility

$325.00

Service Code	CPT G0177
Hospital Charge Code	907804017
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

HC SVC COPING SKILLS

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804014
Hospital Revenue Code	912
Min. Negotiated Rate	$41.00
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	$55.76
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	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
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: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$463.00
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	$178.75
Rate for Payer: Magellan Commercial	$637.00
Rate for Payer: Managed Health Network (MHN) Commercial	$682.00
Rate for Payer: Managed Health Network (MHN) Medicare	$111.37
Rate for Payer: Mary Free Bed Workers' Compensation	$41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75
Rate for Payer: US Behavioral Health Commercial/Medicare	$498.68

HC SVC COPING SKILLS

Facility

$325.00

Service Code	CPT G0177
Hospital Charge Code	907804014
Hospital Revenue Code	942
Min. Negotiated Rate	$178.75
Max. Negotiated Rate	$243.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$195.00
Rate for Payer: Aetna of CA Government/Medicare	$195.00
Rate for Payer: Cash Price	$146.25
Rate for Payer: Health Smart Auto/Commercial	$195.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$195.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC SVC COPING SKILLS

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804014
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

HC SVC COPING SKILLS

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804014
Hospital Revenue Code	942
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$243.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$55.76
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Health Smart Auto/Commercial	$195.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$195.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Mary Free Bed Workers' Compensation	$41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC SVC COPING SKILLS

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804014
Hospital Revenue Code	912
Min. Negotiated Rate	$178.75
Max. Negotiated Rate	$644.00
Rate for Payer: Cash Price	$146.25
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: Mary Free Bed Workers' Compensation	$644.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

Know your out-of-pocket cost for care.

All Charges