Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC CHLAMYDIA AMPLIFICATION

Facility

$356.00

Service Code	CPT 87491
Hospital Charge Code	900912304
Hospital Revenue Code	301
Min. Negotiated Rate	$195.80
Max. Negotiated Rate	$284.80
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cigna of CA HMO/PPO	$284.80
Rate for Payer: Health Smart Auto/Commercial	$213.60
Rate for Payer: LLUH Dept of Risk Management WC	$195.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$267.00

HC CHLAMYDIA PNEU CULTR SOURCE SO

Facility

$21.09

Service Code	CPT 87140 90
Hospital Charge Code	900914083
Hospital Revenue Code	306
Min. Negotiated Rate	$11.60
Max. Negotiated Rate	$15.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.65
Rate for Payer: Aetna of CA Government/Medicare	$12.65
Rate for Payer: Cash Price	$9.49
Rate for Payer: Health Smart Auto/Commercial	$12.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.65
Rate for Payer: LLUH Dept of Risk Management WC	$11.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.82

HC CHLAMYDIA PNEU CULTR SOURCE SO

Facility

$21.09

Service Code	CPT 87140 90
Hospital Charge Code	900914083
Hospital Revenue Code	306
Min. Negotiated Rate	$11.60
Max. Negotiated Rate	$16.87
Rate for Payer: Cash Price	$9.49
Rate for Payer: Cigna of CA HMO/PPO	$16.87
Rate for Payer: Health Smart Auto/Commercial	$12.65
Rate for Payer: LLUH Dept of Risk Management WC	$11.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.82

HC CHLAMYDIA PNEU CULTR SOURCE SO

Facility

$21.09

Service Code	CPT 87140
Hospital Charge Code	900914083
Hospital Revenue Code	306
Min. Negotiated Rate	$11.60
Max. Negotiated Rate	$16.87
Rate for Payer: Cash Price	$9.49
Rate for Payer: Cigna of CA HMO/PPO	$16.87
Rate for Payer: Health Smart Auto/Commercial	$12.65
Rate for Payer: LLUH Dept of Risk Management WC	$11.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.82

HC CHLAMYDIA PNEU CULTR SOURCE SO

Facility

$21.09

Service Code	CPT 87140
Hospital Charge Code	900914083
Hospital Revenue Code	306
Min. Negotiated Rate	$11.60
Max. Negotiated Rate	$15.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.65
Rate for Payer: Aetna of CA Government/Medicare	$12.65
Rate for Payer: Cash Price	$9.49
Rate for Payer: Health Smart Auto/Commercial	$12.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.65
Rate for Payer: LLUH Dept of Risk Management WC	$11.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.82

HC CHLORAMPHENICOL E TEST

Facility

$19.00

Service Code	CPT 87181
Hospital Charge Code	900912442
Hospital Revenue Code	306
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 CHLORAMPHENICOL E TEST

Facility

$87.00

Service Code	CPT 87181
Hospital Charge Code	900912442
Hospital Revenue Code	306
Min. Negotiated Rate	$47.85
Max. Negotiated Rate	$69.60
Rate for Payer: Cash Price	$39.15
Rate for Payer: Cigna of CA HMO/PPO	$69.60
Rate for Payer: Health Smart Auto/Commercial	$52.20
Rate for Payer: LLUH Dept of Risk Management WC	$47.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$65.25

HC CHLORIDE

Facility

$15.00

Service Code	CPT 82435
Hospital Charge Code	900910256
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 CHLORIDE

Facility

$89.00

Service Code	CPT 82435
Hospital Charge Code	900910256
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 CHLORIDE STOOL

Facility

$16.00

Service Code	CPT 82438
Hospital Charge Code	900910420
Hospital Revenue Code	301
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.60
Rate for Payer: Aetna of CA Government/Medicare	$9.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Smart Auto/Commercial	$9.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.60
Rate for Payer: LLUH Dept of Risk Management WC	$8.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.00

HC CHLORIDE STOOL

Facility

$179.00

Service Code	CPT 82438
Hospital Charge Code	900910420
Hospital Revenue Code	301
Min. Negotiated Rate	$98.45
Max. Negotiated Rate	$143.20
Rate for Payer: Cash Price	$80.55
Rate for Payer: Cigna of CA HMO/PPO	$143.20
Rate for Payer: Health Smart Auto/Commercial	$107.40
Rate for Payer: LLUH Dept of Risk Management WC	$98.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$134.25

HC CHLORIDE URINE

Facility

$15.00

Service Code	CPT 82436
Hospital Charge Code	900910268
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 CHLORIDE URINE

Facility

$106.00

Service Code	CPT 82436
Hospital Charge Code	900910268
Hospital Revenue Code	301
Min. Negotiated Rate	$58.30
Max. Negotiated Rate	$84.80
Rate for Payer: Cash Price	$47.70
Rate for Payer: Cigna of CA HMO/PPO	$84.80
Rate for Payer: Health Smart Auto/Commercial	$63.60
Rate for Payer: LLUH Dept of Risk Management WC	$58.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$79.50

HC CHOLESTEROL BODY FLUID

Facility

$25.00

Service Code	CPT 84311
Hospital Charge Code	900912242
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 CHOLESTEROL BODY FLUID

Facility

$17.00

Service Code	CPT 84311
Hospital Charge Code	900912242
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 CHOLESTEROL HDL DIRECT

Facility

$24.00

Service Code	CPT 83718
Hospital Charge Code	900910528
Hospital Revenue Code	301
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.40
Rate for Payer: Aetna of CA Government/Medicare	$14.40
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.00

HC CHOLESTEROL HDL DIRECT

Facility

$138.00

Service Code	CPT 83718
Hospital Charge Code	900910528
Hospital Revenue Code	301
Min. Negotiated Rate	$75.90
Max. Negotiated Rate	$110.40
Rate for Payer: Cash Price	$62.10
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$103.50

HC CHOLESTEROL HDL-DIRECT INDIV

Facility

$138.00

Service Code	CPT 83718
Hospital Charge Code	900910527
Hospital Revenue Code	301
Min. Negotiated Rate	$75.90
Max. Negotiated Rate	$110.40
Rate for Payer: Cash Price	$62.10
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$103.50

HC CHOLESTEROL HDL-DIRECT INDIV

Facility

$24.00

Service Code	CPT 83718
Hospital Charge Code	900910527
Hospital Revenue Code	301
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.40
Rate for Payer: Aetna of CA Government/Medicare	$14.40
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.00

HC CHOLESTEROL LDL-DIRECT

Facility

$162.00

Service Code	CPT 83721
Hospital Charge Code	900910529
Hospital Revenue Code	301
Min. Negotiated Rate	$89.10
Max. Negotiated Rate	$129.60
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cigna of CA HMO/PPO	$129.60
Rate for Payer: Health Smart Auto/Commercial	$97.20
Rate for Payer: LLUH Dept of Risk Management WC	$89.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$121.50

HC CHOLESTEROL LDL-DIRECT

Facility

$24.00

Service Code	CPT 83721
Hospital Charge Code	900910529
Hospital Revenue Code	301
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.40
Rate for Payer: Aetna of CA Government/Medicare	$14.40
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.00

HC CHOLESTEROL TOTAL

Facility

$15.00

Service Code	CPT 82465
Hospital Charge Code	900910221
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 CHOLESTEROL TOTAL

Facility

$89.00

Service Code	CPT 82465
Hospital Charge Code	900910221
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 CHOLESTEROL TOTAL INDIVIDUAL

Facility

$15.00

Service Code	CPT 82465
Hospital Charge Code	900910525
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 CHOLESTEROL TOTAL INDIVIDUAL

Facility

$89.00

Service Code	CPT 82465
Hospital Charge Code	900910525
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

Know your out-of-pocket cost for care.

All Charges