Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC LUTEINIZING HORMON

Facility

$273.00

Service Code	CPT 83002
Hospital Charge Code	900910886
Hospital Revenue Code	301
Min. Negotiated Rate	$150.15
Max. Negotiated Rate	$218.40
Rate for Payer: Cash Price	$122.85
Rate for Payer: Cigna of CA HMO/PPO	$218.40
Rate for Payer: Health Smart Auto/Commercial	$163.80
Rate for Payer: LLUH Dept of Risk Management WC	$150.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$204.75

HC MAGNESIUM

Facility

$137.00

Service Code	CPT 83735
Hospital Charge Code	900910230
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 MAGNESIUM

Facility

$20.00

Service Code	CPT 83735
Hospital Charge Code	900910230
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 MALARIA QUANTITAT

Facility

$39.00

Service Code	CPT 87207
Hospital Charge Code	900911640
Hospital Revenue Code	306
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 MALARIA QUANTITAT

Facility

$200.00

Service Code	CPT 87207
Hospital Charge Code	900911640
Hospital Revenue Code	306
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$160.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cigna of CA HMO/PPO	$160.00
Rate for Payer: Health Smart Auto/Commercial	$120.00
Rate for Payer: LLUH Dept of Risk Management WC	$110.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$150.00

HC MALARIA SCREEN AG TEST

Facility

$39.00

Service Code	CPT 87899
Hospital Charge Code	900912441
Hospital Revenue Code	306
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 MALARIA SCREEN AG TEST

Facility

$200.00

Service Code	CPT 87899
Hospital Charge Code	900912441
Hospital Revenue Code	306
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$160.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cigna of CA HMO/PPO	$160.00
Rate for Payer: Health Smart Auto/Commercial	$120.00
Rate for Payer: LLUH Dept of Risk Management WC	$110.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$150.00

HC MALARIA SMEARS

Facility

$39.00

Service Code	CPT 87207
Hospital Charge Code	900911686
Hospital Revenue Code	306
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 MALARIA SMEARS

Facility

$200.00

Service Code	CPT 87207
Hospital Charge Code	900911686
Hospital Revenue Code	306
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$160.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cigna of CA HMO/PPO	$160.00
Rate for Payer: Health Smart Auto/Commercial	$120.00
Rate for Payer: LLUH Dept of Risk Management WC	$110.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$150.00

HC MANDIBLE-COMPLETE

Facility

$1,613.00

Service Code	CPT 70110
Hospital Charge Code	909001122
Hospital Revenue Code	320
Min. Negotiated Rate	$887.15
Max. Negotiated Rate	$1,209.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$967.80
Rate for Payer: Aetna of CA Government/Medicare	$967.80
Rate for Payer: Cash Price	$725.85
Rate for Payer: Health Smart Auto/Commercial	$967.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$967.80
Rate for Payer: LLUH Dept of Risk Management WC	$887.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,209.75

HC MANDIBLE-COMPLETE

Facility

$1,613.00

Service Code	CPT 70110 TC
Hospital Charge Code	909001122
Hospital Revenue Code	320
Min. Negotiated Rate	$887.15
Max. Negotiated Rate	$1,290.40
Rate for Payer: Cash Price	$725.85
Rate for Payer: Cigna of CA HMO/PPO	$1,290.40
Rate for Payer: Health Smart Auto/Commercial	$967.80
Rate for Payer: LLUH Dept of Risk Management WC	$887.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,209.75

HC MANDIBLE-COMPLETE

Facility

$1,613.00

Service Code	CPT 70110
Hospital Charge Code	909001122
Hospital Revenue Code	320
Min. Negotiated Rate	$887.15
Max. Negotiated Rate	$1,290.40
Rate for Payer: Cash Price	$725.85
Rate for Payer: Cigna of CA HMO/PPO	$1,290.40
Rate for Payer: Health Smart Auto/Commercial	$967.80
Rate for Payer: LLUH Dept of Risk Management WC	$887.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,209.75

HC MANDIBLE-COMPLETE

Facility

$1,613.00

Service Code	CPT 70110 TC
Hospital Charge Code	909001122
Hospital Revenue Code	320
Min. Negotiated Rate	$887.15
Max. Negotiated Rate	$1,209.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$967.80
Rate for Payer: Aetna of CA Government/Medicare	$967.80
Rate for Payer: Cash Price	$725.85
Rate for Payer: Health Smart Auto/Commercial	$967.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$967.80
Rate for Payer: LLUH Dept of Risk Management WC	$887.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,209.75

HC MEASLES AB

Facility

$27.00

Service Code	CPT 86765
Hospital Charge Code	900913530
Hospital Revenue Code	302
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.20
Rate for Payer: Aetna of CA Government/Medicare	$16.20
Rate for Payer: Cash Price	$12.15
Rate for Payer: Health Smart Auto/Commercial	$16.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.20
Rate for Payer: LLUH Dept of Risk Management WC	$14.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.25

HC MEASLES AB

Facility

$204.00

Service Code	CPT 86765
Hospital Charge Code	900913530
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 MENINGITIS PANEL NUCLEIC ACID

Facility

$766.00

Service Code	CPT 87483
Hospital Charge Code	900913643
Hospital Revenue Code	300
Min. Negotiated Rate	$421.30
Max. Negotiated Rate	$612.80
Rate for Payer: Cash Price	$344.70
Rate for Payer: Cigna of CA HMO/PPO	$612.80
Rate for Payer: Health Smart Auto/Commercial	$459.60
Rate for Payer: LLUH Dept of Risk Management WC	$421.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$574.50

HC MENINGITIS PANEL NUCLEIC ACID

Facility

$644.00

Service Code	CPT 87483
Hospital Charge Code	900913643
Hospital Revenue Code	300
Min. Negotiated Rate	$354.20
Max. Negotiated Rate	$483.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$386.40
Rate for Payer: Aetna of CA Government/Medicare	$386.40
Rate for Payer: Cash Price	$289.80
Rate for Payer: Health Smart Auto/Commercial	$386.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$386.40
Rate for Payer: LLUH Dept of Risk Management WC	$354.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$483.00

HC METANEPHRINES FRACTIONATED UR

Facility

$65.00

Service Code	CPT 83835
Hospital Charge Code	900910288
Hospital Revenue Code	301
Min. Negotiated Rate	$35.75
Max. Negotiated Rate	$48.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$39.00
Rate for Payer: Aetna of CA Government/Medicare	$39.00
Rate for Payer: Cash Price	$29.25
Rate for Payer: Health Smart Auto/Commercial	$39.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$39.00
Rate for Payer: LLUH Dept of Risk Management WC	$35.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$48.75

HC METANEPHRINES FRACTIONATED UR

Facility

$171.00

Service Code	CPT 83835
Hospital Charge Code	900910288
Hospital Revenue Code	301
Min. Negotiated Rate	$94.05
Max. Negotiated Rate	$136.80
Rate for Payer: Cash Price	$76.95
Rate for Payer: Cigna of CA HMO/PPO	$136.80
Rate for Payer: Health Smart Auto/Commercial	$102.60
Rate for Payer: LLUH Dept of Risk Management WC	$94.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$128.25

HC METHOTREXATE

Facility

$50.00

Service Code	CPT 80204
Hospital Charge Code	900910937
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 METHOTREXATE

Facility

$169.00

Service Code	CPT 80204
Hospital Charge Code	900910937
Hospital Revenue Code	301
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 MICROALBUMIN

Facility

$194.00

Service Code	CPT 82043
Hospital Charge Code	900912131
Hospital Revenue Code	301
Min. Negotiated Rate	$106.70
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$87.30
Rate for Payer: Cigna of CA HMO/PPO	$155.20
Rate for Payer: Health Smart Auto/Commercial	$116.40
Rate for Payer: LLUH Dept of Risk Management WC	$106.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$145.50

HC MICROALBUMIN

Facility

$31.00

Service Code	CPT 82043
Hospital Charge Code	900912131
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 MICRO EXAM/CRYSTALS

Facility

$27.00

Service Code	CPT 89060
Hospital Charge Code	900910153
Hospital Revenue Code	300
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.20
Rate for Payer: Aetna of CA Government/Medicare	$16.20
Rate for Payer: Cash Price	$12.15
Rate for Payer: Health Smart Auto/Commercial	$16.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.20
Rate for Payer: LLUH Dept of Risk Management WC	$14.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$20.25

HC MICRO EXAM/CRYSTALS

Facility

$194.00

Service Code	CPT 89060
Hospital Charge Code	900910153
Hospital Revenue Code	300
Min. Negotiated Rate	$106.70
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$87.30
Rate for Payer: Cigna of CA HMO/PPO	$155.20
Rate for Payer: Health Smart Auto/Commercial	$116.40
Rate for Payer: LLUH Dept of Risk Management WC	$106.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$145.50

Know your out-of-pocket cost for care.

All Charges