Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC HERPES SIMPLEX TYPE 2

Facility

$58.00

Service Code	CPT 86696
Hospital Charge Code	900913661
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 HISTONE AUTO AB

Facility

$162.00

Service Code	CPT 86255
Hospital Charge Code	900913528
Hospital Revenue Code	302
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 HISTONE AUTO AB

Facility

$22.00

Service Code	CPT 86255
Hospital Charge Code	900913528
Hospital Revenue Code	302
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.20
Rate for Payer: Aetna of CA Government/Medicare	$13.20
Rate for Payer: Cash Price	$9.90
Rate for Payer: Health Smart Auto/Commercial	$13.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.20
Rate for Payer: LLUH Dept of Risk Management WC	$12.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$16.50

HC HIV ANTIGEN, ANTIBODY

Facility

$39.00

Service Code	CPT 87389
Hospital Charge Code	900913662
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 HIV ANTIGEN, ANTIBODY

Facility

$58.00

Service Code	CPT 87389
Hospital Charge Code	900913662
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 HIV RAPID TESTING

Facility

$204.00

Service Code	CPT 86703
Hospital Charge Code	900912325
Hospital Revenue Code	302
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$163.20
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna of CA HMO/PPO	$163.20
Rate for Payer: Health Smart Auto/Commercial	$122.40
Rate for Payer: LLUH Dept of Risk Management WC	$112.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$153.00

HC HIV RAPID TESTING

Facility

$53.00

Service Code	CPT 86703
Hospital Charge Code	900912325
Hospital Revenue Code	302
Min. Negotiated Rate	$29.15
Max. Negotiated Rate	$39.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$31.80
Rate for Payer: Aetna of CA Government/Medicare	$31.80
Rate for Payer: Cash Price	$23.85
Rate for Payer: Health Smart Auto/Commercial	$31.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$31.80
Rate for Payer: LLUH Dept of Risk Management WC	$29.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$39.75

HC HOMOVANILLIC ACID (HVA)

Facility

$74.00

Service Code	CPT 83150
Hospital Charge Code	900910532
Hospital Revenue Code	301
Min. Negotiated Rate	$40.70
Max. Negotiated Rate	$55.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$44.40
Rate for Payer: Aetna of CA Government/Medicare	$44.40
Rate for Payer: Cash Price	$33.30
Rate for Payer: Health Smart Auto/Commercial	$44.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$44.40
Rate for Payer: LLUH Dept of Risk Management WC	$40.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$55.50

HC HOMOVANILLIC ACID (HVA)

Facility

$204.00

Service Code	CPT 83150
Hospital Charge Code	900910532
Hospital Revenue Code	301
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$163.20
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna of CA HMO/PPO	$163.20
Rate for Payer: Health Smart Auto/Commercial	$122.40
Rate for Payer: LLUH Dept of Risk Management WC	$112.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$153.00

HC H. PYLORI AB, IGG

Facility

$204.00

Service Code	CPT 86677
Hospital Charge Code	900913556
Hospital Revenue Code	302
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$163.20
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna of CA HMO/PPO	$163.20
Rate for Payer: Health Smart Auto/Commercial	$122.40
Rate for Payer: LLUH Dept of Risk Management WC	$112.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$153.00

HC H. PYLORI AB, IGG

Facility

$56.00

Service Code	CPT 86677
Hospital Charge Code	900913556
Hospital Revenue Code	302
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.60
Rate for Payer: Aetna of CA Government/Medicare	$33.60
Rate for Payer: Cash Price	$25.20
Rate for Payer: Health Smart Auto/Commercial	$33.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.60
Rate for Payer: LLUH Dept of Risk Management WC	$30.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$42.00

HC HSV 1,2 IGM

Facility

$190.00

Service Code	CPT 86694
Hospital Charge Code	900913562
Hospital Revenue Code	302
Min. Negotiated Rate	$104.50
Max. Negotiated Rate	$152.00
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cigna of CA HMO/PPO	$152.00
Rate for Payer: Health Smart Auto/Commercial	$114.00
Rate for Payer: LLUH Dept of Risk Management WC	$104.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$142.50

HC HSV 1,2 IGM

Facility

$45.00

Service Code	CPT 86694
Hospital Charge Code	900913562
Hospital Revenue Code	302
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 HSV 1&2 PCR

Facility

$172.00

Service Code	CPT 87529
Hospital Charge Code	900912307
Hospital Revenue Code	306
Min. Negotiated Rate	$94.60
Max. Negotiated Rate	$137.60
Rate for Payer: Cash Price	$77.40
Rate for Payer: Cigna of CA HMO/PPO	$137.60
Rate for Payer: Health Smart Auto/Commercial	$103.20
Rate for Payer: LLUH Dept of Risk Management WC	$94.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$129.00

HC HSV 1&2 PCR

Facility

$100.00

Service Code	CPT 87529
Hospital Charge Code	900912307
Hospital Revenue Code	306
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$60.00
Rate for Payer: Aetna of CA Government/Medicare	$60.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Smart Auto/Commercial	$60.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$60.00
Rate for Payer: LLUH Dept of Risk Management WC	$55.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$75.00

HC HSV 1 IGG

Facility

$204.00

Service Code	CPT 86695
Hospital Charge Code	900913540
Hospital Revenue Code	302
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$163.20
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna of CA HMO/PPO	$163.20
Rate for Payer: Health Smart Auto/Commercial	$122.40
Rate for Payer: LLUH Dept of Risk Management WC	$112.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$153.00

HC HSV 1 IGG

Facility

$50.00

Service Code	CPT 86695
Hospital Charge Code	900913540
Hospital Revenue Code	302
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 HSV 2 IGG

Facility

$50.00

Service Code	CPT 86696
Hospital Charge Code	900913541
Hospital Revenue Code	302
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 HSV 2 IGG

Facility

$204.00

Service Code	CPT 86696
Hospital Charge Code	900913541
Hospital Revenue Code	302
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$163.20
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna of CA HMO/PPO	$163.20
Rate for Payer: Health Smart Auto/Commercial	$122.40
Rate for Payer: LLUH Dept of Risk Management WC	$112.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$153.00

HC HUMERUS

Facility

$943.00

Service Code	CPT 73060 TC
Hospital Charge Code	909001508
Hospital Revenue Code	320
Min. Negotiated Rate	$518.65
Max. Negotiated Rate	$707.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$565.80
Rate for Payer: Aetna of CA Government/Medicare	$565.80
Rate for Payer: Cash Price	$424.35
Rate for Payer: Health Smart Auto/Commercial	$565.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$565.80
Rate for Payer: LLUH Dept of Risk Management WC	$518.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$707.25

HC HUMERUS

Facility

$943.00

Service Code	CPT 73060
Hospital Charge Code	909001508
Hospital Revenue Code	320
Min. Negotiated Rate	$518.65
Max. Negotiated Rate	$754.40
Rate for Payer: Cash Price	$424.35
Rate for Payer: Cigna of CA HMO/PPO	$754.40
Rate for Payer: Health Smart Auto/Commercial	$565.80
Rate for Payer: LLUH Dept of Risk Management WC	$518.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$707.25

HC HUMERUS

Facility

$943.00

Service Code	CPT 73060 TC
Hospital Charge Code	909001508
Hospital Revenue Code	320
Min. Negotiated Rate	$518.65
Max. Negotiated Rate	$754.40
Rate for Payer: Cash Price	$424.35
Rate for Payer: Cigna of CA HMO/PPO	$754.40
Rate for Payer: Health Smart Auto/Commercial	$565.80
Rate for Payer: LLUH Dept of Risk Management WC	$518.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$707.25

HC HUMERUS

Facility

$943.00

Service Code	CPT 73060
Hospital Charge Code	909001508
Hospital Revenue Code	320
Min. Negotiated Rate	$518.65
Max. Negotiated Rate	$707.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$565.80
Rate for Payer: Aetna of CA Government/Medicare	$565.80
Rate for Payer: Cash Price	$424.35
Rate for Payer: Health Smart Auto/Commercial	$565.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$565.80
Rate for Payer: LLUH Dept of Risk Management WC	$518.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$707.25

HC IDENT OF ARTHROPOD

Facility

$169.00

Service Code	CPT 87168
Hospital Charge Code	900912431
Hospital Revenue Code	306
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 IDENT OF ARTHROPOD

Facility

$17.00

Service Code	CPT 87168
Hospital Charge Code	900912431
Hospital Revenue Code	306
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