Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC PT SUBSTITUTION

Facility

$15.00

Service Code	CPT 85611
Hospital Charge Code	900910105
Hospital Revenue Code	305
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 PT SUBSTITUTION

Facility

$186.00

Service Code	CPT 85611
Hospital Charge Code	900910105
Hospital Revenue Code	305
Min. Negotiated Rate	$102.30
Max. Negotiated Rate	$148.80
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cigna of CA HMO/PPO	$148.80
Rate for Payer: Health Smart Auto/Commercial	$111.60
Rate for Payer: LLUH Dept of Risk Management WC	$102.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$139.50

HC PTT

Facility

$194.00

Service Code	CPT 85730
Hospital Charge Code	900910007
Hospital Revenue Code	305
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 PTT

Facility

$21.00

Service Code	CPT 85730
Hospital Charge Code	900910007
Hospital Revenue Code	305
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$15.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.60
Rate for Payer: Aetna of CA Government/Medicare	$12.60
Rate for Payer: Cash Price	$9.45
Rate for Payer: Health Smart Auto/Commercial	$12.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.60
Rate for Payer: LLUH Dept of Risk Management WC	$11.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.75

HC PTT SUBSTITUTION

Facility

$194.00

Service Code	CPT 85732
Hospital Charge Code	900910106
Hospital Revenue Code	305
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 PTT SUBSTITUTION

Facility

$31.00

Service Code	CPT 85732
Hospital Charge Code	900910106
Hospital Revenue Code	305
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 PYRUVATE

Facility

$41.00

Service Code	CPT 84210
Hospital Charge Code	900910251
Hospital Revenue Code	301
Min. Negotiated Rate	$22.55
Max. Negotiated Rate	$30.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.60
Rate for Payer: Aetna of CA Government/Medicare	$24.60
Rate for Payer: Cash Price	$18.45
Rate for Payer: Health Smart Auto/Commercial	$24.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.60
Rate for Payer: LLUH Dept of Risk Management WC	$22.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.75

HC PYRUVATE

Facility

$253.00

Service Code	CPT 84210
Hospital Charge Code	900910251
Hospital Revenue Code	301
Min. Negotiated Rate	$139.15
Max. Negotiated Rate	$202.40
Rate for Payer: Cash Price	$113.85
Rate for Payer: Cigna of CA HMO/PPO	$202.40
Rate for Payer: Health Smart Auto/Commercial	$151.80
Rate for Payer: LLUH Dept of Risk Management WC	$139.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$189.75

HC PYRUVATE CSF

Facility

$253.00

Service Code	CPT 84210
Hospital Charge Code	900910344
Hospital Revenue Code	301
Min. Negotiated Rate	$139.15
Max. Negotiated Rate	$202.40
Rate for Payer: Cash Price	$113.85
Rate for Payer: Cigna of CA HMO/PPO	$202.40
Rate for Payer: Health Smart Auto/Commercial	$151.80
Rate for Payer: LLUH Dept of Risk Management WC	$139.15
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$189.75

HC PYRUVATE CSF

Facility

$41.00

Service Code	CPT 84210
Hospital Charge Code	900910344
Hospital Revenue Code	301
Min. Negotiated Rate	$22.55
Max. Negotiated Rate	$30.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$24.60
Rate for Payer: Aetna of CA Government/Medicare	$24.60
Rate for Payer: Cash Price	$18.45
Rate for Payer: Health Smart Auto/Commercial	$24.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$24.60
Rate for Payer: LLUH Dept of Risk Management WC	$22.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$30.75

HC RDLGC SM INT FLW THRGH STDY

Facility

$954.00

Service Code	CPT 74248
Hospital Charge Code	909004248
Hospital Revenue Code	320
Min. Negotiated Rate	$524.70
Max. Negotiated Rate	$763.20
Rate for Payer: Cash Price	$429.30
Rate for Payer: Cigna of CA HMO/PPO	$763.20
Rate for Payer: Health Smart Auto/Commercial	$572.40
Rate for Payer: LLUH Dept of Risk Management WC	$524.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$715.50

HC RDLGC SM INT FLW THRGH STDY

Facility

$954.00

Service Code	CPT 74248 TC
Hospital Charge Code	909004248
Hospital Revenue Code	320
Min. Negotiated Rate	$524.70
Max. Negotiated Rate	$715.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$572.40
Rate for Payer: Aetna of CA Government/Medicare	$572.40
Rate for Payer: Cash Price	$429.30
Rate for Payer: Health Smart Auto/Commercial	$572.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$572.40
Rate for Payer: LLUH Dept of Risk Management WC	$524.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$715.50

HC RDLGC SM INT FLW THRGH STDY

Facility

$954.00

Service Code	CPT 74248 TC
Hospital Charge Code	909004248
Hospital Revenue Code	320
Min. Negotiated Rate	$524.70
Max. Negotiated Rate	$763.20
Rate for Payer: Cash Price	$429.30
Rate for Payer: Cigna of CA HMO/PPO	$763.20
Rate for Payer: Health Smart Auto/Commercial	$572.40
Rate for Payer: LLUH Dept of Risk Management WC	$524.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$715.50

HC RDLGC SM INT FLW THRGH STDY

Facility

$954.00

Service Code	CPT 74248
Hospital Charge Code	909004248
Hospital Revenue Code	320
Min. Negotiated Rate	$524.70
Max. Negotiated Rate	$715.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$572.40
Rate for Payer: Aetna of CA Government/Medicare	$572.40
Rate for Payer: Cash Price	$429.30
Rate for Payer: Health Smart Auto/Commercial	$572.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$572.40
Rate for Payer: LLUH Dept of Risk Management WC	$524.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$715.50

HC REDUCING SUBSTANCE

Facility

$10.00

Service Code	CPT 81005
Hospital Charge Code	900910318
Hospital Revenue Code	307
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.00
Rate for Payer: Aetna of CA Government/Medicare	$6.00
Rate for Payer: Cash Price	$4.50
Rate for Payer: Health Smart Auto/Commercial	$6.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.00
Rate for Payer: LLUH Dept of Risk Management WC	$5.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$7.50

HC REDUCING SUBSTANCE

Facility

$89.00

Service Code	CPT 81005
Hospital Charge Code	900910318
Hospital Revenue Code	307
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$71.20
Rate for Payer: Cash Price	$40.05
Rate for Payer: Cigna of CA HMO/PPO	$71.20
Rate for Payer: Health Smart Auto/Commercial	$53.40
Rate for Payer: LLUH Dept of Risk Management WC	$48.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$66.75

HC RENAL FUNCTION PANEL

Facility

$600.00

Service Code	CPT 80069
Hospital Charge Code	900912172
Hospital Revenue Code	301
Min. Negotiated Rate	$330.00
Max. Negotiated Rate	$480.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cigna of CA HMO/PPO	$480.00
Rate for Payer: Health Smart Auto/Commercial	$360.00
Rate for Payer: LLUH Dept of Risk Management WC	$330.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$450.00

HC RENAL FUNCTION PANEL

Facility

$600.00

Service Code	CPT 80069
Hospital Charge Code	900912172
Hospital Revenue Code	301
Min. Negotiated Rate	$330.00
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$360.00
Rate for Payer: Aetna of CA Government/Medicare	$360.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Health Smart Auto/Commercial	$360.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$360.00
Rate for Payer: LLUH Dept of Risk Management WC	$330.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$450.00

HC RESP VIRUS PANEL NUCLEIC ACID

Facility

$812.00

Service Code	CPT 87633
Hospital Charge Code	900912337
Hospital Revenue Code	306
Min. Negotiated Rate	$446.60
Max. Negotiated Rate	$649.60
Rate for Payer: Cash Price	$365.40
Rate for Payer: Cigna of CA HMO/PPO	$649.60
Rate for Payer: Health Smart Auto/Commercial	$487.20
Rate for Payer: LLUH Dept of Risk Management WC	$446.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$609.00

HC RESP VIRUS PANEL NUCLEIC ACID

Facility

$202.00

Service Code	CPT 87633
Hospital Charge Code	900912337
Hospital Revenue Code	306
Min. Negotiated Rate	$111.10
Max. Negotiated Rate	$151.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$121.20
Rate for Payer: Aetna of CA Government/Medicare	$121.20
Rate for Payer: Cash Price	$90.90
Rate for Payer: Health Smart Auto/Commercial	$121.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$121.20
Rate for Payer: LLUH Dept of Risk Management WC	$111.10
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$151.50

HC RETICULOCYTE COUNT, AUTO

Facility

$110.00

Service Code	CPT 85046
Hospital Charge Code	900910088
Hospital Revenue Code	305
Min. Negotiated Rate	$60.50
Max. Negotiated Rate	$88.00
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna of CA HMO/PPO	$88.00
Rate for Payer: Health Smart Auto/Commercial	$66.00
Rate for Payer: LLUH Dept of Risk Management WC	$60.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$82.50

HC RETICULOCYTE COUNT, AUTO

Facility

$21.00

Service Code	CPT 85046
Hospital Charge Code	900910088
Hospital Revenue Code	305
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$15.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.60
Rate for Payer: Aetna of CA Government/Medicare	$12.60
Rate for Payer: Cash Price	$9.45
Rate for Payer: Health Smart Auto/Commercial	$12.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.60
Rate for Payer: LLUH Dept of Risk Management WC	$11.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$15.75

HC RETICULOCYTE COUNT, MANUAL

Facility

$24.00

Service Code	CPT 85044
Hospital Charge Code	900910063
Hospital Revenue Code	305
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$14.40
Rate for Payer: Aetna of CA Government/Medicare	$14.40
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Smart Auto/Commercial	$14.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$14.40
Rate for Payer: LLUH Dept of Risk Management WC	$13.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.00

HC RETICULOCYTE COUNT, MANUAL

Facility

$131.00

Service Code	CPT 85044
Hospital Charge Code	900910063
Hospital Revenue Code	305
Min. Negotiated Rate	$72.05
Max. Negotiated Rate	$104.80
Rate for Payer: Cash Price	$58.95
Rate for Payer: Cigna of CA HMO/PPO	$104.80
Rate for Payer: Health Smart Auto/Commercial	$78.60
Rate for Payer: LLUH Dept of Risk Management WC	$72.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$98.25

HC RHEUMATOID FACTOR

Facility

$129.00

Service Code	CPT 86431
Hospital Charge Code	900910868
Hospital Revenue Code	302
Min. Negotiated Rate	$70.95
Max. Negotiated Rate	$103.20
Rate for Payer: Cash Price	$58.05
Rate for Payer: Cigna of CA HMO/PPO	$103.20
Rate for Payer: Health Smart Auto/Commercial	$77.40
Rate for Payer: LLUH Dept of Risk Management WC	$70.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$96.75

Know your out-of-pocket cost for care.

All Charges