Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC MULTI-PLANAR RECON

Facility

$2,175.00

Service Code	CPT 76376 TC
Hospital Charge Code	909201350
Hospital Revenue Code	359
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,631.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1,305.00
Rate for Payer: Aetna of CA Government/Medicare	$1,305.00
Rate for Payer: Cash Price	$978.75
Rate for Payer: Health Smart Auto/Commercial	$1,305.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1,305.00
Rate for Payer: LLUH Dept of Risk Management WC	$1,196.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,631.25

HC MULTI-PLANAR RECON

Facility

$2,175.00

Service Code	CPT 76376
Hospital Charge Code	909201350
Hospital Revenue Code	359
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,740.00
Rate for Payer: Cash Price	$978.75
Rate for Payer: Cigna of CA HMO/PPO	$1,740.00
Rate for Payer: Health Smart Auto/Commercial	$1,305.00
Rate for Payer: LLUH Dept of Risk Management WC	$1,196.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,631.25

HC MUMPS AB

Facility

$27.00

Service Code	CPT 86735
Hospital Charge Code	900913533
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 MUMPS AB

Facility

$227.00

Service Code	CPT 86735
Hospital Charge Code	900913533
Hospital Revenue Code	302
Min. Negotiated Rate	$124.85
Max. Negotiated Rate	$181.60
Rate for Payer: Cash Price	$102.15
Rate for Payer: Cigna of CA HMO/PPO	$181.60
Rate for Payer: Health Smart Auto/Commercial	$136.20
Rate for Payer: LLUH Dept of Risk Management WC	$124.85
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$170.25

HC MUMPS ANTIBODY

Facility

$58.00

Service Code	CPT 86735
Hospital Charge Code	900913663
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 MUMPS ANTIBODY

Facility

$39.00

Service Code	CPT 86735
Hospital Charge Code	900913663
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 MYOGLOBIN SCREEN

Facility

$98.00

Service Code	CPT 81003
Hospital Charge Code	900910387
Hospital Revenue Code	307
Min. Negotiated Rate	$53.90
Max. Negotiated Rate	$78.40
Rate for Payer: Cash Price	$44.10
Rate for Payer: Cigna of CA HMO/PPO	$78.40
Rate for Payer: Health Smart Auto/Commercial	$58.80
Rate for Payer: LLUH Dept of Risk Management WC	$53.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$73.50

HC MYOGLOBIN SCREEN

Facility

$11.00

Service Code	CPT 81003
Hospital Charge Code	900910387
Hospital Revenue Code	307
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.60
Rate for Payer: Aetna of CA Government/Medicare	$6.60
Rate for Payer: Cash Price	$4.95
Rate for Payer: Health Smart Auto/Commercial	$6.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.60
Rate for Payer: LLUH Dept of Risk Management WC	$6.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$8.25

HC MYOGLOBIN (SERUM)

Facility

$20.00

Service Code	CPT 83874
Hospital Charge Code	900910825
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 MYOGLOBIN (SERUM)

Facility

$218.00

Service Code	CPT 83874
Hospital Charge Code	900910825
Hospital Revenue Code	301
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$174.40
Rate for Payer: Cash Price	$98.10
Rate for Payer: Cigna of CA HMO/PPO	$174.40
Rate for Payer: Health Smart Auto/Commercial	$130.80
Rate for Payer: LLUH Dept of Risk Management WC	$119.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$163.50

HC NA (POC)

Facility

$82.00

Service Code	CPT 84295
Hospital Charge Code	900912116
Hospital Revenue Code	301
Min. Negotiated Rate	$45.10
Max. Negotiated Rate	$65.60
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cigna of CA HMO/PPO	$65.60
Rate for Payer: Health Smart Auto/Commercial	$49.20
Rate for Payer: LLUH Dept of Risk Management WC	$45.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$61.50

HC NA (POC)

Facility

$82.00

Service Code	CPT 84295
Hospital Charge Code	900912116
Hospital Revenue Code	301
Min. Negotiated Rate	$45.10
Max. Negotiated Rate	$61.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$49.20
Rate for Payer: Aetna of CA Government/Medicare	$49.20
Rate for Payer: Cash Price	$36.90
Rate for Payer: Health Smart Auto/Commercial	$49.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$49.20
Rate for Payer: LLUH Dept of Risk Management WC	$45.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$61.50

HC NASAL BONES

Facility

$1,057.00

Service Code	CPT 70160
Hospital Charge Code	909001104
Hospital Revenue Code	320
Min. Negotiated Rate	$581.35
Max. Negotiated Rate	$845.60
Rate for Payer: Cash Price	$475.65
Rate for Payer: Cigna of CA HMO/PPO	$845.60
Rate for Payer: Health Smart Auto/Commercial	$634.20
Rate for Payer: LLUH Dept of Risk Management WC	$581.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$792.75

HC NASAL BONES

Facility

$1,057.00

Service Code	CPT 70160
Hospital Charge Code	909001104
Hospital Revenue Code	320
Min. Negotiated Rate	$581.35
Max. Negotiated Rate	$792.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$634.20
Rate for Payer: Aetna of CA Government/Medicare	$634.20
Rate for Payer: Cash Price	$475.65
Rate for Payer: Health Smart Auto/Commercial	$634.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$634.20
Rate for Payer: LLUH Dept of Risk Management WC	$581.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$792.75

HC NASAL BONES

Facility

$1,057.00

Service Code	CPT 70160 TC
Hospital Charge Code	909001104
Hospital Revenue Code	320
Min. Negotiated Rate	$581.35
Max. Negotiated Rate	$792.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$634.20
Rate for Payer: Aetna of CA Government/Medicare	$634.20
Rate for Payer: Cash Price	$475.65
Rate for Payer: Health Smart Auto/Commercial	$634.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$634.20
Rate for Payer: LLUH Dept of Risk Management WC	$581.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$792.75

HC NASAL BONES

Facility

$1,057.00

Service Code	CPT 70160 TC
Hospital Charge Code	909001104
Hospital Revenue Code	320
Min. Negotiated Rate	$581.35
Max. Negotiated Rate	$845.60
Rate for Payer: Cash Price	$475.65
Rate for Payer: Cigna of CA HMO/PPO	$845.60
Rate for Payer: Health Smart Auto/Commercial	$634.20
Rate for Payer: LLUH Dept of Risk Management WC	$581.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$792.75

HC NEGATIVE URINE COMBO PANEL 61

Facility

$223.00

Service Code	CPT 87077
Hospital Charge Code	900912450
Hospital Revenue Code	306
Min. Negotiated Rate	$122.65
Max. Negotiated Rate	$178.40
Rate for Payer: Cash Price	$100.35
Rate for Payer: Cigna of CA HMO/PPO	$178.40
Rate for Payer: Health Smart Auto/Commercial	$133.80
Rate for Payer: LLUH Dept of Risk Management WC	$122.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$167.25

HC NEGATIVE URINE COMBO PANEL 61

Facility

$185.00

Service Code	CPT 87077
Hospital Charge Code	900912450
Hospital Revenue Code	306
Min. Negotiated Rate	$101.75
Max. Negotiated Rate	$138.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$111.00
Rate for Payer: Aetna of CA Government/Medicare	$111.00
Rate for Payer: Cash Price	$83.25
Rate for Payer: Health Smart Auto/Commercial	$111.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$111.00
Rate for Payer: LLUH Dept of Risk Management WC	$101.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$138.75

HC N GONNORHOEAE AMPLIFICATION

Facility

$103.00

Service Code	CPT 87591
Hospital Charge Code	900912305
Hospital Revenue Code	306
Min. Negotiated Rate	$56.65
Max. Negotiated Rate	$77.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$61.80
Rate for Payer: Aetna of CA Government/Medicare	$61.80
Rate for Payer: Cash Price	$46.35
Rate for Payer: Health Smart Auto/Commercial	$61.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$61.80
Rate for Payer: LLUH Dept of Risk Management WC	$56.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$77.25

HC N GONNORHOEAE AMPLIFICATION

Facility

$356.00

Service Code	CPT 87591
Hospital Charge Code	900912305
Hospital Revenue Code	306
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 NON SPECIFIC ESTERASE (NSE)

Facility

$392.00

Service Code	CPT 88319
Hospital Charge Code	900910067
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 NON SPECIFIC ESTERASE (NSE)

Facility

$1,080.00

Service Code	CPT 88319 TC
Hospital Charge Code	900910067
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 NON SPECIFIC ESTERASE (NSE)

Facility

$1,080.00

Service Code	CPT 88319
Hospital Charge Code	900910067
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 OCA1 81479 SOUMN

Facility

$1,181.68

Service Code	CPT 81479
Hospital Charge Code	900914802
Hospital Revenue Code	309
Min. Negotiated Rate	$649.92
Max. Negotiated Rate	$945.34
Rate for Payer: Cash Price	$531.76
Rate for Payer: Cigna of CA HMO/PPO	$945.34
Rate for Payer: Health Smart Auto/Commercial	$709.01
Rate for Payer: LLUH Dept of Risk Management WC	$649.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$886.26

HC OCA1 81479 SOUMN

Facility

$1,181.68

Service Code	CPT 81479 90
Hospital Charge Code	900914802
Hospital Revenue Code	300
Min. Negotiated Rate	$649.92
Max. Negotiated Rate	$886.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$709.01
Rate for Payer: Aetna of CA Government/Medicare	$709.01
Rate for Payer: Cash Price	$531.76
Rate for Payer: Health Smart Auto/Commercial	$709.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$709.01
Rate for Payer: LLUH Dept of Risk Management WC	$649.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$886.26

Know your out-of-pocket cost for care.

All Charges