Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC ACID HEMOGLOBIN CONFIRMATION

Facility

$68.00

Service Code	CPT 83020
Hospital Charge Code	900913569
Hospital Revenue Code	302
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$54.40
Rate for Payer: Cash Price	$30.60
Rate for Payer: Cigna of CA HMO/PPO	$54.40
Rate for Payer: Health Smart Auto/Commercial	$40.80
Rate for Payer: LLUH Dept of Risk Management WC	$37.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$51.00

HC ACTH

Facility

$568.00

Service Code	CPT 82024
Hospital Charge Code	900912120
Hospital Revenue Code	301
Min. Negotiated Rate	$312.40
Max. Negotiated Rate	$454.40
Rate for Payer: Cash Price	$255.60
Rate for Payer: Cigna of CA HMO/PPO	$454.40
Rate for Payer: Health Smart Auto/Commercial	$340.80
Rate for Payer: LLUH Dept of Risk Management WC	$312.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$426.00

HC ACTH

Facility

$148.00

Service Code	CPT 82024
Hospital Charge Code	900912120
Hospital Revenue Code	301
Min. Negotiated Rate	$81.40
Max. Negotiated Rate	$111.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$88.80
Rate for Payer: Aetna of CA Government/Medicare	$88.80
Rate for Payer: Cash Price	$66.60
Rate for Payer: Health Smart Auto/Commercial	$88.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$88.80
Rate for Payer: LLUH Dept of Risk Management WC	$81.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$111.00

HC ACT LOW RANGE/PLUS (POC)

Facility

$225.00

Service Code	CPT 85347
Hospital Charge Code	900912013
Hospital Revenue Code	301
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$180.00
Rate for Payer: Cash Price	$101.25
Rate for Payer: Cigna of CA HMO/PPO	$180.00
Rate for Payer: Health Smart Auto/Commercial	$135.00
Rate for Payer: LLUH Dept of Risk Management WC	$123.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$168.75

HC ACT LOW RANGE/PLUS (POC)

Facility

$225.00

Service Code	CPT 85347
Hospital Charge Code	900912013
Hospital Revenue Code	301
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$168.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$135.00
Rate for Payer: Aetna of CA Government/Medicare	$135.00
Rate for Payer: Cash Price	$101.25
Rate for Payer: Health Smart Auto/Commercial	$135.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$135.00
Rate for Payer: LLUH Dept of Risk Management WC	$123.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$168.75

HC ACUTE HEPATITIS PANEL

Facility

$927.00

Service Code	CPT 80074
Hospital Charge Code	900910701
Hospital Revenue Code	301
Min. Negotiated Rate	$509.85
Max. Negotiated Rate	$741.60
Rate for Payer: Cash Price	$417.15
Rate for Payer: Cigna of CA HMO/PPO	$741.60
Rate for Payer: Health Smart Auto/Commercial	$556.20
Rate for Payer: LLUH Dept of Risk Management WC	$509.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$695.25

HC ACUTE HEPATITIS PANEL

Facility

$73.00

Service Code	CPT 80074
Hospital Charge Code	900910701
Hospital Revenue Code	301
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 ADM FR HIGH A/D 2DATES/ HR

Facility

$259.00

Service Code	CPT G0378
Hospital Charge Code	902100006
Hospital Revenue Code	762
Min. Negotiated Rate	$142.45
Max. Negotiated Rate	$207.20
Rate for Payer: Cash Price	$116.55
Rate for Payer: Cigna of CA HMO/PPO	$207.20
Rate for Payer: Health Smart Auto/Commercial	$155.40
Rate for Payer: LLUH Dept of Risk Management WC	$142.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$194.25

HC ADM FR HIGH A/D 2DATES/ HR

Facility

$259.00

Service Code	CPT Z7514
Hospital Charge Code	902100006
Hospital Revenue Code	762
Min. Negotiated Rate	$142.45
Max. Negotiated Rate	$194.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$155.40
Rate for Payer: Aetna of CA Government/Medicare	$155.40
Rate for Payer: Cash Price	$116.55
Rate for Payer: Health Smart Auto/Commercial	$155.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$155.40
Rate for Payer: LLUH Dept of Risk Management WC	$142.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$194.25

HC ADM FR HIGH A/D 2DATES/ HR

Facility

$259.00

Service Code	CPT G0378
Hospital Charge Code	902100006
Hospital Revenue Code	762
Min. Negotiated Rate	$142.45
Max. Negotiated Rate	$194.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$155.40
Rate for Payer: Aetna of CA Government/Medicare	$155.40
Rate for Payer: Cash Price	$116.55
Rate for Payer: Health Smart Auto/Commercial	$155.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$155.40
Rate for Payer: LLUH Dept of Risk Management WC	$142.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$194.25

HC ADM FR HIGH A/D 2DATES/ HR

Facility

$259.00

Service Code	CPT Z7514
Hospital Charge Code	902100006
Hospital Revenue Code	762
Min. Negotiated Rate	$142.45
Max. Negotiated Rate	$207.20
Rate for Payer: Cash Price	$116.55
Rate for Payer: Cigna of CA HMO/PPO	$207.20
Rate for Payer: Health Smart Auto/Commercial	$155.40
Rate for Payer: LLUH Dept of Risk Management WC	$142.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$194.25

HC AFB FLUOROCHROME STAIN CONCEN

Facility

$141.00

Service Code	CPT 87206
Hospital Charge Code	900911546
Hospital Revenue Code	306
Min. Negotiated Rate	$77.55
Max. Negotiated Rate	$112.80
Rate for Payer: Cash Price	$63.45
Rate for Payer: Cigna of CA HMO/PPO	$112.80
Rate for Payer: Health Smart Auto/Commercial	$84.60
Rate for Payer: LLUH Dept of Risk Management WC	$77.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$105.75

HC AFB FLUOROCHROME STAIN CONCEN

Facility

$20.00

Service Code	CPT 87206
Hospital Charge Code	900911546
Hospital Revenue Code	306
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 AFB FLUOROCHROME STAIN DIRECT

Facility

$141.00

Service Code	CPT 87206
Hospital Charge Code	900911545
Hospital Revenue Code	306
Min. Negotiated Rate	$77.55
Max. Negotiated Rate	$112.80
Rate for Payer: Cash Price	$63.45
Rate for Payer: Cigna of CA HMO/PPO	$112.80
Rate for Payer: Health Smart Auto/Commercial	$84.60
Rate for Payer: LLUH Dept of Risk Management WC	$77.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$105.75

HC AFB FLUOROCHROME STAIN DIRECT

Facility

$20.00

Service Code	CPT 87206
Hospital Charge Code	900911545
Hospital Revenue Code	306
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 AFB ZIEHL-NEELSEN STAIN

Facility

$20.00

Service Code	CPT 87206
Hospital Charge Code	900911544
Hospital Revenue Code	306
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 AFB ZIEHL-NEELSEN STAIN

Facility

$141.00

Service Code	CPT 87206
Hospital Charge Code	900911544
Hospital Revenue Code	306
Min. Negotiated Rate	$77.55
Max. Negotiated Rate	$112.80
Rate for Payer: Cash Price	$63.45
Rate for Payer: Cigna of CA HMO/PPO	$112.80
Rate for Payer: Health Smart Auto/Commercial	$84.60
Rate for Payer: LLUH Dept of Risk Management WC	$77.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$105.75

HC ALBUMIN

Facility

$89.00

Service Code	CPT 82040
Hospital Charge Code	900910220
Hospital Revenue Code	301
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$71.20
Rate for Payer: Cash Price	$40.05
Rate for Payer: Cigna of CA HMO/PPO	$71.20
Rate for Payer: Health Smart Auto/Commercial	$53.40
Rate for Payer: LLUH Dept of Risk Management WC	$48.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$66.75

HC ALBUMIN

Facility

$15.00

Service Code	CPT 82040
Hospital Charge Code	900910220
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.00
Rate for Payer: Aetna of CA Government/Medicare	$9.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC ALBUMIN BODY FLUID

Facility

$17.00

Service Code	CPT 82042
Hospital Charge Code	900910715
Hospital Revenue Code	301
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 ALBUMIN BODY FLUID

Facility

$25.00

Service Code	CPT 82042
Hospital Charge Code	900910715
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Cigna of CA HMO/PPO	$20.00
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.75

HC ALBUMIN BODY FLUID

Facility

$25.00

Service Code	CPT 82042 90
Hospital Charge Code	900910715
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Cigna of CA HMO/PPO	$20.00
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.75

HC ALCOHOL ETHANOL (SERUM/URINE)

Facility

$39.00

Service Code	CPT G0480
Hospital Charge Code	900910322
Hospital Revenue Code	301
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.40
Rate for Payer: Aetna of CA Government/Medicare	$23.40
Rate for Payer: Cash Price	$17.55
Rate for Payer: Health Smart Auto/Commercial	$23.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.40
Rate for Payer: LLUH Dept of Risk Management WC	$21.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.25

HC ALCOHOL ETHANOL (SERUM/URINE)

Facility

$380.00

Service Code	CPT 80320
Hospital Charge Code	900910322
Hospital Revenue Code	301
Min. Negotiated Rate	$209.00
Max. Negotiated Rate	$304.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cigna of CA HMO/PPO	$304.00
Rate for Payer: Health Smart Auto/Commercial	$228.00
Rate for Payer: LLUH Dept of Risk Management WC	$209.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$285.00

HC ALCOHOL ETHANOL (SERUM/URINE)

Facility

$39.00

Service Code	CPT 80320
Hospital Charge Code	900910322
Hospital Revenue Code	301
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$23.40
Rate for Payer: Aetna of CA Government/Medicare	$23.40
Rate for Payer: Cash Price	$17.55
Rate for Payer: Health Smart Auto/Commercial	$23.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$23.40
Rate for Payer: LLUH Dept of Risk Management WC	$21.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$29.25

Know your out-of-pocket cost for care.

All Charges