Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

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

HC RIBS BILATERAL

Facility

$1,421.00

Service Code	CPT 71110
Hospital Charge Code	909001425
Hospital Revenue Code	320
Min. Negotiated Rate	$781.55
Max. Negotiated Rate	$1,065.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$852.60
Rate for Payer: Aetna of CA Government/Medicare	$852.60
Rate for Payer: Cash Price	$639.45
Rate for Payer: Health Smart Auto/Commercial	$852.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$852.60
Rate for Payer: LLUH Dept of Risk Management WC	$781.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,065.75

HC RIBS BILATERAL

Facility

$1,421.00

Service Code	CPT 71110 TC
Hospital Charge Code	909001425
Hospital Revenue Code	320
Min. Negotiated Rate	$781.55
Max. Negotiated Rate	$1,065.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$852.60
Rate for Payer: Aetna of CA Government/Medicare	$852.60
Rate for Payer: Cash Price	$639.45
Rate for Payer: Health Smart Auto/Commercial	$852.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$852.60
Rate for Payer: LLUH Dept of Risk Management WC	$781.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,065.75

HC RIBS BILATERAL

Facility

$1,421.00

Service Code	CPT 71110
Hospital Charge Code	909001425
Hospital Revenue Code	320
Min. Negotiated Rate	$781.55
Max. Negotiated Rate	$1,136.80
Rate for Payer: Health Smart Auto/Commercial	$852.60
Rate for Payer: Cash Price	$639.45
Rate for Payer: Cigna of CA HMO/PPO	$1,136.80
Rate for Payer: LLUH Dept of Risk Management WC	$781.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,065.75

HC RIBS BILATERAL

Facility

$1,421.00

Service Code	CPT 71110 TC
Hospital Charge Code	909001425
Hospital Revenue Code	320
Min. Negotiated Rate	$781.55
Max. Negotiated Rate	$1,136.80
Rate for Payer: Cash Price	$639.45
Rate for Payer: Cigna of CA HMO/PPO	$1,136.80
Rate for Payer: Health Smart Auto/Commercial	$852.60
Rate for Payer: LLUH Dept of Risk Management WC	$781.55
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1,065.75

HC RIBS UNILATERAL

Facility

$1,117.00

Service Code	CPT 71100 TC
Hospital Charge Code	909001376
Hospital Revenue Code	320
Min. Negotiated Rate	$614.35
Max. Negotiated Rate	$837.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$670.20
Rate for Payer: Aetna of CA Government/Medicare	$670.20
Rate for Payer: Cash Price	$502.65
Rate for Payer: Health Smart Auto/Commercial	$670.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$670.20
Rate for Payer: LLUH Dept of Risk Management WC	$614.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$837.75

HC RIBS UNILATERAL

Facility

$1,117.00

Service Code	CPT 71100
Hospital Charge Code	909001376
Hospital Revenue Code	320
Min. Negotiated Rate	$614.35
Max. Negotiated Rate	$893.60
Rate for Payer: Cash Price	$502.65
Rate for Payer: Cigna of CA HMO/PPO	$893.60
Rate for Payer: Health Smart Auto/Commercial	$670.20
Rate for Payer: LLUH Dept of Risk Management WC	$614.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$837.75

HC RIBS UNILATERAL

Facility

$1,117.00

Service Code	CPT 71100 TC
Hospital Charge Code	909001376
Hospital Revenue Code	320
Min. Negotiated Rate	$614.35
Max. Negotiated Rate	$893.60
Rate for Payer: Cash Price	$502.65
Rate for Payer: Cigna of CA HMO/PPO	$893.60
Rate for Payer: Health Smart Auto/Commercial	$670.20
Rate for Payer: LLUH Dept of Risk Management WC	$614.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$837.75

HC RIBS UNILATERAL

Facility

$1,117.00

Service Code	CPT 71100
Hospital Charge Code	909001376
Hospital Revenue Code	320
Min. Negotiated Rate	$614.35
Max. Negotiated Rate	$837.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$670.20
Rate for Payer: Aetna of CA Government/Medicare	$670.20
Rate for Payer: Cash Price	$502.65
Rate for Payer: Health Smart Auto/Commercial	$670.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$670.20
Rate for Payer: LLUH Dept of Risk Management WC	$614.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$837.75

HC ROTOVIRUS AG

Facility

$176.00

Service Code	CPT 87425
Hospital Charge Code	900910976
Hospital Revenue Code	306
Min. Negotiated Rate	$96.80
Max. Negotiated Rate	$140.80
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cigna of CA HMO/PPO	$140.80
Rate for Payer: Health Smart Auto/Commercial	$105.60
Rate for Payer: LLUH Dept of Risk Management WC	$96.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$132.00

HC ROTOVIRUS AG

Facility

$36.00

Service Code	CPT 87425
Hospital Charge Code	900910976
Hospital Revenue Code	306
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.60
Rate for Payer: Aetna of CA Government/Medicare	$21.60
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.00

HC ROUTINE URINALYSIS

Facility

$12.00

Service Code	CPT 81001
Hospital Charge Code	900910167
Hospital Revenue Code	307
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$7.20
Rate for Payer: Aetna of CA Government/Medicare	$7.20
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Smart Auto/Commercial	$7.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$7.20
Rate for Payer: LLUH Dept of Risk Management WC	$6.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$9.00

HC ROUTINE URINALYSIS

Facility

$138.00

Service Code	CPT 81001
Hospital Charge Code	900910167
Hospital Revenue Code	307
Min. Negotiated Rate	$75.90
Max. Negotiated Rate	$110.40
Rate for Payer: Cash Price	$62.10
Rate for Payer: Cigna of CA HMO/PPO	$110.40
Rate for Payer: Health Smart Auto/Commercial	$82.80
Rate for Payer: LLUH Dept of Risk Management WC	$75.90
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$103.50

HC RPR

Facility

$58.00

Service Code	CPT 83520
Hospital Charge Code	900913675
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 RPR

Facility

$39.00

Service Code	CPT 83520
Hospital Charge Code	900913675
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 RPR TITER

Facility

$137.00

Service Code	CPT 86593
Hospital Charge Code	900910929
Hospital Revenue Code	302
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 RPR TITER

Facility

$17.00

Service Code	CPT 86593
Hospital Charge Code	900910929
Hospital Revenue Code	302
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 RSV AG

Facility

$189.00

Service Code	CPT 87420
Hospital Charge Code	900911613
Hospital Revenue Code	306
Min. Negotiated Rate	$103.95
Max. Negotiated Rate	$151.20
Rate for Payer: Cash Price	$85.05
Rate for Payer: Cigna of CA HMO/PPO	$151.20
Rate for Payer: Health Smart Auto/Commercial	$113.40
Rate for Payer: LLUH Dept of Risk Management WC	$103.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$141.75

HC RSV AG

Facility

$26.00

Service Code	CPT 87420
Hospital Charge Code	900911613
Hospital Revenue Code	306
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$19.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$15.60
Rate for Payer: Aetna of CA Government/Medicare	$15.60
Rate for Payer: Cash Price	$11.70
Rate for Payer: Health Smart Auto/Commercial	$15.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$15.60
Rate for Payer: LLUH Dept of Risk Management WC	$14.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$19.50

HC RSV DFA

Facility

$339.00

Service Code	CPT 87280
Hospital Charge Code	900911537
Hospital Revenue Code	306
Min. Negotiated Rate	$186.45
Max. Negotiated Rate	$271.20
Rate for Payer: Cash Price	$152.55
Rate for Payer: Cigna of CA HMO/PPO	$271.20
Rate for Payer: Health Smart Auto/Commercial	$203.40
Rate for Payer: LLUH Dept of Risk Management WC	$186.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$254.25

HC RSV DFA

Facility

$36.00

Service Code	CPT 87280
Hospital Charge Code	900911537
Hospital Revenue Code	306
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$21.60
Rate for Payer: Aetna of CA Government/Medicare	$21.60
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Smart Auto/Commercial	$21.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$21.60
Rate for Payer: LLUH Dept of Risk Management WC	$19.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$27.00

HC RUBELLA ANTIBODY

Facility

$58.00

Service Code	CPT 86762
Hospital Charge Code	900913664
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 RUBELLA ANTIBODY

Facility

$39.00

Service Code	CPT 86762
Hospital Charge Code	900913664
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 RUBELLA ANTIBODY IGG QUANT

Facility

$39.00

Service Code	CPT 86762
Hospital Charge Code	900913665
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 RUBELLA ANTIBODY IGG QUANT

Facility

$58.00

Service Code	CPT 86762
Hospital Charge Code	900913665
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

Know your out-of-pocket cost for care.

All Charges