Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC THORACIC SPINE 2VIEWS

Facility

$1,020.00

Service Code	CPT 72070
Hospital Charge Code	909001311
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 THORACIC SPINE 2VIEWS

Facility

$1,020.00

Service Code	CPT 72070 TC
Hospital Charge Code	909001311
Hospital Revenue Code	320
Min. Negotiated Rate	$561.00
Max. Negotiated Rate	$765.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$612.00
Rate for Payer: Aetna of CA Government/Medicare	$612.00
Rate for Payer: Cash Price	$459.00
Rate for Payer: Health Smart Auto/Commercial	$612.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$612.00
Rate for Payer: LLUH Dept of Risk Management WC	$561.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$765.00

HC THORACIC SPINE 2VIEWS

Facility

$1,020.00

Service Code	CPT 72070
Hospital Charge Code	909001311
Hospital Revenue Code	320
Min. Negotiated Rate	$561.00
Max. Negotiated Rate	$765.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$612.00
Rate for Payer: Aetna of CA Government/Medicare	$612.00
Rate for Payer: Cash Price	$459.00
Rate for Payer: Health Smart Auto/Commercial	$612.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$612.00
Rate for Payer: LLUH Dept of Risk Management WC	$561.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$765.00

HC THORACIC SPINE 2VIEWS

Facility

$1,020.00

Service Code	CPT 72070 TC
Hospital Charge Code	909001311
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 THORACIC SPINE 3VIEWS

Facility

$1,118.00

Service Code	CPT 72072
Hospital Charge Code	909001310
Hospital Revenue Code	320
Min. Negotiated Rate	$614.90
Max. Negotiated Rate	$838.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$670.80
Rate for Payer: Aetna of CA Government/Medicare	$670.80
Rate for Payer: Cash Price	$503.10
Rate for Payer: Health Smart Auto/Commercial	$670.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$670.80
Rate for Payer: LLUH Dept of Risk Management WC	$614.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$838.50

HC THORACIC SPINE 3VIEWS

Facility

$1,118.00

Service Code	CPT 72072 TC
Hospital Charge Code	909001310
Hospital Revenue Code	320
Min. Negotiated Rate	$614.90
Max. Negotiated Rate	$894.40
Rate for Payer: Cash Price	$503.10
Rate for Payer: Cigna of CA HMO/PPO	$894.40
Rate for Payer: Health Smart Auto/Commercial	$670.80
Rate for Payer: LLUH Dept of Risk Management WC	$614.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$838.50

HC THORACIC SPINE 3VIEWS

Facility

$1,118.00

Service Code	CPT 72072
Hospital Charge Code	909001310
Hospital Revenue Code	320
Min. Negotiated Rate	$614.90
Max. Negotiated Rate	$894.40
Rate for Payer: Cash Price	$503.10
Rate for Payer: Cigna of CA HMO/PPO	$894.40
Rate for Payer: Health Smart Auto/Commercial	$670.80
Rate for Payer: LLUH Dept of Risk Management WC	$614.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$838.50

HC THORACIC SPINE 3VIEWS

Facility

$1,118.00

Service Code	CPT 72072 TC
Hospital Charge Code	909001310
Hospital Revenue Code	320
Min. Negotiated Rate	$614.90
Max. Negotiated Rate	$838.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$670.80
Rate for Payer: Aetna of CA Government/Medicare	$670.80
Rate for Payer: Cash Price	$503.10
Rate for Payer: Health Smart Auto/Commercial	$670.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$670.80
Rate for Payer: LLUH Dept of Risk Management WC	$614.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$838.50

HC THROMBIN TIME

Facility

$194.00

Service Code	CPT 85670
Hospital Charge Code	900910021
Hospital Revenue Code	305
Min. Negotiated Rate	$106.70
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$87.30
Rate for Payer: Cigna of CA HMO/PPO	$155.20
Rate for Payer: Health Smart Auto/Commercial	$116.40
Rate for Payer: LLUH Dept of Risk Management WC	$106.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$145.50

HC THROMBIN TIME

Facility

$22.00

Service Code	CPT 85670
Hospital Charge Code	900910021
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 THROMBOELASTOGRAPH

Facility

$74.00

Service Code	CPT 85396
Hospital Charge Code	900912024
Hospital Revenue Code	305
Min. Negotiated Rate	$40.70
Max. Negotiated Rate	$55.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$44.40
Rate for Payer: Aetna of CA Government/Medicare	$44.40
Rate for Payer: Cash Price	$33.30
Rate for Payer: Health Smart Auto/Commercial	$44.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$44.40
Rate for Payer: LLUH Dept of Risk Management WC	$40.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$55.50

HC THROMBOELASTOGRAPH

Facility

$561.00

Service Code	CPT 85396
Hospital Charge Code	900912024
Hospital Revenue Code	305
Min. Negotiated Rate	$308.55
Max. Negotiated Rate	$448.80
Rate for Payer: Cash Price	$252.45
Rate for Payer: Cigna of CA HMO/PPO	$448.80
Rate for Payer: Health Smart Auto/Commercial	$336.60
Rate for Payer: LLUH Dept of Risk Management WC	$308.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$420.75

HC THYROID HORMONE T3

Facility

$260.00

Service Code	CPT 84480
Hospital Charge Code	900910827
Hospital Revenue Code	301
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$208.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cigna of CA HMO/PPO	$208.00
Rate for Payer: Health Smart Auto/Commercial	$156.00
Rate for Payer: LLUH Dept of Risk Management WC	$143.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$195.00

HC THYROID HORMONE T3

Facility

$54.00

Service Code	CPT 84480
Hospital Charge Code	900910827
Hospital Revenue Code	301
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 THYROXIN T4

Facility

$138.00

Service Code	CPT 84436
Hospital Charge Code	900910835
Hospital Revenue Code	301
Min. Negotiated Rate	$75.90
Max. Negotiated Rate	$110.40
Rate for Payer: Cash Price	$62.10
Rate for Payer: Cigna of CA HMO/PPO	$110.40
Rate for Payer: Health Smart Auto/Commercial	$82.80
Rate for Payer: LLUH Dept of Risk Management WC	$75.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$103.50

HC THYROXIN T4

Facility

$20.00

Service Code	CPT 84436
Hospital Charge Code	900910835
Hospital Revenue Code	301
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.00
Rate for Payer: Aetna of CA Government/Medicare	$12.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.00

HC TIBIA FIBULA

Facility

$913.00

Service Code	CPT 73590 TC
Hospital Charge Code	909001638
Hospital Revenue Code	320
Min. Negotiated Rate	$502.15
Max. Negotiated Rate	$730.40
Rate for Payer: Cash Price	$410.85
Rate for Payer: Cigna of CA HMO/PPO	$730.40
Rate for Payer: Health Smart Auto/Commercial	$547.80
Rate for Payer: LLUH Dept of Risk Management WC	$502.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$684.75

HC TIBIA FIBULA

Facility

$913.00

Service Code	CPT 73590
Hospital Charge Code	909001638
Hospital Revenue Code	320
Min. Negotiated Rate	$502.15
Max. Negotiated Rate	$684.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$547.80
Rate for Payer: Aetna of CA Government/Medicare	$547.80
Rate for Payer: Cash Price	$410.85
Rate for Payer: Health Smart Auto/Commercial	$547.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$547.80
Rate for Payer: LLUH Dept of Risk Management WC	$502.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$684.75

HC TIBIA FIBULA

Facility

$913.00

Service Code	CPT 73590 TC
Hospital Charge Code	909001638
Hospital Revenue Code	320
Min. Negotiated Rate	$502.15
Max. Negotiated Rate	$684.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$547.80
Rate for Payer: Aetna of CA Government/Medicare	$547.80
Rate for Payer: Cash Price	$410.85
Rate for Payer: Health Smart Auto/Commercial	$547.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$547.80
Rate for Payer: LLUH Dept of Risk Management WC	$502.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$684.75

HC TIBIA FIBULA

Facility

$913.00

Service Code	CPT 73590
Hospital Charge Code	909001638
Hospital Revenue Code	320
Min. Negotiated Rate	$502.15
Max. Negotiated Rate	$730.40
Rate for Payer: Cash Price	$410.85
Rate for Payer: Cigna of CA HMO/PPO	$730.40
Rate for Payer: Health Smart Auto/Commercial	$547.80
Rate for Payer: LLUH Dept of Risk Management WC	$502.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$684.75

HC TISS CUL NEO BONE MARROW BLD

Facility

$412.00

Service Code	CPT 88237
Hospital Charge Code	900918003
Hospital Revenue Code	310
Min. Negotiated Rate	$226.60
Max. Negotiated Rate	$329.60
Rate for Payer: Cash Price	$185.40
Rate for Payer: Cigna of CA HMO/PPO	$329.60
Rate for Payer: Health Smart Auto/Commercial	$247.20
Rate for Payer: LLUH Dept of Risk Management WC	$226.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$309.00

HC TISS CUL NEO BONE MARROW BLD

Facility

$297.00

Service Code	CPT 88237
Hospital Charge Code	900918003
Hospital Revenue Code	310
Min. Negotiated Rate	$163.35
Max. Negotiated Rate	$222.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$178.20
Rate for Payer: Aetna of CA Government/Medicare	$178.20
Rate for Payer: Cash Price	$133.65
Rate for Payer: Health Smart Auto/Commercial	$178.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$178.20
Rate for Payer: LLUH Dept of Risk Management WC	$163.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$222.75

HC TISS CUL NEO BONE MARROW BLD

Facility

$412.00

Service Code	CPT 88237 TC
Hospital Charge Code	900918003
Hospital Revenue Code	310
Min. Negotiated Rate	$226.60
Max. Negotiated Rate	$329.60
Rate for Payer: Cash Price	$185.40
Rate for Payer: Cigna of CA HMO/PPO	$329.60
Rate for Payer: Health Smart Auto/Commercial	$247.20
Rate for Payer: LLUH Dept of Risk Management WC	$226.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$309.00

HC TISS CUL NEO SOLID TUMOR

Facility

$302.00

Service Code	CPT 88239
Hospital Charge Code	900918002
Hospital Revenue Code	310
Min. Negotiated Rate	$166.10
Max. Negotiated Rate	$226.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$181.20
Rate for Payer: Aetna of CA Government/Medicare	$181.20
Rate for Payer: Cash Price	$135.90
Rate for Payer: Health Smart Auto/Commercial	$181.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$181.20
Rate for Payer: LLUH Dept of Risk Management WC	$166.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$226.50

HC TISS CUL NEO SOLID TUMOR

Facility

$419.00

Service Code	CPT 88239
Hospital Charge Code	900918002
Hospital Revenue Code	310
Min. Negotiated Rate	$230.45
Max. Negotiated Rate	$335.20
Rate for Payer: Cash Price	$188.55
Rate for Payer: Cigna of CA HMO/PPO	$335.20
Rate for Payer: Health Smart Auto/Commercial	$251.40
Rate for Payer: LLUH Dept of Risk Management WC	$230.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$314.25

Know your out-of-pocket cost for care.

All Charges