Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC BILIRUBIN ICTOTEST

Facility

$10.00

Service Code	CPT 81002
Hospital Charge Code	900910181
Hospital Revenue Code	307
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 BILIRUBIN ICTOTEST

Facility

$78.00

Service Code	CPT 81002
Hospital Charge Code	900910181
Hospital Revenue Code	307
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$62.40
Rate for Payer: Cash Price	$35.10
Rate for Payer: Cigna of CA HMO/PPO	$62.40
Rate for Payer: Health Smart Auto/Commercial	$46.80
Rate for Payer: LLUH Dept of Risk Management WC	$42.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$58.50

HC BILIRUBIN TOTAL

Facility

$85.00

Service Code	CPT 82247
Hospital Charge Code	900910273
Hospital Revenue Code	301
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$68.00
Rate for Payer: Cash Price	$38.25
Rate for Payer: Cigna of CA HMO/PPO	$68.00
Rate for Payer: Health Smart Auto/Commercial	$51.00
Rate for Payer: LLUH Dept of Risk Management WC	$46.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$63.75

HC BILIRUBIN TOTAL

Facility

$15.00

Service Code	CPT 82247
Hospital Charge Code	900910273
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 BILIRUBIN TRANSCUTANEOUS

Facility

$19.00

Service Code	CPT 88720
Hospital Charge Code	900912154
Hospital Revenue Code	301
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$14.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.40
Rate for Payer: Aetna of CA Government/Medicare	$11.40
Rate for Payer: Cash Price	$8.55
Rate for Payer: Health Smart Auto/Commercial	$11.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.40
Rate for Payer: LLUH Dept of Risk Management WC	$10.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.25

HC BILIRUBIN TRANSCUTANEOUS

Facility

$130.00

Service Code	CPT 88720
Hospital Charge Code	900912154
Hospital Revenue Code	301
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$104.00
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cigna of CA HMO/PPO	$104.00
Rate for Payer: Health Smart Auto/Commercial	$78.00
Rate for Payer: LLUH Dept of Risk Management WC	$71.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$97.50

HC BK VIRUS DNA QUANT

Facility

$339.00

Service Code	CPT 87799
Hospital Charge Code	900913625
Hospital Revenue Code	301
Min. Negotiated Rate	$186.45
Max. Negotiated Rate	$271.20
Rate for Payer: Cash Price	$152.55
Rate for Payer: Cigna of CA HMO/PPO	$271.20
Rate for Payer: Health Smart Auto/Commercial	$203.40
Rate for Payer: LLUH Dept of Risk Management WC	$186.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$254.25

HC BK VIRUS DNA QUANT

Facility

$280.00

Service Code	CPT 87799
Hospital Charge Code	900913625
Hospital Revenue Code	301
Min. Negotiated Rate	$154.00
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$168.00
Rate for Payer: Aetna of CA Government/Medicare	$168.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Health Smart Auto/Commercial	$168.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$168.00
Rate for Payer: LLUH Dept of Risk Management WC	$154.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$210.00

HC BLEEDING TIME TEMPLATE

Facility

$353.00

Service Code	CPT 85002
Hospital Charge Code	900910065
Hospital Revenue Code	305
Min. Negotiated Rate	$194.15
Max. Negotiated Rate	$282.40
Rate for Payer: Cash Price	$158.85
Rate for Payer: Cigna of CA HMO/PPO	$282.40
Rate for Payer: Health Smart Auto/Commercial	$211.80
Rate for Payer: LLUH Dept of Risk Management WC	$194.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$264.75

HC BLEEDING TIME TEMPLATE

Facility

$17.00

Service Code	CPT 85002
Hospital Charge Code	900910065
Hospital Revenue Code	305
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 BLOOD OCCULT FECES

Facility

$122.00

Service Code	CPT 82274
Hospital Charge Code	900911638
Hospital Revenue Code	301
Min. Negotiated Rate	$67.10
Max. Negotiated Rate	$97.60
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cigna of CA HMO/PPO	$97.60
Rate for Payer: Health Smart Auto/Commercial	$73.20
Rate for Payer: LLUH Dept of Risk Management WC	$67.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$91.50

HC BLOOD OCCULT FECES

Facility

$50.00

Service Code	CPT 82274
Hospital Charge Code	900911638
Hospital Revenue Code	301
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$37.50
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: Health Smart Auto/Commercial	$30.00
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 Beech St/Commercial/PHCS	$37.50

HC BLOOD PH PCO2 P02 (POC)

Facility

$227.00

Service Code	CPT 82803
Hospital Charge Code	900912112
Hospital Revenue Code	301
Min. Negotiated Rate	$124.85
Max. Negotiated Rate	$181.60
Rate for Payer: Cash Price	$102.15
Rate for Payer: Cigna of CA HMO/PPO	$181.60
Rate for Payer: Health Smart Auto/Commercial	$136.20
Rate for Payer: LLUH Dept of Risk Management WC	$124.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$170.25

HC BLOOD PH PCO2 P02 (POC)

Facility

$227.00

Service Code	CPT 82803
Hospital Charge Code	900912112
Hospital Revenue Code	301
Min. Negotiated Rate	$124.85
Max. Negotiated Rate	$170.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$136.20
Rate for Payer: Aetna of CA Government/Medicare	$136.20
Rate for Payer: Cash Price	$102.15
Rate for Payer: Health Smart Auto/Commercial	$136.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$136.20
Rate for Payer: LLUH Dept of Risk Management WC	$124.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$170.25

HC BONE MARROW ASP/AT TIME OF BX

Facility

$3,671.00

Service Code	CPT 38222
Hospital Charge Code	911800314
Hospital Revenue Code	361
Min. Negotiated Rate	$2,019.05
Max. Negotiated Rate	$2,753.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2,202.60
Rate for Payer: Aetna of CA Government/Medicare	$2,202.60
Rate for Payer: Cash Price	$1,651.95
Rate for Payer: Health Smart Auto/Commercial	$2,202.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2,202.60
Rate for Payer: LLUH Dept of Risk Management WC	$2,019.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,753.25

HC BONE MARROW ASP/AT TIME OF BX

Facility

$3,671.00

Service Code	CPT 38222
Hospital Charge Code	911800314
Hospital Revenue Code	361
Min. Negotiated Rate	$2,019.05
Max. Negotiated Rate	$2,936.80
Rate for Payer: Cash Price	$1,651.95
Rate for Payer: Cigna of CA HMO/PPO	$2,936.80
Rate for Payer: Health Smart Auto/Commercial	$2,202.60
Rate for Payer: LLUH Dept of Risk Management WC	$2,019.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,753.25

HC BONE MARROW BX ONLY

Facility

$3,671.00

Service Code	CPT 38221
Hospital Charge Code	909020057
Hospital Revenue Code	361
Min. Negotiated Rate	$2,019.05
Max. Negotiated Rate	$2,753.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2,202.60
Rate for Payer: Aetna of CA Government/Medicare	$2,202.60
Rate for Payer: Cash Price	$1,651.95
Rate for Payer: Health Smart Auto/Commercial	$2,202.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2,202.60
Rate for Payer: LLUH Dept of Risk Management WC	$2,019.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,753.25

HC BONE MARROW BX ONLY

Facility

$3,671.00

Service Code	CPT 38221
Hospital Charge Code	909020057
Hospital Revenue Code	361
Min. Negotiated Rate	$2,019.05
Max. Negotiated Rate	$2,936.80
Rate for Payer: Cash Price	$1,651.95
Rate for Payer: Cigna of CA HMO/PPO	$2,936.80
Rate for Payer: Health Smart Auto/Commercial	$2,202.60
Rate for Payer: LLUH Dept of Risk Management WC	$2,019.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2,753.25

HC BRISK PROFILE

Facility

$82.00

Service Code	CPT 85576
Hospital Charge Code	900912001
Hospital Revenue Code	305
Min. Negotiated Rate	$45.10
Max. Negotiated Rate	$61.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$49.20
Rate for Payer: Aetna of CA Government/Medicare	$49.20
Rate for Payer: Cash Price	$36.90
Rate for Payer: Health Smart Auto/Commercial	$49.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$49.20
Rate for Payer: LLUH Dept of Risk Management WC	$45.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$61.50

HC BRISK PROFILE

Facility

$468.00

Service Code	CPT 85576
Hospital Charge Code	900912001
Hospital Revenue Code	305
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$374.40
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cigna of CA HMO/PPO	$374.40
Rate for Payer: Health Smart Auto/Commercial	$280.80
Rate for Payer: LLUH Dept of Risk Management WC	$257.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$351.00

HC BUFFY COAT EXAM

Facility

$15.00

Service Code	CPT 85009
Hospital Charge Code	900910196
Hospital Revenue Code	305
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 BUFFY COAT EXAM

Facility

$279.00

Service Code	CPT 85009
Hospital Charge Code	900910196
Hospital Revenue Code	305
Min. Negotiated Rate	$153.45
Max. Negotiated Rate	$223.20
Rate for Payer: Cash Price	$125.55
Rate for Payer: Cigna of CA HMO/PPO	$223.20
Rate for Payer: Health Smart Auto/Commercial	$167.40
Rate for Payer: LLUH Dept of Risk Management WC	$153.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$209.25

HC BUN

Facility

$15.00

Service Code	CPT 84520
Hospital Charge Code	900910253
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 BUN

Facility

$89.00

Service Code	CPT 84520
Hospital Charge Code	900910253
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 BUN BODY FLUID

Facility

$17.00

Service Code	CPT 84520
Hospital Charge Code	900912241
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

Know your out-of-pocket cost for care.

All Charges