Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC AMPICILLIN E TEST

Facility

$10.00

Service Code	CPT 87181
Hospital Charge Code	900912448
Hospital Revenue Code	306
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.00
Rate for Payer: Aetna of CA Government/Medicare	$6.00
Rate for Payer: Cash Price	$4.50
Rate for Payer: Health Smart Auto/Commercial	$6.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.00
Rate for Payer: LLUH Dept of Risk Management WC	$5.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.50

HC AMYLASE

Facility

$233.00

Service Code	CPT 82150
Hospital Charge Code	900910236
Hospital Revenue Code	301
Min. Negotiated Rate	$128.15
Max. Negotiated Rate	$186.40
Rate for Payer: Cash Price	$104.85
Rate for Payer: Cigna of CA HMO/PPO	$186.40
Rate for Payer: Health Smart Auto/Commercial	$139.80
Rate for Payer: LLUH Dept of Risk Management WC	$128.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$174.75

HC AMYLASE

Facility

$17.00

Service Code	CPT 82150
Hospital Charge Code	900910236
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 AMYLASE BODY FLUID

Facility

$17.00

Service Code	CPT 82150
Hospital Charge Code	900910242
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 AMYLASE BODY FLUID

Facility

$25.00

Service Code	CPT 82150
Hospital Charge Code	900910242
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 AMYLASE URINE

Facility

$25.00

Service Code	CPT 82150
Hospital Charge Code	900910237
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$18.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.00
Rate for Payer: Aetna of CA Government/Medicare	$15.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.75

HC AMYLASE URINE

Facility

$233.00

Service Code	CPT 82150
Hospital Charge Code	900910237
Hospital Revenue Code	301
Min. Negotiated Rate	$128.15
Max. Negotiated Rate	$186.40
Rate for Payer: Cash Price	$104.85
Rate for Payer: Cigna of CA HMO/PPO	$186.40
Rate for Payer: Health Smart Auto/Commercial	$139.80
Rate for Payer: LLUH Dept of Risk Management WC	$128.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$174.75

HC ANA PANEL

Facility

$264.00

Service Code	CPT 86235
Hospital Charge Code	900913646
Hospital Revenue Code	302
Min. Negotiated Rate	$145.20
Max. Negotiated Rate	$211.20
Rate for Payer: Cash Price	$118.80
Rate for Payer: Cigna of CA HMO/PPO	$211.20
Rate for Payer: Health Smart Auto/Commercial	$158.40
Rate for Payer: LLUH Dept of Risk Management WC	$145.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$198.00

HC ANA PANEL

Facility

$185.00

Service Code	CPT 86235
Hospital Charge Code	900913646
Hospital Revenue Code	302
Min. Negotiated Rate	$101.75
Max. Negotiated Rate	$138.75
Rate for Payer: Health Smart Auto/Commercial	$111.00
Rate for Payer: Cash Price	$83.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$111.00
Rate for Payer: Aetna of CA Government/Medicare	$111.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$111.00
Rate for Payer: LLUH Dept of Risk Management WC	$101.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$138.75

HC ANKLE COMPLETE

Facility

$1,012.00

Service Code	CPT 73610
Hospital Charge Code	909001648
Hospital Revenue Code	320
Min. Negotiated Rate	$556.60
Max. Negotiated Rate	$759.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$607.20
Rate for Payer: Aetna of CA Government/Medicare	$607.20
Rate for Payer: Cash Price	$455.40
Rate for Payer: Health Smart Auto/Commercial	$607.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$607.20
Rate for Payer: LLUH Dept of Risk Management WC	$556.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$759.00

HC ANKLE COMPLETE

Facility

$1,012.00

Service Code	CPT 73610 TC
Hospital Charge Code	909001648
Hospital Revenue Code	320
Min. Negotiated Rate	$556.60
Max. Negotiated Rate	$809.60
Rate for Payer: Cash Price	$455.40
Rate for Payer: Cigna of CA HMO/PPO	$809.60
Rate for Payer: Health Smart Auto/Commercial	$607.20
Rate for Payer: LLUH Dept of Risk Management WC	$556.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$759.00

HC ANKLE COMPLETE

Facility

$1,012.00

Service Code	CPT 73610
Hospital Charge Code	909001648
Hospital Revenue Code	320
Min. Negotiated Rate	$556.60
Max. Negotiated Rate	$809.60
Rate for Payer: Cash Price	$455.40
Rate for Payer: Cigna of CA HMO/PPO	$809.60
Rate for Payer: Health Smart Auto/Commercial	$607.20
Rate for Payer: LLUH Dept of Risk Management WC	$556.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$759.00

HC ANKLE COMPLETE

Facility

$1,012.00

Service Code	CPT 73610 TC
Hospital Charge Code	909001648
Hospital Revenue Code	320
Min. Negotiated Rate	$556.60
Max. Negotiated Rate	$759.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$607.20
Rate for Payer: Aetna of CA Government/Medicare	$607.20
Rate for Payer: Cash Price	$455.40
Rate for Payer: Health Smart Auto/Commercial	$607.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$607.20
Rate for Payer: LLUH Dept of Risk Management WC	$556.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$759.00

HC ANKLE LIMITED

Facility

$864.00

Service Code	CPT 73600 TC
Hospital Charge Code	909001642
Hospital Revenue Code	320
Min. Negotiated Rate	$475.20
Max. Negotiated Rate	$691.20
Rate for Payer: Cash Price	$388.80
Rate for Payer: Cigna of CA HMO/PPO	$691.20
Rate for Payer: Health Smart Auto/Commercial	$518.40
Rate for Payer: LLUH Dept of Risk Management WC	$475.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$648.00

HC ANKLE LIMITED

Facility

$864.00

Service Code	CPT 73600
Hospital Charge Code	909001642
Hospital Revenue Code	320
Min. Negotiated Rate	$475.20
Max. Negotiated Rate	$691.20
Rate for Payer: Cash Price	$388.80
Rate for Payer: Cigna of CA HMO/PPO	$691.20
Rate for Payer: Health Smart Auto/Commercial	$518.40
Rate for Payer: LLUH Dept of Risk Management WC	$475.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$648.00

HC ANKLE LIMITED

Facility

$864.00

Service Code	CPT 73600 TC
Hospital Charge Code	909001642
Hospital Revenue Code	320
Min. Negotiated Rate	$475.20
Max. Negotiated Rate	$648.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$518.40
Rate for Payer: Aetna of CA Government/Medicare	$518.40
Rate for Payer: Cash Price	$388.80
Rate for Payer: Health Smart Auto/Commercial	$518.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$518.40
Rate for Payer: LLUH Dept of Risk Management WC	$475.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$648.00

HC ANKLE LIMITED

Facility

$864.00

Service Code	CPT 73600
Hospital Charge Code	909001642
Hospital Revenue Code	320
Min. Negotiated Rate	$475.20
Max. Negotiated Rate	$648.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$518.40
Rate for Payer: Aetna of CA Government/Medicare	$518.40
Rate for Payer: Cash Price	$388.80
Rate for Payer: Health Smart Auto/Commercial	$518.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$518.40
Rate for Payer: LLUH Dept of Risk Management WC	$475.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$648.00

HC ANTIMICROB SUSCEPTIBILITY TEST

Facility

$215.00

Service Code	CPT 87181
Hospital Charge Code	900911660
Hospital Revenue Code	306
Min. Negotiated Rate	$118.25
Max. Negotiated Rate	$172.00
Rate for Payer: Cash Price	$96.75
Rate for Payer: Cigna of CA HMO/PPO	$172.00
Rate for Payer: Health Smart Auto/Commercial	$129.00
Rate for Payer: LLUH Dept of Risk Management WC	$118.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$161.25

HC ANTIMICROB SUSCEPTIBILITY TEST

Facility

$18.00

Service Code	CPT 87181
Hospital Charge Code	900911660
Hospital Revenue Code	306
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.80
Rate for Payer: Aetna of CA Government/Medicare	$10.80
Rate for Payer: Cash Price	$8.10
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.80
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$13.50

HC ANTINUCLEAR ANTIBODIES (ANA)

Facility

$36.00

Service Code	CPT 86038
Hospital Charge Code	900910969
Hospital Revenue Code	302
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.60
Rate for Payer: Aetna of CA Government/Medicare	$21.60
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.00

HC ANTINUCLEAR ANTIBODIES (ANA)

Facility

$169.00

Service Code	CPT 86038
Hospital Charge Code	900910969
Hospital Revenue Code	302
Min. Negotiated Rate	$92.95
Max. Negotiated Rate	$135.20
Rate for Payer: Cash Price	$76.05
Rate for Payer: Cigna of CA HMO/PPO	$135.20
Rate for Payer: Health Smart Auto/Commercial	$101.40
Rate for Payer: LLUH Dept of Risk Management WC	$92.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$126.75

HC ANTISTREPTOLYSIN O

Facility

$168.00

Service Code	CPT 83883
Hospital Charge Code	900910881
Hospital Revenue Code	301
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$134.40
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cigna of CA HMO/PPO	$134.40
Rate for Payer: Health Smart Auto/Commercial	$100.80
Rate for Payer: LLUH Dept of Risk Management WC	$92.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$126.00

HC ANTISTREPTOLYSIN O

Facility

$45.00

Service Code	CPT 83883
Hospital Charge Code	900910881
Hospital Revenue Code	301
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.00
Rate for Payer: Aetna of CA Government/Medicare	$27.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC ANTITHROMBIN III ACTIVITY

Facility

$45.00

Service Code	CPT 85300
Hospital Charge Code	900912010
Hospital Revenue Code	305
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.00
Rate for Payer: Aetna of CA Government/Medicare	$27.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC ANTITHROMBIN III ACTIVITY

Facility

$330.00

Service Code	CPT 85300
Hospital Charge Code	900912010
Hospital Revenue Code	305
Min. Negotiated Rate	$181.50
Max. Negotiated Rate	$264.00
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cigna of CA HMO/PPO	$264.00
Rate for Payer: Health Smart Auto/Commercial	$198.00
Rate for Payer: LLUH Dept of Risk Management WC	$181.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$247.50

Know your out-of-pocket cost for care.

All Charges