Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC ELBOW COMPLETE

Facility

$1,115.00

Service Code	CPT 73080
Hospital Charge Code	909001512
Hospital Revenue Code	320
Min. Negotiated Rate	$613.25
Max. Negotiated Rate	$892.00
Rate for Payer: Cash Price	$501.75
Rate for Payer: Cigna of CA HMO/PPO	$892.00
Rate for Payer: Health Smart Auto/Commercial	$669.00
Rate for Payer: LLUH Dept of Risk Management WC	$613.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$836.25

HC ELBOW LIMITED 2 VIEW

Facility

$788.00

Service Code	CPT 73070 TC
Hospital Charge Code	909001511
Hospital Revenue Code	320
Min. Negotiated Rate	$433.40
Max. Negotiated Rate	$630.40
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cigna of CA HMO/PPO	$630.40
Rate for Payer: Health Smart Auto/Commercial	$472.80
Rate for Payer: LLUH Dept of Risk Management WC	$433.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$591.00

HC ELBOW LIMITED 2 VIEW

Facility

$788.00

Service Code	CPT 73070
Hospital Charge Code	909001511
Hospital Revenue Code	320
Min. Negotiated Rate	$433.40
Max. Negotiated Rate	$630.40
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cigna of CA HMO/PPO	$630.40
Rate for Payer: Health Smart Auto/Commercial	$472.80
Rate for Payer: LLUH Dept of Risk Management WC	$433.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$591.00

HC ELBOW LIMITED 2 VIEW

Facility

$788.00

Service Code	CPT 73070
Hospital Charge Code	909001511
Hospital Revenue Code	320
Min. Negotiated Rate	$433.40
Max. Negotiated Rate	$591.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$472.80
Rate for Payer: Aetna of CA Government/Medicare	$472.80
Rate for Payer: Cash Price	$354.60
Rate for Payer: Health Smart Auto/Commercial	$472.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$472.80
Rate for Payer: LLUH Dept of Risk Management WC	$433.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$591.00

HC ELBOW LIMITED 2 VIEW

Facility

$788.00

Service Code	CPT 73070 TC
Hospital Charge Code	909001511
Hospital Revenue Code	320
Min. Negotiated Rate	$433.40
Max. Negotiated Rate	$591.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$472.80
Rate for Payer: Aetna of CA Government/Medicare	$472.80
Rate for Payer: Cash Price	$354.60
Rate for Payer: Health Smart Auto/Commercial	$472.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$472.80
Rate for Payer: LLUH Dept of Risk Management WC	$433.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$591.00

HC ELECTROLYTE PANEL

Facility

$17.00

Service Code	CPT 80051
Hospital Charge Code	900912165
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 ELECTROLYTE PANEL

Facility

$246.00

Service Code	CPT 80051
Hospital Charge Code	900912165
Hospital Revenue Code	301
Min. Negotiated Rate	$135.30
Max. Negotiated Rate	$196.80
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cigna of CA HMO/PPO	$196.80
Rate for Payer: Health Smart Auto/Commercial	$147.60
Rate for Payer: LLUH Dept of Risk Management WC	$135.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$184.50

HC EOSINOPHIL CT DIR

Facility

$10.00

Service Code	CPT 85048
Hospital Charge Code	900910031
Hospital Revenue Code	305
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 EOSINOPHIL CT DIR

Facility

$101.00

Service Code	CPT 85048
Hospital Charge Code	900910031
Hospital Revenue Code	305
Min. Negotiated Rate	$55.55
Max. Negotiated Rate	$80.80
Rate for Payer: Cash Price	$45.45
Rate for Payer: Cigna of CA HMO/PPO	$80.80
Rate for Payer: Health Smart Auto/Commercial	$60.60
Rate for Payer: LLUH Dept of Risk Management WC	$55.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$75.75

HC EOSINOPHIL SMEAR

Facility

$161.00

Service Code	CPT 89190
Hospital Charge Code	900910030
Hospital Revenue Code	300
Min. Negotiated Rate	$88.55
Max. Negotiated Rate	$128.80
Rate for Payer: Cash Price	$72.45
Rate for Payer: Cigna of CA HMO/PPO	$128.80
Rate for Payer: Health Smart Auto/Commercial	$96.60
Rate for Payer: LLUH Dept of Risk Management WC	$88.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$120.75

HC EOSINOPHIL SMEAR

Facility

$18.00

Service Code	CPT 89190
Hospital Charge Code	900910030
Hospital Revenue Code	300
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 EPSTEIN ANTIBODY SCREEN IGM

Facility

$58.00

Service Code	CPT 86308
Hospital Charge Code	900913657
Hospital Revenue Code	302
Min. Negotiated Rate	$31.90
Max. Negotiated Rate	$46.40
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cigna of CA HMO/PPO	$46.40
Rate for Payer: Health Smart Auto/Commercial	$34.80
Rate for Payer: LLUH Dept of Risk Management WC	$31.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$43.50

HC EPSTEIN ANTIBODY SCREEN IGM

Facility

$39.00

Service Code	CPT 86308
Hospital Charge Code	900913657
Hospital Revenue Code	302
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 EPSTEIN BARR EARLY ANTIGEN IGG

Facility

$39.00

Service Code	CPT 86663
Hospital Charge Code	900913653
Hospital Revenue Code	302
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 EPSTEIN BARR EARLY ANTIGEN IGG

Facility

$58.00

Service Code	CPT 86663
Hospital Charge Code	900913653
Hospital Revenue Code	302
Min. Negotiated Rate	$31.90
Max. Negotiated Rate	$46.40
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cigna of CA HMO/PPO	$46.40
Rate for Payer: Health Smart Auto/Commercial	$34.80
Rate for Payer: LLUH Dept of Risk Management WC	$31.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$43.50

HC EPSTEIN BARR NUCLEAR ANTIGEN IGG

Facility

$58.00

Service Code	CPT 86664
Hospital Charge Code	900913654
Hospital Revenue Code	302
Min. Negotiated Rate	$31.90
Max. Negotiated Rate	$46.40
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cigna of CA HMO/PPO	$46.40
Rate for Payer: Health Smart Auto/Commercial	$34.80
Rate for Payer: LLUH Dept of Risk Management WC	$31.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$43.50

HC EPSTEIN BARR NUCLEAR ANTIGEN IGG

Facility

$39.00

Service Code	CPT 86664
Hospital Charge Code	900913654
Hospital Revenue Code	302
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 EPSTEIN BARR VIRAL CAPSID IGG

Facility

$58.00

Service Code	CPT 86665
Hospital Charge Code	900913655
Hospital Revenue Code	302
Min. Negotiated Rate	$31.90
Max. Negotiated Rate	$46.40
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cigna of CA HMO/PPO	$46.40
Rate for Payer: Health Smart Auto/Commercial	$34.80
Rate for Payer: LLUH Dept of Risk Management WC	$31.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$43.50

HC EPSTEIN BARR VIRAL CAPSID IGG

Facility

$39.00

Service Code	CPT 86665
Hospital Charge Code	900913655
Hospital Revenue Code	302
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 EPSTEIN BARR VIRAL CAPSID IGM

Facility

$58.00

Service Code	CPT 86665
Hospital Charge Code	900913656
Hospital Revenue Code	302
Min. Negotiated Rate	$31.90
Max. Negotiated Rate	$46.40
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cigna of CA HMO/PPO	$46.40
Rate for Payer: Health Smart Auto/Commercial	$34.80
Rate for Payer: LLUH Dept of Risk Management WC	$31.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$43.50

HC EPSTEIN BARR VIRAL CAPSID IGM

Facility

$39.00

Service Code	CPT 86665
Hospital Charge Code	900913656
Hospital Revenue Code	302
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 ESBL DISK CONFIRMATION

Facility

$215.00

Service Code	CPT 87184
Hospital Charge Code	900912449
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 ESBL DISK CONFIRMATION

Facility

$13.00

Service Code	CPT 87184
Hospital Charge Code	900912449
Hospital Revenue Code	306
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.80
Rate for Payer: Aetna of CA Government/Medicare	$7.80
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC ESOPHOGRAM

Facility

$1,198.00

Service Code	CPT 74220 TC
Hospital Charge Code	909001802
Hospital Revenue Code	320
Min. Negotiated Rate	$658.90
Max. Negotiated Rate	$898.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$718.80
Rate for Payer: Aetna of CA Government/Medicare	$718.80
Rate for Payer: Cash Price	$539.10
Rate for Payer: Health Smart Auto/Commercial	$718.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$718.80
Rate for Payer: LLUH Dept of Risk Management WC	$658.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$898.50

HC ESOPHOGRAM

Facility

$1,198.00

Service Code	CPT 74220
Hospital Charge Code	909001802
Hospital Revenue Code	320
Min. Negotiated Rate	$658.90
Max. Negotiated Rate	$898.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$718.80
Rate for Payer: Aetna of CA Government/Medicare	$718.80
Rate for Payer: Cash Price	$539.10
Rate for Payer: Health Smart Auto/Commercial	$718.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$718.80
Rate for Payer: LLUH Dept of Risk Management WC	$658.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$898.50

Know your out-of-pocket cost for care.

All Charges