Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC LAB REF WHITE BEAN IGE

Facility

$13.00

Service Code	CPT 86003 90
Hospital Charge Code	900912545
Hospital Revenue Code	302
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 LAB REF WHITE BEAN IGE

Facility

$13.00

Service Code	CPT 86003
Hospital Charge Code	900912545
Hospital Revenue Code	302
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$10.40
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cigna of CA HMO/PPO	$10.40
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC LAB REF WHITE BEAN IGE

Facility

$13.00

Service Code	CPT 86003
Hospital Charge Code	900912545
Hospital Revenue Code	302
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 LAB REF WHITE BEAN IGE

Facility

$13.00

Service Code	CPT 86003 90
Hospital Charge Code	900912545
Hospital Revenue Code	302
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$10.40
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cigna of CA HMO/PPO	$10.40
Rate for Payer: Health Smart Auto/Commercial	$7.80
Rate for Payer: LLUH Dept of Risk Management WC	$7.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.75

HC LAB REF ZINC URINE

Facility

$25.00

Service Code	CPT 84630 90
Hospital Charge Code	900911153
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 LAB REF ZINC URINE

Facility

$25.00

Service Code	CPT 84630 90
Hospital Charge Code	900911153
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 LAB REF ZINC URINE

Facility

$25.00

Service Code	CPT 84630
Hospital Charge Code	900911153
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 LAB REF ZINC URINE

Facility

$25.00

Service Code	CPT 84630
Hospital Charge Code	900911153
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 LACTATE (CSF/POC)

Facility

$31.00

Service Code	CPT 83605
Hospital Charge Code	900910245
Hospital Revenue Code	301
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.60
Rate for Payer: Aetna of CA Government/Medicare	$18.60
Rate for Payer: Cash Price	$13.95
Rate for Payer: Health Smart Auto/Commercial	$18.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.60
Rate for Payer: LLUH Dept of Risk Management WC	$17.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$23.25

HC LACTATE (CSF/POC)

Facility

$278.00

Service Code	CPT 83605
Hospital Charge Code	900910245
Hospital Revenue Code	301
Min. Negotiated Rate	$152.90
Max. Negotiated Rate	$222.40
Rate for Payer: Cash Price	$125.10
Rate for Payer: Cigna of CA HMO/PPO	$222.40
Rate for Payer: Health Smart Auto/Commercial	$166.80
Rate for Payer: LLUH Dept of Risk Management WC	$152.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$208.50

HC LACTATE DEHYDROGENASE

Facility

$137.00

Service Code	CPT 83615
Hospital Charge Code	900910229
Hospital Revenue Code	301
Min. Negotiated Rate	$75.35
Max. Negotiated Rate	$109.60
Rate for Payer: Cash Price	$61.65
Rate for Payer: Cigna of CA HMO/PPO	$109.60
Rate for Payer: Health Smart Auto/Commercial	$82.20
Rate for Payer: LLUH Dept of Risk Management WC	$75.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$102.75

HC LACTATE DEHYDROGENASE

Facility

$20.00

Service Code	CPT 83615
Hospital Charge Code	900910229
Hospital Revenue Code	301
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.00
Rate for Payer: Aetna of CA Government/Medicare	$12.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Smart Auto/Commercial	$12.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.00
Rate for Payer: LLUH Dept of Risk Management WC	$11.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.00

HC LACTATE DEHYDROGENASE BODY FL

Facility

$17.00

Service Code	CPT 83615
Hospital Charge Code	900912243
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 LACTATE DEHYDROGENASE BODY FL

Facility

$25.00

Service Code	CPT 83615
Hospital Charge Code	900912243
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 LACTOSE TOLERANCE

Facility

$49.00

Service Code	CPT 82951
Hospital Charge Code	900910313
Hospital Revenue Code	301
Min. Negotiated Rate	$26.95
Max. Negotiated Rate	$36.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$29.40
Rate for Payer: Aetna of CA Government/Medicare	$29.40
Rate for Payer: Cash Price	$22.05
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$29.40
Rate for Payer: LLUH Dept of Risk Management WC	$26.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$36.75

HC LACTOSE TOLERANCE

Facility

$204.00

Service Code	CPT 82951
Hospital Charge Code	900910313
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 LAMELLAR BODY COUNT AMNIOTIC

Facility

$73.00

Service Code	CPT 83664
Hospital Charge Code	900912027
Hospital Revenue Code	305
Min. Negotiated Rate	$40.15
Max. Negotiated Rate	$54.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$43.80
Rate for Payer: Aetna of CA Government/Medicare	$43.80
Rate for Payer: Cash Price	$32.85
Rate for Payer: Health Smart Auto/Commercial	$43.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$43.80
Rate for Payer: LLUH Dept of Risk Management WC	$40.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$54.75

HC LAMELLAR BODY COUNT AMNIOTIC

Facility

$116.00

Service Code	CPT 83664
Hospital Charge Code	900912027
Hospital Revenue Code	305
Min. Negotiated Rate	$63.80
Max. Negotiated Rate	$92.80
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cigna of CA HMO/PPO	$92.80
Rate for Payer: Health Smart Auto/Commercial	$69.60
Rate for Payer: LLUH Dept of Risk Management WC	$63.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$87.00

HC LEUK ACID PHOSP (TRAP STAIN)

Facility

$392.00

Service Code	CPT 88319
Hospital Charge Code	900910068
Hospital Revenue Code	310
Min. Negotiated Rate	$215.60
Max. Negotiated Rate	$294.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$235.20
Rate for Payer: Aetna of CA Government/Medicare	$235.20
Rate for Payer: Cash Price	$176.40
Rate for Payer: Health Smart Auto/Commercial	$235.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$235.20
Rate for Payer: LLUH Dept of Risk Management WC	$215.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$294.00

HC LEUK ACID PHOSP (TRAP STAIN)

Facility

$1,080.00

Service Code	CPT 88319
Hospital Charge Code	900910068
Hospital Revenue Code	310
Min. Negotiated Rate	$594.00
Max. Negotiated Rate	$864.00
Rate for Payer: Cash Price	$486.00
Rate for Payer: Cigna of CA HMO/PPO	$864.00
Rate for Payer: Health Smart Auto/Commercial	$648.00
Rate for Payer: LLUH Dept of Risk Management WC	$594.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$810.00

HC LEUK ACID PHOSP (TRAP STAIN)

Facility

$1,080.00

Service Code	CPT 88319 TC
Hospital Charge Code	900910068
Hospital Revenue Code	310
Min. Negotiated Rate	$594.00
Max. Negotiated Rate	$864.00
Rate for Payer: Cash Price	$486.00
Rate for Payer: Cigna of CA HMO/PPO	$864.00
Rate for Payer: Health Smart Auto/Commercial	$648.00
Rate for Payer: LLUH Dept of Risk Management WC	$594.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$810.00

HC LEUK ALK PHOS

Facility

$44.00

Service Code	CPT 85540
Hospital Charge Code	900910059
Hospital Revenue Code	305
Min. Negotiated Rate	$24.20
Max. Negotiated Rate	$33.00
Rate for Payer: Cash Price	$19.80
Rate for Payer: Health Smart Auto/Commercial	$26.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$26.40
Rate for Payer: Aetna of CA Government/Medicare	$26.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$26.40
Rate for Payer: LLUH Dept of Risk Management WC	$24.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.00

HC LEUK ALK PHOS

Facility

$520.00

Service Code	CPT 85540
Hospital Charge Code	900910059
Hospital Revenue Code	305
Min. Negotiated Rate	$286.00
Max. Negotiated Rate	$416.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cigna of CA HMO/PPO	$416.00
Rate for Payer: Health Smart Auto/Commercial	$312.00
Rate for Payer: LLUH Dept of Risk Management WC	$286.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$390.00

HC LEUKOCYTES FECAL

Facility

$179.00

Service Code	CPT 89055
Hospital Charge Code	900911641
Hospital Revenue Code	306
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 LEUKOCYTES FECAL

Facility

$16.00

Service Code	CPT 89055
Hospital Charge Code	900911641
Hospital Revenue Code	306
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

Know your out-of-pocket cost for care.

All Charges