Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC POTASSIUM BODY FLUID

Facility

$17.00

Service Code	CPT 84999
Hospital Charge Code	900912245
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 POTASSIUM POC

Facility

$82.00

Service Code	CPT 84132
Hospital Charge Code	900912117
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 POTASSIUM POC

Facility

$82.00

Service Code	CPT 84132
Hospital Charge Code	900912117
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 POTASSIUM STOOL

Facility

$16.00

Service Code	CPT 84133
Hospital Charge Code	900910416
Hospital Revenue Code	301
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

HC POTASSIUM STOOL

Facility

$179.00

Service Code	CPT 84133
Hospital Charge Code	900910416
Hospital Revenue Code	301
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 POTASSIUM URINE

Facility

$106.00

Service Code	CPT 84133
Hospital Charge Code	900910267
Hospital Revenue Code	301
Min. Negotiated Rate	$58.30
Max. Negotiated Rate	$84.80
Rate for Payer: Cash Price	$47.70
Rate for Payer: Cigna of CA HMO/PPO	$84.80
Rate for Payer: Health Smart Auto/Commercial	$63.60
Rate for Payer: LLUH Dept of Risk Management WC	$58.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$79.50

HC POTASSIUM URINE

Facility

$15.00

Service Code	CPT 84133
Hospital Charge Code	900910267
Hospital Revenue Code	301
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$9.00
Rate for Payer: Aetna of CA Government/Medicare	$9.00
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Smart Auto/Commercial	$9.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$9.00
Rate for Payer: LLUH Dept of Risk Management WC	$8.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$11.25

HC PROB-NATRIURETIC PEPTIDE

Facility

$592.00

Service Code	CPT 83880
Hospital Charge Code	900912306
Hospital Revenue Code	301
Min. Negotiated Rate	$325.60
Max. Negotiated Rate	$473.60
Rate for Payer: Cash Price	$266.40
Rate for Payer: Cigna of CA HMO/PPO	$473.60
Rate for Payer: Health Smart Auto/Commercial	$355.20
Rate for Payer: LLUH Dept of Risk Management WC	$325.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$444.00

HC PROB-NATRIURETIC PEPTIDE

Facility

$95.00

Service Code	CPT 83880
Hospital Charge Code	900912306
Hospital Revenue Code	301
Min. Negotiated Rate	$52.25
Max. Negotiated Rate	$71.25
Rate for Payer: Health Smart Auto/Commercial	$57.00
Rate for Payer: Cash Price	$42.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$57.00
Rate for Payer: Aetna of CA Government/Medicare	$57.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$57.00
Rate for Payer: LLUH Dept of Risk Management WC	$52.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$71.25

HC PROGESTERONE

Facility

$268.00

Service Code	CPT 84144
Hospital Charge Code	900912132
Hospital Revenue Code	301
Min. Negotiated Rate	$147.40
Max. Negotiated Rate	$214.40
Rate for Payer: Cash Price	$120.60
Rate for Payer: Cigna of CA HMO/PPO	$214.40
Rate for Payer: Health Smart Auto/Commercial	$160.80
Rate for Payer: LLUH Dept of Risk Management WC	$147.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$201.00

HC PROGESTERONE

Facility

$43.00

Service Code	CPT 84144
Hospital Charge Code	900912132
Hospital Revenue Code	301
Min. Negotiated Rate	$23.65
Max. Negotiated Rate	$32.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$25.80
Rate for Payer: Aetna of CA Government/Medicare	$25.80
Rate for Payer: Cash Price	$19.35
Rate for Payer: Health Smart Auto/Commercial	$25.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$25.80
Rate for Payer: LLUH Dept of Risk Management WC	$23.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$32.25

HC PROLACTIN

Facility

$398.00

Service Code	CPT 84146
Hospital Charge Code	900910808
Hospital Revenue Code	301
Min. Negotiated Rate	$218.90
Max. Negotiated Rate	$318.40
Rate for Payer: Cash Price	$179.10
Rate for Payer: Cigna of CA HMO/PPO	$318.40
Rate for Payer: Health Smart Auto/Commercial	$238.80
Rate for Payer: LLUH Dept of Risk Management WC	$218.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$298.50

HC PROLACTIN

Facility

$32.00

Service Code	CPT 84146
Hospital Charge Code	900910808
Hospital Revenue Code	301
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$19.20
Rate for Payer: Aetna of CA Government/Medicare	$19.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.00

HC PROSTATE CANCER SCREEN (PSA)

Facility

$212.00

Service Code	CPT G0103
Hospital Charge Code	900912101
Hospital Revenue Code	301
Min. Negotiated Rate	$116.60
Max. Negotiated Rate	$169.60
Rate for Payer: Cash Price	$95.40
Rate for Payer: Cigna of CA HMO/PPO	$169.60
Rate for Payer: Health Smart Auto/Commercial	$127.20
Rate for Payer: LLUH Dept of Risk Management WC	$116.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$159.00

HC PROSTATE CANCER SCREEN (PSA)

Facility

$22.00

Service Code	CPT 84153
Hospital Charge Code	900912101
Hospital Revenue Code	301
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 PROSTATE CANCER SCREEN (PSA)

Facility

$22.00

Service Code	CPT G0103
Hospital Charge Code	900912101
Hospital Revenue Code	301
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 PROSTATE CANCER SCREEN (PSA)

Facility

$212.00

Service Code	CPT 84153
Hospital Charge Code	900912101
Hospital Revenue Code	301
Min. Negotiated Rate	$116.60
Max. Negotiated Rate	$169.60
Rate for Payer: Cash Price	$95.40
Rate for Payer: Cigna of CA HMO/PPO	$169.60
Rate for Payer: Health Smart Auto/Commercial	$127.20
Rate for Payer: LLUH Dept of Risk Management WC	$116.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$159.00

HC PROSTATE SPECIFIC AG. FREE

Facility

$57.00

Service Code	CPT 84154
Hospital Charge Code	900912133
Hospital Revenue Code	301
Min. Negotiated Rate	$31.35
Max. Negotiated Rate	$42.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$34.20
Rate for Payer: Aetna of CA Government/Medicare	$34.20
Rate for Payer: Cash Price	$25.65
Rate for Payer: Health Smart Auto/Commercial	$34.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$34.20
Rate for Payer: LLUH Dept of Risk Management WC	$31.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$42.75

HC PROSTATE SPECIFIC AG. FREE

Facility

$244.00

Service Code	CPT 84154
Hospital Charge Code	900912133
Hospital Revenue Code	301
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$195.20
Rate for Payer: Cash Price	$109.80
Rate for Payer: Cigna of CA HMO/PPO	$195.20
Rate for Payer: Health Smart Auto/Commercial	$146.40
Rate for Payer: LLUH Dept of Risk Management WC	$134.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$183.00

HC PROSTATE SPECIFIC ANTIGEN

Facility

$244.00

Service Code	CPT 84153
Hospital Charge Code	900910879
Hospital Revenue Code	301
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$195.20
Rate for Payer: Cash Price	$109.80
Rate for Payer: Cigna of CA HMO/PPO	$195.20
Rate for Payer: Health Smart Auto/Commercial	$146.40
Rate for Payer: LLUH Dept of Risk Management WC	$134.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$183.00

HC PROSTATE SPECIFIC ANTIGEN

Facility

$22.00

Service Code	CPT 84153
Hospital Charge Code	900910879
Hospital Revenue Code	301
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 PROTEIN BODY FLUID

Facility

$17.00

Service Code	CPT 84157
Hospital Charge Code	900910248
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 PROTEIN BODY FLUID

Facility

$32.00

Service Code	CPT 84157
Hospital Charge Code	900910248
Hospital Revenue Code	301
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$25.60
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna of CA HMO/PPO	$25.60
Rate for Payer: Health Smart Auto/Commercial	$19.20
Rate for Payer: LLUH Dept of Risk Management WC	$17.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$24.00

HC PROTEIN C ACTIVITY

Facility

$440.00

Service Code	CPT 85303
Hospital Charge Code	900912012
Hospital Revenue Code	305
Min. Negotiated Rate	$242.00
Max. Negotiated Rate	$352.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cigna of CA HMO/PPO	$352.00
Rate for Payer: Health Smart Auto/Commercial	$264.00
Rate for Payer: LLUH Dept of Risk Management WC	$242.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$330.00

HC PROTEIN C ACTIVITY

Facility

$53.00

Service Code	CPT 85303
Hospital Charge Code	900912012
Hospital Revenue Code	305
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

Know your out-of-pocket cost for care.

All Charges