Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC WEAK ACIDIC DRUG CONF & ID

Facility

$271.00

Service Code	CPT 80307
Hospital Charge Code	900910512
Hospital Revenue Code	301
Min. Negotiated Rate	$149.05
Max. Negotiated Rate	$216.80
Rate for Payer: Cash Price	$121.95
Rate for Payer: Cigna of CA HMO/PPO	$216.80
Rate for Payer: Health Smart Auto/Commercial	$162.60
Rate for Payer: LLUH Dept of Risk Management WC	$149.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$203.25

HC WEAK ACIDIC DRUG CONF & ID

Facility

$271.00

Service Code	CPT G0480
Hospital Charge Code	900910512
Hospital Revenue Code	301
Min. Negotiated Rate	$149.05
Max. Negotiated Rate	$216.80
Rate for Payer: Cash Price	$121.95
Rate for Payer: Cigna of CA HMO/PPO	$216.80
Rate for Payer: Health Smart Auto/Commercial	$162.60
Rate for Payer: LLUH Dept of Risk Management WC	$149.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$203.25

HC WRIST COMPLETE MIN 3 VIEWS

Facility

$996.00

Service Code	CPT 73110
Hospital Charge Code	909001210
Hospital Revenue Code	320
Min. Negotiated Rate	$547.80
Max. Negotiated Rate	$747.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$597.60
Rate for Payer: Aetna of CA Government/Medicare	$597.60
Rate for Payer: Cash Price	$448.20
Rate for Payer: Health Smart Auto/Commercial	$597.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$597.60
Rate for Payer: LLUH Dept of Risk Management WC	$547.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$747.00

HC WRIST COMPLETE MIN 3 VIEWS

Facility

$996.00

Service Code	CPT 73110 TC
Hospital Charge Code	909001210
Hospital Revenue Code	320
Min. Negotiated Rate	$547.80
Max. Negotiated Rate	$747.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$597.60
Rate for Payer: Aetna of CA Government/Medicare	$597.60
Rate for Payer: Cash Price	$448.20
Rate for Payer: Health Smart Auto/Commercial	$597.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$597.60
Rate for Payer: LLUH Dept of Risk Management WC	$547.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$747.00

HC WRIST COMPLETE MIN 3 VIEWS

Facility

$996.00

Service Code	CPT 73110
Hospital Charge Code	909001210
Hospital Revenue Code	320
Min. Negotiated Rate	$547.80
Max. Negotiated Rate	$796.80
Rate for Payer: Cash Price	$448.20
Rate for Payer: Cigna of CA HMO/PPO	$796.80
Rate for Payer: Health Smart Auto/Commercial	$597.60
Rate for Payer: LLUH Dept of Risk Management WC	$547.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$747.00

HC WRIST COMPLETE MIN 3 VIEWS

Facility

$996.00

Service Code	CPT 73110 TC
Hospital Charge Code	909001210
Hospital Revenue Code	320
Min. Negotiated Rate	$547.80
Max. Negotiated Rate	$796.80
Rate for Payer: Cash Price	$448.20
Rate for Payer: Cigna of CA HMO/PPO	$796.80
Rate for Payer: Health Smart Auto/Commercial	$597.60
Rate for Payer: LLUH Dept of Risk Management WC	$547.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$747.00

HC WRIST LIMITED

Facility

$827.00

Service Code	CPT 73100 TC
Hospital Charge Code	909001514
Hospital Revenue Code	320
Min. Negotiated Rate	$454.85
Max. Negotiated Rate	$620.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$496.20
Rate for Payer: Aetna of CA Government/Medicare	$496.20
Rate for Payer: Cash Price	$372.15
Rate for Payer: Health Smart Auto/Commercial	$496.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$496.20
Rate for Payer: LLUH Dept of Risk Management WC	$454.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$620.25

HC WRIST LIMITED

Facility

$827.00

Service Code	CPT 73100 TC
Hospital Charge Code	909001514
Hospital Revenue Code	320
Min. Negotiated Rate	$454.85
Max. Negotiated Rate	$661.60
Rate for Payer: Cash Price	$372.15
Rate for Payer: Cigna of CA HMO/PPO	$661.60
Rate for Payer: Health Smart Auto/Commercial	$496.20
Rate for Payer: LLUH Dept of Risk Management WC	$454.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$620.25

HC WRIST LIMITED

Facility

$827.00

Service Code	CPT 73100
Hospital Charge Code	909001514
Hospital Revenue Code	320
Min. Negotiated Rate	$454.85
Max. Negotiated Rate	$661.60
Rate for Payer: Cash Price	$372.15
Rate for Payer: Cigna of CA HMO/PPO	$661.60
Rate for Payer: Health Smart Auto/Commercial	$496.20
Rate for Payer: LLUH Dept of Risk Management WC	$454.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$620.25

HC WRIST LIMITED

Facility

$827.00

Service Code	CPT 73100
Hospital Charge Code	909001514
Hospital Revenue Code	320
Min. Negotiated Rate	$454.85
Max. Negotiated Rate	$620.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$496.20
Rate for Payer: Aetna of CA Government/Medicare	$496.20
Rate for Payer: Cash Price	$372.15
Rate for Payer: Health Smart Auto/Commercial	$496.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$496.20
Rate for Payer: LLUH Dept of Risk Management WC	$454.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$620.25

HC XA INHIBITION LMW HEPARIN

Facility

$73.00

Service Code	CPT 85520
Hospital Charge Code	900910107
Hospital Revenue Code	305
Min. Negotiated Rate	$40.15
Max. Negotiated Rate	$54.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$43.80
Rate for Payer: Aetna of CA Government/Medicare	$43.80
Rate for Payer: Cash Price	$32.85
Rate for Payer: Health Smart Auto/Commercial	$43.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$43.80
Rate for Payer: LLUH Dept of Risk Management WC	$40.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$54.75

HC XA INHIBITION LMW HEPARIN

Facility

$129.00

Service Code	CPT 85520
Hospital Charge Code	900910107
Hospital Revenue Code	305
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 XRAY FEMUR 1 VIEW

Facility

$471.00

Service Code	CPT 73551 TC
Hospital Charge Code	909073551
Hospital Revenue Code	320
Min. Negotiated Rate	$259.05
Max. Negotiated Rate	$376.80
Rate for Payer: Cash Price	$211.95
Rate for Payer: Cigna of CA HMO/PPO	$376.80
Rate for Payer: Health Smart Auto/Commercial	$282.60
Rate for Payer: LLUH Dept of Risk Management WC	$259.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$353.25

HC XRAY FEMUR 1 VIEW

Facility

$471.00

Service Code	CPT 73551
Hospital Charge Code	909073551
Hospital Revenue Code	320
Min. Negotiated Rate	$259.05
Max. Negotiated Rate	$376.80
Rate for Payer: Cash Price	$211.95
Rate for Payer: Cigna of CA HMO/PPO	$376.80
Rate for Payer: Health Smart Auto/Commercial	$282.60
Rate for Payer: LLUH Dept of Risk Management WC	$259.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$353.25

HC XRAY FEMUR 1 VIEW

Facility

$471.00

Service Code	CPT 73551 TC
Hospital Charge Code	909073551
Hospital Revenue Code	320
Min. Negotiated Rate	$259.05
Max. Negotiated Rate	$353.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$282.60
Rate for Payer: Aetna of CA Government/Medicare	$282.60
Rate for Payer: Cash Price	$211.95
Rate for Payer: Health Smart Auto/Commercial	$282.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$282.60
Rate for Payer: LLUH Dept of Risk Management WC	$259.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$353.25

HC XRAY FEMUR 1 VIEW

Facility

$471.00

Service Code	CPT 73551
Hospital Charge Code	909073551
Hospital Revenue Code	320
Min. Negotiated Rate	$259.05
Max. Negotiated Rate	$353.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$282.60
Rate for Payer: Aetna of CA Government/Medicare	$282.60
Rate for Payer: Cash Price	$211.95
Rate for Payer: Health Smart Auto/Commercial	$282.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$282.60
Rate for Payer: LLUH Dept of Risk Management WC	$259.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$353.25

HC XRAY FEMUR MIN 2 VIEWS

Facility

$590.00

Service Code	CPT 73552 TC
Hospital Charge Code	909073552
Hospital Revenue Code	320
Min. Negotiated Rate	$324.50
Max. Negotiated Rate	$472.00
Rate for Payer: Cash Price	$265.50
Rate for Payer: Cigna of CA HMO/PPO	$472.00
Rate for Payer: Health Smart Auto/Commercial	$354.00
Rate for Payer: LLUH Dept of Risk Management WC	$324.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$442.50

HC XRAY FEMUR MIN 2 VIEWS

Facility

$590.00

Service Code	CPT 73552 TC
Hospital Charge Code	909073552
Hospital Revenue Code	320
Min. Negotiated Rate	$324.50
Max. Negotiated Rate	$442.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$354.00
Rate for Payer: Aetna of CA Government/Medicare	$354.00
Rate for Payer: Cash Price	$265.50
Rate for Payer: Health Smart Auto/Commercial	$354.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$354.00
Rate for Payer: LLUH Dept of Risk Management WC	$324.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$442.50

HC XRAY FEMUR MIN 2 VIEWS

Facility

$590.00

Service Code	CPT 73552
Hospital Charge Code	909073552
Hospital Revenue Code	320
Min. Negotiated Rate	$324.50
Max. Negotiated Rate	$472.00
Rate for Payer: Cash Price	$265.50
Rate for Payer: Cigna of CA HMO/PPO	$472.00
Rate for Payer: Health Smart Auto/Commercial	$354.00
Rate for Payer: LLUH Dept of Risk Management WC	$324.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$442.50

HC XRAY FEMUR MIN 2 VIEWS

Facility

$590.00

Service Code	CPT 73552
Hospital Charge Code	909073552
Hospital Revenue Code	320
Min. Negotiated Rate	$324.50
Max. Negotiated Rate	$442.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$354.00
Rate for Payer: Aetna of CA Government/Medicare	$354.00
Rate for Payer: Cash Price	$265.50
Rate for Payer: Health Smart Auto/Commercial	$354.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$354.00
Rate for Payer: LLUH Dept of Risk Management WC	$324.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$442.50

HC XRAY HIP W/PELVIS BI 2 VIEWS

Facility

$1,167.00

Service Code	CPT 73521
Hospital Charge Code	909073521
Hospital Revenue Code	320
Min. Negotiated Rate	$641.85
Max. Negotiated Rate	$933.60
Rate for Payer: Cash Price	$525.15
Rate for Payer: Cigna of CA HMO/PPO	$933.60
Rate for Payer: Health Smart Auto/Commercial	$700.20
Rate for Payer: LLUH Dept of Risk Management WC	$641.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$875.25

HC XRAY HIP W/PELVIS BI 2 VIEWS

Facility

$1,167.00

Service Code	CPT 73521 TC
Hospital Charge Code	909073521
Hospital Revenue Code	320
Min. Negotiated Rate	$641.85
Max. Negotiated Rate	$875.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$700.20
Rate for Payer: Aetna of CA Government/Medicare	$700.20
Rate for Payer: Cash Price	$525.15
Rate for Payer: Health Smart Auto/Commercial	$700.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$700.20
Rate for Payer: LLUH Dept of Risk Management WC	$641.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$875.25

HC XRAY HIP W/PELVIS BI 2 VIEWS

Facility

$1,167.00

Service Code	CPT 73521 TC
Hospital Charge Code	909073521
Hospital Revenue Code	320
Min. Negotiated Rate	$641.85
Max. Negotiated Rate	$933.60
Rate for Payer: Cash Price	$525.15
Rate for Payer: Cigna of CA HMO/PPO	$933.60
Rate for Payer: Health Smart Auto/Commercial	$700.20
Rate for Payer: LLUH Dept of Risk Management WC	$641.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$875.25

HC XRAY HIP W/PELVIS BI 2 VIEWS

Facility

$1,167.00

Service Code	CPT 73521
Hospital Charge Code	909073521
Hospital Revenue Code	320
Min. Negotiated Rate	$641.85
Max. Negotiated Rate	$875.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$700.20
Rate for Payer: Aetna of CA Government/Medicare	$700.20
Rate for Payer: Cash Price	$525.15
Rate for Payer: Health Smart Auto/Commercial	$700.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$700.20
Rate for Payer: LLUH Dept of Risk Management WC	$641.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$875.25

HC XRAY HIP W/PELVIS BI 3-4 VIEWS

Facility

$1,303.00

Service Code	CPT 73522 TC
Hospital Charge Code	909073522
Hospital Revenue Code	320
Min. Negotiated Rate	$716.65
Max. Negotiated Rate	$1,042.40
Rate for Payer: Health Smart Auto/Commercial	$781.80
Rate for Payer: Cash Price	$586.35
Rate for Payer: Cigna of CA HMO/PPO	$1,042.40
Rate for Payer: LLUH Dept of Risk Management WC	$716.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$977.25

Know your out-of-pocket cost for care.

All Charges