Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC BETA HCG POC

Facility

$188.00

Service Code	CPT 84703
Hospital Charge Code	900912138
Hospital Revenue Code	306
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$150.40
Rate for Payer: Cash Price	$84.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$150.40
Rate for Payer: Health Smart Auto/Commercial	$112.80
Rate for Payer: LLUH Dept of Risk Management WC	$103.40
Rate for Payer: Multiplan Commercial	$141.00

HC BETA HCG POC

Facility

$54.00

Service Code	CPT 84703
Hospital Charge Code	900912138
Hospital Revenue Code	306
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$43.20
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: Cash Price	$24.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$43.20
Rate for Payer: Health Smart Auto/Commercial	$32.40
Rate for Payer: Intervalley Health Plan Commercial	$7.52
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 Commercial	$40.50

HC BETA HCG, QUAL

Facility

$76.00

Service Code	CPT 84703
Hospital Charge Code	900910840
Hospital Revenue Code	301
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$60.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$45.60
Rate for Payer: Aetna of CA Government/Medicare	$45.60
Rate for Payer: Cash Price	$34.20
Rate for Payer: Cash Price	$34.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$60.80
Rate for Payer: Health Smart Auto/Commercial	$45.60
Rate for Payer: Intervalley Health Plan Commercial	$7.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$45.60
Rate for Payer: LLUH Dept of Risk Management WC	$41.80
Rate for Payer: Multiplan Commercial	$57.00

HC BETA HCG, QUAL

Facility

$188.00

Service Code	CPT 84703
Hospital Charge Code	900910840
Hospital Revenue Code	301
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$150.40
Rate for Payer: Cash Price	$84.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$150.40
Rate for Payer: Health Smart Auto/Commercial	$112.80
Rate for Payer: LLUH Dept of Risk Management WC	$103.40
Rate for Payer: Multiplan Commercial	$141.00

HC BETA HCG, QUANT

Facility

$126.00

Service Code	CPT 84702
Hospital Charge Code	900910814
Hospital Revenue Code	301
Min. Negotiated Rate	$15.05
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$75.60
Rate for Payer: Aetna of CA Government/Medicare	$75.60
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cash Price	$56.70
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$100.80
Rate for Payer: Health Smart Auto/Commercial	$75.60
Rate for Payer: Intervalley Health Plan Commercial	$15.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$75.60
Rate for Payer: LLUH Dept of Risk Management WC	$69.30
Rate for Payer: Multiplan Commercial	$94.50

HC BETA HCG, QUANT

Facility

$449.00

Service Code	CPT 84702
Hospital Charge Code	900910814
Hospital Revenue Code	301
Min. Negotiated Rate	$246.95
Max. Negotiated Rate	$359.20
Rate for Payer: Cash Price	$202.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$359.20
Rate for Payer: Health Smart Auto/Commercial	$269.40
Rate for Payer: LLUH Dept of Risk Management WC	$246.95
Rate for Payer: Multiplan Commercial	$336.75

HC BETA-HYDROXYBUTYRATE

Facility

$260.00

Service Code	CPT 82010
Hospital Charge Code	900910356
Hospital Revenue Code	301
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$208.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$195.00

HC BETA-HYDROXYBUTYRATE

Facility

$41.00

Service Code	CPT 82010
Hospital Charge Code	900910356
Hospital Revenue Code	301
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$32.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.60
Rate for Payer: Aetna of CA Government/Medicare	$24.60
Rate for Payer: Cash Price	$18.45
Rate for Payer: Cash Price	$18.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$32.80
Rate for Payer: Health Smart Auto/Commercial	$24.60
Rate for Payer: Intervalley Health Plan Commercial	$8.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.60
Rate for Payer: LLUH Dept of Risk Management WC	$22.55
Rate for Payer: Multiplan Commercial	$30.75

HC BETA STREP RAPID TEST

Facility

$91.77

Service Code	CPT 87430
Hospital Charge Code	900911635
Hospital Revenue Code	306
Min. Negotiated Rate	$16.81
Max. Negotiated Rate	$73.42
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$55.06
Rate for Payer: Aetna of CA Government/Medicare	$55.06
Rate for Payer: Cash Price	$41.30
Rate for Payer: Cash Price	$41.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$73.42
Rate for Payer: Health Smart Auto/Commercial	$55.06
Rate for Payer: Intervalley Health Plan Commercial	$16.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$55.06
Rate for Payer: LLUH Dept of Risk Management WC	$50.47
Rate for Payer: Multiplan Commercial	$68.83

HC BETA STREP RAPID TEST

Facility

$138.00

Service Code	CPT 87430
Hospital Charge Code	900911635
Hospital Revenue Code	306
Min. Negotiated Rate	$75.90
Max. Negotiated Rate	$110.40
Rate for Payer: Cash Price	$62.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO 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 Commercial	$103.50

HC BILIRUBIN DIRECT

Facility

$34.00

Service Code	CPT 82248
Hospital Charge Code	900910504
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$27.20
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: Cash Price	$15.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$27.20
Rate for Payer: Health Smart Auto/Commercial	$20.40
Rate for Payer: Intervalley Health Plan Commercial	$5.02
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 Commercial	$25.50

HC BILIRUBIN DIRECT

Facility

$98.00

Service Code	CPT 82248
Hospital Charge Code	900910504
Hospital Revenue Code	301
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$78.40
Rate for Payer: Cash Price	$44.10
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$78.40
Rate for Payer: Health Smart Auto/Commercial	$58.80
Rate for Payer: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Commercial	$73.50

HC BILIRUBIN DIRECT INDIVIDUAL

Facility

$50.00

Service Code	CPT 82248
Hospital Charge Code	900910539
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$40.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC BILIRUBIN DIRECT INDIVIDUAL

Facility

$50.00

Service Code	CPT 82248
Hospital Charge Code	900910539
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Intervalley Health Plan Commercial	$5.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC BILIRUBIN ICTOTEST

Facility

$76.00

Service Code	CPT 81002
Hospital Charge Code	900910181
Hospital Revenue Code	307
Min. Negotiated Rate	$41.80
Max. Negotiated Rate	$60.80
Rate for Payer: Cash Price	$34.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$60.80
Rate for Payer: Health Smart Auto/Commercial	$45.60
Rate for Payer: LLUH Dept of Risk Management WC	$41.80
Rate for Payer: Multiplan Commercial	$57.00

HC BILIRUBIN ICTOTEST

Facility

$76.00

Service Code	CPT 81002
Hospital Charge Code	900910181
Hospital Revenue Code	307
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$60.80
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$45.60
Rate for Payer: Aetna of CA Government/Medicare	$45.60
Rate for Payer: Cash Price	$34.20
Rate for Payer: Cash Price	$34.20
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$60.80
Rate for Payer: Health Smart Auto/Commercial	$45.60
Rate for Payer: Intervalley Health Plan Commercial	$3.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$45.60
Rate for Payer: LLUH Dept of Risk Management WC	$41.80
Rate for Payer: Multiplan Commercial	$57.00

HC BILIRUBIN TOTAL

Facility

$50.00

Service Code	CPT 82247
Hospital Charge Code	900910273
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Intervalley Health Plan Commercial	$5.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC BILIRUBIN TOTAL

Facility

$94.00

Service Code	CPT 82247
Hospital Charge Code	900910273
Hospital Revenue Code	301
Min. Negotiated Rate	$51.70
Max. Negotiated Rate	$75.20
Rate for Payer: Cash Price	$42.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$75.20
Rate for Payer: Health Smart Auto/Commercial	$56.40
Rate for Payer: LLUH Dept of Risk Management WC	$51.70
Rate for Payer: Multiplan Commercial	$70.50

HC BILIRUBIN TOTAL INDIVIDUAL

Facility

$50.00

Service Code	CPT 82247
Hospital Charge Code	900910499
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$30.00
Rate for Payer: Aetna of CA Government/Medicare	$30.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: Intervalley Health Plan Commercial	$5.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC BILIRUBIN TOTAL INDIVIDUAL

Facility

$50.00

Service Code	CPT 82247
Hospital Charge Code	900910499
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$40.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$40.00
Rate for Payer: Health Smart Auto/Commercial	$30.00
Rate for Payer: LLUH Dept of Risk Management WC	$27.50
Rate for Payer: Multiplan Commercial	$37.50

HC BILIRUBIN TRANSCUTANEOUS

Facility

$144.00

Service Code	CPT 88720
Hospital Charge Code	900912154
Hospital Revenue Code	301
Min. Negotiated Rate	$79.20
Max. Negotiated Rate	$115.20
Rate for Payer: Cash Price	$64.80
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$115.20
Rate for Payer: Health Smart Auto/Commercial	$86.40
Rate for Payer: LLUH Dept of Risk Management WC	$79.20
Rate for Payer: Multiplan Commercial	$108.00

HC BILIRUBIN TRANSCUTANEOUS

Facility

$21.00

Service Code	CPT 88720
Hospital Charge Code	900912154
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$16.80
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: Cash Price	$9.45
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.80
Rate for Payer: Health Smart Auto/Commercial	$12.60
Rate for Payer: Intervalley Health Plan Commercial	$5.02
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 Commercial	$15.75

HC BK VIRUS DNA QUANT

Facility

$332.00

Service Code	CPT 87799
Hospital Charge Code	900913625
Hospital Revenue Code	301
Min. Negotiated Rate	$182.60
Max. Negotiated Rate	$265.60
Rate for Payer: Cash Price	$149.40
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$265.60
Rate for Payer: Health Smart Auto/Commercial	$199.20
Rate for Payer: LLUH Dept of Risk Management WC	$182.60
Rate for Payer: Multiplan Commercial	$249.00

HC BK VIRUS DNA QUANT

Facility

$274.00

Service Code	CPT 87799
Hospital Charge Code	900913625
Hospital Revenue Code	301
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$219.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$164.40
Rate for Payer: Aetna of CA Government/Medicare	$164.40
Rate for Payer: Cash Price	$123.30
Rate for Payer: Cash Price	$123.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$219.20
Rate for Payer: Health Smart Auto/Commercial	$164.40
Rate for Payer: Intervalley Health Plan Commercial	$42.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$164.40
Rate for Payer: LLUH Dept of Risk Management WC	$150.70
Rate for Payer: Multiplan Commercial	$205.50

HC BLEEDING TIME TEMPLATE

Facility

$335.00

Service Code	CPT 85002
Hospital Charge Code	900910065
Hospital Revenue Code	305
Min. Negotiated Rate	$184.25
Max. Negotiated Rate	$268.00
Rate for Payer: Cash Price	$150.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$268.00
Rate for Payer: Health Smart Auto/Commercial	$201.00
Rate for Payer: LLUH Dept of Risk Management WC	$184.25
Rate for Payer: Multiplan Commercial	$251.25

Know your out-of-pocket cost for care.

All Charges